Implementing Adolescent and Youth Friendly Health Services (AYFHS) in Nigeria

The Adolescent and Youth Friendly Health Services (AYFHS) approach is a guide on how state governments can improve the provision of adolescent and youth reproductive health (AYRH) services based on the needs of those 15- to 24-years-old. AYFHS is offered in a manner and environment that is safe and accessible to adolescents and youth, and follows the Nigeria National Standards & Minimum Service Package for Adolescent & Youth Friendly Health Services, (2018). This document elaborates upon the nine national standards for seamless integration of youth-friendly services into health facilities and at the community level.

This approach provides a step-by-step guide on how The Challenge Initiative provides technical support to local government to ensure that health facilities are adolescent and youth-friendly and facilitate unrestricted access to quality reproductive health services, including contraceptive services in Nigeria. To achieve this, the approach helps health managers and service providers to:

• Operationalize AYFHS according to Standard Operating Procedures defined in the Nigeria National Standards & Minimum Service Package for Adolescent & Youth Friendly Health Services, (2018)
• Enhance their skills and competencies through coaching and supervision to deliver the nationally defined package of health services to adolescents and youth
• Ensure that all staff (including administrative and support staff) undergo Whole-site Orientation (WSO) to ensure access of adolescents and youth to these quality health services including Information and referral as relevant
• Facilitate the engagement of adolescents and youth in designing, providing and monitoring these quality health services
• Implement periodic self-assessments to measure access to and the quality of the AYFHS provided for continuous quality improvement

Facility Selection and Assessment

Local governments identify facilities for the implementation of AYFHS using the following criteria:

• High volume facilities where young people seek medical care (using HMIS data like outpatient department records)
• Communities/facilities with high number of youth population
• Communities/facilities with high number of unmarried / married adolescents
• Proximity of facilities to tertiary institutions
• Other geography peculiar to youth-specific demographic data that might be relevant for consideration

Following facility selection, assessment is carried out in all the selected health facilities, using the Performance Improvement Assessment (PIA) tool to serve as a baseline for AYFHS in these facilities. This tool was developed using the Minimum Package for Standard of Service for Youth Friendly Health and general family planning service provision in Nigeria. This assessment identified existing gaps in these facilities and a Performance Improvement Plan (PIP) is then developed as a remediation to close the gaps and improve service provision in those facilities. The PIP is disseminated to key stakeholders using a Contraceptive Technology Update (CTU) meeting.

Training and Capacity Building

Based on the outcome of the facilities assessment and the validation of the expression of interest, selected state FP and LARC master trainers are trained to serve as TCI coaches, and service providers who do not have requisite skills on youth-friendly services are trained on AYFHS by the master trainer/TCI coach in all supported facilities. The training of the service providers is based on the National Training Manual for the Health & Development of Adolescent and Young People in Nigeria. Among other things, the training is focused on building competencies of providers to communicate with youth and provide full range of contraceptive options, regardless of client age, marital status and parity. Key to this is conducting values-clarification exercises with health providers to reduce biases.

Quality Improvement and Engagement

Improving quality of and increasing access to AYFHS in the health facilities is managed through Supportive Supervision using the state FPSS/ISS, On-The-Job Training (OJT), mentoring & coaching of service providers, QIT meetings, Whole Site Orientation (WSO), and Client Provider Dialogue (CPD). For example, WSO is used to expose all facility staff to ensure access to FP services to adolescents and young people. In addition, TCI supports states to conduct Client-Provider Dialogues (CPD) to also address provider bias. Clients express their opinions about providers’ negative and positive behaviors. The client-provider dialogue approach enables family planning providers to understand their areas of bias that impact family planning service provision. The approach dispels myths and misconceptions and improves client-provider interactions, using view of others to impro...