Although TCI’s primary focus is on strengthening the capacity of the public sector to leads its family planning program, TCI recognizes the important role that the private sector plays, especially in reaching and addressing the family planning needs of the urban poor. As a result and in light of COVID-19, TCI adapted its strategy to engage the pharmacies to bridge service delivery and ensure access to all women but especially youth have readily available access to short-term methods. This approach was rollout in East Africa and Nigeria.

Pharmacy Approach in Action In East Africa

TCI went from engaging 184 in 2019 to 760 in 2021 across Kenya, Tanzania and Uganda. Through this engagement, TCI holds capacity building sessions on family planning and youth-friendly services for relevant pharmacy staff, establishes a referral system whereby pharmacists refer clients to the closest TCI-supported health facility for methods that they cannot dispense and record and report the number and age of clients counseled on family planning methods and sales of different types of methods in pharmacies in their logs but also transferring this data to the closest TCI-supported health facility for input into the national health management information system (HMIS) – so that the data can inform family planning program planning of the entire area.

In addition, it is important to integrate contraceptive products and services into other health services, especially services that adolescents readily seek (e.g., HIV and MNCH) — this is especially important in an environment that requires parental consent for minors to obtain contraceptive services, such as Philippines.

This is why TCI’s immediate postpartum family planning intervention is so important in the Philippines in reaching first-time parents with family planning information and services.

Steps:

1. Understand the context and realities of adolescent and youth to identify where they seek services. Health services can be delivered through schools and workplaces, youth centers, households, streets or markets, and drug shops and pharmacies.
2. Build the capacity of those trusted providers to better serve youth. Knowing who the trusted community members are, and where youth already go for services, enables your program to tap into existing, credible resources for increasing contraceptive uptake or other SRH services.
3. Establish partnerships with the private sector to enable non-traditional service delivery. Ensure a functional referral system is in place so that private sector providers can refer clients to public health facilities for methods they do not offer or cannot dispense.
4. Ensure supportive supervision and ongoing capacity building support by conducting site visits to pharmacies and private sector facilities to evaluate the quality of services and continue to build capacity. Monitor and evaluate the documentation and reporting tools of the pharmacy on a quarterly basis in line with the MOH policy and procedures.

It is not enough to focus on just improving the service delivery environment. One must generate demand among adolescents and youth through appropriate channels to ensure that they access adolescent-responsive contraceptive services. Therefore, social and behavior change interventions that address adolescent-specific cognitive, cultural, and social challenges and barriers should be intentionally linked together in TCI program designs and workplans.

These SBC interventions may include:

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 adolescent and youth-friendly health services (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 has adapted the WHO SEARO Supervisory/Self-Assessment Checklist to best suite each country’s context, aligning with existing supportive supervisory tools.

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.

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.

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. 

TCI engages youth as essential, active participants across family planning programming domains – through our demand generation activities with fellow youth, advocacy efforts nested within formal and informal structures to foster broad participation, and the design of services to increase access by honoring youth’s sexual and reproductive health rights and needs. This engagement occurs at both the community and governance levels across all hubs.

Steps:

1. Integrate youth throughout the project lifecycle to ensure accountability.
2. Institutionalize and mainstream youth participation and leadership at all levels of the project – at the governance level as well as the community and facility levels.
3. 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
4. Provide capacity strengthening opportunities for youth to be able to effectively contribute to advocacy, governance, and accountability efforts.
5. Set up a facility advisory committee that includes youth who will become part of regular quality improvement mechanisms and fora. Youth should be able to see that their opinions and needs and listened to and acted upon.
6. Monitor and track the impact of youth engagement.

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