Does setting adolescent-friendly standards improve the quality of care in clinics? Evidence from South Africa.
OBJECTIVE
To determine whether setting and implementing adolescent-friendly standards improves the quality of adolescent services in clinics.


METHODS
The evaluation used a quasi-experimental case-control design.


METHODS
Eleven public health clinics involved in the adolescent-friendly program [The National Adolescent Friendly Clinic Initiative (NAFCI)] and 11 control clinics.


METHODS
This included implementation of a set of 10 adolescent-friendly standards and 41 corresponding criteria.


METHODS
Percentage scores were achieved for each standard and criterion. Clinics were awarded a Gold Star if they achieved an overall clinic score (average standard score) of >or=90%, a Silver Star for a score between 60 and 89% and a Bronze Star for a score between 30 and 59%.


RESULTS
The NAFCI clinics performed better than the control clinics on most criteria. The combined average overall clinic score of all the NAFCI clinics (79.9%) was significantly higher (P = 0.005) than the overall score for the control group clinics (60.9%). Results showed that the longer NAFCI was implemented at a clinic, the higher the score and the more likely that clinic would be accredited as an 'adolescent friendly' clinic. NAFCI clinics performed significantly better than the control clinics on criteria specific to the provision of adolescent-friendly services including knowledge of adolescent rights and non-judgmental attitudes of staff.


CONCLUSIONS
Setting and implementing standards and criteria improves the quality of adolescent services in clinics. The standards and criteria should be set on the basis of the characteristics of adolescent-friendly services and quality of care indicators. Best results are achieved when a facilitator trained in quality improvement methodologies supports clinics.
Dickson
Kim Eva
KE
Reproductive Health Research Unit, University of the Witwatersrand, Chris Hani Baragwanath Hospital, Bertsham, South Africa. dicksonk@who.int
Ashton
Joanne
J
Smith
Judy-Marie
JM
D000293:Adolescent; D016497:Adolescent Health Services / Q000592:standards*; D003430:Cross-Sectional Studies; D019317:Evidence-Based Medicine; D006801:Humans; D011635:Public Health Administration; D011787:Quality of Health Care / Q000592:standards*; D013019:South Africa