Assessing Efforts to Mainstream Youth-Friendly Health Services in Madagascar, Malawi, and Mali


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Author(s): Janine Barden-O'Fallon and Shara Evans

Year: 2020

Assessing Efforts to Mainstream Youth-Friendly Health Services in Madagascar, Malawi, and Mali Abstract:

High fertility rates and low modern contraceptive use put African youth and adolescents at high risk for health complications, including maternal mortality. Mainstreaming youth-friendly health services (YFHS) into existing services is one approach to improve access to reproductive health services for youth and adolescents. This report details an evaluation MEASURE Evaluation conducted to assess the effects of three YFHS training packages sponsored by Population Services International (PSI) on voluntary uptake of family planning (FP) among youth and perceptions of service quality by youth and trained healthcare providers.

In 2018, a retrospective review and analysis of relevant monitoring and evaluation documents and service statistics from PSI Madagascar, PSI Malawi, and PSI Mali was conducted. Qualitative data on perceptions of service quality from Malawian youth and healthcare providers were also collected and assessed through thematic analysis.

Results show that the number of FP clients ages 15–24 increased after implementation of the YFHS training packages. Data from PSI Madagascar and PSI Malawi show that positive trends were not sustained after other YFHS components ended. Focus group discussions with youth in Malawi indicated that clinics were perceived as providing high-quality services to youth. The main barriers to accessing the services were cost and embarrassment. Malawi’s healthcare providers made many efforts to improve clinic accessibility and understood the barrier of cost and importance of outreach to youth and the broader community. The results provide evidence that provider training alone will not sustain initial increases in youth FP clients. Across the three countries, the greatest benefits of the YFHS training packages were seen when combined with demand-generation activities and increased access to peer education.