The Global Accelerated Action for the Health of Adolescents (AA-HA!): guidance to support country implementation recommends that all health workers who are in places that adolescents visit (e.g. hospitals, primary care facilities and pharmacies) should develop their competencies (i.e. knowledge, skills and attitudes) in adolescent-responsive health-care, to be able to respond to their specific needs. Making competency-based education in adolescent health-care mandatory in pre-service curricula and postgraduate education is one of the key actions towards a workforce that is competent in adolescent health.
To support countries in building an adolescent competent workforce, WHO developed Core competencies in adolescent health and development for primary care providers, which includes a tool to assess the adolescent health and development component in pre-service education, and develop recommendations.
Since the launch of Core competencies in adolescent health and development for primary care providers, many countries have used them to inform national efforts in building an adolescent-competent workforce. Based on WHO training modules, faculty staff from Ethiopia, Kenya, Lesotho, Malawi, Mozambique, Namibia, Nigeria, Rwanda, Tanzania, Uganda, Zambia and Zimbabwe and have been trained in adolescent health and development.
Other countries used the WHO Core competency assessment tool to assess the structure, content and quality of the adolescent health component of pre-service curricula, and develop recommendations for improvement. (e.g. China, Egypt, Ghana, India, Sri Lanka and the United Republic of Tanzania).
Case study
The Republic of Moldova’s addressing of adolescent health and development in state medical university curricula
More than one fifth of the total population in the Republic of Moldova consists of young people aged 10–24 years. Since 2001, a network of youth-friendly health centres (YFHC) has been established and gradually expanded to provide adolescents and young people with the services they need. To ensure that services are being provided according to national quality standards, it was crucial to address providers’ competences, such as age-appropriate communication, confidentiality and integrated health risk assessment, among others. For the first 10 years the initiative relied on in-service training, largely sponsored by donor agencies.
The country, with a population of 3.5 million people, has only one medical university – the State University of Medicine and Pharmacy “Nicolae Testemitanu”. It provides university and postgraduate training, as well as clinical internships, residencies, doctoral, postdoctoral and continuous professional education training. To minimize reliance on donor funding, in 2014 a postgraduate training course for service providers (in-service training as part of ongoing education) was developed, approved and integrated into the university curriculum for ongoing medical education. This 50-hour course is run jointly by the State Medical University and the National Resource Centre for Youth-Friendly Health Services “Neovita”. Providers can choose this course as part of their five annual applications for continuous professional education.
Having a dedicated course on adolescent health in continuous professional education was an important achievement, and a key to sustainability. However, it was soon realized that improving the structure, content and quality of the adolescent health component of pre-service curricula is also very important. There were two reasons for this. First, improving the adolescent health component in pre-service training would ensure that every medical graduate – and therefore the future workforce – is adolescent-competent at the level of basic competencies. Second, primary care reform in the Republic of Moldova was well established, and that reform put the family doctor at the centre of health-care provision. It is important, therefore, to ensure that every adolescent receives responsive care, irrespective of whether he or she seeks care in a primary care facility or in the YFHC. Therefore, targeting the adolescent health component in residency training of family doctors is crucial.
Between 2014–2016, adolescent health and development issues have been incorporated in postgraduate training in three ways:
- In residency training of family doctors (18 hours - 3 hours theory and 15 hours practical seminars).
- In residency training of paediatricians (45 hours - 6 hours theory and 39 hours practical seminars).
- In residency training of obstetricians and gynaecologists (140 hours - 70 hours theory and 70 hours practical). This course was established long before the 2000s, but its content has been recently updated.
With these successful efforts, the country has ensured that adolescent health and development training is now available in both pre-service and in-service education. Therefore, a progression across this spectrum of education is possible to ensure lifelong learning. It was not an easy or obvious process; some of the factors that contributed to the success were:
- Engaging top-level university decision-makers was inherent to gaining formal approval and integrating the adolescent health course into the university curriculum for continuous professional development.
- Having a National Resource Centre for Youth-Friendly Health Services “Neovita” provided the base for practical training in adolescent health-care for residents and practitioners.
- Providing faculty staff from key departments with state-of-the-art adolescent health training was an important factor in building their understanding that adolescents are not simply older children or younger adults.
- Holding biannual National Conferences on Adolescent Health provided the opportunity to unite professionals (i.e. academics, practitioners and policy-makers) working for adolescent and youth health in the Republic of Moldova in sharing scientific and programmatic advances.
- Having longer-term financial support from the project Healthy Generation - Scaling up of YFHS in the Republic of Moldova, financed by the Swiss Agency for Development and Cooperation, made it possible to sustain and expand initial investments in building institutional capacity for adolescent health training.
Regional collaborations
PAHO is partnering with the key universities in the region to develop education and training courses in adolescent health and development. For more than 10 years PAHO has been partnering with the Catholic University of Chile, for implementation of a Diploma Course in Adolescent Health, and PAHO provided more than 800 scholarships for country stakeholders to participate in this post-graduate course. In 2015 PAHO commissioned a review of the implementation of this course and scholarship program. The WHO Core competencies framework informed the review.
In 2015 PAHO initiated a partnership with the University of the West Indies, the largest university in the Caribbean with a (sub) regional scope. As part of this partnership, a graduate level adolescent health course is being developed. In addition, a lower level course is being developed for the Open Campus. The Core Competencies and Global Standards documents are being used as key input for this development. The courses will be launched in 2018.
In partnership with UNFPA and IPPF, PAHO is planning to conduct in 2018 a review of curricula of selected universities in the Region, based on the WHO core competencies framework.
Institutionalising competency based education and training on adolescent and youth friendly health services in pre-and in-service training programmes for health care providers in East and Southern Africa (ESA)
In partnership with WHO and other partners, UNFPA is developing a Regional Guidance for Institutionalising Competency Based Education and Training on Adolescent and Youth Friendly Health Services in Pre- and In-Service Training Programmes for Health Care Providers in East and Southern Africa (SEA). The guidance is aligned with the Global Accelerated Action for the Health of Adolescents (AA-HA!): guidance to support country implementation, and builds on the WHO global standards for quality health care services for adolescents and the WHO core competencies in adolescent health and development for primary care providers.
This guidance aims to strengthen and support training programmes and institutions in ESA countries, through the identification of gaps and the development of national, regional and local plans to increase the focus on adolescent health in competency-based pre- and in-service training programmes for HCPs. The range of options are presented that might be adapted to local contexts. The guidance will be available in 2018.
Building institutional capacity in countries for adolescent and school health training
In February 2019 the WHO Regional Office for Europe in collaboration with the government of Armenia organized an intercountry Adolescent Health and Medicine training of trainer’s course that took place on 4-8 February 2019, in Yerevan, Armenia. Faculty staff, policy makers and health-care providers from Armenia, Georgia, Kazakhstan, Kyrgyzstan, Russian Federation, Tajikistan and Uzbekistan developed more effective skills in teaching and advocating to improve the quality of health care and preventive services delivered to school-age children and adolescents.