Regional Report: Assessment of Adolescents and Youth-Friendly Health Service Delivery: East and Southern Africa
The Assessment of Adolescent and Youth-Friendly Health Services in the East and Southern Africa Region (2015-2017) was undertaken with the purpose of: conducting a review of existing adolescent and youth-friendly health services (AYFHS) guidelines, protocols and standards, and assessing how they are implemented in 23 countries of the East and Southern Africa (ESA) region. The specific objectives were to:
• Review AYFHS guidelines and standards in 23 ESA countries against World Health Organization’s (WHO), International Planned Parenthood Federation’s (IPPF) and other international standards developed and used in the public health, private and non-for-profit health systems.
• Assess the status of AYFHS implementation in the ESA region, how guidelines and standards are being applied to improve quality and coverage of services, and both negative and positive factors affecting provision of services.
• Identify and document promising practices for the implementation of the AYFHS guidelines and standards in selected countries.
• Based on the findings above, provide recommendations for improving and scaling up AYFHS in the ESA region.
The assessment used a mixed methodology with a literature review of published, academic and grey literature on AYFHS; stakeholder meetings with key informants from ministries of health, non-governmental organisations, civil society organisations, youth serving organisations, IPPF Member Associations, and the United Nations Population Fund (UNFPA) country offices; quantitative interviews with health service providers in selected health facilities, and client exit interviews with adolescents and young people aged 15-24 years at the selected health facilities; qualitative focus group discussions (FGDs) with young potential male and female service users (15-24 years) from the catchment areas of the selected health facilities, young peer educators, and adult outreach workers; and observations of operations and set up of selected health facilities.
The Assessment covered 23 countries in the ESA region: Angola, Botswana, Burundi, Comoros, Democratic Republic of Congo (DRC), Eritrea, Ethiopia, Kenya, Lesotho, Madagascar, Malawi, Mauritius, Mozambique, Namibia, Rwanda, Seychelles, South Africa, South Sudan, Swaziland, Tanzania, Uganda, Zambia, and Zimbabwe. In-country studies were conducted in 12 of these countries from November 2015 to January 2016 (i.e., Burundi, Comoros, DRC, Ethiopia, Kenya, Lesotho, Madagascar, Mozambique, Swaziland, Uganda, Zambia, and Zimbabwe). The total health facility observations, including interviews with managers, were 146. The total number of heath service providers interviewed were 146. The total number of young exit clients interviewed were 969.
Key findings are:
The national policies, standards and guidelines on AYFHS of 23 countries were compared with the WHO Global Standards for quality healthcare services for adolescents (2015). The key findings on the policy and legislative framework were that almost all the countries have specific policies or strategies on adolescent and/or youth health, especially sexual and reproductive health (SRH). The policies, strategies or guidelines of at least 14 countries adopt a rights-based framework or refer to young people’s rights. Guidelines and/or standards for AYFHS delivery were found in 19 of the 23 countries studied: all 19 countries had a standard on providers’ competencies; 17 countries had a standard on the appropriate package of services; 16 countries had standards on adolescent’s health literacy, community support, facility characteristics, and data and quality improvement; 15 countries had standards on adolescents’ participation; and only 13 countries had standards on equity and non-discrimination.