Improving the quality and expanding the coverage of health services for adolescents
World Health Organization
September 17, 2012 - Geneva
World Health Organization. Improving the quality and expanding the coverage of health services for adolescents. Paper presented at: Training Course in Sexual and Reproductive Health Research; 2012 Sep 17; Geneva. Available from: http://www.gfmer.ch/SRH-Course-2012/adolescent-health/Health-services-adolescents-WHO-2012.htm
Topics covered in the module
- What is the role of health services in contributing to the health and development of adolescents?
- Adolescent friendly health services: What is the reality on the ground?
- What are we doing to improve the quality and expand the coverage of health services for adolescents and why?
This guidebook sets out the public health rationale for making it easier for adolescents to obtain the health services that they need to protect and improve their health and well-being, including sexual and reproductive health services. It defines ‘adolescent-friendly health services’ from the perspective of quality, and provides step-by-step guidance on developing quality standards for health service provision to adolescents. Drawing upon international experience, it is also tailored to national epidemiological, social, cultural and economic realities, and provides guidance on identifying what actions need to be taken to assess whether appropriate standards have been achieved.
The guidebook is intended to be a companion to the Quality Assessment Guidebook: A guide to assessing health services for adolescent clients, which was published by the World Health Organization (WHO) in 2009. These two guidebooks are part of a set of tools to standardize and scale up the coverage of quality health services to adolescents, as described in another WHO publication: Strengthening the health sector’s response to adolescent health and development.
The current publication is intended for national public health programme managers, and individuals in organizations supporting their work. Its focus is on managers working in the government sector, but it will be equally relevant to those working in nongovernmental organizations (NGOs) and in the commercial sector.
To support the health sector in identifying and implementing a few strategic, do-able, evidence-based interventions to create demand for sexual and reproductive health services by adolescents who need them and to stimulate community acceptance and support for their provision, a global review of the evidence was compiled.
Using a standard methodology, evidence from thirty studies was reviewed on interventions for generating demand through the provision of information, education and communication via several different channels. This included:
- information on accessibility of health services;
- the use of referral systems;
- and the provision of funds/vouchers/subsidies to cover financial costs of services.
Similarly, assessments were done of the effectiveness of interventions for garnering community acceptance and support. These included interventions such as providing information to influential community members about the need for health services for adolescents through a variety of channels: one-to-one discussions, cultural/social or school events, mass media, and activities to foster community engagement and participation in improving access to health services by adolescents.
The available evidence clearly highlights the importance of engaging parents, adolescents and communities as part of a comprehensive strategy for improving health service use by adolescents. Young people are most likely to use youth-friendly services in those communities that demonstrate most awareness and approval. A supportive social environment (folk, popular, professional) also results in higher utilization rates.
The review also highlights the need for stronger programme design and for the evaluation of projects that work with families and communities on influencing reproductive health behaviour and service use.
A range of individuals and institutions have important roles in promoting healthy development in adolescents, and in preventing and responding to health problems challenging this population group. Health-care providers (HCP) have important contributions to make in both these areas. However, situation analyses and needs assessment exercises carried out in different parts of the world point to shortcomings in their professional capabilities and in their 'human qualities' as a result of which they are unable and oftentimes unwilling to deal with adolescents in an effective and sensitive manner. To bridge this gap, the Department of Child and Adolescent Health and Development (CAH) of the World Health Organization (WHO) is developing the Orientation Programme on Adolescent Health for Health-care Providers (OP) with other partners. The OP is a joint effort of the Commonwealth Medical Association Trust, UNICEF and WHO.
The materials consist of a handout for participants and of a facilitator's guide for the overall course (course director guide) and for all the modules. It provides detailed guidance on how to run each module. In addition it contains tips for the trainers, lecturing aids such as overhead slides in electronic form with accompanying talking points and study materials. Facilitator's guide, handouts for participants, the lecturing aids and study materials are all available on a CD ROM. The Orientation programme is available in English, French and Russian.
The Adolescent Job Aid is a handy desk reference tool for health workers (trained and registered doctors, nurses and clinical officers) who provide services to children, adolescents and adults. It aims to help these health workers respond to their adolescent patients more effectively and with greater sensitivity. It provides precise, step-by-step guidance on how to deal with adolescents when they present with a problem or a concern about their health or development.
It comprises three main parts:
- Part 1: The clinical interaction between the adolescent and the health worker.
- Part 2: Algorithms, communication tips and frequently asked questions on 25 presentations related to developmental conditions, pregnancy-related conditions, genital conditions including sexually transmitted infections, HIV and other common presentations.
- Part 3: Information for adolescents and their parents or other accompanying adults on important health and development issues.
The Adolescent Job Aid is intended to be used along with the Orientation Programme on Adolescent Health, a tool which is being used in many countries.
The Quality assessment guidebook: a guide to assessing health services for adolescent clients is part of a set of tools to strengthen programmatic action on adolescent health in countries. It is intended to enable programme managers to assess the quality of health service provision to adolescents, and to take appropriate action where the quality is found wanting.
The Guidebook can be used in countries where there are agreed-upon national quality standards, as well as in ones where there are not.
It contains a user guide, a set of eight instruments to assess the quality of health services, and a framework for analysing and reporting on the data collected.
Please read chapter 1 of the above document (pages 1-9).
Speak to two adolescents – one male and another female – who are not part of your family and ask them what – in their opinion – are the 3 most important characteristics of adolescent friendly health services. Write a brief commentary on your discussion with them.
If you were appointed Director of Health Services of your country on 1st October 2012 and asked to make health services in your country adolescent friendly what would you set as your priority for the next twelve months.