Process and impact of the scale up of a youth friendly health services initiative in Northern Tanzania
Whilst there are a number of examples of successful small-scale Youth Friendly Service (YFS) interventions, aimed at improving reproductive health service provision for young people, these projects are often short-term and have low coverage. In order to have a significant, long-term impact these initiatives must be implemented over a sustained period and on a large scale.
We conducted a process evaluation of the tenfold scale-up of an evaluated YFS intervention in Mwanza Region, Tanzania, in order to identify key facilitating and inhibitory factors from both user and provider perspectives.
Methods: The intervention was scaled up in two training rounds lasting six and ten months. This process was evaluated through the triangulation of multiple methods: (i) a simulated patient study; (ii) focus group discussions and semi-structured interviews with health workers and trainers; (iii) training observations, and; (iv) pre and post training questionnaires, were was used to compare pre and post intervention groups and assess differences between the two training rounds.
Results: Between 2004 and 2007 local government officials trained 429 health workers.
The training was well implemented and over time trainers'confidence and ability to lead sessions improved. The district-led training significantly improved knowledge relating to HIV/AIDS and puberty (RR ranged from 1.06-2.0), attitudes towards condoms, confidentiality and young people's right to treatment (RR ranged from 1.23-1.36).
Intervention health units scored higher in the family planning and condom request simulated patient scenarios but lower in the STI scenario than the control health units. The scale-up faced challenges in the selection and retention of trained health workers and was limited by various contextual factors and structural constraints.
Conclusions: YFS interventions can remain well delivered even after expansion through existing systems.
The scaling up process did affect some aspects of intervention quality and our research supports others in emphasizing the need to train more staff (both clinical and non clinical) per facility in order to ensure YFS delivery. Further research is needed to identify effective strategies to address structural constraints and broader social norms that hampered the scale-up.
Author: Jenny RenjuBahati AndrewKija NyalaliColeman KishamaweCharles KatoJohn ChangaluchaAngela Obasi
Credits/Source: Journal of the International AIDS Society 2010, 13:32
Published on: 2010-08-23
Copyright by the authors listed above - made available via BioMedCentral (Open Access). Please
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