Integrating Sexual and Reproductive Health Services for Youth in Colombia

Denise Kohn, International Planned Parenthood Federation
Rebecca Koladycz, International Planned Parenthood Federation

Background Colombia’s PROFAMILIA has been providing sexual and reproductive health (SRH) services targeted to youth since 1990 when it opened its first youth center in Bogotá in response to high teen pregnancy rates. The organization currently runs youth centers in 4 cities and 22 youth programs in 21 cities. The increase in demand for sexual and reproductive health services among youth led PROFAMILIA to develop a new strategy aimed at integrating services specifically targeted for youth within its adult clinics. This pilot project, which was implemented in 1998-99 with partial funding from the Moriah Foundation, involved 13 PROFAMILIA clinics in medium-sized cities and small towns across Colombia. Project Goals and Objectives The goal of this project was to promote access to and use of sexual and reproductive health services, including family planning, among youth aged 13 to 19 in existing PROFAMILIA clinics. Specifically, the project sought to increase staff capacity and availability to provide quality, youth-friendly services accessible to young people in adult clinics without the infrastructure or support to open centers or programs dedicated exclusively to youth. In general, the focus was on using and improving existing space, materials, and human and other resources rather than investing in new infrastructure and staff. Project Activities Although the PROFAMILIA clinics participating in this youth project had been providing services to adolescents on demand, there was a lack of focus and accommodation to the needs of youth. The project sought to establish standards of care for youth services with respect to privacy, confidentiality, and counseling and to increase access to services among youth by offering subsidized costs and by promoting the services among community groups, local agencies, teachers and parents. A key component of the project was training designed to sensitize all clinic staff to the particular characteristics of working with youth and the need to promote the use of youth-friendly SRH services among this population. Staff at each of the 13 participating clinics participated in a series of trainings, which were divided into three groups: 1) clinic directors and doctors, 2) educational advisors, and 3) administrative personnel. Subjects covered included: adolescent care models; human sexuality; adolescent sexual behavior; myths, beliefs and stereotypes about adolescent sexuality; and program administration and evaluation. All topics were presented within the context and culture of the region where the clinic was located. PROFAMILIA promoted the youth services through contracts with the country’s social insurance program as well as links with a variety of organizations, such as local community organizations, municipal agencies, local media outlets, universities, and high schools. Clinic staff members were encouraged to develop and implement educational and informational activities for youth, parents, teachers, and government officials as a way of supporting the marketing of youth services. Special promotional materials, such as pamphlets, flyers, and posters, with information about clinic services for youth and prices were also developed and printed and audiovisual materials related to adolescent sexuality were redesigned and improved. Evaluation Strategies Project monitoring and evaluation strategies focused on gathering both quantitative and qualitative data. Baseline data were gathered from clinic files on the number of adolescents who had visited the clinic in the past, and a new standardized intake form for adolescent clients and registration form for first-time clients were developed. This allowed clinics to gather key demographic information on youth, their sexual behavior, knowledge, and use of contraceptive methods so as to better meet their specific needs. A monthly registration form for tracking project activities and revenue, covering clinical services, diagnostic exams, contraception sales, educational activities and materials distributed, was also introduced. Project staff gathered qualitative information through in-depth interviews with doctors, directors, and educational advisors in order to explore project obstacles and successes. They also conducted observations related to the physical environment of the clinic settings and their perceived appeal to youth. Key Results Following these efforts to integrate sexual and reproductive health services for youth in adult clinics, there was a 37% increase in adolescent family planning visits during the first 6 months of project execution across the 13 participating clinics, a 61% increase in gynecological visits, and a 64% increase in pregnancy tests for adolescents. Moreover, increased levels in youth services were sustained in the year following project execution. According to PROFAMILIA staff, these statistics are even more noteworthy considering the traditionally conservative and religious nature of the cities where participating clinics were located. Other project successes were that PROFAMILIA staff in participating clinics were sensitized to the particular needs of youth and became part of an integrated team to provide youth with quality services. With the improved registration and intake forms, clinics were also able to better identify adolescents coming into the clinic and gather important information about them in order to adapt their youth services. Key Lessons Learned from Integrating SRH Services for Youth into Adult Clinics Integrating sexual and reproductive health services for youth in existing adult clinics has proven to be a successful strategy for expanding access to quality, youth-centered services where resources are limited. Nonetheless, organizations should plan carefully before undertaking such an approach. • Advocacy among community organizations and government agencies is important for generating demand and support for youth SRH services. • Integrating youth services within existing clinics can stretch institutional capacity. Systematic planning is essential so that clinics are able to meet increased demand for services, and additional investments in staff and infrastructure may ultimately be necessary. • It is important that all members of the clinic staff, from the receptionist to the doctors, are included in training and other activities aimed at sensitizing them to the special needs of youth. • In order to gather accurate data on youth accessing services, clinics must be vigilant in making certain that adolescent clients are identified as such and are provided the appropriate forms. • If the integration of youth services is taking place across multiple clinics in multiple geographic areas, it is important to have a strong national coordinating body in order to ensure appropriate monitoring and evaluation.