Table 3 Characteristics of evaluations (N=18)

A [18]

Delhi: Periurban slums (district not specified)

Madhya Pradesh: Indore

Gujarat: Ahmedabad

2001

BY: Indigenous NGO (Aarogya: Centre for Health-Nutrition Education and Health Promotion based in Fatehganj, Vadodara, Gujarat)

FOR: International NGO (The Centre for Development and Population Activities (CEDPA))

To measure behaviour change among participants of a reproductive health promotion initiative

(Better Life Options) in areas of education, engagement in incomegenerating activities, decision making mobility, self-esteem/self-confidence, empowerment, fertility, age of marriage, child spacing, use of contraceptives, health seeking behaviour as compared to nonparticipants

Better Life Options Programme components:

(1) Building individual capacity through literacy promotion and linkages with formal education

(2) Providing family life education

(3) Providing vocational skills training

(4) Providing age-appropriate general and reproductive health services,

(5) Social mobilization through advocacy and community involvement

Quasi-experimental:

post-implementation comparison of programme participants and non-participants in regards to behavioural and health outcomes

Post-implementation structured interviews with programme participants and nonparticipants using two questionnaires

Type of health facilities within intervention not specified

Number of facilities and adolescent clients using those facilities not specified

B [19]

Delhi: Slums of South Delhi and East Delhi

Haryana: Mewat - 5 villages

Madhya

Pradesh: 4 unspecified districts

2003

BY: International NGO (CEPDA) and indigenous NGO partners (PRAYATIN in slums of South Delhi, YWCA of India in slums of East Delhi, Society for Promotion of Youth and Masses (SPYM) in slums of Delhi and 5 villages in Haryana, Bhartiya Gramin Mahila

Sangh (BGMS) in 4 districts of Madhya Pradesh FOR: International NGO (CEDPA)

To measure the results of the “Adolescent-Friendly Reproductive Health Services Programme” on knowledge and health outcomes of participating adolescents

ENABLE Project: 16 month pilot programme to deliver “Adolescent-Friendly Reproductive Health Services” through 4 NGOs in 3 states of India (Delhi, Haryana, Madhya Pradesh). In addition to traditional Better Life Options programme components (above), ENABLE provided partner organizations opportunity to integrate health services within programme by engaging part-time doctors and lab technicians

Quasi-experimental: Pre- and postimplementation comparison of participants’ perception, knowledge and attitudes regarding ARSH issues, further stratified by long-term and short-term intervention-type, and comparison of participants’ haemoglobin levels

(1) Pre- and postimplementation survey assessing perceptions, knowledge, and attitudes

(2) Pre- and postimplementation collection of height, weight, and haemoglobin to evaluate effectiveness of adolescent-friendly reproductive health services programme on adolescent female haemoglobin levels

Type of health facilities within intervention not specified

Number of facilities and adolescent clients using those facilities not specified

C [20]

Haryana: Yamuna Nagar - Kot, Kharwan, Kalanaur, and Burhia blocks

2008

BY: National government agency (Government of India/Ministry of Health and Family Welfare (GoI/MHFW))

FOR: National government agency (Govt of India/Ministry of Health and Family Welfare)

(1) To assess quality of adolescent-friendly health services (AFHS) at selected health facilities in Haryana and to compare quality in AFHS facilities to non- AFHS facilities

(2) To determine availability of key health system supports required to implement AFHS

(3) To identify barriers to effective implementation of AFHS

Delivering health services based on Government of India’s ARSH Programme

Quasi-experimental: post-implementation comparison of ARSH clinics and other clinics in regards to quality indicators of AFHS

(1) Post-implementation interviews of MOs, ANMs, and adolescent clients

(2) Assessment of clinics using a checklist

PHCs, CHCs, and SCs offering ARSH

Evaluation covered 10 ARSH clinics and 10 other sites in Both AFHS and non-AFHS sites included 2 PHC and 8 SC evaluations

4 MOs, 16 ANMs, 120 adolescents were interviewed

Denominator: ARSH had been implemented in 88 villages served by 4 PHCs, 2 CHCs, and 17 SCs, adolescent population served by facilities not specified

D [21]

Haryana: Yamuna Nagar

2008

BY: Indigenous NGO (Society for Women and Children’s Health (SWACH)) and state government agency (MHFW), Haryana State)

FOR: State government agency (MHFW, Haryana State)

(1) To assess health problems of adolescents

(2) To determine baseline data on coverage of key indicators

(3) To assess use of SRHS by adolescents in relation to quality of care

(4) To assess impact of interventions implemented in selected villages of the district

Delivering health services based on Government of India’s ARSH Programme

Quasi-experimental: post-implementation comparison of reported health problems, service utilization, and quality of services among adolescents villages with ARSH versus adolescents in comparison villages without ARSH

Post-implementation household survey of adolescents to measure reported health problems and reported use and quality of SRHS

Type of government facilities not specified

Evaluation covered 30 intervention villages + 30 comparison villages (with 20 adolescents in each) = 599 adolescents from 893 households in intervention villages, 594 adolescents from 868 households in comparison villages

Denominator: Each cluster had three contiguous villages with an estimated adolescents population of 3000-5000

E [22]

Gujarat: District(s) not specificed

2008

BY: Consulting agency (Centre for Operations Research and Training (CORT)) FOR: International NGO (UNFPA) and state government agency (MHFW, Gujarat State)

(1) To evaluate quality of ARSH services

(2) To understand utilization pattern of ARSH services and client satisfaction and to analyse factors influencing or impeding service utilization

(3) To validate need for special package of ARSH services among adolescents

(4) To suggest ways to improve utilization of services and explore possibilities for expanding package of services

Delivering health services based on Government of India’s ARSH Programme

Descriptive: postimplementation crosssectional evaluation

(1) Qualitative individual interviews with health workers and government health officials

(2) Focus group discussions with adolescent boys and girls

(3) Assessment of clinics using a checklist

Type of health facilities not specified

21 facilities visited, of which 17 (81%) were functional and able to be assessed 3 state officials, 9 district officials, 17 MOs, 19 grassroots level health workers 28 focus group discussions with adolescent boys and girls Denominator: 42 total ARSH facilities = 50% coverage; adolescent population served by facilities not specified)

F [23]

Maharashtra: Raigad-Karjat block

2009

BY: Academic institution/university

(National Institute for Research in Reproductive Health (NIRRH)) FOR: National government agency (GoI/MHFW)

(1) To assess status of ARSH services

(2) To generate baseline data for identifying gaps in delivery of ARSH services

(3) To provide recommendations for improving quality assessment tools

Delivering health services based on Government of India’s ARSH Programme

Descriptive: postimplementation crosssectional evaluation

(1) Qualitative interviews with MOs, ANMs, adolescent clients

(2) Assessment of clinics using a checklist

PHCs, SCs, and sub-divisional hospital (SDH)

Interviews with 6 MOs, 11 ANMs, 24 adolescent clients Assessment of 10 health facilities (3 PHCs, 6 SCs, 1 SDH)

G [24]

Rajasthan: Bhilwara, Chittorgarh, Alwar and Kaurali

2010

BY: Consulting agency (India Institute of Health Management Research (IHMR)) FOR: Multilateral agency (UNFPA, Rajasthan State Office)

(1) To assess status of ARSH services in 4 districts in Rajasthan

(2) To assess status of training of service providers in ARSH services

(3) To assess availability of ARSH information for adolescents

(4) To assess preparedness to improve and sustain provision of services

Delivering health services based on Government of India’s ARSH Programme

Descriptive: postimplementation crosssectional evaluation

(1) Interviews with health service providers and adolescent clients

(2) Assessment of clinics using a checklist

Primary health care centers (PHCs), community health centers (CHCs), and district hospitals (DHs)

Evaluation covered 12 AFHCs in 4 selected districts provided at 1 of each facility type (DH, CHC, and PHC) in each district 24 providers were interviewed 131 adolescents interviewed Denominator: 110 operating AFHCs in 4 selected districts among 8 districts where service package has been implemented. Adolescent population served by facilities not specified

H [25]

Maharashtra: 33 districts not specified

2011

BY: Multilateral agency (UNFPA) FOR: Multilateral agency (UNFPA) on behalf of multiple state governments throughout India (including Government of Maharashtra for this particular portion of report)

(1) To evaluate the functioning of the AFHCs

(2) To assess service environment, status of training of service providers, and availability of information to adolescents with regard to ARSH services

Delivering health services based on Government of India’s ARSH Programme

Descriptive: postimplementation crosssectional study of quality of services

Specific methodology not specified

Type of health facilities within intervention not specified

Number of facilities and adolescent clients using those facilities not specified

I [26]

Uttar Pradesh Madhaya Pradesh Jharkand Orissa Assam Jammu and Kashmir Tamil Nadu (Districts not specified)

2011

BY: Academic institution/university (Population Research Centre, Institute of Economic Growth) FOR: National government (Programme Evaluation Organisation Planning Commission/Government of India)

To evaluate and assess availability, adequacy and utilization of AFHS in rural areas

Delivering health services based on Government of India’s ARSH Programme

Descriptive: postimplementation crosssectional study of quality of services

(1) Household survey

(2) Facility survey

DHs, CHCs, PHCs, SCs and 296 villages over 37 districts in 7 states

Facility survey covered 37 DHs, 74 CHCs, 148 PHCs, 296 SCs, and 296 villages stretched over 37 districts over 7 states of India 25 households for the household survey in each selected village was based on identification of 5 households under each of the following categories: those having pregnant woman, having lactating women, with children 1-5 years, with at least one chronic disease patient, and having utilized family planning services = 7400 households Denominator: Total number of facilities and adolescent population served by these facilities not specified

J [27]

Bihar: Nalanda, Nawada, Patna

2011

BY: International NGO (Pathfinder International) FOR: International NGO (Pathfinder International)

To evaluate knowledge, attitude, and practice changes after Phase I and II of PRACHAR intervention as well as impact of PRACHAR IRH training Evaluation specifically looks at differences in impact based on different components of the intervention

PRACHAR intervention: (1) Social environment building

(2) Providing info on RH and services

(3) Improving access to RH services: training formal and informal rural health service providers on RH issues and contraception, encouraging vulnerable populations to seek services, motivating chemists and village convenience shops to keep regular stocks of condoms and pills

Quasi-experimental: Pre- and postimplementation comparison of participants’ contraception attitudes, knowledge, demand, and use

Pre- and postimplementation survey of participants

Type of health facilities within intervention not specified

Health facilities in intervention communities and number of adolescent participants using facilities not specified

K [28]

Orissa: Kalahandi-Junargarh and Dharmagarh blocks, Rayagada-Rayagada and Gunupur blocks

2012

BY: Academic institution/university (India Council of Medical Research (ICMR)) FOR: ICMR

(1) To assess knowledge, attitude, and behaviour on reproductive health problems in adolescents

(2) To assess quality of care at AFHCs

(3) To assess accessibility and utilization of health care services by adolescents

Delivering health services based on Government of India’s Adolescent Reproductive and Sexual Health Programme

Descriptive: postimplementation crosssectional study of quality of services

(1) Community-based survey of adolescents with measurement of height, weight, midupper arm circumference, haemoglobin of adolescent clients

(2) Survey of stakeholders (community health workers school teachers) using questionnaires (2) Facility-based survey of providers

(3) Assessment of clinics using a checklist

Adolescent friendly health clinics (type of facility not further specified)

Community sample in 2 districts included 720 households in Kalahandi, 657 households in Rayagada -Covered 858 (Junagarh 567, Dharmagarh 291 in Kalahandi) and 755 (Rayagada 420, Gunupur 335 in Rayagada) adolescents respectively 224 stakeholders interviewed (116 in Kalahandi and 108 in Rayagada) 73 health service providers interviewed (30 in Kalahandi, 43 in Rayagada) Quality of care evaluated at 2 AFHCs in Kalahandi and 1 in Rayagada Denominator: Total number of facilities and adolescent population served by these facilities not specified

L [29]

Uttarkhand: District not specified

2012

BY: Consulting agency (Futures Group International) FOR: Foreign government agency (USAID)

To compile a summary of numerous published and unpublished materials to capture best practices, lessons learned and recommendations developed over course of 2 years of work on ARSH within Innovation in Family Planning Services (IFPS) Projects and IFPS Technical Assistance Project (ITAP)

UDAAN intervention:

(1) Pilot phase: advocacy workshops, recruitment and training of health care providers, peer group educators to work within school-going and out-of-school adolescents

(2) Scale up phase: Facilities oriented to become more youthfriendly, establishment of adolescent groups

Quasi-experimental: Pre- and midintervention comparison of sexual and reproductive health knowledge and attitudes

(1) Questionnaire measuring SRH knowledge and behaviors among adolescents

(2) Unspecified facility assessment tools

Type of health facilities within intervention not specified

80 primary sampling units (PSUs) were selected by sampling 10 villages from 8 pilot blocks. 32 adolescents were selected from each PSU to include 2500 adolescents total in assessment Midterm assessment included 317 adolescents who had used at least one UDAAN services and 1273 who had not used any UDAAN service Denominator: Health facilities in intervention communities and number of adolescent participants using facilities not assessed

M [30]

Uttar Pradesh: Varanasi-Arajiline block, Bangalore-Hoskote block

2013

BY: Indigenous NGO (Research Unit at MAMTA-Health Institute for Mother and Child, Delhi) FOR: Not specified

To assess youth friendly health services from clients’ perspectives and role of outreach activities in improving access to the services for purpose of potential upscaling

Delivering health services based on Government of India’s ARSH Programme and community outreach through provision of Youth Information Centers (YIC)

Descriptive: postimplementation crosssectional study of quality of services

(1) Semi-structured interviews to measure demographics, time spent on client-provider interactions, perception regarding privacy and confidentiality, awareness about YIC activities, role of YIC, level of satisfaction

(2) Focus group discussions to measure privacy-confidentiality, attitude of adults towards adolescent concerns, roles of outreach activities in improving access to services

(3) Assessment of clinics using a checklist

Youth friendly health facilities not further specified

Consecutive sample of 120 clients from 4 selected clinics for exit interviews 8 focus group discussions (8-10 participants each) conducted among community members and young people Denominator: Total number of facilities and adolescent population served by these facilities not specified

O [31]

Uttar Pradesh: Hardoi and Siddharth Nagar Bihar: Nalanda and Vaishali

2013

BY: Indigenous NGO (Research Unit at MAMTA-Health Institute for Mother and Child, Delhi) FOR: Not specified

To analyse key determinants of YFHS that influence client’s satisfaction level in order to help decision makers implement programmes tailored to clients’ perceived needs

Delivering health services based on Government of India’s Adolescent Reproductive and Sexual Health Programme

Descriptive: postimplementation crosssectional study of quality of services

Semi-structured interviews with clients to measure demographics, time spent on client-provider interactions, perception regarding privacy and confidentiality, level of satisfaction

Youth friendly health facilities not further specified

Consecutive sample of 120 clients from 4 selected clinics for exit interviews Denominator: Total number of facilities and adolescent population served by these facilities not specified

P [32]

Maharashtra: Raigad - Karjat block

2014

BY: academic institution/university (National Institute for Research in Reproductive Health (NIRRH/Indian Council of Medical Research (ICMR) FOR: State government (Government of Maharashtra)

To assess the quality of adolescent health related services in Maharashtra against the 7 ARSH standards established by GoI in 2005

Delivering health services based on Government of India’s ARSH Programme

Descriptive: postimplementation crosssectional study of quality of services

Quasi-experimental: Time series comparison of health service utilization

(1) Structured interview questionnaires for staff and clients

(2) Assessment of clinics using a checklist

SDH, PHCs, SCs

10 health facilities: 1 SDH, 3 PHCs, 6 SCs during first year SCs excluded during 2nd year 3 additional PHCs and RH added for 2nd-5th years for total 8 facilities (1 SDH, 6 PHCs, 1 RH) 1 Taluk Health Officer, MO, and ANM interviewed at each site Denominator: Total number of facilities and adolescent population served by these facilities not specified. Number of clients interviewed not reported.

Q [33]

Maharashtra: Raigad –Karjat block

2014

BY academic institution/university (National Institute for Research in Reproductive Health (NIRRH)/Indian Council of Medical Research (ICMR) FOR: multilateral agency (WHO) and state government (Government of Maharashtra)

To test (in one block of one district) the feasibility of a developed action plan designed to link ARSH and HIV services in two districts.

Linking Government of India’s Adolescent Reproductive and Sexual Health Programme and HIV services

Feasibility testing: Observations on implementation of linking ARSH services and HIV services

Did not specify tools for testing feasibility interventions to link ARSH-HIV services

SDH, RH, PHCs,

8 facilities included in evaluation: 1 SDH, 1 RH, and 6 PHCs Denominator: Total number of facilities and adolescent population served by these facilities not specified.

R [34]

Jharkand: Jamtara and Palamu districts

Maharashtra: Chandrapur and Nashik; Rajasthan: Bhilwara and Karauli districts

2014

BY: International NGO (Population Council) FOR: National government (Government of India/Ministry of Health and Family Welfare)

To identify approaches to enhanced service delivery through adolescent-friendly health centers through refinements in content of and approaches to training and to inform strategies to generate demand for services

Delivering health services based on Government of India’s ARSH Programme

Descriptive: Postimplementation mixedmethods cross sectional study

(1) In-depth interviews with ASHAs, ANMS, counsellors, and medical officers

(2) Observation of service delivery at AFHCs using mystery clients

(2) Exit interviews with clients accessing services

(4) Cross-sectional, community-based survey of adolescents

Adolescent friendly health centers in community health centers (CHCs), subdistrict hospital (SDH), or rural hospitals

12 AHFCs were evaluated of total 180 AFHCs in Jharkhand, 140 AFHCs in Maharashtra, and unspecific number in Rajasthan 24 mystery client visits (8 each in Jharkhand, Maharashtra, and Rajasthan) Exit interviews performed with 5 adolescents (4 in Jharkhand and 1 in Maharashtra) Community-based survey covered a proportional distribution of 2131 adolescents from 48 villages within the 3 states (736 from Jharkand, 682 from Maharashtra, and 713 from Rajasthan) Denominator: Total number of facilities and adolescent population served by these facilities not specified

S [35]

Delhi: All 9 districts

2013

BY: academic institution/university (Maulana Azad Medical College) and state government (Directorate of Family Welfare)

FOR: Not specified

To evaluate availability, type and quality of facilities providing RH services to adolescents in public and private sector

Delivering health services based on Government of India’s Adolescent Reproductive and Sexual Health Programme

Descriptive: postimplementation crosssectional study of quality of services

(1) Semi-structured interviews with facility managers

(2) Facility checklists

(3) Questionnaires for service providers at primary, secondary, and tertiary health centers

(4) Exit interviews with clients accessing services

Primary, secondary, and tertiary health centres

9 of 9 total district head quarters assessed for availability of services 4 of 9 total districts sample for quality of services: 39 of 39 total facility managers, 31 of 31 secondary and tertiary units, 70 of 250 primary units, and 936 of 907,710 adolescents