Bridging Participation Gaps: A Community-Led Inception for Integrating Comprehensive Adolescent-Friendly Family Planning and Post-Abortion Care (CAFFP–PAC) into Primary Healthcare Facilities in Northern Uganda

Eustes Kigongo,1 Emmanuel Ekungu,2 Acheka Edmonton,3 Anna Grace Auma,2 Morris Chris Ongom,4 Udho Samson,5 Maxson Kenneth Anyolitho,6 Amir Kabunga,7 Odette Murara,8 Judith Abal Akello,9 Bernard Omech10 1Department of Environment Health and Disease Control, Lira University, Lira, Uganda; 2Department of Nursing, Lira University, Lira, Uganda; 3District Health, Lira, Uganda; 4GLOFORD_UGANDA, Lira, Uganda; 5Department of Midwifery, Lira University, Lira, Uganda; 6Department of Community Health, Lira University, Lira, Uganda; 7Department of Psychiatry, Lira University, Lira, Uganda; 8Faculty of Social Work, University of Calgary, Calgary, Canada; 9Department of Commerce and Business Management, Lira University, Lira, Uganda; 10Coordinator for Centre for SET-SRHR Lira University, Lira, UgandaCorrespondence: Amir Kabunga, Email [email protected]: Conventional top-down health interventions often exclude adolescents and community stakeholders from service design and implementation, resulting in low uptake and a mismatch with young people’s needs. The CAFFP–PAC initiative in Northern Uganda sought to explore how a community-led, adolescent-centered inception process could support integration of adolescent-friendly family planning and post-abortion care into primary healthcare services.Methods: A participatory qualitative design was employed during an inception meeting in Lira City on April 1, 2025, guided by principles of community-based participatory research and citizen science. A total of 110 purposively selected stakeholders including adolescents, youth mentors, parents, educators, health professionals, and cultural and religious leaders engaged in dialogue circles, breakout sessions, simulations, and visual storytelling to co-develop integration strategies. Data were collected through audio recordings, field notes, and participatory tools, and analyzed using Braun and Clarke’s thematic analysis framework.Results: Six themes emerged: (1) meaningful participation of adolescents and stakeholders; (2) adolescent-friendly and confidential service environments; (3) health system readiness and provider attitudes; (4) addressing socio-cultural and gender norms; (5) integration strategies for CAFFP–PAC in primary care; and (6) sustained engagement and feedback mechanisms. Adolescents emphasized safe, private, and respectful care environments, while stakeholders stressed community ownership, trust-building, and reliance on local structures. Youth mentors, cultural leaders, and school clubs were identified as key enablers for service uptake.Conclusion: A community-led inception process centered on adolescents and local voices is feasible and essential for successful CAFFP–PAC integration in Northern Uganda. Findings highlight the need to shift from provider-centered models to inclusive, participatory approaches that leverage community assets, foster adolescent agency, and ensure sustained engagement. Such approaches are vital for enhancing service accessibility, responsiveness, and sustainability in resource-constrained settings.Keywords: adolescents, family planning, post-abortion care, community participation, reproductive health, citizen science, gender norms, primary healthcare integration