Bottlenecks and Red Tape Reduce Access to Government Support Programs by Botswana’s Most Vulnerable Young Women

Regroupements stratégiques

Félicitations à Ran van der Wal et collègues qui ont remporté le premier prix catégorie "Lancet Poster Student Competition - Infectious disease" lors de la 8ème CUGH Annual Global Health Conference, Washington DC, à laquelle la chercheure a participé en ayant remporté une bourse de soutien du RRSPQ pour participation à des conférences internationales.

Voir le résumé dans Annals of Global Health 2017; 83(1):5-6

Résumé des auteurs:

"Background: Botswana’s HIV prevalence is among the highest worldwide, with young women disproportionately affected. Structural barriers such as poverty, lack of education, and gender violence mean that young women are unable to implement HIV-prevention choices. Transactional and age disparate sex increase their HIV risk. A national structural intervention, implemented as a stepped-wedge cluster randomized controlled trial (ISRCTN54878784), aims to prepare young women to apply to available government support programs and to align the programs in favour of young women. Records review revealed that these programs don’t reach the most vulnerable. 

Methods: An exploratory study reviewed demand- and supply-side challenges to accessing government support programs in the first intervention district. All participants gave verbal consent and received assurances of anonymity. A young woman from the district and a local researcher undertook semi-structured interviews with 18 young women (not in school/at work). The first author interviewed 4 local service providers. Thematic analysis relied on Nvivo.

Findings: The most vulnerable young women experience serious difficulties accessing government support programs. Lack of self-confidence and ambiguous navigating procedures block institutional assistance. Long delays in processing applications and lack of feedback on application status are discouraging. Successful candidates experienced community-level barriers like third parties unwilling to collaborate. Although motivated to help young women, service providers complained about youth attitudes and behaviour negatively affecting support program success-rates. Agricultural support programs may be incompatible with ambitions of youth unwilling to stay in rural areas. Lack of financial, material, and human resources hamper effective assistance and follow-up of applicants. Lack of available program placements and funding contribute to delays in support. Despite their ideas for improvement, service providers believe that effective change depends on political will, and national-level coordination and direction.

Interpretation: The available programs involved at least five line ministries; lack of coordination results in service gaps, overlap and competition, contributing to confusion among clients. Local service providers could improve vulnerable young women’s access to programs by providing targeted and accessible assistance in application procedures, followed by timely and transparent feedback on application status. Stakeholder-constructed solutions are needed to overcome identified structural barriers."