ADOLESCENT FRIENDLY SERVICES LAC PHN SOTA and Field Officers’ Meeting Miami, FL March, 2001

What are Adolescent Friendly Services?  Providers. Specially trained, respectful, privacy and confidentiality honored, adequate time given, peer counselors available.  Program design: youth involvement, drop-in clients welcomed, short waiting time, no overcrowding, affordable fees, targeted publicity and promotion, wide range of services, referrals.  Facility Characteristics: Separate space and special times, convenient hours, adequate space and privacy, comfortable surroundings.  Other characteristics: education materials available, group discussions, delay of exams possible, mobile services, etc.

Type of Clinic Services  Multiservice centers  Adolescent-friendly services in existing outpatient facilities (private/public)  Hospital-based post-partum and post-abortion programs

Multiservice Centers  Metropolitan areas  Basic health and family planning services AND  Legal assistance, recreation, job, vocational training  Used in Mexico City, Guatemala, Costa Rica, Panama, Colombia, Nicaragua  Effective, acceptable, appreciated, BUT  Very high cost, low attendance, low coverage, not sustainable

PSFN; Monterrey, Mexico, Integrated Youth Center:  Promotion, set-up and initial training per community $4,992  Average Monthly operating costs per community $ 763  Annual cost per active young adult user $ 203 (vs. $64 for Community YP and $ 5 per CBD)

Making Friendlier Out-Patient Clinic Services for Adolescents  Facilities include health centers and posts, private clinics and physicians, pharmacies, etc.  Two main models: training staff and placing staff  Placing staff: reduced coverage, inter-institutional conflicts, and no institutionalization  Training staff: require strong supervision, tolerance to low productivity if staff is dedicated

MOH Mexico Adolescent Program  Service delivery in by specialized teams in selected health centers and hospitals  Multi-disciplinary teams: physicians, psychologists, and social workers  Both special purpose (>130 units) and general- purpose providers (80%)  Contraception, prenatal care, STD prevention, prevention of addictions  Mass media and community promotion of services: mobile stands, fairs, visit to schools

Evaluation (MOH, 2000)  Mean monthly number of RH services provided per unit increased from 6 to 82 in 4 years  75% of visits are for women. 73% are not single  Twice as many services in health centers than at hospitals  However, no difference in utilization of specialized and non- specialized units  Differences in knowledge of RH but not in attitudes or behaviors  Only 9% of adolescents attended for family planning reasons (PNC and birth were the most used services)

Observation and interviews (Inopal III, 1997)  1994 FP Service Delivery Guidelines require providers to inform adolescents.  50% providers aware that STD/AIDs Counseling, 60% contraception, 22% methods should be given to adolescent clients.  84% said they would provide methods, 50% information on STD prevention, 30% counseling on sexuality but few mentioned delivery of methods.  Only 10% of consultations observed were for family planning. Services were provided appropriately.  In none of the non-family planning consultations the providers mentioned contraceptive methods or the use of the condom to prevent STDs and AIDS.

MEXFAM  16 Clinics with Young People spaces (a physician’s office).  One specially trained physician to whom all adolescents are referred.  Also training of and referrals to public and private associated physicians.  Between 20 and 150 monthly clients per clinic on average.  Model has achieved a 50% self-sufficiency (adolescents pay about US $ 2, which is given to the provider).  Model more successful when physician participates in community and school activities.

Post-partum / Post Abortion Services  They provide information and methods to adolescents  A viable PP/PA program usually needs to be in place  Volume of services and early discharge make service delivery difficult. In addition, fewer have prenatal care  Only second and higher order pregnancies are prevented  Difficulties for following-up clients/obtaining space

CORA at Women’s Hospital in Mexico City, 1992  Team placed at hospital by Cora  Cost per adolescent exposed to talks: ≈ US $ 2.20  Increase in knowledge of methods: from ≈20% to ≈ 80%  Percent recruited at hospital: ≈ 50%  Coverage: < 20%  Percent attending follow-up sessions: ≈ 10%  Percent attending FUS using method: 97%

Proportion of Adolescents Choosing Methods at Hospitals With PP/PA Programs:  MUCH HIGHER, but lower than for older women: at MOH hospitals in Mexico, 43% of women over 20 years of age having an obstetric event choose a method, compared to 33% of women less than 20 years of age.  Special educational, service delivery and follow-up activities may be conducted at these hospitals: setting apart beds for adolescents, providing joint care for mothers and children at 40 days post-partum, etc.

Pharmacies as Service Delivery Sites  86% of urban adolescents in Mexico who used a method in their sexual debut obtained it at a pharmacy (1999).  Only 8% of those who use health services have requested a method there.  75% of pharmacists said they would advise a female adolescent on methods, but only 50% think adolescents feel comfortable requesting methods.  In 30 visits of simulated clients to evaluate an EC project in Mexico City, only one pharmacist refused to give information and all gave courteous treatment (although several did not give correct information). In other projects using simulated clients at pharmacies, similar results have been obtained.

Pharmacy Service Delivery Programs  Few and infrequent experiences with service delivery through pharmacies targeting adolescents, both in LAC end elsewhere.  Main problems: staff turnover, unwillingness to leave wor for training.  Mass media crucial in promotion of SD sites and motivating providers.  Mailings can help. F. ex, knowledge of EC pills among pharmacists increased from 5% to 25% by means of mailings in Mexico.

Youth Social Marketing (SM) in Africa  PSI OR Projects in four countries conduced as supplement to existing SM projects.  Radio call-ins, youth clubs, peer education and youth friendly clinics, shops and pharmacies.  Improved: awareness of benefits of prevention and reducing barriers to using condoms.  Less impact: perceptions on own-susceptibility and on actual behavior-condom use.

Improving RH knowledge and practices of boys and girls (10-19) in Mexico, Kenya, Senegal & Bangladesh