Leadership Commitment and the Quality of Adolescent-Friendly Sexual Reproductive Health Services in Public Health Facilities Among Pastoral Districts of Guji Zone, Ethiopia

Abstract

Background

Accessible and high-quality sexual and reproductive health services are essential for adolescents. However, there is a need for more knowledge about the role of leadership and the quality of these services in Ethiopia, where a significant proportion of the population consists of adolescents. Inadequate quality of friendly health services may lead to underutilization and higher rates of unintended pregnancies and sexually transmitted infections. This study aimed to evaluate the leadership role and quality of friendly health services in the pastoral community of East Guji Zone, Ethiopia.

Methods

We implemented in-depth interviews and focus group discussions with eight key informants and fifty participants. Study design: We used a programmatic qualitative research design. Data were collected using 22 semi-structured questions and analyzed using ATLAS.ti7.

Results

The findings indicate significantly less commitment to health sector leadership and substandard quality of adolescent-friendly sexual and reproductive health services. Inadequate achievement of the quality of care frameworks, including accessibility, equitability, availability, acceptability, and appropriateness, contributed to the insufficient quality of friendly health services.

Conclusions and Recommendations

Poor commitment of health facility leaders influenced the quality of adolescent-friendly sexual and reproductive health services in the pastoral community of the East Guji Zone, according to the study. We recommend enhancing organizational and provider readiness, ensuring equitability, and redesigning services through improving leadership commitment, which is crucial to improving the quality of adolescent-friendly health services. The Ministry of Health Ethiopia and relevant stakeholders should consider these recommendations to improve the quality of friendly health services for adolescents in Ethiopia.

Keywords:

• leadership commitment
• adolescent
• sexual and reproductive health
• health services quality
• health facilities
• pastoral community

Abbreviation

AAA, Availability, Accessibility, Acceptability, and Quality of care; AFHS, Adolescent Friendly Health Services; AFSRH, Adolescent Friendly Sexual and Reproductive Health; AYFH, Adolescent and Youth Friendly Health; DHIS, District health information system; EDHS, Ethiopian Demographic and Health Survey; FGD, Focus Group Discussion; FHS, Friendly Health Services; GZHD, Guji Zonal Health Department; HC, Health Center; HCP, Health Care Providers; HEW, Health Extension Workers; ICPD, International Conference on Population Development; IDI, In-Depth Interview; KII, Key Informant Interview; MCHD, Maternal and Child Health Directorate; MoH, Ministry of Health; PHCU, primary health care unit; QDA, Qualitative data analysis; RHB, Regional Health Bureau; RA Research assistance; ZHD, Zonal Health Department.

Data Sharing Statement

Original transcripts of the study are available (in Oromiiffa and English) from the corresponding author upon request.

Ethical Consideration

We obtained ethical clearance from Jimma University (Ref.No IHRPCA/721/202, date 17/08/2020) and the Bureau of Regional Health, Oromia (Lakk/Ref No BEFO/MBTF/2081, date 27/01/2013, ETC. or 07/10/2020). Earlier in the in-depth interview and FGD, all study participants gave verbal informed consent. We completed the qualitative data collection in November 2020. We confirmed that our study complies with the Declaration of Helsinki, and participants’ and parents’ informed consent included the publication of the anonymized responses.

Acknowledgment

As authors, we would like to thank the Population and Family Health Department, and faculty of public health, Jimma University, as well as the MoH of Ethiopia, for sponsoring our expenses and data collectors costs and last but not least, lovely family members for their particular assistance to the progress of the manuscript.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

The research received only minimal Ph.D. students’ funds from Jimma University for data collection and related costs.