On April 8th, Knowledge SUCCESS & FP2030 hosted the third session in the third set of conversations in the Connecting Conversations series, “What does it look like to implement an adolescent responsive approach?” This session focused on the differences between implementing a systems approach versus disconnected approaches and what youth-led accountability strategies are needed to ensure services are adolescent responsive. Missed this session? Read the summary below or access the recordings (in English or French).
Dr. Avoce began the discussion by emphasizing that our current approach—which includes providing family planning services within specialized centers for young people—have played an important role in helping us understand what young people need. He explained that we are in a transition period: We can consider young people’s needs and diversity, and can move towards a more system-level approach. The goal is to meet all of the needs of young people in one place, as opposed to scattered throughout various organizations. Dr. Avoce explained a more holistic strategy: recognizing the role of every service physician, providing necessary training, and implementing quality assurance.
Ms. Mukherji described the process of updating the High Impact Practice (HIP) Enhancement Brief on Adolescent Responsive Contraceptive Services. She emphasized that this version of the brief reflects more intentionality and a more macro-level approach to adolescent responsiveness. Ms. Murkerji explained, “Instead of thinking of adolescent health as a whole separate other thematic, we’re including an adolescent lens into all of the policies and programs that we are initiating.” Incorporating adolescent health into the larger health system means more individuals trained on adolescent health. Ms. Mukherji also explained the importance of incorporating an adolescent health component into the existing system to better use resources, as opposed to creating a separate adolescent program. Ms. Mukherji stressed that an adolescent responsive system takes adolescent feedback and uses it for accountability to provide quality care/interventions,and that adolescent health needs to be at the forefront of a systems approach rather than an afterthought.
Ms. Wina-Chinyama described MSI’s “Diva Centers”—standalone clinics that provide contraception to girls ages 15-19. Most (80%) Diva Center clients leave with a contraceptive method. Despite early success, MSI quickly realized how expensive this project was to scale and sustain. Some questions MSI raised were, “How can we embed the Diva Center lessons into the government structure?” and “What elements from the Diva Center can we get into public facilities?” MSI made improvements to this approach, including: working with government providers to reduce costs, using government facilities, and using commodities within the public sector supply chain. Ms. Wina-Chinyama emphasized that organizations are not looking for immediate results with adolescents, but striving for long-term impact and continuous advocacy at every level.
Dr. Avoce explained that “global” or holistic programs are seen as a whole, and that specific groups are not neglected when these inclusive services are put into place. Some key elements allow organizations to meet the needs of specific groups. These elements include:
Ms. Mukherji emphasized the importance of ensuring that adolescents are present during every stage of a policy or program. She also stressed that the diversity of adolescents needs to be recognized and institutionalized. Most policies currently do not consider the full diversity of adolescents and youth. The HIP brief discusses the barriers that diverse groups of adolescents face when accessing contraceptive services. As policy makers and program managers, we need to try to remove these barriers within input from adolescents. She also discussed the need for disaggregated data, which can then provide insights to inform more inclusive policies.
Ms. Wina-Chinyama described the human centered design that MSI uses—emphasizing that you cannot design anything without the people you are designing for. Beyond this, she also stressed that if one is talking about system strengthening, the people that are operating within the system need to be engaged as well, including different subgroups of adolescents. For example, adolescents with disabilities are often viewed (inaccurately) as asexual, and so working closely with these individuals on how they want information presented to them is a priority. Also, rural and urban adolescents require different services; there needs to be a focus on creating environments where all young people feel safe when seeking services, recognizing that what feels safe to one adolescent might not for another.
Ms. Wina-Chinyama described the advocacy work MSI did to align their approaches with government priorities and guidelines. MSI then took a step back and allowed the government to lead the partnership, ensuring that everybody knows their roles and responsibilities. She explained that providers sometimes create barriers. To combat this, MSI has a values clarification and attitude transformation training that all public providers take when they work with MSI. This training also creates champions at every level who are aware of the issues that adolescents face.
From Ms. Mukherji’s perspective, service providers often don’t know what respectful and friendly treatment is for adolescents, especially when it comes to SRH. She described the Access Project, which developed a tool that measures friendliness and respectfulness of service providers, to see what youth friendliness means to one particular community. Ms. Mukherji emphasized the importance of involving adolescents in these conversations to get an idea of what actually constitutes youth-friendly service provision. She provided another example of the Chilean government creating an adolescent youth advisory council that works with ministry authorities on policies and health services that are geared towards young people. The council meets with representatives of the Chilean Ministry of Health on what they think is working and what should be done, ensuring accountability.
Dr. Avoce closed out the conversation by emphasizing that TCI works with cities upon request to help implement inclusive services through orientation and guidance for professionals and training on quality of care. TCI also emphasizes the participation of young people at every step of the transition. Dr. Avoce emphasized TCI’s tools—such as coaching—to ensure proper implementation of inclusive services, evaluation of quality and sustainability of interventions, and accountability. They post tables listing clients’ rights in each clinic room, along with a charter for providers so that providers are reminded of their commitments throughout every step when engaging with young people. Dr. Avoce said that a final element is supporting people in the decision-making process to increase the accountability of providers.
“Connecting Conversations” is a series tailored specifically for youth leaders and young people, hosted by FP2030 and Knowledge SUCCESS. Featuring 5 thematic modules, with 4-5 conversations per theme, this series presents a comprehensive look at Adolescent and Youth Reproductive Health (AYRH) topics including Adolescent and Youth Development; Measurement and Evaluation of AYRH Programs; Meaningful Youth Engagement; Advancing Integrated Care for Youth; and the 4 Ps of influential players in AYRH. If you’ve attended any of the sessions, then you know these are not your typical webinars. These interactive conversations feature key speakers and encourage open dialogue. Participants are encouraged to submit questions before and during the conversations.
Our third series, One Size Does Not Fit All: Reproductive Health Services Within the Greater Health System Must Respond to Young People’s Diverse Needs, began on March 4 and consisted of four sessions. We hope you’ll join us for our fourth series, coming soon!
Our first series, which ran from July 15 through September 9, 2020, focused on a foundational understanding of adolescent development and health. Our second series, which ran from November 4 through December 18, 2020, focused on critical influencers to improve young people’s reproductive health. You can watch recordings (available in English and French) and read conversation summaries to catch up.