Percent service delivery points providing youth friendly services
This indicator is a composite index measuring whether reproductive health services are “youth friendly.” Services are “youth friendly” if they “have policies and attributes that attract adolescents to the facility or program, provide a comfortable and appropriate setting for youth, meet the needs of adolescents, and are able to retain their adolescents for follow-up and repeat visits” (Senderowitz, 1999). Aspects of an “adolescent friendly” environment can include space or rooms dedicated to ARH services, policies and procedures to ensure privacy and confidentiality, peer educators on site, nonjudgmental staff, and acceptance of drop-in clients.
Evidence as to whether reproductive health services satisfy standards for being “youth friendly.” The following characteristics make facilities/services “youth friendly:”
- Facility hours are convenient for adolescents;
- Facility location is convenient for adolescents;
- Facility has adequate space and sufficient privacy;
- Facility has comfortable surroundings for adolescents;
- Staff have been specially trained to work with or to provide services to adolescents;
- Staff treat adolescent clients with respect;
- Staff honor privacy and confidentiality of adolescent clients;
- Staff allow adequate time for adolescent client and provider interaction;
- Peer counselors are available on site;
- Young male clients are equally welcomed and served as young female clients are;
- Group health discussions are available;
- Necessary referrals are available;
- Service fees are affordable for adolescent clients;
- Drop-in clients are welcomed, and appointments are arranged rapidly;
- A wide range of reproductive services are available;
- Educational materials are available on site for clients to take home;
- Adolescents perceive that they are welcome regardless of their age and marital status; and
- Adolescents perceive that providers will be attentive to their needs.
Evaluators create this index by assigning a score to each item: 2 points for complete fulfillment of the condition, 1 point for partial fulfillment of the condition, and 0 for lack of fulfillment. Evaluators may derive a total facility score if they first sum the item scores and then divide that result by the total number of points possible (Nelson, MacLaren, and Magnani, 2000).
Facility records; facility inventories; interviews with adolescent clients, providers, and managers at clinics; client exit interviews; interviews of youth in the community
Because reproductive health services in most settings have been designed for older, married women, unmarried female and male adolescents face a variety of barriers to service use. Among these are policies that restrict their access to services and information, negative community attitudes toward providing reproductive health services to unmarried adolescents, adolescent embarrassment at being seen at facilities, and fear that the facility will not honor privacy and confidentiality.
To overcome these barriers, a number of service-providing organizations have sought to make their services more “youth friendly.” By offering more youth-friendly reproductive health services, programs may effectively attract young people and may provide quality reproductive health services in a comfortable and responsive environment. Adolescents can receive services in a health facility, such as a clinic, health post or hospital, from trained personnel who provide services in a workplace or school setting, through community outreach workers or peer educators. Regardless of the venue, services must have special characteristics that attract, serve, and retain adolescent clients.
This indicator is most appropriate for assessing facilities and services that were not specifically designed for adolescents (such as a family planning clinics, health posts, or pharmacies), because adolescent facilities were presumably designed with the characteristics of adolescent friendliness in mind. However, this indicator can also monitor the adolescent friendliness of adolescent-centered facilities over time. For example, after a baseline assessment, the program manager may plan to make changes in services over the next 6 months and may allow those changes to become part of the service-delivery protocols over the next 12 months. The program manager may then decide to undertake a follow-up assessment 18 months later to determine if the changes occurred. The follow-up assessment should measure the same characteristics it measured in the initial assessment.
The Pathfinder International-developed Rapid Assessment of Youth Friendly Reproductive Health Services (2003) can be used for the initial assessment. If a facility wishes to quantify its status as one that provides youth friendly services, the Certification Tool for Youth Friendly Services (Pathfinder, 2004) can be used.
access, health system strengthening (HSS), adolescent