Using scorecarding to strengthen youth-friendly health services

In September 2020 the NCD Alliance is highlighting accountability in its Global Week of Action on NCDs. A lot of interest has been generated and promises made by governments to take action on non-communicable diseases (NCDs) in line with the Sustainable Development Goals, but this does not always translate into activity on the ground - however strong the goodwill.

The Young Health Programme (YHP) focuses on NCD prevention in youth - by addressing risk behaviours in youth good habits can be encouraged, which lead to longer and healthier lives. Our approach is at its most effective when developed with the support of governments and local authorities, helping them to become more responsive to the needs of the young people in the communities that they serve.

The provision of Youth Friendly Health Services is central to the YHP activities run by our partner, Plan International UK.   Scorecarding is one particularly effective youth-led tool that goes to the heart of identifying and addressing gaps in care and service at health clinics in local communities.

“The central idea driving YHP’s scorecarding is that if services are overseen by the people they are meant for, then those services are more likely to meet their needs,” explains Jeske Paijmans, YHP Global Programme Manager at Plan International UK.

Scorecarding has been around in business and healthcare for decades, and The World Health Organisation set out detailed scorecarding guidance as part of its comprehensive Global standards for quality health care services for adolescents in 2015. Plan International used this and other guidance to develop a simplified system that could be used by youth volunteers and others in the field.

“The intention is not to criticise,” Paijmans continues, “but to provide constructive feedback and positive suggestions, and the process works best when the service providers are directly involved.”

In Nairobi, Kenya, scorecarding was carried out in close collaboration with Ministry of Health officials from the Lang’ata local authorities in Kibera. It was also run in conjunction with the health centres themselves of which there were twelve – seven run by the Government of Kenya, three by NGOs and the remaining two privately.

In Delhi, India the scorecarding was set up and carried out with the active cooperation of the Primary Health Centres (PHC) using the WHO global standards. It revealed a similar situation to that in Kenya, in which the centres were under-resourced and experiencing very high levels of demand. The work also highlighted that one community did not have a PHC, and so the YHP’s young people put together a powerful 20,000 signature campaign holding the local government to account to meet its own guidance and set up a centre in the area.

Our scorecarding resulted in clear recommendations for all of the centres. For example, there was an obvious need for refresher training on youth-friendly health services for staff. There was also a valuable role for the YHP to play in providing materials and resources aimed at young people on NCD risk behaviours and on sexual and reproductive health and rights.

The clinics needed to be made more accessible to the young people that they wanted to serve.

‘The health facility in Kibera has now created a separate entrance for young people to ensure their privacy”, says Marlene, one of the local young people. ‘We no longer bump into our parents’ friends using the health services because they use the normal entrance. It has curtailed the fear of being judged by such people’’.

Suggestion boxes have been set up;and ‘youth corners’ introduced on specific days so that young people can talk freely about their issues and share experiences. There was also an agreement to develop more scorecarding and closer liaison between young people and the health centre staff to ensure that the changes were maintained and built upon. This of itself represented considerable progress.

Scorecarding clearly has a significant and positive role to play in the strengthening of youth friendly health services but this is only part of the work required. The demands on the health systems in many countries within which the YHP operates are intense, a situation that the COVID pandemic has made even more acute.

A recent report shows that when facilities were made adolescent-friendly they unlocked a huge amount of pent up demand – for example in a recent case in Malawi the number of family planning clients aged 15–24 increased from 72 to 2,278 per quarter[1], but the report also highlighted the need for the sort of ‘sustained outreach and demand-generation activities’ that the YHP provides, and of course the need for more financial resources.

It is understanding and working at a local level that makes YHP programmes so powerful, and scorecarding is a proven and effective way to ensure that health service providers are held to account and that young people get their fair share of whatever resources are available.

References:

[1] Barden-O’Fallon, J., Evans, S., Thakwalakwa, C. et al. Evaluation of mainstreaming youth-friendly health in private clinics in Malawi. BMC Health Serv Res 20, 79 (2020). https://doi.org/10.1186/s12913-020-4937-9