Adolescent responsive health systems
Adolescents have significant needs for health services. They pose different challenges for the health-care system than children and adults, due to their rapidly evolving physical, intellectual and emotional development.
- Progress toward universal health coverage requires a transition from adolescent-friendly projects to adolescent-responsive health systems.
- Services geared for adolescents need to go beyond sexual and reproductive health to address the full range of adolescents’ health and development needs.
- To improve quality, some countries are adopting quality standards.
- There are a number of ways to expand coverage, including mainstream services, school health services, e-health and m-health.
- All health professionals would benefit from pre-service training with knowledge of adolescent health and development and their implications for clinical practice.
- To advance universal coverage, consider pooled prepaid sources of funds to include priority services for all adolescents.
Universal health coverage: a new framework for action
Today, universal health coverage (UHC) – a framework emerging as a unifying post-2015 agenda for global health – provides an opportunity for renewed attention to meeting the health-care needs of adolescents through the strengthening of health systems.
Universal coverage requires that appropriate and effective interventions for improving adolescent health and development are available, and that policy-makers, health-care providers, adolescents and their parents know about these health services.
Service delivery platforms
There is a range of different platforms available to provide health services to adolescents: public and private facilities, schools, mobile clinics, pharmacies, youth centres, e-health and outreach strategies. Within each platform, the focus, content and organization of the services can vary.
These platforms reflect the rich experimentation over the years with various models of care to make services “adolescent-friendly”, a term that describes efforts to systematically respond to the barriers to service use that adolescents and service providers have identified.
Service delivery quality and coverage
Global initiatives are urging countries to prioritize quality as a way of reinforcing human rights-based approaches to health. Yet evidence from both high- and low-income countries shows that services for adolescents are highly fragmented, poorly coordinated and uneven in quality. Pockets of excellent practice exist, but, overall, services need significant improvement and should be brought into conformity with existing guidelines.
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.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.
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).
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.
Developing an adolescent-competent workforce
At the heart of every health system, the workforce is central to improving health. A wide range of professionals are involved in health care for adolescents at the primary and referral levels.
Efforts are underway to re-orient training programmes for health-care professionals from an acute care model to a chronic and preventive care model. This shift highlights the need for new competencies for service providers working in various settings, including primary care, school health services and outreach programmes.
Additionally, in adolescent care the developmental phase and context of the individual require skills in consultation, interpersonal communication and interdisciplinary care.
Financing UHC for adolescents
The way that health services are financed is central to progress towards UHC. For adolescents three aspects of financing are crucial:
- maximizing the number of adolescents covered by an effective prepaid pooling arrangement, which can take the form, for example, of an explicit insurance programme or access to facilities that are financed by prepaid pooled funds;
- reducing or removing out-of-pocket payments at the point of use;
- expanding the range of services covered by the effective prepaid pooling arrangement to include the services in the country’s package for adolescents.
In each of these aspects, adolescents face specific vulnerabilities.
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
- Preventive care
- Workforce capacity