A second chance in the second decade

Towards adolescent-responsive health systems


Steering the transition from adolescent-friendly projects to adolescent-responsive health systems

To make progress toward universal health coverage, ministries of health and the health sector more generally will need to transform how health systems respond to the health needs of adolescents. A number of transitions in service delivery, workforce capacity and financing will be needed.

Service delivery: A transition is needed from “adolescent-friendly” projects to programmes that strengthen mainstream capacity at primary and referral levels to respond to the priority health and development needs of adolescents. A number of actions would facilitate this transition:

  • establishing and implementing a national package of adolescent health interventions at primary and referral levels and strengthening the capacity to deliver the package in an integrated manner;
  • developing and implementing national quality standards and monitoring systems;
  • raising awareness about the health needs of adolescents and generating community support for the delivery of the adolescent health care package and for its uptake.

Preventive care: Transitions are required to create opportunities for all adolescents to make contact with primary care services for individual preventive services. Countries’ experiences179 180 suggest that actions to facilitate this might include:

  • strengthening school health services and exploring the potential of including periodic check-ups for adolescents in primary care;
  • embracing e-health and m-health technologies;
  • undertaking community-based initiatives for demand creation through peers, community health workers, lay counsellors and others.

Workforce capacity: Transitions are required in the ways the workforce is trained, so that all providers have a basic knowledge of adolescent development and their implications for clinical practice. Actions that may facilitate this shift include:

  • making competency-based training in adolescent health care mandatory in pre-service curricula and post-graduate specialist training;
  • designing competency-based training programmes that emphasize the developmental and contextual aspects of adolescent health;
  • including policies and strategies that support the supervision of primary care providers and specialists providing services to adolescents.

Financing: Transitions are required in the way that resources are allocated and purchasing of services is designed, so as to meet the need of adolescents. The following actions may facilitate this transition:

  • removing (or at least reducing) the need for adolescents to pay for services at the time of use by maximizing the number of adolescents covered by effective prepaid pooling arrangements, with adequate subsidization of vulnerable adolescents and their families;
  • making the national package of adolescent health interventions an instrument to guide purchasing decisions and benefit packages, with attention to preventive services and to adolescents’ right to confidentiality and the highest attainable standard of health;
  • providing incentives that motivate health workers to provide specific interventions that are essential for adolescents’ health and development and to comply with quality standards.

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

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

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

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

female, 18-19, Mexico

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: 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

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

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

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

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

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

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

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: Lack of financial resources and lack of access to good treatment.

male, 18-19, Morocco

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: 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

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

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

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 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

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

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

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

female, general practitioner, Australia

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

female, adolescent physician, India

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: 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