Table 3 Key areas of improvement for Ugandan and Kenyan policy frameworks, based on WHO’s recommendations

1. Non-discrimination

No specific recommendations

2. Availability

For Uganda only, policy documents should consistently:

2.1: Prioritise the continuous supply of contraceptive commodities and supplies available through AYF service delivery points

2.1: Ensure the full financing of family planning commodities in the public and private sectors to prevent stock-outs that affect adolescents

3. Accessibility

3.2: Eliminate financial barriers to contraceptive use by marginalized populations including adolescents and the poor, and make contraceptives affordable to all

3.8: Ensure mobile access services are used to improve access to contraceptive information and services for adolescents who face geographical barriers to access

For Uganda only: 3.8: Establish different service delivery models to reach adolescents through community based initiatives in non-medical settings (i.e. youth groups, churches, support groups, etc.), clinical settings, school settings, and virtually including through digital platforms

3.9–3.10: Eliminate third-party authorisation requirements, including spousal and parental authorisation for adolescents accessing contraceptive information and services

4. Acceptability

For Uganda only: 4.1: Ensure gender-sensitive counselling and educational interventions on family planning and contraceptives for adolescents

For Uganda only: 4.1: Prioritise programmes for male involvement in the prevention of early and unintended pregnancy among adolescents

For Uganda only: 4.1: Establish community-based service delivery points and distribution of contraception to reach first time parents or young mothers whose mobility is limited, as well as to engage with adolescent couples and fathers in their new parenting roles

4.2: Provide adolescents with follow-up services for management of contraceptive side-effects as an essential component of all contraceptive service delivery

4.2: Provide adolescents with referrals for methods not available on site be offered and available

5. Quality

5.1: Ensure quality assurance processes, including medical standards of care and client feedback, be incorporated routinely into contraceptive programmes for adolescents

5.2: Provide long-acting reversible contraception (LARC) methods to adolescents, including insertion and removal services, and counselling on side-effects, in the same locality

For Uganda only: 5.3: Ensure ongoing competency-based training and supervision of health-care personnel on the delivery of contraceptive education, information and services to adolescents

For Uganda only: 5.3: Strengthen human resources and skills, build capacity on all FP methods, strengthening pre-service training for practice, AYF service approaches, and create internship training for new graduates

6. Informed decision-making

6.1–6.2: Provide evidence-based information about a range of methods for comprehensive, informed choices, and the use of modern contraception without discrimination to adolescents

7. Privacy and confidentiality

7.1: Respect the privacy of adolescents at any service delivery point (AYF or otherwise), particularly regarding contraceptive information and services

8. Participation

8.1: Ensure that communities, particularly adolescents directly affected, have the opportunity to be meaningfully engaged in all aspects of contraceptive programme and policy design, implementation and monitoring for adolescents

9. Accountability

9.1: Establish effective accountability mechanisms that are accessible for adolescents in the delivery of contraceptive information and services, including monitoring and evaluation, and remedies and redress, at the individual and systems levels

9.1: Ensure that adolescents have easy access to a complaints mechanism or ombudsperson who can help assess and remedy barriers to accessing contraception in a timely way for the individual in question and on a systems level

9.2: Evaluate and monitor all programmes to guarantee the highest quality of services and respect for human rights particularly for adolescents

9.2: Include indicators specific to adolescents, including the teenage pregnancy rate and inclusion of women who are unmarried in the calculation of unmet need for contraceptive services

9.2: In settings where performance-based financing (PBF) occurs, provide a system of checks and balances for adolescents, including assurance of non-coercion and protection of human rights. If PBF occurs, evaluate its effectiveness and its impact on adolescents in terms of increasing availability