Availability and readiness of primary healthcare facilities in the provision of adolescent sexual and reproductive health services in two regions of Burkina Faso: a cross-sectional study

Adolescent sexual and reproductive health (ASRH) remains a major public health concern in Burkina Faso, where adolescents constitute nearly a quarter of the population. Primary healthcare (PHC) facilities are the main entry point for these services, yet evidence on their capacity to deliver them remains limited. To date, little facility-level evidence, whether national or subnational, documents the availability and readiness of PHC facilities to provide ASRH services in Burkina Faso. This study assesses PHC facilities’ availability and readiness to provide comprehensive ASRH services and examines disparities across selected facility characteristics in two regions of Burkina Faso. A cross-sectional survey was conducted in 152 PHC facilities across two purposively selected regions (Centre-Ouest and Hauts-Bassins), within which districts were randomly selected and facilities sampled by systematic random sampling proportional to size. The WHO’s Service Availability and Readiness Assessment tool was adapted to measure ASRH service availability (family planning, sexual health education and rights, antenatal care) and readiness (trained personnel, diagnostic capabilities, essential medicines). Full availability was an all-or-nothing composite requiring every component across the three domains. Proportions are reported as pourcentages; for subgroup comparisons the CI refers to the between-group difference, tested using the two-proportion z test. Most facilities were Health and Social Promotion Centers (HSPC, 77.6%). Although nearly all facilities reported offering some ASRH service, only 30.3% offered the full range, a deliberately conservative measure rather than a conventional coverage indicator. Full availability was significantly higher in urban than rural areas (46.5% vs. 23.9%; 95% CI 5.7 to 39.6; p = 0.006), whereas it did not differ significantly between the two regions (28.6% vs. 32.0%; p = 0.65). Readiness gaps were pronounced for diagnostic capacity and training: syphilis-testing capacity was very low overall and higher in urban than rural facilities (23.2% vs. 4.6%; 95% CI 7.1 to 33.4; p = 0.001), and staff recently trained in refocused antenatal care were more common in urban areas (53.4% vs. 33.0%; 95% CI 3.1 to 37.8; p = 0.020). These are part of a broader set of subgroup comparisons (by region, facility type and residence) reported in the manuscript; differences across facility types were based on small subgroups and are. Availability and readiness of PHC facilities to provide full ASRH services remain limited, especially in rural facilities and in HSPCs and private/faith-based facilities. Priority should be given to in-service training, including refocused antenatal care, and to strengthening family planning method availability and adolescent education activities in rural areas, as well as to guidelines, diagnostics and supply chains in HSPCs and private facilities.