What is our understanding of
the 'reality on the ground' ?
• A wide range of players
• Often with very different objectives
• Operating in a variety of settings
- Providing health services to
adolescents/young people !
• A wide range of players
• Often with very different objectives
• Operating in a variety of settings
- Providing health services to
adolescents/young people !
Poor design & poor
implementation
leads to poor impact !
"…No effects on sexual on
sexual or contraceptive-use
behaviours or on use of public
clinics was observed…"
Source: R J Magnani, L Gaffikin, E M Leao de Aquino, E E Seiber, M de C Chagas Almeida, V Lipovsek. Impact of an
integrated adolescent reproductive health program in Brazil. Studies in Family Planning 2001; 32 (3): 230-243.
Percentage of adolescents using youth
centers & contacted by peer educators
in the past year.
All
All
Boys
boys girls 10-14
Boys
15-19
Girls
10-14
Girls
15-19
Youth centre
20.3
7.2
10.5
27.2
3.9
9.0
Peer
education
26.5
15.1 18.3
32.3
12.7
16.5
Source: A. Erulkar, T Mekbib, N Simie, T Gulema. Differential use of adolescent reproductive health programs in Addis Ababa,
Ethiopia. Journal of Adolescent Health. 2006, 38, 253-260.
What are we doing to strengthen
country-level action in reaching
adolescents with the health
services they need ?
National standards-driven initiatives to
improve quality & expand coverage.
Objective:
To improve the quality &
expand the coverage
of an evidencebased package of
health interventions
in order to achieve
clearly defined health
outcomes.
What is our recommended
approach to reaching
adolescents with the health
services they need ?
# 1. Using strategic entry points, to move
the wider adolescent health agenda.
Overall goal
To improve the health & development of adolescents.
HIV/AIDS
1. Prevention of too early pregnancy
2. Prevention of deaths in
pregnancy & delivery
Substance Use
Mental Health
Intentional & accidental injuries
# 2. Being clear about the main
purpose of delivering health services.
1. What are the health outcomes we are
aiming for
2. What is the place of health service
provision to adolescents within the
overall strategy ?
3. What is the package of health services
to be provided, to achieve the health
outcomes we are aiming for ?
4. Where and by whom should these health
services be provided ?
# 3 Identifying the groups in the adolescent
population whom we need to reach.
• Adolescents are a diverse
population group.
• Not all adolescents are
equally vulnerable.
Alternative approaches to contraceptive
information/services provision, Mexico
100
90
80
70
60
50
40
30
20
10
0
Male
Female
CYP
Youth
Centre
CBD
Townsend J W, Diaz de May E, Sepǘlveda Y, Santos de Garza Y, Rosenhouse S. Sex education and family
planning services for young adults: alternative urban strategies in Mexico. Studies in Family Planning 1987;
18: 103-108.
# 4. Being clear about where & by whom
health services are to be provided ?
Private
doctor
Pharmacy
Hospital
NGO
Traditional
healer
clinic
clinic
clinic
• Working to make
existing servicedelivery points more
"friendly" to
adolescents.
• Setting up new
service-delivery
points exclusively
intended for
adolescents.
A focus on building on what already exists.
# 5. Setting out to do more than just
make health services "friendly".
Utilization
Provision
Striving to ensure that adolescents are
able & willing to obtain the health
services they need.
Striving to ensure that the services that
adolescents need are in fact being
provided & are being provided in the
right manner.
# 6. Using a quality framework
for health-service provision to adolescents.
Utilisation
Accessible
Acceptable
Equitable
Provision
Appropriate
Comprehensive
Effective
Efficient
A quality framework
for health-service provision to adolescents.
Provision
Utilisation
Accessible
Acceptable
Equitable
Appropriate
Comprehensive
Effective
Efficient
A quality framework
for health-service provision to adolescents.
Provision
Utilisation
Accessible
Acceptable
Equitable
Appropriate
Comprehensive
Effective
Efficient
A quality framework
for health-service provision to adolescents.
Provision
Utilisation
Accessible
Acceptable
Equitable
Appropriate
Comprehensive
Effective
Efficient
Clear definitions of 'required' quality
of health service provision to adolescents.
Points of service delivery:
- enable adolescents to obtain
the health services they need
- are appealing to
adolescents & respectful of them
- provide the
health services that adolescents
need
Community
Advocates & facilitates preparedness &
readiness actions
Community
Family
Facility
Facility
is equipped,
staffed & managed
to provide skilled care for
the pregnant woman & the new born
Support pregnant woman’s plans
during pregnancy, childbirth & the
postpartum period.
Community members
support the provision of
health services to
adolescents.
Adolescents
Provider
Provider
provides skilled care
for normal & complicated pr
births & the postpartum period
Community
egnancies,
Service providers:
- are non judgemental
& considerate in their dealings with
adolescents
- deliver the services in
the right way
Adolescents
- are aware of what services are
being provided
- are (& feel) able &
willing to obtain the health
services they need
# 7. Using a standards-driven quality
improvement approach.
What is a standard ?
A standard is a statement of required
quality.
How can standard-driven quality
improvement contribute to our work ?
1. By setting clear goals for the quality of
different aspects of the functioning of
service-delivery points.
2. By providing the basis for assessing the
achievement of these goals.
3. By providing the basis for identifying what
needs to be done to achieve the
goals.
Standards-driven quality improvement
1. Standards set clear goals.
They make explicit the definition of
quality required
Required
quality.
Standards-driven quality improvement
1. Standards set clear goals.
They make explicit the definition of
quality required
Required
quality.
2. Standards provide the basis for
assessing the achievement of
goals.
Gap between
required and
actual quality.
They provide a clear reference against
which quality can be assessed (&
compared).
Actual
quality.
Standards-driven quality improvement
1. Standards set clear goals.
They make explicit the definition of
quality required
Required
quality.
2. Standards provide the basis for
assessing whether goals have
been achieved.
Gap between
required and
actual quality.
They provide a clear reference against
which quality can be assessed/compared.
3. Standards provide the basis for
identifying what needs to be done to
achieve the goals.
They provide an entry point for identifying
why the goals were not achieved, and
what actions need to be taken for the
goals to be achieved.
Actual
quality.
The Quality triangle.
Quality of Care
DEFINE QUALITY
# 8. Working to expand the coverage of
health services, alongside efforts to improve
quality.
What is coverage ?
The proportion of a given population that is
able to/willing to/has in fact obtained
the health services that they need.
Why is a focus on coverage relevant to our
work ?
1.
By pressing for clarification on what
proportion of the adolescents in a
community need a specific health
service.
2.
By providing the basis for determining
what proportion of them are in fact
obtaining the health services they need.
Expanding the coverage of health services.
1. Clarifying what proportion
of adolescents in a
community need a specific
health service.
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Expanding the coverage of health services.
1. Clarifying what proportion
of adolescents in a
community need a specific
health service.
2. Determining what proportion
of these adolescents are in
fact obtaining the health
services they need.
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Expanding the coverage of health services.
1. Clarifying what proportion
of adolescents in a
community need a specific
health service.
2. Determining what proportion
of these adolescents are in
fact obtaining the health
services they need.
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# 9. Being clear about what it takes to
translate ideas into reality.
" Scaling up: Deliberate efforts
to increase the impact of
health service innovations
successfully tested in pilot or
experimental projects so as to
benefit more people ".
Source: WHO, Reproductive Health Resarch
& ExpandNet. From pilot projects to policies &
programmes: Practical guidance for scaling up
health service innovations (WHO, 2006).
Different but complementary actions at
national, district & local levels.
National level
District level
•Providing directions
•Providing methods & tools
•Providing human & material support
•Acting as a bridge between the national
level & the district.
•Playing a facilitating role in the district
•Supporting the service delivery points
•Supporting community action
Local level