Use of specified sexual and reproductive health services by young people
The use of specified sexual and reproductive health (SRH) services by young people can be measured through either facility-based records (measuring service utilization only) or population-based methods such as surveys (which can give an estimate of the coverage of health services) (WHO, 2007).
Health services of particular interest include those concerned with HIV counseling, testing, and treatment; diagnosis and treatment or sexually transmitted infections (STIs); and counseling, provision, and referrals for contraceptives. Evaluators may wish to specify other SRH services, including prenatal care, male circumcision services, counseling and treatment for victims of rape or sexual assault, abortion or postabortion care, treatment for obstetric fistula, etc.
This indicator generally refers to the use of facility-based SRH services only, however evaluators may choose to include SRH service provision from peer providers or community health workers.
At the facility level this indicator is calculated as:
(Number of young people aged 10-24 using an SRH service, disaggregated by service received, in a defined period / Total number of all clients using a specified SRH service in a defined period) x 100
At the population level this indicator is calculated as:
(Number of young people aged 10-24 who report receiving any of the specified SRH services in the preceding 12 months / Total number of young people surveyed who report being sexually in a defined period) x 100
Facility-based data requires the total number of clients who sought specified SRH services in a given reporting period and the percentage of these clients who are aged 10-24. Population-base data requires the number of young people reporting use of specified SRH services in the past year and the number who report having been sexually active in the past 12 months.
For both, data can be disaggregated by gender, age groups (10-14, 15-19, 20-24), in or out of school, marital status, urban/rural location and type of facility (WHO, 2007).
Evaluators may want to disaggregate by the following age ranges: 10-14, 15-19, and 20-24.
Routine facility-based data collection; DHS or other nationally representative general population survey
This indicator tracks the number of young people seeking health services as an indication of care-seeking behavior, since such utilization appears to be low compared to the need (WHO, 2007). It also tracks the percent of all clients of health services who are young people and can be an estimate of the changes in care-seeking behavior among young people. Young people do not access health services in proportion to the health problems they experience (WHO,2004). A basic aim of an HIV/AIDS prevention program, therefore, is to increase the use of services by young people, specifically for STI testing and treatment, contraceptive use, and HIV counseling, testing and treatment.
Generally, an increase in the number and proportion of young clients is considered positive. However, the number and percentage must be interpreted together, as the percentage of clients who are young people may decrease if the overall use of SRH services by adults increases, even though the number of young clients may be increasing as well (WHO, 2004).
The correct interpretation of these numbers, moreover, requires some population-based estimates to understand the magnitude of need in order to interpret increases or decreases in specific services used. For example, if it is known that 40% of the population served by a particular health service are young people aged 20–24, and that in this population the prevalence of Chlamydia is 20%, an estimate can be obtained of the maximum number and percent of young clients who could, ideally, be expected to seek STI testing and treatment. In other words a ceiling is provided against which to gauge the increase or decrease in young clients(WHO, 2004).
At the population level this indicator estimates the proportion of sexually active young people who report seeking specified SRH services. In addition, if data are available on the proportion of young people in need of specific SRH services, either through epidemiological estimates or other surveys, this measure can be an estimate of the coverage of the specific health services. For example, if it is known that in a given region 50% of 15−19 females are sexually active; this provides a benchmark against which to gauge the number and percent of females aged 15−19 years that would theoretically need contraceptives. If more details are known about sexual risk behaviors (e.g. if, of the 50% who are sexually active, 40% report being with more than one partner in the preceding year and only 30% report frequent use of condoms) they can be benchmarks for the percent of girls aged 15-19 who would potentially need HIV testing services (WHO, 2004).
An increase in the number of young people seeking services does not necessarily mean an increase in the percent of young people with SRH needs or issues. The increase may well be attributable to other factors, such as an information campaign advertising the services or a health promotion program that enables more young people to recognize the need for preventative or curative services, e.g. to recognize the symptoms of an STI or to increase the demand for contraceptives. Changes in health seeking behavior are often attributed to changes in health policy as well, such as the instatement or removal of user fees.
A challenge with tracking this indicator is that it depends on facilities having well-maintained and accurate records and logbooks, including age-specific records or at least records in age brackets allowing for disaggregation of young people from adults (WHO, 2004). In many countries there may be no such records, or the recording of services in facilities may not be standardized. Furthermore, clients themselves may not know their exact age. Even where well-maintained clinical records exist, the way in which the information is recorded may limit the ability to collect data for this indicator. Clients may seek multiple services at one visit and where services are not integrated, frequently the record keeping is decentralized, leading to problems in double counting. For example, they may come to a facility for flu like symptoms, but also receive SRH services in addition, and thus the reason for the visit may not reflect the use of SRH services.
Moreover, the measurement of service utilization provides no information about the quality of services. In order to obtain a better understanding of the trends observed in utilization, these data should be complemented by measuring the quality and effectiveness of SRH services with additional indicators on Quality of Care/Service Provision Assessment.
sexually transmitted infection (STI), family planning, HIV/AIDS, adolescent, behavior
Young women’s access to and use of SRH services may be limited by cultural gender norms and related barriers. Less mobility, fewer resources to pay for health services, and stigma associated with being a sexually active adolescent, and visiting facilities that offer HIV services may all contribute to young women not accessing care. Further, lack of female health care providers and or providers trained in youth-friendly services may deter women from accessing services. Young men may also be less likely to access services due to social norms around masculinity and not having a self-identified need.
World Health Organization, 2004. National AIDS Programmes: A guide to indicators for monitoring and evaluating national HIV/AIDS prevention programmes for young people.
World Health Organization, 2007. Introduction Access to Health Services for Young People for Preventing HIV and Improving Sexual and Reproductive Health.