Expanding Access to Youth-Friendly Services
The need for sexual and reproductive health services for young people has never been greater. For one thing, this is the largest-ever youth generation. Moreover, in many countries, young people are marrying later, and spending longer (often sexually active) intervals between puberty and marriage. In addition, the AIDS pandemic has heightened awareness on the need for information and services that can help young people protect themselves.
Most countries now make some effort to provide sexual and reproductive health services for adolescents and young people. However the erroneous belief persists in many places that sexual and reproductive health services encourage sexual activity among adolescents.
Ideally, sexual and reproductive health services for adolescents should be offered as a component of a broader cluster of support services. Surveys show that young people may feel a greater urgency about other issues, including employment, training and shelter.
UNFPA promotes a core package of sexual and reproductive health care and commodities, and works with government ministries, NGOs and other partners to create linkages and synergies that allow for efficient delivery of these and other support services.
Health Services: (Where possible, these should be promoted and delivered through diverse channels, including work places, maternity clinics and recreation centres)
- Sexual and reproductive health (core essential): Information, counselling and services for safe motherhood, contraceptives, post-abortion care, management of sexually transmitted infections, nutrition education and counselling, menstrual hygiene
- HIV/AIDS (core essential): Information, education and counselling for HIV; access to preventive commodities such as male and female condoms; voluntary counselling and testing; early diagnosis and treatment of STIs; and anti-retroviral therapy.
- Gender-based and sexual violence: Prevention, detection, counselling and follow up
- General health: General health check-up, eye, dental, counselling for substance abuse.
Social Services: (UNFPA networks with partners and community-based organizations to create referrals and linkages to these services)
- Legal counselling and services
- Psychosocial counselling
- Career counselling
- Shelter and rehabilitation services
- Income generation skills and services
- Referral linkages to other youth programmes and services
In many places, adequate services that cater to youth are not available. In other places, their utilization is extremely low. Young people are often discouraged from using such services because of cost, disapproval by providers and the community, logistical constraints (including inconvenient hours or lack of transportation), fears about violations of confidentiality, uncertainty, embarrassment, or simply because they are not aware of them. Stigma keeps many young people living with HIV from receiving the treatment they need.
Another barrier is fact that services for young people may be piecemeal – focusing only on sexually transmitted infections, for example, or just on contraception. Or they may be offered in traditional ‘adult’ clinical settings where adolescents and young people may feel ill at ease. Sometimes providers themselves are not comfortable with the legal and moral responsibility of providing services to adolescents and youth.
Youth-friendly services (see characteristics below) aim to overcome these barriers to accessibility and use. Identifying groups of underserved young people – such as married girls in some countries – who may have specific needs and barriers to getting help is also important to widening access.
- Convenient open hours
- Privacy ensured
- Competent staff
- Respect for youth
- Package of essential services available
- Sufficient supply of commodities and drugs
- Range of contraceptives offered
- Emphasis on dual protection/ condoms (male and female)
- Referrals available
- Confidentiality ensured
- Waiting time not excessive
- Affordable fees
- Separate space and/or hours for youth
- Youth input/feedback to operations
- Accessible location
- Publicity that informs and reassures young people
- Comfortable setting
- Peer providers/counsellors available
- Educational materials available
- Partners welcomed and served
- Non-medical staff oriented
- Provision of additional educational opportunities
- Outreach services available
According to a 2004 survey, 90 per cent of countries have made some efforts to provide adolescents with access to reproductive health care. Many have established youth-friendly services designed specifically for young people. But most of these are on a small scale and many are run by NGOs. While NGOs offer can offer excellent and iinnovative services, they rarely have the resources to implement the programmes at the scale that is needed. Vast needs remain unmet. The availability of youth-friendly services has been shown to increase both the demand for and quality of adolescent health care. UNFPA is working with governments and other partners to replicate and scale up successful models.
In Mozambique, for example, Geração Biz, a UNFPA-supported project designed and developed by youth with technical assistance from Pathfinder International, reaches both in-school and out-of-school youth through a variety of activities, including sports, youth centres and school- and community-based interventions.
The project, selected as a ‘best practice’ by World Bank, began in 1999 in two provinces and has been expanded year after year. The number of adolescents aged 15-19 visiting clinics for counselling and services increased more than tenfold in Maputo following the establishment of youth-friendly services there. The programme now reaches 48 districts in all 11 provinces of the country and involves 26 institutions in programme implementation. Its cadre of 4,520 trained peer educators reached over 776,000 young people with information and life skills training in 2004. Peer educators help spur demand for the services offered in 78 facilities. Counselling and contraception are the services in highest demand.
UNFPA, in partnership with WHO, has also helped the Government of India vastly expand its services to young people. The Fund provided strategic, technical and operational guidance to Ministry of Health and Family Welfare as it integrated adolescent friendly service centres into the primary health care infrastructure in 75 districts of the country. Health care facilities target special services for adolescents at specific times. This expanded service provision dovetails with programmes by the Education and Youth Ministries to build life skills and knowledge of sexual and reproductive health issues.