Service delivery platforms
There is a range of different platforms available to provide health services to adolescents: public and private facilities, schools, mobile clinics, pharmacies, youth centres, e-health and outreach strategies. Within each platform, the focus, content and organization of the services can vary.
These platforms reflect the rich experimentation over the years with various models of care to make services “adolescent-friendly”, a term that describes efforts to systematically respond to the barriers to service use that adolescents and service providers have identified.9
Service delivery platforms Youth-friendly health policies and services in the European Region. Sharing experiencesUnfortunately, the principle of “adolescent-friendly” often has not been applied to mainstream primary and referral-level services. Recognizing this gap, WHO has been strengthening the capacity of ministries of health to establish national standards for adolescent health services and to address the barriers to service access through a quality of care framework.
From the UHC perspective what matters is that service delivery platforms are able to deliver the package of interventions to the highest achievable number of the target population and with the required level of quality. Here, despite progress in many countries, there are a number of challenges:
- limited scope
- poor or uneven quality
- limited coverage
- inequity in access and use.
Service delivery: limited scope
Important causes of mortality, morbidity and risk factors in adolescence do not get sufficient attention in current initiatives labelled “adolescent-friendly”. Current initiatives often focus on a limited range of issues, such as sexual and reproductive health. Health problems that are often neglected include mental health disorders, substance use and substance use disorders, intentional and unintentional injuries and chronic illness. These gaps are mirrored in what adolescents indicate are services of interest. In the WHO global consultation with adolescents, more respondents expressed interest in seeking services for mental health and nutritional issues than for sexual and reproductive health issues.
consults with primaryFor example, unipolar depressive disorders are ranked as the top cause of DALYs during adolescence. However, very little is known about the extent of evidence-based services for these conditions,10-15 and the little information that is available indicates that coverage is low.16
Both NGO and government services are limited. While a limited scope is particularly characteristic of NGO initiatives that may have focused funding, it is also true for government services and policies. For example, many national policies that address adolescent health focus primarily on sexual and reproductive health and HIV.
An analysis of 50 published papers on adolescent-friendly health services in low and middle income countries in Africa, Asia, South America and Central America reveals that all of them described initiatives focused on sexual and reproductive health services, and only two papers mentioned other services. This reflects a limited ability both to respond to the needs of adolescents and to identify health needs.
For many adolescents mainstream primary care may not be their entry point to the health system. In the online consultation with primary care providers undertaken for this report, over half of the providers responded that they would not be the first health worker whom adolescent patients in their practices would contact for issues related to suicide, alcohol, gender identity, abortion, smoking cessation or physical or sexual abuse. Respondents to the WHO consultation indicated that “a more youth-oriented primary care culture” is among the three most important factors for them to engage more in adolescent care.
Youth friendlyBroader approaches are developing. However, positive changes are taking place. For example, some countries that have adopted national quality standards for adolescent health have included packages of health services that address a range of health problems and concerns.17-20
A growing number of initiatives also seek to use specific health problems as entry points for adolescent health care more generally. Examples include using HIV-related interventions to also address such other health issues as sexual and reproductive health, substance use and substance use disorders, violence and mental health problems21-24 efforts to strengthen the adolescent health component of global health priorities, such as reproductive, maternal, newborn and child health25 exploring the potential of combining HPV vaccine delivery with other adolescent health interventions26 and initiatives in emergency care settings to address jointly alcohol use and violence prevention.27-31
Beyond SRH HPV vaccination Tackling multiple
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
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
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
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
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
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
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
Education of adolescents is important - they don't know the services available to them.
female, general practitioner, Australia
Adolescents on what can be done to improve health services: To be allowed access to health services without being judged.
female, 18-19, Mexico
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
My mum would have to know, and I am not comfortable with that.
female, 12-14, United Kingdom
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
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
Community people are conservative minded; services in the health centre are not sufficient.
male, community health worker, Bangladesh
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
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
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
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
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
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
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
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
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
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
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 are not able to pay for themselves and have to be dependent on parents for consultations.
female, adolescent physician, India
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
