Universal health coverage—a new framework for action
Adolescents have significant needs for health services, as Sections 3 and 4 illustrate. Adolescents pose different challenges for the health-care system than children and adults, due to their rapidly evolving physical, intellectual and emotional development.
Global public health movements and declarations of the past 30 years have emphasized people-centred care and equity.1-4 Yet, despite adolescents’ special needs, they have not systematically benefitted from such approaches.
Some countries have begun to explore how to respond more effectively to the health needs of adolescents, but more often through the efforts of nongovernmental organizations (NGOs) rather than health ministries, and often such efforts have not been scaled up substantially.
Today, universal health coverage (UHC)—a framework emerging as a unifying post-2015 agenda for global health5 6 —provides an opportunity for renewed attention to meeting the health-care needs of adolescents through the strengthening of health systems.
The World Health Report 2010 defines universal health coverage as: “providing all people with access to needed health services (including prevention, promotion, treatment and rehabilitation) of sufficient quality to be effective; [and to] ensure that the use of these services does not expose the user to financial hardship”.7
Looking at the four key elements of the UHC definition, this section explores what it takes for health systems to achieve UHC for the world’s 1.2 billion adolescents. The section is structured according to the health system’s functions of service delivery, human resource development, financing and stewardship.8
WHO-recommended services and interventions for adolescents
Universal coverage requires that appropriate and effective interventions for improving adolescent health and development are available, and that policy-makers, health-care providers, adolescents and their parents know about these health services.
The services and interventions outlined here include only those currently addressed in WHO guidelines. Some of these interventions are specific to adolescents, and some are also important for other populations. They are delivered through primary and/or referral-level facilities. Countries will need to prioritize their inclusion in service platforms based on a range of factors, including the main health problems facing adolescents and the capacity of the health system.
The interventions included reflect a life-course perspective: Some deal with adolescents’ current problems (e.g. the management of existing health conditions), while others seek to prevent disease both during and beyond adolescence (e.g. addressing risk factors for noncommunicable diseases).
Overview of services recommendations on health
I may not be able to improve my sexual life (as I want to be a girl) because I live in a small town with a population of approximately 25,000, and there are no experts on this subject.
trans, 12-14, Argentina
Adolescents on what can be done to improve health services: That there be more places that offer free services as it is very necessary.
female, 18-19, Mexico
I am scared of the gynecologist, I know I have to go one day, but the idea terrifies me.
female, 18-19, France
I am an adolescent clinical nurse specialist and work exclusively with adolescents. However I do not have the time or resources to see them all. System problems stop me from seeing all patients.
female, nurse, United Kingdom
Community people are conservative minded; services in the health centre are not sufficient.
male, community health worker, Bangladesh
Adolescents on what stops them from using health services: Negative and judgmental attitudes of health care providers, long waiting periods, lack of trust in diagnosis (especially for elective counselling i.e.: pill pushers due to pharmaceutical company endorsement), expensive.
female, 18-19, Romania
Adolescents on what stops them from using health services: Time, because there are too many people in health clinics and few doctors, meaning the waiting times are long, and I honestly don’t have the time to wait.
female, 18-19, Mexico
The demand for services at community health centers is far too high, which quickly becomes exasperating, and the services are terrible. The government spends more money on guns for the army than on the well-being of its population.
male, 15-17, Guatemala
Adolescents on what stops them from using health services: In my country, the high levels of disorganization, the lack of resources. The lack of time, as there are big lines for getting medical attention that start forming extremely early in the morning.
male, 18-19, Peru
They usually scold me when I go to clinics, saying that I am too young to have sex or ask for condoms.
male, 15-17, Mexico
The only problem I really want to see anyone about is, ironically, my anxiety. I intend to seek therapy after leaving home as it's meant to be extremely good. That being said, I am surprised that the NHS doesn't offer general health check-ups - nobody has ever checked to see if I am suffering from symptoms unless I bring it up myself.
male, 15-17, United Kingdom
Long distance from the health center, lack of information on available health services and lack of money to pay for health services like STI's treatment.
female,18-19, Uganda
Adolescents on what stops them from using health services: Lack of financial resources and lack of access to good treatment.
male, 18-19, Morocco
Adolescents on what can be done to improve health services: Greater flexibility and efficiency during emergencies and routine appointments, of any kind in public hospitals. Better equipment, medications in schools, more efficiency when distributing medications in hospitals, and also warmth and patience with patients.
female, 18-19, Mexico
Adolescents on what can be done to improve health services: Educate more doctors and reinforce their competences, construct more sanitary infrastructures and equip them with modern healthcare materials.
male, 18-19, Burundi
Adopt a system of universal healthcare, because if society possess both systems, the private system will have the tendency to look at patients as though they were clients.
male, 15-17, Canada
Adolescents are not able to pay for themselves and have to be dependent on parents for consultations.
female, adolescent physician, India
Adolescents on what can be done to improve health services: Make access to psychiatric services easier because in my opinion, it is vital to see a psychiatrist when you are an adolescent.
female, 18-19, France
I use free healthcare services offered by the government. So nothing gets in the way of me using those services even if they’re not necessarily the best, I am just happy it’s an option because I don’t have the means to pay at a clinic.
female, 18-19, Mauritius
Health risks are so high that services don’t have enough resources. Also the doctors are difficult to access. There are few doctors for many illnesses.
male, 18-19, Burundi
Improve public education and the way in which health is taught. Improve public hospitals. To have a kind of place of care or assistance where youth can go without involving parents.
female, 15-17, Mexico
Adolescents on what can be done to improve health services: To be allowed access to health services without being judged.
female, 18-19, Mexico
The cost. Also the hours and availability. Calling only to find out you can have an appointment in six months, it’s discouraging.
female, 18-19, Switzerland
Linking organizational and delivery of care to payment might raise the profile and lead to better care being offered. QOF drives care in the UK to a large extent and if youth health is absent from the QOF be default it is off the radar.
female, general practitioner, United Kingdom
Education of adolescents is important - they don't know the services available to them.
female, general practitioner, Australia
Delays in public services, like at the hospital; often they attend to your needs but it’s already too late, and they can be very rude, which is psychologically damaging.
female, 18-19, Mexico
My mum would have to know, and I am not comfortable with that.
female, 12-14, United Kingdom
If I want to go to the gynecologist for any given reason, I can't go because it would show up in insurance. I can't get birth control pills, for example, because it would show up on insurance, and there's no free clinics nearby.
female, 18-19, United States of America
There is a lack of information about how to reach health services. For example, I just recently found out that my school has a nurse - two years after getting there!
female, 18-19, Peru
Adolescents on what stops them from using health services: Fear, distance, not being aware that they are available in your region, language barriers.
female, 15-17, Switzerland
In order to have to see specialists, I would need my parents' approval. However, asking them to see a nutritionist or counselor would make them worry.
female, 15-17, United States of America
