The Tarunya Project’s efforts to improve the quality of adolescent reproductive and sexual health services in Jharkhand state, India: a post-hoc evaluation

Abstract

Abstract:Following the International Conference on Population and Development Adolescent Reproductive and Sexual Health (ARSH) was recognized as a top development priority in India's National Population Policy 2000. In 2006 a separate ARSH strategy was articulated within the National Rural Health Mission. In Jharkhand, one of the poorest and least developed states in India, in 2008 the state government launched a Tarunya Project in collaboration with EngenderHealth. The project provided cascading ARSH training to government staff at secondary care facilities and strengthened outreach activities to enhance community engagement. After 5 years of implementation, the project was evaluated by a team from the World Health Organization. The evaluation found that the project provided training and ongoing backstopping support to strengthen the ARSH readiness of health facilities. The project's intervention efforts contributed to improvement in quality and initial use of ARSH services. The performance of health facilities was appreciated by clients. But there was little correspondence between the project's monitoring and the period of exposure of the facilities to the project's interventions and service quality. The evaluation also showed that handholding and backstopping by the project were still very much needed.

A systematic review of the use of adolescent mystery clients in assessing the adolescent friendliness of health services in high, middle, and low-income countries

“…Thirteeen of the 30 reviewed evaluations/studies, recruited both male and female adolescents or young people as MCs to assess health provider behaviour and services [16,20,25–27,32,35–37,39,41,44]. One study recruited only male MCs [45], and only one study included non-binary gendered MCs in their study design [26].…”

“…Five evaluations/studies did not specify sex of the MCs in the description of the methods [28,31,38,40,43]. Eleven of the 30 evaluations/studies reviewed did not specify the ages of the MCs recruited for the study [17,19,20,30,32,33,35,38,40,41,43], while the rest recruited individuals who were 25 years old and under [16,18,21–29,31,34,36,37,39,44,45]. …”

“…Three evaluations/studies did not clearly specify the scenarios the MCs were to play [3,14,41]. The first of these stated that the MCs were to have a reproductive health complaint [14], the second stated that the MCs were to enact scenarios and did not provide further context [3], and the last trained their MCs to present critical SRH scenarios to the health care providers [41].…”

“…Twelve of the reviewed evaluations/studies statistically analysed their quantitative data with a range of methods, such as regression analysis on platforms including SASS and Stata [19,21,22,24,25,33,34,36,42,44,45]. Four of the reviewed evaluations/studies used both statistical and thematic analysis methods [23,37,39,41]. Two employed a rating or score based analysis [35,36], and one analysed their audio-recorded MCs’ debrief manually; however, the last did not provide additional information [30].…”

“…Twelve of the 30 evaluations/studies explicitly stated perceptions or observations on the use of adolescent MCs in evaluating health provider behaviour and service provision [17,20,28,29,31–34,37,39,41,42] Of these, three regarded MCs as being a good method for providing insightful and unique feedback [28,32,39] and six indicated that the use of MCs was successful in assessing services and providers [20,29,31,34,37,42]. …”