Adolescent and Young Adult Health
The Adolescent and Young Adult Health Unit (AYH) leads and coordinates WHO-wide efforts to improve the health and well-being of adolescents and young adults.
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Achieving universal health coverage for the world’s 1.2 billion adolescents

Background

There are nearly 1.2 billion adolescents (10-19 years old) worldwide. In some countries, adolescents make up as much as a quarter of the population and the number of adolescents is expected to rise through 2050, particularly in low- and middle-income countries (LMICs) where close to 90% of 10- to 19-year-olds live.

This has huge implications for the Universal Health Coverage (UHC) agenda. Government commitment to UHC for all ages, a core component of the 2030 Agenda for Sustainable Development, cannot be achieved without reaching an important proportion of country population. This is also the population group that remains overlooked and neglected in nearly every health care system. An estimated 1.2 million adolescents die each year, largely from preventable causes. Adolescents benefited less from the improved health outcomes seen over recent decades among younger children, including because of inadequate levels of resourcing. While the health of younger children remains a priority in many countries, deaths in older adolescents are now greater than for 1 to 4 year old in a growing number of countries.

Adolescents are not “older children” or “younger adults”. Marked by physiological maturation of all body systems and other life-changing transformations, including from childhood dependence on parents and caregivers to adult independence, this period of life requires tailored health and education services, protection and health promotion designed to be aligned with their developmental stage and to meet their needs. Therefore we cannot just assume that what is effective in health care provision for older or younger age groups also works for adolescents. It doesn’t. Adolescents face specific barriers in accessing health care and information:

  • They often find public health care services unacceptable because of perceived lack of respect, privacy and confidentiality, fear of stigma, discrimination, and imposition of the moral values of health-care providers.
  • The impact of out-of-pocket costs including service fees, pharmaceuticals and transportation for adolescents is made worse by their limited capacity to access services independent of their parents and their limited access to cash, either their own or their family’s. If they are covered by health insurance, insurance is generally brokered by family. In addition, most adolescents leave in countries with low levels of public spending on health as a percentage of total health spending. At low levels of spending, variations in financial protection performance at are greater and depend more on deliberate policy decisions than on the level of public spending on health per se. Adolescents do not have their lobby groups and they are the most exposed to be overlooked in these decisions, especially older adolescents of 19 y.o. that are no longer included in insurance schemes tied to family.
  • Furthermore, support or permission of parents and partners is often required to use health services, including for sensitive issues such as sexual and reproductive health. Lack of parental support and parental or partner control stemming from socio-cultural and gender norms, and often reinforced by laws and regulations on consent, can further restrict care-seeking.
  • As with other age groups, barriers including low health literacy, poverty and marginalization also negatively affect adolescents’ access, but likely with stronger impact

To make progress toward universal health coverage, countries will need to transform how health systems respond to the health needs of adolescents. A transition is needed from “adolescent-friendly” projects to adolescent-responsive health systems and Adolescent Health in All Policies approach. This is a smart investment that makes economic sense in both high and low resource settings. Across low and middle income countries investments in health sector actions ranging from HPV vaccination through to quality health care yield returns of between $6 and $22 for every dollar invested.

Similar benefits are found from investments in prevention in other sectors. Investing in adolescent health will also fuel economic growth by contributing to increased productivity, reduced health expenditure, and the interruption of intergenerational transmission of poor health, poverty and discrimination. Ultimately, the wealth of a nation is measured by the knowledge, skills, and health that its people accumulate throughout their lives. Adolescence is the very period when the foundations for all three are set.

What is WHO doing?

WHO is working to support Member States to create transformative outcomes for the world 1.2 billion adolescents and generations to come, through committing to urgently scale up efforts to respond to the needs of adolescents in service delivery, financing and governance. This work will support the implementation of the WHO's 13th General Programme of Work, and more specifically its target of “1 billion more people benefitting from universal health coverage” by 2023.

WHO recommendations for adolescent-responsive health systems

Governance:

  • Within the Ministry of Health, strong leadership for adolescent health is needed to mandate collaboration between different departments and to ensure an adolescent health focus in key policies, including those related to financial risk protection; training and education of providers; quality improvement; health management and information systems; and infrastructure.
  • It is necessary to adopt and implement legal and regulatory frameworks that adopt a human rights approach and guarantee access to services in the best interest of adolescents, including those most marginalized and vulnerable.

Adolescent participation:

  • Countries should ensure that adolescents’ expectations and perspectives are included in national programming processes. Adolescent leadership and participation should be institutionalized and actively supported during the design, implementation, monitoring and evaluation of adolescent health programmes.
  • Put in place mechanisms and procedures to ensure adolescent participation in health services, including in their own care, in line with Standard 8 of the Global Standards for Quality Health-Care Services for Adolescents.

Financing and financial risk protection:

  • Make the national package of adolescent health interventions an instrument to guide purchasing decisions and benefit packages, giving particular attention to preventive services and to adolescents’ rights to confidentiality.
  • Maximize the number of adolescents covered by an effective prepaid pooling arrangement, which can take the form, for example, of an explicit insurance programme or access to facilities that are financed by prepaid pooled funds;
  • reduce or remove out-of-pocket payments at the point of use;
  • expand the range of services covered by the effective prepaid pooling arrangement to include the services in the country’s package for adolescents.

Adolescent-responsive services:

  • Develop and implement national quality standards for adolescent responsive health care services as a mean to minimize variability and ensure a basic level of quality and protect adolescents’ rights.
  • Establish local, sub-national and national learning platforms for quality improvement.
  • Implement e-standards to automate the processes of data collection and analysis, and to improve adolescent participation in providing feedback to facilities by using IT.
  • Efforts should also be made to ensure that services are not simply accessed by a privileged minority of adolescents, but that services are reaching marginalized subgroups of adolescents as well.
  • Strengthen service-delivery platforms that maximize coverage, for example e-health and school health services (school-based and school-linked) to facilitate adolescents’ access to preventive services, and promptly manage conspicuous health problems.

Workforce capacity:

  • All health workers who are in places that adolescents visit (e.g. hospitals, primary care facilities and pharmacies) should develop their competencies (i.e. knowledge, skills and attitudes) in adolescent-responsive health-care, to be able to respond to their specific needs.
  • To support the development of an adolescent-competent workforce at all levels of care, it is necessary to adopt core competencies in adolescent health and development for health cadres in line with WHO Core Competencies for Adolescent Health and Development for Primary Care Providers.
  • In line with core competencies, improve the structure, content and quality of the adolescent health component of pre-service and continuous professional education curricula.

Age- and sex-disaggregated data in health management and information systems

  • Identify and respond to specific weaknesses in national data collection systems, including a review of sources and mechanisms for data collection on impact, outcome, output, process and input indicators
  • Make adolescent visible in national health management and information systems by improving the capacity of national and subnational statistics agencies to report regularly on the health, development and well-being of adolescents, disaggregated by age and sex. At a bare minimum, data should be disaggregated by age and sex, and wherever possible other relevant stratifiers should be included, e.g. education, rural or urban. Ensure that this information is easily accessible to constituents.

WHO recommendations for Adolescent Health in All Policies approach (AHiAP)

  • To achieve the Sustainable Development Goal targets, the health and other sectors need to normalize attention to adolescents’ needs in all aspects of their work. An “Adolescent Health in All Policies (AHiAP)” approach should be practised in policy formulation, implementation, monitoring and evaluation.
  • Create platforms for the Ministry of Health to engage in the planning cycles of other sectors for the development of sectors’ long-, medium- and short-term plans with due consideration to adolescent health needs. This arrangement should be reciprocal, so that other relevant sectors also participate in developing health plans.
  • Support AHiAP by implementing joint activities at all stages of the strategic planning of other sectors, including during situation and needs assessment, policy formulation, preparation of plans, and evaluation of key policies.
  • Progress in primary and secondary school enrolment calls for renewed attention to school health programmes. Investing in school health programmes is a priority for intersectoral action on adolescent health, and every school should become a health-promoting school.
  • Recommendations on adolescent sector specific policies in education, social protection, roads and transport, telecommunications, housing and urban planning, energy, water and sanitation, and environment, and criminal justice system for are presented in the AA-HAI guidance

WHO is working with partners to make adolescents visible in the UHC agenda

The Sustainable Development Goals and global political momentum behind UHC offer significant opportunities to build collective global and national action towards achieving universal health coverage for adolescents. WHO worked with partners to produce a paper that sets out the evidence base on adolescent health and makes the case that to achieve Universal Health Coverage, policy makers need to take urgent action in the areas of service delivery, financing and governance.

The paper will be used as a background document to inform debates in the lead to the Political Declaration of the UN High-Level Meeting (UN HLM) on Universal Health Coverage that will take place on 23 September 2019 during the United Nations General Assembly (UNGA) high-level week. This is a great opportunity to help mobilise high-level political attention to adolescents globally and in countries.