Abstract
BackgroundHealth 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.MethodsA 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 Organisation criteria for ten AYFS standards.ResultsMean 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.ConclusionFacilities 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.
Highlights
Health services for adolescents are increasingly recognised as a priority in low- and middle-income countries (LMICs)
Improving the quality of health services tailored to the needs of urban and peri-urban adolescents, has the potential to address some of the challenges resulting from rapid urbanisation, health transitions and the burden of disease associated with adolescent engagement in risk behaviours [5]
Standards required for AYFS recognition (1, 3, 4, 6 and 10) Tables 1 and 2 highlight the scores for the five standards that need to be achieved for AYFS recognition for each of the facilities in both provinces
Summary
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. Risk behaviours in adolescence contribute substantially to the global burden of disease and it is recognised, that over the past fifty years there has been minimal improvement in adolescent health overall [1]. Improving the quality of health services tailored to the needs of urban and peri-urban adolescents, has the potential to address some of the challenges resulting from rapid urbanisation, health transitions and the burden of disease associated with adolescent engagement in risk behaviours [5]. For all adolescents, those using public health care services, interventions are urgently needed that address risk behaviours and their consequences including sexual and reproductive health (SRH) outcomes. A detailed understanding is needed of the factors explaining adolescent health outcomes, including the physical environment, social context, and the availability and access to social and health services [6]
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