1. Pre-service Education on FP and AYSRH
Session III Topic 4 Adolescent Friendly Services
Adolescent Friendly Services, Session III Topic 4 Slide 1

2. Why Do Adolescents Have Difficulty Using Reproductive Health Services?
A number of factors are likely to make adolescents and young people uncomfortable:
Unmarried young people often think that reproductive health services are not intended for them.
They are often embarrassed at being seen in a reproductive health facility.
They are likely to be concerned about a lack of privacy and confidentiality, or afraid that their parents might find out about their visit.
They are afraid of medical procedures, especially pelvic exams.
They might be ashamed of having experienced coercive or abusive sex.
They find the clinic staff hostile.
Explain that to successfully serve adolescent clients with sexual and reproductive health care, providers and clinics must attract, serve and retain these clients. This requires a good understanding of the many barriers that adolescents face when seeking SRH services, and specific efforts within the health system to reduce some of these barriers by becoming more ‘youth-friendly’ and responsive to the needs and circumstances of young clients.
See A Case Study of Barriers to Good ASRH in the Session Plan
Adolescent Friendly Services, Session III Topic 4 Slide 2

3. Legal Barriers to Obtaining Services
Laws and policies that require parental/guardian or spousal consent for sexual and reproductive health services for adolescents
Laws and policies that restrict what types of services or contraceptive methods are available to adolescents based on their age, marital or other status.
Laws and policies that prevent health care workers or other professionals from providing condoms or other contraceptives to adolescents in certain settings, such as at schools or youth groups.
Slides 3-6
Explain that adolescents face multiple barriers to access services and information about sexual and reproductive health, both internal and external. These barriers can come in many forms, from economic and structural, to social and legal.
Explain that frequently, the service provider who wants to work with adolescent clients will need to also be an advocate for their access, in order to empower them to be able to make healthy and informed decisions about their own health and well-being.
Hand out 8-10 note cards to each student. Ask them to write one barrier that adolescents might face in obtaining services on each card. Collect all of the cards and read them off as you group them by legal barriers, structural/economic barriers, sociocultural barriers and individual barriers to obtaining services.
Show slides 3-6 on the different types of barriers.
Pause and reflect again that Abena faced many of these barriers – especially those involving the health systems (clinic, providers, supplies, financing, etc.). Ask students to look back at the flipchart of barriers that they listed for Abena and compare them to the list they generated using the note cards.
Divide students into 4 groups. Assign one type of barrier (legal barriers, structural/economic barriers, sociocultural barriers and individual barriers to obtaining services) to each group. Ask each group to come up with ways that they might remove or reduce the barriers if they were working in a health clinic and write these on a flip chart.
Allow 30 minutes for the group activity and ask each group to report back to the whole group.
Adolescent Friendly Services, Session III Topic 4 Slide 3

4. Structural/Economic Barriers to Obtaining Services
Structural/economic barriers Include:
Limited clinic hours, or hours that overlap with times when adolescents are typically in school or working
Few providers trained to provide services to adolescents
Services for adolescents only available at set locations
Distance from facilities
Services and commodities only available at prices beyond adolescents earning capacity
Transportation
Long wait times for services
Stock-outs or shortages in contraceptives or other sexual health-related commodities
Lack of privacy and confidentiality for adolescents
Adolescent Friendly Services, Session III Topic 4 Slide 4

5. Sociocultural Barriers to Obtaining Services
Sociocultural barriers include:
Restrictive norms and stigma around adolescent and youth sexuality
Inequitable or harmful gender norms
Discrimination and judgment of adolescents by communities, families, partners, and providers
False belief that young people are not sexually active and that providing contraceptives will increase sexual activity
Myths and misinformation about sex, sexual health and contraceptive side effects
Adolescent Friendly Services, Session III Topic 4 Slide 5

6. Individual Barriers to Obtaining Services
Individual barriers such as:
Young people’s limited or incorrect knowledge of SRH, including myths and misconceptions around contraception
Many adolescents are unaware of the risk of pregnancy. They are also unfamiliar with STD symptoms
Limited self-efficacy and individual agency
Limited ability to navigate internalized social and gender norms
Limited information about what SRH services are available and where to seek services.
Adolescent Friendly Services, Session III Topic 4 Slide 6

7. Characteristics of Adolescent-friendly Services
The World Health Organization has established 5 characteristics for
adolescent-friendly services:
Equitable: All adolescents, not just certain groups, are able to obtain the health services they need.
Accessible: Adolescents are able to obtain the services that are provided.
Acceptable: Health services are provided in ways that meet the expectations of adolescent clients.
Appropriate: The health services that adolescents need are provided.
Effective: The right health services are provided in the right way and make a positive contribution to the health of adolescents.
Introduce the session, highlighting that the special needs of adolescents explored in the previous session means that services need to be designed specifically to meet those needs – or ‘adolescent-friendly.’ Explain that one key pathway to success in designing adolescent-friendly SRH services is the active participation of young people in the design of services and monitoring of quality of care. Young people are better suited to know what the barriers are that keep them out of services, and howto get past them. Students are, therefore, well-positioned to examine the concept of ‘adolescent-friendly’ and identify how health providers and the broader health system can better serve adolescent clients.
Lead a brainstorming exercise to gather student ideas on what may constitute ‘adolescent-friendly’ services. Have flipcharts at the front of a class and ask for a volunteer to write down suggestions from the group. Ask students to share their ideas on adolescent-friendly services, drawing from Abena’s story and their own experience. Once a list has been developed, briefly review key ideas and explain that we will come back to these after learning more on global standards on adolescent-friendly services.
Build from student ideas to present globally identified characteristics of youth- friendly services.
Show the slide on Characteristics of Adolescent-friendly Services.
Adolescent Friendly Services, Session III Topic 4 Slide 7

8. Provider Characteristics of Youth Friendly Services
Provider characteristics include:
Specially trained staff
Ability of staff to provide comprehensive, respectful counseling.
Respect for young people.
Privacy and confidentiality.
Adequate time for client/provider interaction.
Ask students to brainstorm what specific provider characteristics are important. Write their responses on the flip chart. Supplement their responses from the following list. Training for health care providers in Adolescent Friendly Services should include:
Basic concepts in adolescent health and development, including protective and risk factors
Young people’s evolving capacities
Effective communication with adolescents
How to raise and discuss sensitive issues;
Local attitudes, beliefs, and practices related to youth SRH
How gender and life-stage-related norms influence young people’s SRH
Reflection on how providers’ beliefs and values influence the delivery of youth SRH, in addition to the delivery of clinical SRH services tailored to young people.
How to demonstrate non-judgmental attitudes toward all young people.
How to treat male and female young people with respect
How to provide confidential AFS
Adolescent Friendly Services, Session III Topic 4 Slide 8

9. Health Facility Characteristics of Youth Friendly Services
Health facility characteristics include:
• Comfortable waiting area for all clients
Convenient hours.
• Convenient location.
• Adequate space and privacy.
• Comfortable surroundings.
Signs that welcome adolescent and youth clients to FP services.
• Peer counselors available.
Ask students to brainstorm the characteristics of a health facility that make it adolescent-friendly.
Supplement their answers with the slide on Health Facility Characteristics of Adolescent Friendly Services.
Pause and ask students to reflect on these characteristics. Facilitate a discussion by asking the following questions:
Did anything new emerge that was not included in the original brainstorming exercise?
How are adolescent-friendly characteristics different from the expectations for services for adult clients? Where are they the same or similar?
Are there other needs of adolescent clients that should be incorporated into how services are offered?
Conclude this step by noting that both adolescents and adults deserve to receive friendly, respectful and quality care. The added emphasis on being adolescent-friendly, however, recognizes that young people – given their age, development stage and social situation – have special needs and constraints that must be addressed. A strong understanding of youth needs, adolescent-related values and beliefs, adolescent health policies is critical to being a strong youth-friendly provider.
Adolescent Friendly Services, Session III Topic 4 Slide 9

10. Program Design Characteristics of Youth Friendly Services (1)
Program design characteristics include: • Youth involvement in design and continuing feedback. • Drop-in clients welcomed and appointments arranged rapidly. • No overcrowding and short waiting times. • Affordable fees. • Publicity and recruitment that inform and reassure youth. • Both young men and young women welcomed and served.
Slides 10 and 11
Inform students that they are now going to use their understanding of adolescent-friendly characteristics to specifically identify how services could have been improved in Abena’s case. Post the flipchart list (done earlier) with the list of barriers faced by Abena. Ask students to think about to Abena’s story and review the list and identify any health systems related barrier. Ask a volunteer to place an HS next to any of the health systems barrier they identified.
Put up two other flipcharts and label one with ‘clinic’ and the other with ‘service.’ Ask for two volunteers to write down input from students on the appropriate flip chart. Ask students to think about how they might re-design or change the clinic and services to make them more responsive and youth-friendly for Abena and other adolescents. Have them call out their suggestions and track on flipchart. Encourage debate on what would be adolescent-friendly and push for some level of consensus on the changes retained on the flipcharts.
Pause the discussion to briefly share Slides 10 and 11 on the program design characteristics of youth-friendly services.
Resume the discussion on changes to the clinic or services in Abena’s case. Ask students for any additional suggestions based on the points raised in the previous slide. Finalize the two flipchart lists.
Ask students to review the lists and determine which three would be most critical in ensuring that Abena is able to address her ASRH needs over the long-term, including as they evolve over time. Invite students to go to the flipcharts and place a check mark next to their top three selections.
Review their votes and process with the group. Identify which changes were most popular and invite a few students to share why (or why not) these should be prioritized. Ask students to also share which changes they, as providers, may be able to enact or influence directly.
See Values Clarification Activity: Group Activity and Discussion in the Session Plan
Adolescent Friendly Services, Session III Topic 4 Slide 10

11. Program Design Characteristics of Youth Friendly Services (2)
• Wide range of services available
Ensure that age-disaggregated data is collected and used to analyze quality of services;
Full range of methods available to adolescents and youth, regardless of age, marital status or childbearing status.
Necessary referrals available.
• Youth friendly educational material available on-site and to take.
• Group discussions available.
• Delay of pelvic examination and blood tests possible.
• Alternative ways to access information, counseling, and services.
Adolescent Friendly Services, Session III Topic 4 Slide 11