Strengthening the quality of adolescent primary healthcare in South Africa: preliminary work on a complex public health intervention
Medical Research Council
University of Cape Town
Over half the world's adolescents live in countries like South Africa, with high levels of communicable and non-communicable diseases, obesity, high adolescent fecundity and unmet need for contraception. Although at increased risk, adolescents are marginalised and face barriers in accessing healthcare. In South Africa many policies set out to right this, nevertheless, adolescent-specific service provision is lacking especially with regards to inter-sectoral collaboration. The Knowledge Translation Unit has developed a PACK Adolescent health systems strengthening intervention which covers the comprehensive and integrated primary healthcare of a 10 to 19 year old. At 6 clinics and 12 schools in South Africa, we will conduct a situational analysis of adolescent primary healthcare using observations of non-clinical healthcare processes and clinical consultations, interviews with policymakers and community-based organisations and focus groups with managers, clinicians and adolescents. Two theory of change workshops with key stakeholders will help adapt the intervention using minimum components that incorporate an understanding of adolescent health needs across clinics and schools. The customised intervention will then be piloted in 6 schools and 12 clinics. A parallel, mixed methods process evaluation will include observations of consultations and interviews with adolescents and clinicians. A survey questionnaire will be completed by end-users 6 months after implementation to assess the intervention's reach. Impact will be assessed through monitoring routine data of adolescents accessing healthcare in schools and clinics. We will engage with stakeholders in the design, adaptation, pilot and implementation phases through an advisory board of national and provincial stakeholders in health, education and social services, as well as adolescents themselves, to ensure that the study and the intervention speak to the needs of adolescents and their healthcare providers.
8.1 Organisation and delivery of services / Research Grant