Dashboard Global Adolescent-Responsive Contraceptive Services – HIPs Adolescent & Youth-Friendly Health Services

East Africa Toolkit: AYSRH Services & Supply

Adolescent & Youth-Friendly Health 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 health services (AYFHS) 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 AYFHS services

Why Using Adolescent & Youth-Friendly Health 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 health 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.

Evidence

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 AYFHS

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 AYSRH). Work with the Reproductive Health focal person and facility in-charges to identify topics that meet staff’s learning needs and interests in AYSRH. 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.

At minimum, health providers should be familiar with the following topics:

Essential package for AYFHS
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.

The health facility should:

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.

Key Outcomes

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

Monitoring Process

Maintain a register of providers who have completed AYFHS trainings
Monitor AYFHS 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 AYFHS services to improve quality
Monitor on periodic basis the quality of AYFHS service provision through supportive supervision

Success Indicators

Number of whole site orientation sessions on AYFHS held in the last year
Number of service providers competent to provide AYFHS
Proportion of health facilities providing quality AYFHS according to the assessment/checklist
Number of adolescents and youth counseled on SRH
Number of adolescents and youth provided contraception by method
Proportion of adolescents and youth clients who reported a positive experience when seeking services

Cost

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

Sustainability

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 AYFHS checklist/assessment and is carried out periodically
Incorporate AYFHS strengthening component in health budgets, including facility budgets for AYFHS

TCI APP USERS PLEASE NOTE

You will only receive CERTIFICATES by email – when earning a score above 80% – and will not be able to view or print a certificate PDF from the TCI app.