4. ASSESSMENT RATIONALE
Provide insights on:
What is working well and needs to be
continued or expanded;
What is not working well and needs to
be discontinued or reformulated; and
How the model of working with young
people, particularly of those who are
marginalized, vulnerable and at risk,
can be more effective and efficient.
5. ASSESSMENT
OBJECTIVES
To assess whether the YFHSs/YFHCs are accessible, acceptable and
appropriate for provision of prevention and support services for adolescents;
To assess whether the YFHSs/YFHCs are tailored to and able to address
the needs of the most vulnerable and disadvantaged adolescents and
young people and adolescents, engaged in risky behaviour;
To define the relevance, efficiency, effectiveness, potential sustainability
of the work of the YFHCs in accordance with WHO/UNICEF criteria;
To explore potential for introduction of a strength-based psychosocial
assessment SSHADESS (provided by UNICEF) and an adolescent substance
use screening tool CRAFFT (provided by UNICEF) in routine work of YFHCs;
To draw up recommendations on YFHSs modernization, scaling up,
introduction of innovations and adjustment to the needs of the most
vulnerable and marginalized adolescents and young people,
strengthening of partnership of YFHCs and CSOs and strategic directions for
UNICEF assistance for further development of YFHSs serving the
improvement of adolescents’ health and healthy behavior.
6. ASSESSMENT SCOPE
Both national and local
Nationally, the assessment
will focus on national
programme strategies,
policies and legal framework
as well as the financing
mechanism.
Locally, the assessment will
focus on all functioning
YHFS centres established
№ Region Number of
YFHS centers
1 Minsk City 8
2 Vitebsk. 4
3 Brest 4
4 Grodnen 2
5 Gomel 6
6 Mogilev 3
7 Minsk 23
TOTAL 50
7. TARGET AUDIENCE
Ministry of Health
Ministry of Education
Ministry of Interior
Ministry of Justice
Ministry of Finance
Local government authorities and heads of the YFHS
YFHC staff
UNICEF & Development Partners
CSOs
16. RELEVANCE
ALLIGNED TO NATIONAL POLICIES
Youth Policy
HIV strategy
RH strategy (Draft)
Presidential Decree #18
ALLIGNED TO GLOBAL HEALTH STRATEGY 2016-2030
ALLIGNED TO NEEDS OF ADOLSCNETS AND YOUTH
17. YOUTH CHALLANGES Youth Friendly Health Services
Mortality due to suicides
Mental disorders
Alcohol and substance
abuse
Sexually Transmitted
diseases
HIV/AIDS
Providing information , skills,
education, counseling and safe
environments for adolescents
Education & Employment
Health promotion & Counselling on
Healthy Lifestyles
Counselling primarily focused on
sexual and reproductive health
Counselling for professional
orientation
Psychological counselling
Counselling on substance abuse
prevention
Abortions
Injuries and violence
19. STANDARD 1: EQUITABLE SERVICES
Criterion 1.1 Policies and procedures regulating
provision of YFH services mostly ensure provision of
YFHS to adolescents
Promoting equal access Restricting equal access
Citizens of the Republic of Belarus are also entitled to receive
medical care in public health facilities outside their place of
residence (Chapter 3, Article 10)
Health services to minors are provided with written consent of
parents, guardians (Chapter 3, Article 18);
Health services may be given anonymously in the manner and on
terms determined by the Ministry of Health of the Republic of
Belarus to citizens of the Republic of Belarus (Chapter 3, Article
10).
Patients diagnosed with STIs and/or HIV are informed in writing
by the health provider about diagnosis and the required
precautions for prevention of infection transmission, as well as
bearing legal liability under the laws of the Republic of Belarus for
intentionally exposing or infecting another person (Chapter 5.
Article 29)
Patient has the right to: i) receive health services; ii) choice of
doctor and health organizations; iii) participation in the selection of
the methods of care; iv) respectful and humane treatment by
health workers; v) receipt of information in an accessible form
about the state of their health, the methods of health service
delivery, as well as the skill of the attending physician, other health
care providers directly involved in providing services; vi) selection
of persons to whom the information may be communicated about
his health (Chapter 9, Article 41)
Compulsory diagnosis of chronic alcoholism, drug addiction,
substance abuse and compulsory treatment is assigned to the
individual by the court in accordance with the legislation of the
Republic of Belarus (Chapter 5. Article 29)
Minors under the age of fourteen to eighteen years of age have
the right to receive simple medical interventions without parent
consent (Chapter 9, Article 44)
Prioritize health service provision, including drug supply, to minors,
women during pregnancy, childbirth and the postpartum period,
the disabled and veterans in accordance with legislation of the
Republic of Belarus (Chapter 1. Article 3)
Policies and procedures regulating provision of YFH services
mostly ensure provision of YFHS to adolescents
20. STANDARD 1: EQUITABLE SERVICES
Criterion 1.1 Policies and procedures regulating
provision of YFH services mostly ensure provision of
YFHS to adolescents
YFHC location defines access patterns of adolescents
91.5%
8.5%
Access to YFHS by residency
Urban
Rural
12.2%
57.7%
10.9%
19.2%
Access to YFHS by age groups
10-14
15-17
18-19
20-30
21. STANDARD 1: EQUITABLE SERVICES
Criterion 1.1 Policies and procedures regulating
provision of YFH services mostly ensure provision of
YFHS to adolescents
Majority of service users
are school students.
Only 4% of service users
are either unemployed or
do not belong to any of the
aforementioned groups of
young people.
43%
27%
14%
12%
3%
1%
School student
Students of secondary special
educational institutions
Sudent of higher education
Employeed
Non-employeed
Other
0% 10% 20% 30% 40% 50%
Access by education status
22. STANDARD 1: EQUITABLE SERVICES
Criterion 1.1&1.2 - Health-care providers and support staff
treat all adolescent clients with equal care and respect,
regardless of status
75%
80%
85%
90%
95%
100%
Other
Specialists
Nurse Registrator Doctor Psychologist
Staff friendliness and willingness to
assist
Yes No DNK
Health-care providers and support
treat all adolescent clients with equal
care and respect, regardless of
status
Almost 90% of respondents reported
friendliness of YFHS staff and their
willingness to assist them,
particularly psychologists (95%).
24% of respondents find difficult to
assess friendliness and willingness
of health providers and support staff
as 98% of them paid only one visit to
the YFHC.
23. SUMMARY ASSESSMENT:
EQUITABLE SERVICES
CHARACTERISTICS STATUS COMMENT
1.1 Policies and procedures are
in place that does not restrict
the provision of health services
on any terms.
Partly. Policy and regulations, as well as
procedures mostly promote free access to service
for all in need, though there are some remaining
limitations impeding access of most vulnerable.
1.2 Health-care providers treat
all adolescent clients with equal
care and respect, regardless of
status.
Ensured. YFHS providers administer same level of
care and consideration to all adolescents
regardless of age, sex, social status or any other
reason.
1.3 Support staff treats all
adolescent clients with equal
care and respect, regardless of
status.
Ensured. YFHS support staff administer a same
level of care and consideration to all adolescents
regardless of age, sex, social status or any other
reason.
24. STANDARD 2: ACCESSIBILITY OF YOUTH FRIENDLY
HEALTH SERVICES
Criterion 2.1: Policies and procedures are in place that ensures
that health services are either free or affordable to adolescents
92%
2%
6%
Availability of free services at
YFHC
Yes
No
DNK
Payment is required only for those service
that are not provided by the YFHCs and for
which the adolescent is referred to other
health facilities and requests to receive
these services anonymously
1.6% paid for services provided by the
center out of which 14% considered
payment difficult to afford
Those who had to pay for services were
above 18 years (20-30 years old) not eligible
for receiving services in Child policlinic
serving children up to 18 years
25. STANDARD 2: ACCESSIBILITY OF YOUTH FRIENDLY
HEALTH SERVICES
Criterion 2.2: The point of health service delivery has convenient
hours of operation
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
8:00 -10:00 10:00 - 12:0013:00 - 15:0015:00 - 17:0017:00 - 19:00
MON TUS WED THU FRY SAT
Adolescents interviewed expressed
their concerns about working hours of
the center impeding access to services
as the opening hours coincide with the
school period and extracurricular
activities
While these concerns are understood
by some YFHS centers, local
regulations restrict centers to change
operating hours.
26. STANDARD 2: ACCESSIBILITY OF YOUTH FRIENDLY
HEALTH SERVICES
Criterion 2.3: Adolescents are well informed about the range of
available health services and how to obtain them
2%
8%
9%
11%
19%
28%
46%
0% 20% 40% 60%
Other
Vounteers, outreach workers
Parents/Relatives
Media
Health Providers
Friends, Peers
School
Source of information about YFHC services
0%
20%
40%
60%
80%
100%
Organizationofcenter
services
Avaialbleconsultations
Availabilityoflaboratory
tests
Resultsofdiagnostic
tests
Treatment
Recommendations
Information received
Yes No DKN
Clients using YFHSs are well informed about organization of services at the center, about available
consultations and diagnostics possibilities.
27. STANDARD 2: ACCESSIBILITY OF YOUTH FRIENDLY
HEALTH SERVICES
Criterion 2.4: Community members understand the benefits that
adolescents will gain by obtaining the health services they need,
and support their provision
0% 20% 40% 60% 80% 100%
Schools
Secondary specialised education
institutions
Law enforcement structures
NGOs
Social Protection institutions
Higher education institutions
Working relations with different institutions
Regularly Sometimes Often Don't work
Less than 40% of centers have regular
work relationship with schools and
around 65% of centers have occasional
interaction with schools.
YFHCs are less actively involved
working with higher education
institutions and other institutions (law
enforcement and social protection).
28. STANDARD 2: ACCESSIBILITY OF YOUTH FRIENDLY
HEALTH SERVICES
Criterion 2.5: Some health services and health-related
commodities are provided to adolescents in the community by
selected community members, outreach workers and adolescents
themselves
Provision of health commodities to adolescents within communities and/or by
volunteers/peers is not practiced, though volunteers promote dissemination of information
and materials YFHCs are less actively involved working with higher education institutions
and other institutions (law enforcement and social protection).
Number of Volunteers trained by YFHCs mounted from 58 in 2010 to 1366 in 2012, but
number of trained volunteers decreased by 27% in 2014
Each YFHC apply their own methodology for training volunteers and facilitates development
of the annual plan of volunteer activities.
Annual volunteer work plans differ from center to center
29. SUMMARY ASSESSMENT: ACCESSIBLE
SERVICES
CHARACTERISTICS STATUS COMMENT
2.1 Policies and procedures are in place
that ensures that health services are
either free or affordable to adolescents.
Partly, Services provided by YFHCs are free of charge, however
small share of adolescents have to pay for services when referred
for other health services and 35% of those who pay find difficult to
afford.
2.2 The point of health service delivery
has convenient hours of operation
Partly, some clients prefer evening hours for seeking services at
YFHC, which is not always available in all centers.
2.3 Adolescents are well informed about
the range of available reproductive health
services and how to obtain them.
Ensured. Adolescents are aware of what health services are being
provided, where they are provided and how to obtain them. Albeit
more effective information sharing mechanisms have to be
developed particularly reaching MARA and male adolescents.
2.4 Community members understand the
benefits that adolescents will gain by
obtaining the health services they need,
and support their provision.
Partly, community members at schools are well informed about
benefits of YFHS, however lack reactiveness to refer adolescents
with problems and risky behavior to the centers. Level of
information of parents desires improvement.
2.5 Some health services and health-
related commodities are provided to
adolescents in the community by selected
community members, outreach workers
and adolescents themselves
x
Not ensured. Distribution of any commodities to adolescents by
the community members is mostly not practiced. Albeit volunteers
attempt to deliver information to their peers, they lack adequate
number of information materials for distribution.
30. STANDARD 3: ACCEPTABILITY OF YOUTH FRIENDLY
HEALTH SERVICES
Criterion 3.1: Policies and procedures are in place that
guarantees client confidentiality
Confidentiality is guaranteed by the centers
in majority of cases
Identification Coding of clients is not
introduced and practiced
93% of center staff reported that client
documentation (Service registry and/or
individual specialists visit records) is kept in a
safe place with limited access to them
While the confidentiality is guaranteed by
centers, 5% of respondents consider
services not to be confidential.
Confidentiality is no longer guaranteed when
the client is referred to other health facilities
and/or for other services not provided by the
centers
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Satisfaction with client
confidentiality
Yes No DKN Have not been in contact
31. STANDARD 3: ACCEPTABILITY OF YOUTH FRIENDLY
HEALTH SERVICES
Criterion 3.2: The point of health service delivery ensures privacy
Clients are generally satisfied with the
privacy at YFHCs
90.5% of staff interviewed reported having
separate consultation rooms, whereas
small share of centers lack adequate
space for ensuring privacy
The relatively low level of privacy is
reported for the category “others” which is
explained by difficulties clients face to find
center location
Some centers reported not having
separate entrance to the centers
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Satisfaction with service privacy
Yes No DKN Have not been in contact
32. STANDARD 3: ACCEPTABILITY OF YOUTH FRIENDLY
HEALTH SERVICES
Criterion 3.3 Health-care providers are non-judgmental,
considerate, and easy to relate to
82.6%
4.5%
12.9%
Easy to relate
Yes No DKN
91.4%
1.6%
7.0%
Staff respectfullness
Yes No DKN
68.0%
1.6%
30.5%
Considerate
Yes No DKN
• Eight out of ten respondents find it easy to relate with the center staff
• 90% consider that staff relates to them with respect
• 68% consider their ideas and decisions being considered by the center staff and being never
judged.
• 31% of respondents were not able to assess whether center staff were considerate of their
problems, as majority of them were the first time visitors to the center
33. STANDARD 3: ACCEPTABILITY OF YOUTH FRIENDLY
HEALTH SERVICES
Criterion 3.4: The point of health service delivery ensures
consultations occur in a short waiting time, with or without an
appointment, and (where necessary) swift referral.
• Every 5 adolescent used YFHC services without appointment
• 30% had set appointment for required services
• Almost 95% of adolescents visiting center had to wait only 15 minutes to be served by the
specialist
• More than 15 minutes of waiting time was experienced by only about 6% of clients who came to
the center without set appointment.
• Nevertheless, 44.8% of respondents prefer to have set appointment for receiving required
services promptly
30.0%
55.0%
15.0%
Received consultation by
appointment
Yes
No
DNK
94.1%
4.4% 0.0% 1.5%
Waiting time
< 15 minutes
15-30 minutes
30-60 minutes
>60 minutes
34. STANDARD 3: ACCEPTABILITY OF YOUTH FRIENDLY
HEALTH SERVICES
Criterion 3.5 The point of health service delivery has an appealing
and clean environment.
83.0%
10.4% 6.7%
Satisfaction with environment
Comfortable Inconvenient DKN
• Every eight respondent out of ten find
environment at the YFHC appealing and
confortable
• Only 10.4% of respondents were not satisfied
with the environment at the YFHCs
• Main reasons of dissatisfaction named by
respondents were:
• difficult to orient in the health facility and
find the center,
• lack and/or small space in the waiting
area,
• feeling to be in the medical institution,
• absence of separate entrance to the
center,
• limited information materials available for
taking away, etc.
35. STANDARD 3: ACCEPTABILITY OF YOUTH FRIENDLY
HEALTH SERVICES
Criterion 3.6: The point of health service delivery provides
information and education through a variety of channels
3954
195 246 339
5510
381 232 268
0
1000
2000
3000
4000
5000
6000
No. of
lectures,
round tables
No. of
seminars
No. of
campaigns
No. of
trainings
Provision of information and education
messages by types of interventions
2012 2014
Information that is relevant to the health of
adolescents is available in different formats
(e.g. posters, booklets and leaflets) almost in
all centers.
Materials are presented in a familiar
language, easy to understand and eye-
catching, albeit majority of center managers
and staff report shortage of printed
information material available for distribution
36. STANDARD 3: ACCEPTABILITY OF YOUTH FRIENDLY
HEALTH SERVICES
Criterion 3.7 Adolescents are actively involved in designing,
assessing and providing health services
The Managers of YFHCs fully support engagement and participation of adolescents in the provision of
health services,
Less than half of service points report on the adolescent engagement in service provision
85% of adolescents feel to be engaged in center work and 62% were given an opportunity to propose
improvement for service improvement
45%
55%
-
YFHC manager opinion
Yes
No
DNK
45.2%
35.7%
19.0%
YFHC staff opinion
Yes No DKN
62.3%
84.4%
0.0% 50.0% 100.0%
Propose ways for
service improvement
Engagement in the
center work
Adolescent’ opinion
37. SUMMARY ASSESSMENT: ACCEPTABLE
SERVICES
CHARACTERISTICS STATUS COMMENT
3.1 Policies and procedures are in place
that guarantees client confidentiality. Partly. Majority of YFHS centers ensure confidentiality. Disclosure of the
information to parents and family members is subject to client’s consent.
Register and case records are kept in a secure place, client confidentiality
is hampered when referred to other health facilities and/or to other health
services within the health facility where the center is located.
3.2 The point of health service delivery
ensures privacy. Partly. Majority of YFHS centers ensure privacy at all levels, with few
exceptions where privacy cannot be ensured due to structural (building)
constrains of the facility.
3.3 Health-care providers are non-
judgmental, considerate, and easy to relate
to.
Ensured. Staff in YFHCs is friendly, do not criticize clients and are
considerate to their needs.
3.4 The point of health service delivery
ensures consultations occur in a short
waiting time, with or without an
appointment
Ensured. YFHCs ensure seeing clients immediately, with extremely few
cases when clients have to wait for more than 15 minutes before being
seeing by the specialist.
3.5 The point of health service delivery has
an appealing and clean environment
Partly. The clients of some YFHCs suggest improvements in center
environment to be more attractive and appealing.
3.6 The point of health service delivery
provides information and education
through a variety of channels.
Partly. The clients of some YFHCs suggest improvements in center
environment to be more attractive and appealing.
3.7 Adolescents are actively involved in
designing, assessing and providing health
services.
Partly. In few centers adolescents were involved in center design, but
more are engaged in the daily work of the center and are given an
opportunity to propose improvements.
38. STANDARD 4: APPROPRIATNESS OF YOUTH FRIENDLY
HEALTH SERVICES
Criterion 4.1: The required package of health care is provided to
fulfill the needs of all adolescents either at the point of health
service delivery or through referral linkages.
Generally, psychological, sexual and reproductive health services are being provided and they include family
planning counselling, STI testing and treatment, medical abortion
Nevertheless, significant share of centers refer clients for consultation with urologist, neurologist, medical
abortion and contraception, STI diagnostics and treatment, HIV testing and treatment.
Staff in referral facilities are not as friendly as at centers, and in order to receive services anonymously they
have to pay.
0% 20% 40% 60% 80% 100%
Consultation of Psychologist
Consultation of Pediatrician
Consultation of Gynecologist
Consultation of Urologist
Consultation of Narcologist
Services Available at YFHCs
Provided at YFHC Referred to other facilities
0% 20% 40% 60% 80% 100%
Consultation on Professional…
Consultation on Contraceptives
Diagnostics and treatment of…
Medical Abortions
HCT
Express Testing on HIV
Provision of condoms
Consultation on emergency…
Services Available at YFHCs
Provided at YFHC Referred to other facilities
39. STANDARD 4: APPROPRIATNESS OF YOUTH FRIENDLY
HEALTH SERVICES
Criterion 4.2: Health-care providers use evidence-based protocols
and guidelines to provide health services.
Health-care providers have the required knowledge and skills to work with adolescents and to provide them with the
required health services.
71% of staff interviewed, find themselves well equipped with required knowledge and skills to provide quality services
to their clients
Almost half of interviewed YFHCs reported having some type of subject specific training within last three years
Staff also identified main areas they would like to improve/update knowledge and skills
35%
14%
20%
31%
52%
Last training
1 year ago 2 years ago 3 years ago 5 years ago
0% 50% 100%
Mental disorders among…
Legal aspects of health…
Substence abuse
Approaches and skills for…
Working with adolscents
Case management
STI diagnoses and treatment
Contraception
HIV, Hepatitis and other…
General Management,…
Additional Training Needs
40. STANDARD 4: APPROPRIATNESS OF YOUTH FRIENDLY
HEALTH SERVICES
Criterion 4.2: Health-care providers use evidence-based protocols
and guidelines to provide health services.
0% 20% 40% 60% 80% 100%
Legal and social support
Case management
Management of aggressive…
Utilization of medical waste…
Psychological consultation
Assessment of the quality of…
Protection of children's rights…
Informed consent
Individual record keeping
Confidentiality
Complience with clinical protocols and
procedural guidelines
Always Sometimes Never Never heard of
40.5%
33.3%
2.4%
23.8%
Complience with procedural standards
Always Frequently Never DKN
Clinical guidelines/protocols and procedural standards approved by the MoH are generally applied in the
practice and followed by the YFHS staff
Only 40% of staff reported using procedural guidelines regularly and 33% frequently, while remaining 27%
either don’t use or found difficult to respond to this question
Staff would like to have practice standards and protocols in more areas than currently available
For knowledge building they propose periodic knowledge exchange by meeting other YFHC center staff and or
visiting them
41. STANDARD 4: APPROPRIATNESS OF YOUTH FRIENDLY
HEALTH SERVICES
Criterion 4.3: Health-care providers are able to dedicate sufficient
time to work effectively with their adolescent clients
Staff of YFHC are able to dedicate sufficient time to the client to provide required
services
Adolescents using services also confirmed that the center staff devotes sufficient time
to them
While this is encouraging, small number of clients seeking care in the center can
explain ability of staff to dedicate sufficient time to the client. With the given staffing
levels, if the client flow increases centers may find difficult to comply with this quality
criterion.
42. STANDARD 4: APPROPRIATNESS OF YOUTH FRIENDLY
HEALTH SERVICES
Criterion 4.4: The point of health service delivery has the required
equipment, supplies, and basic services necessary to deliver the
required health services.
Most facilities lack consumables, drugs,
office equipment and supplies
Some facility experience periodic
shortage, while some are permanently
lacking
Some facilities lack the necessary
funding support to be fully functional
0% 20% 40% 60% 80% 100%
Information materials
Office equipment
Supply materials
Office supplies
Medicines
Contraceptives
Other
Availability of required equipment, supplies
necessary to deliver required services
Always Sometimes Never
43. SUMMARY ASSESSMENT:
APPROPRIATENESS OF SERVICES
CHARACTERISTICS STATUS COMMENT
4.1 The required package of health care
is provided to fulfill the needs of all
adolescents either at the point of health
service delivery or through referral
linkages.
Partly. Majority of staff is well equipped with the knowledge
required for provision of quality services, however some unmet
needs yet remain
4.2 Health-care providers use evidence-
based protocols and guidelines to
provide health services .
Partly. There are few clinical protocols and procedural standards
available for use. Those that are available are not regularly
applied into practice.
4.3 Health-care providers are able to
dedicate sufficient time to work
effectively with their adolescent clients
Partly. At present staff devote sufficient time to each client, but
taking into account current level of staffing and small number of
clients served, with the potential increase of client flow in future, will
pose a challenge to qualify this quality criterion.
4.4 The point of health service delivery
has the required equipment, supplies,
and basic services necessary to deliver
the required health services.
Partly. Some centers lack required equipment, medicines and
office supplies required for quality service provision.
45. Targeting of risk group adolescents
1%
3%
5%
10%
18%
19%
22%
54%
0% 20% 40% 60%
Drug users including Spices
Having frequent sexual…
Homosexuals
Having unprotected sex
Drinking alcoholic beverages
Smoker
Having psychological problems
Not belonging to any group
Access by risk groups
Majority of YHFS users belong to relatively wealthy families living either with parents (77.6%) or owing private house
(6.6%) or living in husband’s/parent’s apartment
54% of respondents considered not belonging to any risk groups and 22% had psychological problems.
only 20% of respondents identified themselves belonging to risk groups
Majority of YHFS users belong to relatively wealthy families living either with parents (77.6%) or owing private house
(6.6%) or living in husband’s/parent’s apartment
The implication is that this may just be the tip of the iceberg as MARA are generally not willing to report for fears of lack
of confidentiality and stigmatization. It can be argued that cases against adolescents using drugs, or based on sexual
orientation are far more likely to be under reported given the pervasive social stigmas and taboos Add staff opinion
77.6%
9.2%
6.6%
2.6%
1.3%
1.3%
1.3%
0.0% 20.0% 40.0% 60.0% 80.0%
Parent house/appartment
Student Dormitory
Own house/appartment
Rented appartment/room
House/appartment of…
Public Dormitory
Other
Housing
46. Targeting of risk group adolescents
80% of service users are female young people, and only 20% represent male
Many adolescents lack knowledge and information about available services
0% 20% 40% 60% 80% 100%
IDUs
SW
MSM
Psychotropic substence
abusers
Persons who have frequent,
unprotected sex
Staff opinion on MARA access
Yes No DKN
19.9%
80.1%
Utilization od YFHS by gender
Male Female
47. YFHC financing
Underfunding of the centers results in suboptimal status of infrastructure, insufficient office equipment,
shortage of medicines and supplies thus impeding attainment of quality services.
5%
80%
10%
5%
Funding Sources
Republican budget
Local budget
Extrabudgetary
sources
Mixed
40%
15%
45%
Funding Level
Fully covers
Covers > 80%
Covers <80%
48. Human resources
0% 50% 100%
Psychologist
Pediatrician
Gynecologist
Nurse
Urologist
Narcologist
Dermatovenerologist
Psychotherapist
Valeologist
Lab specialist
Staffing
34.9%
41.9%
14.0%
9.3%
Average number of clients served per
day
<3 clients
3-5 clients
5-10 clients
>10 clients
Staffing of YFHCs differ from centre to centre
Lack of Urologists, Narcologists, Psychotherapists and Dermato-Venerologists
35% of centers reported low utilization of services by clients as on average they serve up to three
clients a day.
49. Access YFHC YFHC
Policlinic
OUTREACH WORKERS
(provided by NGO)
✖
TELEPHONE HOTLINE
Provides confidential
counseling and support,
and encourages contact
with YFHS
OTHER HEALTH
CLINICS
✖
✖
Lab test &
Specialists
Mass media
inform
adolescents
about risks,
safe behaviors
and YFHS
Law Enforcement
Agencies
Child protection
Agencies
SCHOOLS
Occasional Referrals
Referral
Referral
No feedback
Nofeedback
NoReferral
Occasional Referrals
Information&Referral
Information
YFHC fail to established feedback mechanism with referral
health facilities and health specialists due to the confidentiality
reasons. The latter particularly affects the continuity of YFHS,
sometimes needed to cope with the problems adolescents and
young people face.
Service Delivery
50. Information, Behavior Change
Communication
Compared to 2012, in 2014 number of lectures and round table discussions
and seminars carried out by staff of the centers increased, but number of
campaigns and trainings declined.
Considering that majority of adolescents received information about centers at
schools, one can consider increase in number of lectures carried out at schools
is justified, however in the absence of comparable data there are no grounds
for making such assumption
The qualitative information obtained during the FGDs questions efficiency of
Information, education communication strategies applied by centers.
Each center pretends to operate “Hot Line” services, albeit average number of
in-coming calls ranges from 1 to 3 calls per day only
Adolescents not using YFHSs learned about the center when they have been
invited to participate in FGDs
52. Leadership & Governance
The Government of Republic of Belarus was successful to establish enabling
environment for provision of services to adolescents by development and
approval of Youth Policy and creation of conducive legislative framework
The MoH is a key ministry responsible for elaboration of the YFHS policy and
standards, whereas the decision on opening and operation of such centers is
delegated to local governments and local health service management teams,
albeit with limited methodological support.
While the designated Resource Center operates as defined by the MoH Decree,
small number of staff and inadequate funding limits the center to effectively
function.
The latter may pose a challenge to sustainability of YFHS organizational-
methodological function, which is so needed for further enhancement of YFHS in
the country.
53. Service Delivery
All YFHCs are established in the public health facilities either in the child
policlinic or at the district hospital, that guarantees sustainability of these
services
The network of YFHS centers have been gradually expanded from 3
centers (in 2003) to 50 by October 2015 indicating continuous
commitment of the government (Republican and Local) and ownership
to expand services and ensure wider access to YFHSs.
Nevertheless, the way centers are organized and scope services
offered differs from center to center
A need to refer the client along with the lack of feedback mechanisms
practiced between YFHCs and referral facilities/specialists, pose a
challenge to sustain quality YFHSs and ensure access of MARA and
male clients.
54. Finance
Inadequate financing of YFHSs revealed during the assessment
results in suboptimal scope of services and coverage of adolescents,
especially those most in need thus raising the risk of sustaining
adequate service quality.
55. Human Resources
Shortage of specialists at YFHCs is a challenge to the
comprehensiveness of the scope of service centers provide, thus
affecting recruitment of all range of different groups of adolescents
and attainment of the main objective of the YFHS
The system of human resource professional development is well
established and serves as a prerequisite for retaining a certain
standard of friendly service provision to adolescents
Nevertheless, experience generated by the staff for the last decade
indicate a need for expansion of the training program by adding
different thematic training modules.
56. Infrastructure, equipment and
supplies
Shortage of required medical and office equipment, medicines,
supplies and consumables were reported by YFHCs, which obviously
affect sustainment of quality of services provided at present as well
as further improvements
57. Information Systems
The information collection and analysis mechanism effectively
functioning at present, does not allow policy makers (at republican
and local levels) and YFHCs managers to measure benefits
(outcomes) and practice evidence based planning
The latter potentially can have negative implications on further
improvement of service delivery and pose a sustainability risk to the
continuation of YFHC operations, if the benefits of these services are
not well-justified and disseminated to policy makers.
59. Relevance
YFHS is aligned to meet the needs of adolescents and youth in the
country, is coherent with the national and international policies and
strategies and remain relevant in future
60. Effectiveness
Not all YFHCs meet quality standards thus ensuring provision of
needed services
It may therefore be appropriate to evolve a practicable approach that
enables access of young people to quality youth friendly health
services by incorporated standardized definitions and quality
improvement approaches.
61. Efficiency
Utilization of YFHS by adolescents is still very low and this has serious
implications on the adolescent sexuality, growth and development, particularly
among risk groups.
Inadequate funding of the YFHS results in periodic stock outs of medicines,
supplies and consumables, shortage of information materials.
Insufficient staffing with specialists is another factor affecting efficiency of these
centers.
The low level of awareness of YFHS among the adolescents and youth means
that there is a gap between policy makers and the community, which needs to be
bridged by improving on the structures of YFHS information dissemination to the
youth and indeed to the whole nation.
This therefore calls upon all stakeholders to create opportunities that help in
passing this crucial information to the youth, particularly reaching out MARA and
male adolescents.
62. Sustainability
YFHSs institutionalized in the country has good perspectives of
sustainability, albeit some improvements are required to ensure long-
term sustainment of results achieved so far and their further
improvement
The leadership and governance of the YFHSs in Belarus can be
strengthened through standardization of service quality and operational
procedures
The weaknesses are observed in the performance of the designated
Resource Center due to the sub-optimal staffing and inadequate funding
that limits the center to effectively function.
The latter may pose a challenge to sustainability of YFHS
organizational-methodological function, which is so needed for further
enhancement of YFHS in the country.
63. Sustainability
The scope of services to be provided by the center differs among centers and
mainly depends on the location of the center and available staff.
A need to refer the client along with the lack of feedback mechanisms practiced
between YFHCs and referral facilities/specialists, pose a challenge to sustain
quality YFHSs to ensure access of MARA and male clients.
Inadequate financing of YFHSs results in suboptimal scope of services and
coverage of adolescents, especially those most in need thus raising the risk of
sustaining adequate service quality.
Shortage of specialists at YFHCs is a challenge to the comprehensiveness of the
scope of service centers provide
There is a need in expanding the program of continuous medical education for
YFHS specialists
64. Sustainability
The information collection and analysis mechanism effectively
functioning at present, does not allow to measure benefits and apply
evidence based planning.
This potentially can have negative implications on further
improvement of service delivery and pose a sustainability risk to the
continuation of YFHC operations, if the benefits of these services are
not well-justified and disseminated to policy makers.
In summary, the present arrangements of YFHSs open a window of
opportunity for expanding adolescent’s access to YFHS by further
enhancement of the service quality.
66. MoH
Local
Governments
Cost resource
mobilization
Service
Providers
Scale up and expansion,
demand creation
Monitoring &
Evaluation
Assessing YFHS costs
Linking scaling up to
macro-level funding
mechanisms
Introduce exceptions
for adolescent and
youth for anonymous
consultations
Ensure adequate
budgetary allocation
Elaborate special
indicators to assess
the process, outcome
and impact of
strategy
implementation
Revise service
statistics data
reporting forms
Build data analysis
capacity at national,
sub-national and
YFHC level;
Implement special
studies, local needs
assessments,
operational research,
environmental
analysis, etc.
YFHS Resource
Center
YFHS
enhancement
strategy
Methodological Support
Human Resource
Planning &
Development
Establishment of
Resource Center
Development/revision of
YFHS guidelines (
Standards, norms, job
aids, forms)
Refinement of referral
algorithms and follow-up
mechanisms
Statistical data collection,
analysis and preparation
of recommendations for
revision/enhancement of
YFHSs
Knowledge exchange
YFHC certification system
design and
institutionalization
Advocate local
government for scaling
up and expansion of
YFHS
Develop YFHC master
plan
Assess effectiveness of
YFHCs activities
(lectures, round tables;
mass media, etc.) and
elaborate effective
mechanisms for
improved targeting of
male and MARA
population;
Design YFHS logo
Standardize and
institutionalize “Peer to
Peer Education” and
“Volunteer training”
Develop human
resource plan;
Develop subject
specific continuous
medical education
training courses for
YFHC as well as other
health and education
system staff;
Consider integration of
YFHS principles into
the undergraduate
education system
curricula
Institutionalize periodic
knowledge and
experience sharing
between YFHCs;
