Table 1 WHO-supported efforts in LMIC to standardize, assess and improve the quality of health service provision to adolescents in primary-level government-run health facilities

The problem:

In many low and middle income countries, there was widespread recognition that adolescents were not obtaining health services, and that this led to missed opportunities to prevent health problems and respond to them when they occurred.

Nongovernment organizations (NGOs) were the first to respond to this need by establishing stand-alone Adolescent Friendly Health Services (AFHS). There was no agreed upon definition of what AFHS meant, although many NGO efforts aimed to make health workers non-judgemental and empathic, make health facilities welcoming and to ensure confidentiality.

Ministries of Health called for WHO guidance to draw upon experiences gained in small-scale and often time-limited nongovernmental projects to make government-run health workers and health facilities more responsive to adolescents.

WHO’s response to the problem:

Gathering and synthesizing evidence:

1. WHO defined attributes of Adolescent Friendly Health Services based on implementation experience and research evidence and placed these attributes in a quality of care framework [5]:

• Accessible: Adolescents are able to obtain the health services that are available

• Acceptable: Adolescents are willing to obtain the health services that are available

• Equitable: All adolescents, not just some groups of adolescents, are able to obtain the health services that are available

• Appropriate: The right health services (i.e. the ones they need) are provided to them

• Effective: The right health services are provided in the right way, and make a positive contribution to their health

2. WHO developed and tested tools to standardize, assess and improve the quality and expand the coverage of health service provision to adolescents in LMIC [5–7].

Taking evidence to action:

Beginning in 2001, WHO worked with partners within and outside the United Nations system to support Ministries of Health to:

1. Develop national quality standards using the five-step process outlined in WHO’s tool Making health services adolescent friendly: developing national quality standards for adolescent friendly health services [5];

2. Improve the quality of health service provision through complementary actions at the national, district/municipal and local levels as described in annex 2 of the above tool [5];

3. Assess the quality of health service provision using national adaptations of WHO’s toolkit: Quality assessment guidebook: A guide to assessing health services for adolescent clients [6];

4. Assess the coverage of health services using national adaptations of WHO’s tool kit: Coverage assessment guidebook: A guide assessing the coverage of quality health services for adolescents [7];

5. Share the findings of the quality and coverage assessments at the national level, and use them to address areas of weakness as part of the ongoing effort to improve the quality of health service provision to adolescents.