Since the launch of Global standards for quality of health-care services for adolescents, many countries have used them to develop national standards (e.g.Benin, Botswana, Ethiopia, Guatemala, Guyana, Haiti, Nigeria, Peru, Sri-Lanka, Zimbabwe). Other countries used the guidance to assess the quality of health care services provided in facilities (e.g. Burundi, Chile, Colombia, Comoros, Democratic Republic of Congo, Ethiopia, Kenya, Lesotho, Madagascar, Mozambique, Swaziland, Uganda, Zambia, and Zimbabwe).
Syrian Arab Republic
In Syria, Global Standards were used to capacitate health care providers working in adolescent-friendly centers in five governorates (Damascus, Damascus countryside, Kenitra, Suwayda, Homs) in adolescent responsive care. Each team developed locally relevant action plans to be implemented during the last quarter of 2018. Their implementation will be reviewed and evaluated at the end of the year. Based on this experience, Global Standards will be nationally adapted, and an action plan for their implementation will be developed for 2019.
Botswana
Young people constitute a significant cohort of Botswana’s population: over 60% of the population is aged below 30 years and 33.5% between 10 and 24, with 21% among them being adolescents (10-19 y.o.). Botswana has cultivated a favourable policy environment to safeguard the sexual and reproductive health of adolescents and youth. The National Development Plan 11 and Vision 2036 have prioritized investing in young people to harness the demographic dividend.
In recognition of the unique challenges and needs of adolescents and youth, the government supported the establishment of cites that have been developed as “youth-friendly health services” (YFHS) – dedicated sites with the limited capacity of the country to expand this model to reach universal health coverage. Increasingly, key stakeholders including officials from the Ministry Of Health & Wellness (MOHW) of Botswana, WHO and UNFPA colleagues, were questioning whether this model is sustainable. Yet opportunities to achieve UHC for adolescents in Botswana are there - 95% of the population lives within 8 km from the MOHW nearest health facility.
In view of the need to expand the reach of adolescents with quality health care services, the MOHW sought UNFPA and WHO technical assistance to develop national standards for quality health care services for adolescents and youth, standards that would guide primary care facilities in their efforts to serve better this population group.
In April 2018, WHO in collaboration with UNFPA supported the MOHW of Botswana in finalization of the national standards for quality health care services for adolescents and youth, based on WHO/UNAIDS Global Standards. National stakeholders that participated in this process represented an adequate mix of expertise across the MOHW (SRH, FP, Health Promotion and Education, Health inspectorate), Ministry of Basic Education, Nursing and Midwifery Council of Botswana, Botswana Family Welfare Association, OFWA, UN agencies (WHO, UNFPA, UNAIDS), NGOs, representatives of teaching institutions, health care providers (primary and referral level), district level representatives.
Regional collaboration
Standards for Adolescents’ Sexual and Reproductive Health Services for Latin America and the Caribbean
PAHO worked together with Latin America and Caribbean Regional Office of the United Nations Population Fund (UNFPA/LACRO) to develop Standards for Adolescents’ Sexual and Reproductive Health Services for Latin America and the Caribbean (LAC ASRH Standards).
Assessment of Adolescent and Youth-Friendly Health Service Delivery in the East and Southern Africa Region
The United Nations Population Fund’s East and Southern Regional Office and the International Planned Parenthood Federation Africa Regional Office, in partnership with WHO and other partners, conducted a review of existing adolescent and youth-friendly health services guidelines and practices in the Eastern and Southern Africa.
As part of an assessment involving 23 countries, 12 countries (Burundi, Comoros, Democratic Republic of Congo, Ethiopia, Kenya, Lesotho, Madagascar, Mozambique, Swaziland, Uganda, Zambia, and Zimbabwe) conducted in-depth assessments of health facilities using tools informed by WHO/UNAIDS Global Standards to interview health service providers, young exit clients, outreach workers, peer educators, and potential young clients.
The findings from this assessment showed that with some exceptions, in most countries young exit clients felt very comfortable and at ease at the health facility, and reported that the health service provider they had seen had responded to all their concerns satisfactorily. Potential areas for improvement include:
- a greater focus on making adolescents and young people aware about the existence of facilities providing adolescent and youth friendly health services, and better assurance of potential young clients about privacy and confidentiality (Standard 1, Adolescents’ health literacy);
- putting in place referral and feedback mechanisms that are appropriate and address the specific needs of adolescents and young people in a particular catchment area, and strengthening linkages between schools, parents and the health facilities (Standard 2, Community support);
- provide a truly comprehensive package of services and pay more attention to services that are currently not in place, i.e. referral to counselling in relation to mental health, drug and alcohol use and gender-based violence, as well as to non-clinical services including social protection and other support programmes, especially for key populations and marginalized groups (Standard 3, Appropriate package of services);
- adopt nationally guidelines and materials for competency-based trainings in adolescent health and systematically implement them in accredited in-service trainings and continuous professional education programmes for all healthcare providers dealing with adolescents and young people (Standard 4, Providers’ competencies);
- implement context-specific solutions to accommodate the needs of adolescents with regards to travel time, opening hours, waiting hours, design of space to ensure privacy in the waiting area and during the consultation (Standard 5, Facility characteristics);
- remove legal and policy barriers to adolescents’ and young people’s access to health services (e.g., requirements for parental or spousal consent, marital status, etc.) (Standard 6, Equity, non-discrimination);
- standardize systems within a country on the use of data recorded at the health facility level, and combine supportive supervision with regular self-assessments to improve the quality of services (Standard 7, Data and quality improvement);
- reinforce young people’s meaningful involvement at all levels of programming for adolescent-responsive services including at the health facility level (Standard 8, Adolescents’ participation).
Informing research
WHO has undertaken a systematic review to assess the effectiveness of adolescent-friendly health services for adolescents living with HIV compared to standard of care. Adolescent-friendly health services were defined according to the WHO characteristics and the Global standards for quality health care services for adolescents. Young people engaged in adolescent-friendly health services compared to standard care showed small but significant improvements in various outcomes, including health outcomes (lower pregnancy rates); health care utilization (presentation at a clinic for mental health, HIV counselling and testing and outpatient visits); uptake (HIV testing); knowledge (HIV and STI acquisition, pregnancy prevention and sexual health); attitudes (towards sex, HIV testing); sexual risk reduction behaviour (condom use); self-efficacy (condom use or diabetes management) and service acceptability. WHO is recommending that adolescent friendly health services should be implemented in HIV services to ensure engagement and improved outcomes (strong recommendation, low quality evidence).