Research and Program Summaries on youth-friendly services are linked below.
Characteristics of Youth-Friendly Services (YFS)
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Providers trained in YRH issues and communication
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Respectful, non-judgmental attitude
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Confidentiality and privacy
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Convenient hours/location
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Comfortable, non-threatening environment
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Affordable fees
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Community involvement/support
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Youth participation
Though these characteristics are widely accepted and agreed upon, it is not known if some of these characteristics have greater impact then others.
Reproductive Health (RH) Needs of Adolescents
RH services for adolescents can be divided into two categories: preventive services and diagnostic/curative services.
Preventive services include: information and counseling on reproductive health topics such as sexually transmitted infections and pregnancy, provision of contraceptives and emergency contraceptive pills, and skill building to negotiate condom use.
Diagnostic/curative services include: prenatal and postpartum services, treatment of post-abortion complications, diagnosis and treatment of sexually transmitted infections, and voluntary counseling and testing of HIV.
Thus far, preventative youth-friendly services have generally been unsuccessful in attracting adolescents. This is possibly because adolescents have no immediate need to use these services. In many cases youth do not perceive themselves at risk or when they do recognize the risk, they may postpone seeking services.
Curative services are more successful as the need is more obvious, often immediate, and more readily accepted by community (especially prenatal care or postpartum services). But research on the effectiveness on YFS is inconclusive: there is evidence that making services youth-friendly does not attract more youth; there is also evidence that while some youth-friendly services lead to better utilization, the same pattern can be observed in clinics that were not design to be "youth-friendly."
Evidence on Youth-Friendly Services
Evidence on effectiveness of clinic-based YFS to increase utilization is extremely limited and inconclusive. The FOCUS on Young Adults Project studied the effectiveness of four programs providing youth-friendly services. All programs included interventions beyond service improvement. Two showed some impact in service utilization, while the other two showed little to no impact. Details can be found on pages 57 -75 of the FOCUS End of Program Report (PDF 1.9MB).
Clinic services are sometimes linked to youth centers. While these may benefit youth in other arenas, they have been proven both costly and ineffective for reproductive health service delivery.
Possible Approaches to YFS:
Making existing curative services more youth-friendly may better accommodate adolescents' needs. Also, taking essential preventive services, including male and female condoms, combined oral contraceptives (COCs) and emergency contraceptive pills (ECPs), outside of the clinics may both meet adolescents' needs and improve utilization.
Steps to improve diagnostic/curative services include:
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Improve the quality of existing services.
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Train providers in counseling techniques and the special needs of adolescents.
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Emphasize the need to link diagnostic/curative services to preventive services.
Steps to improve preventive/outreach services include:
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Continue to make condoms widely available through community outreach programs, social marketing programs, peer educators/promoters networks, school-based health programs, and youth centers.
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Young women who cannot negotiate condom use can be protected from unwanted pregnancy by using other contraceptive methods or emergency contraception. COCs can easily be provided outside of clinics, often through the same channels as condoms. Pills are very safe for adolescents. Those who provide pills, including community workers, pharmacists and peer educators, should be trained in basic counseling about use and side effects.
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ECPs should also be available to adolescent females following unprotected or coerced sex. Advance provision saves time, adds to effectiveness of the regimen, and provides and opportunity for counseling on regular contraceptive options.
Research and Program Summaries
Bridging the Gap Between Health Providers and Youth. Cheetham N, Quintana A, Hidalgo C.
As part of its objective to aid health professionals in the Andean region with developing more youth-friendly services, the YouthAccess project conducted workshops with 120 health professionals in Peru, Bolivia, and Ecuador. As a result, 28 action plans were developed in 54 health centers focusing on training health center personnel, involving youth, promoting services to youth, and improving referral systems. All but one of the health centers advanced one to three levels in terms of youth participation, 439 additional adults from the centers were trained, and various mechanisms of referral improvement were implemented. Some challenges to reform included overcoming internal resistance to increased attention for adolescent health and overcoming the traditional emphasis on treatment versus prevention.
Enhancing Pharmacist Practitioner Contribution to Reproductive Health Access. King R, Loghin F, Bojita M.
In Romania, many adults and youth obtain contraceptive products from community pharmacies. The Train Pharm Project trained more than 1,000 pharmacists in 54 skills-certification workshops through 20 master trainers. The skill certification workshops included an overview of reproductive health and family planning, contraceptives, sexually transmitted diseases, menopause, and communication. As a result, between 1999 and 2002 nearly one-third of Romania's pharmacists were trained to provide frontline health care to youth and women.
Making Health Services More Attractive to Young Men. Nascimento M, Barker G.
Young men are less likely than young women to seek health services when they need them. They also are less likely to be attuned to their own health needs. In this context, Promundo has developed a project to improve access to and quality of health services for young men in Rio de Janeiro, Brazil. The project has taken a two-pronged approach: improving the health centers and increasing demand for their services with young men. Initial project results confirm that changing staff attitudes to welcome and accept young men is a major challenge. Parents are gatekeepers and must be engaged.
Making Public Sector Facilities Youth-Friendly: Tanzania's Case Study. Achimpota N, Keyonzo N, Chalimilla G, et al.
The majority of young people in Tanzania access their health services from the public sector. The Infectious Disease Center (IDC) has been in existence for more than a decade, with adolescents composing thirty percent of its client load. Despite IDC's efforts to provide treatment for sexually transmitted infections to youth, the need for youth-friendly services was essential. In collaboration with Pathfinder International/ African Youth Alliance (AYA), IDC developed and implemented YFS in four of its Dar es Salaam facilities. Baseline studies were conducted to assess key areas and quality improvements were made. Youth-friendly service areas included training of IDC staff in adolescent sexual reproductive health, sensitization of managers and the community, and strengthening of the existing referral system. After initial program implementation, visits increased from a total of 5,681 youth clients served in 2002 to 17,606 in 2003. Success of the program was largely due to participatory involvement and leadership of management to identify and address feasible activities to promote youth-friendly services.
Reaching Vulnerable Youth with Sexual and Reproductive Health Services in Uganda. Ssempebwa R, Tumwebaze L, Colton T.
In an effort to increase access to youth-friendly health services for street children and commercial sex workers in Kampala, the Uganda Youth Development Link (UYDEL) developed and implemented programmatic responses including establishing and upgrading drop-in centers to offer youth-friendly services, establishing "barefoot mobile services" at places where young sex workers and street children congregate, providing the same services as the drop-in centers, strengthening referral networks, and providing livelihood skills training to youth. As a result, visits to drop-in centers and outreach providers rose in 2003, 60 young people have discontinued sex work, and 37 youth have been trained in other means of income generation.
RxGen: Reaching Youth Through Pharmacies. Beitz J.
Pharmacies are uniquely positioned to offer reproductive health information and services to adolescents. However, they often lack client-centered approaches targeted at youth. PATH's RxGen project sought to increase adolescent access to reproductive health services through pharmacies in Cambodia, Kenya, and Nicaragua. Additionally, RxGen sought to increase awareness of pharmacy services and establish reproductive health services within pharmacy training programs. Pharmacists and pharmacy staff were trained in emergency contraception (EC), adolescent health, and customer service. Youth-oriented materials were developed and distributed to adolescent clients and job aid materials for pharmacy staff. Evaluation results showed effective implementation of youth-friendly services, an increase in EC knowledge, and appropriate counseling by pharmacy counter staff.
Striking Alliances with Faith-Based Organizations to Improve Adolescent Sexual and Reproductive Health. Acquah C, Essandoh E.
The Window of Hope project implemented by the Christian Health Association of Ghana (CHAG) works to improve access to youth-friendly services in 10 rural and peri-urban health facilities. Project activities have included staff training and orientation, quality improvements in facilities, and the identification and training of alternative channels for reaching youth. The project also engaged in sensitization and negotiation with board members and church leaders. As a result of the interventions, youth patronage has increased at clinic and outreach sites, as has community awareness and acceptance.
Vietnam's Model for Scaling Up Youth-Friendly Services. Thuy H, Nhan V, Wedeen L, et al.
Vietnamese youth account for a small percentage of reproductive health (RH) clients in government clinics because the facilities are not perceived as youth-friendly. The Reproductive Health Projects (RHPs), a collaboration between the Ministry of Health, Pathfinder International, EngenderHealth and Ipas worked to enhance and increase the quality of RH services. In response to poor utilization of RH services by youth, the RHPs have worked to develop and implement pilot youth-friendly services (YFS) in three provinces. These services were integrated into existing systems in provincial hospitals, MCH/FP centers, and district health centers. A number of strategies were employed including establishing ties with local communities through secondary schools, universities, pharmacies, recreation centers, renovation of facilities to promote YFS, and improvements in social marketing to reflect adolescent RH. Preliminary results of pilot activities suggest progress in YFS implementation.
Youth and Providers Together Define Youth-Friendly Services. De Bruyn M, Nga D, Thuy P, et al.
In this pilot project, university students aged 18-26 in Nigeria and Vietnam were brought together with healthcare providers to engage each other in defining youth-friendly services. The students participated in educational sessions on sexual and reproductive health, following which they wrote plays on the subject of unwanted pregnancy and performed them for the providers and other community leaders. Afterwards, providers and students discussed how existing health services could be made friendlier for youth. While financial constraints hindered replication on a larger scale, videotapes of the plays were made for distribution.
Youth-Friendly Services and Sexual Education in Bosnia and Herzegovina. Blagojeviae Z, Avdiae A.
This project, implemented by the International Rescue Committee and the United Nations Population Fund, aims to introduce youth-friendly services into Bosnia and Herzegovina and to provide information regarding sexuality and medical services to adolescents. Activities include concerts, information stands, debates, workshops, presentations, the creation of health centers, and media appearances. The project has also worked to address sexual and reproductive health issues in the educational curriculum. Overall, it has been found that peer counseling is the most effective choice for educational products, while free products and services are important factors in attracting young people to medical centers.
Do Youth-Friendly Services Make a Difference? (Senderowitz, 1997)
English HTML -- Espaol HTML -- Franais HTML
Making Reproductive Health Services Friendly for Young People (Senderowitz, 1997)
English HTML -- Espaol HTML -- Franais HTML
Young People and STDs/HIV/AIDS Part II: Programs to Address the Problem (Senderowitz, 1997)
English HTML -- Espaol HTML -- Franais HTML
Reaching the Youngest Adolescents with Reproductive Health Programs (Sedlock, 2000)
English PDF 96K
Reaching Adolescents Through Hotlines and Radio Call-in Programs (Moch, Stevens, 1999)
English PDF 96K
Reaching Indigenous Youth with Reproductive Health Information and Services (Farrell, Rosen, Terborgh, 1999)
English HTML -- Espaol HTML
Reproductive Health Programs for Young Adults: Health Facility Programs (Senderowitz, 1998)
English HTML -- Franais HTML
Reaching Young Men with Reproductive Health Programs (Green, 1998)
English HTML
Emergency Contraceptive Pills: An Important Option for Young Adults (Klofkorn, 1998)
English HTML -- Franais HTML
FOCUS End of Program Presentations
Keys to Scale Up Adolescent Programs - Peru Case Study (PDF 483K)
The Experience of IPPF/WHR Providing Youth Reproductive Health Services (PDF 218K)
Zambia Integrated Health Programme (PDF 549K)
