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Assessment of Adolescent and Youth Friendly Service Models Implemented in Five Districts in the Eastern Cape Province

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Assessment of Adolescent and Youth Friendly Service Models Implemented in Five Districts in the Eastern Cape Province EC AYFS ASSESSMENT REPORT ASSESSMENT OF ADOLESCENT AND YOUTH FRIENDLY SERVICE MODELS IMPLEMENTED IN FIVE DISTRICTS IN THE EASTERN CAPE PROVINCE. COMPILED BY SOLUTIONS FOR INNOVATIVE POLICIES PROGRAMS AND TECHNOLOGIES: L DU PLESSIS AND N FUTWA FEBRUARY 2014 United Nations Population Fund 1 EC AYFS ASSESSMENT REPORT ACKNOWLEDGMENTS Solutions for Innovative Policies, Programs and Technologies (Solutions IPPT) would like to acknowledge the Eastern Cape Department of Health (DoH) management for their collaboration and commitment during the assessment. Special thanks go to the District and Sub-District Managers, their Facility Supervisors and Providers at the facilities where the assessment was conducted. Their support during the collection of the data for the assessment is highly appreciated. We also gratefully acknowledge the contributions made by assessment respondents, Pathfinder, loveLife, interview and focus group participants. The Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH and UNFPA signed a Memorandum of Understanding with Eastern Cape Department of Health for the AYFS assessment as part of the MHIVP Programme funded by the German government implemented through GIZ. 2 EC AYFS ASSESSMENT REPORT Table of Contents ACKNOWLEDGMENTS .............................................................................................. 2 TABLE OF CONTENTS ............................................................................................. 3 LIST OF TABLES AND FIGURES ................................................................................. 3 ACRONYMS AND ABBREVIATIONS ............................................................................. 5 EXECUTIVE SUMMARY ............................................................................................ 6 1. INTRODUCTION ............................................................................................... 8 1.1 PROBLEM STATEMENT ................................................................................ 9 1.2 THE RATIONALE ....................................................................................... 12 1.1 PURPOSE OF THE RAPID SITUATIONAL ASSESSMENT ..................................... 12 1.2 RESEARCH GOAL AND OBJECTIVES ............................................................ 13 2. METHODOLOGY ............................................................................................ 14 2.1 TARGET GROUPS ..................................................................................... 14 2.2 SITE AND SAMPLE SELECTION.................................................................... 14 2.3 DATA COLLECTION METHODS .................................................................... 16 2.4 PROCEDURE ........................................................................................... 17 2.5 LIMITATIONS OF THE ASSESSMENT ............................................................. 18 3. RESULTS AND INTERPRETATION OF FINDINGS FROM FGDS ................................. 19 4 RESULTS AND INTERPRETATION OF FINDINGS FROM KEY INFORMANTS ................. 29 5 RECOMMENDATIONS AND CONCLUSION ............................................................ 33 REFERENCES ...................................................................................................... 39 APPENDICES ....................................................................................................... 41 APPENDIX 1 – FOCUS GROUP DISCUSSION GUIDES ................................................ 41 APPENDIX 2 – IN-DEPTH INTERVIEW GUIDE .......................................................... 47 APPENDIX 3 AND 4 – ETHICAL CLEARANCE CERTIFICATES ...................................... 52 APPENDIX 5 – LOVELIFE EC SUPPORT……………………… ………………..…..………………….. 54 APPENDIX 6 - STAKEHOLDER ROLES AND RESPONSIBILITIES. .. 57 3 EC AYFS ASSESSMENT REPORT LIST OF TABLES TABLE 1: DISTRICTS POPULATION SIZE ...................................................................... 12 TABLE 2: SITE SELECTION ...................................................................................... 165 TABLE 3: NUMBER OF IN-DEPTH INTERVIEWS ............................................................... 16 TABLE 4: NUMBER OF FOCUS GROUP DISCUSSIONS CONDUCTED. .17 FIGURES FIGURE 1: PARTICIPATING ADOLESCENT AND YOUTH NEEDS AND SERVICE DEMANDS. 34 FIGURE 2: PROPOSED PROVINCIAL LEVELS AND MULTIPLE STAKEHOLDERS INVOLVEMENT FOR AYFS FOR THE EASTERN CAPE DOH ... .35 FIGURE 3: PROPOSED AYFS RESULTS FRAMEWORK ..... ..36 4 EC AYFS ASSESSMENT REPORT ACRONYMS AND ABBREVIATIONS AYFS Adolescent and Youth Friendly Services BCM Buffalo City Municipality CBO Community Based Organisation CSO Civil Society Organisations DOH Department of Health DBE Department of Basic Education EC Eastern Cape ECPDoH Eastern Cape Provincial Department of Health FGD Focus Group Discussion GDP Gross Domestic Products GIZ Deutsche Gesellschaft fr Internationale Zusammenarbeit (GIZ) GmbH HIV Human Immunodeficiency Virus IDI In-depth Interview ISHP Integrated Schools Health Programme NMBM Nelson Mandela Bay Municipality NGO Non-Governmental Organisation PHC Primary Health Care PDOH Provincial Department of Health SRH Sexual and Reproductive Health SRHR Sexual and Reproductive Health and Rights STI Sexually Transmitted Infections TB Tuberculosis UNFPA United Nations Population Fund WHO World Health Organisation 5 EC AYFS ASSESSMENT REPORT EXECUTIVE SUMMARY This report presents the findings of an assessment conducted by Solutions for Innovative Policies, Programs and Technologies (Solutions-IPPT) in 5 selected districts (O.R. Tambo, Alfred Nzo, Amathole, Cacadu and Chris Hani) of Eastern Cape Province on the implementation of Adolescent and Youth Friendly Services (AYFS). Focus group discussions and in-depth interviews were conducted with health care providers, adolescents and youth in specific sub districts in the selected 5 districts. A total of 150 adolescents and youth took part in the focus group discussions and 20 in-depth interviews were conducted with health care providers. Data was collected over a period of two months from November to December 2013. Focus group discussion and an in-depth interview guides were developed to gather the data needed for the assessment. The focus group discussion guide touched on issues such as assessing the accessibility and effectiveness of existing AYFS, access to accurate and appropriate information on sexual and reproductive health (SRH), barriers to demand for health care services, preferred media, and accountability mechanisms. Each focus group discussion lasted between one to two hours. The in-depth interview guide focused on assess providers capacity to provide quality and effective AYFS, gaining a better understanding of barriers and challenges with the implementation of AYFS, to highlight capacity needs and identify opportunities of linkages with other established programmes. The interviews lasted for approximately an hour and a half. Qualitative research methods were used to analyse the data. The results of the FGDs and key informant interviews highlighted a number of important issues relating to the current services provided to adolescents and youth. Firstly, it is clear that no specific AYFS model exists, all services are integrated and no specific packages of health/SRH services are specifically available to adolescents and youth. The 14 facilities selected from the 5 districts participating in the assessment, are not youth friendly and lack the infrastructure to be conducive to AYFS. Provider attitudes are the main barrier for adolescents and youth accessing the services. Providers are not orientated on youth policies and guidelines to support the SRH rights of the youth and expressed their need to be trained on youth specific SRH and values clarification to deal with negative attitudes. Providers are also not aware of specific program goals, objectives or indicators to measure the outcome of services for adolescents and young people. SRH services are not comprehensive and emergency contraception (EC), Post Exposure Prophylaxis (PEP) for unprotected sex and counselling after positive pregnancy testing results are not offered to adolescents and youth. Quality of counselling for HIV testing needs improvement and there were incidents of forced testing before adolescents and youth could access specific services such as family planning and ante-natal services. Privacy and confidentiality before, during and after consultations are lacking. Boys and young men expressed the need for male nurses and out of clinic services. Considering the above results, the development and pilot testing of a new strategic approach to improve AYFS for the EC is recommended. Building on the strengths of current services and addressing the shortcomings, this strategic approach, after piloting will need the following to be successfully implemented: 6 EC AYFS ASSESSMENT REPORT Set up of M&E framework to assess quality of AYFS, efficiency of processes and to measure impact. Orientation at district, sub-district and facility level needs to create awareness and improve knowledge on implementation guidelines of adolescent and youth friendly health services, standards and norms as set out by National Department of Health (NDOH) for all facility supervisors and providers as well as other support services such as; education, department for social development responsible for rehabilitation, psychological support, welfare grants and any form of abuse. A comprehensive, standardized curriculum
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