Developing and sustaining adolescent-friendly health services: A multiple case study from Ecuador and Peru

ABSTRACT

Adolescent-Friendly Health Services (AFHSs) are those that are accessible, acceptable, equitable, appropriate and effective for different youth sub-populations. This study investigated the process through which four clinics in two countries – Peru and Ecuador – introduced, developed and sustained AFHSs. A multiple case study design was chosen, and data from each clinic were collected through document review, observations and informant interviews. National level data were also collected. Data were analysed following thematic analysis. The findings showed that the process of introducing, developing and sustaining AFHSs was long term, and required a creative team effort and collaboration between donors, public institutions and health providers. The motivation and external support was crucial to initiating and sustaining the implementation of AFHSs. Health facilities’ transformation into AFHSs was linked to the broader organisation of country health systems, and the evolution of national adolescent health policies. In Peru, the centralised approach to AFHSs introduction facilitated the dissemination of a comprehensive national model to health facilities, but dependency on national directives made it more difficult to systemise them when ideological and organisational changes occurred. In Ecuador, a less centralised approach to introducing AFHSs made for easier integration of the AFHSs model.

KEYWORDS:

• Adolescent-friendly health services
• case study
• adolescence
• sexual and reproductive health

Acknowledgements

The authors are grateful to Family Care International, UNFPA Ecuador and Peru, the representatives of the Ministry of Health of Ecuador and Peru, and all the health facilities, NGOs and youth groups that participated in this study for the support provided during the field work.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This study was undertaken within the Umea Center for Global Health Research with support from the Swedish Research Council on Social and Working Life (FAS) [grant number 2006–1512]. Funding for the field work was provided by Family Care International-United Nations Fund for Population Activities (UNFPA) Latin American and Caribbean Region, within the framework of the Andean Plan for Adolescent Pregnancy Prevention.