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Enhancing youth access to health care in high violence urban neighbourhoods: a provisional theory of change

Published onJun 22, 2023
Enhancing youth access to health care in high violence urban neighbourhoods: a provisional theory of change

Background: Violence disproportionately affects both resource limited settings and youth. South Africa and Brazil face different forms of endemic violence which limit youth access to healthcare. This impedes the aspiration of the UN Sustainable Development Goals which aim to achieve universal health coverage and access.

Aim: This project aimed to scope and understand the impact of violence on youth access to care and to review what solutions have emerged in South Africa and Brazil so as to develop a conceptual framework to inform global health research and policy.

Methods: Community engagement and involvement plans and methods were adjusted due to the Covid-19 pandemic. Secondary data analysis and virtual individual qualitative interviews, focus group discussions and meetings with key community stakeholders, such as health care workers, policy makers, community leaders, Non-Governmental Organisations and affected youth, were utilised instead of in person engagement. 

Findings: 1) Health care needs are often not recognised by young people; young victims of violence frequently do not feel confident in seeking care and may have limited knowledge of services, particularly within mental health. 2) Violence is not always recognised or reported and non-disclosure of violence and non or late presentation to health care is prevalent. 3) Institutional violence within health services also manifests in other state agencies with youth reporting that they do not feel welcome, are discriminated against, and feel that health professionals tend to have a moralistic reproach to what they say or do. Fear and distrust of police meant that youth did not want to be around public places where there was a police presence. This may then affect youth ability to seek treatment when police are present in the community or in or near healthcare facilities. 4) Violent interpersonal relationships are common and violence in the community and institutions, such as conflicts involving drug dealers, gangs or local police, occur frequently and tend to be normalised. This can limit how people move about the community and restrict access to health care. Youth are most affected and whether they be victims, perpetrators or bystanders, their proximity to violence can restrict their access to health services. 

Recommendations: Key stakeholders from across the community and health system need to be brought together to validate a theory of change, and together with local communities, co-produce local solutions and interventions. People-centred, whole system approaches are necessary to address the effects of violence in limiting youth access to health care.

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