Beyond Adolescent-Friendly Health Services

The term 'adolescent-friendly health services' began gaining traction in global health discourse in the late 1990s to early 2000s following various reports from the World Health Organization (WHO) that focused on Africa [1,2].In 2002, WHO described adolescent-friendly health services as a framework for improving adolescent health outcomes in every country [3].At this time, there was recognition that many adolescents struggled to engage with mainstream health services which seldom met their needs.Health services were considered 'adolescent friendly' if they were appropriate, effective, acceptable and accessible to young people, and provided equitable care.This approach focused on better orientating primary health services towards adolescents, recognizing that there were many barriers that prevented adolescents from engaging in health care, including poor health literacy, embarrassment, fear, and cost [4].Nowhere was the need for adolescent-friendly health services more critical than for the large number of adolescents around the world needing sexual and reproductive health (SRH) services.Safe, accessible and welcoming environments were identified as a means of providing these.Many programs were established in standalone youth centers which typically offered recreational activities and life-skills training to adolescents, with additional opportunities for SRH education and counseling on contraception and STI, and distribution of condoms.First promulgated in high income countries, [5] this approach was then adopted in many low-and middle-income countries, particularly in those suffering high rates of HIV/AIDS.While some provided direct clinical services, most youth centers were distinct from the health system and did not provide comprehensive SRH services, let alone address wider health-care needs such as mental health.A series of evaluations affirmed that in low-and middle-income countries, standalone programs such