International Journal for Quality in Health Care Advance Access originally published online on February 2, 2007
International Journal for Quality in Health Care 2007 19(2):80-89; doi:10.1093/intqhc/mzl070
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Does setting adolescent-friendly standards improve the quality of care in clinics? Evidence from South Africa
1 Reproductive Health Research Unit, University of the Witwatersrand, Chris Hani Baragwanath Hospital, Bertsham, South Africa
2 World Health Organization
3 Consultant, 4435 E San Carlos Place North, Tucson, Arizona, USA
4 loveLife, 48 Wierda Road West, Weirda Valley, Bertsham, Parklands
Objective. To determine whether setting and implementing adolescent-friendly standards improves the quality of adolescent services in clinics.
Design. The evaluation used a quasi-experimental case–control design.
Setting/participants. Eleven public health clinics involved in the adolescent-friendly program [The National Adolescent Friendly Clinic Initiative (NAFCI)] and 11 control clinics.
Intervention. This included implementation of a set of 10 adolescent-friendly standards and 41 corresponding criteria.
Main outcome measures. Percentage scores were achieved for each standard and criterion. Clinics were awarded a Gold Star if they achieved an overall clinic score (average standard score) of 
90%, a Silver Star for a score between 60 and 89% and a Bronze Star for a score between 30 and 59%.
Results. The NAFCI clinics performed better than the control clinics on most criteria. The combined average overall clinic score of all the NAFCI clinics (79.9%) was significantly higher (P = 0.005) than the overall score for the control group clinics (60.9%). Results showed that the longer NAFCI was implemented at a clinic, the higher the score and the more likely that clinic would be accredited as an ‘adolescent friendly’ clinic. NAFCI clinics performed significantly better than the control clinics on criteria specific to the provision of adolescent-friendly services including knowledge of adolescent rights and non-judgmental attitudes of staff.
Conclusion. Setting and implementing standards and criteria improves the quality of adolescent services in clinics. The standards and criteria should be set on the basis of the characteristics of adolescent-friendly services and quality of care indicators. Best results are achieved when a facilitator trained in quality improvement methodologies supports clinics.
Keywords: adolescents, quality of care, adolescent-friendly services, South Africa
Address reprint requests to Kim Eva Dickson, World Health Organization, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland. Tel: +41 22 791 4548; Fax: +41 22 791 4834; E-mail: dicksonk{at}who.int
Accepted for publication December 12, 2006.
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