Scale-up of Adolescent Contraceptive Services: Lessons from a 5-Country Comparative Analysis
Background: Poor sexual and reproductive health outcomes among adolescents aged 10–19 years are indicative of the barriers this group faces in accessing health services and highlights a gap in the availability of appropriate services, including adolescent-friendly contraceptive services (AFCS). The HIV Investment Framework identifies contraceptive services as an entry point for HIV counseling, testing, and treatment, and as a component of HIV prevention. To effectively meet the needs of adolescents, greater understanding of effective scale-up strategies for adolescent-friendly services is needed.
Methods: The authors conducted a retrospective analysis of AFCS scale-up experiences in Ethiopia, Ghana, Mozambique, Tanzania, and Vietnam using the ExpandNet/World Health Organization framework for systematic scale-up. The authors analyzed the type of scale (expansion or institutionalization), dissemination and advocacy, organizational process, costs and resource mobilization, and monitoring and evaluation.
Results: The analysis showed that all programs simultaneously pursued expansion and institutionalization, contributing to sustainable scale-up. Advocacy complemented by intensive capacity building at all levels of the health system contributed to adoption of AFCS in national and district work plans and budgets as well strengthening collection of age-disaggregated data.
Discussion: To achieve scale-up of AFCS, the authors identified the importance of institutionalization and expansion in tandem for synergy and reinforcement, empowering adolescents to be agents of change and hold government accountable to its commitments, and strengthening health systems to sustain AFCS.
Conclusions: This article contributes to a growing body of evidence around scale-up of AFCS, which can inform the implementation and sustainable scale-up of HIV and other services for adolescents.
Hainsworth, Gwyn MEd*; Engel, Danielle Marie Claire MA+; Simon, Callie MPH*; Rahimtoola, Minal MA, MPH*; Ghiron, Laura Jane MPH~. Scale-up of Adolescent Contraceptive Services: Lessons From a 5-Country Comparative Analysis. JAIDS Journal of Acquired Immune Deficiency Syndromes. Volume 66, Supplement 2, July 1, 2014. doi: 10.1097/QAI.0000000000000180
The online version of the JAIDS Supplement is available electronically at: http://journals.lww.com/jaids/toc/2014/07011.
* Pathfinder International, Watertown, MA;
+ Technical Division, Sexual and Reproductive Health Branch, United Nations Population Fund, New York, NY; and
~Partners in Expanding Health Quality and Access and ExpandNet Secretariat, Davis, CA.
Funding Disclosure: Pathfinder International is currently receiving funding from the United States Agency for International Development for projects that are supporting the scale-up of contraceptive services for adolescents as referenced in this paper in Mozambique and Ethiopia. These include the Extending Service Delivery/Family Planning Initiative Agreement Number 656-A-00-01-00104-00 and the Integrated Family Health Program Agreement Number 663-A-00-08-00414-00.
The purpose of the Working Paper Series is to disseminate work in progress by Pathfinder International staff on critical issues of population, reproductive health, and development.
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