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Developing Youth-Friendly Services
Youth-friendly services attract and retain young clients by offering comfortable surroundings, sympathetic providers, privacy and confidentiality, a convenient location and hours, and other appealing features (38). A youth-friendly approach can encourage young people to visit a clinic, pharmacy, or other facility for needs related to family planning, STIs (including HIV/AIDS), and maternal and child health (9, 14, 46).
Integrated services are an important element of the youth-friendly approach because they let young people avoid the inconvenience and embarrassment of visiting multiple health facilities. They also allow young people to avoid the stigma of visiting a stand-alone HIV testing site or family planning clinic (30).
Making services youth-friendly requires attention to a facility’s physical environment, policies and procedures, and staff attitudes and behaviors. To attract young people, programs often train providers and pharmacy workers; refurbish waiting areas, examination rooms, and store displays; extend hours; reduce fees; and expand the range of services and supplies offered (36).
Most of the tools in this section are designed to help program managers assess the youth-friendliness of integrated services at their facilities, regardless of whether the primary clientele consists of adults or young people. Managers can use these tools for needs assessments, problem-solving, the development of training programs, monitoring and evaluation, and program certification.
When choosing and modifying an assessment tool, managers should consider:
- the purpose of the assessment,
- how quickly results are needed,
- what resources are available, and
- who will be conducting the assessment.
Assessment and planning tools. Program managers can use the first five tools described in this section to measure the youth-friendliness of integrated services and identify areas that need improvement. All of the assessment tools cover:
- the convenience and affordability of services,
- the facility environment,
- privacy and confidentiality,
- staff competence and attitudes,
- the range of services offered, and
- systems to assure youth participation.
Some also examine community activities and broader management issues.
Most of the assessment tools collect information from staff members and young clients. Some also examine clinic records and policies, observe consultations with young people, and/or question community members. Most rely on a staff team at each facility to conduct the assessment, thus encouraging staff members to become involved in and support the provision of youth-friendly services.
The last resource in this section is a planning tool. It offers practical guidance on how to design pharmacy services to attract and serve young people better. Managers can use it to design, implement, monitor, and evaluate youth-friendly services at retail pharmacies.
EngenderHealth. COPE® self-assessment guides for youth reproductive health services. In: Youth-friendly services: A manual for service providers. New York, EngenderHealth, 2002. 167–211 p.
COPE® (client-oriented, provider-efficient services) is a proven approach to quality improvement at the facility level. Staff members from every level and department—including managers, service providers, educators, receptionists, and guards—work in teams to complete a series of self-assessment guides, identify and analyze problems, and develop solutions.This set of COPE guides was developed in Russia to assess services for young people and has since been used in Mongolia and South Africa.The guides examine a range of integrated services, including family planning, maternal care, and screening, diagnosis, testing, and treatment for gynecological disorders and STIs, including HIV. Because the guides address the overall quality of care as well as the youth-friendliness of services, they encompass a broader set of indicators than the other assessment tools reviewed here and may take more time to complete. (Note: Full instructions for conducting COPE exercises can be found in: COPE® Handbook: A Process for Improving Quality in Health Services, Revised Edition. New York: EngenderHealth, 2003. Available at: http://www.engenderhealth.org/res/offc/qi/cope/handbook/index.html)
Available at: http://www.engenderhealth.org/res/offc/qi/yfs/index.html For print copies: Fill out the order form at http://www.engenderhealth.org/pubs/form.html and mail to EngenderHealth, 440 Ninth Avenue, New York, NY 10001 USA. Tel: 212-561-8000. Fax: 212-561-8067. E-mail: info@engenderhealth.org. info@engenderhealth.org.
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South Africa: Certifying Youth-Friendly Clinics
In South Africa, the National Adolescent-Friendly Clinic Initiative uses a certification system to improve the quality of health services for young people at public clinics. The Department of Health and the loveLife program—a national HIV prevention program for youth—have set national standards for every aspect of youth services, including clinic policies, the range of services offered, staff training, and the assessment and care of clients. Participating clinics form a Quality Improvement Team to assess existing youth services and direct needed improvements over a one- or two-year period. When the clinic is ready, an external assessment team visits the site to determine how well it complies with the national standards.
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By December 2004, 235 clinics were participating in the certification program. An external assessment showed that they were performing significantly better than control sites. The 72 clinics visited by assessment teams met 85% of the national standards on average, far exceeding the average baseline score of 29%. Among 32 clinics in the program for at least three years, use of services by young people has grown substantially, especially for HIV testing and STI services. Contraception continues to be the most frequently requested service.
Source: loveLife 2004
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This community information pamphlet tells young people about the services available at youth-friendly public clinics in South Africa. The National Adolescent Friendly Clinic Initiative (NAFCI) uses an accreditation system to improve and maintain the quality of youth services.
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Senderowitz, J., Solter, C., and Hainsworth, G. Clinic assessment of youth-friendly services: A tool for assessing and improving reproductive health services for youth. Watertown, MA, Pathfinder International, 2002.
This tool can be used by assessment teams, project managers, trainers, and supervisors to establish a baseline, to develop plans for training and improving the quality of services, and to assess progress in instituting youth-friendly integrated services. It is based on a systematic review of projects and research findings on youth-friendly services and has been tested in sub-Saharan Africa.The tool employs a wide range of indicators and data sources to assess family planning, STI, HIV/AIDS, maternal and child health, sexual abuse, and nutrition services. For an example of how this tool has been used, see the box on Tanzania. (Further explanation of how to use the tool can be found in: Senderowitz, J., Hainsworth, G., and Solter, C. A rapid assessment of youth friendly reproductive health services. Technical Guidance Series No. 4. Watertown, MA, Pathfinder International, 2003. Available at: http://www.pathfind.org/ite/DocServer/YFS_TG_Final_web_version.pdf?docID=762. POPLINE® Document Delivery Service: order number 305825)
Available at: http://www.pathfind.org/site/DocServer/mergedYFStool.pdf?docID=521
For print copies:Technical Services, Pathfinder International, 9 Galen Street, Suite 217, Watertown, MA 02472, USA.
Tel: 617-924-7200. Fax: 617-924-3833. POPLINE® Document Delivery Service: order number 275476
Hainsworth, G., Senderowitz, J., and Ladha, S. Certification tool for youth-friendly services. Watertown, MA, Pathfinder International, 2004.
This certification tool was designed to complement Pathfinder’s clinic assessment tool (see previous resource, Clinic assessment of youth-friendly services: A tool for assessing and improving reproductive health services for youth) and uses the same 25 indicators to set standards for acceptable youth-friendly services.Two indicators are particularly relevant to integrated services: emphasizing dual protection and providing a minimum package of services, including contraception, pregnancy care, post-abortion care, and the diagnosis and treatment of STIs, including HIV. The tool sets a clear benchmark for facilities to work towards, assesses progress towards that benchmark, and identifies which facilities can be trusted as youth-friendly. External assessment teams are responsible for completing the checklist based on interviews and observations. (For an example of how reproductive health programs directed to young people have applied a certification approach, see the box on South Africa.)
Available at: http://www.pathfind.org/site/DocServer/YES_certification_tool_mb.pdf?docID=4401
For print copies:Technical Services, Pathfinder International, 9 Galen Street, Suite 217,Watertown, MA 02472, USA.
Tel: 617-924-7200. Fax: 617-924-3833.
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Tanzania: Assessing Youth-Friendly Services
In Tanzania the African Youth Alliance (AYA) project used Pathfinder’s clinic assessment and certification tools (see assessment and problem-solving tools by Senderowitz et al.1 2002 and Hainsworth et al.2 2004) to help improve reproductive health care for young people. The assessment identified two key problems—a limited range of services, and lack of privacy and confidentiality. The assessment was designed to help clinic staff understand the concept of youth-friendly services and the practical steps they needed to take to improve youth services. In response, some facilities trained providers to offer a full range of integrated, comprehensive services. Other facilities established separate waiting and consultation areas for young people, sometimes erecting new walls to create private spaces. These and other actions raised average scores on the assessment instrument—from a score of 21 to 28 for offering a minimum package of services, from 9 to 26 for emphasizing dual protection, and from 12 to 20 for ensuring privacy. The improvement process also increased staff commitment to youth-friendly services, youth involvement in service provision, and clinic visits by young people.
Sources: Senderowitz 2004; AYA and Pathfinder 2005
1 Clinic assessment of youth-friendly services: A tool for assessing and improving reproductive health services for youth2 Certification tool for youth-friendly services for youth
2 Certification tool for youth-frienly services
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International Planned Parenthood Federation (IPPF). Your comments count! London, IPPF, 2002.
This leaflet was designed to collect feedback from young reproductive health clients, but it can be used as part of a broader assessment of youth-friendly integrated services. Developed by the IPPF Youth Committee, which is made up of people under age 25 from around the world who have experience with reproductive health programs,it contains a checklist that assesses how well a facility’s staff, services, and organization contribute to youth-friendly services. A question on comprehensive services asks about the availability of counseling, testing, treatment and other services related to family planning, STIs, HIV, and sexual violence. Guidelines explain how staff members can use the checklist to assess services at a facility or program and provide supplemental questions on staff recruitment and development, creating effective programs, and mechanisms for continuity and sustainability.
For print copies: International Planned Parenthood Federation, Regent’s College, Inner Circle, Regent’s Park, London NW1 4NS, UK.Tel: 44-0-20-7487-7900. Fax: 44-0-20-7487-7950. E-mail: info@ippf.org.
Nelson, K., MacLaren, L., and Magnani, R. Assessing and planning for youth-friendly reproductive health services. FOCUS Tool Series #2. Washington, D.C., FOCUS on Young Adults/Pathfinder, 2000.
This tool can help programs assess a range of integrated services, including family planning, maternal care, and STIs, including HIV. Its development reflects feedback from reproductive health professionals in Cambodia and Zambia, along with a review of youth programs. A series of four workbooks includes data collection instruments, score sheets, and planning worksheets for a comprehensive assessment of youth-friendly services. Data from facility records, managers, providers, clients, and community members are used to score each of 21 indicators of youth-friendly services.The final workbook prompts managers to identify and address weaknesses in existing services.
Available at: http://www.fhi.org/en/Youth/YouthNet/Publications/FOCUS/ToolsGuides/index.htm
POPLINE® Document Delivery Service: order number 301784 for Workbook 1, order number 301785 for Workbook 2, order number 301786 for Workbook 3, and order number 301787 for Workbook 4
Beitz, J., Srimuangboon, H., Lion-Coleman, A., Transgrud, R., Hutchings, J., and Weldin, M. Youth-friendly pharmacy program implementation kit: Guidelines and tools for implementing a youth-friendly reproductive pharmacy program. Seattle, PATH, 2003.
This toolkit offers complete and detailed instructions for creating a network of youth-friendly pharmacies based on the experiences of the RxGen project in Cambodia, Kenya, and Nicaragua (see box, RxGen: Making Pharmacies Youth-Friendly).The kit contains a curriculum for training pharmacists and other pharmacy staff, evaluation tools, and sample job aids and health education materials.The training is designed to strengthen the ability of pharmacy workers to counsel youth on reproductive health matters, advise them about such products as condoms and pregnancy tests, and refer them for clinical services, such as HIV testing.The kit is available in English and Spanish.
Available at: htttp://www.path.org/publications/details.php?i=860. For print copies: PATH, 1455 NW Leary Way, Seattle, WA 98107. Tel: 206-285-3500. Fax: 206-285-6619. E-mail: publications@path.org.. For
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RxGen: Making Pharmacies Youth-Friendly
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A pharmacy assistant in Managua, Nicaragua reads a training brochure on youth-friendly services developed by PATH and Ixchen, a local NGO. Youth like the convenience and anonymity that pharmacies offer.
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For young people in need of reproductive health and family planning supplies and services, pharmacies are a quick, convenient, affordable, and anonymous outlet. The RxGen project is working to improve the quality of reproductive health and family planning information that pharmacies offer young people and to make their services youth-friendly. Pharmacists and counter staff at participating outlets attend a training workshop to raise their awareness of young people’s needs, strengthen their communication skills, and increase their technical knowledge. The project marks the location of participating pharmacies with a youth-friendly logo and also stocks them with educational materials for young customers.
During its first three years, the RxGen project trained over 1,000 workers from about 530 pharmacies in Cambodia, Kenya, and Nicaragua. Mystery shoppers assessed the impact of the project on the quality of reproductive health and family planning services at the pharmacies. They found that workers at participating pharmacies were more likely to use interpersonal communication skills, respect client privacy, offer appropriate information, advice, and products, and make referrals. Both client satisfaction and the number of young people seeking reproductive health and family planning services at participating pharmacies increased.
Sources: Bond et al. 2003; Firestone 2003; Path 2006
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