MEASURE Evaluation, Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, USA.
Department of Maternal & Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA.
BMC Health Serv Res. 2020 Feb 3;20(1):79. doi: 10.1186/s12913-020-4937-9.
High fertility rates and low modern contraceptive use put African youth and adolescents at high risk for health complications, including maternal mortality. Mainstreaming youth-friendly health services (YFHS) into existing services is one approach to improve access to reproductive health services for youth and adolescents. The objective of the evaluation was to assess the effects of a Population Services International (PSI)-sponsored YFHS training package on voluntary uptake of family planning among youth and perceptions of service quality by youth and trained healthcare providers in Malawi.
In 2018, a mixed-methods convergent parallel design was used to assess relevant monitoring and evaluation documents and service statistics from PSI Malawi and qualitative data on perceptions of service quality from Malawian youth and healthcare providers. The data were assessed through separate descriptive and thematic analysis and integrated to generate conclusions.
Results show that the number of family planning clients ages 15-24 increased from 72 to 2278 per quarter during the implementation of the YFHS training packages, however, positive trends in client numbers were not sustained after youth outreach activities ended. Focus group discussions with 70 youth and adolescents indicated that clinics were perceived as providing high-quality services to youth. The main barriers to accessing the services were cost and embarrassment. Interviews with ten healthcare providers indicated that many made efforts to improve clinic accessibility and understood the barrier of cost and importance of outreach to youth and the broader community.
The findings support research showing positive effects of mainstreaming YFHS when training for healthcare staff is combined with additional YFHS programming components. Furthermore, the findings provide evidence that provider training alone, though beneficial to perceived service quality, is not sufficient to sustain increases in the number of adolescent and youth family planning clients.
高生育率和低现代避孕措施的使用使非洲青年和青少年面临健康并发症的高风险，包括孕产妇死亡率。将青年友好型卫生服务（YFHS）纳入现有服务是改善青年和青少年获得生殖健康服务的一种方法。评估的目的是评估人口服务国际（PSI）赞助的 YFHS 培训包对自愿采用计划生育的青年和青年和经过培训的医疗保健提供者对服务质量的看法的影响在马拉维。
2018 年，采用混合方法收敛平行设计评估了 PSI 马拉维的相关监测和评估文件以及服务统计数据以及来自马拉维青年和医疗保健提供者的服务质量看法的定性数据。通过单独的描述性和主题分析评估数据，并进行综合以得出结论。
结果表明，在实施 YFHS 培训包期间，15-24 岁的计划生育客户数量从每季度 72 人增加到 2278 人，然而，在青年外展活动结束后，客户数量的积极趋势并未持续。与 70 名青年和青少年进行的焦点小组讨论表明，诊所被认为向青年提供高质量的服务。获得服务的主要障碍是成本和尴尬。对十名医疗保健提供者的访谈表明，许多人努力改善诊所的可及性，并理解成本的障碍以及向青年和更广泛的社区进行外展的重要性。
这些发现支持了将 YFHS 纳入主流时，培训医疗保健人员与额外的 YFHS 编程组件相结合会产生积极影响的研究。此外，这些发现提供了证据，即仅提供提供者培训虽然有利于感知的服务质量，但不足以维持青少年和青年计划生育客户数量的增加。
