AYSRH: Adolescent & Youth-Friendly Services

The approach provides a guide on how to provide sexual reproductive health (SRH) services to adolescents and young people based on an understanding of what young people in a particular society or community want.

Adolescent and youth-friendly services (AYFS) must be offered in an environment where the adolescents and young people feel free to access them without being judged or condemned by those who work in the health facility or the entire society. Given the unique developmental stage in which adolescents and youth are at, health consultations with adolescents should be carried out with special attention to the service provider’s communication style, the structure of the consultation and adolescents’ involvement in decisions that affect their SRH. 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 face in accessing and utilizing SRH services. 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.

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 field, and deliver services, PSI Kenya trained and certified 22 franchise providers. The main objective of the training was to address provider attitude and beliefs in providing youths with SRH services. As a result, a total 0f 59,781 contraceptive methods were issued to adolescent girls and young women. This accounted for 27% of all contraceptive methods served through the Tunza franchise.
Evidence
  • A project on mainstreaming youth-friendly services in Mozambique and Tanzania demonstrated an increase in new contraceptive users among 10-24 year olds, and a significant number of young clients reported satisfaction with the services and being treated with respect by the service providers (Pathfinder International, 2017).
  • A literature review on young people’s perspectives on health care revealed that there are eight indicators which are central to young people’s positive experience of care: accessibility of health care; staff attitude; communication; medical competency; guideline-driven care; age appropriate environments; youth involvement in health care; and health outcomes (Ambresin et al., 2013).
  • Evaluations of young people’s access to services show that competent health providers alone are not enough to increase young people’s access to SRH services (Chandra-Mouli et al., 2015; Dick et al., 2006). Approaches to scaling up services should use four complementary approaches:
    • Providers are trained and supported to be nonjudgmental and friendly to adolescent clients
    • Health facilities are welcoming and appealing
    • Communication and outreach activities inform adolescents about services and encourage them to make use of services
    • Community members are supportive of the importance of providing health services to adolescents
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. 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 and deliver a training program based on the facility assessment results. Competencies in adolescent health care can be categorized in three domains (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. The training can be through on-the-job or whole site orientation. See this agenda for an example of six training sessions that can be added to an existing whole site orientation training.
Health service providers should receive training on but not limited to:

  • Essential package for AYFS
  • Value clarification and attitude transformation (VCAT) training on adolescent and youth sexuality and provision of services such as contraception
  • Characteristics of adolescent growth and development (including neurobiological, developmental and physical) which impact health
  • Privacy and confidentiality
  • 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 young persons on how to access and obtain SRH health services,g., signages with appropriate services available and operating hours. If necessary, carry out necessary renovations, procurements and adaptations to support AYFS service delivery.
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.
Monitoring Process
  • 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
  • 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 SRH services to improve quality
  • Monitor on quarterly basis the quality of AYFS service provision through supportive supervision
Success Indicators
  • Number of service providers who have completed training on AYFS
  • Proportion of family planning facilities providing quality AYFS
  • Number of adolescents and youth counseled on AYSRH
  • 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
Cost
  • Workshop/meeting conference package
  • Advocacy and training material printing cost
  • Trainers/facilitators costs
  • Cost of equipment
  • Information, education and communication (IEC) materials
  • Job aids, tools and guideline material printing
  • Cost of renovations
  • Refreshments and transportation costs for engaging youth
Sustainability
  • Inclusion of adolescents and young people in strategic planning
  • Staff performance contracts include AYFS
  • Participation of adolescents and young persons in implementation/supervision working groups
  • Continuous capacity building through mentorships/on-the-job trainings/whole site orientation for service providers
  • The geography support supervision team to carry out supervision on a regular basis
  • Advocacy with geography management teams to ensure facilities budget for AYFS
  • Incorporate AYFS strengthening component in health budgets

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