Youth Friendly Services: Lessons from the Field and Implications for Scale Up

1. Youth Friendly Services: Lessons from the Field and Implications for Scale Up Judith Senderowitz Africa Regional Forum on Youth Reproductive Health (RH) and HIV Dar es Salaam, Tanzania June 7, 2006

2. Lessons Learned from: African Youth Alliance (AYA) YFS component Botswana, Ghana, Tanzania, Uganda Gera��o Biz YFS component Mozambique

3. Lessons Learned about: Status of YFS/Design Needs Assessment and Quality Improvement Training, Supervision, and Other Implementation Monitoring and Evaluation Sustainability and Scaling Up

4. What are YFS? Services able to: Effectively attract young people Meet young people�s needs comfortably and responsively Retain young clients for continuing care

5. Where can YFS be delivered? In health facilities (GO and NGO hospitals, clinics, health centers) Through private providers In social and community settings (clubs, organizations) At entertainment and recreational venues At commercial outlets At schools At the workplace

6. What are the characteristics of YFS? Essential: Convenient open hours Privacy ensured Competent staff Respect for youth Minimum service package Sufficient commodities Range of methods offered Dual protection emphasis Referrals available Young adolescents served Confidentiality ensured Waiting time acceptable Affordable fees Separate space/hours

7. YFS Characteristics Supportive: Youth input/feedback mechanism Accessible location Publicity for YFS Comfortable setting Peer educators/counselors available Educational materials available Delay of tests Partners welcomed Non-medical staff oriented Provision of additional educational opportunities Outreach services available

8. AYA: A Brief Overview Partnership of 3 organizations. (PATH, Pathfinder, UNFPA) With host governments, NGOs, civil society, youth Program in 4 countries (Botswana, Ghana, Tanzania, Uganda) Integration of 6 components (Policy & Advocacy, BCC, YFS, Institutional Capacity Building, ASRH into Livelihood Programs, Coordination and Dissemination)

9. AYA Strategies for YFS Work with existing RH services to make them youth-friendly Graft RH services onto existing youth activities and venues Institutionalize YFS within MOH/NGOs

10. YFS Facility Assessment and QI Process Service providers, management, supervisors trained Assessment to determine baseline and QI plans TA to facilities [ongoing provision of services] Assessment tool reapplied Other evaluation: analysis of service statistics and client satisfaction (mystery client visits), interviews and focus group discussions, case studies

11. Results of YFS Quality Improvement

12. Facility Elements Most ImprovedBotswana, Tanzania

13. Grafting RH Services(Examples) Sports events Commercial venues (barbershops, dressmakers) Youth organizations University settings Mobile services to CSWs Workplace programs

14. Institutionalizing YFS Incorporation of ASRH/YFS in pre-service training Training of supervisors/MOH/all levels Adjustment of data collection instruments to reflect ASRH Approval and incorporation of TOT/SP curricula for in-service training Process and plan in place for upgrading and certifying YFS

15. Gera��o Biz (GB) Multisectoral program (Ministries of Health, Education, Youth & Sports with NGOs and Youth Associations) Strategies: Build national capacity & government ownership Improve policy environment Strengthen coordination and partnerships Interrelated program interventions: clinics, schools, outreach/community (o/s youth)

16. GB Service Provision Integrate YFS into existing public sector clinics Limited adolescent-only clinics/centers Coordinate with school- and community-based efforts Introduce VCT into YFS Pilot and expand HIV treatment and care

17. Client Satisfaction Study Conducted in 2004 1,400 interviews in 14 YFS facilities Conducted in 3 areas: Maputo City, Maputo Province and Gaza Province

18. Study Results(Selected Characteristics)

19. Study Results(Selected Indicators)

20. YFS Scale Up

21. Lessons Learned Status of YFS/Design Needs Very few clinics welcoming youth Providers not specially trained Inadequate management/supervisory capacity Concepts not well understood by: Youth Parents/community Providers/health establishment Policy-makers Involve community for support Engage government as early as possible

22. Lessons Learned (Continued) Assessment and Quality Improvement Management must be sensitized and committed Involve supervisors, technical advisors in process Areas most improved: dual protection, privacy, serving young adolescents, establishing separate spaces Areas of remaining need: continued training, confidentiality, sufficient commodities and supplies, available educational methods, more outreach and use of alternative channels, coverage of sensitive topics (GBV)

23. Lessons Learned (Continued) Training, Supervision and Other Implementation Continue training and refresher courses Train supervisors before service providers Clarify and apply national policy guidelines at service points Incorporate YFS into regular service provision (YFS is not a project!) YFS = good quality +

24. Lessons Learned (Continued) Monitoring and Evaluation Ensure M & E activities from the start Train personnel expected to monitor implementation Assure data collection by useful age groups Use mystery clients and client exit interviews to do routine quality monitoring Use findings to improve programs

25. Lessons Learned (Continued) Sustainability and Scaling Up Government must be involved and active from the start Implement pre-service training Encourage adoption of sustainable tools Build on supportive facilities Assure integration of YFS into district planning and financial resource allocation Public health facilities have great potential to scale up