Developing and sustaining adolescent-friendly health services: A multiple case study from Ecuador and Peru

Area of Science:

• Public Health
• Adolescent Health
• Health Systems Research

Background:

• Adolescent-Friendly Health Services (AFHSs) are crucial for meeting diverse youth healthcare needs.
• Understanding the implementation process of AFHSs is essential for effective healthcare delivery to adolescents.
• Previous research highlights the need for context-specific strategies in establishing youth-centered health services.

Purpose of the Study:

• To investigate the introduction, development, and sustainability processes of AFHSs in four clinics across Peru and Ecuador.
• To identify critical factors influencing the successful implementation and long-term viability of AFHSs.
• To compare the impact of centralized versus decentralized approaches on AFHSs integration.

Main Methods:

• A multiple case study design was employed.
• Data collection involved document review, observations, and informant interviews at clinic and national levels.
• Thematic analysis was used to analyze collected data.

Main Results:

• The implementation of AFHSs is a long-term process demanding collaborative efforts between donors, public institutions, and health providers.
• Sustained motivation and external support are critical for initiating and maintaining AFHSs.
• National health system organization and adolescent health policies significantly influence health facility transformation into AFHSs.

Conclusions:

• Centralized approaches (Peru) facilitate national model dissemination but can hinder systemization during policy changes.
• Decentralized approaches (Ecuador) promote easier integration of the AFHSs model into local health facilities.
• Successful AFHS implementation hinges on adaptive strategies, sustained support, and alignment with national health policies.