Exploratory Study on Youth Friendly Services in Vietnam

Exploratory Study on Youth Friendly Services in Vietnam Hoang Tu Anh, Vu Song Ha, Tran Hung Minh, Laura Wedeen, Ngo Van Huu, Gwyn Hainsworth PATHFINDER INTERNATIONAL CONSULTATION FOR INVESTMENT IN HEALTH PROMOTION (CIHP) 30 th Annual Conference, Global Health Council Washington, DC May 29, 2003

Introduction ¨ Youth account for roughly 30% of the population ¨ Growing RH Concerns: – High proportion of total abortion cases – High proportion of HIV ¨ Youth don’t come to public RH clinics

Objectives of Study ¨ Explore factors which affect youth’s decision to use or not use RH services (public & private) ¨ Identify subjective and objective factors influencing providers’ readiness to offer quality RH services to youth ¨ Form the concept of "Youth Friendly Services" from the point of view of young people

Methodology ¨ Study methodology: Qualitative methods § § IDIs FGDs Observations Self–assessment checklist for providers ¨ Study sites: Public and private RH facilities in 4 Pathfinder/RHP-supported provinces (2 South, 2 North) ¨ Study population: ü Youth ages 15– 24: Service users and non-users ü Health providers ü Key informants (stakeholders, researchers)

Factors Affecting Utilization of RH Services ¨ Privacy ¨ Quality of Care ¨ Provider Attitudes and Qualifications ¨ Administrative Procedures

Privacy ¨ Privacy is the number one concern of youth due to the stigma associated with youth’s RH problems ¨ There are many service delivery issues that affect youth’s sense of privacy: § § § Location Signboard/Advertisement of Services Infrastructure Crowdedness Client Intake/Recording system Administrative Formalities and Service Flow

¨ “I do not think that there is privacy in the examination room. I always have a feeling that someone can hear the conversation between the doctor and me”. (Girl, 20 years old – Public setting) ¨ “I do not want to go to public clinic because they ask and record my information” (Boy, non-user)

Quality of Care ¨ Youth judge the quality of a health facility by: § Asking other people about their experience. § Observing the level of hygiene and equipment. § Assessing the range of services provided. ¨ Youth do not think there is much difference in “technical competency” between public and private facilities because the providers tend to be the same. However, big public facilities are perceived to be more capable of solving complicated RH problems because of the availability of equipment. ¨ Youth do not think all private clinics are good but they are very confident that they are able to identify which ones are good.

Provider Attitudes & Qualifications ¨ The attitude of staff who serve youth is very important to youth with RH problems. Besides professional qualifications, young clients expect health staff to have sympathetic attitudes. “Attitude is the most important thing. A sick person is a weak person without knowledge. Thus when clients go to the doctor, they want to be able to count on the doctor. However, doctors meet a lot of clients, so they may become brazen and don’t sympathize with the clients. Private doctors are often better. If the problem is not very serious, going to the hospital will take too much time and we will not be treated as human. Going to a private clinic, I feel taken care of. ” (Girl 24 y. o - Private clinic)

¨ Youth generally feel that attitudes are better at private clinics. “I don’t want to go to public clinic because it is very crowded, not very caring, and the equipment is not very hygienic. I have to wait for a long time to buy the record book. . I also don’t like when the health staff shout at me. ” (Girl 24 y. o, private clinic).

Administrative Procedures and Cost ¨ Youth appreciate quick and simple intake procedures. ¨ Youth prefer RH facilities that can offer services before or after school/work. ¨ According to youth, there is not a big difference in the cost of public and private RH services. ¨ Youth prefer a “package cost” rather than having to pay for each service and commodity separately.

“Private service is very quick. We can come and get the service right away. It is not like in the provincial hospital, where there is a lot of paper. We also have to come back and forth several times. ” (FGD boy) “First, I bought an examination voucher on the first floor. They told me to go to the second floor for the examination. Then, they told me to buy gloves. Thus, I had to come down again to buy them and then go back to the second floor for the examination. After the examination, they asked me to take an ultra sound. I had to go down to first floor again. Overall, I had to go up and down many times and felt dizzy. ” (Girl, 18 yr. Public Clinic)

Suggested Components of Youth Friendly Services – Privacy in term of physical environment. – Staff should have warm, respectful and sympathetic. attitudes, as well as technical competency. – Staff should be the same sex as clients. – Quick and friendly administrative procedures. – Wide range of services including counseling as part of the service package and services for males. – Well-equipped and hygienic. – Youth friendly (demedicalized) environment. – Availability of IEC for youth. – Subsidized fees for youth.

Self-Assessment of Providers in Selected MCH-FP Centers Questions Positive Response Is there adequate space and sufficient privacy? 8/21 Are the surrounding of the facility welcome by youth? 9/21 Have you been trained specifically to best serve 1/21 youth? Do you think you are skilled at working with youth? Are there any posters/leaflets in the facility that target youth? 4/21 8/21

Conclusions ¨ Youth consider privacy, provider attitudes, and streamlined administrative procedures as the most important characteristics of youth friendly RH services. ¨ In general, youth perceive these characteristics to be more readily found in the private sector. ¨ Youth appreciate the public sector for its technical infrastructure.

Conclusions (con’t) ¨ Many youth do not think of the public sector MCH/FP Centers as places where they can find services for their age groups. ¨ Youth, especially males, do not see many RH services available for them. ¨ Promotion activities are very important to make YFS well-known, appropriately visible, and attractive to both males and females. ¨ Outreach activities are also important to reach groups that do not go to the clinic.

Conclusions (con’t) ¨ Health staff in public settings are generally open and aware of the increase in youth’s RH problems but they lack the training to interact with youth and effectively handle their RH issues. ¨ Although a legal framework is available for public RH settings to develop youth friendly services, there is no concrete plan, guidance and support for the public setting to take action. In addition, there is no specific plan to motivate health staff to provide YFS.

Thank you! For additional information, contact Hoang Tu Anh at tuanh@cihp. org or Laura Wedeen at lwedeen@pathfind. org