Standard Operating Procedures

Standard Operating Procedures (SOPs) are guidelines to reduce misunderstanding within a sector when referring to expected quality outcomes, service efficiency, standard performance and quality outputs. Standard Operating Procedures are needed for all aspects of implementing research, not only providing adolescent services.

Within the adolescent and youth health services sector, the WHO has developed a quality framework for improving the provision and use of health services, including sexual and reproductive health services by adolescents. The quality framework equips governments and partners with the minimum expected standards in the care package when providing adolescent and youth-friendly health services (AYFHS).

All governments and health care providers are expected to have youth health care packages that are aligned with the following international standards of quality service:

Equitable:   All adolescents, not just some groups of adolescents, can obtain the available health services.
Accessible:   Adolescents can obtain the health services available
Acceptable:   Adolescents are willing to obtain the health services available
Appropriate:   The right health services (i.e., the ones they need) are provided to them
Effective:   The right health services are provided in the right way and make a positive contribution to their health

Some African countries have developed adolescent and youth health policies and service guidelines in line with the recommendations of the WHO quality framework for providing adolescent-friendly services.

Benefits of standard operating procedures

  • Sharing country-specific SOPs that ensure youth friendly health services
  • Ensure standardisation of youth services globally and in sub-Sahara Africa
  • Promote the development of SOPs with stakeholders like NGOs that also provide health care services to young people
  • Promote the use of the WHO quality assessment tools to evaluate the effectiveness of the SOPs that are already in place in various countries

The UNAIDS 2019 Report put a spotlight on HIV and the health status of adolescent girls and young women (AGYW) and underscores the following startling facts that are enough motivation for health ministries in African countries to improve the ability of young people to access health care services:

  • In eastern and Southern Africa, in 2017, 79% of new HIV infections were among 10 – 19-year-olds.
  • An estimated 50 adolescent girls die every day from AIDS-related illnesses. Globally, at least 460 adolescent girls become infected with HIV daily
  • In sub-Saharan Africa, three in five new HIV infections among 15 – 19 years of age are among girls.
  • In sub-Saharan Africa, 42 % of women living in urban areas aged 15-24 years had a pregnancy before the age of 18.
  • In rural areas, more than 50% of women aged 15-24 years had a pregnancy before the age of 18

Yet, health and HIV services are failing to reach this population group that is also vulnerable to gender-based violence, sexual exploitation, and drug use. Health researchers, policymakers and programme implementers need to make efforts to ensure that health ministries and partners develop health facility programmes that are accessible and user-friendly to the intended young clientele.

Several countries in sub-Sahara Africa already have a policy document that describes the provision of adolescent and youth-friendly health services. Most countries are expected to use the WHO quality framework as a guide to develop a youth policy document that aligns with its national epidemiological, social, cultural, and economic realities. Also, use the WHO quality assessment guidelines to evaluate the efficiency of the country’s youth health carecentres as in Malawi.

Case Study – Malawi

For example, the Malawi Ministry of Health – Reproductive Health Directorate partnered with the USAID-supported Evidence to Action project and the Centre for Social Research, University of Malawi, conducted a comprehensive evaluation of the Youth Friendly Health Services. The evaluation assessed the implementation of YFHS and the level of adherence to the national standards in the context of meeting the sexual and reproductive health (SRH) needs of youth. The evaluation was conducted in 10 districts across the five health zones, with qualitative and quantitative components. An evaluation of the YFHS yielded critical information necessary for reaching the country’s goal of safeguarding young people’s transition into adulthood and improving health indicators for 5 million people in Malawi.

Acceptable youth-friendly health services

WHO quality framework proposes that health services follow this step-by-step guide in developing globally acceptable SOPs for youth-friendly health services:

Step 1: Establish the basis for addressing adolescents within the national HIV/AIDS and/or RH policies and strategies. Purpose of this step: To establish that this initiative is in line with national policies and strategies

Step 2: Establish the basis for providing health services to adolescents within the framework of the national HIV/AIDS and/or RH policies/strategies. Purpose of this step: To ensure that the national quality standards for health service provision to adolescents are formulated in line with national policies and strategies.

Step 3: Gather experiences from within the country in applying quality improvement principles and practices in public health programmes. Purpose of this step: –– To draw out the experiences gained from initiatives in the country that have worked to improve the quality of health service provision and to increase health service utilisation by any population group to achieve a clearly defined health outcome.

Step 4: Identify the place of the unit driving the national standards-driven initiative in the country, as well as programmatic opportunities and challenges in applying them. Purpose of this step: To identify the ‘driver’ of the national standards-driven initiative, the strengths and weaknesses of the unit, and its linkages with other units in the Ministry of Health. To identify environmental factors that could help or hinder the initiative’s implementation.

When developing SOPs for youth service centres, ensure that the statements made align with the WHO guidelines and are measurable and attainable. The Tanzanian Ministry of health sets up a good practice model by setting up a youth service standard that is aligned with the characteristics of the adolescent and youth-friendly services guidelines:

“Service providers in all delivery points have the required knowledge, skills and
positive attitudes to provide sexual and reproductive health services to adolescents
effectively and in a friendly manner”.

Some of the generic characteristics of adolescent and youth-friendly services are:

  • Health-care providers are non-judgmental, considerate, and easy to relate to.
  • Health-care providers have the competencies to work with adolescents and provide them with the required health services.
  • Health-care providers use evidence-based protocols and guidelines to provide health services.

BY YOLISWA NTSEPE (MA, PhD)
ADOLESCENT PROGRAMMES MANAGER

UPDATED NOV 22, 2023

TABLE OF CONTENTS:

REFERENCES & ADDITIONAL RESOURCES:

Youth-friendly health services in Malawi: Policy brief. https://www.healthpolicyproject.com/pubs/751_StandardsBriefA.pdf

National standards for adolescent and youth friendly health services for all young people: Standard statements and implementation steps. Health Protection Agency, Ministry of health. Maldives.
https://maldives.unfpa.org/sites/default/files/pub-pdf/1F.NationalStandards_YFHS-online.pdf

National adolescent and youth health policy, 2017. Department of health. Republic of South Africa.
https://www.datocms-assets.com/7245/1574921711-national-adolescent-and-youth-health-policy-2017.pdf

Making health services adolescent friendly: Developing national quality standards for adolescent friendly health services. ISBN:978 928 150 3594. https://apps.who.int/iris/bitstream/handle/10665/75217/9789241503594_eng.pdf

Quality assessment guidebook: A guide to assessing health services for adolescent clients. ISBN: 978 924 159 8859. http://apps.who.int/iris/bitstream/handle/10665/44240/9789241598859_eng.pdf?sequence=1

Some resources on how to go about writing SOPs:
https://hub.ucsf.edu/sops
https://globalhealth.duke.edu/standard-operating-procedures-clinical-trials-sops
https://www.appliedclinicaltrialsonline.com/view/sites-still-necessary-for-decentralized-trials
https://www.hopkinsmedicine.org/institutional_review_board/about/compliance_monitoring/researchers_tool_kit/standard_operating_procedure.pdf


Qualitative research SOP writing:
http://www.wales.nhs.uk/sitesplus/documents/1056/WWORTH-SOP27QualitativeMethodsv2%201-140507.pdf