Beruflich Dokumente
Kultur Dokumente
September 9, 2010
TABLE OF CONTENTS
I. Introduction
1.1. Background Information
1.2. Rationale
1.3. Intended Users of the Manual
1.4. Health Outcomes to be Achieved
1.5. Service Package
1.6. Health Service Delivery Points
1.7. Service Providers
References
Annexure
I. Introduction
Adolescents (10- 19 years age group) constitute 22.3% of the population and young people 10 – 24 years of age
account for 30.3% of the country’s total population (NDHS, 2008). The youth (15 – 24 years), on the other hand,
comprise 20% of the population with an annual growth rate of 2.1 (YAFS 3, 2002). They face many health and
development problems (substance use and alcohol consumption, STI/HIV/AIDS, unwanted pregnancies, nutritional
deficiencies, etc) which today affect their lives adversely.
A little less than half (47%) of young people have tried smoking with males being more prone to cigarette smoking
than females. However, the prevalence of smoking among young females almost doubled from 17% to 30% in 1994
and 2002 respectively. The proportion of young people who tried drinking alcohol is about 93% in males. Like
smoking, the proportion showed an increasing trend among the female populace (54% in 1994 and 70% in 2002).
Although the proportion of young people exposed to drugs is significantly lower compared to smoking and alcohol,
the proportion doubled from 6% in 1994 to 11% in 2002. Those who smoke, drink and use drugs are more likely to
have sex.
The YAFS 3 (2002) data showed that one in three of young people think that it is alright for young men to engage in
premarital sex while the approval rate for young women is lower at 22%. A comparison of the results of YAFS 2 and 3
showed an increasing tolerance for women engaging in pre martial sex – 13% and 22% in 1994 and 2002 respectively.
With regards the age of first sexual intercourse, the 2008 NDHS showed that among women 15 – 49 years old, 3%
had their first sexual intercourse by age 15; 37% by age 19; 57%by age 22 and 71% by age 25. In addition, 10% of
15-19 years old have begun childbearing (NDHS, 2008). Around 23% of Filipino youth had premarital sex (2002).
This is higher than the 18% in 1994. One out of three youths admitted to having more than one sexual partner beside
their first sexual partner.
STI and HIV are issues of concern in the country. The YAFS 3 (2002) survey showed that although awareness about
STIs is increasing, misconceptions about AIDS appear to have the same trend. The survey also showed that Filipino
males and females are at-risk of STIs, HIV/AIDS. 62 % of sexually transmitted infections affect the adolescents
(YAFS 3, 2002) while 29 % of HIV positive Filipino cases are young people. Awareness of AIDS for both sexes was
near universal (85%) but misconceptions on its curability have deteriorated. The proportion of those who think AIDS
is curable more than doubled (from 12% in 1994 to 28% in 2002). Many adolescents also resort to services of
unqualified traditional healers, obtain antibiotics from pharmacies or drug hawkers or resort to advices from friends
(e.g. drinking detergent dissolved in water) without proper diagnosis to address problems of STIs. The newly reported
HIV cases among 15-24 years old increased sharply from 41 to 218 in 2007 to 2009 (National AIDS Registry, NEC,
DOH).
1.2. Rationale
In line with the above concerns of the adolescents, several initiatives were undertaken. In line with the Adolescent and
Youth Health Policy (Department of Health, Administrative Order No. 34-A, s. 2000), A Guidebook on Adolescent
and Youth Health and Development Programme was developed by a multi-sectoral body headed by the Department of
Health and supported by the United Nations Population Fund (UNFPA). However, during its implementation (from
2002 to the present), a huge gap developed between the guidelines and their actual use. Adolescents and the youth
have limited access to RH services that meet the standards of quality care, user friendly and culture sensitive. Despite
the evidence presented in policy documents, most services continue to target adults or children. Thus, these fail to
meet the special needs of the youth especially in terms of confidentiality, privacy, accessibility and cost. There is only
a handful of health care providers trained to cater to the special needs of the youth. There are also missed
opportunities for prevention of health problems because young people are unwilling to utilize available health
services. Often, due to insufficient knowledge transfer, new or updated practice guides were not systematically
introduced and promoted to improve health service delivery or to advocate for the application of models of best
practices. In addition, since most programs were initiated by non-governmental agencies and the private sector, they
were limited in coverage and sustainability. Correspondingly, in reference to the Adolescent and Youth Health
Program Implementation Review held in January 2009, the recommendation was to establish standards on
adolescent-friendly health services.
This document outlines the four national standards for provision of Adolescent-Friendly Health services and the steps
required to implement the standards. It is expected that this document will guide program implementers at various
levels in providing adolescent-friendly health services. The document is also expected to be used by planners and
policy makers.
1. Healthy Development
a. Promote healthy development
b. Reduce the health and social consequences when developmental problems occur.
2. Healthy Nutrition
a. Improve healthy nutrition
b. Reduce under/over nutrition
c. Reduce the health and social consequences of over/under nutrition.
3. Sexual and Reproductive Health
a. Reduce too early, unwanted pregnancy
b. Reduce morality and morbidity during pregnancy, child birth,
c. Reduce Sexually Transmitted Infections/Human Immunodeficiency Virus (STI/HIV)
d. Reduce health and social consequences of STI / HIV infection when they occur
4. Substance use
a. Reduce substance use
b. Reduce the health and social consequences of substance use
5. Injuries
a. Reduce injuries
b. Reduce health consequences (mortality and morbidity) and psychosocial consequences when
injuries occur.
6. Violence (All Forms)
a. Reduce all forms of violence
b. Reduce health consequences (mortality and morbidity) and psychosocial consequences when
violence occurs.
7. Mental Health
a. Improve mental health and well being
b. Reduce mental health problems
c. Reduce the health and social consequences when mental health problems occur.
Based on the national objectives and strategic thrusts of the Department of Health, Philippines, the following
Adolescent Core Package has been proposed for implementation:
The core package will be made available from Rural Health Unit (RHU. However, the district, provincial and tertiary
level hospitals will provide services in other areas including substance use, sexual abuse and sexual violence and
mental health. They will also cater to clients and patients referred from RHU and BHS.
1.6. Health Service Delivery Points
The services will be given at the following health service delivery points: Retained hospitals / provincial / district
hospitals, Rural Health Unit. Innovative mechanism for utilization of other facilities, including but not limited to
social hygiene clinic, schools, “one-stop-shops”, workplace, shopping malls, sports centers, youth hang-outs, will be
utilized by the government in coordination with non-government and other private institutions.
The following health providers, both at the health and non-health sectors at the above-mentioned health service
delivery points which include doctors, nurses, and midwives (DOH AO 34-A) will provide the services. Community-
based volunteers, peer group leaders, psychologists and counselors and other staff (e.g. pharmacists and others) will
also provide appropriate services depending upon the circumstances.
The right to health, according to the UN Committee on Economic, Social and Cultural Rights, consists of six
normative elements namely health availability, health physical accessibility, health economic accessibility, health
information accessibility, health acceptability and health quality (see Annex 3: Guiding Principles). WHO’s criteria
for adolescent-friendly health services include services being equitable, affordable, acceptable, adequate,
comprehensive, effective, and efficient (See Appendix 4: Standard and Criteria Definitions).
Cognizant of the right of the adolescent to the highest attainable standard of health through improved access and
utilization of health services and the WHO criteria for provision of Adolescent Friendly Health services, the
Philippines adopts four national standards for the provision of Adolescent-Friendly Health Services:
A standard is a statement of desired quality. The four quality standards for provision of Adolescent-Friendly Health
Services (AFHS) were developed to ensure that adolescents will be able to enjoy a variety of facilities, goods,
services and conditions necessary to realize the highest attainable standard of health. These standards are in line with
the WHO's criteria for Adolescent-Friendly Health Services and with the policy documents that exist in the country.
These standards will also apply to health services that address the needs of youth.
Standard 1 "Adolescents in the catchment area of the facility are aware about the health services it provides and find
the health facility easy to reach and obtain services from it".
Standard 2 “The services provided by health facilities to adolescents are in line with the accepted package of health
services and are provided on site or through referral linkages by well-trained staff effectively”.
Standard 3 “The health services are provided in ways that respect the rights of adolescents and their privacy and
confidentiality. Adolescents find surroundings and procedures of the health facility appealing and acceptable”.
Standard 4. “An enabling environment exists in the community for adolescents to seek and utilize the health services
that they need and for the health care providers to provide the needed services”.
The standards criteria were developed keeping in view the necessary resources, operational activities and the expected
outcomes. The National standards will ensure that services being provided to the adolescents are uniform across all
the service delivery points and are relevant to the present day needs of the adolescents. It is expected that adhering to
the laid down standards would improve the utilization of such services.
III. Criteria of the Quality Standards of Adolescent-Friendly Health Services (AFHS) and
Implementation Guide
Standard 1: "Adolescents in the catchment area of the facility are aware about the health services it provides and
find the health facility easy to reach and obtain services from it."
Rationale: Adolescents are generally not aware about the availability of health services that cater to their needs. They
either do not know about the location of the facility that provides health services in an adolescent friendly manner or
the type of services that are available from the facility. Thus despite the availability of these services and competent
personnel to provide such services, there is a low utilization rate of such services. Some of the reasons for low
utilization could be the lack of informational activities to promote the adolescent services provided by these facilities;
accessibility of the facility in terms of distance, cost and time; or the affordability of services. Actions are to be taken
to ensure that adolescents are well-informed about the availability of health services.
Implementation Guide:
1.1. Elements of a plan to inform adolescents. The IEC plan should contain the activities for information
dissemination, place and time frame that they will be conducted, persons responsible, the resources needed, as
well as the evaluation indicators and methods. In terms of activities, the facility may conduct periodic community
sessions, information dissemination activities in schools especially during home room period, produce and post
billboards in community areas being frequented by community residents especially the adolescents, and seminars
in schools during special occasions. Posters containing the services in the facility may also be posted in strategic
locations in the community. The information material, such as flyers, which can be distributed to adolescents
during community festivities, after school hours, and in malls where adolescents usually go to, should contain
the services available, time and place where these are available as well as the contact persons. Linkages with
ongoing programmes of various departments can be established and, if available, "peer group workers" and
volunteers of various health programmes should be informed about the services.
1.2. Appropriate signboard. The facility is to have an appropriate signage in the health facility reflecting the
services being provided and when they are provided. Tarpaulin, banners or posters stating that adolescents are
welcome in the facility are posted/placed in an area in the facility that can easily be read by the adolescent
clients.
1.3. Use of a flexible time schedule. It is advisable to have facility timings that suit the needs of the adolescents. In
government-owned and operated facilities, services are offered on the usual schedule which is 8:00 AM to 5:00
PM. However, some private and non-government facilities should have flexible time schedule so that they can
cater to the needs of adolescents who may be engaged in other activities during the 8:00 AM to 5:00 PM
schedule. The services could be offered from 7:00 AM to 10:00 PM, on a 24-hour basis, Saturdays and Sundays
in these facilities.
1.4. Provision of 'free' health services. Government facilities offer health services to adolescents without any
charges. As much as possible, services for adolescents should be given for free from other facilities, too.
However, considering the expenses incurred for the maintenance and improvement of the facility vis-a-vis the
budget given for the operation of these facilities, LGUs may resort to cost-sharing schemes. The amount to be
paid should be by consensus and reached through consultations with different stakeholders including the clients,
services providers, representatives from agencies concerned with adolescent care, community and even the
government through the barangays. The cost of services and/or commodities will be posted in strategic places to
inform the clients, general population and all stakeholders.
Private and non-government organizations may also institute schemes to sustain the operations of their facilities.
Some of their services can be availed by adolescent clients at affordable prices or in a subsidized form.
1.5. Elements of a plan to provide outreach services to adolescents. Outreach services are needed to provide
services to follow-up outcome of cases and / or defaulters, adolescents as the "first contact" services in hard to
reach areas and / or clients with special needs, cater to special circumstances (i.e. victim of abuse/violence, etc).
These outreach activities should be planned. The plan should include the date and time, place, the personnel to
conduct outreach, the services to be given, resources needed, other agencies involved (if any) and the assistance
that these agencies/organizations will provide. The outreach provider must have the necessary supplies.
Outreach activities may include periodic health check-ups, mobile clinics, community health camps, education
sessions utilizing the available IEC material, home visitation, and use of traditional media such as puppet shows
and psychodrama. The provider should develop and maintain linkages with peer educators, volunteers, school
teachers, school physicians and school nurses (where available), personnel from youth centres and other relevant
agencies and develop joint activities to provide services. The provider should link up with schools to organize
"question box" activities in the schools. The general questions could be taken up during the school health
assembly.
Standard 2: “The services provided by health facilities to adolescents are in line with the accepted package of health
services and are provided on site or through referral linkages by well-trained staff effectively”.
Rationale: Some of the health needs of adolescents may appear to be similar to those of adults (Example: ANC
services, services for STIs, etc) yet the unique characteristics of this age group in terms of their physical,
physiological, psycho-emotional, and even socio-cultural aspects necessitates that the needed services be provided in
line with the required package effectively. In many cases the services that meet the adolescents' needs are either not
fully provided from the health facilities or the services that are provided are not effective. This standard ensures that
protocols, guidelines as well as services as per the accepted package that cater to the special needs of individuals in
this age group are available from the designated health facilities.
This standard also ensures that the staff of adolescent-friendly health facilities possesses the necessary knowledge,
attitude, skills and behavior to deal with their target clients
I2.8. -Appropriate forms for referral and P2.8. -The appropriate forms are utilized for
feedback are available referral and feedback
Implementation Guide:
2.1. The package of health services to be provided. The list of essential health services to be provided to the
adolescents as packages include basic essential health package, adolescent pregnancy package and STI/HIV
package. The components of the package may be modified in the future as evidence for specific components are
updated periodically by the Department of Health.
Essential Resources
Basic Essential Health Package
Writing materials, Individual Treatment Record Forms (ITR),
Dental mirror, Dental record form, Dental Equipment
Psychosocial Risk Assessment Form
BP apparatus, Adult weighing scale, tape measure, height chart, orchidometer, dietary prescription form,
exchange list
Iron with folic acid tablets
Vaccines: Tetanus toxoid, MMR, Hepatitis B
Centrifuge, heparinized capilet, microscope, syringes and needles, cotton, alcohol, slides, cover slip, vaginal
speculum, cotton pledget
ITR, Reproductive Health Assessment Checklist, Flipchart on reproductive health
HIV testing kit, microscope, glass slides, reagents for Gram’s stain
Adolescent Pregnancy Package
ITR, FP flipchart, iron tablets, blood typing and Rh sera, pregnancy test, centrifuge, microscope, TT vaccine,
syringes, cotton balls, alcohol, FP commodities
HBsAg reagent, birth plan form, NBS kit, BCG, Hepatitis B vaccine, delivery table, sterile scissors, gloves,
cotton, alcohol, plastic clamp, equipment and supplies as per BEmONC guidelines
Iron tablets and vitamin A capsules, FP flipchart, FP commodities, Breastfeeding chart, diet plan
Sexually Transmitted Infections/HIV Packages
ITR
Reagents for Gram’s stain, RPR, Glass slides, microscope, cotton pledgets
Counseling Cards or Chart
2.3 Focal person in the health facility. The facility must have a designated focal person who will render services
to adolescent clients and coordinate within and outside the facility. She / He should be oriented by attending
orientation /training programs on dealing with adolescent clients such as the Orientation Program on Adolescent
Health and Adolescent Job Aid (AJA). The focal person must provide the services to adolescents either at the
facility or through appropriate referral and coordinate with parents, opinion makers and institutions – educational,
NGOs, community-based organizations, media and with referral institutions.
2.4 Capability building for AFHS service providers. It would be preferred that like the focal person in the
facility, other service providers who are likely to deal with adolescents must have the competencies to deal with
adolescents and their health needs effectively. They should attend capability building programs so that they can
deal effectively with their adolescent clients. Programs include Orientation Program on Adolescent Health,
Orientation on Standards and Implementation Guide for AFHS, Adolescent Job Aid.
2.5 Dealing in a non-judgmental and caring manner with adolescents. The adolescent client should be dealt
with respect and shown all courtesies that are due to a human being. Facility staff should be polite and considerate
and avoid making any hurtful or damaging remarks for what so ever reason. Service providers must cultivate a
non-judgmental attitude and not deprive adolescents from appropriate services on extraneous grounds including
those on gender, education, social class, marital status, religious and political beliefs, and orientation. They should
deal with adolescents sensitively and in a caring and considerate and gender and culturally-sensitive manner.
Clinic Rooms must have window curtains and a bed-screen surrounding the examination tables. Nobody else
should be allowed to enter the room when the client is already there, in order to ensure privacy. Confidentiality
policy of the clinic should be displayed and clearly expressed to the client and the individuals accompanying them
in the first session itself.
2.6 Clinical management of adolescents. The Adolescent Job Aid (AJA) that was developed by a multi-sectoral
group spearheaded by the DOH will be used for the common conditions of adolescents. The service provider
should also refer to other relevant clinical guidelines (STI, management of specific conditions, general guidelines)
that are periodically issued / circulated by DOH.
2.7 Resource directory of individuals/organizations and referral networks. All facilities must develop a
resource directory that should contain contact details of the relevant institutions and individuals. The resource
directory should include the names of the organization/individual, address, contact person as well as contact
details including the telephone numbers, email address or websites
2.8 Referral form. A referral form which contains the name of the referring facility and service provider, client’s
details (name, age, address), history of present condition, physical/laboratory findings if appropriate, name and
address of the facility where the client is to be referred, and reason for referral must be in place. A return referral
form should be present and the client be instructed to bring this back to the referring facility. The referral form
should be sealed in envelope and addressed to the service provider of the facility to which the client is being
referred to. All referrals made and their outcome should be listed in a referral logbook that should be maintained at
the facility.
REFERRAL FORM
(To be left in the Referral Facility)
Reference number ----
Name of Referring Facility:
Address: Tel No:
Name/Position of Service Provider Referring: Date of Referral:
Address:
Brief History (Include pertinent PE and laboratory findings and actions taken, if any.)
Clinical Impression:
Signature of Person Referring Signature Over Printed Name
of Client/Guardian:
Final Diagnosis:
Actions Taken (Include results of laboratory/ancillary procedures done and management)
Follow up advice:
Standard 3 “The health services are provided in ways that respect the rights of adolescents and their privacy and
confidentiality. Adolescents find surroundings and procedures of the health facility appealing and acceptable”.
Rationale: Adolescents will not seek services if the physical environment and procedures are not appealing to them.
While ensuring the adolescents’ comfort and ease at the facility, it is crucial that the privacy and confidentiality of
adolescents should be preserved and maintained throughout. Aside from the quality of services and attitude of
personnel, the condition and features of the facility will also help contribute to client satisfaction and quality of care.
It is important to get feedback, suggestions and recommendations from adolescents to be able to design facilities,
procedures and protocols that will appeal to adolescents as well as suit their needs and taste.
I3.4. -Health facility procedures to ensure P3.4. -Health facility staffs apply the procedures to
privacy for the adolescent clients and their ensure privacy for their adolescent clients and their
parents are in place. parents. (including private room for consultation,
simplified registration process)
I3.5. -Protocols for the staff to provide P3.5. -Service providers follow the protocols to provide
services in a friendly and appropriate services to adolescents in a friendly and appropriate
manner are in place manner.
I3.6. -Mechanisms to involve adolescents P3.6. -Adolescents are kept involved in designing,
in the designing, assessing and provision of provision and assessment of health services
health services are in place
I3.7. -Flow design of utilization of services P3.7. -The designed flow to keep the waiting time short Services to
to keep the waiting time short and is followed. The waiting time is filled in by holding adolescents
informative is in place. informative sessions are ideally
provided
within 30
minutes of
their arrival in
the facility.
Implementation Guide:
For a stand alone clinic: The clinic within the facility should be located preferably in a separate room that
provides the needed privacy so that the adolescents are comfortable in accessing services from it
This set-up will ensure that the facility is appealing to adolescents. This will also make the adolescents feel
comfortable while availing services in the facility.
3.2 Confidentiality and privacy policy. The confidentiality and privacy should include provisions stating the
mechanisms for registration, the filing and storage of records (records keeping), access to these records
(specifying the personnel who can access to these records as well as protocols to follow if people outside of
the health facility would want to access records and information), general guidelines on non-disclosing
information regarding the patient, designated spaces for provider – client interaction to provide audio-visual
privacy, provision of barriers such as curtains, separate rooms, etc.
3.3. Ensuring confidentiality. Clients and their accompanying adults should be informed about the measures to
maintain confidentiality. Each client should have an envelop or folder where their Medical records (ITRs),
results of laboratory examinations or other special procedures done, referrals and other pertinent documents
are filed. These are filed depending on a prescribed system (by numbers, family name, barangays, etc). As
much as possible, there should be a designated room with lock and key where these records should be filed. If
this is not possible, these records should be kept in a filing cabinet with lock and key. There will be designated
personnel with access to these records. They will only be pulled out only if a client – provider interaction will
occur or in any situation as may be necessary. Personnel working outside the facility should have a written
request if they want to access to the clients’ records for purposes of research, follow up, etc. A verbal/written
consent of the client should be obtained before information contained in their records will be disclosed to
outside parties. The staff should not discuss the client’s
situation with non-concerned parties.
3.4. Ensuring privacy. Audio and visual privacy of the client must be maintained. As mush as possible, there
should be a separate room where provider – client interaction should take place and where examinations such
as pap smear, physical examination, etc should be done. If it is not possible to provide a separate room,
barriers such as curtains should be provided. The provider should only attend to one client at a time not unless
the clients request that they be counseled together with other clients with similar problems or with
friends/families/significant others. Specifically, the following must be observed:
Ensure that the consultation and examination are done in a place where the interaction between the health
worker and the adolescent cannot be heard or seen by anyone else;
Ensure that no interruption occurs when a consultation or examination is in progress (like phone/text calls,
signing papers, etc)
Ensure that no needless delays occur;
Ensure that the adolescent is clear about what to do (e.g. by labeling the different rooms such as pharmacy,
and providing clear instructions as to where to go, have a lab test and when to come back for the results).
Examples: Privacy and Confidentiality
# 1 - “We will be spending some time to talk about Maria’s history, especially her immunization, past illnesses and your
concerns about her health. After that, I would like to spend some time alone with Maria. After I have examined her, I
will ask you in again and we can discuss my assessment and our plans, any laboratory tests, treatments and follow-up
plans. Is that all right with you?”
# 2 – “First of all, I would like to say that whatever we talk about in this interview will be kept strictly confidential. Do
you understand what is meant by confidential Maria? Or would you want me to explain it further? However, there are
certain situations when we may have to break this confidentiality –usually in the person's own interest. First is, if the
person plans to hurt herself or hurt others, if she has been abused, if she has engaged in a serious crime or any activity
that makes us believe that she could be in danger… in these situations, we will have to break confidentiality. So Mrs. X
please be assured that I will notify you if I need to. Is that all right with you ?”
3.5. Providing service in a friendly and appropriate manner. Service providers should view the adolescent as
the primary patient. They should greet the adolescents and accompanying adult when they enter the clinic.
Their behavior should inspire confidence in the adolescents. They should also offer a seat to the waiting clients
if there are other clients seeking consultation and availing of the services. They must get the initial information
from the client in an area designated for this purpose.
3.6 Adolescent involvement. As much as possible, adolescents should be involved in layout of the room and for
putting up posters and IEC material. The adolescents from the catchment area should be involved in making
decisions about the type of IEC material that should be kept in the facility. Once they are in the facility, they
may be asked about the set-up of the facility, how equipment, materials and furniture can be arranged in such a
way that they will not be hesitant to interact with the health personnel. A suggestion box on the manner by
which services are provided can be placed in area in the facility
3.7. Ensuring a smooth patient flow. A schematic diagram showing the flow of activities from admission to the
different service providers including the approximate time it would take to complete each transaction should
be posted in strategic areas. All efforts to reduce the waiting time to a minimum should be adopted.
Standard 4. “An enabling environment exists in the community for adolescents to seek and utilize the health services
that they need and for the health care providers to provide the needed services”.
Rationale: In many situations, the community members are not aware of the importance of providing health services
to adolescents. At times, there is reluctance, reservations and even opposition to ensuring access to such services. This
deters not only adolescents from availing the services but also the service providers from delivering the needed health
services to adolescents.
This standard encompasses community actions including educational campaigns that are aimed to increase the
awareness of the community to the need and importance of providing health services to adolescent including those
that aim to improve the sexual and reproductive health of adolescents. This standard seeks the assistance of
individuals, agencies and organizations in the community to assist in providing the resources needed to be able to
deliver the services.
Implementation Guide:
4.1 Activities to inform community members about the value of providing adolescents with services. The
community can be engaged in a variety of ways like seeking their views, informing them about the benefits
and availability of services to adolescents and involving them in prioritizing the areas that need to be
addressed. The energies of the community members should be utilized in a variety of ways to create an
enabling environment. Community assemblies can be utilized to explain to the members of the community the
benefits that adolescents can derive from seeking services from the facility. In schools, concerns of adolescents
can be discussed during parent-teacher meetings and the service providers can discuss the services that
adolescents can avail of depending on the issues and concerns that are presented in the meeting. Service
providers may visit schools during health fairs and have a booth that displays their services. In these events, a
health communication material developed by the facility and prepared in the vernacular can also be
distributed. Short meetings should be organized with women's groups, self-help groups and other relevant
sections and discussion about adolescent vulnerabilities and availability of services should be discussed.
Advantage should be taken of fairs and other festivals where adolescents are expected to gather in large
numbers.
Folk media and mass media (TV, Radio, newspapers, magazines and web-based) should be effectively
engaged in generating awareness about issues that impact the health of adolescents as well as for improving
awareness regarding the availability of adolescent friendly health services.
4.2 Communicating with other ADULTS visiting the facility about the value of providing adolescents with
services. All adults visiting the facility should be informed of the current status of adolescent health in the
community. IEC materials (comics, leaflets) with the adults/parents as target audience can be given so that
they will be informed of the value of availing of the services of the facility whenever their adolescent sons and
daughters are in need of these services. Sessions with adults can also be done in the health center/facility using
a flipchart. Concerns of these adults/parents can also be addressed in the open forum/question and answer part
right after the education session.
Community members and organizations may also be involved in other activities such as sportsfest, clean and
green campaigns, and tree planting. The elected officials of the community may also pass ordinances banning
smoking and alcohol use among minors. In this way, adolescents can be productive and responsible members
of the community. In the event that there are adolescents that need to be rehabilitated, elected officials may
also be involved in community-based rehabilitation programs.
4.4 Advocating for support in the local development plan. A Task Force on adolescent health can be
created/established. Members of the task force would be representatives from planning, budget, health, NGOs,
social services, among others. Other approaches should also be explored. The facility manager or focal person
may present the services being provided during meetings of the local health board. In this way, the
representative of the local health unit, together with the elected officials in the community will be enlightened
on the importance of providing services to adolescents. Meetings of the school board are also another venue
for generating support to the provision of health services to adolescents. Local government units (LGUs) may
develop resolution and pass ordinances in support of adolescent health activities and programs.
This part of the document describes interventions organized in packages. The packages of interventions are described
for each level of facility and the essential commodities are identified to assure adequacy and quality of care
Package of Service Basic Interventions at the Primary Key Supplies and Commodities Needed
Level (RHU, Lying–in Clinics)
General Health Writing materials, Individual Treatment
Essential Health Package Assessment – History and Record Forms (ITR),
Physical Exam Dental mirror, Dental record form, Dental
Dental Assessment Equipment
Psychosocial Risk Psychosocial Risk Assessment Form
Assessment and BP apparatus, Adult weighing scale, tape
Management measure, height chart, orchidometer, dietary
Nutrition Assessment and prescription form, exchange list
Counselling Iron with folic acid tablets
Micronutrient Vaccines: Tetanus toxoid, MMR, Hepatitis B
Supplementation Centrifuge, heparinized capilet, microscope,
Immunization syringes and needles, cotton, alcohol, slides,
Basic Diagnostic Tests cover slip, vaginal speculum, cotton pledget
Reproductive Health ITR, Reproductive Health Assessment
Assessment and Checklist, Flipchart on reproductive health
Counselling
Adolescent Pregnancy Prenatal Services ITR, FP flipchart, iron tablets, blood typing
Package Natal Services and Rh sera, pregnancy test, centrifuge,
Post Natal Visits microscope, TT vaccine, syringes, cotton
balls, alcohol, FP commodities
HBsAg reagent, birth plan form, NBS kit,
BCG, Hepatitis B vaccine, delivery table,
sterile scissors, gloves, cotton, alcohol, plastic
clamp, equipment and supplies as per
BEmONC guidelines
Iron tablets and vitamin A capsules, FP
flipchart, FP commodities, Breastfeeding
chart, diet plan
Package of Service Interventions at the Referral Key Supplies and Commodities Needed
Facilities (District Hospitals,
Provincial, Tertiary Facilities)
Sexually Transmitted History and Assessment ITR
Infections/HIV Packages
Package of Service Interventions at the Referral Key Supplies and Commodities Needed
Facilities (District Hospitals,
Provincial, Tertiary Facilities)
Sexually Transmitted Diagnostics ITR
Infections/HIV Packages Reagents for Gram’s stain, RPR, Glass slides,
microscope, cotton pledgets
Basic Essential Health Voluntary Testing for Reagents for Gram’s stain, RPR, Glass slides,
Package HIV/STIs microscope, cotton pledgets
Counselling Cards or Chart
Sexually Transmitted Management, Treatment
Infections/HIV Packages and Counseling
Different sectors and facilities are involved in the provision of adolescent-friendly health services. Roles are outlined
so that respective sectors and facilities are informed of what they should do in catering to the needs of adolescents.
Professional Organizations
Orient the members of the organization on the standards and implementation guide
Disseminate the guidelines and other directives to its members that may be circulated by the Department of
Health periodically
Act as technical resource group on adolescent health
Participate in the conduct of orientation programs related to adolescent health
Academic Institutions
Promote adolescent-friendly institutions
Act as technical resource persons on adolescent health
Develop adolescent-oriented programs and activities
Orient the teachers and other personnel of the standards and implementation guide
Refer adolescents to facilities that provide services to adolescents
Conduct orientation programs to adolescents regarding the services which they can avail from adolescent
friendly health facilities
The AFHS quality standards will be monitored and evaluated in two ways:
1. Continuous monitoring of the AFHS package implementation
2. Periodic evaluation on compliance with the AFHS quality standards
The implementation of quality standards of AFHS will be monitored by the authorities. The initial activity will be
spearheaded by the National Technical Working Group (TWG) and will be done six (6) months after the
implementation of the standards and implementation guide. A bi-annual monitoring will be conducted by the regional
technical working group among the facilities under its jurisdiction.
The evaluation on the compliance with the AFHS quality standards will be carried out in line with Department of
Health (DOH) guidelines. Tools contained in this document may be utilized by various organizations and facilities in
the monitoring and evaluation activities.
Standard 1. Adolescents in the catchment area of the facility are aware about the health services it provides and find the health
facility easy to reach and to obtain services from it.
Standard 2 “The services provided by health facilities to adolescents are in line with the accepted package of health services and
are provided on site or through referral linkages by well-trained staff effectively”.
Standard 3“The health services are provided in ways that respect the rights of adolescents and their privacy and confidentiality.
Adolescents find surroundings and procedures of the health facility appealing and acceptable”.
Item Self Assessment Assessment Team Recommendations
Facility
Patient flow from admission to delivery of services including
the average time for each step is posted in strategic places.
A policy to ensure confidentiality is posted.
Policies to ensure privacy is posted
Individual records are kept in separate envelopes.
All records are kept in a safe place, preferably in a separate
room or a filing cabinet with lock and key.
There is a designated person with access to the records.
There are designated admission and waiting areas.
There are separate rooms for consultation, treatment and
counseling. If there are limited rooms, there are at least
curtains to separate each provider.
There is a suggestion box.
Conversation between provider and client cannot be heard by
others.
There are peer educators assisting in clinic operations and
providing services (lectures, counseling, etc)
Materials being used by the adolescents in the facility
Documents
SOP for maintenance of facility
Policies and procedures to ensure confidentiality
Policies and procedures to ensure privacy
Protocol and procedures for patient – provider interaction
Minutes of meetings of TWG
Standard 4. “An enabling environment exists in the community for adolescents to seek and utilize the health services that they need
and for the health care providers to provide the needed services”.
Name of Facility:
Type of Facility:
Date of Assessment (dd/mm/yyyy)
Please List the Staff Members and check the Training specific for Adolescents they have received:
Name of Provider:
Designation:
Service Delivery
1. When and what time is the facility open (Days and time)?
2. Is the facility open after office hours and weekends? If not, what mechanisms were put in place to ensure that the
adolescents get the services after office hours and during weekends?
3. What agencies provide these services?
4. How do you get information from these facilities regarding the clients that they serve/provide services to?
5. What services are available in your facility? In other public health facilities (laboratories, social hygiene clinics,
etc)
6. What do you do when the services needed are not available in the facility?
7. How do you keep track of the outcome of these referrals?
8. Do you provide adolescents with appropriate information about treatments, procedures, contraceptive methods, as
well as counseling to make decisions?
9. Describe the flow of patients from admission to the time they leave the facility.
10. What mechanisms are in place to ensure:
a. Confidentiality
b. Privacy
11. Do you explain that services are confidential?
Financing
1. How much budget is given to the Adolescent Friendly Health Services?
2. What are the sources of budget to maintain operations of the facility?
3. Are the services given for free? If payment is made:
a. How much?
b. How did you come up with the amount?
c. How are the funds handled (liquidation, disbursement, accountability)
4. Are there financing schemes available? If yes, what are they?
Regulations
1. What are the national and local policies/laws/ statutes enacted in support of Adolescent Friendly Health Care and
Facilities?
2. What policies and procedures have been formulated by the facility to govern operations and service delivery?
Governance
1. Is monitoring and supervision conducted? If yes,
a. How often?
b. By Whom?
c. What are the results?
d. How long will it take to implement the recommendations made?
If no, Why do you think so?
2. Are you trained on Adolescent Reproductive Health? If yes, what training course did you attend? If no. Why?
A Practical Guide on Adolescent Health Care, Department of Health and UNFPA, _________
Adolescent Friendly Health Services: An Agenda for Change. Geneva. WHO, October 2002
Adolescent Friendly Reproductive Health Services Network Operations Manual. Philippines. Save the Children.
_________.
Department of Health. Guide Book on Adolescent and Youth Health and Development Program. DOH, Philippines.
2002.
Department of Health. Manual of Standards for Adolescent Friendly Health Services. DOH, Philippines. 2008.
Dickson, K., Ashton, J, and Smith, J. Do setting adolescent-friendly standards improve quality of care in clinics?
Evidence from South Africa. International Journal for Quality in Health Care. Oxford University Press. 1-10. 2007.
Implementation Guide on RCH II: Adolescent Reproductive Sexual Health Strategy: India. May 2006.
Marquez, L. 2001. Helping Healthcare Providers Perform According to Standards. QA Operations Research Issue
Paper 2 (3): 3-30.
National Consultation on RCH II ARSH Strategy: A Report. New Delhi. September 2005
National Standards for Provision of Youth Friendly Health Services in Bhutan (Draft National Standards and
Implementation Guide. May 2008.
National Standards and Implementation Guide for Youth Friendly Health Services: Bhutan. May 2008
National AIDS Registry, Department of Health National Epidemiology Center (Data from January to October 2009).
Package of Interventions for Family Planning, Safe Abortion Care, Maternal, Newborn and Child Care, WHO, 2010.
Quality Standards of Youth Friendly Health Services in the Republic of Moldova. Moldova. 2009
Workshop Output. Workshop on the Development of Standards of Adolescent Friendly-Health Services, Tagaytay
City. August 2009
Youth Friendly Health Services (YFHS) standards, criteria, actions to achieve criteria, means of verification.
Bangladesh. April 2005.
International Issuances
1. Republic Act 7610: Special Protection of Children Against Child Abuse, Exploitation and
Discrimination Act
7. R.A. 9262: Anti-Violence Against Women and their Children Act of 2004
A Strategic Planning Workshop for Accelerating Action for Adolescent and Youth Health was conducted from
September 23-26, 2008 in Pranjetto Hills Hotel in Tanay, Rizal. Gaps and critical activities for Adolescent and Youth
Health were identified. In the same year (2008), the Framework for the Adolescent Health Strategic Plan was started
and finished in 2009.
A Workshop on the Development of National Standards for Adolescent-Friendly Health Services was organized by the
Department of Health, Philippines with the support of the WHO Regional Office for the Western Pacific in Tagaytay
City from 4 to 7 August 2009. The intended beneficiaries of this workshop are all adolescents (10-19) in the
Philippines. This workshop was organized to build wide consensus and to develop a set of standards to ensure the
provision of good quality adolescent health services at the different levels of care, to respond appropriately to
adolescent health needs.
To build wide ownership and shared understanding, the workshop brought together a range of stakeholders from the
government (from national, regional, provincial and city/municipal levels), local non-governmental organizations
(NGOs) working with adolescents, international NGOs and United Nations agencies (United Nations Children's Fund
[UNICEF], UNFPA and WHO) and participants from Cambodia. Fifty-five participants attended the opening session
of the workshop.
The workshop utilized a mix of methods including interactive sessions, small group discussions, brainstorming, VIPP,
and plenary presentations. The participants discussed and finalized the health outcomes to be achieved, the package of
services to help achieve the agreed upon health outcomes, service delivery points from where the services should be
provided and the service providers who will provide the said services to adolescents. Four "standards" were
developed by this consultative process.
All efforts to establish facilities and services that are friendly to adolescents are in line with the right of the adolescent
to the highest attainable standard of health. The UN Committee on Economic, Social and Cultural Rights has said that
the right to health consists of six normative elements:
1. Health availability refers to the availability of a sufficient number of functioning public health and health care
facilities, goods, services, programs and underlying determinants of health.
2. Health physical accessibility means that all health facilities, centers, programs and goods must be within safe
physical reach for all, and includes timely access to health services. Physical access also requires the construction
of access paths to buildings and other public places for persons with disabilities.
3. Health economic accessibility means that the costs of availing health services, goods, and facilities and the
underlying determinants of health must be based on the principle of equity and must be affordable for all.
4. Health information accessibility refers to the right to seek, receive and impart information and ideas regarding
health issues and concerns. Health information accessibility, however, does not in any way impair the individual’s
right to privacy and confidentiality of personal health data. The Committee on the Rights of the Child urges the
active involvement of adolescents in the design and dissemination of health information through a variety of
channels beyond the school, including youth organizations, religious, community and other groups and media.
5. Health acceptability means that health services, goods and facilities and underlying determinants of health must
respect medical ethics, be culturally appropriate, be sensitive to gender and life-cycle requirements, respect
confidentiality of personal health data, and must be designed to improve everyone’s health status.
6. Health quality means that all health goods, services, facilities and underlying determinants of health must be
scientifically and medically sound and of good quality.
A standard is a statement of desired quality. In some countries, standards for ensuring the performance of health
facilities for adolescents have been developed. These standards strengthen program implementation as well as
monitoring, supervision and evaluation by setting clear performance goals, defining the quality required for a service
and providing a clear basis against which performance can be monitored, assessed and / or compared.
The key “friendly” characteristics of services for adolescent are viewed from the perspectives of the users, providers
and health system.