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Evaluation of adolescent-friendly health services in India

Authors:
  • National Institute of Medical Statistics, Indian Council of Medical Research
  • National Institute of Medical Statistics, New Delhi, India
Article

Evaluation of adolescent-friendly health services in India

Abstract and Figures

The study was undertaken on the request of World Health Organisation through the Ministry of Health and Family Welfare to evaluate the role of the adolescent-friendly clinics (AFCs) being operationalized in three medical college hospitals in Delhi, Kolkata and Chandigarh. The evaluation covers the role of the adolescent-friendly health services clinics (AFHC) and their feasibility, sustainability. The researchers interviewed the key stakeholders on issues related to AFHC. Out of the 14 sites, three sites which are functional for more than three years in tertiary care hospita ls located in medical colleges were selected. The impact of AFHS clinics was visible in all the three sites. The clients in the AFHS clinics seem to be more satisfied as far as accessibility and timing at the clinics are concerned. Percentage of clients wh o say that the clinics are accessible easily is higher in AFHS clinics vis -à-vis other OPDs. The waiting time to see the health worker at the AFHS clinics is lesser as compared to other OPDs. 20 per cent of the adolescents visiting AFHC in Delhi were livin g alone and the figures of adolescents living alone were quite low in Kolkata. Similarly, satisfaction level of the clients in the AFHS clinics is also much better than in other OPDs. They liked the environment and the friendliness of the staff. The differences between AFHC and other clinics were more evident in Chandigarh and Delhi than in Kolkata. To improve the utilization of these services, the service users suggested to get the activities of AFHS clinics advertised through media, motivate the peers and friends and publicize these clinics through various programmes targeting school children.
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HealthandPopulation:Perspectives andIssues
Vol. 32 (2),96
-
104, 2009
96
EVALUATION OF ADOLESCENT
-
FRIENDLY HEALTH
R.J. Yadav*, Rajesh Mehta**, Arvind Pandey* and Tulsi Adhikari*
ABSTRACT
The study was undertaken on the request of World Health Organisation
through the Ministry of Health and Family Welfare to evaluate the role of the
adolescent
-
friendly clinics (AFCs) being operationalized in three medical
college hospitals in Delhi, Kolkata and Chandigarh. The evaluation covers
the role of the adolescent
-
fri
endly health services clinics (AFHC) and their
feasibility, sustainability. The researchers interviewed the key stakeholders on
issues related to AFHC. Out of the 14 sites, three sites which are functional
for more than three years in tertiary care hospita
ls located in medical colleges
were selected.
The impact of AFHS clinics was visible in all the three sites. The clients in the
AFHS clinics seem to be more satisfied as far as accessibility and timing at
the clinics are concerned. Percentage of clients wh
o say that the clinics are
accessible easily is higher in AFHS clinics vis
-
à
-
vis other OPDs. The waiting
time to see the health worker at the AFHS clinics is lesser as compared to
other OPDs. 20 per cent of the adolescents visiting AFHC in Delhi were livin
g
alone and the figures of adolescents living alone were quite low in Kolkata.
Similarly, satisfaction level of the clients in the AFHS clinics is also much better
than in other OPDs. They liked the environment and the friendliness of the
staff. The differ
ences between AFHC and other clinics were more evident
in Chandigarh and Delhi than in Kolkata. To improve the utilization of these
services, the service users suggested to get the activities of AFHS clinics
advertised through media, motivate the peers and friends and publicize these
clinics through various programmes targeting school children.
KeyWords:
Adolescent
-
Friendly Health Services (AFHS), Behaviour, OPDs, Medical
Staff.
It has increasingly been recognized
that adolescents form a specific group
in society and have their own specific
needs. Adolescence has become a
more clearly defined developmental
stage in human life; and there is
currently a greater recognition of this
group’s biological, psychosocial and
health needs than before. Exploration
and experimentation, the hallmark of
adolescent behaviour, often propel
adolescents towards risk
-
taking and
exposure to unwanted pregnancy,
HIV/AIDS
and
other
sexually
transmitted infections, substance
abuse and unintended injuries. At
the same time, adolescents often
face constraints in seeking services
including misperceptio
ns about their
own needs, fear of disclosure and
service provider’s negative attitudes.
To overcome these constraints, it is
imperative to develop specifically
designated services for adolescents.
Adolescent
-
friendly services should
be able to attract youn
g people, meet
*National Institute of Medical Statistics, Indian Council of Medical Research, New Delhi.
**WHO,
Nirman Bhawan, New Delhi.
________________________________
________________________________
___________
HPPI, Vol. 32 (2), 2009
97
their needs comfortably and with
sensitivity, and retain young clients for
continuing (follow
-
up) care. The most
important attributes of adolescent
-
friendly services are specially trained
staff with attitudes to respect privacy
and confidentiality, and a comfortable
clinic environment. Ideally, the holistic
package of services should include
reproductive health services, nutrition
counseling, counseli
ng to promote
responsible sexual behaviour and
prevent substance abuse, and services
such as immunizations and life skills
education. Although outreach services
such as school
-
linked clinics, workplace
clinics, satellite clinics and mobile clinics
have proven to be more successful and
cost
-
effective, services for adolescents
can be provided from fixed sites such
as hospitals and clinics. AFHCs are
government health care facilities that
provide services free of cost to the
public. Children up to 12 y
ears of age
are seen in the paediatrics out
-
patient
department (OPD), and those above 12
years of age are seen in the medical out
-
patient department or other specialty
clinics. However, with the increased
recognition of adolescents’ needs, the
AFHCs implem
ent a specially designed
set of services for adolescents.
OBJECTIVE
The paper examines whether the
adolescent friendly health centres
have increased the quality and access
to health services as per the client’s
perceptions.
METHODOLOGY
Out of a total of 14 sites, three sites
run in tertiary care hospitals located
in medical colleges and have been
functional without interruption for more
than 3 years were included in the study.
These three sites were Safdarjung
Hospital, Delhi; Government
Medical
College and Hospital, Chandigarh
and Government Medical College
and Hospital, Kolkata. Each site has
established a centre and trained health
providers in other departments of the
hospital as well as personnel out of
the hospital. All three sites h
ave run
an outreach programme for schools. A
qualitative assessment was carried out
to evaluate the role of the adolescent
-
friendly health services clinics (AFHCs)
and their feasibility, sustainability. The
assessment included interviews with
the key stakeholders such as facility
coordinators, hospital/institution chiefs,
and review of relevant documents.
Since there were no baseline data on
the quality of services for adolescents,
the evaluation assessed levels of quality
using Standards Frame
work in these
dedicated adolescent centres. Out
-
patient departments like Obstetrics,
Skin Care, etc. where health workers
have not been oriented in adolescent
-
friendly approaches (‘Control Group’)
were also assessed with regard to their
roles in this prog
ramme. Students were
also interviewed to assess the outreach
of intervention on schools and the level
of access to information and health
services by them.
In each AFHC intervention site and
other OPD sites, 4 staff members,
25 adolescents and 25 parents were
interviewed.
FINDINGS AND DISCUSSION
Background Characteristics
Sex of the adolescents visiting the
hospital, his/her religion, caste as well
as their mother tongues and their marital
status were studied. It was observed
that proportion of adolescent girls
visiting the AFHCs in Delhi and Kolkata
was higher whereas the situation was
reverse in Chandigarh (Table 1). As
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________________________________
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HPPI, Vol. 32 (2), 2009
98
expected, the proportion of Hindu
adolescents was more in Delhi and
Chandigarh but Muslim adolescents
were more in Kolkata. The adolescents
belonging to other castes were more
than two
-
thirds in Chandigarh and
Kolkata. About three
-
fourths of the
adolescent
s in Delhi and Chandigarh
had Hindi as their mother tongue. With
regard to their marital status, all the
adolescents were unmarried in Delhi
and Chandigarh while a few (6.5%)
were married in Kolkata. Data given
in Table 1 show that a majority of the
client
s coming to the AFHS clinics
belonged to literate families than
the other OPD clinics in all the three
sites. This difference was statistically
significant.
Family Profile
TABLE 1
SOCIO
-
DEMOGRAPHIC PROFILE OF ADOLESCENTS (%)
Chandigarh
Delhi
Kolkata
AFHC
Other
OPDs
AFHC
Other
OPDs
AFHC
Other
OPDs
Age (Years)
13
15
13
14
16
18
Gender
Male
60.0
57.1
44.4
27.8
41.7
24.0
Female
40.0
42.9
55.6
72.2
58.3
76.0
Marital Status
Never Married
100
94.1
100
94.4
93.5
69.6
Others
5.9
5.6
6.5
30.4
Education of
Mother
Illiterate
21.1
48.6
11.1
44.4
22.4
28
Up to High School
68.4
48.5
77.8
55.5
77.6
72
Graduate & Above
10.5
2.9
11.1
p
-
value
(.000)
(.06)
(.488)
Education
of Father
Illiterate
11.1
24.2
17.1
14.8
20
Up to High School
66.7
60.6
88.9
77.2
78.8
76
Graduate & Above
22.2
15.2
11.1
5.7
6.4
4
Number of Adolescents
64
34
45
36
46
36
TABLE 2
FAMILY PROFILE OF THE ADOLESCENTS (% )
Living Details
Chandigarh
Delhi
Kolkata
AFHC
Others
AFHC
Others
AFHC
Others
Place of
Living
Parent House
95.0
88.6
100.0
94.4
93.9
76.0
Spouses House
2.9
5.6
4.1
16.0
Guardian House
5.0
5.7
2.0
4.0
Others
2.9
4.0
Living
With
Alone
12.5
12.9
20.0
3.2
6.3
8.0
Mother/Mother
-
in
-
Law
81.3
74.2
80.0
93.5
83.3
84.0
Father/Father
-
in
-
Law
6.3
6.5
8.3
4.0
Married Brothers/Sisters
3.2
Others
3.2
3.2
2.1
4.0
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________________________________
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HPPI, Vol. 32 (2), 2009
99
Almost all the adolescents were
residing in their resepctive parental
homes. Only a few (5) were residing
either in theirguardian houses or house
of the spouse. More than three
-
fourths
of the adolescents were living in their
mother’s house (Table 2). Interestingly,
20 per cent of the adolescents visiting
AFHC in Delhi were living alone and
the figures of adolescents living alone
were quite low in Kolkata.
TABLE 3
LOCATION OF HOUSE (%)
Residence Details
Chandigarh
Delhi
Kolkata
AFHC
Others
AFHC
Others
AFHC
Others
Place
City
66.7
61.8
66.7
94.4
60.4
32.0
Village
33.3
38.2
33.3
5.6
39.6
68.0
Locality
Slum
16.7
23.1
11.1
22.9
43.6
28.6
Colony
83.3
76.9
88.9
77.1
56.4
71.4
Number
of rooms
excluding
kitchen
1
16.7
15.2
25.0
22.9
46.8
30.4
2
16.7
27.3
50.0
45.7
23.4
43.5
3
44.4
39.4
14.3
14.9
4.3
> 4
22.2
18.2
25.0
17.1
14.8
21.6
Residing in Own House
72.2
75.0
55.6
82.4
62.2
80.0
TABLE 4
ACCESSIBILITY/APPROPRIATENESS OF SERVICES IN TERMS OF TIME AND
PLACE (%)
Accessibility and Acceptability
Chandigarh
Delhi
Kolkata
AFHC
Others
AFHC
Others
AFHC
Others
Time
required
reaching
health
facility
<30 min
45
34.3
55.6
44.4
40
67.3
30
-
60 min
35
37.1
22.2
2.8
16
26.5
>60 min
20
28.6
22.2
47.2
40
6.1
Easy accessibility
70
54.3
88.9
88.9
72
67.3
Having an appointment
50
57.1
22.2
8.3
36
16.3
Suitable
hours
for
the clinic
2
4
p.m.
65
20
100
5.6
8
20.4
8
12
a.m.
25
8 0
94.7
82
79.5
Waiting time to see
health worker
<30 min
60
34.3
66.7
61.1
44
42.9
30
-
60 min
15
34.3
22.2
16.7
16
34.7
>60 min
25
28.6
11.1
11.1
36
20.4
p
-
value
(.34)
(.05)
(.04)
Long waiting for services
50
77.1
44.4
69.4
51
48
All
services
provided
free
of
charge
40
34.3
100
69.4
34.7
44
HPPI, Vol. 32 (2), 2009
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________________________________
__________
100
Location of House
It was noted that about two
-
thirds of
the adolescents belonged to cities
and most of them were residing in a
government colony or government
approved housing colony. More than
60 per cent of the adolescents were
residing in their own houses with two or
mor
e rooms (Table 3).
Accessibility and Timing
The clients in the AFHS clinics seem to
be more satisfied as far as accessibility
and the timing of the clinics are
concerned. Number of clients who
stated that clinics were easily accessible
was higher for AFHS vis
-
a
-
vis other
OPDs. 45 per cent and 55.6 per cent of
the service seekers in Chandigarh and
Delhi respectively told that it took less
than 30 minutes for them to reach the
respective AFHCs which were higher
than service seekers to othe
r OPDs.
In contrast, more number of service
seekers in other OPDs in Kolkata
(67.3%) took less than 30 minutes than
people visiting AFHC. Also the waiting
time to see the health workers was
lesser in AFHS clinics as compared to
the other OPDs (Table 4).
Cl
inic Environment
The service seekers visiting AFHS
clinics were more satisfied with the clinic
environment than those visiting other
OPDs. It was observed that the waiting
area was more clean, better furnished
and had better lighting in AFHCs than
other OPDs. The toilet facility at the
AFHS clinics was better than the other
OPDs. The AFHS clinics had more
educational material displayed and
those were also of interest to the clients
(Table 5). Responding to the quality of
the waiting areas, not a sin
gle service
seeker in Delhi viewed it as very good
although 66.7 per cent and 33.3 per
cent of the seekers in AFHC and other
OPDs stated it as good. Nobody in
Delhi or Kolkata termed the quality of
toilets in service centres was very good
but 35 per cent o
f the seekers of AFHC
clinic and 11.4 per cent of the seekers
of other OPDs in Chandigarh termed
the toilet quality very good.
AFHS Care Providers
Data findings given in Table 6 reveal
that the care provided at the AFHS
clinics was better than other OPDs. The
care included friendliness of the health
care workers, their readiness to listen to
the patients, quality of the counseling,
readiness to provide the clients with the
required information regarding the clinic
hours,
test to be carried out, follow
-
up
arrangement, etc. More than 95 per
cent of the service seekers both in
AFHCs and other OPDs in all the cities
told that doctors were quite friendly with
them with the only exception for service
seekers availing of service
from other
OPDs in Chandigarh. Cent per cent of
the seekers in Delhi AFHC told that they
got every information on clinic timings,
types of medical services provided,
tests and treatments carried out and
follow
-
up arrangements whereas the
figures were lower
in other AFHC clinics
and OPDs.
Confidentiality at the Clinics
The confidentiality in the AFHS clinics
was found to be more than the other
OPDs. Though the consent of the
parents was required before accessing
the services, the proper confidentiality
is maintained at the clinics. About
95 per cent of the service seekers in
Chandigarh clinics stated that parental
consent was required before accessing
services but it was as low as 2.8 per
cent for the seekers in other OPDs of
Delhi (Table 7). There are s
eparate
private waiting areas for the clients
HPPI, Vol. 32 (2), 2009
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101
TABLE 5
ENVIRONMENT OF CLINICS (%)
Environment of Clinics
Chandigarh
Delhi
Kolkata
AFHC
Others
AFHC
Others
AFHC
Others
Waiting area
is comfortable
Very good
50
34.3
32
10.2
Good
66.7
33.3
p
-
value
(.04)
(.12)
(.003)
Rating of basic
quality of toilet
facilities
Very good
35
11.4
Good
55.6
19.4
16
8.2
p
-
value
(.10)
(.25)
(.000)
Availability of reading health
materials in waiting
55
31.4
55.6
41.7
55.1
12
p
-
value
(.025)
(.32)
(.000)
These materials of interest
35
25.7
33.3
13.9
44.9
8
in the AFHS clinics and also they can
talk to the health workers privately so
that other people could not overhear
what was discussed between the client
and the doctor (p<.05). Confidentiality
and privacy levels were much lesser
in Delhi‘s clinics than Chandigarh and
Kolkata.
Overall Impression and Suggestions
about the Services
The satisfaction level of the clients in
the AFHS clinics was found to be much
better than the other OPDs in all the
three cities. The service seekers lik
ed
the environment and the friendliness of
the staff. The clients of the AFHS clinics
were more satisfied as compared to
their counterparts availing of services
from other OPDs. Clients of AFHS
told that the doctors talked to them
in isolation. The clients
of the AFHS
clinics wanted to come back to the
clinics and also thought that they would
encourage their friends also to avail of
the facilities (p<.05). They suggested
that the services available in AFHCs
should be advertised through media,
peers and friends and publicity sould
also be done through various school
-
targeted programmes (Table 8). The
differences between AFHC and other
clinics were more evident in Chandigarh
and Delhi than in Kolkata.
CONCLUSION
The impact of AFHS clinics was vi
sible
in all the three sites. The clients in the
AFHS clinics seem to be more satisfied
as far as accessibility, timing and time
given to listen to their problems at the
clinics were concerned. Percentage of
clients who said that the clinics were
accessibl
e easily was higher in AFHS
clinics vis
-
a
-
vis other OPDs. The
waiting time to see the health worker
at the clinics was lesser in AFHS clinics
as compared to the other OPDs. The
satisfaction level of the clients in the
AFHS clinics was also much better than
the other OPDs. The confidentiality in
the AFHS clinics was better maintained
than in other OPDs. The clients liked
the environment and the friendliness of
the staff. To improve and expand the
services available in AF
HCs, the clients
HPPI, Vol. 32 (2), 2009
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________________________________
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102
TABLE 6
ADOLESCENT FRIENDLY HEALTH CARE PROVIDERS (% )
Details ofHealth Care Providers
Chandigarh
Delhi
Kolkata
AFHC
Others
AFHC
Others
AFHC
Others
Reception/Registration Counter
70
60
88.9
80.6
95.9
92
Doctor
95
85.7
100
97.2
100
96
Nurse
95
62.9
88.9
58.3
2
36
Felt comfortable in presence of
HW
90
88.6
88.9
75
85.7
96
HW listen carefullyto you
90
82.9
100
88.9
91.8
96
HW explain thingsin a way client
understand
95
74.3
100
94.4
91.8
92
HWgivetimetoaskaboutyour
health problem
80
65.7
88.9
80.6
83.7
96
Time givenfor examination/
counseling
100
100
100
100
100
100
Abletoaskallquestionsyou
wanted to
85
85.7
100
75
79.6
84
Received information on the following
Clinic hours
75
68.6
100
91.7
95.9
92
Typesofmedicalservices
provided
75
62.9
100
86.1
53.1
84
Tests carried out
70
82.9
100
80.6
38.8
84
Treatment
80
82.9
100
86.1
85.7
92
Follow
-
up arrangements
85
80
100
88.9
51
92
Reasonsof
not getting
information
Lack of time
5
31.4
11.1
13.9
8
20.4
Inadequate
staff attitude
11.1
2.8
6.1
Youwere treatedin amanner
you wanted
90
85.7
100
88.9
98
88
Staff respected your opinions
and decisions
55
45.7
88.9
69.4
46.9
76
HPPI, Vol. 32 (2), 2009
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103
TABLE 7
CONFIDENTIALITY AND PRIVACY (%)
Confidentiality and Privacy
Chandigarh
Delhi
Kolkata
AFHC
Others
AFHC
Others
AFHC
Others
Parental consent required
before accessing services
95
94.3
22.2
2.8
63.3
56
p
-
value
(.106)
(.112)
(.105)
Private/separate waiting area
for adolescents
35
2.9
22.2
46.9
44
p
-
value
(.000)
(.036)
(.206)
Client talked with HWs
privately so other people
could not overhear
65
28.6
22.2
2.8
61.2
20
p
-
value
(.000)
(.211)
(.002)
TABLE 8
OVERALL IMPRESSION/SUGGESTIONS (%)
Chandigarh
Delhi
Kolkata
AFHC
Others
AFHC
Others
AFHC
Others
Very much satisfied with
service received
90
65.7
88.9
77.8
80
81.6
p
-
value
(.004)
(.716)
(>66)
Client liked
the best about
service
Environment
65
88.6
88.9
44.4
40
16.3
Staff friendliness
45
22.9
40
46.9
Doctor talked to client separately
90
80
100
27.8
40
42.9
Would come back in future for health
problem
100
77.1
100
80.6
91.8
96
p
-
value
(.007)
(.276)
(.111)
Adolescent would be happy to come
here
20
8.6
44.4
36.1
89.8
92
Client encourage friends to use
these services
100
82.9
100
83.3
63.3
56
Suggestions
for creating
awareness
among
adolescents
about health
facility and
services
Advertise through
media
25
25.7
33.3
36.1
93.9
96
Advertise through
peers and friends
50
54.3
44.4
30.6
32
30.6
Publicize services
to school
25
33.3
30.6
44
32.7
HPPI, Vol. 32 (2), 2009
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104
wanted these services to be advertised
through media, peers and friends and
school
-
targeted programmes.
REFERENCES
1. Adolescent
Friendly
Health
Services Centres Quality and
Access to Health Service: Client’s
Perception: National Institute of
Medical Statistics (2008)
2.
WHO (2002): Global Consultation
on Adolescent
-
Friendly Health
Services: A Consensus Statement.
h tt p : //www. who . in t/c hi l d _
adolescent_health/docu ments/
pdfs/who_fch_cah_02. 1 8.pdf
3.
WHO (2008): Quality Assessment
Guidebook: A Guide to Assessi
ng
of Health Services for Adolescent
Clients.
... Hence, adolescent satisfaction survey should be given equal priority along with the unanimous emphasis on adolescent-friendliness as a central aspect of healthcare for young people to allow monitoring and evaluation of ongoing initiatives aimed to enhance the adolescent-friendliness of health services (Malm, Bishop, Gustafsson, Waenerlund, & Goicolea, 2017). Previous studies had demonstrated good correlation between adolescent satisfaction and level of clinic friendliness (p < 0.05) (Sovd et al., 2006;Yadav, Mehta, Pandey, & Adhikari, 2009). ...
... Policies that ensure services to be provided in places which adolescents can reach and at times which they can get there are crucial to increasing the uptake of services among adolescents and hence making the clinics more adolescent-friendly (McIntyre, 2002). Meanwhile, health facilities designed to be adolescent-friendly with appealing clinic settings, clean toilets, better furnished and lighting, more IEC materials provided were more preferred to be visited by adolescent clients as reported by studies in Malawi and India (USAID, 2014;Yadav et al., 2009). ...
... A study in India showed having separate private waiting areas for adolescent clients allows for greater privacy during consultation. Confidentiality and privacy level were much lesser in conventional clinics as compared to adolescent-friendly clinics in India (Hoopes et al., 2016;Yadav et al., 2009). ...
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A cross-sectional study through clinic assessment and adolescent satisfaction survey was conducted in a Malaysian state to determine the proportion of clinics that provided adolescent-friendly health services, identify the crucial criteria for the provision of adolescent-friendly health services and determine the correlation of adolescent-friendliness level with the satisfaction level of adolescents. Out of 85 clinics, only 35.3% (95%CI: 0.25, 0.46) can be regarded as adolescent-friendly clinics. Large clinics showed significantly [F(2,84) = 13.82, p < 0.001] higher mean score than smaller clinics. Adolescent-friendly clinics had significantly (p < 0.05) higher mean score in 11 of 12 criteria of best practices than conventional clinics. Adolescents were more satisfied with the health services provided by adolescent-friendly clinics than conventional clinics (p < 0.05). There is a significantly (p < 0.05) strong correlation between clinic assessment score and adolescent satisfaction level (r = 0.643). This study provides important insight for the Ministry of Health to strengthen the provision of adolescent-friendly health services in Malaysia.
... While a study from Maharashtra reported that there had been an increase in the number of adolescents seeking clinics for preventive or curative services, [11] the others reported that only a few adolescent girls/young women, and none of the boys/men, utilized the clinics [11,12,26,27]. Clinics attached to medical colleges or hospitals are accessible, clean, and the timings are appropriate [28]. ...
... Services pertaining to resolving queries about physiological changes during adolescence, menstruation-and nutrition-related issues, reproductive tract infections, and skin disorders were sought by adolescents [11][12][13]26]. Quite often, privacy and confidentiality are maintained in clinics, [13,28] but it is still breached in many places [26]. However, providers lacked comprehensive knowledge about the management of adolescent health problems, and their adherence to protocols or guidelines was lacking [13]. ...
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Frontline workers are instrumental in bridging the gap in the utilization of maternal health services. We performed a qualitative cross-sectional study with medical officers, accredited social health activists (ASHA), and auxiliary nurse midwifes (ANM), across 13 districts of India, in order to understand the barriers and enablers, at the system and population levels, for improving access of adolescents and mothers to services. The data were collected by means of in-depth interviews (IDI) with medical officers and focus group discussions (FGD) with ASHA and ANM in 2016. The interview guide was based on the conceptual framework of WHO health interventions to decrease maternal morbidity. Content analysis was performed. In total, 532 frontline workers participated in 52 FGD and 52 medical officers in IDI. Adolescent clinics seemed nonexistent in most places; however, services were provided, such as counselling, iron tablets, or sanitary pads. Frontline workers perceived limited awareness and access to facilities among women for antenatal care. There were challenges in receiving the cash under maternity benefit schemes. Mothers-in-law and husbands were major influencers in women’s access to health services. Adolescent clinics and antenatal or postnatal care visits should be seen as windows of opportunities for approaching adolescents and women with good quality services.
... Dedicated adolescent waiting area, separate building from adult health services and private room for consultation were among the described features of adolescent-friendly clinics in previous studies (Dagnew et al., 2015;Mulugeta et al., 2019;Sovd et al., 2006). Besides physical clinic's setting, healthcare providers in other countries cited the need of convenient working hours to deliver health services to adolescents (Sovd et al., 2006;Yadav et al., 2009). All these settings are crucial to ensure adolescent clients are highly satisfied with the services provided in clinics (Sovd et al., 2006;Yadav et al., 2009). ...
... Besides physical clinic's setting, healthcare providers in other countries cited the need of convenient working hours to deliver health services to adolescents (Sovd et al., 2006;Yadav et al., 2009). All these settings are crucial to ensure adolescent clients are highly satisfied with the services provided in clinics (Sovd et al., 2006;Yadav et al., 2009). Satisfaction level of adolescents will determine the outcome of health services utilization in which higher satisfaction level will increase utilization of services (Awang et al., 2020c). ...
Article
Adolescent health services are often misperceived as less important scope of health services, hence, diminishing the rights of adolescents to have optimal healthcare services. Inputs on perceptions regarding adolescent health services would facilitate policy makers in improving the quality of healthcare services delivery to adolescent clients attending health facilities. This qualitative study aimed to explore the perceptions of healthcare providers regarding adolescents and adolescent health services in Malaysian setting through in-depth interview. A descriptive, phenomenological approach was employed as the method of inquiry. Thematic analysis was used to evaluate the data. From this study, respondents perceived adolescents as healthy, thus, less important compared to other group of population. Adolescent health services were perceived as a demanding scope of health service; requiring considerable time and specialized clinic settings. Healthcare providers also believed that adolescent health services are crucial yet overlooked, with various management issues such as short-staffed, lack of promotion, budget, and monitoring which hamper its progress. In conclusion, healthcare providers in this study have some negative perceptions toward adolescents and their health services. Improving clinics work processes and setting, allocating more staff and training sessions, gaining more political will and strengthening adolescent-friendly health services are recommended to improve healthcare providers' perceptions toward adolescent health services.
... 4 October- December , 2020 197 to adolescent health. 9,20,28,29 Therefore, the aim of this study was to assess the infrastructure, supplies and preparedness of the existing health centres in central India to deliver AFHS and to evaluate the fruitfulness of the RKSK programme. ...
... Yadav et al 29 have stressed upon the importance and the role of good physical environment and adequate waiting space in increasing uptake of services from these facility. ...
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Background-There is a need to address adolescents' reproductive and sexual health needs, which is not looked upon very well in India. To fulfill this aim, the concepts of the Adolescent Friendly Health Services were applied to all levels of the healthcare systems of the country. Objectives-To assess the infrastructure and preparedness of the health facilities to deliver adolescent friendly health services (AFHS) in central India. Methods-Data was gathered by visiting 30 secondary and tertiary level health facilities to assess their infrastructure and preparedness for providing AFHS using a pre-designed questionnaire based on WHO guidelines for assessing AFHS and Indian Public health standards (IPHS). Analysis was done using SPSS v21 and Microsoft Excel. Result-Most of the healthcare facilities in all the study districts were not yet perfectly ready to deliver the AFHS in Madhya Pradesh. Most physical infrastructure and preparedness to ensure privacy and confidentiality was better in health facilities in the districts where Rashtriya Kishor Swasthya Karyakram (RKSK) was launched, but with no statistically significant difference. Conclusion-The launch of RKSK neither resulted in substantial improvement in the health facilities with regards to the infrastructure for the provision of AFHS, nor the general preparedness of the facilities.
... Adolescence is a period of opportunities; provides an opportunity for measures to be taken to ensure a healthy adult life (World Health Organization, 2012). It is also a period of risk which is marked by exploration and trialing (Yadav, Mehta, Pandey & Adhikari, 2009). Young people tend to take risks and/or adopt risky sexual and reproductive health behaviours including unprotected sex engagement that expose them to unwanted pregnancy, unsafe abortion, sexually transmitted infections and HIV, and others that dispose them to future ailments (World Health Organization, 2012). ...
... Nevertheless, young people tend to lack the knowledge and skills on reproductive health and access to health services which is cheap and private, and besides are unable to talk about reproductive health issues with their parents (Motuma, Syre, Egata, Kenay, 2016). For instance, there is misunderstanding surrounding their wants, fear of lack of privacy over the revelation of sexual activities, and off-putting attitudes of health professionals which limits young people to access reproductive health services (Yadav et al., 2009). ...
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Background The utilization of reproductive health services among high-risk youth populations is low in developing countries. This study was aimed at assessing the sexual behaviours, and utilization of youth-friendly health services (YFHS) and its factors among urban youth in Ghana. Method This was a cross-sectional study that employed a structured questionnaire to interview 403 youth aged 15–24 years in the Accra Metropolitan area of Ghana. Logistic regression analyses were conducted to examine the relationship between the utilization of YFHS and independent variables. Results The mean age of the respondents was 18.3 ± 2.5 years. Approximately half of the youth were sexually active (50.4%), and 77.3% of them initiated sex after 15 years. Sexual debut was mostly consensual (94.6%), without the use of condoms (66%). Current contraceptive use was low (35%), and only 10.3% had multiple sexual partners. Awareness (25.1%) and the utilization (7.9%) of YFHS were low. Multiple regression analysis revealed awareness or knowledge about YFHS (OR = 55.93; 95% CI = 12.32–253.88) and perceived expensive cost of YFHS (OR = 0.10; 95% CI = 0.01–0.87) were significantly associated with the use of YFHS by the youth. Conclusion Contraceptive use and the utilization of YFHS were low among this urban youth. Awareness or knowledge about YFHS corner and its services and the cost of YFHS influenced the utilization of the YFHS among the youth. Evidence presented by the study is important to guide the development of health policy and interventions on addressing the gaps in the provision of sexual and reproductive health services among young people in Ghana.
... Again the findings highlight the fact that the impact of the RKSK programme has not been successful. 16 Significant areas where additional training was needed were communication, counseling and ARSH as reported by another study. 11 Understandably, the trained providers who knew about GATHER approach listened attentively to the client as compared to where the services were delivered by clinical providers, which makes a case for improving and expanding the scope of training and placement of trained providers in all health care facilities. ...
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Despite existing frameworks for the improvement of adolescent reproductive health, there is a lack in the provision of the Adolescent Friendly Health Services (AFHS). The primary objective of this study was to assess the quality and proficiency of service providers to deliver Adolescent Friendly Health Services (AFHS) in central India. Data was gathered by visiting 30 secondary and tertiary level health facilities to assess their infrastructure and preparedness for providing AFHS using a pre-designed questionnaire based on WHO guidelines for assessing quality. Descriptive analysis was done using SPSS v21 and Microsoft Excel. The quality of AFHS services was found to be poor in non-RKSK facilities. However, the knowledge level, training status, and counseling skills of the service provider were found to be highly substandard in both RKSK and Non-RKSK facilities. The RKSK program has not been properly implemented and has failed to make an impact where it was required.
... Various evaluations conducted from time to time have documented their uneven distribution, suboptimal quality of services provided at these clinics, and limited utilization by adolescents. [8][9][10][11] An evaluation of AFHCs in Bangladesh also showed very limited public awareness about AFHCs, more so among the target group. [12] The model tested for strengthening selected high caseload AFHCs emerged as a successful approach and results have shown that a model with a comprehensive strategy, ensuring facility readiness, capacity building of service providers, mentoring support, and periodic review of progress can contribute toward improvements in the AH service delivery. ...
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Background India has been at the forefront of designing adolescent health (AH) policies. The National Adolescent Reproductive and Sexual Health policy (2006), the Reproductive, Maternal, Newborn Child, and AH strategy (2013), and the “Rashtriya Kishor Swasthya Karyakram (RKSK)” (2014) have been the critical milestones in this direction. However, despite policies being available, the AH outcomes need improvement through operationalization of focused and need-based AH interventions. Objectives The objectives of this study were to improve services for RKSK interventions across select geographies of India. Materials and Methods USAID's VRIDDHI Project has been providing technical support at the national level and in six focus states to improve uptake of evidence-based high-impact reproductive, maternal, newborn, child, and AH interventions. To improve AH services and outcomes, two approaches were implemented, namely (a) strengthen the functioning of adolescent-friendly health clinics in 95 high caseload health facilities in 26 high priority districts across six states and (b) demonstrate other operational strategies outlined in RKSK program including strengthening of district committees on AH, undertaking formative research for developing adolescent-focused communication strategy, and operationalizing weekly iron and folic acid supplementation program. Results As a result of ongoing technical support over 2-year period (January 2016–December 2017), improvements were noted across multiple AH indicators. In addition, evidence-based learnings were also generated from the demonstration models for potential scale up to other geographies. Conclusion The project was successful in improving AH services in the intervention facilities through an integrated approach which is replicable, sustainable, and scalable for driving the AH program in India.
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The Adolescent Friendly Health Clinic (AFHCs), a key component of the Government of India’s National Adolescent Health Programme a.k.a. Rashtriya Kishor Swasthya Karyakram (RKSK), aims to increase the accessibility and utilization of sexual-reproductive health services by adolescents and youth. However, low quality of care provided at AFHCs by counsellors calls for attention. We, thus, explore both the clients’ and providers’ perspectives using the World Health Organization’s (WHO) global standards for quality health-care services for adolescents to assess the quality of the sexual reproductive health service delivery at AFHCs in Rajasthan, India. We conducted a qualitative study, comprising observation of the service delivery using mystery clients (MCs) (n = 12) and in-depth interviews with the counsellors (n = 4) in four AFHCs. Interviews were transcribed in local language and were translated in English. The transcripts were coded thematically. Our study, using five of the eight WHO global standards for quality health-care services for adolescents highlighted several gaps in the quality-of-service delivery at AFHCs. We unearth various intricacies related to the quality of the services provided at the AFHCs by referring to the relevant input, process, and the output criteria of WHO global standards I, III, IV, V and VI. Our study calls for efforts to improve- (i) the counsellors’ competencies to increase adolescents’ health literacy on sensitive topics, (ii) the facilities at the clinic to ensure privacy, comfort and confidentiality of the adolescents seeking services, (iii) the referrals to improve appropriate package of services, and (iv) an overall environment to ensure an equity and non-discrimination for all the adolescents. Our findings unearth the barriers that both the service providers and the adolescents face at the AFHCs and underscore the need for regular monitoring and evaluation of the AFHCs to strengthen the facility-based intervention of the RKSK programme.
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Global Consultation on Adolescent-Friendly Health Services: A Consensus Statement
WHO (2002): Global Consultation on Adolescent-Friendly Health Services: A Consensus Statement. h tt p : //www. who. in t/c hi l d _ adolescent_health/docu
Quality and Access to Health Service: Client's Perception: National Institute of
Quality and Access to Health Service: Client's Perception: National Institute of Medical Statistics (2008)
Quality Assessment Guidebook: A Guide to Assessing of Health Services for Adolescent Clients
WHO (2008): Quality Assessment Guidebook: A Guide to Assessing of Health Services for Adolescent Clients.