title: The health status of adolescents in Ecuador and the country's response to the need for differentiated healthcare for adolescents.
abstract: BACKGROUND
  Adolescents face a range of health problems but many barriers block their access to health services, and in particular to sexual and reproductive health services. The objective of this study was to assess the health needs of adolescents in Ecuador and to draw lessons from the ways the country has responded to their need for differentiated care.
  
  
  METHODS
  We conducted a literature review and consulted key stakeholders.
  
  
  RESULTS
  Adolescents in Ecuador today have a wide range of health care needs, in particular related to sexual and reproductive health. A major concern is the high rates of adolescent pregnancy. A national programme was established in 2007 to offer differentiated health care for adolescents-an effort that featured specially trained staff, enclaved facilities, respect for adolescents' privacy and confidentiality, a friendly atmosphere, and a dedication to establishing trust. It resulted in rapid increases in visits by young persons both for preventive and curative services. In 2011, the government initiated a model for "integrated family and community health care" which led to a disruption of the central support for capacity building and follow-up of adolescent friendly services.
  
  
  CONCLUSIONS
  The Ecuadorian experience has demonstrated the need for institutionalised differentiated care for adolescents who are facing a wide range of health issues.
authors.affiliation: Chr. Michelsen Institute, P.O. Box 6033 Bedriftssenteret, N-5892, Bergen, Norway. joars@cmi.no.
authors.forename: Joar
authors.initials: J
authors.lastname: Svanemyr
authors.affiliation: Adolescent Health, Standardization, Ministry of Public Health Ecuador, Av. República del Salvador 36-64, Quito, Ecuador.
authors.forename: Susana
authors.initials: S
authors.lastname: Guijarro
authors.affiliation: PAHO Ecuador, Edificio de Naciones Unidas piso 8, Av Amazonas y República, Quito, Ecuador.
authors.forename: Betzabe Butron
authors.initials: BB
authors.lastname: Riveros
authors.affiliation: Department of Reproductive Health and Research, World Health Organization, 20 Avenue Appia, 1211, Geneva 27, Switzerland.
authors.forename: Venkatraman
authors.initials: V
authors.lastname: Chandra-Mouli
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services / Q000706:statistics & numerical data*; D001294:Attitude to Health; D004484:Ecuador; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D020380:Needs Assessment; D011247:Pregnancy; D011253:Pregnancy in Adolescence / Q000517:prevention & control; D000297:Psychology, Adolescent; D060728:Reproductive Health; D012725:Sexual Behavior / Q000523:psychology*
keywords: Adolescents; Differentiated health services; Ecuador; Sexual and reproductive health; Youth