A second chance in the second decade

Towards adolescent-responsive health systems


Service delivery: inequity in access and use

Identifying adolescents who are not covered by existing services is important. For example, boys may be excluded from sexual and reproductive health services if they are organized around maternity care. Expanding access through dedicated youth centres or clinics in urban areas excludes rural adolescents. School health services do not serve adolescents who are not in school.

Similarly, it is important to evaluate the utilization of health services provided through different settings. For example, despite the popularity of youth centres, they may serve only a small proportion of the target population, mostly those who live nearby; there may be significant gender differences in use; and the clientele may be older than the age group for whom the services were designed.99

Because of restrictions imposed by providers, women who are young, unmarried, have few or no children, do not have the support of their partners, or are less educated may not be able to access family planning services or obtain their preferred family planning method.100 In the WHO consultation one in every four primary care providers indicated that in their setting there are restrictive policies related to age or marital status or other reasons that might prevent some adolescents from receiving care. Services often do not reach the most vulnerable groups, such as homeless adolescents,101-103 those with mental health disorders,104 105 those from a different cultural background such as Roma adolescents, immigrant youth,106 including those needing an interpreter, adolescents in youth justice settings107 108 and those stigmatized by sexual orientation or transgender status.109-111

There are growing experiences with providing health services to marginalized adolescents who are not reached by facility-based services.112 Successful approaches include postal-based chlamydia screening,113 114 condom distribution via street outreach,115 home-based HIV counselling and testing116 and over-the-counter access to emergency contraception.117 118

Gender disparities Ethnic disparities

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 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

I am scared of the gynecologist, I know I have to go one day, but the idea terrifies me.

female, 18-19, France

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

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: To be allowed access to health services without being judged.

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

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

Adolescents are not able to pay for themselves and have to be dependent on parents for consultations.

female, adolescent physician, India

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 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

Education of adolescents is important - they don't know the services available to them.

female, general practitioner, Australia

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

My mum would have to know, and I am not comfortable with that.

female, 12-14, United Kingdom

Community people are conservative minded; services in the health centre are not sufficient.

male, community health worker, Bangladesh

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

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 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

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 stops them from using health services: Lack of financial resources and lack of access to good treatment.

male, 18-19, Morocco

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

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

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 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 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 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

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

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 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