Abstract:
Background: Adolescents worldwide face considerable challenges to their sexual and reproductive health and rights. Adolescent and youth-friendly services (AYFS) is an evidence-based public health intervention to reduce youth sexual and reproductive health problems. However, there is an evidence gap in its implementation with required comprehensiveness. Hence, the study’s main objective is to assess the quality of the public primary healthcare facilities to provide youth-friendly reproductive health services to young people in relation to standards for adolescent-friendly public health centers in Addis Ababa, Ethiopia.
Objectives: The main aim of this study is to assess the quality of the public primary healthcare facilities to provide youth-friendly reproductive health services to young people in relation to standards for adolescent-friendly facilities in Addis Ababa, Ethiopia.
Methods A facility-based descriptive cross-sectional study of AYFS was conducted from November 01, 2022 to May 30, 2023 at 31 public primary healthcare facilities in Addis Ababa, Ethiopia. Data on AYFHS per standards were collected through interviews with healthcare providers, facility manager and observation. Responses were scored using a tool with criterions and standards for assessing youth-friendly services quality adapted from the WHO’s global standards for quality health-care services for adolescents for six measured AYFS standards (Appropriate package of services, Provider's competency, Facility characteristics, Equity and non-discrimination, Data and quality improvement, and Adolescents’ participation). Two standards, Adolescents’ health literacy and community support, were not assessed in this study as they extend beyond its objectives. Quantitative data analyzed using SPSS version 20 software.
Results: The level of implementation of the assessed standards ranges from 54% to 73%, indicated the need for some improvement across all assessed facilities, as none of them met all six standards. Notably, standards related to general service delivery, such as facility characteristics, data, and quality improvement, scored above 70%, demonstrating a relatively higher level of implementation. However, standards specifically addressing adolescent health services, including AYFHS packages, provider competency, and equity, showed scores of 69%, 67%, and 62%, respectively, indicating a relatively moderate level of implementation. Of particular concern was the low implementation of standards related to adolescent participation, revealing disparities in engagement in planning, monitoring, and evaluation processes, with the lowest mean score of 54.7% among the assessed standards.
Conclusion and Recommendation: Closing the identified gap between the required level of quality and facility-level performance to meet the needs of adolescents necessitates comprehensive measures. Recommendations include the development of transition plans for adolescents with chronic conditions, systematic enforcement of regulations in healthcare professional education, and establishment of each standards SOPs at the facility level. Ensuring the affordability of comprehensive AYFHS, implementing a uniform system of supportive supervision, and facilitating meaningful adolescent involvement in monitoring and feedback systems are crucial steps. Implementing these recommendations has the potential to address the current preparation gap effectively and enhance the quality of Sexual and Reproductive Health (SRH) services for young people.