Professional Documents
Culture Documents
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WHO Library Cataloguing-in-Publication Data
t e e
ia national quality standards for adolescent
prdeveloping c t veservices.
ihealth a c
p p r o t e e ff e
q u i t a blhealthe friendly:
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health programs. 4.Adolescent.
b q u I.World Health
l e ap p r
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ble ac ISBN 978 92 4 150359c4 p t a b l
(NLM e eq WA 330)
classification:
s s i b l e a ce
ve a cc e © World Health Organization 2012
ff e c t
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opriate e ff e c t i ve a c e s si b le a
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Contents
quita b l p p rop r ffe ctiv e
itab l e a pri a te e
b le e q u e a p p r o p r i a te eff
ccept a q u itab l a ppr o
tab l e e uit a b l e p p
e a cc e p a b l e e q a b le a
essibl b l e a c c ept b l e eq uit
v e a c c essi l e a c c e pta t a b le e
e effe ct i acce s s i b e ac c e p
e c t i v e c e ss i b l
p r ia t e eff e c t i v e ac ss ib le a
appro r i a te eff iv e acc e
r o p
pp . . . . . . . . . . . . . . . . . . . . . .o . .p . . r . .i . a eff e ct ce
b le a . .e
. . . t e a c
t a ppr ffec t iv
e equi
Abbreviations . . . . . Iv
a b l e a r ia te e
b le e q ui .t . . . . . . . . . . . . . . . . . . . . . . . . .l .e . . . .a
Introduction .
p . Vop
. . .r
. . . . . p
a uitab
e accept p ta . . .l . e
Chapter 1 . . . . . b . . q
. . . . e
e a c c e . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
l Chapter 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
accessib
Chapter 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Annex 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Annex 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
q u i t a b
table e UNFPA United Nations Population Fund
UNICEF United Nations Children’s Fund
a b l e
and reproductive quservices. It defines ‘adolescent-friendly
ehealth s ib l ehealth c from the perspective tive ac
aservices’
p t
acce ofprovision t i ve
quality, and provides step-by-step guidance a c
on e s
cdeveloping quality standards for health
r ia t e
service e ffec
ia t e e ec upon international experience, itais p
ffDrawing p ropto national ble
p r o p r to adolescents.
social, cultural and economicu i t a b le
provides guidance on identifying whataccepta
also tailored
i t a b l
assessing health apfor adolescent clients, which was published by the World Health Organization
eservices
ble eq(WHO)u 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.
Chapter 1 outlines the theoretical basis for actions to improve the quality of health service provision to
adolescents. It covers the following issues and themes:
a c c e p t ab
relation to adolescents).
b l e e q u ithealth a b l e eq
essib le • • WHO recommendations for
a ccep
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t a
adolescents with essential services.
e acc e p t
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c standards for health serviceve acces
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provision to adolescents. i
r Ita t e e ff national
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explains the
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ia t e e
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b l e o p r
equit •• Developing aa e e q
sharedlunderstanding
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adolescent health and of strengthening health service
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•• Establishing the basis fore
s s i b l formulating
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b l e a c cep t a b l e eq i t a b le a
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c to prepare for and conduct a workshop b l e eq u
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•• The outline of a background
ve a
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•• The objectives and agenda
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services, and a facilitators guide to conduct
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b le a p
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for the facilitator use the workshop.
eq u i t a
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a c c e p t a b l e
a c c e p tabl
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c s s
dimensions
c e i b of le
quality health services for adolescents
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and
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the
s i b
twenty le
e ff e c t i ve a
characteristics that relate to them.
e e ff e c t i ve e ff e c tive
pria te Annex 2 lists the actionsp torbeo
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b l e a p taken
l e a p p r
to improve quality of health
Chapter 1
ffectiv e e e ffe c t e ff ect iv
r i a t ia t e
b l e a p prop e a p p r opr r ia te effe
quita e e q u i t abl b l e a p p rop
a c ce p t abl l e e q u ita
b le e q u i
essible e a cc e p tab e a cc e p ta
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health services,
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e effec a c cess i e a c cep t
ffec t i v e cess i b l
o p r ia t e e e c t iv e a c
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acby the term ‘adolescents’? ective a c ce ss i
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1. What
e e ff e ff e c t i
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5. What is the
1 The health of young people: A challenge and a promise. Geneva, World Health Organization, 1993.
Adolescents are a diverse group. For example, a boy of twelve is at a very different stage of personal
development than a boy of eighteen. Similarly, in addition to the obvious physical differences, he is
different in psychological and social terms from a girl of the same age. A boy of twelve who is fending for
himself on the street is likely to be growing and developing very differently from a boy of a similar age
who is growing up with a caring and financially secure family. Even two boys of the same age, growing
up in very similar circumstances, may grow and develop in different ways and time lines.
A useful analogy is that of an 8 year-old girl who needs to cross the road every day to get to school. She
needs information and skills: on where to look, what to look for, when to walk across, and when not to
do so. She needs a safe and supportive environment: a pedestrian crossing, traffic lights that work or a
traffic warden in position, drivers who respect traffic rules or are punished if they do not do so. She may
also need health and counselling services, if she stumbles and falls, or is struck down by a vehicle.
2 Constitution of the World Health Organization. Geneva, World Health Organization, 1948.
3 WHO, UNFPA, UNICEF. Common agenda for action in adolescent health and development. Geneva, World Health
Organization, 1997.
As indicated above, health workers are part of the list of players who need to contribute to the health
and development of adolescents. They have two complementary roles to play. Firstly, as service
providers, they have important contributions to make in helping well adolescents stay well, and in
helping ill adolescents get back to good health.
•• the provision of information, advice, counselling and clinical services aimed at promoting health and
preventing health problems and problem behaviours;
•• the diagnosis, detection and management of health problems and problem behaviours; and
•• referral to other health and social service providers, when necessary.
•• Health workers have another important role to play – that of change agents in their communities.
They have credibility and influence in their communities and need to use this to help influential
community members take adolescent health seriously. They could make an invaluable contribution
in helping educators, religious leaders, political leaders and others understand the needs of
4
adolescents, and the importance of working together to meet these needs.
4 Programming for adolescent health and development. Report of a WHO/UNFPA/UNICEF study group on programming
for adolescent health. Geneva, World Health Organization, 1999.
Some of these health problems affect the individual during adolescence (e.g. a death caused by suicide
or interpersonal violence or from the consequences of an unsafe abortion). Others affect the individual
later in life (e.g. lung cancer resulting from tobacco use initiated during adolescence).
Not surprisingly, a key factor that influences adolescents’ health care-seeking behaviour is whether or
not the act of seeking health care could get them into trouble with their parents or guardians. If, as in
many cultures, social norms strongly forbid premarital sex, unmarried adolescents are likely to be wary
about seeking care even if they have a painful genital ulcer or a possible unwanted pregnancy. They
are likely to try to deal with the problem themselves, or with the help of friends or siblings whom they
can trust to keep their secrets. To ensure that no one around them comes to learn about their problem,
they tend to turn to service delivery points such as pharmacies and clinics at a safe distance from their
homes, as well as to service providers who are as keen as they are to maintain secrecy (such as those
who carry out abortions illegally).
5 Patton GC, Coffey C, Sawyer SM et al. Global patterns of mortality in young people. A systematic analysis of population
data. The Lancet, 2009, 374: 881–892.
6 Gore F, Bloem PJN, Patton GC et al. Global burden of disease in young people aged 10—24 years: a systematic analysis.
The Lancet, 2011, 377: 2093–2102.
7 Barker G, Olukoya A and Aggleton P. Young people, social support and help-seeking. International Journal of Adolescent
Medical Health, 2005, 17, 4:315–336.
Firstly, in many places, health services such as emergency contraception and safe abortion are simply
not available to anyone, either to adolescents or to adults.
Secondly, even where health services are available, adolescents may be unable to obtain them for a
variety of reasons – restrictive laws and policies may prevent some health services from being provided
to some groups of adolescents (e.g. the provision of contraceptives to unmarried adolescents);
adolescents may not know where and when health services are provided; health facilities may be
located a long distance from where they live/study/work; or health services may be expensive and
beyond their reach). What this means is that the health services are not accessible to them.
Thirdly, health services may be delivered in a way that adolescents do not want to obtain them, even
if they can. One common reason for this is that they have to go to, and wait in, a place where they
could be seen by people they know. Other reasons are the fear that health workers will scold them, ask
them difficult questions, and put them through unpleasant procedures; or that health workers will not
maintain confidentiality. What this means is that the health services are not acceptable to them.
Finally, health services may be ‘friendly’ to some adolescents, such as those from well-to-do families,
but may be decidedly ‘unfriendly’ to others, such as young people living and working on the streets. In
other words, they may be available, accessible and acceptable but not necessarily equitable.
It is interesting to note, however, that different groups of adolescents, from various parts of the world,
identify two key, common characteristics. They want to be treated with respect and to be sure that their
9
confidentiality is protected.
8 Adolescent-friendly health services: An agenda for change. Geneva, World Health Organization, 2003.
NGOs are in the forefront of these efforts in most places, although in a growing number of countries,
government-run health facilities are also reorienting themselves in order to reach out to adolescents.
Initiatives are being undertaken in a variety of settings:
Most of these initiatives are small in scale and of limited duration. However, there are a steadily growing
number of initiatives that have moved beyond the ‘pilot’ or ‘demonstration project’ stage to scale up
their operations to reach out to adolescents across an entire district, province or country.
Is there any evidence that efforts to make health services adolescent friendly can increase their
utilization by adolescents?
There is growing evidence for the effectiveness of some of these initiatives in improving the way health
services are provided, and in increasing their use by adolescents.
In 2006, WHO published a systematic review of the effectiveness of interventions to improve the use
10
of health services by adolescents in developing countries. This review identified twelve initiatives,
including one randomized controlled trial (Nigeria), six quasi-experimental studies (Bangladesh, China,
Madagascar, Mongolia, Uganda and Zimbabwe), two national programmes (Mozambique and South
Africa), and three projects (Ghana, Rwanda and Zimbabwe), which demonstrated that actions to make
health services user friendly and appealing had led to increases – sometimes substantial– in the use of
health services by adolescents.
9 Global Consultation on adolescent-friendly health services. A consensus statement. Geneva, World Health Organization, 2002.
10 Dick B, Ferguson J, Chandra-Mouli V, Brabin L et al. A review of the evidence for interventions to increase young people’s use of health
services in developing countries in Ross D, Dick B, J Ferguson (Eds.). Preventing HIV/AIDS in young people: A systematic review of the
evidence from developing countries. Geneva, World Health Organization, 2006.
Precise answers to these questions will provide a sound basis for developing a national strategy to
improve the quality of health service provision to adolescents.
It is important to build on what already exists. What this means is 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, rather than on setting up new service-delivery points
exclusively intended for adolescents. Having said that, dedicated health service-delivery points and
outreach work could play a useful role in reaching marginalized and stigmatized groups of adolescents
(such as injection drug users), who may be reluctant to use a service-delivery point that is open to all.
Two complementary efforts are needed – firstly, to make health-service provision friendly, so that
adolescents are more likely to be able and willing to obtain the health services they need; and
secondly, to ensure that the health services that adolescents need to stay healthy or to get back to good
health are in fact being provided, and are being provided in the right manner. In other words, efforts
must be made to increase both health service utilization and health service provision.
The WHO ‘quality of care’ framework provides a useful guide to work on improving health service
12
provision and utilization. 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.
The quality of care framework provides a useful working definition of adolescent-friendly health
services. To be considered adolescent friendly, health services should be accessible, acceptable,
13
equitable, appropriate and effective, as outlined below:
Accessible
Adolescents are able to obtain the health services that are available.
11 Tylee A, Haller DM, Graham T, Churchill R et al Youth-friendly primary-care services: how are we doing and what more needs to be
done. The Lancet, 2007, 369.
12 Quality of Care. A process for making strategic choices in health systems. Geneva, World Health Organization, 2006.
13 Quality Assessment Guidebook. A guide to assessing health services for adolescent clients. Geneva, World Health Organization, 2009.
Equitable
All adolescents, not just selected groups, are able to obtain the health services that are available.
Appropriate
The right health services (i.e. the ones they need) are provided to them
Effective
The right health services are provided in the right way, and make a positive contribution to their health.
It provides a useful way of organizing the characteristics that have been shown in research and in
programmatic experience to contribute to making health services adolescent friendly (see also Annex 1).
Specifying standards, i.e. statements of required quality,14 is a key first step. Once that is done actions
need to be taken to achieve those standards. A standards-driven quality improvement approach
enables this to be accomplished in the following three ways:
1. It helps set clear goals for different aspects of service-delivery point operations. For example, a
standard statement could specify what medicines (e.g. antibiotics) and supplies (e.g. needles and
syringes, cotton swabs and spirit to clean injection sites) need to be in place in a service-delivery point.
It could also specify the quantity of each of these medicines and supplies that need to be in place.
2. It provides the basis for assessing the achievement of goals. In relation to the example, the standard
statement provides a basis to assess whether in a particular service-delivery point, the specified medicines
and supplies are in place, and whether the specified quantities of these medicines and supplies are in place.
3. It provides an entry point for identifying why the goals were not achieved.
Based on this standards can help indicate what needs to be done, by when and by whom for the goals
to be achieved. In relation to the example, if antibiotics to treat sexually transmitted infections in
adolescents and adults are out of stock, the main reasons for this and actions to solve the problem –
and to prevent it from occurring again in the future – need to be identified. These actions may need
to be taken at the point service delivery, or they may need to be taken at other levels, for example
at the district or national level. Once these actions are put in place, the situation must be reviewed
periodically to determine whether specific problems recur.
Using these three complementary aspects – defining quality, measuring quality and improving quality
– ministries of health can put in place national initiatives to improve the quality of health service
15
provision to adolescents in order to achieve clearly defined health outcomes. This can be done as part
of wider initiatives to improve the quality of health services intended for all segments of the population.
14 E Necohea, D Bossemeyer. Standards based management and recognition. A practical approach for improving the performance and
quality of health services. Baltimore, Jhpiego, 2005.
15 R Massoud, K Askov, J Reinke et al. A modern paradigm for improving health care quality. Bethesda, Quality Assurance Project, 2001.
Scaling up has been defined by WHO and ExpandNet as: “Deliberate efforts to increase the impact of
successfully tested health innovations so as to benefit more people and to foster policy and programme
16
development on a lasting basis.” Deliberate efforts are needed to reach out to all adolescents who
need health services.
17
Using the WHO nine-step approach to developing a scaling up strategy, a systematic process has been developed
for scale-up of health service provision to adolescents. The process begins with actions at the national level, which
are followed by subsequent actions at the state/district level and the health facility levels. The process is outlined in
18
the document titled: Strengthening the health sector response to adolescent health and development.
16 Practical guidance on scaling up health service innovations. Geneva, World Health Organization (with ExpandNet), 2009.
17 Nine steps to developing a scaling up strategy. Geneva, World Health Organization (with ExpandNet), 2010.
18 Strengthening the health sector’s response to adolescent health and development. Geneva, World Health Organization, 2009.
CHAPTER 2
u ita b l e e ff ec t i v e cce
ta b l e e q o p r ia te s s ib le a
accep a b l e a ppr e c t i v e a cce
b le e q uit p r ia t e eff i b le a cc
accept a a ppr o e a cces s
uit a b l e effe ct i v
ta b l e e q o p r i a te s s i b l e ac
acce p le app r i v e ac c e
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t a b l e r o p r i a c t iv e
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p r o p r iate
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ccep t a b e eq u i t a e a
s i b le a e p t a b l u it a b l
acces s s ib le acc p t a b l e eq
iv e acc e b l e acc e a ble
e ff e c t c ce s si
a understanding of adolescent a c c e p t
ate Section I. Develop
e ff e c t i vaeshared a c c e s s i ble health
r o p r i a te e ff e c t i ve to adolescentsccessible
le ap p and strengthening
p
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r iate service provision
c t iv e a
ap p r o ate e ff e
e q u it a
Thereb e step
islone in this section:
a p p r o p ri
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ble q u i t a bofleWHO’s approach to promotingtadolescent
e ff e ctiandveto providing
t a e
1. Develop a clear understanding
ble with the health services theya r o keyr
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c c e p adolescents
p p
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c e p t a b le e p p r o p r iat c c e s s ib le
ble ac q u it a b le a e ff e c t ive a
iate
What is the step?
c e p t a b le e p r o p r c c e s s ible
–– Develop a clear understanding of the WHO approach to promoting adolescent health and to providing adolescents
p
ble a c a ble a ctive a
with the health services they need, among key stakeholders involved in the national effort to strengthen health
t e
e q u i ria t e e ff
ble
service provision to adolescents.
cc e p t a a p p ro p a c c e s s ibl
ible a u i t a ble
What is the purpose of this step?
e q e e ff e c t ive
c e p t a ble p ro p r iat c c e s sib
–– To ensure that key stakeholders involved in the national effort to strengthen health service provision to
p
sible a c abl e a ctiv e a
adolescents have a clear understanding of WHO’s approach to promoting adolescent health and to providing
t e
e q u i t e e ff
adolescents with the health services they need. Key stakeholders may include officials from the ministry of health,
e a
a cc e p t abl a p p r o pri a c c e s sib
officials from influential national NGOs, academics, and representatives of international organizations.
ssible ble e q u it a e ff e
promoting adolescent health and of providing adolescents with the health services they need.
ria t e
a c c e p ta
How could this step be taken?
a p p r o p a c c e ss
ssibl e u i t ab le e ff ecti v e
–– In both formal and informal meetings with individuals, small groups or large groups, seek to understand the
abl e e q opr ia te
perspectives of key stakeholders and to explain the WHO approach to promoting adolescent health and to
t c ti
a c c e p e a p p r
providing adolescents with the health services they need. (Please refer to Chapter 1).
t e e ff e
essible e q u i t a bl p p r o p ria
e p t able i ta ble a p pr
le a c c le e q u b l e a
essib a c c e p t ab b le e q uita
a c c e s sible l e a cc e pta b l e e q u i
ective 10 e a cc e ssib le a c c e p ta
t e e e ctiv
Making health services adolescent friendly
ff a cc e ssib l e a cce
o p r ia ect i v e es s ib
ptable
e
p r o p ri ate c e s s ib l e a
i t a b le ap e c tiv e ac p ta
e e q u a te e ff e a c c e
ptabl a p p r o pri
e a c c e s sibl
e q u it a ble te e ff e ctivthe a c c e p ta
ptablenational quality
Section II. Establish
a p
the
p basis
r o pria for formulating
a c c e s s ible
q u it a blestandards for health e ff e
service ve
ctiprovision cc e pt
l e e r i a te ssib le a
eptab to adolescents, l p
in national
e a p p
roHIV/AIDS and/or reproductive
v e a c c e
e
health
l e q u itab and strategies*riate effecti
policies b l e a c c ep
eptab a p p r op e a c ce ssi
u i t e
blsection:
athis e ff ecti v c c ess
b le e q
There are two steps in
p ri a te i v e a
cepta 1. Establish the basistaforbaddressing
l e a ppro within the national HIV/AIDS r ia t e e ffect
rop
adolescents and/or reproductive
healthe
l e q u i and strategies. e a p p p ri a t e e
b
ccepta2. Establish the basis
(RH) policies
q u iofthealth l
abservices to adolescents within a p pofro
e
forlthe e
ab and/or RH policies and strategies. uita b l e
t pp
provision the framework
le a c c e p t a b l e e q a b le a
cessi b the national HIV/AIDS
le a cce p l e e qu i t
a cces s i b ccep ta b e eq
c ti v e ib l e a p t a b l
cess
What is step 1?
e effe ti v e a c s i b l e a cce
–– Establish the basis for addressing adolescents within the national HIV/AIDS and/or RH policies and strategies.
t a b l e p ri a te s i b le a cc
e equ i e a ppr
What is the importance of taking this step? o v e a cce s
uit a b l eff e c ti
t a b l e q
r o p r te s s i b ac
–– Firstly, in many countries there are individuals, groups and organizations who are uncomfortable with providing
e i a l e
acce p l e ap p iv e ac c e
adolescents sexual and reproductive health information and services. If there is resistance to the initiative from any
equ i t a b te e ff e c t
quarter, it would be helpful to show that it is entirely in line with national policies and strategies.
ac
p t a l e r o p ri a e s s i l e
–– Secondly, grounding the initiative in national policies and strategies may make it more likely that it will receive both
b b
acce app acc
moral and material support of decision-makers in the government and in international organizations.
i t a b l e ff e c t i v e
t a b le equ
How could this step be taken?
r o p ri a te e s s i b le a
ac ce p le a p p
–– Review the national HIV/AIDS and RH policy and strategy documents.
i v e a c c e
eq u i ta b e ff e c t
e p ta b le p ro p r ate c c e s s i b e a
–– Hold one-to-one/small group discussions with officials responsible for the national HIV/AIDS and RH programmes.
i l
e acc e ap e a
–– Based on your findings, prepare a paper and table this for discussion in the process leading to the development of
u i ta b l e ff e ct iv
the national quality standards for health service provision to adolescents. Some suggested questions to ask include:
ta b l e eq ro p ri a te e s s ib
(i) Does the national HIV/AIDS and/or RH policy/strategy identify adolescents as a population group to be
l e a
e acce p addressed?
b l e ap p t iv e ac c
equ i ta te e ff e c
e a le
(ii) Does the national HIV/AIDS or RH policy/strategy identify:- the magnitude of the problem(s) in adolescents (e.g.
ce p ta b l p p r o p ri c
the prevalence of HIV infection in males aged 15–19 years among the general population);
c e s s ib
le a c t a b le a e c t ive a
le e q i riate ff
–– the behaviours that contribute to the problem(s) in adolescents, (e.g. the prevalence of unprotected sexual activity
u e le
ce p ta b
with multiple partners);
p p ro p c c e s s ib
ble ac l e a iv e a
–– the factors influencing these behaviours in adolescents (e.g. low perception of the risk of HIV)?
eq u i ta b e ff e c t
e p ta b l e p ro p r ate
(i) Does the national HIV/AIDS and/or RH policy/strategy include a component to prevent HIV/AIDS and RH
i a c c e s s ibl
c p
problems in adolescents?
a c c e p ta e q u i ta b l
l e a p p rop
sible c c e p a
What is the purpose of this step?
t ble le e q u i tab
c c e s s le a a cc tab
e e q u t ab
–– To ensure that the national quality standards for health service provision to adolescents are formulated in line with
ib e p i
ive a sible abl
national policies and strategies.
a c c e s a c c e p t
e e ct ive
What is the importance of taking this step?
e ff a cc e s s ib le a c ce p ta
ropriat ff e c t ive s s ibl e
–– Grounding the initiative in national policies and strategies will make it more likely that it will receive both the moral
c c e
iat e e tive a
and the material support of decision-makers in the government and in international organizations.
p r e c
p p r o te e ff
itable a pria
* Where national adolescent health policies and strategies address HIV and Sexual and Reproductive Health, they should be
a p p r o
le
reviewed.
e q u it a b
eptable 11
Making health services adolescent friendly
How could this step be taken?
–– Review the national HIV/AIDS and RH policy and strategy documents.
–– Hold one to-one/small group discussions with officials responsible for national HIV/AIDS and reproductive health
programmes.
–– Based on your findings, prepare a paper and table this for discussion in the consultancy process leading to the
formulation of the national quality standards.
To begin with, point to the sections of the national HIV/AIDS and/or reproductive health policies/strategies that identify the
need to provide sexual and reproductive health services to adolescents? Then, move on the following points.
(i) The population groups to be addressed.
(Note: Do the policy/strategy documents specify whether the health outcomes are being aimed for in all adolescents or
only in some groups of adolescents?).
(ii) The health outcomes being aimed for.
(Note: Do the policy/strategy documents specify what changes in the health status are being aimed for?).
(iii) The role of health service provision within a broader strategy.
(Note: Do the policy/strategy documents specify that health service provision is grounded in a broader strategy that
includes providing information and education to adolescents, providing them with counselling services, and making
their environment safer and more supportive?).
(iv) The package of health services to be provided.
(Note: Do the policy/strategy documents specify the package of preventive and curative health services that need to be
delivered at the primary and at various referral levels in order to contribute to the desired health outcomes?).
(v) The delivery of these health services – where and by whom.
(Note: Do the policy/strategy documents specify where (i.e. from which health service delivery points) and by whom
(i.e. which health-service providers) the stipulated package of health services should be delivered ?).
(vi) A clear position on the authorization of adolescents to obtain the health services they need, and the requirement
for the consent of parents/guardians.
(Note: Do the policy/strategy documents clearly state whether all groups of adolescents are authorized to obtain the
stipulated package of health services; and whether they can do so autonomously – i.e. without the consent of parents
or guardians).
1. Develop a clear understanding of what a standards-driven initiative to improve the quality and
expand the coverage of health service provision to adolescents means in practice, and what it takes
to translate quality-standard statements into tangible improvements in quality and coverage at
health service delivery points, among key stakeholders involved in the national effort to strengthen
health service provision to adolescents.
2. Develop a good understanding of the current situation regarding the provision of health services to
adolescents, and their utilization by adolescents.
3. Gather experiences from within the country in applying quality improvement principles and
practices in public health programmes.
4. Identify the place of the unit driving of the national standards-driven initiative in the country; as
well as programmatic opportunities and challenges in applying them.
What is step 2?
–– Develop a good understanding of the current situation regarding the provision of health services to adolescents, and
their utilization by adolescents.
–– If possible, bring together a small working group to prepare a working paper highlighting the lessons that could be
drawn from their work for scaling up health service provision to adolescents.
–– Identify possible individuals who could be involved in the formulation of the national quality standards
What is step 4?
–– Identify the place of the unit driving the national standards-driven initiative in the country; as well as programmatic
opportunities and challenges in applying them.
What is step 1?
–– Obtain the support of a wide range of stakeholders whose support is important for the national standards-driven
quality improvement initiative to succeed. In addition to individuals and organizations involved in the preparatory
work, this step should involve other community members such as political leaders, religious leaders, teachers
and officials from government departments other than health whose work affects adolescents/young people. It is
important to involve adolescents as well in the consultative process.
What is step 2?
–– Develop the national standards (and accompanying elements of a standards-driven quality improvement initiative).
What is step 1?
–– Ensure that the draft standards and accompanying elements are cleared by the relevant authorities after being
reviewed and revised, as needed.
What is step 2?
–– Develop an implementation guide that outlines what district health management teams and managers of health
facilities need to do to ensure that the structure criteria accompanying each standard statement are in place.
What is step 3?
–– Develop a monitoring guide that outlines what and how district health management teams and managers of health
facilities need to track implementation.
What is step 4?
–– Inform key stakeholders at the national level, who could help or hinder the implementation of the initiative; explain
to them what it aims to achieve and how it aims to do this.
3
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e ap 4. Individuals and organizationse ff e c t i v
thateare a p t a b
carrying out research and/or implementing programmes/
c e le e
r o projectsa
p r i e service provision to adolescents.
onthealth
s s i b l e ac i ta b le a
p
e ap 5. The lessons that could i v e c e
acwork for scaling up health servicepprovision b toe e
l q u
te e ff e c
be drawnt from their
acc e t a
p r o p r i a
adolescents.
c c e s s i b l e q u i ta b le
p
le a Part 3 National experiences c t i vequalitya improvement and coverage expansion t a ble and e
e ff ineapplying c c e p
p p r o p r iatehealth, even if this does not address c c e s s i b le a principles
q u i ta b le a
le a 1. Brief descriptions of noteworthy
practices in public
e c t i ve athat have applied quality improvement
adolescents
ta b le and e
r i apublic e ff
te health work. le ac c e p p r ia
p r o p initiatives
c e s s i b principles
p p r o
ble ap2. A list of published
practices in
e ff e c t i v e ac q u i t a b le a
p r o p r i a tepapers or reports that describe the c e p t a b le eby these initiatives and the ppropr
process employed
t e e ff e ctive health
a c c e p t ab
e a p p r o p
opria 5. Opportunities c c e
and challenges in setting
a s siupbalenational quality improvement andeq u i
coverage t a bl
expansion
t ive health service provision toa
initiative tocstrengthen adolescents.table
ia t e e ff e le ccep
ro pr a c ces s ib
e ffec t iv e
rop ria t e
Making health services adolescent friendly 19
Workshop to develop national quality standards for
adolescent-friendly health services: Objectives, agenda and
facilitators guide
Objectives
To draft national quality standards and accompanying elements for providing health services to
adolescents.
Agenda
1 –– Opening remarks –– Identify the intended –– Define the health –– Define the health
–– Introductions beneficiaries outcomes to be services and health-
achieved related commodities
–– Statement of to be delivered
objectives of the
workshop
–– Explanation of working
methods to be used
2 –– Identify the health –– Identify the problem –– Formulate the quality standards
service and health- statements to be
related commodity addressed
delivery points
3 –– Choose the set of criteria to be achieved for each –– Identify the actions to be taken at national, district
quality standard to be achieved and local levels for the criteria to be achieved
4 –– Specify ways and means of verifying the –– Outline the preparatory –– Closing remarks
achievement of the criteria work that needs to be
done at the national
level before the quality
standards can be
applied
Deal with the first question in plenary. Ask the group to name the
population segment to be addressed and the rationale for this.
Split up the larger group into buzz groups of 3 people. Ask each group to fill in the table. When they
are done, ask them to share their outputs in plenary. Work with them to arrive at a short list of health
outcomes to be addressed, using the criteria listed in the table. Stress that the longer the list is, the
more challenging this will be for implementation.
(ii)Healthy nutrition:
(vi) Injuries:
To prevent violence
Depending on the size of the group, split them up into buzz groups of 3 people. Ask each group to
address some of the health outcomes. Ask them to share their outputs in plenary. Based on the
discussion revise and finalize the following table.
Depending on the size of the group, split them up into buzz groups of 3 people. Ask each group to
address 1–2 delivery points, using the matrix below. Ask them to share their conclusions in plenary.
Based on the discussion, finalize the matrix below.
Health service/ Groups of adolescents The health services that could be The health-related
health-related who are likely to come in provided: commodities that could
commodity delivery or to be reached - Information provision; be provided
points
- Counselling provision;
- Clinical service provision;
- Referral.
A.
B.
C.
D.
E.
Task:
a. the size of the gap between the actual and desired quality;
b. which of the gaps are most relevant to the groups of adolescents
we are concerned about?
Health workers:
–– are non-judgemental and considerate in their dealings
with adolescents
–– deliver the services in the ‘right’ way
Support staff:
–– are non-judgemental and considerate in their dealings
with adolescents
Adolescents
–– are aware of what services are being provided
–– are (and feel) able and willing to obtain the health
services they need.
Task:
Explain to the group that a standard is defined as a statement of required quality. In other words, it is a
precise description of what the situation will be like after the problem has been tackled and successful-
ly addressed.
Task:
ii. Process criteria: The way in which staff in the health service delivery point deal with
adolescent patients and with other community members.
Examples: Health workers manage adolescents as stated in the guidelines; support staff are welcoming
to adolescents.
iii. Output criteria: The desired effect on adolescent users of the health service delivery point
and on other community members.
Examples: Adolescents feel that health workers are concerned about their welfare; community
members are aware of what health services are being provided by the clinic.
•• Potential impact (i.e. the potential impact of the criteria in contributing to the standard).
•• Feasibility (i.e. the feasibility of putting the criteria in place, in the local context).
•• Complementarity (i.e. how the set of criteria complement each other).
Stress that the criteria that they choose need to be ambitious but not overambitious, in line with
national laws and policies, and sensitive to the social and cultural norms.
Standard statement # 1
Criteria
1.
2.
3.
4.
5.
8. Identify the actions to be taken at national, district and local levels for the
criteria to be achieved
Task:
Lead the group through an example. In doing so, explain to the group that they need to identify actions
that are required at the national, district and local levels. Stress that
they need to consider the complementary nature of these actions.
For example, a logo for the initiative will need to developed at the
national level; officials at the district level will need to provide
support to clinics in painting the logo on their notice boards; and
clinic managers will need to ensure that their notice boards are not
covered by unauthorised posters.
Please note that they only need to identify actions for the input criteria.
Standard statement # 1
Criteria
Input criteria Process criteria Local level District level National level
(that correspond to (i.e. health service
the input criteria) delivery point)
1.
2.
3.
4.
5.
Task:
Lead the group through an example. In doing so, stress to the working group that for each item in the
list they need to consider the effort and the expense of the proposed actions. Encourage them to use
existing monitoring mechanisms as far as possible to reduce the cost and to increase the likelihood that
monitoring will in fact be done.
Note that this will need to be done for input, process and output criteria.
Input criteria
1.
2.
3.
4.
5.
Process criteria:
1.
2.
Output criteria:
1.
2.
10. Outline the preparatory work that needs to be done at the national level before
the quality standards can be applied
What groundwork needs to be done in order for all these ideas can
be translated into reality?
Task:
Do this exercise in plenary. Lead the group through a quick brainstorming session on what preparatory
work needs to be done. Once you have a 6–8 points on a flip chart, ask them to review each item and to
identify why it is important to do, using the following matrix:
1.
2.
3.
4.
5.
6.
8.
9.
10.
Once the list has been completed, press the group to specify who will be responsible for each item and
to propose a date by when the task has to be carried out.
What preparatory work needs to be Who will be responsible for When will this task be carried out?
done? carrying out this task?
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
ANNEX 1
b le a c c ept t iv e a cces
a c c essi t e e ffe c app
e c ti v e r o p r ia it a b l e
eff a b le a pp t a b le e qu
le equi t e a ccep a cc ess
ta b cces s i b l ffec ti v e
accep c t iv e a r ia te e
p r ia t e effe l e a p p rop p t a b l e eq
appro l e e q u itab s ib le a cce
a c c e p tab
c t iv e a cces o p r ia te
cessi b l e a te e ff e le ap p r
r o p r i u it a b
i ta b l e app p t a b l e eq
e s s ib l e a
e equ s s i b l e acce e ct i v e acc
ti v e a cce p r i a t e eff a b l e a
ff e c p r o u it
ate e u i t a b l e ap e p t a b le eq
p t a b l e eq s s i b l e acc e c ti v e a cc
e acce i v e acc e ia te eff
te eff e c t ppr o p r
p p r o p r ia i t a b l e a cc e p ta ble
e a Generic characteristics
p t a b l e of equ
adolescent-friendly health services
c c e s s i b le a
cce
aWHO-defined dimensions of quality tive a p r iat
s s i b l e
within
e ff e c p p r o
acce p r o p r iate u i t a b le a
u i t a l
Dimensions
b e ap of quality health c e pservices
t a b l e toeqadolescents
c ce s s ible
ble e q s ible a c e c t ive a
a c c e s
ve not just some groups of adolescents,
Equitable
r e e ff
t the health services that are itable
itoaobtain
e ff e t i
Allcadolescents,
a p p r oarep
e q u
riate l e le
able
e q uita b c c ept a b
p
available.
t a b l e s s ib l e a e c ti v e a
c e c c e ff
ble ac Accessible e ff e c t i ve a r o p ri a te e
p r o p r
Adolescentsiaareteable to obtain the health servicesitthata b le app
are available.
cc e p tab
ble a p b le e q u s s ible a
Acceptable
ce p t a
aarecwilling to obtain the health services ive a c c e ri
c e s s i b l e t e e ff e c tavailable. a p p r o p
ve ac pria ble
Adolescents that are
a p p r o e q u it a
e q u i t a
Appropriateble c c e p t a ble a cc e ssib
tabl e s s ible a e ff e ctiv e
The right health services
a c c e
(i.e. the ones they need) are provided to them.
a t e
t e e ff e ctive a p p ro pri
l e e q u i tab
opria The right healthlservices
Effective
e qareu i ta bin ltheeright way, and make a positiveacontribution
cc e p t b health.
atheir
ab e sible
provided to
a c c e p t a c c e s e e ff e c tiv
ssible e e ff e c t ive p p r o p r iat
p p r o p r iat u i t a b le a a cc e pta
itabl e a t able e q e ssib le
a c c e p v e a c c
c c e s sible t e e ff e cti
ctive a p r opri a
a bl e a p
e q u i t
eptable tive
t e e ff e c
propria 30 Making health services adolescent friendly
itable a ta b l e e s s ib l e a
l e acc e p iv e ac ce
a cc e s si b te e ff e c t a p p rop
ffectiv e p ro pri a u it ab l e
a ble a p t abl e e q le
e q u it a cc e p c ce s si b
ptable a c c e s s ible c ti ve a
EQUITABLE: All adolescents, not just some groups of adolescents, are able to obtain the health services that are
e ff e
ive ate
available
te e ff ec t p p r o p r i l e e q u
propr ia Characteristics
t a ble a c cept a b
e q u i ib l e a
c c e p ble i v e c ess
Policies and procedures are in place that do not restrict the provision of health services.
t a a c r i a te eff
sible a a t e e ffect l e a p p rop
Health care providers treat all adolescent clients with equal care and respect, regardless of status.
i
p p ropr e q u ita b a cce
b le a t a b l e s ib l e
quita cep cces
Support staff treat all adolescent clients with equal care and respect, regardless of status.
i b l e a c ct i v e a
iv a c c ess te e ffe
ACCESSIBLE: Adolescents are able to obtain the health services that are available
e r ia b l e app
effe c t a pp r o p e qu it a
e
Characteristics
ta b le ta b l
ta b le equi l e a ccep a c c ess
Policies and procedures are in place that ensure that health services are either free or affordable to adolescents.
s ib ti v e
accep c ti v e a cces ri a t e e ffec
ffe rop qu
Point of service delivery has convenient working hours.
r i a t e e le a p p ta b l e e
approp u itab a ccep
Adolescents are well informed about the range of reproductive health services available and how to obtain them.
ab l e e q cess ib l e
b l e a c ce p t
ff e t i ve a c
r o r ia te e
Community members understand the benefits that adolescents will gain by obtaining the health services they need,
c p
cessi te e app
and support their provision.
r o p r ia i ta b l e
a b le a pp a b le e qu s ib l e a cc
Some health services and health-related commodities are provided to adolescents in the community by selected
t
equi t a ccep
community members, outreach workers and adolescents themselves .
e v e a cce s
cces s ib l e eff e c ti ap
e c t i e a ro p i a t
ACCEPTABLE: Adolescents are willing to obtain the health services that are available
v r i ta b l e
te e ff Characteristics
b l e ap p b l e eq u
equ i ta acc e p ta a cce
p t a b le ib le
Policies and procedures are in place that guarantee client confidentiality.
s s e c ti v e
acce e c ti v e acce p r ia t e eff
eff pro
Point of service delivery ensures privacy.
r o p r ia t e a b le a p e p t a b le
e ap p le equ i t
Health care providers are non-judgmental, considerate, and easy to relate to.
i b l e a cc
ccep ta b e a c c e s s ate
s i b le a ct iv p r i
Point of service delivery ensures consultations occur in a short waiting time, with or without an appointment, and
e ff e p r o
acces ate ap
(where necessary) swift referral.
p r o p r i u i ta b l e
u i t l e ap c e p t a le eq
Point of service delivery has an appealing and clean environment.
a b b a cc e s s ible
ble eq ib le a c e c tive
cc e s e e ff
Point of service delivery provides information and education through a variety of channels.
s
e ff e ct i ve a a p p r o priat e
Adolescents are actively involved in designing, assessing and providing health services.
q u it a ble
iate q u i t a b le cc e p t a ble
c e p t a b le e cc e s s i le a
APPROPRIATE: he right health services (i.e. the ones they need) are provided to them
b e ff e c tive
ble a c Characteristics
e ctive a p ria te
te e ff a p p r o
a p p r o pria q u i ta b le a cc e p t ab
The required package of health care is provided to fulfil the needs of all adolescents either at the point of service
ble e sible
delivery or through referral linkages.
ble cc e p t a a c c es
a ive
EFFECTIVE: The right health services are provided in the right way, and make a positive contribution to their health
c e s s ib l e e e ff e c t
ve ac p riat
Characteristics
p p r o
q t a b le a
Health care providers have the required competencies to work with adolescents and to provide them with the required
u i
able e
health services.
Health care providers use evidenced-based protocols and guidelines to provide health services.
Health care providers are able to dedicate sufficient time to deal effectively with their adolescent clients.
The point of service delivery has the required equipment, supplies, and basic services necessary to deliver the required
health services.
2. Health care providers treat all their adolescent patients with equal care and
respect, regardless of status
What does this mean?
Health care providers administer the same level of care and consideration to all adolescents
regardless of age, sex, social status, cultural background, ethnic origin, disability or any other
reason.
Why is this important?
Being treated disrespectfully is a strong disincentive for adolescents to seek help. Being
treated equally will have a positive effect on adolescents, encouraging them to attend further
appointments and recommend the service to their peers.
3. Support staff treat all their adolescent patients with equal care and respect,
regardless of status
What does this mean?
Support staff administer the same level of care and consideration to all adolescents regardless of
age, sex, social status, cultural background, ethnic origin, disability or any other reason.
6. Adolescents are well informed about the range of health services available and
how to obtain them
What does this mean?
Adolescents are aware of what health services are being provided, where they are provided, and
how to obtain them.
Why is this important?
Informing adolescents about the range of health services available to them can help to encourage
usage of services.
11. Health care providers are non-judgemental, considerate and easy to relate to
What does this mean?
Health care providers do not criticize their adolescent patients even if they do not approve of
their words and actions. They are considerate to their patients and reach out to them in a friendly
manner.
Why is this important?
Health care providers do not need to abandon their own beliefs and values, but they must ensure
that these beliefs and values do not negatively influence the way in which they deal with their
adolescent patients. In addition, the ability to respond to adolescents with empathy and sensitivity
will contribute to the development of good communication and mutual respect.
Judgemental, inconsiderate and unfriendly behaviour will hinder communication. It is also likely to
turn adolescents away.
12. The point of health service delivery ensures consultations occur in a short waiting
time, with or without an appointment and (where necessary) swift referral
What does this mean?
Adolescents are able to consult with health care providers at short notice, whether they have
a formal appointment or not. If their medical condition is such that they need to be referred
elsewhere, the referral appointment should also take place within a short timeframe.
Why is this important?
Adolescents are more likely than adults to be deterred by long waiting times or by rigid
appointment-making policies. Having to wait for an appointment in advance could lead to a missed
appointment or seeking help from other possibly less effective or even harmful service providers
offering shorter waiting times.
13. The point of health service delivery has an appealing and clean environment
What does this mean?
A point of health service delivery that is welcoming, attractive and clean.
Why is this important?
Adolescents – like adults – may not want to go to a poorly maintained and dirty place.
15. Adolescents are actively involved in the assessment and provision of health
services
What does this mean?
Adolescents are given the opportunity to share their experiences in obtaining health services, and
to express their needs and preferences. They are involved in certain appropriate aspects of health
service provision.
Why is this important?
Involving adolescents in assessing service provision, and in actually participating in service
provision, can help make health services more sensitive and responsive to their needs.
18. Health care providers used evidence-based protocols and guidelines to provide
health services
What does this mean?
Health service provision is based on protocols and guidelines that are technically sound and
of proven usefulness. Ideally they should be adapted to the requirements of the national/sub-
national situation and approved by the relevant authorities.
Why is this important?
In using such tools, health care providers are assured of the best course of action in responding to
their adolescent patients.
19. Health care providers are able to devote adequate time to their patients
What does this mean?
Health care providers are able to dedicate sufficient time to deal effectively with their adolescent
patients.
Why is this important?
This is important for two reasons: firstly, adolescents may find it difficult to communicate, be shy
or frightened and may need extra time and encouragement to talk about their real concerns; and
secondly, because health care providers need adequate time to deal with their patients in an
effective manner.
20. Points of health service delivery have the necessary equipment, supplies and
basic services to deliver the required health services
What does this mean?
Each point of health service delivery has the necessary equipment, supplies (including medicines)
and basic services (e.g. water and sanitation) needed to deliver essential health services.
Why is this important?
Without the basic materials, health services cannot be provided effectively. The provision of health
services in such a context may even endanger the health of adolescents.
ANNEX 2
p tab l e e ffe ct iv eq
b le a c c e ro p r ia t e ep t a b l e
essi t a b le a pp s s ib l e acc
l e equi i v e acc e le app
t a b effe c t it a b
accep o p r ia t e ta b l e e qu
a b le a ppr ib l e a ccep o p r ia t e e
equit ti v e a ccess a b le a p pr
ri a t e effec b l e e q uit v e a cces
app ro p acce p ta e eff e c ti
ss i b l e p r i a t
e c t iv e acce b l e a p pro s s ib le ac
te eff b le e q uita e ct iv e acce
e a cc e pta p r ia te eff t a b le e
s ib l p r o c ce p
acces u i ta b le ap c e s s ib l e a
t a b l e eq e c ti v e ac ita b le a
e acce p r iate e ff b le eq u
ap p r o p acce p ta a t
it a b l e s s ib l e p r o p r i
le equ A menu ofecomplementary e c ti v e acceactions at national, i t a b le
district a
andp
p r ia te ff
t a b l e eqofuadolescent- ctive a
o p effe
le appr friendly health acce
local levels to ensure that characteristics e
s s ib le p r ia t
ct i v e a cce services are achieved b l e a p pro s ible
e e ff e q u i ta a cc e s
riat ce p ta b le e e e ff e ct ive
e s s i b le ac p p r o p riat
e ac c i ta b le a
b le e q u
c e p t a
ble ac
quita
services
e a c c e s sib l e a p p rop
t e e ff e ctiv
Actions to make HSDPs more equitable
l e e q u itab a cc es s ib
propri a c c e p tab ff e c tive
Policies and
s ibl e a
−− National officials to review
ria t e e
−− District officials to −− Manager to work with
t iv e cc e s
procedures are
a
laws and policies; and
le a p p ro p communicate laws
ib l e a ccep
service providers and
effec ab ess
in place that do modify existing ones where and policies to HSDP support staff to ensure
not restrict the
e e q u it
they restrict the provision of
ti v e a
managers.cc that the procedures are
a cc e p tabl
provision of health health services.
r ia te e ffec −− District officials to
b le equapplied.
ssib le services
pp ro p
−− National officials to
a cce p t a
support the formulation
a
ui t a b le communicate laws and
cce s si b le
of procedures for HSDP
pp
a b le e q e c ti v e a
policies to relevant officials at managers, in line with
ta b l e a
ccept eff q ui
district level. these laws and policies.
p r ia te a b le e
b l e a p
Health care
pro −− National officials to
e ff ec ti v e of avoiding discrimination to
e q u it a b
HSDP managers of the support staff to identify
c ce
r ia e
clients with equal
t
district officials.
t a b le
importance of preventing
approp cep
care and respect, discrimination. could be discriminated
regardless of
i b l a c
−− National officials to
e ri a te e ff against.
ess op
ensure that preventing −− District officials to work
t
status
i v e a cc a
discrimination is addressed
le p p r with HSDP managers
ib le ac
−− Manager to communicate
te eff e c uit a b
in training materials and in
eq a cce ss
to identify groups of the importance of avoiding
b l e e c t iv e
epta
handbooks. . adolescents who could be discrimination.
Policies and −− National officials to review −− District officials to −− Manager to work with
procedures are laws and policies; and modify communicate laws service providers and
in place that existing ones to ensure that and policies to HSDP support staff to ensure
ensure that health health services are free or managers. that the procedures are
services are either affordable to adolescents. −− District officials to applied.
free or affordable −− National officials to support the formulation
to adolescents communicate laws and of procedures for HSDP
policies to relevant officials at managers, in line with
district level. these laws and policies.
The HSDP has −− National officials to −− District officials to −− Manager to work with
convenient communicate the importance communicate the service providers and
working hours of local actions (i.e. importance of local support staff to determine
modifying working hours to actions (i.e. modifying whether the working
meet the needs of specific working hours to meet the hours could be modified
groups of adolescents) to needs of specific groups to take into account the
address this issue. of adolescents) to address needs of specific groups of
this issue, to HSDP adolescents.
managers.
Adolescents are −− National officials to −− District officials to −− Manager to carry out the
well informed communicate the need for communicate what health following actions:
about the range district officials and HSDP services are provided, (i) Put up a notice board
of reproductive managers to take actions where and when they are indicating what health
health services to help inform adolescents provided, and how much services are provided, when
available and how about the range of health they cost: they are provided, and how
to obtain them services that are be provided (i) in the mass media (where much they cost;
at HSDP. possible); (ii) Prepare a leaflet
(ii) in meetings with indicating what health
representatives of other services are provided, when
sectors (e.g. education) and they are provided, and how
civil society institutions (e.g. much they cost.
NGOs);
−− District officials to
communicate the
importance of local
action (i.e. putting up a
notice board) to address
this issue, to HSDP
managers.
Some health −− National officials to −− District officials to −− Manager to set aside some
services and communicate the importance communicate the time from selected staff
health-related of reaching out to selected importance of outreach members for outreach
commodities groups of adolescents in the activities and/or work.
are provided to community with selected working with NGOs in −− Manager and staff to
adolescents in health services (e.g. some the community that identify NGOs which
the community aspects of antenatal care) could engage selected could engage selected
by selected and commodities (e.g. iron adults or adolescents to adults and adolescents
community and folic acid tablets). provide health services to provide health services
members, and commodities to and commodities to
outreach workers adolescents in the adolescents in the
and adolescents community. community.
themselves −− District officials to work
with HSDP managers to
identify which groups
of adolescents to reach,
where to reach them, and
what health services and
commodities to reach
them with.
Policies and −− National officials to: −− District officials to ensure −− Managers to work
procedures are (i) clearly outline the events/ that HSDP managers are with service providers
in place that conditions service providers aware of the national and support staff to
guarantee client are required to report to the policy on confidentiality ensure that they are all
confidentiality relevant authorities (such as and the procedures to aware of the policies
sexual assault, road traffic translate these policies and recommended
accidents and gunshot into action. procedures.
wounds); −− District officials to −− Managers to ensure
(ii) communicate that in all communicate the that the recommended
other circumstances, HSDP importance of applying procedures are translated
managers, service providers these procedures. into concrete actions
and support staff are required with clear designation of
to maintain the confidentiality responsibilities within the
of their adolescent clients. HSDP.
Point of service −− National officials to −− District officials to work −− Managers to work with
delivery ensures communicate the importance with HSDP managers service providers and
consultations of actions to keep waiting in the district, to set support staff to determine
occur in a short times as short as possible up/strengthen referral what could be done to
waiting time, with and to ensure that referral mechanisms. keep waiting times as
or without an mechanisms are in place and short as possible.
appointment, and function well. −− Managers to ensure that
(where necessary) service providers and
swift referral support staff are aware
of, and apply, referral
mechanisms to providers
of health and social
services.
Point of service −− National officials to develop −− District officials to −− Managers to ensure that
delivery provides informational/educational arrange for the delivery of educational/informational
information materials and send them to informational/educational materials are displayed/
and education the districts. materials obtained from distributed.
through a variety −− National officials to liaise national officials or NGOs, −− Even if no materials are
of channels with NGOs working on to HSDPs. obtained from district
adolescent health issues −− District officials to liaise officials, managers to work
in the country to explore with NGOs working in their with service providers
whether the materials they district to explore whether to ensure that clipping
produce could be displayed/ the materials they produce from newspapers and
disseminated to the districts. could be displayed and magazines, and hand-
disseminated by HDSPs. made materials are
displayed.
The required −− National officials to list the −− District officials to work −− Managers to ensure that
package of health health services that are to be with HSDP managers HSDPs provide all the
care is provided provided at each level (e.g. ensure that HSDPs provide health services they are
to fulfil the needs primary level, secondary level all the health services that required to, and facilitate
of all adolescents and referral level). they are required to, and to access to those they do
either at the point facilitate access to those not provide with referral
of service delivery that they do not provide linkages to other HSDPs.
or through referral with referral linkages.
linkages
Health care −− National officials need to −− District officials to work −− Managers to ensure that:
providers have develop teaching/learning with HSDP managers (i) service providers are
the required materials to build the to ensure that service trained/oriented;
competencies competencies of service providers in the district
to work with providers to deliver the undergo training/ (ii) services providers have
adolescents and required based on a needs orientation. desk reference tools;
to provide them assessment. −− District officials to supply (iii) self, peer and supervisor
with the required −− National officials to develop/ HSDP managers with desk assessments are carried out
health services adapt a handy desk reference reference tools to service in the context of supportive
tool for service providers. providers. supervision.
The HSDP has −− National officials to prepare −− District officials to give −− Managers to have at-hand
the required lists of equipment and HSDP managers the list of lists of equipment and
equipment, supplies that HSDPs need equipment and supplies supplies that are needed
supplies, and to have to provide the that HSDPs need to have to provide the stipulated
basic services stipulated package of health to provide the stipulated package of health
necessary to services. package of health services.
deliver the −− National officials to send services. −− Managers to work with
required health these lists to district officials. −− District officials to work service providers and
services with HSDP managers support staff to put in
−− National officials to work
with district officials to to determine what place a system to review if
determine what equipment equipment and what the pieces of equipment
and what stocks of supplies quantities of supplies are are in good order and that
are required to provide the required on a monthly/ the stocks of supplies are
stipulated package of health quarterly basis. adequate.
services; and to ensure that −− District officials to work −− Managers to organize
they are sent out on in good with national officials to regular servicing/repairs
time. obtain the equipment and of equipment and to
supplies required by the ensure that adequate
district in good time. stocks of supplies are
maintained.
e a cc e s s ti v e a c c i a t e e ff
ectiv ri a t e ffec
Department of Maternal, Child and Adolescent Health (MCA)
e e a p p ropr
rop abl
World Health Organization 20 Avenue Appia, 1211 Geneva 27, Switzerland
e a p p e q u i t le e q u i
quitab l abl e
Tel +41 22 791-2668 Fax +4122 791-4853
e p t cc e pta b
Email: mca@who.int
ible a c c ssib l e a
e a cc e s s ti v e a c ce
Website: http://www.who.int/maternal_child_adolescent/
i a t e e ff ect
ffecti v te effe c p p rop r
pro p ri a itab l e a e qu
a b le a p b le e q u p t a b le