HEALTH FOR THE WORLD'S ADOLESCENTS

A second chance in the second decade

Strategic information to guide the health sector response

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Summary

Effective policy-making and programme design require strategic information on the health-related behaviour of adolescents and on health services for them. Various sources can provide this information, but data on the adolescent age group are often not available:

  • Programme input data come from administrative sources and databases including financial tracking systems, human resources, national health accounts and policy data.
  • Programme output data come from routine facility data collection and facility assessments of services and service quality.
  • Outcome data on health-related behaviours and services coverage come largely from nationally representative household surveys and school-based surveys.
  • Health impact data come from vital registration statistics, disease surveillance, clinical reporting systems and household surveys.

A necessary first step toward obtaining strategic information on adolescents is disaggregating the data specific to the 10–14 and 15–19 age groups.

Strategic information informs policy and programmes

Simply put, strategic information is data that can inform policy-making and programme design. Sections 3 and 4 provide an overview of the data describing the major causes of mortality, morbidity and disability among adolescents and the prevalence of health-related behaviours. Countries need these data to define priorities, for advocacy and to select appropriate interventions.

Unfortunately, many countries lack age-disaggregated data on adolescents—often those countries that most need these data: those with large adolescent populations, significant disease burden and relatively weak infrastructure. Often, data are compiled in ways that hide adolescents (for example, use of the 5–14 and 15–49 years age bands). Increasingly, however, countries are recognizing the importance of stratifying data in 5-year age groups for the first 20 years of life.

This section provides an overview of the kinds and sources of data that countries are collecting to obtain a deeper understanding of adolescents’ health problems and the response of the health sector and other sectors to these problems. These data provide the strategic information needed to develop, implement and monitor policies and programmes for a range of services in different sectors.

Building on Section 6, this section also offers an overview of data on health services for adolescents. This information is needed to answer questions about the quality and coverage of health services for adolescents, such as: Are services reaching them? Who is using services? Which groups of adolescents are using them and for what health problems? And are the services effective in meeting their health needs?

The examples of indicators presented in this section are organized according to the Monitoring and Evaluation framework used by the World Health Organization (WHO) and the International Health Partnership & Related Initiatives (IHP+)1 (see Figure 1 below). This framework is built on four core sequential domains: inputs and processes, outputs, outcomes and impact.

Figure 1. The WHO monitoring and evaluation framework
Inputs and processes
Outputs
Outcomes
Impact
Governance and financing
Infrastructure; information and communications technology Intervention access and service readiness Coverage of interventions (services, policies) Improved health outcomes and equity
Health workforce Intervention quality, safety and efficiency Prevalence of health-related behaviours Social and financial risk protection
Supply chain Responsiveness
Information
Contextual changes
Non-health system determinants

WHO proposes indicators. WHO is proposing a list of 32 core health indicators for the adolescent years, based on the WHO/IHP+ measurement framework, for use in countries.2 As summarized in the table, the availability of data on these indicators vary. Currently, an expert group is reviewing these indicators prior to a consultation involving UN partners. A recent paper reviews 17 of the 32 proposed indicators in terms of their quality and availability.3 An additional eight of the proposed indicators are included in the same nationally representative multi-country surveys reviewed in this paper while WHO-supported surveys collect a further five. Only one indicator in the list is a new indicator, on sexual competency/readiness, that will have to be validated and tested. Of the 32 indicators 13 measure impact, 11 measure outcome/coverage, five measure inputs/outputs, and three measure determinants. Systematic collection of data on these indicators will provide essential information to monitor the health of adolescents and the quality of the response nationally, regionally and globally.

Proposed health

Examples of the collection and use of strategic information in programmes to improve adolescent health and service delivery to adolescents

During the past decade a growing number of countries have strengthened and developed the strategic information that they collect and use to plan and monitor their adolescent health interventions.

In Chile, for example the National Health Strategy for 2011–2020 includes a Healthy Youth Check-up component, with promotion, prevention, care and referral strategies. It has been possible to measure coverage, which increased from 5% in 2011 to 7% in 2012, and where the check-ups took place: 64% in schools and 28% in health facilities. Young people have participated in all phases of the design, implementation and assessment of the programme. Based on the preliminary information collected, the Healthy Youth Check-up has been incorporated into the national programme to strengthen primary care and will gradually be scaled up throughout the country.

In Indonesia the government was convinced of the need to disaggregate the health surveillance data for all ICD codes by 5-year age groups and to do this in ways that ensure that the information is not aggregated as it moves up the system from facility to district, province and then national levels. Disaggregated data will provide important details to support programming and the allocation of resources. They also will complement the quarterly monitoring by the Ministry of Health, at these different levels, of the national scale-up of adolescent-friendly health services.

In Malawi,4 one in every four 15–19 year olds has begun childbearing, and so improving adolescents’ access to quality health services is a priority. Since 2007 Malawi had been implementing an Adolescent Friendly Health Services (AFHS) programme. The strategic information collected through the quarterly reporting system from registers and supervisory visits, and the programme review carried out in 2010, indicated that the quality of the services was not adequate. The Ministry of Health is, therefore, undertaking an assessment of the quality and coverage of AFHS before planning further scale-up.

In Tajikistan,5 strategic information about adolescent health is being collected from a variety of different sources. There is an electronic data recording system in AFHS facilities that provides service use statistics for each client and information about their diagnoses.6 It is, therefore, possible to monitor the use of the services per client by sex, health conditions and frequency of usage. By combining this information with the age-disaggregated data available from existing infectious disease surveillance registries, it has been possible to monitor the health situation of some vulnerable adolescents.

The MOH has carried out a facility-based evaluation of the country’s 21 AFHS facilities. This evaluation indicated that the quality of the services was good and that, although the facilities were established in response to HIV, half of the clients using the facilities came for other health problems. The MOH is using this information to conduct an overall evaluation of the AFHS programme since its start in 2006, assessing its relevance, efficiency, effectiveness and impact as part of the mid-term review of the Comprehensive National Health Strategy of Tajikistan 2010–2020.

Barriers to using services- Negative / judgmental attitude of health care providers, long waiting periods, lack of trust in diagnosis.

female, 18-19 Romania

Adolescents on what stops them from using health services: 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 do not find enough time to perform sports and I find unhealthy food in front of me.

female, 18-19 Saudi Arabia

I just found out that my school has a nurse (two years after getting there).

female, 18-19 Peru

I don’t sleep well often; sometimes I don’t eat enough because I’m scared of gaining weight and sometimes I just don’t feel the need. I am also enormously stressed.

female, 18-19 France

Adolescents on what stops them from using health services: Fear, distance, not being aware that they (health services) are available in your region

female, 15-17 Switzerland

Adolescents on what stops them from using health services: 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