1
Going for Gold S. Africas Approach to
Quality Adolescent Health Services

• National Adolescent Friendly Clinic Initiative
  (NAFCI)

2
A public health priority South Africas
adolescent crisis

• Demographics 45 total population are young
• HIV/AIDS
• Over 60 of new infections (900/day) occur in
  those between 15-25
• Rate of HIV infection is increasing fastest among
  15-20
• Teen pregnancies
• More than 1/3 of babies are born to mothers lt18
• By 19, 35 have been pregnant, given birth
• Sexual behavior
• STIs are endemic among young people
• Rape, violence coercion are common features of
  adolescent sexual behavior

3
NAFCI's health service provision work A part of
an overall strategy

• loveLife
• NAFCI

4
Collaborative program NGOS, national govt.,
international organizations, private sector
The primary GOAL is to effect positive
behavior change among young S Africansto reduce
teenage pregnancy, sexually transmitted diseases
and HIV/AIDS
What is
5

• loveLife Awareness Raising Information
• Billboards
• Radio Talk-shows
• Television

Thetha Junction

• Peer Educators
• Community
• Mobilisers

• Y-Centers

NAFCI

• Franchises

• Tours,games, train

• Social Services
• Referral Hospitals
• Other NGOs

6
NAFCI includes a range of service-delivery points

• Government run primary health centres
• Private clinics
• Youth centers with clinics
• School based clinics

7
NAFCI Essential Service Packageaddresses the
public health priorities

• Information and education on SRH
• Contraceptive information,counseling, and
  provision
• Pregnancy testing and counseling, antenatal and
  postnatal care
• STI information, prevention, diagnosis and
  syndromic managment
• HIV information, VCT, appropriate referral
• Information, counseling and referral for
  violence/abuse and mental health problems

8
NAFCI uses Quality Assurance to makes health
services adolescent friendly

• Define Quality develop standards for quality
  adolescent friendly health services
• Implement Quality Improvement
• focused accreditation Going for Gold

9
Steps to Develop NAFCI Quality Standards
Pilot project
Revision
Field testing
International expert consultation
National consultations with experts, providers
youth
Review of existing standards and literature
10

10 NAFCI Standards

• Management
• Adolescent Rights
• Access
• Environment of Care
• Drugs, Supplies, Equipment

• Information, Education, Communication
• Trained Staff
• Client Assessment
• Individualised Client Care
• Continuity of Care

11
Each NAFCI Standard

• Intent Statement
• Standard
• Criteria
• Self appraisal questions
• Self appraisal data collection and exercises to
  answer questions

12
Focused Accreditation

• The process by which a recognized body performs a
  selective (or focused) review of one or more
  functions of a health care organization, and
• Assesses its ability to meet a set of standards
  and criteria specifically related to the selected
  function or service area.

13
NAFCI Accreditation Process Standards-based QA
Approach
Clinic Self Appraisal
14
Self Appraisal measures clinic performance
according to standards

• Self Appraisal to assess whether
  criteria/standards are met
• Assessment methods
• Observation of clinical practice
• Inventory
• Interviews with providers, clients
• Review of clinic documents

15
NAFCI Quality Improvement Process

• Use appraisal results to identify gaps in
  performance
• Implement Quality Improvement QI to bridge gaps
  and solve problems in compliance
• Quick fix
• Rapid team-based problem solving to identify
  causes of non-compliance and develop
  interventions
• Repeat appraisal after quality improvement
  actions to assess if actions result in improved
  performance

16
Monitoring Quality of NAFCI Program

• Clinic self monitoring of performance per
  Standard
• Coordinators use Monitoring Guide per visit
• Quarterly Indicator Collection
• Utilization (client profile and total visits)
• Utilization per service type
• Indicators of case management (STI, prenatal
  care, referral)
• Outreach events

17

• NAFCI aims to reach adolescents with
• a package of essential services
• It is based upon AFHS characteristics
• It uses focused accreditation as its QA approach
• It incorporates core QA activities
• standards defining Q
• self/external assessment measuring Q
• continuous problem-solving improving Q

18
NAFCI expansion
19
NAFCI CLINICS
20
NAFCI quality improvement
21
Average number of services used per month by each
NAFCI clinic.
22
NAFCI utilization

• An assessment of clinic utilization by 10-19 year
  olds in 32 NAFCI clinics, from 2002 to 2004
  showed that there was a statistically significant
  increase in average monthly clinic utilization
  (340 in 2002 to 420 in 2004).
• The longer NAFCI is implemented at clinics the
  more client visits are recorded at clinics
  (clinics where NAFCI was implemented for less
  than ten months saw on average 125 clients per
  month while clinics where NAFCI was implemented
  for more than 30 months saw 598 youth clients on
  average per month).