Assessment of the quality of sexual and reproductive health services delivered to adolescents at Ujala clinics: A qualitative study in Rajasthan, India

• Published in: PloS one Vol. 17; no. 1; p. e0261757
• Main Authors: Dayal, Radhika, Gundi, Mukta
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 10-01-2022; Public Library of Science (PLoS)
• Subjects: Adolescent; Adolescents; Adult; Behavior; Care and treatment; Clients; Confidentiality; Councils; Counseling services; Family planning services; Female; Health aspects; Health care; Health Knowledge, Attitudes, Practice; Health services; Health Services Accessibility; Humans; India; Intervention; Male; Medical personnel; Medicine and Health Sciences; People and Places; Population; Pregnancy; Qualitative research; Quality assessment; Quality management; Quality standards; Reproductive Health; Reproductive Health Services; Services; Sex counseling; Sexual Behavior; Sexual health; Social Sciences; Surveys; Systematic review; Teenagers; Young adults; Youth; India; Rajasthan India; Tanzania
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0261757

The Adolescent Friendly Health Clinic (AFHCs), a key component of the Government of India's National Adolescent Health Programme a.k.a. Rashtriya Kishor Swasthya Karyakram (RKSK), aims to increase the accessibility and utilization of sexual-reproductive health services by adolescents and youth. However, low quality of care provided at AFHCs by counsellors calls for attention. We, thus, explore both the clients' and providers' perspectives using the World Health Organization's (WHO) global standards for quality health-care services for adolescents to assess the quality of the sexual reproductive health service delivery at AFHCs in Rajasthan, India. We conducted a qualitative study, comprising observation of the service delivery using mystery clients (MCs) (n = 12) and in-depth interviews with the counsellors (n = 4) in four AFHCs. Interviews were transcribed in local language and were translated in English. The transcripts were coded thematically. Our study, using five of the eight WHO global standards for quality health-care services for adolescents highlighted several gaps in the quality-of-service delivery at AFHCs. We unearth various intricacies related to the quality of the services provided at the AFHCs by referring to the relevant input, process, and the output criteria of WHO global standards I, III, IV, V and VI. Our study calls for efforts to improve- (i) the counsellors' competencies to increase adolescents' health literacy on sensitive topics, (ii) the facilities at the clinic to ensure privacy, comfort and confidentiality of the adolescents seeking services, (iii) the referrals to improve appropriate package of services, and (iv) an overall environment to ensure an equity and non-discrimination for all the adolescents. Our findings unearth the barriers that both the service providers and the adolescents face at the AFHCs and underscore the need for regular monitoring and evaluation of the AFHCs to strengthen the facility-based intervention of the RKSK programme.