Callie Simon is technical advisor for adolescent and youth sexual and reproductive health (AYSRH) at Pathfinder International. Based in Washington DC, Ms. Simon provides technical assistance to Pathfinder’s AYSRH programs globally, in addition to supporting Pathfinder’s AYSRH advocacy efforts domestically and abroad.
Claire Cole is technical documentation advisor at Pathfinder International. Based in Boston, MA, she supports Pathfinder’s global offices in implementation analysis to advance technical practice.
Today’s generation of young people is the largest in history. Through the sheer size of their numbers and where they live— predominantly in resource-limited countries—young people represent the future and present of development. Yet, essential sexual and reproductive (SRH) health services that have the power to help a young person shape the direction of his or her life (and health) are often out of reach. Young people are unable to access the high-quality services they need because of community and provider stigma, lack of confidentiality and privacy, and health-system limitations like cost, operating hours, location of services, and shortages of trained providers.
Thankfully, in recent decades this issue has increased in prominence among our global health professional community. The concept of youth-friendly services (YFS) is more readily discussed as a core part of global health services—as evidenced at the 2011International Conference on Family Planning in Dakar, as well as the 2012 International AIDS Conference just last month in Washington, D.C.
Unfortunately though, when we think of the size of the global population of young people, we have to recognize how insufficient current coverage of YFS is to meet the challenge posed to us. Boutique YFS programs and small-scale pilots are never going to enable us to ensure these populations have the health services they need. Scalable YFS strategies are essential to fulfilling the rights of the nearly 3 billion people under the age of 25 who need these services now, and who will continue to need them in the years to come. But getting to this goal will require multi-dimensional thinking on our part. What does multi-dimensional thinking mean in this context? It means recognizing that geographic expansion to more and more clinics is not going to be a sufficient answer to the challenges posed by larger upstream factors that create barriers to sustainable, institutionally-supported YFS. We need solutions like pre-service training, which has the power to produce providers readily able to respond to young clients’ needs from the start of their medical careers, and policies that support young people’s right to quality SRH —regardless of marital status or sexual orientation. We need to capitalize on opportunities to take existing YFS to scale, and push wherever possible to introduce YFS into current large-scale programming.
In Pathfinder’s experience in Ethiopia over the past eight years, we’ve learned a substantial amount about what it looks like to do this. We found ways to mainstream adolescent and youth sexual and reproductive health by introducing YFS into large-scale reproductive health and family planning programs. When funding gaps looked to be signaling the end to our first large-scale YFS effort, we found ways to work YFS into our next large-scale collaboration with the FMOH—in this case via the Integrated Family Health Program (IFHP). Working in regions that comprise more than 80 percent of the country’s population, the potential for geographic scale was a given. But institutional scale—that is, ensuring that YFS was part of the national reproductive health strategy, that there were national training curricula, guidelines, and standards for YFS, and that YFS was a part of regional MOH work planning and monitoring structures—was equally important. Working at these two angles in tandem, we were able to support the FMOH in navigating the myriad challenges that are inevitably part of scaling a critical but often neglected and stigmatized service like YFS.
But more is needed. We need collective action, partnerships, and learning to ensure YFS is brought to scale more regularly across our global health landscape. Across agencies, we need to share our lessons, our challenges, and our failures from implementation as we strive toward this goal. With the increased attention being given to YFS, there’s good cause for optimism that this learning-oriented dialogue around YFS will only continue to grow. Our recent technical brief, Bringing Youth Friendly Services to Scale in Ethiopia, captures many of the key lessons and take-aways from our experience scaling YFS through IFHP. We look forward to continuing this important dialogue with the greater YFS community in the future.
IFHP is a five-year (2008-2013) USAID-funded project that collaborates with the government of Ethiopia to promote an integrated model to strengthen family planning, reproductive health, and maternal and child health services for rural and hard-to-reach populations. The project works in six regions: Oromiya; Tigray; Southern Nations, Nationalities, and Peoples (SNNPR); Amhara; and parts of BenishangulGumuz and Somali. The project is led by Pathfinder International and John Snow, Inc. in partnership with the Consortium of Reproductive Health Associations (COHRA) and 11 other local implementing partners.