Assessment of the quality of sexual and reproductive health services delivered to adolescents at Ujala clinics: A qualitative study in Rajasthan, India

Abstract

The Adolescent Friendly Health Clinic (AFHCs), a key component of the Government of India’s National Adolescent Health Programme a.k.a. Rashtriya Kishor Swasthya Karyakram (RKSK), aims to increase the accessibility and utilization of sexual-reproductive health services by adolescents and youth. However, low quality of care provided at AFHCs by counsellors calls for attention. We, thus, explore both the clients’ and providers’ perspectives using the World Health Organization’s (WHO) global standards for quality health-care services for adolescents to assess the quality of the sexual reproductive health service delivery at AFHCs in Rajasthan, India. We conducted a qualitative study, comprising observation of the service delivery using mystery clients (MCs) (n = 12) and in-depth interviews with the counsellors (n = 4) in four AFHCs. Interviews were transcribed in local language and were translated in English. The transcripts were coded thematically. Our study, using five of the eight WHO global standards for quality health-care services for adolescents highlighted several gaps in the quality-of-service delivery at AFHCs. We unearth various intricacies related to the quality of the services provided at the AFHCs by referring to the relevant input, process, and the output criteria of WHO global standards I, III, IV, V and VI. Our study calls for efforts to improve- (i) the counsellors’ competencies to increase adolescents’ health literacy on sensitive topics, (ii) the facilities at the clinic to ensure privacy, comfort and confidentiality of the adolescents seeking services, (iii) the referrals to improve appropriate package of services, and (iv) an overall environment to ensure an equity and non-discrimination for all the adolescents. Our findings unearth the barriers that both the service providers and the adolescents face at the AFHCs and underscore the need for regular monitoring and evaluation of the AFHCs to strengthen the facility-based intervention of the RKSK programme.

Compliance of Adolescent Friendly Health Clinics with National and International Standards: Quantitative findings from the i-Saathiya study

“…Similar findings have been observed in the state of Ahmedabad24 and West Bengal 27. Moreover, AFHCs in both the study states were accessible by local transport, unlike AFHCs in Rajasthan, where ease of accessibility was a major concern 28. Study results showed that the privacy and confidentiality of the patient were maintained, as all case records were kept in secured place and only authorised personnel (counsellor, ANM and MO) had access to retrieve them.…”

“…Therefore, the absence of IEC materials, specifically in the regional language at the health facility, can act as a hurdle in utilisation of the health services by adolescents. Studies across various Indian states including Gujarat (Ahmedabad),24 Rajasthan28 replicate the finding of limited IEC material at the AFHCs, while AFHCs in West Bengal27 provided IEC material on SRH. To make the Indian AFHC compliant to this benchmark, key is to have a combination of no-tech and high-tech resources in AFHCs that may assist in catering to a wider range of literacy levels of adolescents.…”

“…Similarly, in AFHCs observed in two study states, the rights of adolescents to information, including privacy, confidentiality, non-discrimination and non-judgemental attitude were not displayed, hindering the structural quality. Likewise, studies from India28 31 and across the globe have reported judgemental and discriminatory behaviour,42 43 and breach of confidentiality42 by healthcare providers. Strong policies and protocols can enhance the quality of healthcare in India as evident in Ghana38 where adolescents’ positive perception of quality healthcare was influenced by fair, non-discriminatory, respectful, competent and trustworthy healthcare providers.…”

Understanding of Islam Reproduction as Muhammadiyah's Dakwah Movement

“…Adolescent reproductive health information service is a form of two-way communication between teachers and students in solving problems faced by adolescent reproductive health activities. Adolescent reproductive health information services aim to assist adolescents by exploring the conditions and problems they face, so that adolescents are able to make the right decisions in solving problems and what they see around them (Dayal & Gundi, 2022) Adolescent reproductive health information service is a form of two-way communication between teachers and students in solving problems faced by adolescent reproductive health activities (binti Shuib, bin Mohd Yasin, & bin Tahar, 2022). Adolescent reproductive health information services aim to help adolescents by exploring the conditions and problems they face, so that adolescents are able to make the right decisions in solving problems and what they see around them.…”

Co-creating sexual and reproductive health interventions with adolescents: the experience from Rajasthan

“…9 However, studies in Rajasthan reflect that the Ujala counsellors had limited knowledge and competencies in providing accurate information on the SRH topics. 10 In addition, the gaps in the availability and utilisation of IEC materials, referral linkages and the maintenance of privacy and confidentiality of the clients exacerbate the issue. 11 Overall, the RKSK programme in Rajasthan had crucial implementation issues, and the current Ayushman Bharat School Health Programme hardly covers SRH topics.…”