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UNIVERSAL HEALTH COVERAGE AND ACCESS FOR ADOLESCENTS

Creating an adolescent-responsive health system

Creating demand and utilization of health services by adolescents
Bring adolescents in Universal health coverage & access dialogue

Package of services

Protocols/

Job aids

Standards

Quality monitoring

Pre- and in-service training for providers

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A guide to implement a standards-driven approach to improve the quality of health-care services for adolescents

Contribute to better health outcomes

Increase adolescents’ use of services

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Adolescent health literacy	Standard 1: the health facility implements systems to ensure that adolescents are knowledgeable about their own health, and they know where and when to obtain health services
Community support	Standard 2: The health facility implements systems to ensure that parents, guardians and other community members and organizations recognize the value of providing health services to adolescents and support their utilization
Appropriate package of services	Standard 3: the health facility provides a package of information, counseling, diagnostic, treatment and care services that fulfils the needs of all adolescents; services are provided in the facility and through referral and outreach
Providers’ competencies	Standard 4: Health care providers demonstrate the technical competence required to provide effective health services to adolescents; health care providers and support staff respect, protect, and fulfil adolescents’ rights to information, privacy, confidentiality, non-discrimination, non-judgmental attitude and respect

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STANDARD #4: CORE COMPETENCIES FOR PRIMARY CARE PROVIDERS

http://www.who.int/maternal_child_adolescent/documents/core_competencies/en/

3 DOMAINS:

BASIC CONCEPTS IN ADOLESCENT HEALTH AND DEVELOPMENT, AND EFFECTIVE COMMUNICATION
LAWS, POLICIES AND QUALITY STANDARDS
- CLINICAL CARE OF ADOLESCENTS WITH SPECIFIC CONDITIONS

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Facility characteristics	Standard 5: The health facility has convenient operating hours, a welcoming and clean environment and maintains privacy and confidentiality. It has the equipment, medicines, supplies and technology needed to ensure effective service provision to adolescents.
Equity and non-discrimination	Standard 6:The health facility provides quality services to all adolescents irrespective of their ability to pay, age, sex, marital status, education level, ethnic origin, sexual orientation or other characteristics.
Data and quality improvement	Standard 7: The health facility collects, analyses and uses data on service utilization and quality of care, disaggregated by age and sex, to support quality improvement. Health facility staff is supported to participate in continuous quality improvement.
Adolescents’ participation	Standard 8: Adolescents are involved in the planning, monitoring and evaluation of health services and in decisions regarding their own care, as well as in certain appropriate aspects of service provision.

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EACH STANDARD OPERATIONALIZED IN INPUT, PROCESS AND OUTPUT CRITERIA

Input criteria	Process criteria	Output criteria
1. The health facility has a signboard that mentions operating hours. 2. The health facility has in the waiting area up-to-date information, education and communication materials specifically developed for adolescents. 3. Health-care providers have competencies to provide health education to adolescents and to communicate about health and available services 4. The health facility has outreach workers that are trained. …	Health-care providers provide age and developmentally appropriate health education and counselling to adolescent clients and inform them about the availability of health, social services and other services. Outreach activities to promote health and increase adolescents’ use of services are carried out according to the health facility’s plan.	8. Adolescents are knowledgeable about health. 9. Adolescents are aware of what health services are being provided, where and when they are provided and how to obtain them.

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http://www.who.int/maternal_child_adolescent/documents/global-standards-adolescent-care/en/

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Standards must be monitored

Laborious and expensive process to organize surveys

Manual data entry
Need for expertise to calculate scores
Manual presentation of data (graphs, reports)
Manual compilation and presentation of data to reveal trends

No feeling of ownership of data (external surveys)

Inconvenient for adolescents (no choice of time or location to participate), concerns over confidentiality

No link to actions to improve quality
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Monitoring standards: E-standards tool

Adolescents will fill the questionnaire either after the consultation, or even later at home by accessing the web questionnaire

Confidential, convenient time

Data will aggregate over time from many adolescent clients

Providers will fill in questionnaires twice a year (the frequency is decided by the facility)

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Standards within the quality improvement cycle

The report screen allows you to query the data by time, age, gender and questionnaire type.
Automatic reports – graphs, Power Points – will be generated for the managers to use and discuss with staff
Reports will suggest a menu of possible actions
The facility will decide which actions to undertake to improve quality The recommendation screen will provide recommendations on how to improve across criteria and standards.
National and District managers can also apply a weighting which will determine the priority of the recommendations for the user level below (I.E. District and Facility respectively).

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