East Africa Toolkit: AYSRH Services & Supply
Adolescent & Youth-Friendly Services
This approach provides a guide on how to provide responsive sexual reproductive health (SRH) services to adolescents and young people based on an understanding of what young people want in a particular society or community.
Adolescent and youth-friendly services (AYFS) must be offered in an environment where service providers are non-judgmental and considerate in their dealings with adolescents and youth, have competencies needed to deliver youth responsive SRH services, health facilities are equipped to provide adolescents and youth with services they need and commodities that they want in an appealing and friendly manner, adolescents are aware of where to obtain the services and community members are aware of the health service needs of different groups of adolescents and youth and support their provision. Given the unique developmental stage in which adolescents and youth are at, their meaningful participation is key. They must be involved in the planning, implementation, monitoring and evaluation of health services and decisions regarding their own care. In addition, the characteristics of the health facilities that young people visit are just as important as the service providers they meet and the choices available to them.
This tool will help in:
- Implementing quality SRH services to meet the needs of adolescents and young people
- Strengthening the capacity of service providers in providing SRH information and services to adolescents and youth
- Ensuring appropriate, comprehensive, and effective SRH services are provided in an accessible, acceptable, and equitable manner
- Supporting both utilization and provision of AYFS services
Why Using Adolescent & Youth-Friendly Services is Important?
There is growing recognition of the importance to overcome the individual, socio- cultural and systemic barriers adolescents and youth face in accessing and utilizing SRH services. Thus, in order, for adolescents and youth to achieve their full potential, they need to be provided with opportunities to live in a safe and supportive environment, acquire accurate information and values about health and development needs, build life skills they need to protect and safe guard their health, obtain counseling services and have access to a wide range of services addressing their SRH needs. Through regulatory or policy frameworks, the Kenya, Tanzania and Uganda governments have committed to making it easier for adolescents and young persons to obtain the health services they need.
This means that efforts should be directed at making existing service delivery points – intended to provide health services to all segments of the population – more friendly to adolescents and young people in an accessible, acceptable, equitable, appropriate and effective manner.
A necessary part of youth-friendly service provision is awareness among providers of the barriers that young people face in accessing sexual and reproductive health services. WHO’s Health for the world’s adolescents: A second chance in the second decade suggests that progress towards universal health coverage for adolescents will require renewed attention to the education of health care providers (WHO, 2014).
- The workforce is at the heart of every service delivery setting and certain youth-friendly competencies are essential for effective services.
- Health care providers should be trained to work competently, sensitively and respectfully with adolescents and young people on their sexual and reproductive health needs.
To make sure that the service providers are equipped with skills and have the right attitude to provide services, local governments have trained and oriented over 1,850 providers since 2018 to-date. The main objective of the training was to address and overcome provider bias in providing youth with SRH services.
|“In the last FY, we approved budget lines for FP and AYSRH separately. This is something that we will continue to do. The resilience of the County Executive Committee Member for Health, Dr Anisa, with her team including the advocacy effort by the youth groups will ensure that the programs will be sustained long after TCI. What drives us to invest in FP and AYSRH is due to advocacy led by the department of health, data sharing by the department with ward specific performances more so on teenage pregnancies.” – Hon. Hassan Mohamed, MCA Matsangoni ward|
Guidance: How to Implement AYFS
The WHO ‘quality of care’ framework (see Figure at the right) provides a useful guide to work on improving health service provision and utilization for adolescents and young people. It brings together the complementary imperatives of, on the one hand, making it easier for adolescents to obtain the health services they need and, on the other, providing them with the health services they need in the right way.
- Conduct a facility assessment, using IPPF’s Provide or WHO SEARO’s Supervisory/Self-Assessment Checklist for Adolescent Friendly Health Services, to assess the status of the characteristics of the health facility, service providers and program in place to evaluate how adolescent and youth-friendly the services currently are. Ensure that this facility assessment is part of the government’s periodic supportive supervision assessment. Introducing youth-friendly services in a health facility requires training and overcoming provider and staff biases as well as structural and operational time adjustments. As part of the assessment, engage adolescents and youth. There’s no better way to ensure whether or not young people find your facility to be youth-friendly than engaging them in the process of defining what it would look 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.
- Develop an action plan based on the facility assessment results for improving the quality of service delivery. Ensure that health providers are trained in competencies in adolescent health care (see Fig 1. WHO Core Competencies in AYRSH). Work with the Reproductive Health focal person and facility in-charges to identify topics that meet staff’s learning needs and interests in AYRSH. This orientation program is best provided through whole site orientation. See this agenda for an example of six sessions that can be added to an existing whole site orientation, which should be done among all staff of a facility from support staff to the in-charge.
- Essential package for AYFS
- Value clarification and attitude transformation on adolescent and youth sexuality and provision of services such as contraception
- Privacy and confidentiality
- Characteristics of adolescent growth and development (including neurobiological, developmental and physical) which impact health
- Identify adolescent SRH/FP trainers who can act as mentors.
- Conduct coaching and mentorship on regular basis to increase the number of competent skilled service providers within the facility who are able to offer FP services as well as to ensure quality assurance.
- Ensure staff participation in continuous professional education in adolescent health care.
- Provide systems to inform adolescents and youth on how to access and obtain SRH health services, e.g., signages with appropriate services available and operating hours, display the AYFS national standards like a charter, ensure CHAs/CHEWs/VHTs are well-aware of AYFS facilities to refer to, etc.
- Operate within convenient working hours, in a welcoming and clean environment that maintains privacy and confidentiality
- Ensure the appropriate equipment, medicines, supplies and technology are available for effective service provision to adolescents
- Provide quality services to all adolescents irrespective of their ability to pay, age, sex, marital status, education level, ethnic origin, sexual orientation or other characteristics
- Inform adolescents about the range of health services available and how to obtain them
- Engage and involve community members so that they understand the benefits that adolescents will gain by obtaining health services, and support their provision
- Ensure availability of information, education and communication (IEC) materials at service delivery sites (See the Tupange Youth Information Pack for an example)
- Monitor and evaluate the standard of care delivered to adolescents at service delivery points. The monitoring framework should make it possible to measure short- and medium-term progress including feedback from recipients of SRH services. This is a great step to make sure that youth are once again engaged in the process of collecting this information as well as providing it.
- Partner with the Reproductive Health Management teams to conduct assessments and certifications of eligible providers who receive positive feedback as being AYFS providers.
- Adolescents and youth have access to contraception services as and when they need them
- Increased support from various stakeholders towards adolescent and youth-friendly contraception services
- Maintain a register of providers who have completed AYFS trainings
- Monitor AYFS service data recorded (ideally, disaggregated by 10-14, 15-19, 20-24) and reported on a monthly basis through TCI referral forms
- Hold quality improvement meetings to report on progress
- Conduct routine gaps assessments using either of the following approaches: client satisfaction exits interviews, facility assessment, support supervision and focused group discussions
- Incorporate feedback from recipients of AYFS services to improve quality
- Monitor on periodic basis the quality of AYFS service provision through supportive supervision
- Number of whole site orientation sessions on AYFS held in the last year
- Number of service providers competent to provide AYFS
- Proportion of health facilities providing quality AYFS according to the assessment/checklist
- Number of adolescents and youth counseled on AYSRH
- Number of adolescents and youth provided contraception by method
- Proportion of adolescents and youth clients who reported a positive experience when seeking services
- Venue space, if necessary, because should use space outside or inside the facility if possible
- Whole site orientation and training material printing costs
- Information, education and communication (IEC) materials Job aids, tools and guideline material printing
- Refreshments and transportation costs for engaging youth
- Inclusion of adolescents and young people in strategic planning
- Participation of adolescents and young persons in implementation/supervision working groups
- Inclusion and demonstration of non-judgmental and equitable attitudes towards adolescents and youth as part of annual staff performance assessments/reviews
- Continuous capacity building through mentorships/on-the-job trainings/whole site orientation for service providers
- Ensure supportive supervision tools, include the AYFS checklist/assessment and is carried out periodically
- Incorporate AYFS strengthening component in health budgets, including facility budgets for AYFS
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- Core competencies in adolescent health and development for primary health care providers, WHO
- Global Standards for Quality Health-Care Services for Adolescents, WHO
- Supervisory/Self-Assessment Checklist for Adolescent Friendly Health Services, WHO SEARO
- WHO recommendations on adolescent sexual and reproductive health and rights, WHO
- National Adolescent Sexual Reproductive Health Policy Implementation Framework, 2017-2021
- National Guidelines for Provision of Adolescent and Youth Friendly Services in Kenya (2016)
- National Adolescent Sexual and Reproductive Health Policy
- Kenya National Youth Policy, 2006
- The National Adolescent Sexual and Reproductive Health Policy 2015: Policy Brief
- National Adolescent Health and Development Strategy 2018-2022