Friendly health services: For adolescents
Adolescents are curious by nature and are new to the domains of sexual and reproductive life. Comprehensive counseling, to adolescents seeking services, is therefore necessary
To make existing health services adolescent friendly, GoN has developed an Adolescent Sexual and Reproductive Health (ASRH) program whose major target is to make existing health facilities adolescent friendly.
The International Conference on Population and Development (ICPD) has recognized the need and importance of sexual and reproductive health in which adolescents health hold a significant position. Nepal being a signatory party to ICPD, prepared and implemented a National Reproductive Health Strategy and Plan in 1998 where adolescent health and development was a central issue. In 2011(2067) a National ASRH program, based on a pilot program in 2009 in 26 health facilities, was designed. It was gradually scaled up to meet the target of Nepal Health Sector Program II i.e. making 1000 health facilities adolescent friendly by 2015.
In the past it was assumed that adolescents didn’t require reproductive services and the general services provided at health facilities were sufficient to address the needs of all age groups. However, such a blanket approach led to poor utilization of services by the adolescent population. To overcome this, the concept of Adolescent Friendly Health Service (AFHS) was introduced in existing health facilities making them Adolescent Friendly Health Facilities (AFHF). AFHFs must provide adolescents with appropriate information and skills, counseling and services and safe and supportive environment.
In efforts to make the services provide accessible by the adolescent population, services must be adolescent friendly in terms of accessibility, affordability and acceptability. The services also must be inclusive regardless of gender, religion, disability, social status etc. It must also be ensured that the service providers are specially trained to communicate with adolescents in a friendly manner without being judgmental, respecting their confidentiality and privacy.
According to the District Public Health Office (DPHO) of Kathmandu, as of fiscal year 2070/71, a total of 13 health facilities were listed under health posts providing AFHS. However, when we visited these health facilities to conduct our survey, only four of them were operational. None out of these four health facilities are providing services in line with the standards mentioned in the implementation guide developed by GoN. AFHFs must be easily accessed by transport and its infrastructure must be disabled friendly.
AFHFs must also be operational beyond office hours and during weekends. All four health facilities were accessible in terms of transport but none of them was disabled friendly. The health facilities were also closed during weekends and only operational during office times.
A separate signboard is provided by the GoN to indicate availability of adolescent friendly health services, and displaying them is mandatory. However, it was absent in all the health facilities visited, with some even claiming to have never received such signboards. A separate room must be maintained to ensure privacy to adolescents seeking service. But in reality, adolescent services were run simultaneously with other general services in the same room. The service providers were also found to be inadequately trained, with their training sessions lasting a mere 2 hours.
Staffs, in some heath facilities, who had received the training to run an AFHF had failed to implement it in their health facilities citing various reasons.
Adolescents are curious by nature and are new to the domains of sexual and reproductive life. Comprehensive counseling, to adolescents seeking services, is therefore necessary. The counseling provision was primarily focused to females whereas males and LGBT were neglected.
Information Education and Communication (IEC) materials related to their health and development are another effective means of disseminating information. They must be appropriate (simple language, visually attractive, comprehensive) and conveniently accessible for adolescent’s reading. The health facilities admitted to having no supply of IEC materials. School outreach is an affiliation of health facilities with local schools to provide information on adolescent issues in a classroom setting. Only one health facility had collaborated with a local school for health education of adolescents. But it must be noted that, such outreach programs were targeted only to school going adolescents with total disregard to dropouts and non-school going adolescents.
Through our survey it was also realized that the utilization of services by sexual minorities, the LGBT community, was absent (none of the health facilities reported to have had a LGBT client). And no efforts were made by the health facilities to improve this situation. Still, very few of the health facilities had maintained an up-to-date ASRH register, with even fewer reporting the data collected. This attitude was reflected in the annual report of DPHO Kathmandu, where the usually published section of Adolescent Health related data was absent.
Adolescents are one of the most vulnerable populations of a country. On top of existing combination of legal, physical, economic and psychological barriers, adolescents can be excluded by poor service delivery. So it is necessary for the government to exercise accountability and responsibility to run only programs targeted for them.