Mchome Zaina, Richards Esther, Nnko Soori, Dusabe John, Mapella Elizabeth, Obasi Angela
National Institute for Medical Research, Mwanza, United Republic of Tanzania.
Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
PLoS One. 2015 Mar 24;10(3):e0120822. doi: 10.1371/journal.pone.0120822. eCollection 2015.
Unwelcoming behaviours and judgemental attitudes have long been recognised as a barrier to young people's access to reproductive health services. Over the last decade youth friendly reproductive health services have been promoted and implemented world-wide. However, long term evidence of the impact of these programmes is lacking. We report the results of a large mystery client evaluation of adolescent sexual and reproductive health services in Tanzania, a country that has had a long established youth friendly policy. Forty-eight visits made to thirty-three health facilities were conducted by twelve young people (six in each region) trained to perform three different scripted scenarios (i.e., condom request, information on sexually transmitted infections and family planning). The study revealed barriers in relation to poor signage and reception for services. In addition health workers demonstrated paternalistic attitudes as well as lack of knowledge about adolescent sexual and reproductive health services. In some cases, health workers discouraged young people from using services such as condoms and family planning methods. Lack of confidentiality and privacy were also noted to be common challenges for the young people involved. Intervention strategies that focus on changing health workers' mind-set in relation to adolescent sexual and reproductive health are crucial for ensuring quality provision of sexual and reproductive health services to young people. The study identified the importance of reception or signs at the health units, as this can facilitate young people's efforts in seeking sexual and reproductive health services. Likewise, improvement of health workers knowledge of existing policy and practice on sexual and reproductive health services and youth friendly services is much needed.
不友好的行为和评判性态度长期以来一直被视为阻碍年轻人获得生殖健康服务的障碍。在过去十年中，青年友好型生殖健康服务在全球范围内得到了推广和实施。然而，缺乏这些项目影响的长期证据。我们报告了在坦桑尼亚对青少年性健康和生殖健康服务进行的一项大型神秘顾客评估的结果，该国长期以来一直有青年友好政策。12名年轻人（每个地区6名）对33个卫生设施进行了48次访问，这些年轻人经过培训，要表演三种不同的预设场景（即索要避孕套、了解性传播感染信息和计划生育）。研究揭示了服务标识不佳和接待方面的障碍。此外，卫生工作者表现出家长式态度，并且对青少年性健康和生殖健康服务缺乏了解。在某些情况下，卫生工作者劝阻年轻人使用避孕套和计划生育方法等服务。缺乏保密性和隐私也被指出是参与其中的年轻人面临的常见挑战。专注于改变卫生工作者对青少年性健康和生殖健康思维模式的干预策略对于确保向年轻人提供高质量的性健康和生殖健康服务至关重要。该研究确定了卫生单位接待处或标识的重要性，因为这可以方便年轻人寻求性健康和生殖健康服务。同样，非常需要提高卫生工作者对现有性健康和生殖健康服务政策及实践以及青年友好型服务的了解。
