48. Assessment of Adolescent Friendly Health Clinics (afhcs) in Two States of India

Seeking professional help through counselling is a valuable modality for preventing and treating adolescent health issues. Aligning to this, India’s National Adolescent Health Programme (Rashtriya Kishor Swasthya Karyakram) aims to strengthen Adolescent Friendly Health Clinics (AFHCs) to offer clinical and counselling services on diverse adolescent health issues. To make the health services adolescent-friendly, AFHC should provide services in accordance with the national and international quality standards. With this background, a study was conducted to assess the compliance of AFHCs against defined international standards. To the best of our knowledge, this is one of the first studies in India that assessed the compliance of AFHCs against the global standards. A cross-sectional assessment was carried out in 14 AFHCs, established across all levels of the health system in Madhya Pradesh (n=6) and Maharashtra (n=8), India. Structured observations were conducted using a checklist developed adapting World Health Organization’s Global standards for quality health-care services for adolescents. Observations was conducted by trained researchers during November 2021-January 2022. The checklist included thirteen criteria covering: accessibility, signage, waiting area, registration desk, physical infrastructure, basic amenities, availability of functional equipment, commodities, visual and auditory privacy features, confidentiality procedures, items on display, Standard Operating Procedures, job description. Each criterion included multiple items and each item was given a score of “0” (Not meeting criteria) and “1” (meeting criteria). An average score of each facility and criteria was calculated and classified as: <10% (not meeting criteria), 10-40% (needs major improvement), 40-80% (needs some improvement), and 80% or more (meets criteria). Study was approved by the Institutional Ethics Committee of Public Health Foundation of India. None of the AFHCs (n=14) scored above 80% and below 10%. Most AFHCs (n=9) needed major (10% - 40%) and others (n=5) some improvement (40-80%). Analysis of these AFHCs by criterion showed that, most criteria were either not met or required improvements: Waiting Area (<10%=2, 10-40%=4, 40-80%=8); Registration Desk (<10%=10, >80%=4); Physical infrastructure (10-40%=2, 40-80%=10, >80%=2); Basic amenities (<10%=1, 10-40%=4, 40-80%=9); Availability of functional equipment (<10%=2, 10-40%=11, 40-80%=1); Availability of commodities (<10%=5, 10-40%=6, 40-80%=2, >80%=1); Visual and auditory privacy features (<10%=3, 10-40%=4, 40-80%=6, >80%=1); Availability of Registers (10-40%=2, 40-80%=10, >80%=2); Items on display (<10%=13, 40-80%=1); SOPs (<10%=13,10-40%=1); Job description with focus on adolescent (<10%=12, 10-40%=2), Accessibility (>80%=14); Signage (<10%=3, 10-40%=2, 40-80%=2, >80%=7), Confidentiality procedures (<10%=2, 40-80%=2, >80%=10). The findings revealed that the overall quality of health care provided at AFHCs was still lower than the WHO quality standards. Criteria that were met in most AFHCs included, signage, confidentiality procedures and accessibility. However, considerable efforts are needed in the remaining criteria to improve the quality of care provided to adolescent health. This can contribute to enhancement in AFHCs utilisation and thereby improving adolescents' health outcomes. Improved health of adolescents will catalyse the achievement of Sustainable Development Goals (SDGs) indicators that are associated with nutrition, reproductive health, sexual and intimate partner violence, child marriage, education, and employment.