How to cite this article: Achamyelesh G, Nebiyu M, Yemisrach S. Facility Readiness Assessment for
Implementationof Adolescent and Youth Health
Care Service in Central Zone, Southern Ethiopia. Glob J Reprod Med. 2019; 6(4): 555693. DOI:10.19080/GJORM.2019.06.555693.
Background: In 2016, a new strategic plan is developed nationally to address the adolescent and youth health issues holistically. For its implementation, it is important to assess the available resources at health facilities. The aim of this study was to assess the readiness of the health facilities for the implementation of comprehensive adolescent and youth health care.
Methods: A cross-sectional study was conducted among the youth-friendly service delivering and not delivering health facilities with 1:1 ratio in the central zones of Southern Nations Nationalities People Region from May 14-26, 2017. A total of 14 health centers was selected using lottery methods. The data were collected through interview and observation. Interviews were done among 14 health facility managers 14 health care providers and 5 district health office heads. Data were entered into Microsoft Excel 2010 software and descriptive analysis was made.
Result: Totally, 14 health facilities were observed. Of all 42.8% of health facilities have at least six health officers, 78.5% have more than ten diploma nurses, 85.7% have diploma midwifery at least one, 70% have no displayed information items such as the rights of adolescent to information, only 50% of them have a waiting room. 75% were working in a room with no curtains in windows and doors, no screen separating the consultation area from the examination area to maintain privacy during the consultation. All health facility managers and heads of the district health office mentioned that shortage of trained manpower as a result of frequent turnover, budget, vehicle, and room were critically hampered the implementation of the services as required.
Conclusion: It is possible to begin the comprehensive adolescent and youth health care service with the existing manpower health professionals and rooms. However, the training of health care providers and fulfilling the necessary medical supplies and materials are important. So, service quality will be improved based on the standards in collaboration with different stakeholders and partners.
Adolescents and youth comprise one-third of the world’s population , whom 90% live in developing countries . Overall the proportion of adolescent and youth expected to rise from 20% to 50% within the coming thirty years . Ethiopia is a young country with 71 % of the populations are under the age of thirty and 10-24 years were 33.8 % [3,4]. Investing in young people (ages 10 to 29) now will lay the groundwork for future. Adolescent and youth is a critical age for risk taking and critical period for professional intervention [5,6]. Intervention in this time help adolescent and youth to make appropriate decision for the future live and can prevent risk behaviors which can also affect their adulthood health. Adolescent and youth need different
approach than adult in service provision. Currently adolescent and youth are not getting the expected services worldwide [6,7].
Mortality rate of adolescent and youth are rising due to several health problems. Especially road traffic accident is the first contributor for mortality. Non communicable diseases and mental illness also another contributor for morbidity and mortality of adolescent and youth . Globally a number of initiatives have been taken place over the last decades to provide adolescent and youth responsive health care [8,9]. However, most of the initiatives were focusing only on sexual and reproductive health issues [10-12].
Similarly, in Ethiopia though it was not in an integrated and
comprehensive manner there were a lot of straggles to address
adolescent and youth health since 2000 [13-16]. However, with
all the efforts made the intended improvement not achieved in
the health of adolescents and youth due to health system was not
responsive and young people not utilized the service. Therefore,
federal ministry of health revised the previous strategy and
launched a new strategy that comprise comprehensive adolescent
and youth health care and to make the health system responsive
for that comprehensive approach . Therefore, the aim of this
study was to assess facility readiness for the implementation of
comprehensive adolescent and youth health care.
The Southern Nations Nationalities and Peoples’ Regional
State is the third largest administrative region of Ethiopia and
represents about 20% of the country’s population with close to 20
million people. The central zones of Wolita and Hadiya zones and
Halaba special district contributes more than 20% of the regions
population. Wolaita zone has five hospitals, 69 health centers, 372
health posts and 98 private clinics. Hadiya zone has one general
hospital, 4 primary hospitals 61 health centers and 305 health
posts. In Halaba there are 7 health centers and 50 health posts.
Study area and period: This readiness assessment was
conducted in 14 health centers of the central zones of Southern
Nation Nationalities People Region health facilities from May 14-
Study design: A cross-sectional study was conducted in two
central zones namely Wolaita and Hadiya and one special district
Sampling criteria: The zones and special district were
selected purposively. Since these two zones and districts have high
population density and their proximity to the head quarter of the
region might be a true representative of the general health facility
of the region. From Wolaita zone, six health centers were selected
from five districts (namely, Offa, Damot Pulasa, Damot Gale, Bodity
and Sodo). And from Hadiya zone, three districts and six health
facilities and from Halaba special district one from started and
one from not started were selected based on their youth friendly
service delivery status among started and non-started 1:1 ratio.
The health centers were selected using lottery methods (Table 1).
Study population: Health care providers (nurse and health
officers), health center managers and district health office heads
of the selected health facility.
Data collection and sources: Data were collected from 7-19
May 2017. Five reproductive health professional data collectors/
technical assistant were hired and trained to collect the data.
Data were collected through interview and observation using
questionnaires and observation check list prepared to assess
national adolescent and youth health service quality by Federal
Ministry of Health (FMOH). Interview were done among health
providers (nurse and health officers) those working in youth
friendly service room from started health centers and maternal
and child health nurses from non-started health centers and
health center managers and district health office heads. The
collected data were entered in to Microsoft Excel 2010 software
and descriptive analysis was made using percentage.
Classification criteria: Readiness of the facility was
assessed based on the standard set by World Health Organization
for adolescent and youth health . When the facilities
fulfilled>=75% of the standards we considered ready for that
element i.e. staff, basic amenities etc. Support letter was also taken
from RHB maternal and child health and nutrition core process office to the two zones and Halaba special district and district
health office heads also communicated officially to get consent
from each health centers.
During the survey, 14 health facilities, their managers, one
health care provider from each and 5 district health office heads
were interviewed. Of all 6 (42.8%) of health facilities have at least
five health officers, 9 (64.2%) have more than ten diploma nurses,
7 (50%) have diploma midwifery at least four and 6 (42.8%) have
no bachelor nurse and midwifery (Table 1). Staff numbers and
their orientation to the right and confidential delivery of service
is important for provision of quality adolescent and youth friendly
services. In this survey 12 (86%) of the health facility managers
have no training for quality improvement in adolescent and youth
health care and supportive supervision. All youth friendly service
started health facilities have 2-3 trained health persons. Among
non YFS started health facilities only one had training. During the
survey time except one health center with YFS, they were closed
due to community mobilization for community based health
insurance, while other units are operating their routine activities.
In all YFS available health centers service for adolescent and youth
were in working hours.
All started health centers have clearly visible signboard that
mentions operating hours of the facility. Among all 13(92.8%)
have functional toilet but, only 1/14(7.1%) have functioning hand
washing facilities after toilet, 3/14(21.4%) of toilets were clean,
4/14(28.5%) had disposal bin in the toilet. About 11/14(80%) of
health facilities do not have adequate and comfortable seating in
their waiting area. Almost all health facilities are clean and well
coming however; only 2/7(28.5%) health facilities have a clean
and well coming separate waiting room and 5/7(75%) were
working in a room where windows and doors have no curtains.
3/7(42.8%) have no screen to separate consultation area from
the examination to maintain privacy during consultation. There is
pipe water in the entire health centers compound but no drinking
water facilities in waiting area. Nine out of fourteen (64.2%)
has permanent electric supply during working hours. All the
facilities have general waste disposal system in the health center.
Communication equipment (phone or shortwave radio) found in
5/14 (35.7% %) of the health facilities.
Seven out of fourteen (50 %) of the health centers have
adequate, whereas 5/14 (36%) need repair of their furniture and
2/14 (14 %) of the health facilities do not have furniture while
having separate room prepared for YSFs (Figure 1). Computer is
available in7/14 (50%) of health facilities and no internet access
was observed in all health facilities.
Equipment/material/supplies are available in all health
facilities: Blood pressure measurement machine, binaural adult
stethoscope, monaural fetal stethoscope, clinical thermometer,
an adult weighing scales, latex gloves, single-use standard
disposable or auto-disposable syringes, pregnancy test strips
and haemoglobinometer. Materials inadequately supplied /found
in surveyed health facilities: Measuring tape, Light source, for
example a torch, height meter, soap or alcohol-based hand rubs
for hand hygiene body mass index growth charts for adolescents,
test strips for urine with 10 parameters, ophthalmoscope set and
otoscope set were not found in any of the health centers.
Condoms, oral contraceptive pills, emergency contraceptive
pills, injectable contraceptives, contraceptive implants,
intravenous fluids, paracetamol, amoxicillin, Ceftriaxone,
ciprofloxacin, cotrimoxazole suspension, diclofenac, omeprazole,
diazepam and vaccines found in all health centers uniformly. Only
8/14 (59%) of health centers have magnesium sulfate. Atenolol,
Salbutamol, Glibenclamide not available in all health centers,
which are important for the treatment of diabetes mellitus,
hypertension and asthma respectively.
All health facilities have sharps/box/container and a general
waste disposal incinerator in the compound. Nine out of fourteen
(64.3%) have safe storage and disposal of clinical waste and
potentially infectious waste that requires special disposal i.e.
disposal of equipment that may have in contact with body fluids
and safe storage and disposal of sharps. However, 5 (35.7%) have
adequate hand hygiene facilities that are located in or adjacent to
the office/examination room.
In health facilities where services are started 4/7 (57%)
health care providers involved the adolescents in the planning,
monitoring, evaluation and in any aspects of health service
provision for adolescents. But the vulnerable groups of adolescents
are not participating.
Readiness assessment survey was conducted for the
implementation of the national adolescent and youth friendly
health care strategies in SNNPR. Out of nine standards, four
of them were seen in this survey, which are important for the
readiness assessment, this includes: facility characteristics,
data and quality improvement, adolescents’ participation and
intersect oral collaboration. This study showed majorities (86%)
of manager lack to get training of adolescent and youth friendly
services (AYFS). According to current Ethiopia AYHS, advocate for
district managers to guarantee their ownership and support for
implementation the designed strategy . The health workers in
YFS not started health facilities were deficient in training which
is one of the tools for readiness assessment. This finding is in line
with study in Uganda in which all staff including the managers lack
training. For the implementation of comprehensive AYH all type
of health worker received the basic knowledge and skill in preservice
training, but at least one person needs to have a training
on AYH and can provide orientation for others to overcome the
staff shortage and turnover.
Facility characteristics: this is the third standard as this is
a readiness assessment study it focusses on the input aspect of
the standard: among the elements of the standard availability
of essential medicines were acceptable >= 75% in all surveyed
facilities. This finding is in line with study conducted in Sudan
, and higher than Northern Rwanda in which up to 73% of
health facilities faced a challenge of medium to high levels of stock
outs and slightly higher than study done in South west Ethiopia,
which one third of the health facilities are below the standard
[20,21]. This variation may be explained that the drugs were used
to assess the readiness in this study may varies in types.
To provide quality and standard health care it is important
to fulfill the necessary equipment and availability of basic equipment. Only 35.7% fulfilled the standard equipment needed
for AYHS. Among the listed infection prevention precautions
64.9% and 78.5% of HFs fulfilled laboratory service required
for AYFHS respectively . This also in line with study done in
10 developing countries . One of the significances of health
information management system is to make evidence-based
decision at all level. We could not find age and sex disaggregated
data in all non-started health facilities. This might be due to the
national HMIS format not captured age and sex of adolescent
and youth. In the revised HIMS format the above problem might
be solved. Adolescent participation in planning, monitoring and
evaluation of health services and in decisions regarding their own
care, as well as in certain appropriate aspects of service provision
is considered as very crucial according to the current AYHS
. However, in this study only 4/7 health facilities delivering
youth friendly service were participated adolescent and youth
in planning, monitoring, evaluation and in any aspects of health
services provision. This is low according to the standard and study
done in Uganda. Possible explanation for this low result may be
currently the program was not running very well [22,24].
On the other hand, they were not participated in decision
making none of them are member of facility governing board.
Possible explanation for this might be the program is not
implemented properly as the standard. This may be improved
when the program is implemented throughout the health facilities
in the region. In assigning health workers less priority was given
for AYH rooms. In addition, the working hours were not convenient
for adolescents most adolescents prefer out of working hours for
With available resources it is possible to implement AYHS
in central zones of SNNPR. Lack of training for facility managers
and health care providers, Essential medicines supply were in
satisfactory manner. There were shortages of essential equipment,
no intersectoral collaboration and also non-governmental partners
working to support this program. Less attention was given for noncommunicable
disease for adolescent and youth. Job description
for each profession were not including about adolescent and
youth health. Therefore, training of trainers at zone level, training
of managers, providers at zone and district level is very important.
Health facilities should include adolescents in facility governing
board. Facility-level registers and health management information
systems (HMIS) need to include client information about age,
sex, presenting problem, diagnosis and services provided for
adolescent and youth. Communication and collaboration with
the community, different governmental and non-governmental
organizations are very mandatory.
AG: Supervised the data collection, coded the data, carried out
the analysis, and wrote the of the article. NM &YS: Contributed
design of the study and analysis, comments throughout the entire
process. All authors approved the final version of the manuscript
prior to submission
We greatly acknowledge Southern Nation Nationalities People
Regional Health Bureau of Medicine and Health Sciences support
letter and financial support for this research. I would like to thank
study participants and data collectors as well.
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