Availability, Accessibility, and Quality of Adolescent Sexual and Reproductive Health Services in Urban Health Facilities of Rwanda: A survey among social and healthcare providers
Abstract Background : Access and utilization of quality and comprehensive sexual and reproductive health services (SRHS) is a very crucial point for young adolescents worldwide. This study assessed the quality of SRHS provided to Rwandan adolescents in urban health facilities in terms of availability, accessibility, cost, counseling, with particular emphasis on HIV and family planning-related cases. Method : The study was a descriptive cross-sectional survey conducted during the year 2019 in six selected cities of Rwanda using a mixed-methods approach, including s emi-structured questionnaire administration and in-depth interviews with social and healthcare workers. The study sample consisted of 159 social and healthcare providers ( 54.5 % men and 45.5% women) enrolled by convenience based on their responsibilities in the selected entities. All survey tools were pre-tested. SPSS version 20 served for descriptive statistics analysis of quantitative data, whereas ATLAS TI version 5.2 helped to code and analyze the qualitative data thematically. Results : Overall, the availability of adolescents sexual reproductive health services is satisfactory in more than 80% of health facilities surveyed, but the accessibility is a little bit low for some services. According to the respondents dire, some products available like female condoms are less demanded and often expire unused. In-depth interviews revealed that 94.3% of centers provide information to adolescents on SRHS available, and 51.6% affirmed delivering services at a low cost. One nurse clarified that they render services at a low price if an adolescent has insurance medical coverture. Private health facilities offer HIV testing for free, but for treatment and other services, they channel adolescents to public health facilities. Only 57.2% of respondents mentioned that adolescents are involved in designing the feedback mechanisms at their facilities. Religious leaders and family members may hinder adolescents from seeking behavior. Conclusion : SRHS were generally physically available at most of the facilities but limited in access as not all facilities were allowed to deliver some services. Adolescents were said to face structural and social challenges towards accessing services. There is a need to improve the accessibility of SRH services delivery sites while considering innovative methods to broaden access to services.