Department of Health

Republic of the Philippines

National Standards and Implementation Guide

for the Provision of
Adolescent-Friendly Health Services

September 9, 2010

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 TABLE OF CONTENTS

I. Introduction
1.1. Background Information
1.2. Rationale
1.3. Intended Users of the Manual
1.4. Health Outcomes to be Achieved
1.5. Service Package
1.6. Health Service Delivery Points
1.7. Service Providers

II. Standards for Adolescent-Friendly Health Services

2.1. Standard 1
2.2. Standard 2
2.3. Standard 3
2.4. Standard 4

III. Criteria of the Quality Standards of Adolescent-Friendly Health Services

and Implementation Guide

IV. Implementing Mechanisms at Various Levels

V. Monitoring and Evaluation of the AFHS Quality Standards

References

Annexure

I. Introduction

1.1. Background Information

Adolescents (10- 19 years age group) constitute 22.3% of the population and young people
10 – 24 years of age account for 30.3% of the country’s total population (NDHS, 2008). The
youth (15 – 24 years), on the other hand, comprise 20% of the population with an annual
growth rate of 2.1 (YAFS 3, 2002). They face many health and development problems
(substance use and alcohol consumption, STI/HIV/AIDS, unwanted pregnancies, nutritional
deficiencies, etc) which today affect their lives adversely.

A little less than half (47%) of young people have tried smoking with males being more
prone to cigarette smoking than females. However, the prevalence of smoking among young
females almost doubled from 17% to 30% in 1994 and 2002 respectively. The proportion of
young people who tried drinking alcohol is about 93% in males. Like smoking, the proportion
showed an increasing trend among the female populace (54% in 1994 and 70% in 2002).
Although the proportion of young people exposed to drugs is significantly lower compared to

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smoking and alcohol, the proportion doubled from 6% in 1994 to 11% in 2002. Those who
smoke, drink and use drugs are more likely to have sex.

The YAFS 3 (2002) data showed that one in three of young people think that it is alright for
young men to engage in premarital sex while the approval rate for young women is lower at
22%. A comparison of the results of YAFS 2 and 3 showed an increasing tolerance for
women engaging in pre martial sex – 13% and 22% in 1994 and 2002 respectively. With
regards the age of first sexual intercourse, the 2008 NDHS showed that among women 15 –
49 years old, 3% had their first sexual intercourse by age 15; 37% by age 19; 57%by age 22
and 71% by age 25. In addition, 10% of 15-19 years old have begun childbearing (NDHS,
2008). Around 23% of Filipino youth had premarital sex (2002). This is higher than the 18%
in 1994. One out of three youths admitted to having more than one sexual partner beside their
first sexual partner.

STI and HIV are issues of concern in the country. The YAFS 3 (2002) survey showed that
although awareness about STIs is increasing, misconceptions about AIDS appear to have the
same trend. The survey also showed that Filipino males and females are at-risk of STIs,
HIV/AIDS. 62 % of sexually transmitted infections affect the adolescents (YAFS 3, 2002)
while 29 % of HIV positive Filipino cases are young people. Awareness of AIDS for both
sexes was near universal (85%) but misconceptions on its curability have deteriorated. The
proportion of those who think AIDS is curable more than doubled (from 12% in 1994 to 28%
in 2002). Many adolescents also resort to services of unqualified traditional healers, obtain
antibiotics from pharmacies or drug hawkers or resort to advices from friends (e.g. drinking
detergent dissolved in water) without proper diagnosis to address problems of STIs. The
newly reported HIV cases among 15-24 years old increased sharply from 41 to 218 in 2007 to
2009 (National AIDS Registry, NEC, DOH).

1.2. Rationale

In line with the above concerns of the adolescents, several initiatives were undertaken. In line
with the Adolescent and Youth Health Policy (Department of Health, Administrative Order
No. 34-A, s. 2000), A Guidebook on Adolescent and Youth Health and Development
Programme was developed by a multi-sectoral body headed by the Department of Health and
supported by the United Nations Population Fund (UNFPA). However, during its
implementation (from 2002 to the present), a huge gap developed between the guidelines and
their actual use. Adolescents and the youth have limited access to RH services that meet the
standards of quality care, user friendly and culture sensitive. Despite the evidence presented
in policy documents, most services continue to target adults or children. Thus, these fail to
meet the special needs of the youth especially in terms of confidentiality, privacy,
accessibility and cost. There is only a handful of health care providers trained to cater to the
special needs of the youth. There are also missed opportunities for prevention of health
problems because young people are unwilling to utilize available health services. Often, due
to insufficient knowledge transfer, new or updated practice guides were not systematically
introduced and promoted to improve health service delivery or to advocate for the application
of models of best practices. In addition, since most programs were initiated by non-
governmental agencies and the private sector, they were limited in coverage and
sustainability. Correspondingly, in reference to the Adolescent and Youth Health Program
Implementation Review held in January 2009, the recommendation was to establish
standards on adolescent-friendly health services.

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1.3. Intended Users of the Manual

This document outlines the four national standards for provision of Adolescent-Friendly
Health services and the steps required to implement the standards. It is expected that this
document will guide program implementers at various levels in providing adolescent-friendly
health services. The document is also expected to be used by planners and policy makers.
1.4. Health Outcomes to be Achieved

1. Healthy Development
a. Promote healthy development
b. Reduce the health and social consequences when developmental problems
occur.
2. Healthy Nutrition
a. Improve healthy nutrition
b. Reduce under/over nutrition
c. Reduce the health and social consequences of over/under nutrition.
3. Sexual and Reproductive Health
a. Reduce too early, unwanted pregnancy
b. Reduce morality and morbidity during pregnancy, child birth,
c. Reduce Sexually Transmitted Infections/Human Immunodeficiency Virus
(STI/HIV)
d. Reduce health and social consequences of STI / HIV infection when they
occur
4. Substance use
a. Reduce substance use
b. Reduce the health and social consequences of substance use
5. Injuries
a. Reduce injuries
b. Reduce health consequences (mortality and morbidity) and psychosocial
consequences when injuries occur.
6. Violence (All Forms)
a. Reduce all forms of violence
b. Reduce health consequences (mortality and morbidity) and psychosocial
consequences when violence occurs.
7. Mental Health
a. Improve mental health and well being
b. Reduce mental health problems
c. Reduce the health and social consequences when mental health problems
occur.

1.5. Service Package

Based on the national objectives and strategic thrusts of the Department of Health,
Philippines, the following Adolescent Core Package has been proposed for implementation:

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 CORE PACKAGE OF SERVICES

Key Services Objective of the Package

A. Basic Essential Health Package
B. Adolescent Pregnancy Package
C. Sexually Transmitted
Infections/HIV Packages
Source: Manual of Standards for Adolescent-Friendly Health Services, DOH, 2008
1. To provide basic health care and
management to all adolescents
2. To identify the most common health
concerns and issues among adolescents
3. To screen all adolescents for risk-taking
behaviors
4. To render preventive health management and
counseling to all adolescents, including on
substance use, sexuality, violence and injury
prevention, and for improving mental health
1. To reduce rates of adolescent pregnancy
through comprehensive health package
2. To reduce mortality and morbidity brought
about by adolescent pregnancy and
puerperium
1. To reduce morbidity and mortality brought
about by STIs and HIV
2. To prevent STIs/HIV and its complications

The core package will be made available from Rural Health Unit (RHU. However, the
district, provincial and tertiary level hospitals will provide services in other areas including
substance use, sexual abuse and sexual violence and mental health. They will also cater to
clients and patients referred from RHU and BHS.

1.6. Health Service Delivery Points

The services will be given at the following health service delivery points: Retained hospitals /
provincial / district hospitals, Rural Health Unit. Innovative mechanism for utilization of
other facilities, including but not limited to social hygiene clinic, schools, “one-stop-shops”,
workplace, shopping malls, sports centers, youth hang-outs, will be utilized by the
government in coordination with non-government and other private institutions.

1.7. Service Providers

The following health providers, both at the health and non-health sectors at the above-
mentioned health service delivery points which include doctors, nurses, and midwives (DOH
AO 34-A) will provide the services. Community-based volunteers, peer group leaders,
psychologists and counselors and other staff (e.g. pharmacists and others) will also provide
appropriate services depending upon the circumstances.

II. Standards for Adolescent-Friendly Health Services (AFHS)

The right to health, according to the UN Committee on Economic, Social and Cultural
Rights, consists of six normative elements namely health availability, health physical
accessibility, health economic accessibility, health information accessibility, health
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acceptability and health quality (see Annex 3: Guiding Principles). WHO’s criteria for
adolescent-friendly health services include services being equitable, affordable, acceptable,
adequate, comprehensive, effective, and efficient (See Appendix 4: Standard and Criteria
Definitions).

Cognizant of the right of the adolescent to the highest attainable standard of health through
improved access and utilization of health services and the WHO criteria for provision of
Adolescent Friendly Health services, the Philippines adopts four national standards for the
provision of Adolescent-Friendly Health Services:

Philippines National Standards for Adolescent-Friendly Health Services:

A standard is a statement of desired quality. The four quality standards for provision of
Adolescent-Friendly Health Services (AFHS) were developed to ensure that adolescents will
be able to enjoy a variety of facilities, goods, services and conditions necessary to realize the
highest attainable standard of health. These standards are in line with the WHO's criteria for
Adolescent-Friendly Health Services and with the policy documents that exist in the country.
These standards will also apply to health services that address the needs of youth.

Standard 1 "Adolescents in the catchment area of the facility are aware about the health
services it provides and find the health facility easy to reach and obtain services from it".

Standard 2 “The services provided by health facilities to adolescents are in line with the
accepted package of health services and are provided on site or through referral linkages by
well-trained staff effectively”.

Standard 3 “The health services are provided in ways that respect the rights of adolescents
and their privacy and confidentiality. Adolescents find surroundings and procedures of the
health facility appealing and acceptable”.

Standard 4. “An enabling environment exists in the community for adolescents to seek and
utilize the health services that they need and for the health care providers to provide the
needed services”.

The standards criteria were developed keeping in view the necessary resources, operational
activities and the expected outcomes. The National standards will ensure that services being
provided to the adolescents are uniform across all the service delivery points and are relevant
to the present day needs of the adolescents. It is expected that adhering to the laid down
standards would improve the utilization of such services.

III. Criteria of the Quality Standards of Adolescent-Friendly Health

Services (AFHS) and Implementation Guide

Standard 1: "Adolescents in the catchment area of the facility are aware about the health
services it provides and find the health facility easy to reach and obtain services from it."

Rationale: Adolescents are generally not aware about the availability of health services that
cater to their needs. They either do not know about the location of the facility that provides
health services in an adolescent friendly manner or the type of services that are available
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from the facility. Thus despite the availability of these services and competent personnel to
provide such services, there is a low utilization rate of such services. Some of the reasons for
low utilization could be the lack of informational activities to promote the adolescent services
provided by these facilities; accessibility of the facility in terms of distance, cost and time; or
the affordability of services. Actions are to be taken to ensure that adolescents are well-
informed about the availability of health services.

Input Criteria Process Criteria Output Criteria

I1.1. - There is a well-defined
plan to inform adolescents in
the community as to the
availability of services from
the facility
I1.2. - Health facility has a
signboard which indicates
-the type of health services
that are provided
-when they are provided
-that adolescents are welcome
I1.3. -Flexible time schedule
for adolescent clients, if
possible, is in place,
I1.4. -Policies and procedures
to provide health services to
adolescents free of charge or
at affordable prices are in
place.
I1.5. -A plan to provide
outreach health services to
adolescents, particularly those
belonging to special groups in
the catchment area of the
health facility, is in place
P1.1.-Activities to inform Adolescents are aware about
adolescents about the the type of services from the
availability of services from health facility, their working
the facility are carried out as days and hours and know that
per the existing plan. they are welcome.
P1.3.- Health services are
provided as per the flexible
time schedule
P1.4. -Service providers
provide adolescent with
services free of charge or at
affordable prices in line with
the policies and procedures.
P1.5. -Outreach services are
being delivered to special
groups of adolescents as per
the plan.

Implementation Guide:

1.1. Elements of a plan to inform adolescents. The IEC plan should contain the activities
for information dissemination, place and time frame that they will be conducted, persons
responsible, the resources needed, as well as the evaluation indicators and methods. In
terms of activities, the facility may conduct periodic community sessions, information
dissemination activities in schools especially during home room period, produce and
post billboards in community areas being frequented by community residents especially
the adolescents, and seminars in schools during special occasions. Posters containing the
services in the facility may also be posted in strategic locations in the community. The
information material, such as flyers, which can be distributed to adolescents during
community festivities, after school hours, and in malls where adolescents usually go to,
should contain the services available, time and place where these are available as well as
the contact persons. Linkages with ongoing programmes of various departments can be
established and, if available, "peer group workers" and volunteers of various health
programmes should be informed about the services.

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1.2. Appropriate signboard. The facility is to have an appropriate signage in the health
facility reflecting the services being provided and when they are provided. Tarpaulin,
banners or posters stating that adolescents are welcome in the facility are posted/placed
in an area in the facility that can easily be read by the adolescent clients.

1.3. Use of a flexible time schedule. It is advisable to have facility timings that suit the
needs of the adolescents. In government-owned and operated facilities, services are
offered on the usual schedule which is 8:00 AM to 5:00 PM. However, some private and
non-government facilities should have flexible time schedule so that they can cater to the
needs of adolescents who may be engaged in other activities during the 8:00 AM to 5:00
PM schedule. The services could be offered from 7:00 AM to 10:00 PM, on a 24-hour
basis, Saturdays and Sundays in these facilities.

1.4. Provision of 'free' health services. Government facilities offer health services to
adolescents without any charges. As much as possible, services for adolescents should be
given for free from other facilities, too. However, considering the expenses incurred for
the maintenance and improvement of the facility vis-a-vis the budget given for the
operation of these facilities, LGUs may resort to cost-sharing schemes. The amount to be
paid should be by consensus and reached through consultations with different
stakeholders including the clients, services providers, representatives from agencies
concerned with adolescent care, community and even the government through the
barangays. The cost of services and/or commodities will be posted in strategic places to
inform the clients, general population and all stakeholders.

Private and non-government organizations may also institute schemes to sustain the
operations of their facilities. Some of their services can be availed by adolescent clients
at affordable prices or in a subsidized form.

1.5. Elements of a plan to provide outreach services to adolescents. Outreach services are
needed to provide services to follow-up outcome of cases and / or defaulters, adolescents
as the "first contact" services in hard to reach areas and / or clients with special needs,
cater to special circumstances (i.e. victim of abuse/violence, etc). These outreach
activities should be planned. The plan should include the date and time, place, the
personnel to conduct outreach, the services to be given, resources needed, other agencies
involved (if any) and the assistance that these agencies/organizations will provide. The
outreach provider must have the necessary supplies.

Outreach activities may include periodic health check-ups, mobile clinics, community
health camps, education sessions utilizing the available IEC material, home visitation, and
use of traditional media such as puppet shows and psychodrama. The provider should
develop and maintain linkages with peer educators, volunteers, school teachers, school
physicians and school nurses (where available), personnel from youth centres and other
relevant agencies and develop joint activities to provide services. The provider should
link up with schools to organize "question box" activities in the schools. The general
questions could be taken up during the school health assembly.

Standard 2: “The services provided by health facilities to adolescents are in line with the
accepted package of health services and are provided on site or through referral linkages by
well-trained staff effectively”.

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Rationale: Some of the health needs of adolescents may appear to be similar to those of
adults (Example: ANC services, services for STIs, etc) yet the unique characteristics of this
age group in terms of their physical, physiological, psycho-emotional, and even socio-cultural
aspects necessitates that the needed services be provided in line with the required package
effectively. In many cases the services that meet the adolescents' needs are either not fully
provided from the health facilities or the services that are provided are not effective. This
standard ensures that protocols, guidelines as well as services as per the accepted package
that cater to the special needs of individuals in this age group are available from the
designated health facilities.

This standard also ensures that the staff of adolescent-friendly health facilities possesses the
necessary knowledge, attitude, skills and behavior to deal with their target clients

Input Criteria Process Criteria Output Criteria

I2.1. -An agreed upon
'package' of services to be
provided to adolescents is in
place.
I2.2. -An agreed upon list of
essential commodities and
supplies is in place
P2.1. - Services provided /
delivered on site or through
referrals are based on the
agreed upon adolescent health
package
P2.2. -The essential
commodities and supplies as
per the agreed upon list are
available and are provided to
adolescents.
The services provided by the
health facilities are effective
and in line with the accepted
package of services, and are
provided on site or through
referral linkages by well
trained staff. The adolescents
find the services to be in line
with the defined package of
services.

I2.3. -A focal person has been P2.3. -The focal person

designated for provision of
adolescent-friendly health
services.
I2.4. -Service Providers have
been trained / oriented for the
provision of AFHS and are
competent in managing
adolescent clients and
providing guidance to their
parents.
I2.5 -Protocols / guidelines to
provide services competently
in non judgmental, caring,
considerate, and gender and
culturally-sensitive attitude
and manner are in place.
I2.6. -Clinical management
guidelines for the provision of
the specified health services
are in place
I2.7. -A resource directory of
organizations and referral
networks providing health
services that are not provided
actually provides services to
adolescents either at the
facility or through referral and
coordinates other activities.
P2.4. -The facility staff utilizes
their competencies to provide
health services effectively and
competently.
P2.5. -The service providers
follow the protocols
/guidelines to provide services
competently and with a non-
judgmental, caring, considerate
and gender and culturally
sensitive attitude and manner
P2.6. -The service providers
follow the clinical guidelines
for provision of services.
P2.7.-The resource directory is
utilized to refer the needy
adolescents for the particular
services that are not available
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 at the facility is available. at the facility.

I2.8. -Appropriate forms for P2.8. -The appropriate forms

referral and feedback are are utilized for referral and
available feedback

Implementation Guide:

2.1. The package of health services to be provided. The list of essential health services
to be provided to the adolescents as packages include basic essential health package,
adolescent pregnancy package and STI/HIV package. The components of the package
may be modified in the future as evidence for specific components are updated
periodically by the Department of Health.

Package of Services Specific Services

Basic Essential Health
Package
General Health Assessment – History (HEADSS) and Physical
Examination, including blood pressure measurement, vision and
hearing screening
Dental Assessment
Psychosocial Risk Assessment and Management
Nutrition Assessment and Counseling
Micronutrient Supplementation- Iron and Folic Acid
Immunization – TT, MMR, Hepatitis B
Basic Diagnostic Tests (CBC, Urinalysis, Fecalysis, sputum
PPD)
Reproductive Health Assessment and Counseling
 Fertility awareness, menstrual health issues and counseling
 Pap smear and pelvic exam if sexually active
 Adolescent male reproductive health issues
 Gender issues
Voluntary Testing for STIs /HIV
Adolescent Pregnancy
Package
Prenatal visits
 History and Physical Examination
 Immunization – Tetanus toxoid
 Micronutrient supplementation with iron, folate
 Psychosocial risk assessment
 Laboratory – CBC, blood typing (if not available, refer),
pregnancy test, urinalysis
 Pregnancy counseling
 Nutrition counseling
 Birth plan including exclusive breastfeeding counseling
 Family planning counseling
Natal (Birthing Homes)
 Safe delivery by skilled health worker at a mother-and baby
friendly health facility

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  HBsAg test for pregnant mothers
 Essential Newborn Care Protocol
 Newborn package:, Vitamin K, Hepatitis B – birth dose,
BCG, eye prophylaxis, Newborn Screening
Postnatal Visits
 Micronutrient Iron supplementation
 Counseling services: Family planning, Nutrition counseling,
Exclusive Breastfeeding, Parenting
Sexually Transmitted
Infections/HIV Packages
History and Assessment Forms
Diagnostics: Grams Stain, RPR, C/S, Pap smear, HIV
Counseling
Psychosocial risk assessment
Management, Treatment and Counseling

2.2. Essential medicines, equipment and supplies. At the minimum, the following basic
medicines, equipment and supplies needed in the provision of services should be present:

Essential Resources
Basic Essential Health Package
Writing materials, Individual Treatment Record Forms (ITR),
Dental mirror, Dental record form, Dental Equipment
Psychosocial Risk Assessment Form
BP apparatus, Adult weighing scale, tape measure, height chart, orchidometer, dietary
prescription form, exchange list
Iron with folic acid tablets
Vaccines: Tetanus toxoid, MMR, Hepatitis B
Centrifuge, heparinized capilet, microscope, syringes and needles, cotton, alcohol, slides,
cover slip, vaginal speculum, cotton pledget
ITR, Reproductive Health Assessment Checklist, Flipchart on reproductive health
HIV testing kit, microscope, glass slides, reagents for Gram’s stain
Adolescent Pregnancy Package
ITR, FP flipchart, iron tablets, blood typing and Rh sera, pregnancy test, centrifuge,
microscope, TT vaccine, syringes, cotton balls, alcohol, FP commodities
HBsAg reagent, birth plan form, NBS kit, BCG, Hepatitis B vaccine, delivery table, sterile
scissors, gloves, cotton, alcohol, plastic clamp, equipment and supplies as per BEmONC
guidelines
Iron tablets and vitamin A capsules, FP flipchart, FP commodities, Breastfeeding chart, diet
plan
Sexually Transmitted Infections/HIV Packages
ITR
Reagents for Gram’s stain, RPR, Glass slides, microscope, cotton pledgets
Counseling Cards or Chart

2.3 Focal person in the health facility. The facility must have a designated focal person
who will render services to adolescent clients and coordinate within and outside the
facility. She / He should be oriented by attending orientation /training programs on

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 dealing with adolescent clients such as the Orientation Program on Adolescent Health and
Adolescent Job Aid (AJA). The focal person must provide the services to adolescents
either at the facility or through appropriate referral and coordinate with parents, opinion
makers and institutions – educational, NGOs, community-based organizations, media and
with referral institutions.

2.4 Capability building for AFHS service providers. It would be preferred that like the
focal person in the facility, other service providers who are likely to deal with adolescents
must have the competencies to deal with adolescents and their health needs effectively.
They should attend capability building programs so that they can deal effectively with
their adolescent clients. Programs include Orientation Program on Adolescent Health,
Orientation on Standards and Implementation Guide for AFHS, Adolescent Job Aid.

2.5 Dealing in a non-judgmental and caring manner with adolescents. The adolescent
client should be dealt with respect and shown all courtesies that are due to a human being.
Facility staff should be polite and considerate and avoid making any hurtful or damaging
remarks for what so ever reason. Service providers must cultivate a non-judgmental
attitude and not deprive adolescents from appropriate services on extraneous grounds
including those on gender, education, social class, marital status, religious and political
beliefs, and orientation. They should deal with adolescents sensitively and in a caring and
considerate and gender and culturally-sensitive manner. Clinic Rooms must have window
curtains and a bed-screen surrounding the examination tables. Nobody else should be
allowed to enter the room when the client is already there, in order to ensure privacy.
Confidentiality policy of the clinic should be displayed and clearly expressed to the client
and the individuals accompanying them in the first session itself.

2.6 Clinical management of adolescents. The Adolescent Job Aid (AJA) that was
developed by a multi-sectoral group spearheaded by the DOH will be used for the
common conditions of adolescents. The service provider should also refer to other
relevant clinical guidelines (STI, management of specific conditions, general guidelines)
that are periodically issued / circulated by DOH.

2.7 Resource directory of individuals/organizations and referral networks. All

facilities must develop a resource directory that should contain contact details of the
relevant institutions and individuals. The resource directory should include the names of
the organization/individual, address, contact person as well as contact details including
the telephone numbers, email address or websites
The national level Resource Directory is being provided.

Resource Directory of Individuals and Organizations

# NAME / COMPANY / ORGANIZATION / CONTACT DETAILS

POSITION COMPLETE ADDRESS

1 Maristela P. Abenojar Philippine Nurses Association (PNA) DL/ 5361888

2 Jill S. Alvarez /
Program Manager
1663 F.T. Benitez Street F/ 5251596
Malate, Manila M/ 09273448505
e-mail/ maris_presto@yahoo.com.ph
FAD, Inc. DL/ 4001827 / 5250428
1066 Remedios Street corner San F/ 4001827
Bartolome Street M/ 09155196598
Malate, Manila 1004 e-mail/ fadthqctrl@pldtdsl.net /
jill.alvarez@gmail.com

3 Elmer M. Angus, M.D. / Philippine Academy of Physicians in DL/ 5243011 local 4410
Immediate Past School Health, Inc. (PAPSHI) F/
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 President M/ 09209540992
e-mail/ macarthur_52@yahoo.com
4 Pamela Averion / UNFPA DL/ 9010328
National Programme Gender & Culture and ARH F/ 9010348
Officer M/
e-mail/ averion@unfpa.org
5 Marciano Fidel L. Private School Health Officers Association DL/ 7315127 local 111
Avendaño / c/o Lourdes School Quezon City F/ 7315127 local 119
President Don Manuel corner Kanlaon Street, Sta. M/ 09177938846
Mesa Heights, QC e-mail/ dr_jun_avendano@yahoo.com
6 Edna A. Beguia / IMAP, Inc. DL/ 7244849 / (042) 3311311
PRO Pinaglabanan Street corner Ejercito Street, F/ 7275225 / (042) 5366353
San Juan City M/ 09053440173
Brgy. Kiloloron, Real, Quezon e-mail/ edna_beguia@yahoo.com

8 Deborah B. Cabanag NAPC Youth & Students DL/ 4265028

3rd Floor ATI Building, Elliptical Road, F/
Quezon City M/ 09182567492
e-mail/ debbie_cabanag@yahoo.com
9 Marlene de Castro / Baguio Center for Young Adults, Inc. DL/ (074) 4450623
Executive Director 33 Assumption, Baguio City F/ (074) 4428193 (telefax)
M/ 09189102124
e-mail/ mbdc_bcya@yahoo.com.ph
10 Jonathan D. Chua NAPC-YSSSC DL/
F/
M/ 09288571932
e-mail/ jonathanchua_02@yahoo.com
11 Gloria Cirineo AFRHS Network DL/ 8205215
F/
M/
e-mail/ gloriacirineo@yahoo.com

12 Erlyn Della-Caparro, Society of Adolescent Medicine of the DL/ 4948298

M.D. Philippines, Inc. (SAMPI) F/
M/ 09238115729
e-mail/
13 Moses de Guzman / SAMPI DL/ 9246601 local 272
Adolescent Medicine Bahay ng Alumni F/
Specialist University of the Philippines M/ 09195872444
Diliman, Quezon City e-mail/ dittsdeguzman@yahoo.com

14 Robinson F. Espinoza / National Youth Commission DL/ 7812373

Chief of Policy and 373 Quezon Ave., Quezon City F/ 7812373
Planning Division M/ 09189217915
e-mail/ robin_espinoza@yahoo.com
15 Denia Gamboa / Council for the Welfare of Children DL/ 7811039 local 1006
Head, Public Affairs 10 Apo Street, Sta. Mesa Heights F/ 7811039 local 1006
and Information Office Quezon City M/ 09294208481
e-mail/ denia_3154@yahoo.com
16 Dexter M. Garcia / TRIDEV Specialists Foundation DL/
Project Officer F/
M/ 0917-8512782
e-mail/ dexgarcia@hotmail.com

17 Dr. Arvin Marbibi AFRHS Network DL/

F/
M/
e-mail/
18 Robert T. Mendoza / Philippine League of Government and DL/
President (Hospital Private Midwives, Inc. F/
Based) M/ 0908-933-1659, 0908-7110805
e-mail/
19 Dr. Rosa Maria H. PGH-Society of Adolescent Medicine of the DL/ 9316251 / 9315898
Nancho Philippines, Inc. (SAMPI) F/ 3733461
M/ 09178294968
e-mail/ rosenan830@yahoo.com
20 Lita Orbillo / NCDPC-DOH DL/ 7329956
Nurse VI F/ 7114846
M/ 09185836580
e-mail/ litaorbillo@yahoo.com

21 Dr. Luz P. Revita Philippine Academy of Physicians in DL/920-1342

School Health, Inc. (PAPSHI) F/ 928-6051
M/ 0922-8309044 or 0918-9309041
e-mail/ lprevita@yahoo.com
Page | 13
22 Ma. Loida Y. Sevilla / Plan International, Philippines DL/ 817-3187
Country Health 104 Salustiana Ty Tower F/ 840-3940
Advisor Paseo de Roxas Ave., Makati City M/ 0917-5012145
e-mail/ malou.sevilla@plan-international.org
23 Cherryl Mendoza Adolescent Wellness Center T/635-6789
Nurse Teen Health Hub By Appointment
The Medical City
Ortigas Avenue, Pasig City
24 Dr. Alicia Tamesis Teen Republic T/924-6601
Philippine Children’s Medical Center Loc 234 and 294
Quezon Avenue, Quezon City

2.8 Referral form. A referral form which contains the name of the referring facility and
service provider, client’s details (name, age, address), history of present condition,
physical/laboratory findings if appropriate, name and address of the facility where the
client is to be referred, and reason for referral must be in place. A return referral form
should be present and the client be instructed to bring this back to the referring facility.
The referral form should be sealed in envelope and addressed to the service provider of
the facility to which the client is being referred to. All referrals made and their outcome
should be listed in a referral logbook that should be maintained at the facility.

Page | 14
 Sample Referral Form

REFERRAL FORM
(To be left in the Referral Facility)
Reference number ----
Name of Referring Facility:
Address: Tel No:
Name/Position of Service Provider Referring: Date of Referral:

Name of the facility to which the client is being referred :

Name of Client: Age:

Address:

Reason for Referral:

Brief History (Include pertinent PE and laboratory findings and actions taken, if
any.)

Clinical Impression:
Signature of Person Referring Signature Over Printed Name
of Client/Guardian:

REFERRAL RETURN SLIP

(Please cut and instruct patient/guardian to deliver back to Referring Facility)
Reference Number -----
Name of Referral Facility:
Address: Tel No:
Name/Position of Person Who Attended to the Patient: Date Seen:

Final Diagnosis:
Actions Taken (Include results of laboratory/ancillary procedures done and
management)

Follow up advice:

Signature of Person Who Attended Signature Over Printed Name

to the Patient: of Client/Guardian:

Standard 3 “The health services are provided in ways that respect the rights of adolescents
and their privacy and confidentiality. Adolescents find surroundings and procedures of the
health facility appealing and acceptable”.

Page | 15
Rationale: Adolescents will not seek services if the physical environment and procedures are
not appealing to them. While ensuring the adolescents’ comfort and ease at the facility, it is
crucial that the privacy and confidentiality of adolescents should be preserved and maintained
throughout. Aside from the quality of services and attitude of personnel, the condition and
features of the facility will also help contribute to client satisfaction and quality of care. It is
important to get feedback, suggestions and recommendations from adolescents to be able to
design facilities, procedures and protocols that will appeal to adolescents as well as suit their
needs and taste.

Input Criteria Process Criteria Output Criteria

I3.1. –Standard operating protocols
(SOP) to maintain a good
ambience for adolescents -
including a clean spacious waiting
area, potable drinking water, clean
toilets and educational material are
in place
I3.2. -The confidentiality and
privacy policy of the facility is
clearly displayed in the clinic and is
clearly expressed to the client and
their parents or accompanying
adults.
I3.3. -Health facility procedures to
ensure confidentiality of the
adolescent clients and their parents
are in place.
P3.1 - Facilities are maintained / Adolescents feel
provided as per the SOP comfortable when they
visit health facility and
find the surroundings
and procedures
appealing and
acceptable.
P3.2. -Health facility displays the
confidentiality and privacy policy
and adolescents and parents and
accompanying adults are informed
about it at all available
opportunities.
P3.3. -Health facility staffs apply
the procedures to ensure the
confidentiality of their adolescent
clients and their parents.

I3.4. -Health facility procedures to P3.4. -Health facility staffs apply

ensure privacy for the adolescent
clients and their parents are in
place.
I3.5. -Protocols for the staff to
provide services in a friendly and
appropriate manner are in place
I3.6. -Mechanisms to involve
adolescents in the designing,
assessing and provision of health
services are in place
I3.7. -Flow design of utilization of
services to keep the waiting time
short and informative is in place.
the procedures to ensure privacy for
their adolescent clients and their
parents. (including private room for
consultation, simplified registration
process)
P3.5. -Service providers follow the
protocols to provide services to
adolescents in a friendly and
appropriate manner.
P3.6. -Adolescents are kept
involved in designing, provision
and assessment of health services
P3.7. -The designed flow to keep Services to adolescents
the waiting time short is followed. are ideally provided
The waiting time is filled in by within 30 minutes of
holding informative sessions their arrival in the
facility.

Page | 16
Implementation Guide:

3.1 Ambiance of the facility. The facility should:

 Provide comfortable seating with proper ventilation, good lighting, fans, and
reading/information materials.
 Provide access to clean drinking water and clean toilets. A separate toilet for
female should be provided
 Provide appealing reference (posters, audio-video, reading) material for the
adolescent to browse through while waiting.

For a stand alone clinic: The clinic within the facility should be located preferably in a
separate room that provides the needed privacy so that the adolescents are
comfortable in accessing services from it

This set-up will ensure that the facility is appealing to adolescents. This will also
make the adolescents feel comfortable while availing services in the facility.

3.2 Confidentiality and privacy policy. The confidentiality and privacy should include
provisions stating the mechanisms for registration, the filing and storage of records
(records keeping), access to these records (specifying the personnel who can access to
these records as well as protocols to follow if people outside of the health facility
would want to access records and information), general guidelines on non-disclosing
information regarding the patient, designated spaces for provider – client interaction
to provide audio-visual privacy, provision of barriers such as curtains, separate rooms,
etc.

3.3. Ensuring confidentiality. Clients and their accompanying adults should be informed
about the measures to maintain confidentiality. Each client should have an envelop or
folder where their Medical records (ITRs), results of laboratory examinations or other
special procedures done, referrals and other pertinent documents are filed. These are
filed depending on a prescribed system (by numbers, family name, barangays, etc). As
much as possible, there should be a designated room with lock and key where these
records should be filed. If this is not possible, these records should be kept in a filing
cabinet with lock and key. There will be designated personnel with access to these
records. They will only be pulled out only if a client – provider interaction will occur
or in any situation as may be necessary. Personnel working outside the facility should
have a written request if they want to access to the clients’ records for purposes of
research, follow up, etc. A verbal/written consent of the client should be obtained
before information contained in their records will be disclosed to outside parties. The
staff should not discuss the client’s
situation with non-concerned parties.

3.4. Ensuring privacy. Audio and visual privacy of the client must be maintained. As
mush as possible, there should be a separate room where provider – client interaction
should take place and where examinations such as pap smear, physical examination,
etc should be done. If it is not possible to provide a separate room, barriers such as
curtains should be provided. The provider should only attend to one client at a time
not unless the clients request that they be counseled together with other clients with
similar problems or with friends/families/significant others. Specifically, the
following must be observed:

Page | 17
  Ensure that the consultation and examination are done in a place where the
interaction between the health worker and the adolescent cannot be heard or seen
by anyone else;
 Ensure that no interruption occurs when a consultation or examination is in
progress (like phone/text calls, signing papers, etc)
 Ensure that no needless delays occur;
 Ensure that the adolescent is clear about what to do (e.g. by labeling the different
rooms such as pharmacy, and providing clear instructions as to where to go, have
a lab test and when to come back for the results)
Examples: Privacy and Confidentiality

# 1 - “We will be spending some time to talk about Maria’s history, especially her
immunization, past illnesses and your concerns about her health. After that, I would like to
spend some time alone with Maria. After I have examined her, I will ask you in again and we
can discuss my assessment and our plans, any laboratory tests, treatments and follow-up
plans. Is that all right with you?”

# 2 – “First of all, I would like to say that whatever we talk about in this interview will be
kept strictly confidential. Do you understand what is meant by confidential Maria? Or would
you want me to explain it further? However, there are certain situations when we may have to
break this confidentiality –usually in the person's own interest. First is, if the person plans to
hurt herself or hurt others, if she has been abused, if she has engaged in a serious crime or any
activity that makes us believe that she could be in danger… in these situations, we will have
to break confidentiality. So Mrs. X please be assured that I will notify you if I need to. Is that
all right with you ?”

3.5. Providing service in a friendly and appropriate manner. Service providers should
view the adolescent as the primary patient. They should greet the adolescents and
accompanying adult when they enter the clinic. Their behavior should inspire
confidence in the adolescents. They should also offer a seat to the waiting clients if
there are other clients seeking consultation and availing of the services. They must get
the initial information from the client in an area designated for this purpose.

3.6 Adolescent involvement. As much as possible, adolescents should be involved in

layout of the room and for putting up posters and IEC material. The adolescents from
the catchment area should be involved in making decisions about the type of IEC
material that should be kept in the facility. Once they are in the facility, they may be
asked about the set-up of the facility, how equipment, materials and furniture can be
arranged in such a way that they will not be hesitant to interact with the health
personnel. A suggestion box on the manner by which services are provided can be
placed in area in the facility

3.7. Ensuring a smooth patient flow. A schematic diagram showing the flow of
activities from admission to the different service providers including the approximate
time it would take to complete each transaction should be posted in strategic areas.
All efforts to reduce the waiting time to a minimum should be adopted.
Standard 4. “An enabling environment exists in the community for adolescents to seek and
utilize the health services that they need and for the health care providers to provide the
needed services”.

Page | 18
Rationale: In many situations, the community members are not aware of the importance of
providing health services to adolescents. At times, there is reluctance, reservations and even
opposition to ensuring access to such services. This deters not only adolescents from availing
the services but also the service providers from delivering the needed health services to
adolescents.

This standard encompasses community actions including educational campaigns that are
aimed to increase the awareness of the community to the need and importance of providing
health services to adolescent including those that aim to improve the sexual and reproductive
health of adolescents. This standard seeks the assistance of individuals, agencies and
organizations in the community to assist in providing the resources needed to be able to
deliver the services.

Input Criteria Process Criteria Output Criteria

I4.1. -A plan of activities (including P4.1. - Activities as per the Community members
community assemblies, meetings with plan are carried out are aware of provision
parents, group meetings and school of services and
visits,) to be carried out in the convinced about the
community to inform community benefits of providing
members about the benefits and adolescents with health
availability of services to adolescents is information and
in place. services.
I4.2. -Procedures to communicate with P4.2. -Service providers
all adults visiting the health facility the communicate effectively
benefits and availability of services to about the value of
adolescents are in place. providing health services
to adolescents and the type
of services available in
their interactions with adult
patients.
I4.3. -Plan to provide some health P4.3. -Activities as Adolescents receive
services and commodities to adolescents mentioned in the plan are services from NGOs,
by selected community members, carried out selected community
NGOs, outreach workers and members, outreach
adolescents themselves are in place.
workers and other
I4.4. -A plan to carry out advocacy for P4.4. -Activities in the plan
adolescents
support to provision of services for to seek support from the
adolescents from the Local Local Development Plan
Development Plan (LDP) exists. (LDP) are carried out.

Implementation Guide:

4.1 Activities to inform community members about the value of providing

adolescents with services. The community can be engaged in a variety of ways like
seeking their views, informing them about the benefits and availability of services to
adolescents and involving them in prioritizing the areas that need to be addressed. The
energies of the community members should be utilized in a variety of ways to create
an enabling environment. Community assemblies can be utilized to explain to the
members of the community the benefits that adolescents can derive from seeking
services from the facility. In schools, concerns of adolescents can be discussed during
parent-teacher meetings and the service providers can discuss the services that
adolescents can avail of depending on the issues and concerns that are presented in the
Page | 19
 meeting. Service providers may visit schools during health fairs and have a booth that
displays their services. In these events, a health communication material developed by
the facility and prepared in the vernacular can also be distributed. Short meetings
should be organized with women's groups, self-help groups and other relevant
sections and discussion about adolescent vulnerabilities and availability of services
should be discussed.

Advantage should be taken of fairs and other festivals where adolescents are expected
to gather in large numbers.

Folk media and mass media (TV, Radio, newspapers, magazines and web-based)
should be effectively engaged in generating awareness about issues that impact the
health of adolescents as well as for improving awareness regarding the availability of
adolescent friendly health services.

4.2 Communicating with other ADULTS visiting the facility about the value of
providing adolescents with services. All adults visiting the facility should be
informed of the current status of adolescent health in the community. IEC materials
(comics, leaflets) with the adults/parents as target audience can be given so that they
will be informed of the value of availing of the services of the facility whenever their
adolescent sons and daughters are in need of these services. Sessions with adults can
also be done in the health center/facility using a flipchart. Concerns of these
adults/parents can also be addressed in the open forum/question and answer part right
after the education session.

4.3 Involving selected community members in providing health

services/commodities. It is necessary to identify different organizations, individuals,
agencies in the community who have adolescent care as their main area of concern or
interest. These different stakeholders should be involved in formulating plans for the
provision or improvement of services. This will enable them to identify their roles and
contributions to the overall plan for service provision to this special group. It is also
an opportunity to forge partnerships and devise procedures and mechanisms to ensure
the smooth flow of service delivery.

Community members and organizations may also be involved in other activities such
as sportsfest, clean and green campaigns, and tree planting. The elected officials of
the community may also pass ordinances banning smoking and alcohol use among
minors. In this way, adolescents can be productive and responsible members of the
community. In the event that there are adolescents that need to be rehabilitated,
elected officials may also be involved in community-based rehabilitation programs.

4.4 Advocating for support in the local development plan. A Task Force on adolescent
health can be created/established. Members of the task force would be representatives
from planning, budget, health, NGOs, social services, among others. Other
approaches should also be explored. The facility manager or focal person may present
the services being provided during meetings of the local health board. In this way, the
representative of the local health unit, together with the elected officials in the
community will be enlightened on the importance of providing services to
adolescents. Meetings of the school board are also another venue for generating
support to the provision of health services to adolescents. Local government units

Page | 20
 (LGUs) may develop resolution and pass ordinances in support of adolescent health
activities and programs.
The Package of Services
This part of the document describes interventions organized in packages. The packages of
interventions are described for each level of facility and the essential commodities are
identified to assure adequacy and quality of care.
Package of Service Interventions at the Primary Key Supplies and Commodities Needed
Basic Level (RHU, Lying–in
Clinics)
 General Health
Essential Health Assessment – History
Package and Physical Exam
 Dental Assessment
 Psychosocial Risk
Assessment and
Management
 Nutrition Assessment
and Counselling
 Micronutrient
Supplementation
 Immunization
 Basic Diagnostic Tests
 Reproductive Health
Assessment and
Counselling
Adolescent Pregnancy  Prenatal Services
Package  Natal Services
 Post Natal Visits
 Writing materials, Individual
Treatment Record Forms (ITR),
 Dental mirror, Dental record
form, Dental Equipment
 Psychosocial Risk Assessment
Form
 BP apparatus, Adult weighing
scale, tape measure, height chart,
orchidometer, dietary
prescription form, exchange list
 Iron with folic acid tablets
 Vaccines: Tetanus toxoid, MMR,
Hepatitis B
 Centrifuge, heparinized capilet,
microscope, syringes and
needles, cotton, alcohol, slides,
cover slip, vaginal speculum,
cotton pledget
 ITR, Reproductive Health
Assessment Checklist, Flipchart
on reproductive health
 ITR, FP flipchart, iron tablets,
blood typing and Rh sera,
pregnancy test, centrifuge,
microscope, TT vaccine,
syringes, cotton balls, alcohol,
FP commodities
 HBsAg reagent, birth plan form,
NBS kit, BCG, Hepatitis B
vaccine, delivery table, sterile
scissors, gloves, cotton, alcohol,
plastic clamp, equipment and
supplies as per BEmONC
guidelines
 Iron tablets and vitamin A
capsules, FP flipchart, FP
commodities, Breastfeeding
chart, diet plan
Page | 21
Package of Service Interventions at the Referral Key Supplies and Commodities
Facilities (District Hospitals, Needed
Provincial, Tertiary
Facilities)
Sexually Transmitted  History and  ITR
Infections/HIV Packages Assessment

Package of Service Interventions at the Referral Key Supplies and Commodities

Facilities (District Hospitals,
Provincial, Tertiary
Facilities)
Sexually Transmitted  Diagnostics
Infections/HIV Packages
Basic Essential Health  Voluntary Testing for
Package HIV/STIs
Sexually Transmitted  Management,
Infections/HIV Packages Treatment and
Counseling
Needed
 ITR
 Reagents for Gram’s stain, RPR,
Glass slides, microscope, cotton
pledgets
 Reagents for Gram’s stain, RPR,
Glass slides, microscope, cotton
pledgets
 Counselling Cards or Chart

IV. Implementing Mechanisms at Various Levels

Different sectors and facilities are involved in the provision of adolescent-friendly health
services. Roles are outlined so that respective sectors and facilities are informed of what they
should do in catering to the needs of adolescents.

National Level (Department of Health):

 Formulate standards/policies/guidelines
 Develop communication plan on adolescent health
 Develop training manual for personnel rendering health services to adolescents
 Conduct capability-building activities for personnel involved in the provision of
services for the adolescents
 Coordinate with other agencies (GOs and NGOs) on the implementation of standards
and guidelines for health facilities
 Develop guidelines which are in line with the implementation of AFHS
 Mobilize resources for the implementation of adolescent health activities
 Conduct monitoring and evaluation activities

Center for Health Development (CHD) Level:

 Provide technical assistance to LGUs (plan preparation, materials development etc.)
 Disseminate guidelines to LGUs and other directives that may be circulated by the
Department of Health periodically
 Appoint focal person in the region who will be in-charge of the implementation of the
standards and implementation guide
 Organize a multi-sectoral technical working group in the region
 Formulate a region-wide plan on the implementation of standards and implementation
guide
 Establish a database of facilities in the region proving adolescent health services

Page | 22
  Monitor and evaluate the facilities providing services to adolescents in the provinces
under its jurisdiction

LGU (Provincial/Municipality/City) Level:

 Develop ordinances, resolutions in support of adolescent health
 Disseminate guidelines, protocols, policies and procedures which may be circulated
by the Department of Health in relation to the provision of health services to
adolescents
 Provide support to adolescent health activities and advocacy efforts
 Network with various sectors
 Prepare report on the services utilized by the adolescents; commodities used and
needed to be replaced; personnel who provided services; and attended capability
building activities

Non-Government Organizations
 Utilize the standards and implementation guide in the provision of health services
 Provide services needed by adolescents within the capability of the organization
 Share good practices in the provision of services to adolescents

Professional Organizations
 Orient the members of the organization on the standards and implementation guide
 Disseminate the guidelines and other directives to its members that may be circulated
by the Department of Health periodically
 Act as technical resource group on adolescent health
 Participate in the conduct of orientation programs related to adolescent health

Academic Institutions
 Promote adolescent-friendly institutions
 Act as technical resource persons on adolescent health
 Develop adolescent-oriented programs and activities
 Orient the teachers and other personnel of the standards and implementation guide
 Refer adolescents to facilities that provide services to adolescents
 Conduct orientation programs to adolescents regarding the services which they can
avail from adolescent friendly health facilities

V. Monitoring and Evaluation of the AFHS Quality Standards

The AFHS quality standards will be monitored and evaluated in two ways:
1. Continuous monitoring of the AFHS package implementation
2. Periodic evaluation on compliance with the AFHS quality standards

The implementation of quality standards of AFHS will be monitored by the authorities. The
initial activity will be spearheaded by the National Technical Working Group (TWG) and
will be done six (6) months after the implementation of the standards and implementation
guide. A bi-annual monitoring will be conducted by the regional technical working group
among the facilities under its jurisdiction.

Page | 23
The evaluation on the compliance with the AFHS quality standards will be carried out in line
with Department of Health (DOH) guidelines. Tools contained in this document may be
utilized by various organizations and facilities in the monitoring and evaluation activities.

Monitoring Tool 1. Facility Observation Checklist

Standard 1. Adolescents in the catchment area of the facility are aware about the health services it provides and
find the health facility easy to reach and to obtain services from it.

Item Self Assessment Assessment Team Recommendations

Signages
Welcome Signage
Schedule of Clinic Hours
(Day and Time)
Health Services
Clinical Guidelines
Documents
Action Plan for
Information
Dissemination
Policy regarding flexible
time schedule
Policies for provision of
services
Policies for payment
schemes
Plan for outreach
program
Registration logbook
containing the list of
clients who consulted and
were given services

Standard 2 “The services provided by health facilities to adolescents are in line with the accepted package of
health services and are provided on site or through referral linkages by well-trained staff effectively”.

Item Self Assessment Assessment Team Recommendations

Documents
National Standards for
Adolescent Service
Package
List of services provided
by the facility
Stock cards showing the
delivery and utilization of
medicines, commodities
for adolescent health care
Certificates of training on
the minimum training
courses prescribed by
DOH for adolescent focal
persons and other
providers
Protocols and guidelines
for patient interaction
Clinical management
guidelines and Adolescent
Job Aid are available
Page | 24
Individual Treatment
Records that shows the
chief complaint, findings
on examination, clinical
impression and
management of clients
Directory of organizations
– name, address, services
provided, contact number
and contact person
Referral logbook – name,
age, address, Clinical
Impression, where
referred, reason for
referral, result of referral
Referral forms

Standard 3“The health services are provided in ways that respect the rights of adolescents and their privacy and
confidentiality. Adolescents find surroundings and procedures of the health facility appealing and acceptable”.
Item Self Assessment Assessment Team Recommendations
Facility
Patient flow from admission
to delivery of services
including the average time
for each step is posted in
strategic places.
A policy to ensure
confidentiality is posted.
Policies to ensure privacy is
posted
Individual records are kept in
separate envelopes.
All records are kept in a safe
place, preferably in a
separate room or a filing
cabinet with lock and key.
There is a designated person
with access to the records.
There are designated
admission and waiting areas.
There are separate rooms for
consultation, treatment and
counseling. If there are
limited rooms, there are at
least curtains to separate
each provider.
There is a suggestion box.
Conversation between
provider and client cannot be
heard by others.
There are peer educators
assisting in clinic operations
and providing services
(lectures, counseling, etc)
Materials being used by the
adolescents in the facility
Documents
SOP for maintenance of
facility
Page | 25
Policies and procedures to
ensure confidentiality
Policies and procedures to
ensure privacy
Protocol and procedures for
patient – provider interaction
Minutes of meetings of
TWG

Standard 4. “An enabling environment exists in the community for adolescents to seek and utilize the health
services that they need and for the health care providers to provide the needed services”.

Item Self Assessment Assessment Team Recommendations

There are leaflets containing
the clinic schedule and
services which the
patients/community
members can bring home and
share to other community
members.
IEC materials on the
different programs / services
available (Example IEC on
maternal care, family
planning, etc). The IEC
materials should also include
the directory of other
agencies/organizations where
the services can be obtained.
Documents
IEC Plan
Copy of the Local
Development Plan
Advocacy Plan
Action Plan showing
different agency participation
– the name of the agency,
resources/assistance they will
provide, the person’s
responsible
Accomplishment report
showing the services given at
the public health facility as
well as those given by other
agencies, individuals and
peer counselors

Page | 26
 Monitoring Tool 2. Facility Manager Interview Questionnaire

Name of Facility:
Type of Facility:
Date of Assessment (dd/mm/yyyy)

Type of staff Number

Clinical-Total
o Medical doctors
o Nurses
o Midwife
Non-clinical-Total
o Psychologist, Counselors etc.
o Social workers
o Support staff (receptionist, cleaners, administrative clerks)
o Barangay Health Workers
Total

Criteria Yes No Remarks

Does the facility have the following signages
o Schedule of clinic hours for adolescents
o Services available
o Adolescents are Welcome
o “Services are Free of Charge”
Service Provision
Services provided
o Counseling
o Nutritional Assessment and counseling
o Maternal Care Services
 Pre natal
 Natal
 Post natal
o Services for STIs including HIV/AIDS
o FP Services
o Dental Assessment
o Micronutrient Supplementation
o Immunization – TT. Hepa B, MMR
o Reproductive Health Assessment and Counseling
 Fertility awareness , menstrual health issues and
counseling
 Pap smear and pelvic exams, if sexually active
 Adolescent male reproductive health issues
 Gender issues
o Health prevention and promotion
o Psychological Counseling
o Social and legal support
o Substance abuse
o Commodities and Supplies
o BP Apparatus
o Weighing Scale
o Tape measure
o Height chart
o Orchidometer
Page | 27
o Dietary prescription form
o Exchange list
o Vaccines – TT, MMR, Hepa B
o Disposable syringes
o Cotton
o Alcohol
o Centrifuge
o Heparinized capilet
o Microscope
o Slides
o HIV testing kit
o RPR
o Reagents for Gram stain
o Cotton pledgets
o NBS kit
o BCG vaccine
o Gloves
o Cord clamp
o Vit K injection
o Iron with folic acid tablets
o FP Commodities
o Writing materials
o Individual Treatment Records
o Dental Record Forms
o Referral Forms
o Feedback Form
Planning
Written Plan for:
o IEC Campaigns
o Promotion of adolescent health services and facility
o Outreach including schedule
Procedures and Policies
Standard Operating Procedures
o Maintaining good clinic ambience conducive to adolescents
o Provision of Free Services to Adolescents
o Procedures for Dealing with Adolescents
o Clinical Protocols for the different health and health related
programs and conditions
o Two way referral
o Ensuring privacy and confidentiality
Documentation
Ledgers for:
o Clients seen at the clinic
o Clients seen during outreach
o IEC activities done, topic and list of participants
o Results for feedback
o Results of supervisory visits
Adolescent Participation
o Feedback mechanism on the services provided
o Participation in the design, implementation and assessment
of the following services:
Monitoring and Evaluation
o Inventory of supplies and equipment
o Client satisfaction
o Clinical Case management

Page | 28
o Provider performance

Please List the Staff Members and check the Training specific for Adolescents they have received:

Name of Physician Nurse Midwife Psychologist Social

Training Worker
Orientation
Program on
Adolescent
Health
Adolescent
Job Aid
Others:
Specify

Monitoring Tool 3. Service Provider Interview Questionnaire

Name of Provider:
Designation:

Service Delivery
1. When and what time is the facility open (Days and time)?
2. Is the facility open after office hours and weekends? If not, what mechanisms were put in
place to ensure that the adolescents get the services after office hours and during
weekends?
3. What agencies provide these services?
4. How do you get information from these facilities regarding the clients that they
serve/provide services to?
5. What services are available in your facility? In other public health facilities (laboratories,
social hygiene clinics, etc)
6. What do you do when the services needed are not available in the facility?
7. How do you keep track of the outcome of these referrals?
8. Do you provide adolescents with appropriate information about treatments, procedures,
contraceptive methods, as well as counseling to make decisions?
9. Describe the flow of patients from admission to the time they leave the facility.
10. What mechanisms are in place to ensure:
a. Confidentiality
b. Privacy
11. Do you explain that services are confidential?

Financing
1. How much budget is given to the Adolescent Friendly Health Services?
2. What are the sources of budget to maintain operations of the facility?
3. Are the services given for free? If payment is made:
a. How much?
b. How did you come up with the amount?
c. How are the funds handled (liquidation, disbursement, accountability)
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4. Are there financing schemes available? If yes, what are they?

Regulations
1. What are the national and local policies/laws/ statutes enacted in support of Adolescent
Friendly Health Care and Facilities?
2. What policies and procedures have been formulated by the facility to govern operations
and service delivery?

Governance
1. Is monitoring and supervision conducted? If yes,
a. How often?
b. By Whom?
c. What are the results?
d. How long will it take to implement the recommendations made?
If no, Why do you think so?
2. Are you trained on Adolescent Reproductive Health? If yes, what training course did you
attend? If no. Why?

Recommendations: What would you recommend to improve the following?

1. Physical structure and appearance of the facility
2. Clinic procedures including patient flow and waiting time
3. Measures to ensure
a. Confidentiality
b. Privacy
4. Capability of staff to deal with adolescents and address their needs
5. Training. Are there any other training you would want to recommend aside from those
required by DOH
6. Staff capability in dealing with adolescents
7. Referral
8. Information dissemination
9. Adolescent participation
10. Community participation
=
Monitoring Tool 4. Client (Adolescent) Interview Questionnaire

1. What is the schedule of operations of the facility?

2. Can you enumerate the services offered in the facility that you know of?
3. Can you please describe the process from admission to the time you leave the facility?
4. How did you come to know about this facility and the services they offer?
5. What are the features that would ensure:
a. Confidentiality
b. Privacy
6. What mechanisms are in place to solicit your opinion regarding the facility and improving
its condition and operations?
7. Give your comments on the following:
a. Facility
b. Admission
c. Waiting time
d. Services
e. Staff
f. Availability of needed supplies and commodities
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8. What is your overall rating of the facility and its operations?
9. What are your recommendations/suggestions to improve the facility and its operations?

References

A Practical Guide on Adolescent Health Care, Department of Health and UNFPA,

_________

Adolescent Friendly Health Services: An Agenda for Change. Geneva. WHO, October 2002

Adolescent Friendly Reproductive Health Services Network Operations Manual. Philippines.

Save the Children. _________.

Department of Health. Guide Book on Adolescent and Youth Health and Development
Program. DOH, Philippines. 2002.

Department of Health. Manual of Standards for Adolescent Friendly Health Services. DOH,
Philippines. 2008.

Dickson, K., Ashton, J, and Smith, J. Do setting adolescent-friendly standards improve

quality of care in clinics? Evidence from South Africa. International Journal for Quality in
Health Care. Oxford University Press. 1-10. 2007.

Implementation Guide on RCH II: Adolescent Reproductive Sexual Health Strategy: India.
May 2006.

Marquez, L. 2001. Helping Healthcare Providers Perform According to Standards. QA

Operations Research Issue Paper 2 (3): 3-30.

National Consultation on RCH II ARSH Strategy: A Report. New Delhi. September 2005

National Demographic Health Survey 2008, Philippines. December 2009.

National Standards for Provision of Youth Friendly Health Services in Bhutan (Draft
National Standards and Implementation Guide. May 2008.

National Standards and Implementation Guide for Youth Friendly Health Services: Bhutan.
May 2008

National AIDS Registry, Department of Health National Epidemiology Center (Data from
January to October 2009).

Package of Interventions for Family Planning, Safe Abortion Care, Maternal, Newborn and
Child Care, WHO, 2010.

Quality Standards of Youth Friendly Health Services in the Republic of Moldova. Moldova.
2009

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Workshop Output. Workshop on the Development of Standards of Adolescent Friendly-
Health Services, Tagaytay City. August 2009

Youth Friendly Health Services (YFHS) standards, criteria, actions to achieve criteria, means
of verification. Bangladesh. April 2005.

Annex 1. Laws and Issuances on the Provision of AFHS in the Philippines

International Issuances

1. Committee on the Rights of the Child General Comment No. 4

2. Convention on the Elimination of All Forms of Discrimination Against
Women (CEDAW)
3. Beijing Platform For Action (BPFA)
4. Article 6 of the United Nations Convention on the Rights of the Child

National Issuances

1. Republic Act 7610: Special Protection of Children Against Child Abuse,

Exploitation and Discrimination Act

2. Republic Act 9231: Worst Form of Child Labor

3. Republic Act 9710: The Magna Carta of Women
4. Republic Act 8504: Philippine Aids and Control Act of 1998
5. Article 54 of the Civil Code of the Philippines

6. P.D. 603: Child and Youth Welfare Code of 1974

7. R.A. 9262: Anti-Violence Against Women and their Children Act of 2004

8. R.A. 9211 (Tobacco Regulation Act of 2003)

9. R.A. 9165 (Comprehensive Dangerous Drugs Act of 2002)

10. DOH Administrative Order (AO) 34 – A series of 2000

Annex 2. The Process of Developing National Standards

on Adolescent Friendly Health Services

A Strategic Planning Workshop for Accelerating Action for Adolescent and Youth Health
was conducted from September 23-26, 2008 in Pranjetto Hills Hotel in Tanay, Rizal. Gaps
and critical activities for Adolescent and Youth Health were identified. In the same year
(2008), the Framework for the Adolescent Health Strategic Plan was started and finished in
2009.
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A Workshop on the Development of National Standards for Adolescent-Friendly Health
Services was organized by the Department of Health, Philippines with the support of the
WHO Regional Office for the Western Pacific in Tagaytay City from 4 to 7 August 2009.
The intended beneficiaries of this workshop are all adolescents (10-19) in the Philippines.
This workshop was organized to build wide consensus and to develop a set of standards to
ensure the provision of good quality adolescent health services at the different levels of care,
to respond appropriately to adolescent health needs.

The workshop was guided by the principles that AHFS should:

 Respect, fulfill and protect the rights of adolescents
 Comply with accepted standards of medical ethics in the delivery of services
 Given due consideration to national laws and policies and the socio-cultural context
 Ensure access to comprehensive and holistic services
 Provide adequate attention to the different needs of adolescents
 Ensure young people’s privacy and confidentiality
 Ensure adolescent’s participation at all levels
 Provide evidenced-based services
 Promote community ownership and active involvement of all stakeholders including
parents and community members, and
 Link with other sectors

To build wide ownership and shared understanding, the workshop brought together a range of
stakeholders from the government (from national, regional, provincial and city/municipal
levels), local non-governmental organizations (NGOs) working with adolescents,
international NGOs and United Nations agencies (United Nations Children's Fund
[UNICEF], UNFPA and WHO) and participants from Cambodia. Fifty-five participants
attended the opening session of the workshop.

The workshop utilized a mix of methods including interactive sessions, small group
discussions, brainstorming, VIPP, and plenary presentations. The participants discussed and
finalized the health outcomes to be achieved, the package of services to help achieve the
agreed upon health outcomes, service delivery points from where the services should be
provided and the service providers who will provide the said services to adolescents. Four
"standards" were developed by this consultative process.

Annex 3. Guiding Principles

All efforts to establish facilities and services that are friendly to adolescents are in line with
the right of the adolescent to the highest attainable standard of health. The UN Committee on
Economic, Social and Cultural Rights has said that the right to health consists of six
normative elements:
1. Health availability refers to the availability of a sufficient number of functioning public
health and health care facilities, goods, services, programs and underlying determinants of
health.
2. Health physical accessibility means that all health facilities, centers, programs and goods
must be within safe physical reach for all, and includes timely access to health services.
Physical access also requires the construction of access paths to buildings and other
public places for persons with disabilities.

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3. Health economic accessibility means that the costs of availing health services, goods, and
facilities and the underlying determinants of health must be based on the principle of
equity and must be affordable for all.
4. Health information accessibility refers to the right to seek, receive and impart information
and ideas regarding health issues and concerns. Health information accessibility,
however, does not in any way impair the individual’s right to privacy and confidentiality
of personal health data. The Committee on the Rights of the Child urges the active
involvement of adolescents in the design and dissemination of health information through
a variety of channels beyond the school, including youth organizations, religious,
community and other groups and media.
5. Health acceptability means that health services, goods and facilities and underlying
determinants of health must respect medical ethics, be culturally appropriate, be sensitive
to gender and life-cycle requirements, respect confidentiality of personal health data, and
must be designed to improve everyone’s health status.
6. Health quality means that all health goods, services, facilities and underlying
determinants of health must be scientifically and medically sound and of good quality.

Annex 4. Standard and Criteria Definitions

A standard is a statement of desired quality. In some countries, standards for ensuring the
performance of health facilities for adolescents have been developed. These standards
strengthen program implementation as well as monitoring, supervision and evaluation by
setting clear performance goals, defining the quality required for a service and providing a
clear basis against which performance can be monitored, assessed and / or compared.

The key “friendly” characteristics of services for adolescent are viewed from the
perspectives of the users, providers and health system.

From the users’ perspective, health services must be:

 Accessible: ready access to services is provided

 Acceptable: health care meets the expectations of adolescents who use the services
 Gender-sensitive: there shall be no discrimination, services must be given regardless of
orientation
 Culturally-appropriate: services must not run counter to existing value systems
 Rights-based: in all aspects of program implementation, the promotion of young people’s
rights shall be applied.

From the providers’ / managers’ perspective, health services must be:

 Age-appropriate: required care is provided ; unnecessary and harmful care is avoided
 Comprehensive: care provision covers aspects for prevention through counseling to
treatment
 Effective: health care produces positive change in the health status of the adolescent. The
health system should focus on the efficiency in the health system, that is providing high
quality care at the lowest possible cost
 Equitable: services are provided to all adolescents who need them especially the poor,
marginalized, vulnerable and difficult to reach groups.

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 Annex 5. Adolescent and Youth Health Program Technical Committee

Adolescent and Youth Health Program

Technical Committee
Dr. Juanita A. Basilio FHO
Dr. Manuel Calonge FHO
Ms. Lita Orbillo FHO
Ms. Onofria de Guzman FHO
Mr. Raymond Mazo FHO
Ms. Lyra Gay Borja FHO
Ms. Jill Alvarez FAD
Ms. Ma. Loida Sevilla PLAN
Atty Mylen Gonzales Child Justice
Ms. Pamela Marie Averion UNFPA
Ms. Lauren Musa CWC
Dr. Mariella Castillo WHO, Country Office
Dr. Howard Sobel WHO, Country Office
Dr. Patanjali Nayar WHO-WPRO
Ms. Gudrun Nadoll UNICEF
Dr. Rosa Maria Nancho SAMPI
Mr. Melvin Dayrit DSWD
Ms. Maribeth Casin BWYW, DOLE
Ms. Myrna V. Santos NBOO-DILG
Mr. Robin Espinosa NYC
Ms. Loida Ramos HNC,DepEd
Dr. Gerald Belimac IDO
Dr. Olga Virtucio AFRHS Network
Dr. Esther Oliveros AFRHS Network
Ms. Socorro Baluyot CHD-MM
Dr. Lani Samonte Save the Children
Ms. Maristela Abenojar PNA
Ms. Edna Nito NCHP
Ms. Frances Rose Elgo HPDPB

Annex 6. Workshop Participants, August 3-7, 2009, Tagaytay City, Philippines

Juanita A. Basilio, M.D Family Health Office-National Center for Disease

Rudy Albornoz Prevention and Control, Department of Health
Lita Orbillo (FHO, NCDPC, HOH)
Maristela P. Abenojar Philippine Nurses Association (PNA)
Jill S. Alvarez FAD, Inc.
Elmer M. Angus, M.D Philippine Academy of Physicians in School Health,
Inc.
Pamela Averion UNFPA, Gender & Culture and ARH

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Marciano Fidel Avendaño Private School Health Officers Association
Medalla P. Balandra DOH-CHD Western Visayas
Ma. Socorro R. Baluyut DOH-CHD-MM
Edna A. Beguia IMAP, Inc.
Ma. Maila C. Bernabe DOH-CHD Western Visayas
Marifel S. Bogabel Save The Children
Deborah B. Cabanag NAPC Youth & Students
Hamilton Calderon FHO, Department of Health
Marlene de Castro Baguio Center for Young Adults, Inc.
Venkatraman Chandra-Mouli World Health Organization
Adolescent Health and Development
Department of Child and Adolescent Health and
Development
Jonathan D. Chua NAPC-YSSSC
Gloria Cirineo AFRHS Network
Mick Creati Burnett, Australia
Dr. Reinhard M. Dalumpines Department of Health
Center for Health Development/Family Health Cluster
Melvin C. Dayrit DSWD Central Office
Social Technology Bureau
Erlyn Della-Caparro, M.D. Society of Adolescent Medicine of the Philippines, Inc.
(SAMPI)
Moses de Guzman SAMPI
Marlyn Endozo TUCP
Robinson F. Espinoza National Youth Commission
Denia Gamboa Council for the Welfare of Children
Dexter M. Garcia TRIDEV Specialists Foundation
Brayant Gonzales Family Planning Organization of the Philippines
Chetra Kaeoun National Center for HIV/AIDS, Dermatology, and STD,
Ministry of Health, Cambodia
Ma. Evelyn Q. Lleno DOH –HHRDB
Susan Yanga Mabunga UP College of Public Health
Dr. Arvin Marbibi AFRHS Network
Robert T. Mendoza Philippine League of Government and Private
Midwives, Inc.
Raquel Montejo DOH – Davao
Ma. Doreen Era E. Murata UNFPA – Youth Advisory Panel
Gudrun Nadoll United Nations Children’s Fund
Philippine Country Office
Dr. Rosa Maria H. Nancho PGH-Society of Adolescent Medicine of the
Philippines, Inc. (SAMPI)
Dr. Virginia L. Narciso CHD-CAR
Baguio City
Dr. Gloria A. Narvaez CHD-4A
Dr. Patanjali Dev Nayar World Health Organization (WPRO)
Joyce E. Ocampo CHD 3
Fe b. Paler DOH-CHD Northern Mindanao
Valerie M. Pascual CHD 4A
Mylene Mirasol C. Quiray POPCOM
Dr. Luz P. Revita Philippine Academy of Physicians in School Health,
Inc. (PAPSHI)
Lynny A. Sarigumba, CHO – Bislig City LGU
Ma. Loida Y. Sevilla Plan International, Philippines
Cristina V. Sison CHD-4B
Dr. Howard Sobel Office of the WHO Representative

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Dr. Srun Sok The Ministry of Health
Department of Hospital Services
Cambodia
Lucita O. Tagudin DOH-Caraga
Dr. Marianna Trias World Health Organization (WPRO) Child and
Adolescent Health
Gloria Villena Dr. Jose Fabella Memorial Hospital
Dr. Olga Virtusio City Health Office, Paranaque City

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