Do efforts to standardize, assess and improve the quality of health service provision to adolescents by government-run health services in low and middle income countries, lead to improvements in service-quality and service-utilization by adolescents?

BACKGROUND: Researchers and implementers working in adolescent health, and adolescents themselves question whether government-run health services in conservative and resource-constrained settings can be made adolescent friendly. This paper aims to find out what selected low and middle income country (LMIC) governments have set out to do to improve the quality of health service provision to adolescents; whether their efforts led to measurable improvements in quality and to increased health service-utilization by adolescents. METHODS: We gathered normative guidance and reports from eight LMICs in Asia, Africa, Central and Eastern Europe and the Western Pacific. We analysed national quality standards for adolescent friendly health services, findings from the assessments of the quality of health service provision, and findings on the utilization of health services. RESULTS: Governments of LMICs have set out to improve the accessibility, acceptability, equity, appropriateness and effectiveness of health service provision to adolescents by defining standards and actions to achieve them. Their actions have led to measurable improvements in quality and to increases in health service utilisation by adolescents. CONCLUSIONS: With support, government-run health facilities in LMICs can improve the quality of health services and their utilization by adolescents.

Review of the evidence for interventions to increase young people's use of health services in developing countries.

OBJECTIVE: This chapter reviews the evidence base for interventions that aim to increase young people's use of health services in developing countries. METHODS: We identified published and unpublished studies and reports from developing countries that provided information about interventions designed to increase young people's use of health services. The studies were classified into six different types based on whether they included some or all of the following characteristics: training for service providers and clinic staff; making efforts to improve the quality of the facilities; implementing community activities to generate demand and support for the services; and involving other sectors, notably schools and the media. The levels of evidence required to make decisions about policies and programmes were defined for each of these types. FINDINGS: Despite the lack of detailed descriptions of interventions in the studies and difficulties interpreting the data reported in the evaluations, the studies provided evidence of increased use of health services by young people for those types of interventions that included training for service providers, making improvements to clinic facilities and implementing activities in the community, with or without the involvement of other sectors. CONCLUSION: The evidence for the effectiveness of interventions to increase young people's use of health services was sufficient to recommend that interventions that include training for service providers, making improvements to clinics and using activities in the community should be widely implemented with careful monitoring of quality and coverage and that those that additionally involve other sectors should also be widely but cautiously implemented, provided they include a strong evaluation component. Operations research is also required to better understand the content of the interventions and their mechanisms of action.

Enabling medical professionals to respond effectively and with sensitivity to the needs of adolescents.

Adolescence is a period when important changes occur in an individual's life. It is a period of both risk to health and well-being, and of opportunity to set the stage for healthy adulthood. Most adolescents are healthy, but a small (and in some places not so small) proportion of them face health (including both physical and psychological) problems as well as social problems. Many individuals and institutions have important contributions to make in ensuring the health of adolescents. Medical professionals have crucial contributions to make--both as service providers and as community-change agents. Studies from many places show that adolescents value medical professionals as credible sources of help, and reach out to them for health information and services, albeit in small numbers. However, studies from many parts of the world suggest that medical professionals are unable and/or unwilling to respond to the needs of adolescents effectively and with sensitivity. There is growing recognition of the public-health benefits of strengthening the technical as well as the inter-personal competencies of medical professionals, and of helping them clarify their attitudes so that they could deal with adolescents with understanding and respect. Initiatives in this area are under way in many countries. WHO strongly supports these capacity-building initiatives, and urges that orientation and training programmes be followed up with ongoing support to enable medical professionals to perform to the best of their abilities. WHO also stresses the importance of informing and engaging families and communities to support the provision of health information and services to young people.