Institutionalizing youth-friendly health services
This indicator measures two key characteristics in the institutionalization of youth-friendly services: the existence of facility-based policies and guidelines for the treatment of young clients, and the training of health providers in youth-friendly approaches and methods. Both the existence of youth-friendly policies and youth-friendly health care providers are key elements of the WHO recommended generic characteristics of a youth-friendly health service. This is a facility-based indicator, i.e. it does not assess policy at the national level. It is an estimate of the effort to institutionalize youth-friendly services but does not measure service delivery at health facilities or the quality of the services provided. For tools that focus on operationally improving health services at facility level, reference may be made to guides such as those of NAFCI (19) and FOCUS (20).
A nationally representative sample of health service delivery points is preferred for this measurement. Depending on the setting, the sample may include facilities at the primary, secondary and tertiary levels. The sample should be limited to facilities offering one or more of the three essential services related to HIV/AIDS prevention: STI diagnosis and treatment, contraceptive/family planning services, and HIV testing. If possible, both public and private facilities should be included. Furthermore, in cases where intravenous drug use is a major factor in driving the epidemic, substance abuse prevention and treatment programmes can be included. If this is done the type of staff trained is likely to change, e.g. the personnel may not be doctors and nurses but other types of professionals. The questions below should be tailored accordingly. Directors/heads of a nationally representative sample of health service delivery points are asked the following questions.
1. Does your facility have written policies and/or guidelines for health professionals specifically on how to treat young clients?
Young clients are aged 10-24; the relevant facility policies may include the entire age range or only a subrange, e.g. up to 19 years of age.
Experience indicates that it is important to ask to see the written guidelines, in addition to asking whether they exist.
2. Does your facility have at least one qualified health professional (doctor, nurse, counsellor, etc.) who has been trained in the provision of youth-friendly services in the last five years?
Geographic location: N/A
Pregnancy status: N/A
Time period: N/A
Type of orphan: N/A
Vulnerability status: N/A
This measure of the institutionalization of youth-friendly health services is simple to collect. For it to be representative, however, a national sampling frame of all health service delivery points is required. This indicator is useful in allowing national programme managers to keep track of the proportion of health settings that are making efforts to become youth-friendly. The tracking of changes over time in this measure can provide a useful overview of the trend in implementing such services. It must be kept in mind, however, that for a health setting to qualify as fully youth-friendly a series of characteristics and functions must be in place, including convenient opening hours, the treatment of young clients with respect, affordability, and effectiveness of the services. Written guidelines and trained health professionals are only the most basic of the requirements. In order to be most useful for individual service delivery points the quality of services is best assessed in depth at the level of each health facility through a quality improvement approach or a similar process. For these data to be representative at the national level the sample of health facilities must also be nationally representative. Criteria must be established with respect to the types of facilities to be considered (e.g. primary, secondary, and tertiam-level care, public and private). It is very important to differentiate between facilities aimed at young people and those targeting the general population, as the former are more likely to have staff trained in youth-friendly services. Once the criteria have been established a complete listing of all eligible health facilities is needed. For the results to be validly disaggregated for each subgroup of facilities as well as aggregated at the national level, sampling must be done for each subgroup. If a particular subcategory includes less than 20 facilities there is no advantage in randomly sampling it. In this case a representative sample of facilities can be selected with regard to factors such as client volume, location and the socioeconomic level of the catchment area. There is no need to sample within facilities because the information for this indicator is collected from a director, head doctor or similar person.