Adolescent and youth friendly services: Are Sexual and Reproductive Health services that are accessible, acceptable appropriate, effective and equitable for adolescents and youth.
Assessment of adolescent and youth-friendly services in primary healthcare facilities in two provinces in South Africa
Abstract
Background: Health services for adolescents are increasingly recognised as a priority in low- and middle-income countries (LMICs). The Adolescent and Youth Friendly Service (AYFS) approach has been promoted in South Africa by the National Department of Health and partners, as a means of standardising the quality of adolescent health services in the country. The objective of this paper is to detail the evaluation of AYFS against defined standards to inform initiatives for strengthening these services.
Methods: A cross-sectional assessment of AYFS was carried out in 14 healthcare facilities in a sub-district of Gauteng Province and 16 in a sub-district in North West Province, South Africa.
Data on adolescent care and service management systems were collected through interviews with healthcare providers, non-clinical staff and document review. Responses were scored using a tool based on national and World Health Organization criteria for ten AYFS standards.
Results: Mean scores for the ten standards showed substantial variation across facilities in the two sub-Districts, with Gauteng Province scoring lower than the North West for 9 standards.
The sub-district median for Gauteng was 38% and the North West 48%. In both provinces standards related to the general service delivery, such as Standards 4 and 5, scored above 75%. Assessment of services specifically addressing sexual, reproductive and mental health (Standard 3) showed that almost all these services were scored above 50%.
Exploration of services related to psycho-social and physical assessments (Standard 8) demonstrated differences in the healthcare facilities’ management of adolescents’ presenting complaints and their comprehensive management including psycho-social status and risk profile. Additionally, none of the facilities in either sub-district was able to meet the minimum criteria for the five standards required for AYFS recognition.
Conclusion: Facilities had the essential components for general service delivery in place, but adolescent-specific service provision was lacking. AYFS is a government priority, but additional support for facilities is needed to achieve the agreed standards.
Meeting these standards could make a major contribution to securing adolescents’ health, especially in preventing unintended pregnancies and HIV as well as improving psycho-social management.
Keywords: Adolescent and youth health services (AYFS); Adolescents; South Africa.
WHY AYFS?
• Adolescents and youth are at risk of long term ill-health due to behaviours and choices that they make during these years
• They are at increased risk of STIs, HIV and unintended pregnancy (all associated with negative impact on school attainment)
• Regardless of our own values, beliefs and desires, many young people are sexually active and require access to quality HIV, STI and pregnancy prevention services
• Adolescents living with HIV account for the highest rate of deaths among all living with HIV; we need to work to keep them engaged in services and taking their ART
• We need to work to prevent illness as well as provide treatment services to those who need them.
ADOLESCENT AND YOUTH-FRIENDLY SERVICES – ESSENTIAL SERVICE PACKAGE
EDUCATION AND COUNSELLING ON SEXUALITY, SAFER SEX AND REPRODUCTIVE HEALTH
STI EDUCATION, DIAGNOSIS AND MANAGEMENT, INCLUDING PARTNER NOTIFICATION
HIV EDUCATION, COUNSELLING AND TESTING; HIV TREATMENT, CARE AND SUPPORT SERVICES
CONTRACEPTIVE EDUCATION AND PROVISION WITH AN EMPHASIS ON DUAL PROTECTION METHOD
PREGNANCY SERVICES INCLUDING TESTING, ANTENATAL AND POSTNATAL CARE, AND EMTCT (ELIMINATION OF MOTHER TO CHILD TRANSMISSION) OF HIV
TB EDUCATION, COUNSELLING AND TESTING; TB TREATMENT, CARE AND SUPPORT SERVICES INCLUDING INH PROPHYLAXIS
PRE AND POST TOP (TERMINATION OF PREGNANCY) COUNSELLING AND REFERRAL WHERE NECESSARY
SEXUAL EXPLOITATION, VIOLENCE AND ABUSE EDUCATION AND COUNSELLING, AND REFERRAL FOR RELATED SERVICES
MENTAL HEALTH EDUCATION AND COUNSELLING, AND REFERRAL FOR RELATED SERVICES
COMPREHENSIVE PREVENTION APPROACHES, INCLUDING VMMC (VOLUNTARY MEDICAL MALE CIRCUMCISION), TB AND HIV INTERVENTIONS
AYFS STANDARDS IN SOUTH AFRICA
Management systems are in place to support the effective provision of health services for young people.
The clinic has policies and processes that specifically support the rights of young people.
Appropriate health services are widely available and accessible.
The clinic has a physical environment conducive to the provision of youth-friendly services.
The clinic has the drugs, supplies and equipment necessary to provide the AYF essential service package.
Information, educational sessions and other communication services promoting young people’s healthy behaviour is provided.
Systems are in place to train all staff to provide effective and friendly health services to young people.
Young people receive adequate psychosocial and physical assessments.
Young people receive individualized care based on standard case management guidelines/protocols.
The clinic has mechanisms in place that ensures continuity of care for young people
AYFS 11 implementation steps
Ensure management support is strong
Hold an AYFS orientation workshop
Ensure community support is strong
Establish an AYFS Team and select a Team Leader (Champion)
Conduct AYFS Team meetings
Conduct a baseline AYFS appraisal
Measure AYFS Standards and Criteria
Implement AYFS services and quality improvements
Monitor and evaluate AYFS
Conduct subsequent AYFS appraisals
Apply for AYFS recognition/accreditation
What are characteristics of youth friendly services In South Africa?
✓ Youth feedback is sought and incorporated continuously. ✓ Affordable fees. ✓ Boys and young men were welcomed and served.
✓ Familiarity with adolescent physiology and development. ✓ Knowledge of appropriate medical options for adolescents according to age and maturity.
✓ Convenient location. ✓ Adequate space.
What are the components of Adolescent friendly health services In South Africa?
Counselling. a. Sex and sexuality AND.
Contraceptives. a. Counselling, AND.
Safe abortion care. At least one of a.
RTIs/STIs. a. At least one RTI/STI treatment method, OR b.
HIV. a. Pre- and post-test counselling, AND.
Gynaecology. a.
Prenatal and postnatal care. a.
Sexual and gender-based violence. a.
What is Adolescent Health and development program In South Africa?
The Adolescent Health and Youth Development Program (AHYDP) is POPCOM’s response to the growing awareness worldwide on the reproductive health issues and concerns of the youth and their significant contribution to future population and health trends.
What Should adolescents do In South Africa?
During adolescence, children develop the ability to: Understand abstract ideas. These include grasping higher math concepts and developing moral philosophies, including rights and privileges. Establish and maintain satisfying relationships.
What solutions will you suggest for adolescent to overcome these challenges In South Africa?
The following tips will help you to do just that:
Know your values. Your values are what you believe in, what you think is right or wrong, and what is most important to you. …
Draw up a plan for your life.
Develop yourself.
Have a role model.
Make decisions.
Be Assertive.
Learn a Skill.
Take advantage of holiday periods.
How do teens deal with adolescence In South Africa?
7 Keys to Handling Difficult Teenagers
Avoid Giving Away Your Power
Establish Clear Boundaries.
Utilize Assertive and Effective Communication.
When Dealing with a Group of Difficult Teens, Focus on the Leader.
In Mild Situations, Maintain Humor and Show Empathy.
Give Them a Chance to Help Solve Problems (If Appropriate)