PurposeTo improve adolescent health measurement, the Global Action for the Measurement of Adolescent health (GAMA) Advisory Group was formed in 2018 and published a draft list of 52 indicators across six adolescent health domains in 2022. We describe the process and results of selecting the adolescent health indicators recommended by GAMA (hereafter, “GAMA-recommended indicators”).MethodsEach indicator in the draft list was assessed using the following inputs: (1) availability of data and stakeholders' perceptions on their relevance, acceptability, and feasibility across selected countries; (2) alignment with current measurement recommendations and practices; and (3) data in global databases. Topic-specific working groups comprised of GAMA experts and representatives of United Nations partner agencies reviewed results and provided preliminary recommendations, which were appraised by all GAMA members and finalized.ResultsThere are 47 GAMA-recommended indicators (36 core and 11 additional) for adolescent health measurement across six domains: policies, programs, and laws (4 indicators); systems performance and interventions (4); health determinants (7); health behaviors and risks (20); subjective well-being (2); and health outcomes and conditions (10).DiscussionThese indicators are the result of a robust and structured five-year process to identify a priority set of indicators with relevance to adolescent health globally. This inclusive and participatory approach incorporated inputs from a broad range of stakeholders, including adolescents and young people themselves. The GAMA-recommended indicators are now ready to be used to measure adolescent health at the country, regional, and global levels.

PurposeTo explore data availability, perceived relevance, acceptability and feasibility of implementing 52 draft indicators for adolescent health measurement in different countries globally.MethodsA mixed-methods, sequential explanatory study was conducted in 12 countries. An online spreadsheet was used to assess data availability and a stakeholder survey to assess perceived relevance, acceptability, and feasibility of implementing each draft indicator proposed by the Global Action for Measurement of Adolescent health (GAMA). The assessments were discussed in virtual meetings with all countries and in deep dives with three countries. Findings were synthesized using descriptive statistics and qualitative thematic analysis.ResultsData availability varied across the 52 draft GAMA indicators and across countries. Nine countries reported measuring over half of the indicators. Most indicators were rated relevant by stakeholders, while some were considered less acceptable and feasible. The ten lowest-ranking indicators were related to mental health, sexual health and substance use; the highest-ranking indicators centered on broader adolescent health issues, like use of health services. Indicators with higher data availability and alignment with national priorities were generally considered most relevant, acceptable and feasible. Barriers to measurement included legal, ethical and sensitivity issues, challenges with multi-sectoral coordination and data systems flexibility.DiscussionMost of the draft GAMA indicators were deemed relevant and feasible, but contextual priorities and perceived acceptability influenced their implementation in countries. To increase their use for a more comprehensive understanding of adolescent health, better multi-sectoral coordination and tailored capacity building to accommodate the diverse data systems in countries will be required.

Purpose: To assess the relevance of the Sustainable Development Goals (SDGs) framework for adolescent health measurement, both in terms of age disaggregation and different health domains captured, and how the adolescent health indicators recommended by the Global Action for Measurement of Adolescent Health (GAMA) can complement the SDG framework. Methods: We conducted a desk review to systematically map all 248 SDG indicators using the UN metadata repository in three steps: 1) age-related mandates for SDG reporting; 2) linkages between the SDG indicators and priority areas for adolescent health measurement; 3) comparison between the GAMA indicators and the SDG framework. Results: Of the 248 SDG indicators, 35 (14%) targeted an age range overlapping with adolescence (10-19 years) and 33 (13%) called for age disaggregation. Only one indicator (3.7.2 "adolescent birth rate") covered the entire 10-19 age range. Almost half (41%) of the SDG indicators were directly related to adolescent health, but only 33 of those (13% of all SDG indicators) overlapped with the ages 10-19, and 15 (6% of allSDG indicators) explicitly mandated age disaggregation. Amongthe 47 GAMA indicators, five corresponded to existing SDG indicators, and eight were adolescent-specific age adaptations. Several GAMA indicators shed light on aspects not tracked in the SDG framework, such as obesity, mental health, physical activity, and bullying among 10-19-year-olds. Discussion: Adolescent health cannot be monitored comprehensively with the SDG framework alone. The GAMA indicators complement this framework via age-disaggregated adaptations and by tracking aspects of adolescent health currently absent from the SDGs. (c) 2024 Published by Elsevier Inc. on behalf of Society for Adolescent Health and Medicine. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

The Sustainable Development Goals (SDGs) constitute one of the most ambitious frameworks globally, yet the extent to which it covers the unique priorities and vulnerabilities of adolescents is unclear. We aimed to assess how well the SDGs capture different domains of adolescent health including age disaggregation of indicators; and how the priority indicators recommended by the Global Action for Measurement of Adolescent Health (GAMA) Advisory Group (AG) can complement the SDG framework. First, we reviewed the SDG metadata repository to systematically map all 248 indicators according to: a) age ranges of indicators overlapping with the adolescent period (10-19 years); and b) age disaggregation based on including age in the indicator definition, or by mandating disaggregation in the metadata. Second, we categorized each SDG indicator as directly, closely or remotely related to adolescent health measurement according to six domains: 1) health determinants; 2) health behaviors/risks; 3) policies/programs/laws; 4) systems performance/interventions; 5) subjective well-being; 6) health outcomes/conditions. Third, we reviewed each of the 52 adolescent health priority indicators recommended by the GAMA AG according to whether they: directly overlap; modify; or support achievement of an SDG even if absent from the official monitoring framework. Of the 248 SDG indicators, 35 (14.1%) target an age range overlapping with adolescence, mainly focusing on ages 15+ years. Additionally, 33 indicators (13.3%) across the SDG framework explicitly call for age disaggregation. Only one indicator, SDG 3.7.2 "Adolescent birth rate," covers the entire 10-19 age range. We classified almost half (46.4%, N=115) of the SDG indicators as directly related to adolescent health measurement, and one third (34.2%, N=85) as closely related. These selected indicators mostly focused on health determinants and outcomes, while none were linked to either policies or subjective well-being. Overall, 34 indicators (13.7%) were found to overlap with ages 10-19 and to be directly relevant to at least one adolescent health measurement area. However, of these only 15 – 6.0% of all SDG indicators – were found to explicitly mandate age disaggregation. Most of these fall within SDG 4 (education), SDG 5 (gender equality), SDG 8 (decent work) and SDG 3 (good health). Among the 52 adolescent health priority indicators recommended by the GAMA AG, four were directly drawn from the SDGs, and 13 were adaptations. Several priority indicators were found to complement the SDG framework by shedding light on aspects not tracked, such as obesity, mental health, physical activity and bullying among 10-19-year-olds. The SDG framework must be complemented to address gaps in adolescent health monitoring, currently captured by only 6% of SDG indicators. The GAMA AG priority indicators can contribute towards filling this gap, both via age-disaggregated adaptations, and by tracking aspects of adolescent health that can help achieve broader goals (e.g., obesity and SDG 2 on improved nutrition). Doing so can enable governments and other key stakeholders to (better) understand the adolescent health profile of their countries and prioritize investment.

Purpose: This study identified alignment of indicators across different initiatives and data collection instruments as a foundation for future harmonization of adolescent health measurement. Methods: Using the Global Action for Measurement of Adolescent health (GAMA) recommended indicators as the basis for comparison, we conducted a desk review of 14 global-level initiatives, such as the Sustainable Development Goals and the Global Strategy for Women's, Children's and Adolescents' Health, and five multicountry survey programs, such as the Multiple Indicator Cluster Surveys and the Global school-based Student Health Survey. We identified initiative and survey indicators similar to a GAMA indicator, deconstructed indicators into standard elements to facilitate comparison, and assessed alignment to the corresponding GAMA indicator across each of the elements. Results: A total of 144 initiative indicators and 90 survey indicators were identified. Twenty-four initiative indicators (17%) and 14 survey indicators (16%) matched the corresponding GAMA indicators across all elements. Population of interest was the most commonly discrepant element; whereas GAMA indicators mostly refer to ages 10-19, many survey and initiative indicators encompass only part of this age range, for example, 15-19-year-olds as a subset of adults ages 15-49 years. An additional 53 initiative indicators (39%) and 44 survey indicators (49%) matched on all elements except the population of interest. Discussion: The current adolescent measurement landscape is inconsistent, with differing recommendations on what and how to measure. Findings from this study support efforts to promote indicator alignment and harmonization across adolescent health measurement stakeholders at the global, regional, and country levels. (c) 2024 Published by Elsevier Inc. on behalf of Society for Adolescent Health and Medicine. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Data Source: WHO Maternal, Newborn, Child and Adolescent and Ageing data portal. Available at: https://platform.who.int/data/maternal-newborn-child-adolescent-ageing and World Health Organization. Sexual, Reproductive, Maternal, Newborn, Child and Adolescent Health Policy Survey, 2018–2019: Summary Report. Geneva: World Health Organization; 2020.•National adolescent health programs are instrumental in prioritizing adolescents and their health needs and these programs function best when adequately staffed and funded.•Globally, 77% of the 150 countries responding to the Sexual, Reproductive, Maternal, Newborn, Child and Adolescent Health Policy Survey (2018–2019) reported having a national adolescent health program, while only 29% reported that the program included at least one designated full-time person and a regular government budget allocation.•The proportion of countries reporting having a national adolescent health programme increased with decreasing country income.•

Available data are insufficient and inconsistent, but increasing focus on adolescent wellbeing provides the impetus to advance measurement, argue Holly Newby and colleagues

PURPOSE:This article describes the selection of priority indicators for adolescent (10-19 years) health measurement proposed by the Global Action for Measurement of Adolescent health advisory group and partners, building on previous work identifying 33 core measurement areas and mapping 413 indicators across these areas.METHODS:The indicator selection process considered inputs from a broad range of stakeholders through a structured four-step approach: (1) definition of selection criteria and indicator scoring; (2) development of a draft list of indicators with metadata; (3) collection of public feedback through a survey; and (4) review of the feedback and finalization of the indicator list. As a part of the process, measurement gaps were also identified.RESULTS:Fifty-two priority indicators were identified, including 36 core indicators considered to be most important for measuring the health of all adolescents, one alternative indicator for settings where measuring the core indicator is not feasible, and 15 additional indicators for settings where further detail on a topic would add value. Of these indicators, 17 (33%) measure health behaviors and risks, 16 (31%) health outcomes and conditions, eight (15%) health determinants, five (10%) systems performance and interventions, four (8%) policies, programmes, laws, and two (4%) subjective well-being.DISCUSSION:A consensus list of priority indicators with metadata covering the most important health issues for adolescents was developed with structured inputs from a broad range of stakeholders. This list will now be pilot tested to assess the feasibility of indicator data collection to inform global, regional, national, and sub-national monitoring.

Purpose: A host of recent initiatives relating to adolescent health have been accompanied by varying indicator recommendations, with little stakeholder coordination. We assessed currently included adolescent health-related indicators for their measurement focus, identified overlap across initiatives, and determined measurement gaps. Methods: We conducted a scoping review to map the existing indicator landscape as depicted by major measurement initiatives. We classified indicators as per 33 previously identified core adolescent health measurement areas across five domains and by age groups. We also identified indicators common across measurement initiatives even if differing in details. Results: We identified 413 indicators across 16 measurement initiatives, with most measuring health outcomes and conditions (162 [39%]) and health behaviors and risks (136 [33%]); followed by policies, programs, and laws (49 [12%]); health determinants (44 [11%]); and system performance and interventions (22 [5%]). Age specification was available for 221 (54%) indicators, with 51 (23%) focusing on the full adolescent age range (10-19 years), 1 (<1%) on 10-14 years, 27 (12%) on 15-19 years, and 142 (64%) on a broader age range including adolescents. No definitional information, such as numerator and denominator, was available for 138 indicators. We identified 236 distinct indicators after accounting for overlap. Conclusion: The adolescent health measurement landscape is vast and includes substantial variation among indicators purportedly assessing the same concept. Gaps persist in measuring systems performance and interventions; policies, programs, and laws; and younger adolescents' health. Addressing these gaps and harmonizing measurement is fundamental to improve program implementation and accountability for adolescent health globally. (c) 2021 Society for Adolescent Health and Medicine. Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Intervention coverage-the proportion of the population with a health-care need who receive care-does not account for intervention quality and potentially overestimates health benefits of services provided to populations. Effective coverage introduces the dimension of quality of care to the measurement of intervention coverage. Many definitions and methodological approaches to measuring effective coverage have been developed, resulting in confusion over definition, calculation, interpretation, and monitoring of these measures. To develop a consensus on the definition and measurement of effective coverage for maternal, newborn, child, and adolescent health and nutrition (MNCAHN), WHO and UNICEF convened a group of experts, the Effective Coverage Think Tank Group, to make recommendations for standardising the definition of effective coverage, measurement approaches for effective coverage, indicators of effective coverage in MNCAHN, and to develop future effective coverage research priorities. Via a series of consultations, the group recommended that effective coverage be defined as the proportion of a population in need of a service that resulted in a positive health outcome from the service. The proposed effective coverage measures and care cascade steps can be applied to further develop effective coverage measures across a broad range of MNCAHN services. Furthermore, advances in measurement of effective coverage could improve monitoring efforts towards the achievement of universal health coverage.