On April 29th, Knowledge SUCCESS & Family Planning 2030 (FP2030) hosted the fourth and final session in the third set of conversations in the Connecting Conversations series, One Size Does Not Fit All: Reproductive Health Services Within the Greater Health System Must Respond to Young People’s Diverse Needs. This session focused on how health systems can adapt to meet the changing needs of young people as they grow to ensure that they remain in care. Missed this session? Read the summary below or access the recordings (in English or French).
Moderator Brittany Goetsch, Program Officer with Knowledge SUCCESS, kicked off the discussion by asking each speaker to describe the current situation regarding retaining youth in healthcare systems.
There are a number of issues that make it difficult for health services to retain youth. Ms. Streifel discussed the USAID-funded PACE Project’s analysis of service provision assessment data among youth in seven countries. The analysis highlights waiting times as an issue, but more qualitative research is needed to unpack this further: Is it the amount of waiting time or the stigma associated with being seen waiting for family planning services that has a bigger impact on youth retention? Youth also reported dissatisfaction with the quality of counseling, availability of medical supplies, privacy, hours and days of service, and cleanliness. Ms. Streifel also pointed out that the lack of follow-up mechanisms between appointments can be an obstacle to retaining youth in health systems. Actively following up with women who use a contraceptive method increases contraceptive continuation and facilitates switching when side effects occur. Ms. Streifel suggested several follow-up methods to increase retention, including phone calls, automated text messages, home-based visits from a health provider, or establishing a hotline.
Dr. Muriuki provided a different perspective, stating that in looking at outpatient data, the number of adolescents who make contact with the system is surprising. However, she suggests the need for integration of family planning and other health areas.
Dr. Fonkwo raised that what happens within the community (where adolescents spend most of their time, what they know about the health system, etc.) contributes to retaining adolescents. What happens at the international level guides the national level, which then translates to what health care providers are providing to different communities.
Ms. Streifel expressed that a key challenge to health system responsiveness is insufficient customization in service delivery. Family planning programs must respond to the varying needs of youth, and not assume that they are a homogenous group. Family planning needs also vary by geographical contexts. She suggested that a way to provide client centered care is through high quality supportive contraceptive counseling. This should include a case history (a discussion of prior contraceptive use and current contraceptive needs), proactively addressing the management of side effects, and providing information that dispels myths about contraceptive methods. Ms. Streifel also noted the importance of ensuring that young people have the resources, knowledge, and opportunities to directly engage with decision makers to obtain what they want.
“In order to retain them, we really need to be responsive to the feedback they’re providing,” she said.
Dr. Fonkwo explained that the private sector has only recently begun having conversations about adolescents within the global context. She suggested that best practices have to be holistic. Within her own academic studies, Dr. Fonkwo has realized that data about adolescents can be extremely limited.
Dr. Muriuki added that when it comes to the health system, we need to have young people at the table and actually listen to their needs. Murikui posed the question, “If health systems came up with their own way of doing things, would adolescents agree with what we are saying are their priorities and needs?”
Given Dr. Fonkwo’s medical background, she stressed that this question must be raised and raised again. She stated that if a doctor doesn’t receive sufficient medical training to provide health services to adolescents, they will not be equipped to deliver the services. Medical training must to be structured to address the needs of adolescents. Lastly, Dr. Fonkwo suggested several elements that can contribute to better outcomes: system-level approaches, attention to training and coursework, continuous medical education, feedback mechanisms, and national indicators.
Dr. Muriuki, who also has a clinical background, remarked that when the provider fails, the client will remember. Various issues—such as long workdays—can influence how they treat their patients. Dr. Muriuki noted that providers are members of a community, and have their own values and issues. The health system expects that, in walking into a clinic, providers will set aside their own beliefs and biases—but the system does little to support providers in navigating the potential conflict between who they are and what they do, to ensure that clients are provided with unbiased services. Provider bias has to be addressed within the system so that we are not just targeting the end result of a system failure.
Ms. Streifel added that provider bias can lead to women using contraceptive methods other than their own choice (non-preferred methods), which can result in them abandoning that method (contraceptive discontinuation). Ms. Streifel noted that, according to a PRB analysis on policies in 22 countries, only 4 countries out of 22 support youth access to family planning services without consent from both parents and spouses; only 10 support a full range of family planning options. Policies that remove requirements for third party consent and restrictions are necessary to promote contraceptive use among youth. She expressed that provider training should include values clarification and knowledge of youth cognitive development. Ms. Streifel emphasized that providers need to take a case history, provide information on how to manage side effects, and dispel myths about contraceptive methods. She also stated that training should be given to all who work in the health system, as anybody can have an impact on an adolescent’s visit. Ms. Streifel closed this section with a comment that since unmarried youth have a preference for obtaining contraception from the private and informal sector, pharmacy and drug shop staff should also receive training to better serve youth.
Dr. Muriuki brought up the work of the Child Rights Team at Save the Children in Kenya. The organization brings together groups of children in various parts of the country to debate issues related to reproductive health; at the end they meet with senior leadership (councils of government, members of parliament, etc.) to provide this information and hold them accountable. Dr. Muiruki admires this work because of the importance of preparing young leaders so that when they get a seat at the table, they have a clear, well-delivered message. This builds young people’s capacity for leadership positions and allows older leaders to be intentional about listening to youth.
Dr. Fonkwo added that FP2030 has youth focal points for each participating country. These focal points are individuals who effectively engage and capture the voices of young people. She emphasized the importance of being culturally sensitive. When adolescents try to make their voices heard, we want to be aware of their context.
Ms. Streifel mentioned the importance of training researchers and advocates on how to translate data and research into language that resonates with decision-makers. Developing advocacy tools with youth is extremely important, so they can directly engage with decision-makers on issues affecting them and their future.
According to Dr. Muriuki, data-sharing is a major challenge in collaboration between the public and private sectors. Dr. Fonkwo agreed, and emphasized the strong divide between what happens in the private sector versus the public sector. Dr. Fonkwo shared an example from Cameroon, where the proportion of health care providers trained in the private sector is high compared to the proportion trained in the public sector, but there are challenges with collaboration. In working with FP2030 as her country’s focal point, she has identified many opportunities for private and public sector organizations to collaborate—including identifying how decisions are translated into community practice, highlighting good practices for interacting with adolescents, establishing feedback mechanisms for improvement, and working with governmental focal points. Dr. Fonkwo recognized the need for spaces for private and public sectors to learn from each other.
Moderator Brittany Goetsch asked each speaker to share one sentence to close out the webinar:
Dr. Muriuki: We could do better with building systems for adolescents and this is beyond the service delivery point—this is involving issues around other issues that adolescents face.
Dr. Fonkwo: I think that to make it more responsive—for example, if the pharmaceutical companies can factor in how adolescents want their contraceptives, how they should be designed—we will need their voices more and more. They are not in a box, they are different.
Ms. Streifel: Retaining youth in health systems requires meaningfully engaging them and a systems approach.
“Connecting Conversations” is a series tailored specifically for youth leaders and young people, hosted by FP2030 and Knowledge SUCCESS. Featuring 5 themes, 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, ran from March 18 through April 29, 2021. Our fourth series will begin in July 2021. We hope you’ll join us!
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.