Bringing services closer to adolescents —school health services, e-health and m-health
School health services have potential. As a way to bring health care closer to adolescents, school health services may have advantages in terms of access, equity and responsiveness to adolescents’ needs. They are common in both high income countries and low and middle income countries.75-83 In the online consultation with primary care providers, more than half of the respondents indicated that there are school health personnel (school doctors and/or school nurses) employed in their area. Nearly half of the adolescents (47%) responding to the WHO global consultation indicated that they would prefer to obtain health services at school.
Advantages of schoolThere is a great diversity in how school health services are organized.84 Different models have been developed that provide some or all of the following services: individual clinical care, group-based health promotion, prevention, infectious disease control, screening, case management for chronic conditions and referrals for further health services.85-90
models of school
Data from the European region show that school health services face common challenges, such as poor alignment of services with health priorities, inadequate workforce capacity and shortage of school health personnel, insufficient involvement of families and teachers in school-based health promotion programmes, inadequate funding and unclear division of responsibilities among school nurses, school doctors and general practitioners/family doctors.91 A number of countries have overhauled school health services to respond to these challenges.
school health services "The European framework for quality standards for school health services and competencies for personnel"Despite the prevalence in school health services, little evidence on their effectiveness is available, especially from low and middle income countries. The cost-effectiveness of different organizational models also needs more study, and quality standards for school health services need to be defined.
E-health and m-health have promise. A number of interventions have demonstrated the potential for high coverage offered by Internet and mobile communication technologies (e-health and m-health).92 In the WHO consultation, one in every three primary care providers indicated that adolescents in their practice could have a consultation via e-mail, and one in every 10 indicated that a consultation via web site or social media was possible. Communication technologies cannot replace contact with a competent health-care provider. Still, e-health and m-health technologies may complement efforts to bring services closer to adolescents, as they can achieve high coverage at low cost. They can, for example, provide confidential and anonymous interactions, easy access 24 hours a day and the possibility for personalized interaction—all of which appeal to adolescents. They have shown promise of effectiveness in the area of sexual and reproductive health, smoking cessation and alcohol-related problems.93-97 To date there are few quality randomized controlled trials of e- and m-health, however, and even fewer of interventions specifically addressing adolescents.98
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
My mum would have to know, and I am not comfortable with that.
female, 12-14, United Kingdom
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
I am scared of the gynecologist, I know I have to go one day, but the idea terrifies me.
female, 18-19, France
Adolescents on what can be done to improve health services: To be allowed access to health services without being judged.
female, 18-19, Mexico
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 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
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
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
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
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
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 are not able to pay for themselves and have to be dependent on parents for consultations.
female, adolescent physician, India
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: Fear, distance, not being aware that they are available in your region, language barriers.
female, 15-17, Switzerland
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
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
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
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
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
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
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: Educate more doctors and reinforce their competences, construct more sanitary infrastructures and equip them with modern healthcare materials.
male, 18-19, Burundi
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
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
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: Lack of financial resources and lack of access to good treatment.
male, 18-19, Morocco
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
Education of adolescents is important - they don't know the services available to them.
female, general practitioner, Australia
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
