Mainstreaming youth-friendly health services into existing primary health care facilities: experiences from South-South Nigeria

Rosemary Ogu 1 , 2 , Omosivie Maduka 1 , 3 , Folusho Alamina 1 , 4 , Obelebra Adebiyi 1 , 5 , Vetty Agala 1 , 6 , Gracia Eke 1 , 7 , Ibimonye Porbeni 1 , Nnesochi Offor 1 , 6 , Claribel Abam 1 , 8 , Alice Nte 1 , 7  and Friday Okonofua 9
  • 1 Medical Women’s Association of Nigeria, Rivers State Branch, Port Harcourt, Nigeria
  • 2 Department of Obstetrics and Gynaecology, University of Port Harcourt, Port Harcourt, Rivers State, Nigeria
  • 3 Department of Preventive and Social Medicine, University of Port Harcourt, Port Harcourt, Rivers State, Nigeria
  • 4 Department of Community Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
  • 5 Department of Medical and Dental Services, Rivers State Hospitals Management Board, Port Harcourt, Nigeria
  • 6 Free Medical Care Programme, Rivers State Ministry of Health, Port Harcourt, Nigeria
  • 7 Department of Paediatrics, University of Port Harcourt, Port Harcourt, Rivers State, Nigeria
  • 8 Office of the Executive Secretary, Rivers State Primary Health Care Management Board, Port Harcourt, Nigeria
  • 9 Department of Youth Sexuality, Reproductive Health and Rights, Ford Foundation Office of West Africa, Lagos, Nigeria
Rosemary Ogu
  • Corresponding author
  • Medical Women’s Association of Nigeria, Rivers State Branch, Port Harcourt, Nigeria
  • Department of Obstetrics and Gynaecology, University of Port Harcourt, Port Harcourt, Rivers State, Nigeria
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, Omosivie Maduka
  • Medical Women’s Association of Nigeria, Rivers State Branch, Port Harcourt, Nigeria
  • Department of Preventive and Social Medicine, University of Port Harcourt, Port Harcourt, Rivers State, Nigeria
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, Folusho Alamina
  • Medical Women’s Association of Nigeria, Rivers State Branch, Port Harcourt, Nigeria
  • Department of Community Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
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, Obelebra Adebiyi
  • Medical Women’s Association of Nigeria, Rivers State Branch, Port Harcourt, Nigeria
  • Department of Medical and Dental Services, Rivers State Hospitals Management Board, Port Harcourt, Nigeria
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, Vetty Agala
  • Medical Women’s Association of Nigeria, Rivers State Branch, Port Harcourt, Nigeria
  • Free Medical Care Programme, Rivers State Ministry of Health, Port Harcourt, Nigeria
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, Gracia Eke
  • Medical Women’s Association of Nigeria, Rivers State Branch, Port Harcourt, Nigeria
  • Department of Paediatrics, University of Port Harcourt, Port Harcourt, Rivers State, Nigeria
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, Ibimonye Porbeni
  • Medical Women’s Association of Nigeria, Rivers State Branch, Port Harcourt, Nigeria
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, Nnesochi Offor
  • Medical Women’s Association of Nigeria, Rivers State Branch, Port Harcourt, Nigeria
  • Free Medical Care Programme, Rivers State Ministry of Health, Port Harcourt, Nigeria
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, Claribel Abam
  • Medical Women’s Association of Nigeria, Rivers State Branch, Port Harcourt, Nigeria
  • Office of the Executive Secretary, Rivers State Primary Health Care Management Board, Port Harcourt, Nigeria
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, Alice Nte
  • Medical Women’s Association of Nigeria, Rivers State Branch, Port Harcourt, Nigeria
  • Department of Paediatrics, University of Port Harcourt, Port Harcourt, Rivers State, Nigeria
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and Friday Okonofua
  • Department of Youth Sexuality, Reproductive Health and Rights, Ford Foundation Office of West Africa, Lagos, Nigeria
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Abstract

Background

Youth friendly services, an evidence based approach to overcome the barriers experienced by youths in accessing care, is poorly implemented. The Medical Women’s Association of Nigeria (MWAN) Rivers State chapter, was supported by Ford Foundation to mainstream youth-friendly health services (YFHS) into existing primary health care facilities in two hard-to-reach communities. This paper presents the interventions, findings, challenges and recommendations.

Methods

This study project was implemented in stages: design, baseline survey, interventions and evaluation, between 2014 and 2016. Interventions included facility modifications, health worker capacity building, school and community outreaches, peer group activities, and interpersonal communication. Pre-and-post-intervention surveys were carried out among in- and out-of-school youths to determine the effects of the interventions.

Results

The most commonly stated barriers to uptake of youth friendly health services included: unavailability of services (154; 33.1%), unavailability of health care workers (167; 38.9%), unaffordability of services (108; 45.8%) and difficulty in communicating with health workers (85; 36.0%). Post-intervention, utilization improved across all services while the perception of barriers to utilization of services reduced (p < 0.05). The interventions implemented increased the odds of youths utilizing YFHS 1.81 times (95% CI = 1.39–2.37).

Conclusion

Facility modifications, capacity building of health workers, school and community outreaches, peer group activities, and interpersonal communication improved utilization across all services while the perception of barriers to utilization of services reduced. Implementation of YFHS is impacted by external factors often beyond the control of project implementers. Innovative solutions outside of routine health care delivery systems are critical for success. Further evaluation to explore the effect of these interventions is needed. Strengthening of health systems remains a vital strategy for scale-up of YFHS.

    • Supplementary material
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