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Department of Health

Republic of the Philippines

National Standards and Implementation Guide


for the Provision of
Adolescent-Friendly Health Services

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

II. Standards for Adolescent-Friendly Health Services


2.1. Standard 1
2.2. Standard 2
2.3. Standard 3
2.4. Standard 4

III. Criteria of the Quality Standards of Adolescent-Friendly Health Services


and Implementation Guide

IV. Implementing Mechanisms at Various Levels

V. Monitoring and Evaluation of the AFHS Quality Standards

References

Annexure

I. Introduction

1.1. Background Information

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.

1.3. Intended Users of the Manual

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.

1.4. Health Outcomes to be Achieved

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.

1.5. Service Package

Based on the national objectives and strategic thrusts of the Department of Health, Philippines, the following
Adolescent Core Package has been proposed for implementation:

CORE PACKAGE OF SERVICES

Key Services Objective of the Package


A. Basic Essential Health Package 1. To provide basic health care and management to all
adolescents
2. To identify the most common health concerns and issues
among adolescents
3. To screen all adolescents for risk-taking behaviors
4. To render preventive health management and counseling to
all adolescents, including on substance use, sexuality,
violence and injury prevention, and for improving mental
health
B. Adolescent Pregnancy Package 1. To reduce rates of adolescent pregnancy through
comprehensive health package
2. To reduce mortality and morbidity brought about by
adolescent pregnancy and puerperium
C. Sexually Transmitted 1. To reduce morbidity and mortality brought about by STIs
Infections/HIV Packages and HIV
2. To prevent STIs/HIV and its complications
Source: Manual of Standards for Adolescent-Friendly Health Services, DOH, 2008

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.

1.7. Service Providers

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.

II. Standards for Adolescent-Friendly Health Services (AFHS)

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:

Philippines National Standards for 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.

Input Criteria Process Criteria Output Criteria


I1.1. - There is a well-defined plan to P1.1.-Activities to inform Adolescents are aware
about the type of services
inform adolescents in the community as adolescents about the availability from the health facility,
to the availability of services from the of services from the facility are their working days and
facility carried out as per the existing hours and know that they
plan. are welcome.
I1.2. - Health facility has a signboard which
indicates
-the type of health services that are provided
-when they are provided
-that adolescents are welcome
I1.3. -Flexible time schedule for adolescent clients, P1.3.- Health services are provided as per
if possible, is in place, the flexible time schedule
I1.4. -Policies and procedures to provide health P1.4. -Service providers provide
services to adolescents free of charge or at adolescent with services free of charge or
affordable prices are in place. at affordable prices in line with the
policies and procedures.
I1.5. -A plan to provide outreach health services to P1.5. -Outreach services are being
adolescents, particularly those belonging to special delivered to special groups of adolescents
groups in the catchment area of the health facility, as per the plan.
is in place

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

Input Criteria Process Criteria Output Criteria


I2.1. -An agreed upon 'package' of services to P2.1. - Services provided / delivered on site or The services
be provided to adolescents is in place. through referrals are based on the agreed upon provided by the
adolescent health package health facilities are
effective and in line
I2.2. -An agreed upon list of essential P2.2. -The essential commodities and supplies as with the accepted
commodities and supplies is in place per the agreed upon list are available and are package of
provided to adolescents. services, and are
provided on site or
I2.3. -A focal person has been designated for P2.3. -The focal person actually provides through referral
provision of adolescent-friendly health services. services to adolescents either at the facility or linkages by well
through referral and coordinates other activities. trained staff. The
I2.4. -Service Providers have been trained / P2.4. -The facility staff utilizes their adolescents find the
oriented for the provision of AFHS and are competencies to provide health services services to be in
competent in managing adolescent clients and effectively and competently. line with the
providing guidance to their parents. defined package of
I2.5 -Protocols / guidelines to provide services P2.5. -The service providers follow the services.
competently in non judgmental, caring, protocols /guidelines to provide services
considerate, and gender and culturally-sensitive competently and with a non-judgmental, caring,
attitude and manner are in place. considerate and gender and culturally sensitive
attitude and manner
I2.6. -Clinical management guidelines for the P2.6. -The service providers follow the clinical
provision of the specified health services are in guidelines for provision of services.
place
I2.7. -A resource directory of organizations and P2.7.-The resource directory is utilized to refer
referral networks providing health services that the needy adolescents for the particular services
are not provided at the facility is available. that are not available at the facility.

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.

Package of Specific Services


Services
Basic Essential
Health Package
General Health Assessment – History (HEADSS) and Physical Examination, including
blood pressure measurement, vision and hearing screening
Dental Assessment
Psychosocial Risk Assessment and Management
Nutrition Assessment and Counseling
Micronutrient Supplementation- Iron and Folic Acid
Immunization – TT, MMR, Hepatitis B
Basic Diagnostic Tests (CBC, Urinalysis, Fecalysis, sputum PPD)
Reproductive Health Assessment and Counseling
 Fertility awareness, menstrual health issues and counseling
 Pap smear and pelvic exam if sexually active
 Adolescent male reproductive health issues
 Gender issues
Voluntary Testing for STIs /HIV
Adolescent
Pregnancy
Package
Prenatal visits
 History and Physical Examination
 Immunization – Tetanus toxoid
 Micronutrient supplementation with iron, folate
 Psychosocial risk assessment
 Laboratory – CBC, blood typing (if not available, refer), pregnancy test, urinalysis
 Pregnancy counseling
 Nutrition counseling
 Birth plan including exclusive breastfeeding counseling
 Family planning counseling
Natal (Birthing Homes)
 Safe delivery by skilled health worker at a mother-and baby friendly health facility
 HBsAg test for pregnant mothers
 Essential Newborn Care Protocol
 Newborn package:, Vitamin K, Hepatitis B – birth dose, BCG, eye prophylaxis,
Newborn Screening
Postnatal Visits
 Micronutrient Iron supplementation
 Counseling services: Family planning, Nutrition counseling, Exclusive Breastfeeding,
Parenting
Sexually
Transmitted
Infections/HIV
Packages
History and Assessment Forms
Diagnostics: Grams Stain, RPR, C/S, Pap smear, HIV Counseling
Psychosocial risk assessment
Management, Treatment and Counseling
2.2. Essential medicines, equipment and supplies. At the minimum, the following basic medicines, equipment
and supplies needed in the provision of services should be present:

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

The national level Resource Directory is being provided.

Resource Directory of Individuals and Organizations

# NAME / COMPANY / ORGANIZATION / CONTACT DETAILS


POSITION COMPLETE ADDRESS
1 Maristela P. Philippine Nurses Association (PNA) DL/ 5361888
Abenojar 1663 F.T. Benitez Street F/ 5251596
Malate, Manila M/ 09273448505
e-mail/ maris_presto@yahoo.com.ph
2 Jill S. Alvarez / FAD, Inc. DL/ 4001827 / 5250428
Program Manager 1066 Remedios Street corner San F/ 4001827
Bartolome Street M/ 09155196598
Malate, Manila 1004 e-mail/ fadthqctrl@pldtdsl.net /
jill.alvarez@gmail.com
3 Elmer M. Angus, Philippine Academy of Physicians in DL/ 5243011 local 4410
M.D. / School Health, Inc. (PAPSHI) F/
Immediate Past M/ 09209540992
President e-mail/ macarthur_52@yahoo.com
4 Pamela Averion / UNFPA DL/ 9010328
National Gender & Culture and ARH F/ 9010348
Programme M/
Officer e-mail/ averion@unfpa.org
5 Marciano Fidel L. Private School Health Officers DL/ 7315127 local 111
Avendaño / Association F/ 7315127 local 119
President c/o Lourdes School Quezon City M/ 09177938846
Don Manuel corner Kanlaon Street, Sta. e-mail/ dr_jun_avendano@yahoo.com
Mesa Heights, QC
6 Edna A. Beguia / IMAP, Inc. DL/ 7244849 / (042) 3311311
PRO Pinaglabanan Street corner Ejercito F/ 7275225 / (042) 5366353
Street, San Juan City M/ 09053440173
Brgy. Kiloloron, Real, Quezon e-mail/ edna_beguia@yahoo.com
8 Deborah B. NAPC Youth & Students DL/ 4265028
Cabanag 3rd Floor ATI Building, Elliptical Road, F/
Quezon City M/ 09182567492
e-mail/ debbie_cabanag@yahoo.com
9 Marlene de Castro Baguio Center for Young Adults, Inc. DL/ (074) 4450623
/ 33 Assumption, Baguio City F/ (074) 4428193 (telefax)
Executive M/ 09189102124
Director e-mail/ mbdc_bcya@yahoo.com.ph
10 Jonathan D. Chua NAPC-YSSSC DL/
F/
M/ 09288571932
e-mail/ jonathanchua_02@yahoo.com
11 Gloria Cirineo AFRHS Network DL/ 8205215
F/
M/
e-mail/ gloriacirineo@yahoo.com
12 Erlyn Della- Society of Adolescent Medicine of the DL/ 4948298
Caparro, M.D. Philippines, Inc. (SAMPI) F/
M/ 09238115729
e-mail/
13 Moses de SAMPI DL/ 9246601 local 272
Guzman / Bahay ng Alumni F/
Adolescent University of the Philippines M/ 09195872444
Medicine Diliman, Quezon City e-mail/ dittsdeguzman@yahoo.com
Specialist
14 Robinson F. National Youth Commission DL/ 7812373
Espinoza / 373 Quezon Ave., Quezon City F/ 7812373
Chief of Policy M/ 09189217915
and Planning e-mail/ robin_espinoza@yahoo.com
Division
15 Denia Gamboa / Council for the Welfare of Children DL/ 7811039 local 1006
Head, Public 10 Apo Street, Sta. Mesa Heights F/ 7811039 local 1006
Affairs and Quezon City M/ 09294208481
Information Office e-mail/ denia_3154@yahoo.com
16 Dexter M. Garcia / TRIDEV Specialists Foundation DL/
Project Officer F/
M/ 0917-8512782
e-mail/ dexgarcia@hotmail.com
17 Dr. Arvin Marbibi AFRHS Network DL/
F/
M/
e-mail/
18 Robert T. Philippine League of Government and DL/
Mendoza / Private Midwives, Inc. F/
President M/ 0908-933-1659, 0908-7110805
(Hospital Based) e-mail/
19 Dr. Rosa Maria H. PGH-Society of Adolescent Medicine of DL/ 9316251 / 9315898
Nancho the Philippines, Inc. (SAMPI) F/ 3733461
M/ 09178294968
e-mail/ rosenan830@yahoo.com
20 Lita Orbillo / NCDPC-DOH DL/ 7329956
Nurse VI F/ 7114846
M/ 09185836580
e-mail/ litaorbillo@yahoo.com
21 Dr. Luz P. Revita Philippine Academy of Physicians in DL/920-1342
School Health, Inc. (PAPSHI) F/ 928-6051
M/ 0922-8309044 or 0918-9309041
e-mail/ lprevita@yahoo.com
22 Ma. Loida Y. Plan International, Philippines DL/ 817-3187
Sevilla / 104 Salustiana Ty Tower F/ 840-3940
Country Health Paseo de Roxas Ave., Makati City M/ 0917-5012145
Advisor e-mail/ malou.sevilla@plan-international.org
23 Cherryl Mendoza Adolescent Wellness Center T/635-6789
Nurse Teen Health Hub By Appointment
The Medical City
Ortigas Avenue, Pasig City
24 Dr. Alicia Tamesis Teen Republic T/924-6601
Philippine Children’s Medical Center Loc 234 and 294
Quezon Avenue, Quezon City

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.

Sample Referral Form

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:

Name of the facility to which the client is being referred :

Name of Client: Age:

Address:

Reason for Referral:

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:

REFERRAL RETURN SLIP


(Please cut and instruct patient/guardian to deliver back to Referring Facility)
Reference Number -----
Name of Referral Facility:
Address: Tel No:
Name/Position of Person Who Attended to the Patient: Date Seen:

Final Diagnosis:
Actions Taken (Include results of laboratory/ancillary procedures done and management)

Follow up advice:

Signature of Person Who Attended to Signature Over Printed Name


the Patient: of Client/Guardian:

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.

Input Criteria Process Criteria Output


Criteria
I3.1. –Standard operating protocols (SOP) P3.1 - Facilities are maintained / provided as per the Adolescents
to maintain a good ambience for SOP feel
adolescents - including a clean spacious comfortable
waiting area, potable drinking water, clean when they
toilets and educational material are in place visit health
I3.2. -The confidentiality and privacy P3.2. -Health facility displays the confidentiality and facility and
policy of the facility is clearly displayed in privacy policy and adolescents and parents and find the
the clinic and is clearly expressed to the accompanying adults are informed about it at all surroundings
client and their parents or accompanying available opportunities. and
adults. procedures
I3.3. -Health facility procedures to ensure P3.3. -Health facility staffs apply the procedures to appealing and
confidentiality of the adolescent clients and ensure the confidentiality of their adolescent clients and acceptable.
their parents are in place. their parents.

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:

3.1 Ambiance of the facility. The facility should:


 Provide comfortable seating with proper ventilation, good lighting, fans, and reading/information
materials.
 Provide access to clean drinking water and clean toilets. A separate toilet for female should be provided
 Provide appealing reference (posters, audio-video, reading) material for the adolescent to browse through
while waiting.

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.

Input Criteria Process Criteria Output Criteria


I4.1. -A plan of activities (including community P4.1. - Activities as per the plan are Community members
assemblies, meetings with parents, group meetings carried out are aware of provision
and school visits,) to be carried out in the of services and
community to inform community members about convinced about the
the benefits and availability of services to benefits of providing
adolescents is in place. adolescents with health
I4.2. -Procedures to communicate with all adults P4.2. -Service providers communicate information and
visiting the health facility the benefits and effectively about the value of services.
availability of services to adolescents are in place. providing health services to
adolescents and the type of services
available in their interactions with
adult patients.
I4.3. -Plan to provide some health services and P4.3. -Activities as mentioned in the Adolescents receive
commodities to adolescents by selected community plan are carried out services from NGOs,
members, NGOs, outreach workers and adolescents selected community
themselves are in place. members, outreach
I4.4. -A plan to carry out advocacy for support to P4.4. -Activities in the plan to seek workers and other
provision of services for adolescents from the Local support from the Local Development
adolescents
Development Plan (LDP) exists. Plan (LDP) are carried out.

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.

4.3 Involving selected community members in providing health services/commodities. It is necessary to


identify different organizations, individuals, agencies in the community who have adolescent care as their
main area of concern or interest. These different stakeholders should be involved in formulating plans for the
provision or improvement of services. This will enable them to identify their roles and contributions to the
overall plan for service provision to this special group. It is also an opportunity to forge partnerships and
devise procedures and mechanisms to ensure the smooth flow of service delivery.

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.

The Package of Services

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

IV. Implementing Mechanisms at Various Levels

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.

National Level (Department of Health):


 Formulate standards/policies/guidelines
 Develop communication plan on adolescent health
 Develop training manual for personnel rendering health services to adolescents
 Conduct capability-building activities for personnel involved in the provision of services for the adolescents
 Coordinate with other agencies (GOs and NGOs) on the implementation of standards and guidelines for health
facilities
 Develop guidelines which are in line with the implementation of AFHS
 Mobilize resources for the implementation of adolescent health activities
 Conduct monitoring and evaluation activities

Center for Health Development (CHD) Level:


 Provide technical assistance to LGUs (plan preparation, materials development etc.)
 Disseminate guidelines to LGUs and other directives that may be circulated by the Department of Health
periodically
 Appoint focal person in the region who will be in-charge of the implementation of the standards and
implementation guide
 Organize a multi-sectoral technical working group in the region
 Formulate a region-wide plan on the implementation of standards and implementation guide
 Establish a database of facilities in the region proving adolescent health services
 Monitor and evaluate the facilities providing services to adolescents in the provinces under its jurisdiction

LGU (Provincial/Municipality/City) Level:


 Develop ordinances, resolutions in support of adolescent health
 Disseminate guidelines, protocols, policies and procedures which may be circulated by the Department of
Health in relation to the provision of health services to adolescents
 Provide support to adolescent health activities and advocacy efforts
 Network with various sectors
 Prepare report on the services utilized by the adolescents; commodities used and needed to be replaced;
personnel who provided services; and attended capability building activities
Non-Government Organizations
 Utilize the standards and implementation guide in the provision of health services
 Provide services needed by adolescents within the capability of the organization
 Share good practices in the provision of services to 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

V. Monitoring and Evaluation of the AFHS Quality Standards

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.

Monitoring Tool 1. Facility Observation Checklist

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.

Item Self Assessment Assessment Team Recommendations


Signages
Welcome Signage
Schedule of Clinic Hours (Day and Time)
Health Services
Clinical Guidelines
Documents
Action Plan for Information Dissemination
Policy regarding flexible time schedule
Policies for provision of services
Policies for payment schemes
Plan for outreach program
Registration logbook containing the list of clients who
consulted and were given services

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”.

Item Self Assessment Assessment Team Recommendations


Documents
National Standards for Adolescent Service Package
List of services provided by the facility
Stock cards showing the delivery and utilization of
medicines, commodities for adolescent health care
Certificates of training on the minimum training courses
prescribed by DOH for adolescent focal persons and other
providers
Protocols and guidelines for patient interaction
Clinical management guidelines and Adolescent Job Aid are
available
Individual Treatment Records that shows the chief
complaint, findings on examination, clinical impression and
management of clients
Directory of organizations – name, address, services
provided, contact number and contact person
Referral logbook – name, age, address, Clinical Impression,
where referred, reason for referral, result of referral
Referral forms

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”.

Item Self Assessment Assessment Team Recommendations


There are leaflets containing the clinic schedule and services
which the patients/community members can bring home and
share to other community members.
IEC materials on the different programs / services available
(Example IEC on maternal care, family planning, etc). The
IEC materials should also include the directory of other
agencies/organizations where the services can be obtained.
Documents
IEC Plan
Copy of the Local Development Plan
Advocacy Plan
Action Plan showing different agency participation – the
name of the agency, resources/assistance they will provide,
the person’s responsible
Accomplishment report showing the services given at the
public health facility as well as those given by other agencies,
individuals and peer counselors

Monitoring Tool 2. Facility Manager Interview Questionnaire

Name of Facility:
Type of Facility:
Date of Assessment (dd/mm/yyyy)

Type of staff Number


Clinical-Total
o Medical doctors
o Nurses
o Midwife
Non-clinical-Total
o Psychologist, Counselors etc.
o Social workers
o Support staff (receptionist, cleaners, administrative clerks)
o Barangay Health Workers
Total

Criteria Yes No Remarks


Does the facility have the following signages
o Schedule of clinic hours for adolescents
o Services available
o Adolescents are Welcome
o “Services are Free of Charge”
Service Provision
Services provided
o Counseling
o Nutritional Assessment and counseling
o Maternal Care Services
 Pre natal
 Natal
 Post natal
o Services for STIs including HIV/AIDS
o FP Services
o Dental Assessment
o Micronutrient Supplementation
o Immunization – TT. Hepa B, MMR
o Reproductive Health Assessment and Counseling
 Fertility awareness , menstrual health issues and counseling
 Pap smear and pelvic exams, if sexually active
 Adolescent male reproductive health issues
 Gender issues
o Health prevention and promotion
o Psychological Counseling
o Social and legal support
o Substance abuse
o Commodities and Supplies
o BP Apparatus
o Weighing Scale
o Tape measure
o Height chart
o Orchidometer
o Dietary prescription form
o Exchange list
o Vaccines – TT, MMR, Hepa B
o Disposable syringes
o Cotton
o Alcohol
o Centrifuge
o Heparinized capilet
o Microscope
o Slides
o HIV testing kit
o RPR
o Reagents for Gram stain
o Cotton pledgets
o NBS kit
o BCG vaccine
o Gloves
o Cord clamp
o Vit K injection
o Iron with folic acid tablets
o FP Commodities
o Writing materials
o Individual Treatment Records
o Dental Record Forms
o Referral Forms
o Feedback Form
Planning
Written Plan for:
o IEC Campaigns
o Promotion of adolescent health services and facility
o Outreach including schedule
Procedures and Policies
Standard Operating Procedures
o Maintaining good clinic ambience conducive to adolescents
o Provision of Free Services to Adolescents
o Procedures for Dealing with Adolescents
o Clinical Protocols for the different health and health related programs
and conditions
o Two way referral
o Ensuring privacy and confidentiality
Documentation
Ledgers for:
o Clients seen at the clinic
o Clients seen during outreach
o IEC activities done, topic and list of participants
o Results for feedback
o Results of supervisory visits
Adolescent Participation
o Feedback mechanism on the services provided
o Participation in the design, implementation and assessment of the
following services:
Monitoring and Evaluation
o Inventory of supplies and equipment
o Client satisfaction
o Clinical Case management
o Provider performance

Please List the Staff Members and check the Training specific for Adolescents they have received:

Name of Training Physician Nurse Midwife Psychologist Social Worker


Orientation Program on
Adolescent Health
Adolescent Job Aid
Others: Specify

Monitoring Tool 3. Service Provider Interview Questionnaire

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?

Recommendations: What would you recommend to improve the following?


1. Physical structure and appearance of the facility
2. Clinic procedures including patient flow and waiting time
3. Measures to ensure
a. Confidentiality
b. Privacy
4. Capability of staff to deal with adolescents and address their needs
5. Training. Are there any other training you would want to recommend aside from those required by DOH
6. Staff capability in dealing with adolescents
7. Referral
8. Information dissemination
9. Adolescent participation
10. Community participation

Monitoring Tool 4. Client (Adolescent) Interview Questionnaire

1. What is the schedule of operations of the facility?


2. Can you enumerate the services offered in the facility that you know of?
3. Can you please describe the process from admission to the time you leave the facility?
4. How did you come to know about this facility and the services they offer?
5. What are the features that would ensure:
a. Confidentiality
b. Privacy
6. What mechanisms are in place to solicit your opinion regarding the facility and improving its condition and
operations?
7. Give your comments on the following:
a. Facility
b. Admission
c. Waiting time
d. Services
e. Staff
f. Availability of needed supplies and commodities
8. What is your overall rating of the facility and its operations?
9. What are your recommendations/suggestions to improve the facility and its operations?
References

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 Demographic Health Survey 2008, Philippines. December 2009.

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.

Annex 1. Laws and Issuances on the Provision of AFHS in the Philippines

International Issuances

1. Committee on the Rights of the Child General Comment No. 4


2. Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW)
3. Beijing Platform For Action (BPFA)
4. Article 6 of the United Nations Convention on the Rights of the Child
National Issuances

1. Republic Act 7610: Special Protection of Children Against Child Abuse, Exploitation and
Discrimination Act

2. Republic Act 9231: Worst Form of Child Labor


3. Republic Act 9710: The Magna Carta of Women
4. Republic Act 8504: Philippine Aids and Control Act of 1998
5. Article 54 of the Civil Code of the Philippines

6. P.D. 603: Child and Youth Welfare Code of 1974

7. R.A. 9262: Anti-Violence Against Women and their Children Act of 2004

8. R.A. 9211 (Tobacco Regulation Act of 2003)

9. R.A. 9165 (Comprehensive Dangerous Drugs Act of 2002)

10. DOH Administrative Order (AO) 34 – A series of 2000

Annex 2. The Process of Developing National Standards


on Adolescent Friendly Health Services

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.

The workshop was guided by the principles that AHFS should:


 Respect, fulfill and protect the rights of adolescents
 Comply with accepted standards of medical ethics in the delivery of services
 Given due consideration to national laws and policies and the socio-cultural context
 Ensure access to comprehensive and holistic services
 Provide adequate attention to the different needs of adolescents
 Ensure young people’s privacy and confidentiality
 Ensure adolescent’s participation at all levels
 Provide evidenced-based services
 Promote community ownership and active involvement of all stakeholders including parents and community
members, and
 Link with other sectors

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.

Annex 3. Guiding Principles

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.

Annex 4. Standard and Criteria Definitions

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.

From the users’ perspective, health services must be:

 Accessible: ready access to services is provided


 Acceptable: health care meets the expectations of adolescents who use the services
 Gender-sensitive: there shall be no discrimination, services must be given regardless of orientation
 Culturally-appropriate: services must not run counter to existing value systems
 Rights-based: in all aspects of program implementation, the promotion of young people’s rights shall be applied.

From the providers’ / managers’ perspective, health services must be:


 Age-appropriate: required care is provided ; unnecessary and harmful care is avoided
 Comprehensive: care provision covers aspects for prevention through counseling to treatment
 Effective: health care produces positive change in the health status of the adolescent. The health system should
focus on the efficiency in the health system, that is providing high quality care at the lowest possible cost
 Equitable: services are provided to all adolescents who need them especially the poor, marginalized, vulnerable
and difficult to reach groups.

Annex 5. Adolescent and Youth Health Program Technical Committee

Adolescent and Youth Health Program


Technical Committee
Dr. Juanita A. Basilio FHO
Dr. Manuel Calonge FHO
Ms. Lita Orbillo FHO
Ms. Onofria de Guzman FHO
Mr. Raymond Mazo FHO
Ms. Lyra Gay Borja FHO