Assessing health care quality in adolescent clinics, implications for quality improvement

Evaluating the Implementation of Adolescent- and Youth-Friendly Services in the Selected Primary Healthcare Facilities in Vhembe District, Limpopo Province

BACKGROUND

The adolescent- and youth-friendly services (AYFS) programme has the potential to address several diverse problems within adolescents' healthcare systems by improving the quality, accessibility, efficiency, and effectiveness of healthcare services. The country continues to suffer from structural and systemic factors that hinder the effective provision and implementation of AYFS despite its comprehensive legal and policy framework and commitment to enhancing young people's health. Vhembe District has not been evaluated regarding the implementation of AYFS based on WHO global standards. Therefore, the objective of this study was to evaluate the implementation of AYFS against the World Health Organization (WHO) global standards for quality healthcare services for adolescents to strengthen these services in Vhembe District, Limpopo.

METHODS

A cross-sectional study was used to evaluate the implementation of AYFS against the WHO global standards for quality healthcare services for adolescents in Vhembe District, Limpopo. Evaluating the implementation of AYFS was conducted through questionnaires distributed to healthcare providers in the selected primary healthcare facilities in Vhembe District. For descriptive statistical analysis, research data were analysed using Statistical Package for the Social Sciences (SPSS).

RESULTS

The AYFS have been evaluated in depth across eight WHO global standards for quality health-care services for adolescents, with areas of success and areas for improvement identified. Provider competency reveals a disparity, with a majority (67.0%) of healthcare providers trained in effective communication with adolescents. In comparison, significantly fewer have received specific training in AYFS (16%) or on Pre-Exposure Prophylaxis (PrEP) (25.9%), underscoring the need for a more balanced approach to training focus.

CONCLUSION

Research findings highlight the strengths and gaps of AYFS in Vhembe District, aligned with government and WHO priorities for adolescent health. Addressing the identified gaps is vital to ensuring that healthcare facilities are adolescent- and youth-friendly, easily accessible, and can be implemented effectively to address adolescent and youth health challenges in Vhembe District.

Compliance of Adolescent Friendly Health Clinics with National and International Standards: Quantitative findings from the i-Saathiya study

OBJECTIVE

Indian adolescents experience several health challenges requiring acceptable, equitable, appropriate and effective healthcare services. Our objective was to assess the compliance of Adolescent Friendly Health Clinics (AFHCs) in two of India's largest states, using both national benchmarks (under Rashtriya Kishor Swasthya Karyakram-RKSK) and global standards (by WHO).

DESIGN

Cross-sectional study comprising structured observations and interactions (November 2021 to June 2022).

SETTING

Fourteen AFHCs across all levels of health system were included from two districts of Maharashtra (n=8) and Madhya Pradesh (n=6). These AFHCs were observed using checklist, and few items of checklist were verified by interactions with AFHC's health workers (medical officers/auxillary nurse midwives/counsellors) handlings adolescents. The developed checklist included 57 items based on adapted global standards and 25 items using national benchmarks.

RESULT

High compliance of AFHCs with RKSK's benchmarks was attributed to various items including the accessibility through local transport (n=14, 100%), clean surroundings (n=11, 78.5%), presence of signage (n=10, 71.4%), convenient operating days and time (n=11, 78.5%), and secure storage of records (n=13, 92.9%). Concurrently, items that showed low compliance encompassed, the availability of Information, Education and communication (IEC) resources, which were deficient in 57.1% of AFHCs (n=8). Similarly, designated areas for clinical services (n=10, 71.4%) and commodity disbursement (n=9, 64.3%) lacked in more than half of the recruited AFHCs. Additionally, lack of guidelines for referrals (n=13, 92.9%), as well as standard operating procedures to ensure equity, non-judgemental attitude, competence, confidentiality and referral as per WHO standards.

CONCLUSION

Evidence spotlights the strengths and gaps in AFHCs, aligning with, government's priorities on adolescent health. Addressing the identified gaps is crucial to creating healthcare facilities that are adolescent-friendly, easily accessible and effectively navigate adolescent health challenges. This concerted effort would contribute to their development and transformation, playing a pivotal role in India's progress.