Assessing Barriers to Effective Coverage of Health Services for Adolescents in Low- and Middle-Income Countries: A Scoping Review

Abstract

Understanding barriers to health services, as experienced by adolescents, is important to expand effective and equitable coverage; however, there is limited discussion on methods for conducting barrier assessments and translating findings into action. Methods: We conducted a scoping review of literature published between 2005 and 2019 on barriers to health services for adolescents in low-and middle-income countries. The review was guided by a framework that conceptualized barriers across multiple dimensions of access (availability, geographic accessibility, affordability, and acceptability), utilization, and effective coverage. Results: We identified 339 studies that assessed barriers related to at least one dimension of the operational framework. Acceptability (93%) and availability (88%) of health services were the most frequently studied access dimensions; affordability (45%) and geographic access (32%) were studied less frequently. Less than half (40%) of the studies evaluated utilization, and none of the 339 studies assessed effective coverage. Attention to equity stratifiers (e.g., income, disability) was limited. Topics studied reflected only a subset of the major causes of adolescent death and disability. Conclusions: Holistic, equity-oriented approaches are needed to better understand barriers across multiple dimensions that together determine whether health services are accessible, used, and effectively meet the needs of different adolescent groups.

Bilateral Mucous Retention Cyst of the Submandibular Salivary Gland: A Rare Unusual Presentation and Review of the Literature.

“…The patient cited financial constraints as a reason for late presentation. This is supported by the conclusion in the study conducted by Stierman et al 11 on assessing effective health coverage in the low and middle income countries. They identified affordability as a barrier to effective health coverage.…”

Multiple Impacts of Ethiopia’s Health Extension Program on Adolescent Health and Well-Being: A Quasi-Experimental Study 2002–2013

“…Adolescence is a critical period for growth and development when interventions can be especially beneficial [4]. Currently, knowledge around scalable interventions during this period of life is lacking [5]. In Ethiopia, a series of multisectoral policy initiatives have been attributed to significant progress in achieving global development goals particularly in primary education and addressing child marriage [6].…”

“…Twelve outcomes were investigated at round 4 following a comprehensive review of the Young Lives data for indicators plausibly related to HEP. They included 10 binary indicators: (1) not underweight, measured as a weight-for-age zscore no lower than À2 standard deviations below the mean on the World Health Organization Child Growth Standards for adolescents younger than 18 years, and body mass index >18.5 for adolescents older than 18 years [20]; (2) very good health, measured as scoring five on a five-point scale ranging from very poor to very good; (3) fertility knowledge, measured as correct responses to both true/false statements "a woman/girl cannot get pregnant the first time she has sex" and "If a girl washes herself after sex she will not get pregnant"; (4) sexually transmitted infection (STI) knowledge, measured as correct responses to the true/false statements "Using a condom can prevent getting a disease through sex," "A person who looks very healthy cannot pass on a disease through sex," and "A person can get HIV or AIDS by having sex"; (5) no child marriage, measured as no self-reported marriage before the international and national legal age of 18; (6) no adolescent pregnancy, measured as no self-reported pregnancy or birth before age 20; (7) low/no alcohol use, measured as consuming alcohol no more than once per week; (8) education enrolment, measured as enrolment in formal education during the survey year; (9) <3 hours of domestic activities per day, which included household chores and caring for others. This threshold was previously associated with worse education outcomes in Ethiopia [21]; (10) >4 hours of income-generating activities per day, which included work inside the household that generated income (e.g., farming) or paid work outside of the household.…”

The science of child and adolescent mental health in Greece: a nationwide systematic review of the literature

“…14 Moreover, there are substantial gaps in epidemiological knowledge on mental health issues for the Greek general population, 15 and mental health care provision has beenunderstudied. 16 The "Child and Adolescent Mental Health Initiative" (CAMHI) project is a five-year program that aims to enhance child and adolescent mental health care capacity and to help strengthen the infrastructure for the prevention, assessment, and treatment of mental health difficulties faced by children and adolescents across Greece. With the goal of facilitating the systematic uptake of evidence to inform policy and practice, we began this program by examining the scientific literature to map available resources and trace research priorities on child and adolescent mental health within the country.…”