INSTITUTE OF MEDICINE AND HEALTH SCIENCE DEPARTMENT
OF PUBLIC HEALTH
Adolescent sexual and reproductive health services and
challenges
By:
1. Abera Endale
2. Debebe Dejenie
3. Michael Amera
4. Tirunesh Zewude
11/08/2024 May ,2019 1
Presentation outline
• Introduction
• Intervention for adolescent RH problems.
• Adolescent Friendly RH Services(AFRHS)
• Monitoring and Evaluation
• System challenges
• Recommendations
11/08/2024 2
Introduction
• Adolescents and youth constitute 33.8% of the
total population of Ethiopia.
• Nearly one of eight (13%) adolescent girls are
anemic
• 36% are chronically malnourished (BMI<18.5).
• More than half (51%) consumed khat with high
regional variation;
11/08/2024 3
con’t…
• About 46% of them consume alcohol six or
more times per month; and
• 4.4% of adolescents are cigarette smokers.
• Moreover, the prevalence of road tra ffic
accidents among young people aged 15-29
years is 2.7% (HSTP, 2016/2017).
11/08/2024 4
1. Intervention for adolescent reproductive
health problem
Adolescent interventions can be broadly divided in
to:
• Behavioral interventions- which seek to change
the knowledge, skills and attitudes of individuals.
• Structural interventions-which aim to tackle
broader societal issues that drive the spread of
STIs.
11/08/2024 5
Behavioral Interventions
• Improving control over sexual activity
• Delaying initiation of intercourse
• Minimizing partner change
• Promoting appropriate health seeking behavior
• Encouraging use of contraception
• Peer educators can act as effective role models.
11/08/2024 6
Structural Interventions
• Economically empower young women
• Providing reproductive health services within
schools
• Mass media approaches
(A J Robinson, K Rogstad,2002)
11/08/2024 7
• 10 areas of intervention that together address the risks and causes of
poor health and mortality in the adolescent age group(WHO 2014).
11/08/2024 8
con’t…
11/08/2024 9
2. Adolescent Friendly Reproductive Health
Services(AFRHS)
• A program that focuses on the welfare of
adolescents through guidance on how to maximize
the use of health care services.
• Aims to build the capacity of health service providers
in providing adolescent friendly RH services and
• The promotion and instillation of healthy behaviors
among adolescents.
11/08/2024 10
con’t…
• Seeks to advocate and institutionalize policies
that promote adolescent welfare and
reproductive health rights.
• Intends to establish and organize adolescent
defined quality services with local government
units and multi sectorial partners.
11/08/2024 11
Key program components
• AFRHS facilities initially provided the following
services:
Family Planning and Supplies Provision,
Prenatal Care,
Postnatal Care,
Dental Care, and
Medical Care
11/08/2024 12
Cont.
• The AFRHS facility now provides comprehensive
health services for adolescents and adopts
The 7 standards of adolescent friendliness
Multi sectorial Partnership in Quality Service
Adolescent and Youth Involvement and
Participation
Respect Diversity and Acceptance
Adolescent Friendly Health Service Providers
11/08/2024 13
Cont.
Accessible and Suitable Health Facilities,
Three-Way Referral System,
Adolescent Gender and Culture Sensitive
Information, Education and Communication.
(AFRHS,2004)
11/08/2024 14
3. Monitoring and Evaluation
Measuring performance against set targets in the AYH
program is crucial ;
To generating essential information
To guide strategic investments and operational
planning
• M & E of the AYH strategy will rely on various systems
and data sources (routine and periodic)
• Supported and maintained by numerous stakeholders
(AYHS 2016-2020).
11/08/2024 15
Con’t…
Key performance indicators from the strategic document
will be integrated;
within the HMIS, MNCH scorecard and associated
monitoring tools.
• Data will be collected for several categories and levels
of indicators.
• The indicators for M&E of AYH are built into the
framework of four core sequential domains:
Inputs and processes, outputs, outcomes and impact .
11/08/2024 16
Performance Tracking Systems
Service utilization data will be collected
through:
• The HMIS,
• population based surveys such as DHS and
PMA 2020, and
• Studies that provide data on services, such as
the ESPA+ Survey (AYHS 2016-2020).
11/08/2024 17
Performance…
• Process monitoring will allow for corrective and preventive
action along the way, including ,planning and coordination.
• Frequent and regular joint supportive supervisions will be
done;
To identify problems early on and
To take immediate remedial actions
Using the integrated supervisory mechanism and
Checklist with attendant human resources and financial
commitments.
11/08/2024 18
Table 1: Monitoring and evaluation matrix
11/08/2024 19
Strength
• Population based surveys such as the
EDHS,PMA to measure impact at regular
intervals.
• Use of health and health related indicators
• Existence of national health information system
• Series of research and publications by
academic institutions on AYH.
11/08/2024 20
weakness
• Poor health information and vital registration system.
• AYH data and indicators are not integrated with in
HMIS tools.
• Researches and publications on AYH are not sufficient.
• Weak generation, collection and analysis of data and
dissemination of information.
• Available data on AYH are of low quality.
• EDHS miss important age groups (10-14 years).
11/08/2024 21
4. System Challenges of attaining Adolescent
Sexual & Reproductive health
• Young people (10-24 years of age) around the world face
tremendous challenges to meeting their SRH needs.
• Between 25 and 33 percent of adolescents for go needed
care and many others lack access.
(Susan W. 2010)
11/08/2024 22
Some of the factors hindering adolescents’ use of
or access to programs and services are:-
Lack of confidentiality
Lack of access and utilization to preventive care
Lack of adequate insurance coverage.
Lack of providers trained in adolescent health
Lack of comprehensive sexuality education
11/08/2024 23
Con’t…
Lack of confidentiality –
Inconsistent and unclear policies regarding
adolescent patient confidentiality.
60% of adolescents seeking reproductive
health services at family planning clinics do so
with parental knowledge,
11/08/2024 24
Con’t…
Lack of access and utilization to preventive
care
Among all children and youth, adolescents were
the least likely to attend preventive well child visits
based on medical recommendations.
Adolescents’ low rates of outpatient visits put them
at increased risk for health complications, and
High school dropouts are at even greater risk than
their non-dropout peers.
11/08/2024 25
Con’t…
Lack of adequate insurance coverage
Adolescents and young adults are more likely
to be uninsured than any other age group,
with 16.2% between the ages of 13 and 17
lacking any insurance.
11/08/2024 26
Con’t…
Lack of providers trained in adolescent health
Of the 195 accredited pediatric residency training
programs in the U.S.,
Only 27 have fellowship programs to train
clinicians in adolescent care.
Lack of comprehensive sexuality education
Public schools to teach sex education
11/08/2024 27
Recommendations
Fund positive youth development and afterschool
programs.
Reduce sexual risk behaviors in adolescents.
Fund programs that bring services to youth who are
disconnected from school, employment, and social
supports.
Support programs that educate and empower young
people as peer educators and advocates.
11/08/2024 28
Con’t…
Establish and expand school-based health
centers, particularly those that provide
comprehensive primary care services.
Pass legislation to enhance confidentiality
protection to improve adolescents’ access to
confidential services
Make contraceptives widely available in venues
frequented by adolescents, including schools.
11/08/2024 29
Reference
1. Federal Democratic Republic of Ethiopia
Ministry of Health, annual performance report, HSTP
2016/2017.
2. A J Robinson, K Rogstad (Adolescent sexual health)
ARTCLE 315-318,2002.
3. WHO recommendations on adolescent sexual and
reproductive health and rights ,2014.
4. National adolescent and youth health strategy (2016-
2020) ,FDRE,MOH Ethiopia.
5. Adolescent Reproductive and Sexual Health Facts for
Policymakers Susan Wile Schwarz ,April 2010.
6. Adolescent friendly RH service program,2004.
11/08/2024 30
Thank you !!!!!!!
11/08/2024 31
