Projects

Assessing adolescent friendly health services in Nepal

Adolescents and youth (collectively termed ‘young people’ aged 10-24 years) account for one third of Nepal’s population. Despite significant sexual and reproductive health (SRH) and other health needs, young people in Nepal have poor access to quality, non-discriminatory health services.

Recognising the imperatives to improve adolescent SRH, the Family Health Division (FHD) of the Ministry of Health developed the National Health and Development Strategy in 2000 and the National Adolescent Sexual and Reproductive Health Program in 2010, with adolescent friendly health services (AFHS) a central component. The Program sets a target of 1000 AFHS established through existing public facilities by 2015, and provides detailed guidance on national standards and implementation of AFHS to guide districts and facilities.

Objectives:

The aim of this study was to explore the supply and demand side barriers impacting on access to and utilization of adolescent-friendly health services (AFHS) by young people aged 10-24 years across diverse socio-cultural and geographical settings in Nepal.

The specific objectives were to:

  1. Assess the extent to which existing AFHS are meeting national and WHO guidelines
  2. Assess current utilisation of services by young people aged 10-24 years and identify service provision gaps
  3. Assess the availability, comprehensiveness and quality of service provider training and job aides
  4. Explore providers’ and facility mangers’ perceptions about the challenges providing AFHS and how these might be overcome
  5. Explore young people’s perceptions of current AFHS
  6. Identify the barriers that limit young people’s access to AFHS
  7. Explore young people’s perceptions about how to improve access to AFHS
  8. Explore the perceptions and attitudes of community gatekeepers (including parents) regarding AFHS

Activities:

A mixed methods study was conducted in 12 districts of Nepal, including 72 urban and rural public health facilities providing AFHS and surrounding communities. Data collection was conducted from May 12 to June 3, 2014 and included the following:

Qualitative

  • Nine focus group discussions with young people aged 15-14 years (male and female) and parents to explore barriers impacting on health service access, perceptions of AFHS and preferred features of AFHS
  • Free-listing with 241 young people aged 10-24 years to explore health needs, health-seeking behaviour and barriers to accessing services
  • In-depth interviews with four young people living with disability
  • Exit-interviews with 11 young clients of AFHS
  • 10 key informant interviews with community gatekeepers (leaders, teachers, religious leaders, female community health volunteers)
  • 72 key informant interviews with AFHS providers to explore supply-side challenges

Quantitative

  • Structured facility observation checklist at 72 facilities to determine the proportion of facilities meeting national standards
  • Secondary analysis of facility client record data to determine utilisaiton of services by young people aged 10-24 years

Timeline

5 March 2014 - 27 February 2015

Results

The key findings and recommendations from the assessment study have been presented to the ASRH Sub-Committee (including FHD) and will be used to strengthen the delivery of AFHS through the national ASRH program. Specifically, the findings are contributing to a review of the current AFHS provider training curriculum and the development of certification criteria and monitoring tools.

Outcomes

There have been some important gains made to increase the coverage of AFHS and meet the health needs of adolescents, particularly needs related to SRH. However there are multiple challenges impacting on accessibility and delivery of AFHS. These challenges exist at many levels – from the individual knowledge, attitudes and skills of adolescents themselves to family and community factors, competencies of providers, facility constraints, management and the policy environment.

The key findings included:

  1. Despite demand for SRH services and a preference for seeking care from public facilities, awareness of existing AFHS among adolescents is very low
  2. Facility records and data on utilisation are very limited, but suggest that unmarried adolescents (particularly girls), boys, young people living with a disability, and young key affected populations are currently underserved by AFHS
  3. Community-level socio-cultural norms and attitudes are an important barrier and have not been given adequate attention
  4. AFHS providers need additional training and supportive supervision to provide high quality, non-judgmental and confidential services to adolescents
  5. Facilities require increased resources, monitoring and supervision to implement national AFHS standards

As a result of this study, UNFPA has commissioned a further activity to develop and pilot certification criteria and a quality monitoring tool for AFHS to support the implementation of AFHS in Nepal. This work will be conducted by SISo Nepal with technical support from Burnet Institute.

Collaborators

Centre for Research on Environment Health and Population Activities (CREHPA) (assessment study);
Skill Information Society (SISo) Nepal (certification criteria and monitoring tool development)

Funding

UNICEF and UNFPA

Contact Details

For any general enquiries relating to this project, please contact:

Doctor Elissa Kennedy

Co-Program Director, Maternal and Child Health; Co-Head Global Adolescent Health

Telephone

+61392822119

Email

elissa.kennedy@burnet.edu.au