Quality of adolescent and youth-friendly health services in Dehana district public health facilities, northeast Ethiopia: Using the Donabedian quality framework

Abstract

Introduction Adolescents and youths who need exceptional healthcare are the shapers and leaders of our global future. However, many of them are died prematurely, while others suffer from diseases partly because of the poor quality of health services. Thus, this study aimed to assess the quality of Adolescent and Youth-friendly Health Services (AYFHS) and associated factors in the public health facilities of Dehana district, Northeast Ethiopia. Methods A facility-based quantitative cross-sectional study supported with a qualitative component was conducted from February 24 to March 30, 2020. The quality of AYFHS was measured using the Donbidean framework (structure, process and output component). Accordingly, a total of 431 adolescents and youths, five health facilities, twenty-five client-provider interaction observations, and nine key informant interviews were conducted. Binary logistic regression analysis was done, and variables with a p-value of < 0.05 and Adjusted Odds Ratio (AOR) with its 95% Confidence Interval (CI) were used to measure the association. The qualitative data were audio-recorded and transcribed verbatim. Then, Open Code 4.03 software was used to manage and analyze the data. Results The quality of adolescent and youth-friendly health services was 58.8, 46.4, and 47.2% for structural, process, and output quality dimensions, respectively. The predictor variables for output quality were, being a student (AOR: 2.07, 95%CI: 1.07–3.40), farmers (AOR: 2.59, 95%CI: 1.25–5.39), own income sources (AOR: 1.99, 95%CI: 1.03–3.85), exempted services (AOR: 2.30, 95%CI: 1.43–3.71) and long waiting time (AOR: 3.8495%CI: 1.80–8.23). Conclusions The overall quality of adolescent and youth-friendly health services was still lower than the WHO good quality standards. The structural quality dimension was affected by the unavailability of adequate and trained health service providers, poor engagement of adolescents and youths in the facility governance structure, unavailability of guidelines, protocols and procedures. In contrast, the process quality dimension was also compromised due to the provider’s poor compliance with the national AYFHS guidelines. Therefore, health facilities need to engage adolescents and youths in the health facility governance structure, and providers should comply with the national guideline.

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

“…Additional lacunae, highlighted as per the RKSK benchmark in our selected AFHC, included the lack of guidelines on services, such as referral guidelines, further limiting the utilisation of quality services. These findings are consistent with other national 29 and international studies 39 40 where most AFHCs lack guidelines and SOPs. These guidelines are a roadmap to a strong connection between various healthcare systems, ensuring efficient use of medical services.…”

“…The need for infrastructural and medical supplies for effective and appropriate service delivery and adolescent satisfaction has been substantiated in the assessment of services across countries. 38 46 The insufficient medical supplies and equipment is congruent with facilities in Rajasthan (India) 28 and Uganda, 40 Nigeria 47 while contrast to the AFHC in Dehana district, Ethiopia 39 where availability of facility characteristics was found to be appropriate. Further, to support quality improvement adolescent participation holds prime importance, as healthcare services should be participant-sensitive and reflect their needs.…”

The practice of menstrual hygiene management and associated factors among secondary school girls in eastern Ethiopia: The need for water, sanitation, and hygiene support

“…Problems to access education on puberty and menstrual health 64 , 65 are among the challenges of addressing adolescents and youth health services which include stigma, service costs, provider bias, facility setup, client–provider interaction, waiting time of services, and service sensitivity to all young groups. 15 , 66 – 68 …”

“…Problems to access education on puberty and menstrual health 64,65 are among the challenges of addressing adolescents and youth health services which include stigma, service costs, provider bias, facility setup, client-provider interaction, waiting time of services, and service sensitivity to all young groups. 15,[66][67][68] The Ethiopian government prioritized adolescent and youth development through focused policies and strategies which enabled a favorable work climate for non-governmental organizations' support. However, it was agreed that the setting was relatively restricted in general, with regional variations and dynamic changes in the countries.…”

Quality of adolescent and youth-friendly sexual and reproductive health services and associated factors in Ethiopia: a systematic review and meta-analysis

“…The general quality of health services provided for the young people in Ethiopia varies greatly depending on the context. For example, structural, process, and output quality dimensions were 54.4, 42.0, and 49.1%, respectively, in Southern Ethiopia ( 16 ) whereas they were 58.8, 46.4, and 47.2%, respectively, in North East Ethiopia ( 17 ). The overall quality of YFS is classified as “not good quality” or “below standard” since all of the YFS sites' performance in three of the quality dimensions fell below the predetermined cutoff criterion (75%) ( 16 ).…”