AGYW Advocacy for Inclusive PHC Services

From Silence to Voice: AGYW Advocacy for Inclusive PHC Services

AGYW Advocacy for Inclusive PHC Services

In September 2025, a quiet revolution unfolded across six Primary Health Centres (PHCs) in Chikun Local Government Area of Kaduna State — Kakuri, Narayi, Gwagwada, Television, Sabon Tasha, and Romi. What began as a recognition of silence — the absence of adolescent girls and young women (AGYW) in decision-making around their own health — evolved into a bold step toward inclusive service delivery.

This is the story of how AGYW, once overlooked in policy and program planning, co-created a responsive service integration model with PHC leadership, turning silence into a collective voice for change.

Identifying the Gaps

Open Heart’s advocacy visits and consultations in early 2025 uncovered stark service delivery gaps. Despite PHCs being the first point of contact for many AGYW, several limitations were evident:

HIV and TB treatment services were absent at the PHC level.
Referral pathways to higher facilities were weak, often leaving AGYW lost in the system.
Staff lacked adolescent/youth-friendly training, leading to experiences of stigma and judgment.
AGYW themselves were excluded from PHC management or feedback processes.

For young women living with HIV, LGBTQ women, sex workers, and women with disabilities, these gaps meant more than inconvenience — they represented barriers to dignity, access, and health outcomes.

Engaging AGYW in the Process

Rather than design solutions behind closed doors, Open Heart and partners placed AGYW at the center of the response. Across the six PHCs, 28 AGYW representatives were mobilized to gather feedback from peers, highlight lived realities, and define what meaningful inclusion should look like.

Workshops and focus group discussions were convened where young women spoke candidly about their challenges:

“Sometimes I walk into the clinic, and I feel judged before I even say a word,” one participant noted.
Another, a young woman with disability, shared: “Accessibility is not just about ramps. It is about attitude and respect.”

This participatory process shifted the narrative from AGYW being passive recipients of services to active co-creators of solutions.

Co-Developing the Model

In September, a landmark series of dialogues brought AGYW representatives, PHC staff, management committees, and community stakeholders together. Instead of working in silos, they mapped a shared pathway for service integration, guided by both evidence and lived realities.

The resulting AGYW-Responsive PHC Service Integration Model provided a structured but practical framework for adoption across the six facilities. It emphasized:

Integrated Service Package – on-site HIV testing and counseling, STI and malaria services, TB screening, family planning, psychosocial support, and GBV referrals.
Referral Strengthening – clear, documented pathways to secondary/tertiary facilities for ART initiation, advanced TB care, mental health, and legal aid.
AGYW-Friendly Service Delivery Flow – from dedicated reception desks to confidential counseling and peer-led follow-up mechanisms.
Inclusive Governance – AGYW representatives formally included in PHC quarterly review meetings.
Capacity Building – training PHC staff to provide stigma-free, gender-responsive, and youth-friendly care.

The Turning Point

For many AGYW, the development of this model marked their first tangible influence on health system design. As one LGBTQ participant reflected:

“We are not just here to receive. We are here to shape what services look like, because we know what we need.”

PHC leadership also embraced the process, recognizing that inclusion was not an external imposition but a means to improve outcomes and trust. A PHC officer from Kakuri PHC noted:

“When young women trust us enough to come forward, our work becomes easier, and the community becomes healthier.”

From Silence to Voice

The September 2025 case is more than a technical model; it is a story of empowerment. By documenting service gaps, engaging AGYW across diversities, and co-developing solutions with PHC leadership, six PHCs in Chikun LGA now stand as pioneers of inclusion.

The AGYW-Responsive PHC Service Integration Model has created a foundation where policy advocacy meets practical service delivery. Its lessons extend beyond Kaduna, offering a roadmap for health systems across Nigeria to listen, include, and act with the voices of young women at the center.

Looking Ahead

The journey is not over. Adoption is the first step; sustainability will depend on continued engagement, capacity building, and accountability. Yet, the transformation is clear: what began with silence now echoes with a collective voice for dignity, health, and inclusion.

AGYW have proven that when given space at the table, they do not just contribute — they lead.

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