title: Barriers to and facilitators of the provision of a youth-friendly health services programme in rural South Africa.
abstract: BACKGROUND
  Youth-friendly health services are a key strategy for improving young people's health. This is the first study investigating provision of the Youth Friendly Services programme in South Africa since the national Department of Health took over its management in 2006. In a rural area of South Africa, we aimed to describe the characteristics of the publicly-funded primary healthcare facilities, investigate the proportion of facilities that provided the Youth Friendly Services programme and examine healthcare workers' perceived barriers to and facilitators of the provision of youth-friendly health services.
  
  
  METHODS
  Semi-structured interviews were conducted with nurses of all eight publicly-funded primary healthcare facilities in Agincourt sub-district, Mpumalanga Province, South Africa. Thematic analysis of interview transcripts was conducted and data saturation was reached.
  
  
  RESULTS
  Participants largely felt that the Youth Friendly Services programme was not implemented in their primary healthcare facilities, with the exception of one clinic. Barriers to provision reported by nurses were: lack of youth-friendly training among staff and lack of a dedicated space for young people. Four of the eight facilities did not appear to uphold the right of young people aged 12 years and older to access healthcare independently. Breaches in young people's confidentiality to parents were reported.
  
  
  CONCLUSIONS
  Participants reported that provision of the Youth Friendly Services programme is limited in this sub-district, and below the Department of Health's target that 70% of primary healthcare facilities should provide these services. Whilst a dedicated space for young people is unlikely to be feasible or necessary, all facilities have the potential to be youth-friendly in terms of staff attitudes and actions. Training and on-going support should be provided to facilitate this; the importance of such training is emphasised by staff. More than one member of staff per facility should be trained to allow for staff turnover. As one of a few countrywide, government-run youth-friendly clinic programmes in a low or middle-income country, these results may be of interest to programme managers and policy makers in such settings.
authors.affiliation: Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK. r.geary@imperial.ac.uk.
authors.forename: Rebecca Sally
authors.initials: RS
authors.lastname: Geary
authors.forename: Francesc Xavier
authors.initials: FX
authors.lastname: Gómez-Olivé
authors.forename: Kathleen
authors.initials: K
authors.lastname: Kahn
authors.forename: Stephen
authors.initials: S
authors.lastname: Tollman
authors.forename: Shane Anthony
authors.initials: SA
authors.lastname: Norris
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services / Q000458:organization & administration*; D001291:Attitude of Health Personnel; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D009726:Nurses; D017060:Patient Satisfaction; D016730:Program Development; D036301:Qualitative Research; D019035:Rural Health Services / Q000458:organization & administration*; D013019:South Africa; D000078329:Workforce; D055815:Young Adult