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

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.

Sexual Reproductive Health: Improving Child Survival Initiatives in Botswana

Improving maternal and child survival it’s an important integral part of health care. A large number of deaths in Africa emanate from preventable diseases and largely in the first month of life. Majority of deaths were from preventable causes such as pneumonia, diarrhea and malaria and all accounting to 14.9%, 9.2% and 7.3% respectively. In an endeavour to the prevent and promote healthcare system, the government of Botswana came up with a special programme geared toward protecting the locals against common diseases. The government of Botswana, through the Ministry of Health (MoH), introduced the Accelerated Child Survival and Development (ACSD) strategic plan intervention with a specific focus on reducing the ‘under five mortality rate’ (U5MR). One of the high-impact interventions for reducing the U5MR is the Integrated Management of Childhood Illness (IMCI) strategy. The strategic goal of IMCI is to reduce death, illness, and disability and to promote improved growth and development among children under 5 years of age. Child welfare clinic and Nutrition has been discovered as one of the strategy to promote child’s growth and development. This strategy can be effective if it is implemented with IMCI and Immunisation.

Adolescent girls and young women’s PrEP-user journey during an implementation science study in South Africa and Kenya

Successful scale-up of PrEP for HIV prevention in African adolescent girls and young women (AGYW) requires integration of PrEP into young women’s everyday lives. We conducted interviews and focus group discussions with 137 AGYW PrEP users aged 16–25 from South Africa and Kenya. Individual and relational enablers and disablers were explored at key moments during their PrEP-user journey from awareness, initiation and early use through persistence, including PrEP pauses, restarts, and discontinuation. PrEP uptake was facilitated when offered as part of an integrated sexual reproductive health service, but hampered by low awareness, stigma and misconceptions about PrEP in the community. Daily pill-taking was challenging for AGYW due to individual, relational and structural factors and PrEP interruptions (intended or unintended) were described as part of AGYW’s PrEP-user journey. Disclosure, social support, adolescent-friendly health counseling, and convenient access to PrEP were reported as key enablers for PrEP persistence.

THE EFFECTS OF DONOR FUNDING ON THE PERFORMANCE OF SEXUAL REPRODUCTIVE HEALTH NGOS IN MOMBASA COUNTY

Purpose: Local Non-Governmental Organizations (NGOs) play crucial role in uplifting livelihoods and overall economic development in Kenya. However, several local NGOs have experienced dwindling performance as a result of insufficient donor funding. It is in this vein that the current study assessed the effects of donor funding on the organizational performance of local sexual reproductive health NGOs in Mombasa County. The specific study objectives included; to establish the effect of availability of donor funds, funds management, and capacity building on the performance of local NGOs. Methodology: The study adopted a descriptive survey research design while the target population was all the employees of sexual reproductive health NGOs in Mombasa County. The study used simple random sampling technique. A structured questionnaire was self-administered to all employees of the 14 NGOs. The study utilized descriptive statistics and multiple regression analysis. Diagnostic tests such as normality and multicollinearity were used. Results: The research found that funds’ management, funds’ availability, capacity building, and government policies had positive relationship with NGOs project performance. The study concludes that NGOs had various sources of funding. It concludes that the NGOs ensured funds’ management by employing qualified accounting staff, embracing openness for regular donor evaluations, ensuring financial disclosures to stakeholders. The study concludes that NGOs’ staff had adequate experience in running projects. It was concluded that there was no level business environment for local NGOs, the available government NGO operation policies were unfriendly and the Co-ordination Act needed improvement. Unique contribution to theory, policy and practice: The study recommends that all NGOs should continue sourcing for multiple reliable funders. The study recommend that all NGOs should uphold proper planning for finances, monitoring, evaluation, and budgeting control to ensure accountability to promote successful completion of projects. The study recommends that NGOs’ staff should be subjected to regular timely task-oriented training.

Sexual Reproductive Health Challenges and Health-Care-Seeking Behaviour Among Children Who Live on the Streets in Harare

Drawing on interviews and focus group discussions with 26 participants aged between 10 and 17, the paper describes sexual reproductive health problems, health-seeking behaviour, access to and utilisation of sexual reproductive health services among children living on the street in Harare. An intersectionality approach showed how participants’ social location, age and gender created vulnerabilities leading to STIs, maternal complications and sexual violence among others. Additionally, these factors contributed to challenges in accessing sexual reproductive health services among children living on the street. Thus there is need for tailor-made interventions to influence better health outcomes among children living on the street.

Healthcare Priority-Setting in Essential Health Packages for Sexual Reproductive Health: Going Beyond the Commonly Prioritised Services

There is a systematic exclusion of gender-based violence, safe abortion, reproductive cancers, infertility services, comprehensive sexuality education, sexuality services, and STI’s other than HIV in essential health packages in LMICs. To accelerate progress on sexual reproductive health (SRH), the Guttmacher–Lancet Commission proposed the adoption of these interventions into an essential health package of SRH services that should be universally available. In this commentary, we use a healthcare priority-setting processes lens to review the importance of these services for universal health coverage. We isolate inherent challenges in social value judgments for terminal, process and content evidence for their healthcare priority-setting. We then advance promising emerging practical examples from low to middle-income countries on evidence-informed decision-making processes. We recommend capacity development through regional support, generating equity and efficiency evidence and strengthening political and publicly acceptable processes to institutionalise and operationalise evidence-informed decision-making.