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Rationale There is growing recognition among reproductive health providers worldwide that youth-friendly services (YFS) are needed if young people are to be adequately provided with reproductive health care. Such services are able to effectively attract young people, comfortably and responsively meet their needs, and succeed in retaining these young clients for continuing care. Whether services are provided in a clinical setting, in a youth-oriented site or program, at a workplace or through outreach to informal venues, certain youth-friendly characteristics are essential for effective programming. Basic components of YFS include specially trained service providers, privacy, and confidentiality, and accessibility. [Click here for Characteristics of Youth-Friendly Services checklist.] Definition Provider characteristics, especially negative attitudes and a lack of the skills necessary for working with young people, can pose a strong barrier to adolescent use of reproductive health (RH) services. Thus, special training of staff is an essential program requirement. Clinic (or program) assessments to identify the status of other characteristics is an important preliminary action for quality improvement, as specific technical assistance can then be provided to help programs improve their youth-friendliness. As part of any plan to achieve this, young people should be involved and surveyed in order to help determine specific needs and preferences for service provision. Youth can also help publicize clinic or program offerings, recruit clients, and participate in providing education and counseling. A minimum package of youth-friendly RH services typically includes: information and counseling on sexuality, safe sex and reproductive health; contraception and protective method provision with an emphasis o dual protection; diagnosis and management of sexually transmitted infections (STIs); IV counseling and referral for testing and care; pregnancy testing and ante- and post-natal care; sexual violence and abuse counseling, with referral for needed services; and post-abortion care, counseling and contraception (with referral when necessary). To the extent that any service cannot be provided on-site, an effective referral system to external youth-friendly sites should be established. As much as possible, referrals should also be made for additional youth needs identified in needs assessments. Strategic Approaches In view of AYA's limited time and financial resources, it is advisable to work with existing facility-based RH services to make them more youth-friendly, rather than creating new services. In most countries, extensive RH services already exist, and these could, with appropriate adaptation, potentially serve youth needs. With regard to outreach services, an analogous approach should be grated onto existing youth activities or venues. Youth-friendly approaches can also be incorporated into private sector services and commercial sector offerings. At the same time, it should be recognized that the primary method for prevention of both STIs (including HIV) and pregnancy is the condom, which should be made available in diverse settings in addition to clinics. Condom availability and distribution in the community, at social ,recreational, educational and entertainment venues, therefore, is a priority approach for youth reproductive health. Linkage to Other Program Areas Linkages with AYA partners are essential to successful expansion of YFS availability, access and use. Policies must foster YFS provisions, backed by a supportive community and program environment. Young people must understand why they can benefit from RH services, learn where services are available, and feel assured that the services they seek will be appropriate for their needs and that providers will treat them with respect and confidentiality. Scaling-Up Scaling-up signifies significant program expansion to reach large proportions of the target audience. Thus, if scaling-up is a program objective, existing networks capable of such reach must be selected for program partnership. Given the institutional structures that already exist, Ministry of Health networks are often obvious partners for such expansion, and in some countries, family planning associations and/or other nongovernmental organizations have the potential to reach sizable numbers of adolescents. In certain instances, organizations with more limited reach can also be used to test innovative approaches that can be later adopted by larger networks. Mechanisms of Sustainability Efforts must be employed that foster sustainable activities that will continue beyond the life of the project and should include the incorporation and systematization of youth-friendly approaches into existing programs. One essential objective that should be pursued in all AYA countries is the effective incorporation of pre-service training into all countries' institutional programs for educating service providers. Evaluation Methods for Assessing Program Interventions Evaluation of YFS has been limited, with mixed results. The few rigorous evaluations completed to date find modest impacts, although less rigorous evaluations and process-level data suggest that well-designed programs can successfully attract and serve young clients. Evaluations of youth centers in which multiple program offerings are provided have consistently shown poor results, attracting few RH clients and requiring significant resources. The challenge for adolescent reproductive health programmers is to create a youth-friendly environment that can attract young people for needed RH services. Methods that will be used to assess YFS implementation and effectiveness include: collection and analysis of service statistics, provider interviews, client exit interviews, mystery client assessments, pre- and post-intervention clinic and non-static service delivery assessments, immediate post-training and application assessments, and population-based surveys. |
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