Most health ministries and service-providing institutions have articulated the core competencies that health providers need in order to provide youth-friendly SRH services, including them in policies, strategies and/or national standards. These important reference documents ensure awareness and standardization across programs, service delivery points, and providers.

If such guidelines do not exist and must be developed, review WHO’s Core Competencies in Adolescent Health and Development for Primary Care Providers and engage youth and youth organizations are crucial allies in ensuring that they are youth-responsive and context-specific.

Steps:

1. Assess health facility against the existing standards to see if you have staff already trained in AYFHS.

Work with local government stakeholders to determine a target number of health facilities in the geography to assess against existing standards. Work with the facility quality assurance/improvement team to conduct the assessment, using tools such as:

• WHO SEARO’s Supervisory/Self-Assessment Checklist for Adolescent Friendly Health Services
• IPPF’s Provide: Self-Assessment Tool for Youth-friendly Services
• WHO’s Vol 3. Tools to conduct quality and coverage measurement surveys to collect data about compliance with the global standards

 TCI’s Hubs are in the process of adapting the WHO SEARO Supervisory/Self-Assessment Checklist.

2. Train providers to offer AYFHS, focusing on improving provider knowledge and competencies so that they can offer a full range of contraceptive options as well as overcoming provider bias.

Based on the data from the assessment, prioritize low-performing facilities and develop your training plan. Evidence indicates that training for health providers should include not only information about adolescent development and health, but also their rights (Evidence to Action, 2014). Training should include providing nonjudgmental information and services; accurate information on medical eligibility criteria for adolescent contraceptive use; legal policies and rights of adolescents to services and information; values clarification on adolescent sexuality; and skills on how to communicate with adolescent clients (HIPs, 2015). Promote doing good, not just doing no harm; support, rather than blame, health providers as they implement new practices. For an example of a health provider training with a particular focus on values clarification and attitude transformation, view this training curriculum adapted by TCI’s Francophone West Africa Hub (in French) or any of the other curriculums under Training Packages on the right hand side of this page.

3. Use a whole-site orientation approach to train on YFS

In the absence of pre-service training on YFS, training can take place as part of on-the-job training or whole-site orientation. See this agenda and slide deck for an example of six training sessions that can be included as a whole site orientation training schedule. Include administrative, cleaning and laboratory staff in trainings on AYFHS to ensure that young clients’ have positive interactions with all staff members. This approach will help ensure adolescent-friendly care is not invested in only one provider and that youth do not experience resistance from support staff, such as an intake nurse or pharmacist.

4. Reinforce training through supportive supervision, job aids and mentorship to change behavior attitudes and behaviors.

Provide ongoing training and support. One-off trainings are not effective at improving the quality of or demand for AYFHS. Ongoing reinforcement—including supportive supervision, job aids, and mentoring—ensures that providers can meet young clients’ needs and encourages them to advocate for young people’s SRHR. 

• Provide job aids that are easy to access during or between consultations.
• Establish case management support groups for health providers to discuss cases and best practices in youth SRH provision.
• Support the creation of a mentorship model for health providers to learn from one another.
• Identify “early adopters” of AYFHS and make them champions of the cause.

In East Africa, TCI works with youth to serve as trainers and mentors and in India, TCIHC draws from a pool of AYSRH-trained coaches.

Perception is just as important as reality for young people. If your facility is not considered youth-friendly, then they will not come. Management, providers, and other staff must all work to promote the perception that services are meant for youth and meet existing standards.

While some aesthetic and structural improvements to a facility add to its youth-friendliness, especially those that encourage privacy and confidentiality, it’s important not to oversimplify. A fresh coat of paint doesn’t replace a trained provider or a full stock of contraceptive supplies.

If services aren’t affordable, it won’t matter what the facility looks like. As a result, removing or reducing user fees or providing vouchers and cash transfers to adolescents and youth may be required. In Francophone West Africa, services are not free across much of the region. To address this structural barrier, TCI works with community health workers (CHWs) (locally referred to as community relays) and youth associations to offer coupons for free services to both married and unmarried youth. 

In addition, TCI’s whole-site orientation approach and approaches for overcoming provider bias (as described in Standard 4: Providers’ Competencies) ensures that providers and staff at the facility as a whole are open and non-judgmental in providing services to youth.

Systems should be in place to collect and analyze data on health providers’ competencies related to AYFHS, as well as statistics on the services sought by youth, disaggregated by age, sex, parity and service type. Hold regular meetings with staff to review this data. Identify data quality issues in terms of gaps in record-keeping and analyze what the data tells you given the youth population in your area. Are youth represented in the data? What segments are missing?

TCI’s East Africa Hub uses the following indicators to assess AYFHS effectiveness:

• Number of service providers who have completed training on AYFHS
• Proportion of family planning facilities providing quality AYFHS
• Number of adolescents and youth counseled on SRH
• Number of adolescents and youth provided contraceptive methods (condoms and/or other method)
• Percentage of adolescents and youth who reported a positive experience when seeking services

Develop partnerships with youth-led organizations that can help monitor youth-friendliness of services (both of the provider and facility) using mystery client, focus group, or other data collection methodologies. This data should be discussed regularly with health providers to ensure quality improvement.

Additionally, program implementers should develop systems to address situations where a health provider violates a young client’s sexual and reproductive rights.

For more information on TCI’s approach to making adolescent and youth data visible, check out our approach on Data Collection & Use.

Steps:

1. Solicit feedback from adolescents and youth who visit your facility. There’s no better way to determine whether or not young people find your facility to be youth-friendly than engaging them in the process of defining what that looks like. It can be as simple as holding focus groups and running through the different criteria that matter to them when accessing facility-based services. Ask young clients:

• • How they found out about your facility
  • If they would refer your facility to their peers
  • If they felt respected
  • If their privacy was protected
  • If they received the services they came for or were denied on the basis of age, marital status, or other markers

2. Setting up a facility advisory committee that includes youth will enable regular quality improvement and ensure that young people can hold the facility accountable. Toolkits like IPPF’s Provide: Self-Assessment Tool for Youth-friendly Services can also support ongoing self-monitoring. Using monitoring tools and disaggregated data on client age, sex, parity and service type, facilities can be very responsive to the needs and realities of the youth they serve. It is important to act on the results and recommendations coming from these feedback mechanisms as well as those from the assessments. Youth should be able to see that their opinions and needs and listened to and acted upon.

For more information on how to ensure youth participation, check out TCI’s Youth Participation & Engagement approach.