September 9, 2010

I. Introduction
1.1.
Background Information
1.2.
1.3.
1.4.
1.5.
1.6.
1.7.
Rationale
Intended Users of the Manual
Health Outcomes to be Achieved
Service Package
Health Service Delivery Points
Service Providers
II. Standards for Adolescent-Friendly Health Services
2.1. Standard 1
2.2. Standard 2
2.3. Standard 3
2.4. Standard 4
III. Criteria of the Quality Standards of Adolescent-Friendly Health Services and Implementation Guide
IV. Implementing Mechanisms at Various Levels
V. Monitoring and Evaluation of the AFHS Quality Standards
References
Annexure

1.1.
Background Information
Adolescents (10- 19 years age group) constitute 22.3% of the population and young people 10 –
24 years of age account for 30.3% of the country’s total population (NDHS, 2008). The youth
(15 – 24 years), on the other hand, comprise 20% of the population with an annual growth rate of
2.1 (YAFS 3, 2002). They face many health and development problems (substance use and alcohol consumption, STI/HIV/AIDS, unwanted pregnancies, nutritional deficiencies, etc) which today affect their lives adversely.
A little less than half (47%) of young people have tried smoking with males being more prone to cigarette smoking than females. However, the prevalence of smoking among young females almost doubled from 17% to 30% in 1994 and 2002 respectively. The proportion of young people who tried drinking alcohol is about 93% in males. Like smoking, the proportion showed an increasing trend among the female populace (54% in 1994 and 70% in 2002). Although the proportion of young people exposed to drugs is significantly lower compared to smoking and alcohol, the proportion doubled from 6% in 1994 to 11% in 2002. Those who smoke, drink and use drugs are more likely to have sex.
The YAFS 3 (2002) data showed that one in three of young people think that it is alright for young men to engage in premarital sex while the approval rate for young women is lower at
22%. A comparison of the results of YAFS 2 and 3 showed an increasing tolerance for women engaging in pre martial sex – 13% and 22% in 1994 and 2002 respectively. With regards the age of first sexual intercourse, the 2008 NDHS showed that among women 15 – 49 years old, 3% had their first sexual intercourse by age 15; 37% by age 19; 57%by age 22 and 71% by age 25.
In addition, 10% of 15-19 years old have begun childbearing (NDHS, 2008). Around 23% of
Filipino youth had premarital sex (2002). This is higher than the 18% in 1994. One out of three youths admitted to having more than one sexual partner beside their first sexual partner.
STI and HIV are issues of concern in the country. The YAFS 3 (2002 ) survey showed that although awareness about STIs is increasing, misconceptions about AIDS appear to have the same trend. The survey also showed that Filipino males and females are at-risk of STIs,
HIV/AIDS. 62 % of sexually transmitted infections affect the adolescents (YAFS 3, 2002) while
29 % of HIV positive Filipino cases are young people. Awareness of AIDS for both sexes was near universal (85%) but misconceptions on its curability have deteriorated. The proportion of those who think AIDS is curable more than doubled (from 12% in 1994 to 28% in 2002). Many adolescents also resort to services of unqualified traditional healers, obtain antibiotics from pharmacies or drug hawkers or resort to advices from friends (e.g. drinking detergent dissolved in water) without proper diagnosis to address problems of STIs. The newly reported HIV cases among 15-24 years old increased sharply from 41 to 218 in 2007 to 2009 (National AIDS
Registry, NEC, DOH).

1.2.
Rationale
In line with the above concerns of the adolescents, several initiatives were undertaken. In line with the Adolescent and Youth Health Policy (Department of Health, Administrative Order No.
34-A, s. 2000), A Guidebook on Adolescent and Youth Health and Development Programme was developed by a multi-sectoral body headed by the Department of Health and supported by the United Nations Population Fund (UNFPA). However, during its implementation (from 2002 to the present), a huge gap developed between the guidelines and their actual use. Adolescents and the youth have limited access to RH services that meet the standards of quality care, user friendly and culture sensitive. Despite the evidence presented in policy documents, most services continue to target adults or children. Thus, these fail to meet the special needs of the youth especially in terms of confidentiality, privacy, accessibility and cost. There is only a handful of health care providers trained to cater to the special needs of the youth. There are also missed opportunities for prevention of health problems because young people are unwilling to utilize available health services. Often, due to insufficient knowledge transfer, new or updated practice guides were not systematically introduced and promoted to improve health service delivery or to advocate for the application of models of best practices. In addition, since most programs were initiated by non-governmental agencies and the private sector, they were limited in coverage and sustainability. Correspondingly, in reference to the Adolescent and Youth Health Program
Implementation Review held in January 2009, the recommendation was to establish s tandards on adolescent-friendly health services .
1.3.
Intended Users of the Manual
This document outlines the four national standards for provision of Adolescent-Friendly Health services and the steps required to implement the standards. It is expected that this document will guide program implementers at various levels in providing adolescent-friendly health services.
The document is also expected to be used by planners and policy makers.
1.4.
Health Outcomes to be Achieved
1.
Healthy Development a.
Promote healthy development b.
Reduce the health and social consequences when developmental problems occur.
2.
Healthy Nutrition a.
Improve healthy nutrition b.
Reduce under/over nutrition c.
Reduce the health and social consequences of over/under nutrition.
3.
Sexual and Reproductive Health a.
Reduce too early, unwanted pregnancy b.
Reduce morality and morbidity during pregnancy, child birth, c.
Reduce Sexually Transmitted Infections/Human Immunodeficiency Virus
(STI/HIV) d.
Reduce health and social consequences of STI / HIV infection when they occur

4.
Substance use a.
Reduce substance use b.
Reduce the health and social consequences of substance use
5.
Injuries a.
Reduce injuries b.
Reduce health consequences (mortality and morbidity) and psychosocial consequences when injuries occur.
6.
Violence (All Forms) a.
Reduce all forms of violence b.
Reduce health consequences (mortality and morbidity) and psychosocial consequences when violence occurs.
7.
Mental Health a.
Improve mental health and well being b.
Reduce mental health problems c.
Reduce the health and social consequences when mental health problems occur.
1.5.
Service Package
Based on the national objectives and strategic thrusts of the Department of Health, Philippines, the following Adolescent Core Package has been proposed for implementation:
CORE PACKAGE OF SERVICES
A.
Key Services
Basic Essential Health Package
Objective of the Package
1.
To provide basic health care and management to all adolescents
2.
To identify the most common health concerns and issues among adolescents
3.
To screen all adolescents for risk-taking behaviors
4.
To render preventive health management and counseling to all adolescents, including on substance use, sexuality, violence and injury prevention, and for improving mental health
B.
Adolescent Pregnancy Package 1.
To reduce rates of adolescent pregnancy through comprehensive health package
2.
To reduce mortality and morbidity brought about by adolescent pregnancy and puerperium
C.
Sexually Transmitted
Infections/HIV Packages
1.
To reduce morbidity and mortality brought about by STIs and HIV
2.
To prevent STIs/HIV and its complications
Source: Manual of Standards for Adolescent-Friendly Health Services, DOH, 2008

The core package will be made available from Rural Health Unit (RHU. However, the district, provincial and tertiary level hospitals will provide services in other areas including substance use, sexual abuse and sexual violence and mental health. They will also cater to clients and patients referred from RHU and BHS.
1.6.
Health Service Delivery Points
The services will be given at the following health service delivery points: Retained hospitals / provincial / district hospitals, Rural Health Unit. Innovative mechanism for utilization of other facilities, including but not limited to social hygiene clinic, schools, “one-stop-shops”, workplace, shopping malls, sports centers, youth hang-outs, will be utilized by the government in coordination with non-government and other private institutions.
1.7.
Service Providers
The following health providers, both at the health and non-health sectors at the above-mentioned health service delivery points which include doctors, nurses, and midwives (DOH AO 34-A) will provide the services. Community-based volunteers, peer group leaders, psychologists and counselors and other staff (e.g. pharmacists and others) will also provide appropriate services depending upon the circumstances.

The right to health, according to the UN Committee on Economic, Social and Cultural Rights, consists of six normative elements namely health availability, health physical accessibility, health economic accessibility, health information accessibility, health acceptability and health quality (see Annex 3: Guiding Principles). WHO’s criteria for adolescent-friendly health services include services being equitable, affordable, acceptable, adequate, comprehensive, effective, and efficient (See Appendix 4: Standard and Criteria Definitions).
Cognizant of the right of the adolescent to the highest attainable standard of health through improved access and utilization of health services and the WHO criteria for provision of
Adolescent Friendly Health services, the Philippines adopts four national standards for the provision of Adolescent-Friendly Health Services:
Philippines National Standards for Adolescent-Friendly Health Services :
A standard is a statement of desired quality. The four quality standards for provision of
Adolescent-Friendly Health Services (AFHS) were developed to ensure that adolescents will be able to enjoy a variety of facilities, goods, services and conditions necessary to realize the highest attainable standard of health. These standards are in line with the WHO's criteria for
Adolescent-Friendly Health Services and with the policy documents that exist in the country.
These standards will also apply to health services that address the needs of youth.
Standard 1 " Adolescents in the catchment area of the facility are aware about the health services it provides and find the health facility easy to reach and obtain services from it".
Standard 2 “The services provided by health facilities to adolescents are in line with the accepted package of health services and are provided on site or through referral linkages by welltrained staff effectively”.
Standard 3 “The health services are provided in ways that respect the rights of adolescents and their privacy and confidentiality. Adolescents find surroundings and procedures of the health facility appealing and acceptable”.
Standard 4.
“An enabling environment exists in the community for adolescents to seek and utilize the health services that they need and for the health care providers to provide the needed services”.
The standards criteria were developed keeping in view the necessary resources, operational activities and the expected outcomes. The National standards will ensure that services being provided to the adolescents are uniform across all the service delivery points and are relevant to the present day needs of the adolescents. It is expected that adhering to the laid down standards would improve the utilization of such services.

Standard 1: " Adolescents in the catchment area of the facility are aware about the health services it provides and find the health facility easy to reach and obtain services from it."
Rationale: Adolescents are generally not aware about the availability of health services that cater to their needs. They either do not know about the location of the facility that provides health services in an adolescent friendly manner or the type of services that are available from the facility. Thus despite the availability of these services and competent personnel to provide such services, there is a low utilization rate of such services. Some of the reasons for low utilization could be the lack of informational activities to promote the adolescent services provided by these facilities; accessibility of the facility in terms of distance, cost and time; or the affordability of services. Actions are to be taken to ensure that adolescents are well-informed about the availability of health services.
Input Criteria
I1.1. - There is a well-defined plan to inform adolescents in the community as to the availability of services from the facility
Output Criteria
Adolescents are aware about the type of services from the health facility, their working days and hours and know that they are welcome.
Process Criteria
P1.1.-Activities to inform adolescents about the availability of services from the facility are carried out as per the existing plan.
I1.2. - Health facility has a signboard which indicates
-the type of health services that are provided
-when they are provided
-that adolescents are welcome
I1.3. -Flexible time schedule for adolescent clients, if possible, is in place,
I1.4. -Policies and procedures to provide health services to adolescents free of charge or at affordable prices are in place.
I1.5. -A plan to provide outreach health services to adolescents, particularly those belonging to special groups in the catchment area of the health facility, is in place
P1.3.- Health services are provided as per the flexible time schedule
P1.4. -Service providers provide adolescent with services free of charge or at affordable prices in line with the policies and procedures.
P1.5. -Outreach services are being delivered to special groups of adolescents as per the plan.

Implementation Guide:
1.1.
Elements of a plan to inform adolescents.
The IEC plan should contain the activities for information dissemination, place and time frame that they will be conducted, persons responsible, the resources needed, as well as the evaluation indicators and methods. In terms of activities, the facility may conduct periodic community sessions, information dissemination activities in schools especially during home room period, produce and post billboards in community areas being frequented by community residents especially the adolescents, and seminars in schools during special occasions. Posters containing the services in the facility may also be posted in strategic locations in the community. The information material, such as flyers, which can be distributed to adolescents during community festivities, after school hours, and in malls where adolescents usually go to, should contain the services available, time and place where these are available as well as the contact persons. Linkages with ongoing programmes of various departments can be established and, if available, "peer group workers" and volunteers of various health programmes should be informed about the services.
1.2.
Appropriate signboard.
The facility is to have an appropriate signage in the health facility reflecting the services being provided and when they are provided. Tarpaulin, banners or posters stating that adolescents are welcome in the facility are posted/placed in an area in the facility that can easily be read by the adolescent clients.
1.3.
Use of a flexible time schedule.
It is advisable to have facility timings that suit the needs of the adolescents. In government-owned and operated facilities, services are offered on the usual schedule which is 8:00 AM to 5:00 PM. However, some private and non-government facilities should have flexible time schedule so that they can cater to the needs of adolescents who may be engaged in other activities during the 8:00 AM to 5:00 PM schedule. The services could be offered from 7:00 AM to 10:00 PM, on a 24-hour basis,
Saturdays and Sundays in these facilities.
1.4.
Provision of 'free' health services.
Government facilities offer health services to adolescents without any charges. As much as possible, services for adolescents should be given for free from other facilities, too. However, considering the expenses incurred for the maintenance and improvement of the facility vis-a-vis the budget given for the operation of these facilities, LGUs may resort to cost-sharing schemes. The amount to be paid should be by consensus and reached through consultations with different stakeholders including the clients, services providers, representatives from agencies concerned with adolescent care, community and even the government through the barangays. The cost of services and/or commodities will be posted in strategic places to inform the clients, general population and all stakeholders.
Private and non-government organizations may also institute schemes to sustain the operations of their facilities. Some of their services can be availed by adolescent clients at affordable prices or in a subsidized form.

1.5.
Elements of a plan to provide outreach services to adolescents.
Outreach services are needed to provide services to follow-up outcome of cases and / or defaulters, adolescents as the "first contact" services in hard to reach areas and / or clients with special needs, cater to special circumstances (i.e. victim of abuse/violence, etc). These outreach activities should be planned. The plan should include the date and time, place, the personnel to conduct outreach, the services to be given, resources needed, other agencies involved (if any) and the assistance that these agencies/organizations will provide. The outreach provider must have the necessary supplies.
Outreach activities may include periodic health check-ups, mobile clinics, community health camps, education sessions utilizing the available IEC material, home visitation, and use of traditional media such as puppet shows and psychodrama. The provider should develop and maintain linkages with peer educators, volunteers, school teachers, school physicians and school nurses (where available), personnel from youth centres and other relevant agencies and develop joint activities to provide services. The provider should link up with schools to organize "question box" activities in the schools. The general questions could be taken up during the school health assembly.

Standard 2: “The services provided by health facilities to adolescents are in line with the accepted package of health services and are provided on site or through referral linkages by welltrained staff effectively”.
Rationale: Some of the health needs of adolescents may appear to be similar to those of adults
(Example: ANC services, services for STIs, etc) yet the unique characteristics of this age group in terms of their physical, physiological, psycho-emotional, and even socio-cultural aspects necessitates that the needed services be provided in line with the required package effectively. In many cases the services that meet the adolescents' needs are either not fully provided from the health facilities or the services that are provided are not effective. This standard ensures that protocols, guidelines as well as services as per the accepted package that cater to the special needs of individuals in this age group are available from the designated health facilities.
This standard also ensures that the staff of adolescent-friendly health facilities possesses the necessary knowledge, attitude, skills and behavior to deal with their target clients
Input Criteria
I2.1. -An agreed upon
'package' of services to be provided to adolescents is in place.
I2.2. -An agreed upon list of essential commodities and supplies is in place
Process Criteria
P2.1. - Services provided / delivered on site or through referrals are based on the agreed upon adolescent health package
P2.2. -The essential commodities and supplies as per the agreed upon list are available and are provided to adolescents.
Output Criteria
The services provided by the health facilities are effective and in line with the accepted package of services, and are provided on site or through referral linkages by well trained staff. The adolescents find the services to be in line with the defined package of services.
I2.3. -A focal person has been designated for provision of adolescent-friendly health services.
P2.3. -The focal person actually provides services to adolescents either at the facility or through referral and coordinates other activities.
P2.4. -The facility staff utilizes their competencies to provide health services effectively and competently.
I2.4. -Service Providers have been trained / oriented for the provision of AFHS and are competent in managing adolescent clients and providing guidance to their parents.
I2.5 -Protocols / guidelines to provide services competently in non judgmental, caring, considerate, and gender and culturally-sensitive attitude and manner are in place.
I2.6. -Clinical management
P2.5. -The service providers follow the protocols
/guidelines to provide services competently and with a nonjudgmental, caring, considerate and gender and culturally sensitive attitude and manner
P2.6. -The service providers

guidelines for the provision of the specified health services are in place
I2.7. -A resource directory of organizations and referral networks providing health services that are not provided at the facility is available.
I2.8. -Appropriate forms for referral and feedback are available follow the clinical guidelines for provision of services.
Implementation Guide:
2.1. The package of health services to be provided. The list of essential health services to be provided to the adolescents as packages include basic essential health package, adolescent pregnancy package and STI/HIV package. The components of the package may be modified in the future as evidence for specific components are updated periodically by the Department of Health.
Package of Services Specific Services
Basic Essential Health
Package
P2.7.-The resource directory is utilized to refer the needy adolescents for the particular services that are not available at the facility.
P2.8. -The appropriate forms are utilized for referral and feedback
General Health Assessment – History (HEADSS) and Physical
Examination, including blood pressure measurement, vision and hearing screening
Dental Assessment
Psychosocial Risk Assessment and Management
Nutrition Assessment and Counseling
Micronutrient Supplementation- Iron and Folic Acid
Immunization – TT, MMR, Hepatitis B
Basic Diagnostic Tests (CBC, Urinalysis, Fecalysis, sputum
PPD)
Reproductive Health Assessment and Counseling

Fertility awareness, menstrual health issues and counseling

Pap smear and pelvic exam if sexually active

Adolescent male reproductive health issues

Gender issues
Voluntary Testing for STIs /HIV
Adolescent Pregnancy
Package
Prenatal visits

History and Physical Examination

Immunization – Tetanus toxoid


Micronutrient supplementation with iron, folate

Psychosocial risk assessment

Laboratory – CBC, blood typing (if not available, refer), pregnancy test, urinalysis

Pregnancy counseling

Nutrition counseling

Birth plan including exclusive breastfeeding counseling

Family planning counseling
Natal (Birthing Homes)

Safe delivery by skilled health worker at a mother-and baby friendly health facility

HBsAg test for pregnant mothers

Essential Newborn Care Protocol

Newborn package:, Vitamin K, Hepatitis B – birth dose,
BCG, eye prophylaxis, Newborn Screening
Postnatal Visits

Micronutrient Iron supplementation

Counseling services: Family planning, Nutrition counseling,
Exclusive Breastfeeding, Parenting
Sexually Transmitted
Infections/HIV Packages
History and Assessment Forms
Diagnostics: Grams Stain, RPR, C/S, Pap smear, HIV
Counseling
Psychosocial risk assessment
Management, Treatment and Counseling
2.2. Essential medicines, equipment and supplies. At the minimum, the following basic medicines, equipment and supplies needed in the provision of services should be present:
Essential Resources
Basic Essential Health Package
Writing materials, Individual Treatment Record Forms (ITR),
Dental mirror, Dental record form, Dental Equipment
Psychosocial Risk Assessment Form
BP apparatus, Adult weighing scale, tape measure, height chart, orchidometer, dietary prescription form, exchange list
Iron with folic acid tablets
Vaccines: Tetanus toxoid, MMR, Hepatitis B
Centrifuge, heparinized capilet, microscope, syringes and needles, cotton, alcohol, slides, cover slip, vaginal speculum, cotton pledget
ITR, Reproductive Health Assessment Checklist, Flipchart on reproductive health
HIV testing kit, microscope, glass slides, reagents for Gram’s stain

Adolescent Pregnancy Package
ITR, FP flipchart, iron tablets, blood typing and Rh sera, pregnancy test, centrifuge, microscope, TT vaccine, syringes, cotton balls, alcohol, FP commodities
HBsAg reagent, birth plan form, NBS kit, BCG, Hepatitis B vaccine, delivery table, sterile scissors, gloves, cotton, alcohol, plastic clamp, equipment and supplies as per BEmONC guidelines
Iron tablets and vitamin A capsules, FP flipchart, FP commodities, Breastfeeding chart, diet plan
Sexually Transmitted Infections/HIV Packages
ITR
Reagents for Gram’s stain, RPR, Glass slides, microscope, cotton pledgets
Counseling Cards or Chart
2.3
Focal person in the health facility.
The facility must have a designated focal person who will render services to adolescent clients and coordinate within and outside the facility.
She / He should be oriented by attending orientation /training programs on dealing with adolescent clients such as the Orientation Program on Adolescent Health and Adolescent Job
Aid (AJA). The focal person must provide the services to adolescents either at the facility or through appropriate referral and coordinate with parents, opinion makers and institutions – educational, NGOs, community-based organizations, media and with referral institutions.
2.4
Capability building for AFHS service providers.
It would be preferred that like the focal person in the facility, other service providers who are likely to deal with adolescents must have the competencies to deal with adolescents and their health needs effectively. They should attend capability building programs so that they can deal effectively with their adolescent clients. Programs include Orientation Program on Adolescent Health, Orientation on Standards and Implementation Guide for AFHS, Adolescent Job Aid.
2.5
Dealing in a non-judgmental and caring manner with adolescents.
The adolescent client should be dealt with respect and shown all courtesies that are due to a human being.
Facility staff should be polite and considerate and avoid making any hurtful or damaging remarks for what so ever reason. Service providers must cultivate a non-judgmental attitude and not deprive adolescents from appropriate services on extraneous grounds including those on gender, education, social class, marital status, religious and political beliefs, and orientation. They should deal with adolescents sensitively and in a caring and considerate and gender and culturally-sensitive manner. Clinic Rooms must have window curtains and a bedscreen surrounding the examination tables. Nobody else should be allowed to enter the room when the client is already there, in order to ensure privacy. Confidentiality policy of the clinic should be displayed and clearly expressed to the client and the individuals accompanying them in the first session itself.
2.6
Clinical management of adolescents.
The Adolescent Job Aid (AJA) that was developed by a multi-sectoral group spearheaded by the DOH will be used for the common conditions of adolescents. The service provider should also refer to other relevant clinical

guidelines (STI, management of specific conditions, general guidelines) that are periodically issued / circulated by DOH.
2.7
Resource directory of individuals/organizations and referral networks.
All facilities must develop a resource directory that should contain contact details of the relevant institutions and individuals. The resource directory should include the names of the organization/individual, address, contact person as well as contact details including the telephone numbers, email address or websites
The national level Resource Directory is being provided.
1
3
2
4
5
8
9
6
# NAME /
POSITION
Maristela P. Abenojar
Jill S. Alvarez /
Program Manager
Resource Directory of Individuals and Organizations
COMPANY / ORGANIZATION /
COMPLETE ADDRESS
CONTACT DETAILS
Philippine Nurses Association (PNA)
1663 F.T. Benitez Street
Malate, Manila
FAD, Inc.
1066 Remedios Street corner San
Bartolome Street
Malate, Manila 1004
DL/ 5361888
F/ 5251596
M/ 09273448505 e-mail/ maris_presto@yahoo.com.ph
DL/ 4001827 / 5250428
F/ 4001827
M/ 09155196598 e-mail/ fadthqctrl@pldtdsl.net
/ jill.alvarez@gmail.com
Elmer M. Angus, M.D. /
Immediate Past
President
Pamela Averion /
National Programme
Officer
Marciano Fidel L.
Avendaño /
President
Edna A. Beguia /
PRO
Philippine Academy of Physicians in
School Health, Inc. (PAPSHI)
UNFPA
Gender & Culture and ARH
Private School Health Officers Association c/o Lourdes School Quezon City
Don Manuel corner Kanlaon Street, Sta.
Mesa Heights, QC
IMAP, Inc.
Pinaglabanan Street corner Ejercito Street,
San Juan City
Brgy. Kiloloron, Real, Quezon
DL/ 5243011 local 4410
F/
M/ 09209540992 e-mail/ macarthur_52@yahoo.com
DL/ 9010328
F/ 9010348
M/ e-mail/ averion@unfpa.org
DL/ 7315127 local 111
F/ 7315127 local 119
M/ 09177938846 e-mail/ dr_jun_avendano@yahoo.com
DL/ 7244849 / (042) 3311311
F/ 7275225 / (042) 5366353
M/ 09053440173 e-mail/ edna_beguia@yahoo.com
Deborah B. Cabanag
Marlene de Castro /
Executive Director
10 Jonathan D. Chua
11 Gloria Cirineo
12 Erlyn Della-Caparro,
M.D.
NAPC Youth & Students
3 rd Floor ATI Building, Elliptical Road,
Quezon City
Baguio Center for Young Adults, Inc.
33 Assumption, Baguio City
NAPC-YSSSC
AFRHS Network
Society of Adolescent Medicine of the
Philippines, Inc. (SAMPI)
DL/ 4265028
F/
M/ 09182567492 e-mail/ debbie_cabanag@yahoo.com
DL/ (074) 4450623
F/ (074) 4428193 (telefax)
M/ 09189102124 e-mail/ mbdc_bcya@yahoo.com.ph
DL/
F/
M/ 09288571932 e-mail/ jonathanchua_02@yahoo.com
DL/ 8205215
F/
M/ e-mail/ gloriacirineo@yahoo.com
DL/ 4948298
F/

13
14
Moses de Guzman /
Adolescent Medicine
Specialist
SAMPI
Bahay ng Alumni
University of the Philippines
Diliman, Quezon City
M/ 09238115729 e-mail/
DL/ 9246601 local 272
F/
M/ 09195872444 e-mail/ dittsdeguzman@yahoo.com
Robinson F. Espinoza /
Chief of Policy and
Planning Division
15 Denia Gamboa /
Head, Public Affairs and Information Office
18
19
16 Dexter M. Garcia /
Project Officer
17 Dr. Arvin Marbibi
National Youth Commission
373 Quezon Ave., Quezon City
Council for the Welfare of Children
10 Apo Street, Sta. Mesa Heights
Quezon City
TRIDEV Specialists Foundation
DL/ 7812373
F/ 7812373
M/ 09189217915 e-mail/ robin_espinoza@yahoo.com
DL/ 7811039 local 1006
F/ 7811039 local 1006
M/ 09294208481 e-mail/ denia_3154@yahoo.com
DL/
F/
M/ 0917-8512782 e-mail/ dexgarcia@hotmail.com
Robert T. Mendoza /
President (Hospital
Based)
Dr. Rosa Maria H.
Nancho
AFRHS Network
Philippine League of Government and
Private Midwives, Inc.
PGH-Society of Adolescent Medicine of the
Philippines, Inc. (SAMPI)
DL/
F/
M/ e-mail/
DL/
F/
M/ 0908-933-1659, 0908-7110805 e-mail/
DL/ 9316251 / 9315898
F/ 3733461
M/ 09178294968 e-mail/ rosenan830@yahoo.com
DL/ 7329956
F/ 7114846
M/ 09185836580 e-mail/ litaorbillo@yahoo.com
20
21
Lita Orbillo /
Nurse VI
Dr. Luz P. Revita
22 Ma. Loida Y. Sevilla /
Country Health
Advisor
NCDPC-DOH
Philippine Academy of Physicians in
School Health, Inc. (PAPSHI)
DL/920-1342
F/ 928-6051
M/ 0922-8309044 or 0918-9309041 e-mail/ lprevita@yahoo.com
23 Cherryl Mendoza
Nurse
24 Dr. Alicia Tamesis
Plan International, Philippines
104 Salustiana Ty Tower
Paseo de Roxas Ave., Makati City
Adolescent Wellness Center
Teen Health Hub
The Medical City
Ortigas Avenue, Pasig City
Teen Republic
Philippine Children’s Medical Center
Quezon Avenue, Quezon City
DL/ 817-3187
F/ 840-3940
M/ 0917-5012145 e-mail/ malou.sevilla@plan-international.org
T/635-6789
By Appointment
T/924-6601
Loc 234 and 294
2.8
Referral form . A referral form which contains the name of the referring facility and service provider, client’s details (name, age, address), history of present condition, physical/laboratory findings if appropriate, name and address of the facility where the client is to be referred, and reason for referral must be in place. A return referral form should be present and the client be instructed to bring this back to the referring facility. The referral form should be sealed in envelope and addressed to the service provider of the facility to which the client is being referred to. All referrals made and their outcome should be listed in a referral logbook that should be maintained at the facility.

Sample Referral Form
REFERRAL FORM
(To be left in the Referral Facility)
Reference number ----
Name of Referring Facility:
Address: Tel No:
Name/Position of Service Provider Referring: Date of Referral:
Name of the facility to which the client is being referred :
Age: Name of Client:
Address:
Reason for Referral:
Brief History (Include pertinent PE and laboratory findings and actions taken, if any.)
Clinical Impression:
Signature of Person Referring Signature Over Printed Name of Client/Guardian:
REFERRAL RETURN SLIP
(Please cut and instruct patient/guardian to deliver back to Referring Facility)
Reference Number -----
Name of Referral Facility:
Address: Tel No:
Name/Position of Person Who Attended to the Patient: Date Seen:
Final Diagnosis:
Actions Taken (Include results of laboratory/ancillary procedures done and management)
Follow up advice:
Signature of Person Who Attended to the Patient:
Signature Over Printed Name of Client/Guardian:

Standard 3 “The health services are provided in ways that respect the rights of adolescents and their privacy and confidentiality. Adolescents find surroundings and procedures of the health facility appealing and acceptable”.
Rationale: Adolescents will not seek services if the physical environment and procedures are not appealing to them. While ensuring the adolescents’ comfort and ease at the facility, it is crucial that the privacy and confidentiality of adolescents should be preserved and maintained throughout. Aside from the quality of services and attitude of personnel, the condition and features of the facility will also help contribute to client satisfaction and quality of care. It is important to get feedback, suggestions and recommendations from adolescents to be able to design facilities, procedures and protocols that will appeal to adolescents as well as suit their needs and taste.
Input Criteria
I3.1. –Standard operating protocols
(SOP) to maintain a good ambience for adolescents - including a clean spacious waiting area, potable drinking water, clean toilets and educational material are in place
I3.2. -The confidentiality and privacy policy of the facility is clearly displayed in the clinic and is clearly expressed to the client and their parents or accompanying adults.
I3.3. -Health facility procedures to ensure confidentiality of the adolescent clients and their parents are in place.
I3.4. -Health facility procedures to ensure privacy for the adolescent clients and their parents are in place.
I3.5. -Protocols for the staff to provide services in a friendly and appropriate manner are in place
I3.6. -Mechanisms to involve adolescents in the designing, assessing and provision of health services are in place
I3.7. -Flow design of utilization of services to keep the waiting time short and informative is in place.
Process Criteria
P3.1 - Facilities are maintained / provided as per the SOP
P3.2. -Health facility displays the confidentiality and privacy policy and adolescents and parents and accompanying adults are informed about it at all available opportunities.
P3.3. -Health facility staffs apply the procedures to ensure the confidentiality of their adolescent clients and their parents.
P3.4. -Health facility staffs apply the procedures to ensure privacy for their adolescent clients and their parents. (including private room for consultation, simplified registration process)
P3.5. -Service providers follow the protocols to provide services to adolescents in a friendly and appropriate manner.
P3.6. -Adolescents are kept involved in designing, provision and assessment of health services
P3.7. -The designed flow to keep the waiting time short is followed. The waiting time is filled in by holding informative sessions
Output Criteria
Adolescents feel comfortable when they visit health facility and find the surroundings and procedures appealing and acceptable.
Services to adolescents are ideally provided within 30 minutes of their arrival in the facility.

Implementation Guide:
3.1
Ambiance of the facility.
The facility should:

Provide comfortable seating with proper ventilation, good lighting, fans, and reading/information materials.

Provide access to clean drinking water and clean toilets. A separate toilet for female should be provided

Provide appealing reference (posters, audio-video, reading) material for the adolescent to browse through while waiting.
For a stand alone clinic: The clinic within the facility should be located preferably in a separate room that provides the needed privacy so that the adolescents are comfortable in accessing services from it
This set-up will ensure that the facility is appealing to adolescents. This will also make the adolescents feel comfortable while availing services in the facility.
3.2
Confidentiality and privacy policy.
The confidentiality and privacy should include provisions stating the mechanisms for registration, the filing and storage of records
(records keeping), access to these records (specifying the personnel who can access to these records as well as protocols to follow if people outside of the health facility would want to access records and information), general guidelines on non-disclosing information regarding the patient, designated spaces for provider – client interaction to provide audio-visual privacy, provision of barriers such as curtains, separate rooms, etc.
3.3. Ensuring confidentiality.
Clients and their accompanying adults should be informed about the measures to maintain confidentiality. Each client should have an envelop or folder where their Medical records (ITRs), results of laboratory examinations or other special procedures done, referrals and other pertinent documents are filed. These are filed depending on a prescribed system (by numbers, family name, barangays, etc). As much as possible, there should be a designated room with lock and key where these records should be filed. If this is not possible, these records should be kept in a filing cabinet with lock and key. There will be designated personnel with access to these records. They will only be pulled out only if a client – provider interaction will occur or in any situation as may be necessary. Personnel working outside the facility should have a written request if they want to access to the clients’ records for purposes of research, follow up, etc. A verbal/written consent of the client should be obtained before information contained in their records will be disclosed to outside parties. The staff should not discuss the client’s situation with non-concerned parties.
3.4. Ensuring privacy.
Audio and visual privacy of the client must be maintained. As mush as possible, there should be a separate room where provider – client interaction should take place and where examinations such as pap smear, physical examination, etc should be done. If it is not possible to provide a separate room, barriers such as curtains should be provided. The provider should only attend to one client at a time not unless the clients

request that they be counseled together with other clients with similar problems or with friends/families/significant others. Specifically, the following must be observed:

Ensure that the consultation and examination are done in a place where the interaction between the health worker and the adolescent cannot be heard or seen by anyone else;

Ensure that no interruption occurs when a consultation or examination is in progress
(like phone/text calls, signing papers, etc)

Ensure that no needless delays occur;

Ensure that the adolescent is clear about what to do (e.g. by labeling the different rooms such as pharmacy, and providing clear instructions as to where to go, have a lab test and when to come back for the results).
Examples: Privacy and Confidentiality
# 1 - “We will be spending some time to talk about Maria’s history, especially her immunization, past illnesses and your concerns about her health. After that, I would like to spend some time alone with Maria. After I have examined her, I will ask you in again and we can discuss my assessment and our plans, any laboratory tests, treatments and follow-up plans. Is that all right with you?”
# 2 – “First of all, I would like to say that whatever we talk about in this interview will be kept strictly confidential. Do you understand what is meant by confidential Maria? Or would you want me to explain it further? However, there are certain situations when we may have to break this confidentiality –usually in the person's own interest. First is, if the person plans to hurt herself or hurt others, if she has been abused, if she has engaged in a serious crime or any activity that makes us believe that she could be in danger… in these situations, we will have to break confidentiality. So Mrs. X please be assured that I will notify you if I need to. Is that all right with you ?”
3.5. Providing service in a friendly and appropriate manner . Service providers should view the adolescent as the primary patient. They should greet the adolescents and accompanying adult when they enter the clinic. Their behavior should inspire confidence in the adolescents. They should also offer a seat to the waiting clients if there are other clients seeking consultation and availing of the services. They must get the initial information from the client in an area designated for this purpose.
3.6 Adolescent involvement.
As much as possible, adolescents should be involved in layout of the room and for putting up posters and IEC material. The adolescents from the catchment area should be involved in making decisions about the type of IEC material that should be kept in the facility. Once they are in the facility, they may be asked about the set-up of the facility, how equipment, materials and furniture can be arranged in such a way that they will not be hesitant to interact with the health personnel. A suggestion box on the manner by which services are provided can be placed in area in the facility
3.7. Ensuring a smooth patient flow.
A schematic diagram showing the flow of activities from admission to the different service providers including the approximate time it would take to complete each transaction should be posted in strategic areas. All efforts to reduce the waiting time to a minimum should be adopted.

Standard 4.
“An enabling environment exists in the community for adolescents to seek and utilize the health services that they need and for the health care providers to provide the needed services”.
Rationale: In many situations, the community members are not aware of the importance of providing health services to adolescents. At times, there is reluctance, reservations and even opposition to ensuring access to such services. This deters not only adolescents from availing the services but also the service providers from delivering the needed health services to adolescents.
This standard encompasses community actions including educational campaigns that are aimed to increase the awareness of the community to the need and importance of providing health services to adolescent including those that aim to improve the sexual and reproductive health of adolescents. This standard seeks the assistance of individuals, agencies and organizations in the community to assist in providing the resources needed to be able to deliver the services.
Input Criteria
I4.1. -A plan of activities (including community assemblies, meetings with parents, group meetings and school visits,) to be carried out in the community to inform community members about the benefits and availability of services to adolescents is in place.
I4.2. -Procedures to communicate with all adults visiting the health facility the benefits and availability of services to adolescents are in place.
I4.3. -Plan to provide some health services and commodities to adolescents by selected community members,
NGOs, outreach workers and adolescents themselves are in place.
I4.4. -A plan to carry out advocacy for support to provision of services for adolescents from the Local
Development Plan (LDP) exists.
Process Criteria
P4.1. - Activities as per the plan are carried out
P4.2. -Service providers communicate effectively about the value of providing health services to adolescents and the type of services available in their interactions with adult patients.
P4.3. -Activities as mentioned in the plan are carried out
P4.4. -Activities in the plan to seek support from the
Local Development Plan
(LDP) are carried out.
Output Criteria
Community members are aware of provision of services and convinced about the benefits of providing adolescents with health information and services.
Adolescents receive services from NGOs, selected community members, outreach workers and other adolescents

Implementation Guide:
4.1
Activities to inform community members about the value of providing adolescents with services.
The community can be engaged in a variety of ways like seeking their views, informing them about the benefits and availability of services to adolescents and involving them in prioritizing the areas that need to be addressed. The energies of the community members should be utilized in a variety of ways to create an enabling environment. Community assemblies can be utilized to explain to the members of the community the benefits that adolescents can derive from seeking services from the facility. In schools, concerns of adolescents can be discussed during parent-teacher meetings and the service providers can discuss the services that adolescents can avail of depending on the issues and concerns that are presented in the meeting. Service providers may visit schools during health fairs and have a booth that displays their services. In these events, a health communication material developed by the facility and prepared in the vernacular can also be distributed. Short meetings should be organized with women's groups, self-help groups and other relevant sections and discussion about adolescent vulnerabilities and availability of services should be discussed.
Advantage should be taken of fairs and other festivals where adolescents are expected to gather in large numbers.
Folk media and mass media (TV, Radio, newspapers, magazines and web-based) should be effectively engaged in generating awareness about issues that impact the health of adolescents as well as for improving awareness regarding the availability of adolescent friendly health services.
4.2
Communicating with other ADULTS visiting the facility about the value of providing adolescents with services. All adults visiting the facility should be informed of the current status of adolescent health in the community. IEC materials (comics, leaflets) with the adults/parents as target audience can be given so that they will be informed of the value of availing of the services of the facility whenever their adolescent sons and daughters are in need of these services. Sessions with adults can also be done in the health center/facility using a flipchart. Concerns of these adults/parents can also be addressed in the open forum/question and answer part right after the education session.
4.3
Involving selected community members in providing health services/commodities . It is necessary to identify different organizations, individuals, agencies in the community who have adolescent care as their main area of concern or interest. These different stakeholders should be involved in formulating plans for the provision or improvement of services. This will enable them to identify their roles and contributions to the overall plan for service provision to this special group. It is also an opportunity to forge partnerships and devise procedures and mechanisms to ensure the smooth flow of service delivery.
Community members and organizations may also be involved in other activities such as sportsfest, clean and green campaigns, and tree planting. The elected officials of the community may also pass ordinances banning smoking and alcohol use among minors. In

this way, adolescents can be productive and responsible members of the community. In the event that there are adolescents that need to be rehabilitated, elected officials may also be involved in community-based rehabilitation programs.
4.4
Advocating for support in the local development plan.
A Task Force on adolescent health can be created/established. Members of the task force would be representatives from planning, budget, health, NGOs, social services, among others. Other approaches should also be explored. The facility manager or focal person may present the services being provided during meetings of the local health board. In this way, the representative of the local health unit, together with the elected officials in the community will be enlightened on the importance of providing services to adolescents. Meetings of the school board are also another venue for generating support to the provision of health services to adolescents. Local government units (LGUs) may develop resolution and pass ordinances in support of adolescent health activities and programs.

The Package of Services
This part of the document describes interventions organized in packages. The packages of interventions are described for each level of facility and the essential commodities are identified to assure adequacy and quality of care.
Key Supplies and Commodities Needed Package of Service
Basic
Essential Health Package
Interventions at the Primary
Level (RHU, Lying–in
Clinics)

General Health
Assessment – History and Physical Exam

Dental Assessment

Psychosocial Risk
Assessment and
Management

Nutrition Assessment and Counselling

Micronutrient
Supplementation

Immunization

Basic Diagnostic Tests

Reproductive Health
Assessment and
Counselling

Writing materials, Individual
Treatment Record Forms (ITR),

Dental mirror, Dental record form,
Dental Equipment

Psychosocial Risk Assessment
Form

BP apparatus, Adult weighing scale, tape measure, height chart, orchidometer, dietary prescription form, exchange list

Iron with folic acid tablets

Vaccines: Tetanus toxoid, MMR,
Hepatitis B

Centrifuge, heparinized capilet, microscope, syringes and needles, cotton, alcohol, slides, cover slip, vaginal speculum, cotton pledget

ITR, Reproductive Health
Assessment Checklist, Flipchart on reproductive health
Adolescent Pregnancy
Package

Prenatal Services

Natal Services

Post Natal Visits

ITR, FP flipchart, iron tablets, blood typing and Rh sera, pregnancy test, centrifuge, microscope, TT vaccine, syringes, cotton balls, alcohol, FP commodities

HBsAg reagent, birth plan form,
NBS kit, BCG, Hepatitis B vaccine, delivery table, sterile scissors, gloves, cotton, alcohol, plastic clamp, equipment and supplies as per BEmONC guidelines

Iron tablets and vitamin A capsules, FP flipchart, FP commodities, Breastfeeding chart, diet plan

Package of Service
Sexually Transmitted
Infections/HIV Packages
Package of Service
Sexually Transmitted
Infections/HIV Packages
Basic Essential Health
Package
Sexually Transmitted
Infections/HIV Packages
Interventions at the Referral
Facilities (District Hospitals,
Provincial, Tertiary
Facilities)

History and
Assessment
Interventions at the Referral
Facilities (District Hospitals,
Provincial, Tertiary
Facilities)

Diagnostics
Key Supplies and Commodities Needed

ITR
Key Supplies and Commodities Needed

Voluntary Testing for
HIV/STIs

Management,
Treatment and
Counseling

ITR
 Reagents for Gram’s stain, RPR,
Glass slides, microscope, cotton pledgets
 Reagents for Gram’s stain, RPR,
Glass slides, microscope, cotton pledgets

Counselling Cards or Chart

IV. Implementing Mechanisms at Various Levels
Different sectors and facilities are involved in the provision of adolescent-friendly health services. Roles are outlined so that respective sectors and facilities are informed of what they should do in catering to the needs of adolescents.
National Level (Department of Health):
 Formulate standards/policies/guidelines
 Develop communication plan on adolescent health
 Develop training manual for personnel rendering health services to adolescents
 Conduct capability-building activities for personnel involved in the provision of services
 for the adolescents
Coordinate with other agencies (GOs and NGOs) on the implementation of standards and guidelines for health facilities
 Develop guidelines which are in line with the implementation of AFHS
 Mobilize resources for the implementation of adolescent health activities
 Conduct monitoring and evaluation activities
Center for Health Development (CHD) Level:
 Provide technical assistance to LGUs (plan preparation, materials development etc.)
 Disseminate guidelines to LGUs and other directives that may be circulated by the

Department of Health periodically
Appoint focal person in the region who will be in-charge of the implementation of the standards and implementation guide
Organize a multi-sectoral technical working group in the region 



Formulate a region-wide plan on the implementation of standards and implementation guide
Establish a database of facilities in the region proving adolescent health services
Monitor and evaluate the facilities providing services to adolescents in the provinces under its jurisdiction
LGU (Provincial/Municipality/City) Level:
 Develop ordinances, resolutions in support of adolescent health
 Disseminate guidelines, protocols, policies and procedures which may be circulated by the Department of Health in relation to the provision of health services to adolescents
 Provide support to adolescent health activities and advocacy efforts
 Network with various sectors
 Prepare report on the services utilized by the adolescents; commodities used and needed to be replaced; personnel who provided services; and attended capability building activities
Non-Government Organizations

Utilize the standards and implementation guide in the provision of health services

Provide services needed by adolescents within the capability of the organization

Share good practices in the provision of services to adolescents

Professional Organizations

Orient the members of the organization on the standards and implementation guide

Disseminate the guidelines and other directives to its members that may be circulated by the Department of Health periodically

Act as technical resource group on adolescent health

Participate in the conduct of orientation programs related to adolescent health
Academic Institutions

Promote adolescent-friendly institutions

Act as technical resource persons on adolescent health

Develop adolescent-oriented programs and activities

Orient the teachers and other personnel of the standards and implementation guide

Refer adolescents to facilities that provide services to adolescents

Conduct orientation programs to adolescents regarding the services which they can avail from adolescent friendly health facilities

V. Monitoring and Evaluation of the AFHS Quality Standards
The AFHS quality standards will be monitored and evaluated in two ways:
1.
Continuous monitoring of the AFHS package implementation
2.
Periodic evaluation on compliance with the AFHS quality standards
The implementation of quality standards of AFHS will be monitored by the authorities. The initial activity will be spearheaded by the National Technical Working Group (TWG) and will be done six (6) months after the implementation of the standards and implementation guide. A biannual monitoring will be conducted by the regional technical working group among the facilities under its jurisdiction.
The evaluation on the compliance with the AFHS quality standards will be carried out in line with Department of Health (DOH) guidelines. Tools contained in this document may be utilized by various organizations and facilities in the monitoring and evaluation activities.

Monitoring Tool 1. Facility Observation Checklist
Standard 1.
Adolescents in the catchment area of the facility are aware about the health services it provides and find the health facility easy to reach and to obtain services from it.
Item Self Assessment Assessment Team
Signages
Welcome Signage
Schedule of Clinic Hours
(Day and Time)
Health Services
Clinical Guidelines
Documents
Action Plan for
Information Dissemination
Policy regarding flexible time schedule
Policies for provision of services
Policies for payment schemes
Plan for outreach program
Registration logbook containing the list of
Recommendations clients who consulted and were given services
Standard 2 “The services provided by health facilities to adolescents are in line with the accepted package of health services and are provided on site or through referral linkages by well-trained staff effectively”.
Item
Documents
National Standards for
Adolescent Service Package
List of services provided by the facility
Stock cards showing the delivery and utilization of medicines, commodities for adolescent health care
Certificates of training on the minimum training courses prescribed by DOH for adolescent focal persons and other providers
Protocols and guidelines for patient interaction
Clinical management guidelines and Adolescent
Job Aid are available
Individual Treatment
Records that shows the chief complaint, findings on examination, clinical
Self Assessment Assessment Team Recommendations

impression and management of clients
Directory of organizations – name, address, services provided, contact number and contact person
Referral logbook – name, age, address, Clinical
Impression, where referred, reason for referral, result of referral
Referral forms
Standard 3 “The health services are provided in ways that respect the rights of adolescents and their privacy and confidentiality. Adolescents find surroundings and procedures of the health facility appealing and acceptable”.
Self Assessment Assessment Team Recommendations Item
Facility
Patient flow from admission to delivery of services including the average time for each step is posted in strategic places.
A policy to ensure confidentiality is posted.
Policies to ensure privacy is posted
Individual records are kept in separate envelopes.
All records are kept in a safe place, preferably in a separate room or a filing cabinet with lock and key.
There is a designated person with access to the records.
There are designated admission and waiting areas.
There are separate rooms for consultation, treatment and counseling. If there are limited rooms, there are at least curtains to separate each provider.
There is a suggestion box.
Conversation between provider and client cannot be heard by others.
There are peer educators assisting in clinic operations and providing services
(lectures, counseling, etc)
Materials being used by the adolescents in the facility
Documents
SOP for maintenance of facility

Policies and procedures to ensure confidentiality
Policies and procedures to ensure privacy
Protocol and procedures for patient – provider interaction
Minutes of meetings of TWG
Standard 4.
“An enabling environment exists in the community for adolescents to seek and utilize the health services that they need and for the health care providers to provide the needed services”.
Item
There are leaflets containing the clinic schedule and services which the patients/community members can bring home and share to other community members.
IEC materials on the different programs / services available
(Example IEC on maternal care, family planning, etc).
The IEC materials should also include the directory of other agencies/organizations where the services can be obtained.
Self Assessment Assessment Team Recommendations
Documents
IEC Plan
Copy of the Local
Development Plan
Advocacy Plan
Action Plan showing different agency participation – the name of the agency, resources/assistance they will provide, the person’s responsible
Accomplishment report showing the services given at the public health facility as well as those given by other agencies, individuals and peer counselors

Monitoring Tool 2. Facility Manager Interview Questionnaire
Name of Facility:
Type of Facility:
Date of Assessment (dd/mm/yyyy)
Type of staff
Clinical-Total o
Medical doctors o
Nurses o
Midwife
Non-clinical-Total o
Psychologist, Counselors etc. o
Social workers o
Support staff (receptionist, cleaners, administrative clerks) o
Barangay Health Workers
Total
Criteria
Does the facility have the following signages o Schedule of clinic hours for adolescents o Services available o Adolescents are Welcome o “Services are Free of Charge”
Service Provision
Services provided o Counseling o Nutritional Assessment and counseling o Maternal Care Services

Pre natal

Natal

Post natal o Services for STIs including HIV/AIDS o FP Services o Dental Assessment o Micronutrient Supplementation o Immunization – TT. Hepa B, MMR o Reproductive Health Assessment and Counseling

Fertility awareness , menstrual health issues and counseling

Pap smear and pelvic exams, if sexually active

Adolescent male reproductive health issues

Gender issues o Health prevention and promotion o Psychological Counseling o Social and legal support o Substance abuse o Commodities and Supplies o BP Apparatus
Yes
Number
No Remarks

o Weighing Scale o Tape measure o Height chart o Orchidometer o Dietary prescription form o Exchange list o Vaccines – TT, MMR, Hepa B o Disposable syringes o Cotton o Alcohol o Centrifuge o Heparinized capilet o Microscope o Slides o HIV testing kit o RPR o Reagents for Gram stain o Cotton pledgets o NBS kit o BCG vaccine o Gloves o Cord clamp o Vit K injection o Iron with folic acid tablets o FP Commodities o Writing materials o Individual Treatment Records o Dental Record Forms o Referral Forms o Feedback Form
Planning
Written Plan for: o IEC Campaigns o Promotion of adolescent health services and facility o Outreach including schedule
Procedures and Policies
Standard Operating Procedures o Maintaining good clinic ambience conducive to adolescents o Provision of Free Services to Adolescents o Procedures for Dealing with Adolescents o Clinical Protocols for the different health and health related programs and conditions o Two way referral o Ensuring privacy and confidentiality
Documentation
Ledgers for: o Clients seen at the clinic o Clients seen during outreach o IEC activities done, topic and list of participants o Results for feedback o Results of supervisory visits
Adolescent Participation o Feedback mechanism on the services provided o Participation in the design, implementation and assessment

of the following services:
Monitoring and Evaluation o Inventory of supplies and equipment o Client satisfaction o Clinical Case management o Provider performance
Please List the Staff Members and check the Training specific for Adolescents they have received:
Name of
Training
Physician Nurse Midwife Psychologist Social
Worker
Orientation
Program on
Adolescent
Health
Adolescent
Job Aid
Others:
Specify

Monitoring Tool 3. Service Provider Interview Questionnaire
Name of Provider:
Designation:
Service Delivery
1.
When and what time is the facility open (Days and time)?
2.
Is the facility open after office hours and weekends? If not, what mechanisms were put in place to ensure that the adolescents get the services after office hours and during weekends?
3.
What agencies provide these services?
4.
How do you get information from these facilities regarding the clients that they serve/provide services to?
5.
What services are available in your facility? In other public health facilities (laboratories, social hygiene clinics, etc)
6.
What do you do when the services needed are not available in the facility?
7.
How do you keep track of the outcome of these referrals?
8.
Do you provide adolescents with appropriate information about treatments, procedures, contraceptive methods, as well as counseling to make decisions?
9.
Describe the flow of patients from admission to the time they leave the facility.
10.
What mechanisms are in place to ensure: a.
Confidentiality b.
Privacy
11.
Do you explain that services are confidential?
Financing
1.
How much budget is given to the Adolescent Friendly Health Services?
2.
What are the sources of budget to maintain operations of the facility?
3.
Are the services given for free? If payment is made: a.
How much? b.
How did you come up with the amount? c.
How are the funds handled (liquidation, disbursement, accountability)
4.
Are there financing schemes available? If yes, what are they?
Regulations
1.
What are the national and local policies/laws/ statutes enacted in support of Adolescent
Friendly Health Care and Facilities?
2.
What policies and procedures have been formulated by the facility to govern operations and service delivery?
Governance
1.
Is monitoring and supervision conducted? If yes, a.
How often? b.
By Whom? c.
What are the results? d.
How long will it take to implement the recommendations made?
If no, Why do you think so?

2.
Are you trained on Adolescent Reproductive Health? If yes, what training course did you attend? If no. Why?
Recommendations: What would you recommend to improve the following?
1.
Physical structure and appearance of the facility
2.
Clinic procedures including patient flow and waiting time
3.
Measures to ensure a.
Confidentiality b.
Privacy
4.
Capability of staff to deal with adolescents and address their needs
5.
Training. Are there any other training you would want to recommend aside from those required by DOH
6.
Staff capability in dealing with adolescents
7.
Referral
8.
Information dissemination
9.
Adolescent participation
10.
Community participation

Monitoring Tool 4. Client (Adolescent) Interview Questionnaire
1.
What is the schedule of operations of the facility?
2.
Can you enumerate the services offered in the facility that you know of?
3.
Can you please describe the process from admission to the time you leave the facility?
4.
How did you come to know about this facility and the services they offer?
5.
What are the features that would ensure: a.
Confidentiality b.
Privacy
6.
What mechanisms are in place to solicit your opinion regarding the facility and improving its condition and operations?
7.
Give your comments on the following: a.
Facility b.
Admission c.
Waiting time d.
Services e.
Staff f.
Availability of needed supplies and commodities
8.
What is your overall rating of the facility and its operations?
9.
What are your recommendations/suggestions to improve the facility and its operations?

References
A Practical Guide on Adolescent Health Care, Department of Health and UNFPA, _________
Adolescent Friendly Health Services: An Agenda for Change. Geneva. WHO, October 2002
Adolescent Friendly Reproductive Health Services Network Operations Manual. Philippines.
Save the Children. _________.
Department of Health. Guide Book on Adolescent and Youth Health and Development Program.
DOH, Philippines. 2002.
Department of Health. Manual of Standards for Adolescent Friendly Health Services. DOH,
Philippines. 2008.
Dickson, K., Ashton, J, and Smith, J. Do setting adolescent-friendly standards improve quality of care in clinics? Evidence from South Africa. International Journal for Quality in Health Care.
Oxford University Press. 1-10. 2007.
Implementation Guide on RCH II: Adolescent Reproductive Sexual Health Strategy: India. May
2006.
Marquez, L. 2001. Helping Healthcare Providers Perform According to Standards. QA
Operations Research Issue Paper 2 (3): 3-30.
National Consultation on RCH II ARSH Strategy: A Report. New Delhi. September 2005
National Demographic Health Survey 2008, Philippines. December 2009.
National Standards for Provision of Youth Friendly Health Services in Bhutan (Draft National
Standards and Implementation Guide. May 2008.
National Standards and Implementation Guide for Youth Friendly Health Services: Bhutan. May
2008
National AIDS Registry, Department of Health National Epidemiology Center (Data from
January to October 2009).
Package of Interventions for Family Planning, Safe Abortion Care, Maternal, Newborn and
Child Care, WHO, 2010.
Quality Standards of Youth Friendly Health Services in the Republic of Moldova. Moldova.
2009
Workshop Output. Workshop on the Development of Standards of Adolescent Friendly-Health
Services, Tagaytay City. August 2009

Youth Friendly Health Services (YFHS) standards, criteria, actions to achieve criteria, means of verification. Bangladesh. April 2005.

Annex 1. Laws and Issuances on the Provision of AFHS in the Philippines
International Issuances
1.
Committee on the Rights of the Child General Comment No. 4
2.
Convention on the Elimination of All Forms of Discrimination Against Women
(CEDAW)
3.
Beijing Platform For Action (BPFA)
4.
Article 6 of the United Nations Convention on the Rights of the Child
National Issuances
1.
Republic Act 7610: Special Protection of Children Against Child Abuse,
Exploitation and Discrimination Act
2.
Republic Act 9231: Worst Form of Child Labor
3.
Republic Act 9710: The Magna Carta of Women
4.
Republic Act 8504: Philippine Aids and Control Act of 1998
5.
Article 54 of the Civil Code of the Philippines
6.
P.D. 603: Child and Youth Welfare Code of 1974
7.
R.A. 9262: Anti-Violence Against Women and their Children Act of 2004
8.
R.A. 9211 ( Tobacco Regulation Act of 2003)
9.
R.A. 9165 ( Comprehensive Dangerous Drugs Act of 2002 )
10.
DOH Administrative Order (AO) 34 – A series of 2000

Annex 2. The Process of Developing National Standards on Adolescent Friendly Health Services
A Strategic Planning Workshop for Accelerating Action for Adolescent and Youth Health was conducted from September 23-26, 2008 in Pranjetto Hills Hotel in Tanay, Rizal. Gaps and critical activities for Adolescent and Youth Health were identified. In the same year (2008), the
Framework for the Adolescent Health Strategic Plan was started and finished in 2009.
A Workshop on the Development of National Standards for Adolescent-Friendly Health Services was organized by the Department of Health, Philippines with the support of the WHO Regional
Office for the Western Pacific in Tagaytay City from 4 to 7 August 2009. The intended beneficiaries of this workshop are all adolescents (10-19) in the Philippines. This workshop was organized to build wide consensus and to develop a set of standards to ensure the provision of good quality adolescent health services at the different levels of care, to respond appropriately to adolescent health needs.
The workshop was guided by the principles that AHFS should:

Respect, fulfill and protect the rights of adolescents

Comply with accepted standards of medical ethics in the delivery of services

Given due consideration to national laws and policies and the socio-cultural context

Ensure access to comprehensive and holistic services

Provide adequate attention to the different needs of adolescents
 Ensure young people’s privacy and confidentiality
 Ensure adolescent’s participation at all levels

Provide evidenced-based services

Promote community ownership and active involvement of all stakeholders including parents and community members, and

Link with other sectors
To build wide ownership and shared understanding, the workshop brought together a range of stakeholders from the government (from national, regional, provincial and city/municipal levels), local non-governmental organizations (NGOs) working with adolescents, international NGOs and United Nations agencies (United Nations Children's Fund [UNICEF], UNFPA and WHO) and participants from Cambodia. Fifty-five participants attended the opening session of the workshop.
The workshop utilized a mix of methods including interactive sessions, small group discussions, brainstorming, VIPP, and plenary presentations. The participants discussed and finalized the health outcomes to be achieved, the package of services to help achieve the agreed upon health outcomes, service delivery points from where the services should be provided and the service providers who will provide the said services to adolescents. Four "standards" were developed by this consultative process.

Annex 3. Guiding Principles
All efforts to establish facilities and services that are friendly to adolescents are in line with the right of the adolescent to the highest attainable standard of health. The UN Committee on
Economic, Social and Cultural Rights has said that the right to health consists of six normative elements:
1.
Health availability refers to the availability of a sufficient number of functioning public health and health care facilities, goods, services, programs and underlying determinants of health.
2.
Health physical accessibility means that all health facilities, centers, programs and goods must be within safe physical reach for all, and includes timely access to health services.
Physical access also requires the construction of access paths to buildings and other public places for persons with disabilities.
3.
Health economic accessibility means that the costs of availing health services, goods, and facilities and the underlying determinants of health must be based on the principle of equity and must be affordable for all.
4.
Health information accessibility refers to the right to seek, receive and impart information and ideas regarding health issues and concerns. Health information accessibility, however, does not in any way impair the individual’s right to privacy and confidentiality of personal health data. The Committee on the Rights of the Child urges the active involvement of adolescents in the design and dissemination of health information through a variety of channels beyond the school, including youth organizations, religious, community and other groups and media.
5.
Health acceptability means that health services, goods and facilities and underlying determinants of health must respect medical ethics, be culturally appropriate, be sensitive to gender and life-cycle requirements, respect confidentiality of personal health data, and must be designed to improve everyone’s health status.
6.
Health quality means that all health goods, services, facilities and underlying determinants of health must be scientifically and medically sound and of good quality.

Annex 4. Standard and Criteria Definitions
A standard is a statement of desired quality . In some countries, standards for ensuring the performance of health facilities for adolescents have been developed. These standards strengthen program implementation as well as monitoring, supervision and evaluation by setting clear performance goals, defining the quality required for a service and providing a clear basis against which performance can be monitored, assessed and / or compared.
The key “friendly” characteristics of services for adolescent are viewed from the perspectives of the users, providers and health system.
From the users’ perspective, health services must be:

Accessible : ready access to services is provided

Acceptable : health care meets the expectations of adolescents who use the services

Gender-sensitive : there shall be no discrimination, services must be given regardless of orientation

Culturally-appropriate : services must not run counter to existing value systems

Rights-based
: in all aspects of program implementation, the promotion of young people’s rights shall be applied.
From the providers’ / managers’ perspective, health services must be:

Age-appropriate : required care is provided ; unnecessary and harmful care is avoided

Comprehensive : care provision covers aspects for prevention through counseling to treatment

Effective : health care produces positive change in the health status of the adolescent. The health system should focus on the efficiency in the health system, that is providing high quality care at the lowest possible cost

Equitable : services are provided to all adolescents who need them especially the poor, marginalized, vulnerable and difficult to reach groups.

Annex 5. Adolescent and Youth Health Program Technical Committee
Dr. Juanita A. Basilio
Dr. Manuel Calonge
Ms. Lita Orbillo
Ms. Onofria de Guzman
Mr. Raymond Mazo
Ms. Lyra Gay Borja
Ms. Jill Alvarez
Ms. Ma. Loida Sevilla
Atty Mylen Gonzales
Ms. Pamela Marie Averion
Ms. Lauren Musa
Dr. Mariella Castillo
Dr. Howard Sobel
Dr. Patanjali Nayar
Ms. Gudrun Nadoll
Dr. Rosa Maria Nancho
Mr. Melvin Dayrit
Ms. Maribeth Casin
Ms. Myrna V. Santos
Mr. Robin Espinosa
Ms. Loida Ramos
Dr. Gerald Belimac
Dr. Olga Virtucio
Dr. Esther Oliveros
Ms. Socorro Baluyot
Dr. Lani Samonte
Ms. Maristela Abenojar
Ms. Edna Nito
Ms. Frances Rose Elgo
FHO
FHO
FHO
FHO
FHO
FHO
FAD
PLAN
Child Justice
UNFPA
CWC
WHO, Country Office
WHO, Country Office
WHO-WPRO
UNICEF
SAMPI
DSWD
BWYW, DOLE
NBOO-DILG
NYC
HNC,DepEd
IDO
AFRHS Network
AFRHS Network
CHD-MM
Save the Children
PNA
NCHP
HPDPB

Annex 6. Workshop Participants, August 3-7, 2009, Tagaytay City, Philippines
Juanita A. Basilio, M.D Family Health Office-National Center for Disease
Rudy Albornoz
Lita Orbillo
Maristela P. Abenojar
Jill S. Alvarez
Elmer M. Angus, M.D
Pamela Averion
Marciano Fidel Avendaño
Medalla P. Balandra
Ma. Socorro R. Baluyut
Edna A. Beguia
Ma. Maila C. Bernabe
Marifel S. Bogabel
Deborah B. Cabanag
Hamilton Calderon
Marlene de Castro
Venkatraman Chandra-Mouli
Jonathan D. Chua
Gloria Cirineo
Mick Creati
Dr. Reinhard M. Dalumpines
Melvin C. Dayrit
Erlyn Della-Caparro, M.D.
Moses de Guzman
Marlyn Endozo
Robinson F. Espinoza
Denia Gamboa
Dexter M. Garcia
Brayant Gonzales
Chetra Kaeoun
Ma. Evelyn Q. Lleno
Susan Yanga Mabunga
Dr. Arvin Marbibi
Robert T. Mendoza
Raquel Montejo
Ma. Doreen Era E. Murata
Gudrun Nadoll
Prevention and Control , Department of Health
(FHO, NCDPC, HOH)
Philippine Nurses Association (PNA)
FAD, Inc.
Philippine Academy of Physicians in School Health,
Inc.
UNFPA , Gender & Culture and ARH
Private School Health Officers Association
DOH-CHD Western Visayas
DOH-CHD-MM
IMAP, Inc.
DOH-CHD Western Visayas
Save The Children
NAPC Youth & Students
FHO, Department of Health
Baguio Center for Young Adults, Inc.
World Health Organization
Adolescent Health and Development
Department of Child and Adolescent Health and
Development
NAPC-YSSSC
AFRHS Network
Burnett, Australia
Department of Health
Center for Health Development/Family Health Cluster
DSWD Central Office
Social Technology Bureau
Society of Adolescent Medicine of the Philippines, Inc.
(SAMPI)
SAMPI
TUCP
National Youth Commission
Council for the Welfare of Children
TRIDEV Specialists Foundation
Family Planning Organization of the Philippines
National Center for HIV/AIDS, Dermatology, and STD ,
Ministry of Health, Cambodia
DOH –HHRDB
UP College of Public Health
AFRHS Network
Philippine League of Government and Private Midwives,
Inc.
DOH – Davao
UNFPA
– Youth Advisory Panel
United Nations Children’s Fund
Philippine Country Office

Dr. Rosa Maria H. Nancho
Dr. Virginia L. Narciso
Dr. Gloria A. Narvaez
Dr. Patanjali Dev Nayar
Joyce E. Ocampo
Fe b. Paler
Valerie M. Pascual
Mylene Mirasol C. Quiray
Dr. Luz P. Revita
Lynny A. Sarigumba,
Ma. Loida Y. Sevilla
Cristina V. Sison
Dr. Howard Sobel
Dr. Srun Sok
Lucita O. Tagudin
Dr. Marianna Trias
Gloria Villena
Dr. Olga Virtusio
PGH-Society of Adolescent Medicine of the
Philippines, Inc. (SAMPI)
CHD-CAR
Baguio City
CHD-4A
World Health Organization (WPRO)
CHD 3
DOH-CHD Northern Mindanao
CHD 4A
POPCOM
Philippine Academy of Physicians in School Health, Inc.
(PAPSHI)
CHO – Bislig City LGU
Plan International, Philippines
CHD-4B
Office of the WHO Representative
The Ministry of Health
Department of Hospital Services
Cambodia
DOH-Caraga
World Health Organization (WPRO) Child and Adolescent
Health
Dr. Jose Fabella Memorial Hospital
City Health Office, Paranaque City