The world’s population in 2014 was composed of nearly 1.8 billion young people 90% of whom were in low and middle income countries (LMICs)[i]. Adolescents everywhere face many challenges as they go through major physical and mental development. However, adolescent health has long been a neglected topic in global health and the burden of disease among adolescents has not reduced significantly in the past decades. The post-2015 development agenda has recognized the importance of addressing adolescent health as emphasized by the 2016-2030 United Nation’s Global Strategy for Women’s, Children’s and Adolescent’s Health.
CHMI's database of more than 1400 private health programs features 298 programs that are already making a difference in bringing health services close to adolescents and addressing the main causes of mortality and morbidity among adolescents.
Which health areas are these programs addressing?
Reproductive Health and Family Planning
Forty-eight percent of the 298 programs in the CHMI database working with adolescents and young people offer services in Reproductive Health and Family Planning. This is because issues related to reproductive health rank high in the causes of mortality among adolescents. For example, maternal and childbirth deaths rank second in causes of mortality in 15–19 year old females globally[ii]. The lack of information on sexual and reproductive health among young people together with cultural and gender norms often prevent adolescents from accessing sexual and reproductive health services even when these services are available.
India’s MAMTA – Health Institute uses a gender sensitive and participatory approach to address young people’s sexual and reproductive health and rights. MAMTA focuses on changing harmful traditional practices like early child forced marriages, developing adolescent friendly health centers and providing comprehensive sex education.
The Youth Truck in Uganda is a mobile outreach service which sensitizes youth in rural areas and urban slums on sexual and reproductive health and rights including HIV/AIDS prevention through film screenings, youth clubs, games and other activities. This project seeks to provide sexual and reproductive health information and services to all youth including youth with no formal education.
I-Care, a program based in Kenya, seeks to empower girls by providing them with high-quality affordable and reusable sanitary towels to improve school attendance and self-esteem. Similarly, BanaPads and ZanaAfrica in Kenya sell eco-friendly sanitary pads using saleswomen that go door-to-door providing the products and delivering messages on menstrual hygiene and family planning.
Young people living with disabilities also deserve access to reproductive health and family planning services. Using Your Hands to Talk about Sex in Vietnam developed a sexual and reproductive health curriculum in sign language for deaf students. Teachers are trained in SRH, HIV/AIDS and counseling to equip their students with the necessary knowledge.
HIV/AIDS is another focus area in adolescent health. 128 programs focus on HIV/AIDS among adolescents and young people. Today, one in seven new HIV infections happens during adolescence (10-19 years old)[iii] . In LMICs, where most of the HIV burden is concentrated, adolescents account for almost 40% of new HIV infections[iv].
Tuungane Youth Center in Kenya offers free, youth-specific HIV care services to promote HIV prevention and improve the use of STI services and Volunteer Counseling and Testing (VCT) services.
Project Khuluma in South Africa provides a support structure to HIV positive adolescents who are facing stigma and discrimination in their communities. The young people are given individual psychological support, interactive support in closed groups, and an SMS line where they can ask questions anonymously.
The Sizophila Project also in South Africa provides training to unemployed and HIV positive community members and employs them as Therapeutic Counselors (TCs). The TCs ensure ART adherence and conduct one-on-one counseling, education and support (including home-based support) to other people that have been diagnosed with HIV including adolescent and pediatric patients.
What approaches are these programs using?
Behavioral change through consumer education and social marketing
235 programs (78%) use a behavioral change approach to address adolescent health through consumer education and social marketing strategies. Behavioral change is one of the most effective ways to empower the youth to make informed health choices now and in their adult lives since behavior started in adolescence often result in long lasting outcomes well into adulthood.
For example, in Vietnam the Youth Union together with local coffee shops created Youth Café, a chain of youth-friendly coffee shops. Using the behavioral change communication model, trained peer educators and sometimes health experts and local counselors are invited to address the youth. In addition, through interactive theater and competitions, youth discuss sexual reproductive health, love, marriage and life skills. Information Education and Communication (IEC) materials like posters and leaflets on HIV, STIs and reproductive health are provided to the young clients in addition to normal coffee shop services. Condoms are also available at convenient locations within the coffee shops.
Matibabu Foundation in Kenya is a home grown community initiative that aims to reach the most underserved youth in rural areas and engage them in health education and counseling programs on HIV, SRH, and cervical cancer among others. Matibabu also offers an integrated continuum of services through its main clinic.
Enhancing the process through Information Communication Technology and virtual services
Of the 179 programs using the process enhancement approach, 85 programs (47%) focus on information and technology. Fifty-four other adolescent programs provide virtual services. The use of ICT can reduce barriers to health information and services for adolescents. Youth who go to clinics are often scared or embarrassed to ask questions related to sexual and reproductive health due to judgmental and unfriendly providers, lack of confidentiality and lack of trained providers with trustworthy information[v]. Virtual services offer an avenue for the youth to have conversations with experts and peers without the fear of being exposed.
Learning About Living uses a mobile and online e-learning platform to engage Nigerian youth in conversation on HIV/AIDS, SRH, gender violence and more.
Partners in Reproductive Health (PIRH), based in Kenya, hosts the Stay Alive Youth radio program and encourages youth to form Radio Listeners Clubs. Expert guest speakers are invited to the weekly show to answer questions on SRH. Similarly, 100% Jeune in Cameroon and Window of Love in Vietnam are call-in radio programs that use radio serial drama and peer education sessions to promote condom use and SRH education.
Freedom HIV/AIDS is a company that develop interactive mobile phone games to help combat the spread of HIV/AIDS and fight stigma and discrimination.
The Way Forward
Adolescent health is gaining more interest from researchers, governments and other international institutions. However, to ensure healthier transitions into adulthood for all adolescents, there is more work to be done in addressing other causes of mortality and morbidity among adolescents such as mental health, suicide, Non Communicable Diseases (NCDs) and violence. In addition, there is a need for more reliable data collection and analysis on adolescent health at all levels to inform future decisions.
The Center for Health Market Innovations will continue to track emerging models of programs that improve access to health services for adolescents.
[i] State of World Population. United Nations Population Fund (UNFPA), 2014
[ii] Health for the World’s Adolescents: A Second Chance in the Second Decade. World Health Organization, 2014
[iii] UNFPA, 2014
[iv] Every Woman, Every Child: Strengthening Equity and Dignity through Health. iERG, 2013