title: "There are bugs in condoms": Tanzanian close-to-community providers' ability to offer effective adolescent reproductive health services.
abstract: OBJECTIVE
  Young people in Tanzania are known to access reproductive health services from a range of close-to-community providers outside formal health settings such as drug stores, village AIDS committees, traditional healers and traditional birth attendants (TBAs). However, questions remain about the quality of services such agents provide. This study investigated their capacity to provide adolescent reproductive health (ARH) services and explored their readiness and ability to integrate with the mainstream health sector through community referral interventions.
  
  
  METHODS
  Thirty-five focus group discussions exploring close-to-community provider experiences and attitudes to ARH service provision were carried out in two districts in Northern Tanzania. Discussions were conducted in Kiswahili, digitally recorded, verbatim-transcribed, translated and back-translated from Swahili to English. A thematic analysis was conducted using NVivo 9.
  
  
  RESULTS
  The major close-to-community cadres providing reproductive health services were drug stores, traditional healers, TBAs and village health workers. They reported being the first port of call for adolescents seeking reproductive health services, but their knowledge of ARH needs was poor. They had negative attitudes to, and lacked the necessary resources for, the provision of such services for adolescents. Some were particularly unwilling to provide condom services and were prejudiced against adolescents using them. There was poor integration between the close-to-community providers and the formal health sector, further limiting their ability to provide adequate services.
  
  
  CONCLUSIONS
  Although close-to-community providers are considered a key resource in the community, most have limited capacity to provide ARH services. Without capacity-building investments such as training and cooperation with the mainstream health sector, their contribution to positive reproductive health outcomes is limited, or could indeed lead to adverse outcomes.
authors.affiliation: Research Assistant, Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK.
authors.forename: John
authors.initials: J
authors.lastname: Dusabe
authors.affiliation: Researcher, Tanzania National Institute for Medical Research, Mwanza, United Republic of Tanzania.
authors.forename: Zaina
authors.initials: Z
authors.lastname: Mchome
authors.affiliation: Principal Research Scientist, Tanzania National Institute for Medical Research, Mwanza, United Republic of Tanzania.
authors.forename: Soori
authors.initials: S
authors.lastname: Nnko
authors.affiliation: Principal Research Scientist and NIMR Mwanza Director, Tanzania National Institute for Medical Research, Mwanza, United Republic of Tanzania.
authors.forename: John
authors.initials: J
authors.lastname: Changalucha
authors.affiliation: Senior Clinical Lecturer, Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK.
authors.forename: Angela
authors.initials: A
authors.lastname: Obasi
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services / Q000592:standards; D003153:Community Health Services / Q000592:standards; D017280:Condoms; D005260:Female; D017144:Focus Groups; D006282:Health Personnel / Q000523:psychology*; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D036301:Qualitative Research; D034121:Reproductive Health Services / Q000592:standards*; D013636:Tanzania
keywords: Tanzania; family planning service provision; qualitative research; reproductive health politics; service delivery; teenagers