Access to Healthcare amongst Adolescent Girls and Young Women in Ugandan Artisanal and Small-Scale Mining Communities

Background Artisanal small scale-mining (ASM) provides work to many adolescent girls and young women (AGYW) in Uganda. AGYW working in ASM face a unique set of health challenges such as exposure to toxins and increased vulnerability to contract HIV and sexually transmitted infections. AGYW in ASM are more vulnerable and less likely to access care given their remoteness and work in the informal sector, however their access to care, including SRH care, is not well understood or documented making it difficult to address despite Uganda’s commitment to Universal Health Coverage (UHC). This paper aims to explore the current healthcare access challenges and bottlenecks amongst Ugandan AGYW working in ASM communities. Methods This study was conducted in Busia, Mubende, and Namayingo communities through a mixed methods approach. We completed in depth interviews and a survey with AGYW, focus group discussions with adolescent boys, older women, and AGYW, key informant interviews with local leaders and policymakers. Data were analyzed using the Tanahashi Model on access to care. Results Despite some variation between communities, results show that generally, access to healthcare for AGYW working in ASM communities is a challenge although some availability and accessibility of health facilities and care exists. All participants discussed challenges such as lack of personnel at facilities, lack of youth friendly services, limited resources, distance to facilities, cost of care, and negative provider attitudes especially towards sexual and reproductive health care for unmarried AGYW. Despite these challenges, participants reiterated the use of most healthcare services available amongst AGYW for family planning and treatment for sickness. Conclusions Findings indicate that despite some availability, accessibility, acceptability, and contact coverage, there is significant opportunity to strengthen health systems and especially sexual and reproductive health care available to AGYW in ASM communities in Uganda towards greater UHC and ultimately health equity. Mitigating the inequities in accessing care amongst ASM AGYW involves processes such as formalization, advocacy and rights-based accountability, and leveraging existing initiatives proposed in national Ugandan health policies.