医療システムと政策研究

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Evaluating the Impact of the National Adolescent Health Strategic Plan on Adolescent Sexual Reproductive Health Services in Zambia: A Qualitative Study

Mercy ZC, Chris M and Wilbroad M

Introduction: In 2011, the government of Zambia implemented the National Adolescent Health Strategic Plan 2011-2015 which aimed at addressing adolescent health problems in a comprehensive and consistent manner. Thus far, no formal evaluation has been conducted and it remains unclear whether interventions which were implemented had led to improved access to the services by adolescents. Using the WHO six building blocks framework for health system strengthening, the study sought to qualitatively evaluate the achievements of the 5-year strategic plan and draw generalizable knowledge for best practices for improving adolescent reproductive health in Low Middle Income Country (LMIC) settings.

Methods: To provide insight into the implementation of the strategic plan in relation to the six building blocks a qualitative case study approach was adopted for this evaluation. Twenty one Key Informant Interviews (KIIs) were conducted with key stakeholders involved in the implementation process at different levels in the health system in Zambia. Thematic analysis using the WHO building blocks framework was used to analyze data. NVivo 11 was used to aid coding, management and analysis.

Results: Close linkages across the six building blocks of the health system were observed. Observed weaknesses in one building block affected other health system building blocks negatively. Nonetheless, some successes were also reported including consistence and standardised packages for Adolescent Sexual Reproductive Health Services (ASRH), health worker training in ASRH, use of data for decision making, and better policy harmonisation. The major barriers to the implementation were inadequate infrastructure, funding and human resources.

Conclusion: The major barriers to implementation included inadequate human resources and funding which negatively affected service delivery. However positive trends were noted in health worker training and policy environment.