National Standards and Minimum Service

Package for Adolescent and Youth-Friendly

Health Services in Nigeria

1
 Credits

The production of this document was commissioned by Federal Ministry of

Health, with support from the United Nations Population Fund (UNFPA)

Consultant

Professor Adesegun O. Fatusi

i
Acknowledgements

ii
Acronyms and Abbreviations

AFHS Adolescent Friendly Health Services

AHD Adolescent Health and Development

AIDS Acquired Immune Deficiency Syndrome

AYFHS Adolescent and Youth Friendly Health Services

BCC Behaviour Change Communication

COPAD Community Programme Advisory Board

CSOs Civil Society Organisations

FMOH Federal Ministry of Health

FMOI Federal Ministry of Information

HIV Human Immunodeficiency Virus

IDPs International Development Partners

IEC Information, Education, and Communication,

LGA Local Government Authority

NGO Non-Governmental Organisations

NOA National Orientation Agency

NPHCDA National Primary Health Care Development Agency

NPHDAYP National Policy on the Health and Development of Adolescents and Young
People in Nigeria

PHC Primary Health Care

PP Global Planned Parenthood Global

RTIs Training and Research Institutions

SMOH State Ministry of Health

SMOI State Ministry of Information

TWG Technical Working Group

UNFPA United Nations Population Fund

UNICEF United Nations Children’s Fund

iii
WHO World Health Organisation

YAG Youth Advisory Group

YFHS Youth Friendly Health Services

YP Young People

iv
Contents
Acknowledgements................................................................................................................................. ii
Acronyms and Abbreviations ................................................................................................................. iii
1. BACKGROUND ................................................................................................................................. 1
1.1. Introduction ............................................................................................................................ 1
1.2. Rationale for the document .................................................................................................... 2
1.3. The Process of Developing the Document .............................................................................. 3
1.4. The Purpose of the Document ................................................................................................ 4
1.5. Intended Audience and Beneficiaries ..................................................................................... 4
1.6. Guiding Principle for the Document ....................................................................................... 5
2. STANDARDS AND CRITERIA FOR ADOLESCENT- AND YOUTH-FRIENDLY SERVICES IN NIGERIA ..... 6
2.1. Criteria of the Quality Standards of Adolescent- and Youth-Friendly Health Services
(AYFHS) and Implementation Guide ................................................................................................... 7
Standard 1: ...................................................................................................................................... 8
Standard 2: ...................................................................................................................................... 9
Standard 3: .................................................................................................................................... 11
Standard 4: .................................................................................................................................... 12
Standard 5: .................................................................................................................................... 13
Standard 6: .................................................................................................................................... 14
Standard 7: .................................................................................................................................... 15
Standard 8: .................................................................................................................................... 16
Standard 9: .................................................................................................................................... 17
2.2. Implementation Plan for the National Standard .................................................................. 18
4. MINIMUM SERVICE DELIVERY PACKAGE FOR ADOLESCENT- AND YOUTH- FRIENDLY HEALTH
SERVICES ............................................................................................................................................... 48
4.2. Minimum package of services for AYFHS in Nigeria ............................................................. 49
APPENDIX 1: Required National Minimum Resources and Infrastructure for Primary Health Clinics in
Nigeria ................................................................................................................................................... 61
APPENDIX 2: Required National Minimum Resources and Infrastructure for Primary Health Centres in
Nigeria ................................................................................................................................................... 68

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1. BACKGROUND

1.1. Introduction
Young people between the ages of 10 and 24 years constitute almost a third of Nigeria’s
population; they constitute the critical link between childhood and adulthood and a major
force in the national’s development quest. As the next generation of adults, the health and
well-being of today’s young people is critical to the future of the country; their health
situation will not only determine the overall health development of the country, but will
impact every facet of national development. In recognition of these facts, the need to invest
more in the health and development of young people is increasingly recognised by policy
makers and other stakeholders. In the words of the National Policy on the Health and
Development of Adolescents and Young People in Nigeria (NPHDAYP), “The government and
people of Nigeria are convinced that investing in the health and development of adolescents
and other young people will yield benefits for both young people and the entire Nigerian
society, and is critical for the sustained economic and social development of the country”.

Young people, while generally healthy, are a vulnerable population, and at greater risk of
some health problems and health-risk behaviour compared to other population groups. The
leading health challenges of young people in Nigeria, as identified by the national policy
(NPHDAYP), are sexual and reproductive health issues, trauma and injures, mental health,
substance use, and nutritional problems. Provision of adolescent and youth friendly health
services (AYFHS) has identified globally and nationally as a key strategy in improving the
health and development of young people. Till date, unfortunately, availability of AYFHS
remains poor in Nigeria, with its attendant negative consequence on young people’s health.
In general, most public health sector facilities in Nigeria do not provide adolescent and
youth-friendly services, and neither does the private-for-profit health sector that caters to
the health of most Nigerians when they are ill. Non-governental organisations have been in
the forefront of providing AYFHS, but their reach is understandably low and their number as
well as spatial distribution cannot guarantee equitable access to young people across the
country. There is also wide disparity in the package and quality of services as there are no
national standards and policy guide in that direction.

1
 1.2. Rationale for the document
Several national policy documents recognise, and indeed, advocate for improved availability
and accessibility of AYFHS in Nigeria as a key strategy to advancing the health and
development of young people in Nigeria. These include the National Policy on the Health
and Development of Adolescents and Young People, the National Action Plan on Advancing
the Health and Development of Young People in Nigeria, the National Youth Policy, and the
Health Sector Strategic Plan for HIV/AIDS, and the National Policy on Population and
Development. Yet, the availability and accessibility of AYFHS remains critically low in Nigeria
till date, due to poor or non-implementation of the relevant policy provisions. AYFHS has
been defined as “facilities that have policies and attributes that attract youth to the
facility/programme, provide a comfortable and appropriate setting for serving youth,
meeting the needs of young people and are able to retain the youth clientele for follow-ups
and repeat visits”.1 They are recognised as facilities that are able to effectively attract
adolescents, responsively meet their needs, and succeed in retaining these young clients for
continuing care.

In developing its first Clinical Protocol and Service Guidelines for Adolescent Health Services
in Nigeria in 2001, a list of minimum package of services was included. The list included
three broad activities: education and communication, health and general lifestyle
(consisting of general health services, contraceptive services, sexually transmitted
infections, sexual violence, mental health services, and referral system), and recreation
services. However, no standards were specified, severely limiting its usefulness. The list was
also not drawn up in participatory or consultative manner, which made buy-in difficult and
there was also low awareness of the minimum package.

This document aims to address the deficit in the past approach, as it was developed with
input from a wide group of stakeholders across the health sector, and has clear
performance focus as well as identify what quality means in practice and what it will take to

1
Focus on young adults. (1999) Making reproductive health services youth-friendly

2
translate quality-standard statements into tangible improvements in quality and coverage of
AYFHS. The standards are also expected to address the low rate of utilisation of available
health services by young people as it will make services more acceptable to young people.
The standard responds to the criteria specified by WHO in its quality framework for adolescent
2
friendly health services ; these specify that AYFHS must be:

 Accessible: Adolescents are able to obtain the services that are available.
 Acceptable: Health services are provided in ways that meet the expectations of
adolescent clients.
 Equitable: All adolescents, not just certain groups, are able to obtain the health
services they need.
 Appropriate: The health services that adolescents need are provided to them.
 Effective: The right health services are provided in the right way and make a positive
contribution to the health of adolescents.

1.3. The Process of Developing the Document

The development of this document has been guided by the Nigeria’s national policy
documents on young people’s health and development, WHO’s quality framework for
adolescent health services, and global experiences in standards of care-driven initiatives for
AYFHS, as well as local programming experiences in adolescent health and development.
The process was consultative and participatory, involving a wide cross-section of
stakeholders in the field of adolescent and young people’s health, including young people
themselves, health care providers, programme managers from government agencies and
non-governmental organisations, the academia, and representatives of international
development organisations. It particularly benefitted from the technical insight and inputs
of the National Working Group on Adolescent Health and Development, representing
diverse group of experts on adolescent and young people’s health in Nigeria.

The development process involved the development of background material and

“framework”, based on extensive review of the literature, local experiences and global best

2
WHO, 2002. Global Consultation on adolescent-friendly health services

3
practices. The document served as the critical input for a three-day national Workshop,
which involved a wide group of stakeholders, during which consensus was built on the
standards and details of its implementation. The document was thereafter technically
edited by an adolescent health expert, to produce the initial draft which was widely
circulated to harvest comments and additional inputs, after which the final version of the
document was produced. This was followed by a national forum, where the document
underwent its final review and adoption.

1.4. The Purpose of the Document

This document specifies the standard of health services to be provided by health service
delivery points to young people in Nigeria, with the aim of improving the quality, access and
utilization of appropriate health facilities by young people. Specifically it is designed to serve
as a platform for the implementation of a standards-driven initiative to improve the quality
and expand the coverage of health service provision to young people.

The defined “National Standards” will ensure that the services being provided to adolescents and
other young people are not only responsive to their health and development and effective in terms
of technical quality, but are also available, accessible, acceptable, and equitable. It will also ensure
that the service quality is uniform across all the health service delivery points. Overall, it is expected
that adhering to the specified national will appropriately improve the access of young people to
needed health services as well as their utilisation of such services

1.5. Intended Audience and Beneficiaries

The primary beneficiaries of this document are young people (10-24 years) in Nigeria, whose
health and lives are expected to be impacted through an expanded and improved quality of
care that should result with the implementation of the standard. Service providers, policy
makers and community members are all secondary beneficiaries as the document provide
clear guidelines for health-related policy making and service implementation, and the
benefit of improved health of young people impact the community and the nation positively
in health and socio-economic development terms.

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The document is directed to all service providers and all other stakeholders working in the
area of adolescent and young people’s health at all levels within the health sector, including
policy/ decision makers, programme managers, service providers in the Government, non-
government, private sectors and international development organisations.

1.6. Guiding Principle for the Document

The following principles undergird the development of this document and are critical to the
implementation of the developed national standards:
 Rights-based – to protect, promote and fulfil the human rights of young people in Nigeria,
including their rights to information and health care
 Evidence-informed and scientifically sound approaches
 Compliance with highest level of quality healthcare practice and accepted standards
of ethics.
 Adolescent and youth participation in health services and related developmental
opportunities
 Cultural sensitivity and concordance with relevant policies and laws
 Gender-sensitivity and gender-responsive approaches to needs of both males and
females

 Promotion of increased access of young people to appropriately friendly and quality
health services
 Parental involvement and community ownership
 Appropriate linkages with other sectors

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2. STANDARDS AND CRITERIA FOR ADOLESCENT- AND YOUTH-FRIENDLY
SERVICES IN NIGERIA

A standard is a statement of desired quality. Standards are critical in terms of adolescent and youth
friendly services as they specify clear performance goals and make explicit the definition of quality
required for a service. They provide a clear basis against which performance can be monitored,
assessed and/or compared. They are, thus, valuable in strengthening programme implementation,
monitoring and evaluation. This is because they set clear performance goals and make explicit the
definition of quality required for a service. They provide a clear basis against which performance can
be monitored, assessed and/or compared.

The national quality standards for provision of Adolescent- and Youth Friendly Health
Services (AYFHS) in Nigeria have been developed to provide a platform for the optimal
health and development of young people. These standards are consistent with existing
national adolescent and youth health and development policies, and in line with the WHO's
criteria for Adolescent-Friendly Health Services. The standards criteria were also informed by
global and national experiences, and keeping in view the necessary resources, operational activities
and the expected health and development outcomes. The National standards will ensure that health
services being provided to young people are uniform across all service delivery points and are
effective and responsive to their needs.

In all, Nigeria has adopted nine standards for its AYFHS: these standards address the various
dimensions of service delivery

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 2.1. Criteria of the Quality Standards of Adolescent- and Youth-Friendly Health
Services (AYFHS) and Implementation Guide

1. GATEKEEPERS’ SUPPORT: An enabling environment exists in the community for health care
workers to provide quality services to young people, and for young people to appropriately
utilise health services

2. ACCESSIBILITY OF SERVICES: Young people in the catchment area of the health facility are
aware of the services it provides, find the health facility easy to reach and obtain services
from it

3. ACCEPTABLE SERVICES: Young people find the environment, setting, and procedures of
health facilities appealing and acceptable

4. EQUITABLE & RIGHTS-BASED SERVICES: All young people who visit health service delivery
facilities are treated with respect, dignity and in equitable manner irrespective of their
health, socio-demographic or political status

5. APPROPRIATE & EFFECTIVE SERVICES: The services provided by health facilities to young
people are effective and in line with the nationally defined package

6. PRIVACY AND CONFIDENTIALITY: Service providers are sensitive to the needs of young
people, and maintain their privacy and confidentiality in service provision

7. MOTIVATION OF HEALTH WORKERS: Service providers are motivated to provide health

services to young people in adolescent/youth-friendly manner

8. QUALITY ASSURANCE &IMPROVEMENT: Management systems are in place to

improve/sustain the quality of health services provided to young people by the health service
delivery facilities

9. YOUNG PEOPLE’S INVOLVEMENT: Young people are actively involved in the design, the
provision and monitoring of services at the adolescent and youth-friendly health services

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Standard 1:
An enabling environment exists in the community for health care providers to provide quality
services to young people, and for young people to appropriately utilise health services

Input Criteria Process Criteria Output Criteria

I. A plan for advocacy activities Implementation of the Community influentials
targeting influential community advocacy activities as per support the provision of
members (including traditional and the plan services to young
religious leaders, educational people
authorities, ward/village health
committee members, and school
principals/heads) to secure their
support for AYFHS exists.
2. A plan of activities (including Implementation of the Community members
community meetings, meetings with activities in the plan are aware of the
parents, and school visits) to be carried availability and
out in the community to inform and convinced about the
educate community members about benefits of AYFHS, and
the availability and benefits of AYFHS to support the provision of
young people and their community. relevant health
3. Procedures are in place to Service providers information and quality
communicate with all adults visiting the communicate effectively services to young
health facility as regards the availability about the value of people.
and benefits of AYFHS to young people. providing health services
to adolescents and the
type of services available
in their interactions with
adult patients and clients.

8
Standard 2:
Young people in the catchment area of the health facility are aware of the services it provides, find
the health facility easy to reach and obtain services from it

Input Criteria Process Criteria Output Criteria

1. There is a well-defined plan Activities to inform Young people are aware about
to inform young people in the adolescents about the the type of services from the
community as to the availability of services from health facility, their working
availability of quality services the facility are carried out as days and hours and know that
from the facility per the plan developed. they are welcome.
2. Health facility has well- Well-written Signboard(s)
written signboard(s) which with required information are
indicate the following with placed conspicuously in the
regards to services aimed at front of the health facility
young people:
(a) the type of health services
that are provided
(b) when they are provided
(c) that adolescents are
welcome
3. Print and other relevant Print and other relevant
Informational materials are Informational materials are
developed and distributed/ developed and distributed
disseminated to young people widely through venues and
and their significant others in channels that are attractive
the community (including at to young people
the facility, schools, religious
settings, community meetings
and through electronic media)
about the type of services
available in the health facility,
their working days and hours
and that young people are
welcome
4. Flexible time schedule for Health services are provided Young people have improved
adolescent and youth clients, as per the flexible time access to quality health
if possible, is in place schedule services
5. Policies and procedures to Service providers provide
provide health services to young people with services
young people free of charge free of charge or at affordable
or at affordable prices are in prices in line with defined
place. policies and procedures.
6. Plan is in place to provide Outreach services are being
outreach health services to delivered to special groups of
young people, particularly young people as per the plan
those belonging to special developed.
groups in the catchment area
of the health facility
7. Plan is in place to facilitate/ Provisions are made in line
ensure the access of young with the plan to enable

9
 Input Criteria Process Criteria Output Criteria

people with special challenges specially-challenged young

(such as physically challenged people to access services at
young people) to quality the facility and/or through
health services referral and outreach services

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Standard 3:
Young people find the environment, setting, organisation and procedures of health facilities
appealing and acceptable

Input Criteria Process Criteria Output Criteria

1. Standard operating protocols Facilities are maintained / provided Young people feel
(SOP) to maintain a good ambience as per the SOP comfortable when they
for young people - including a clean visit health facility and
spacious waiting area, potable find the surroundings
drinking water, clean toilets and and procedures
educational material are in place appealing and
2. Separate waiting room that are Separate waiting room or youth acceptable.
clean, adequate in space, and have corner meeting the specified
adequate seats, indoor games, criteria are provided and daily
adolescent/youth-appropriate maintained
educational materials, or young
people’s corner are provided for
adolescent and youth clients in
facilities serving general population

3. Protocols for the staff to provide Service providers follow the

services in a friendly and protocols to provide services to
appropriate manner are in place adolescents in a friendly and
appropriate manner.
4. Mechanisms to involve young Young people are involved in
people in the designing, provision designing, provision and monitoring
and monitoring of health services of health services
are in place
5. Flow design of utilization of The designed flow to keep the Services to young
services to keep the waiting time waiting time short is followed. The people are ideally
short and informative is in place. waiting time is filled in by holding provided within 30
appropriate health education minutes of their arrival
sessions in the facility.

11
Standard 4:
All young people who visit health service delivery facilities are treated with respect, dignity and in
equitable manner irrespective of their health, socio-demographic or political status

Input Criteria Process Criteria Output Criteria

1. The rights of young people to Health facility conspicuously All young people that
dignity, respect, privacy and displays the rights of young people visit the health facility
confidentiality are clearly written in the context of health care in the feel satisfied with the
out and prominently displayed health facility. way they are treated
within the health facility ,
2. Protocols/ guidelines to provide Service providers follow the
services competently in non- protocols /guidelines to provide
judgmental, caring, considerate, services competently and with a
gender-responsible and culturally- non-judgmental, caring,
sensitive attitude and equitable considerate, gender-responsible
manner are in place. and culturally sensitive attitude
and equitable manner
3. Orientation programme is All staff undergo training in
designed for all staff – both clinical appropriate procedures to ensure
and non-clinical categories – to that privacy and confidentiality are
ensure privacy and confidentiality ensured in the provision of services
in services provided to young to young people
people
4. Provisions are put in place for
challenged young people
programme is designed for all staff
– both clinical and non-clinical
categories – to ensure privacy and
confidentiality in services provided
to young people

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Standard 5:
The services provided by health facilities to young people are effective and in line with the nationally
defined package

Input Criteria Process Criteria Output Criteria

1. A national defined package Services provided / delivered The services provided by the
of health services to be on site or through referrals are health facilities are effective
provided to young people is in based on the agreed upon and in line with the accepted
place. health package for young package of services, and are
people provided on site or through
2. A standard list of The essential health/aware referral linkages by well
equipment for health service equipment are available for trained staff.
provision for young people is service delivery to young
in place people
3. A standard list of essential The essential commodities and
commodities and supplies is in supplies in line with the
place standard list are available for
service delivery to young
people
4. The nationally-approved Service providers follow the
clinical protocol and other job clinical protocol for the
aides are available in the provision of services for young
facility for the management of people.
the health problems of young
people
5. The nationally-approved All health staff are trained/
training manual is available in oriented in AYFHS based on
the health facility for the the national training manual
training/orientation and re-
training of service providers
6. A focal person has been The focal person coordinates
designated for the and oversees service provision
oversight/coordination to young people
provision of AYFHS in the
facility.
7. Health workers trained in Health facility staff utilises
AYFHS are available in number their competencies to provide
adequate for the level of health services effectively and
health care for the provision competently to young people
of quality health services to
young people
8. A resource directory of The resource directory is
organizations and referral utilized to refer the needy
networks providing health young person for the
services to young people that particular services that are not
are not provided at the facility available at the facility.
is available.
9. Appropriate forms for The appropriate forms are
referral and feedback are utilized for referral and
available feedback

13
Standard 6:
Service providers are sensitive to the needs of young people, and maintain their privacy and
confidentiality in service provision

Input Criteria Process Criteria Output Criteria

1. The confidentiality and privacy Health facility displays the All young people that
policy of the facility is clearly confidentiality and privacy policy visit the health facility
displayed in the clinic and is clearly for adolescent and youth clients. feel satisfied that their
expressed to all adolescent and privacy and
youth clients confidentiality was
2. Health facility procedures to Health facility staffs apply the assured
ensure confidentiality of the procedures to ensure the
adolescent and youth clients are in confidentiality of their adolescent
place. and youth clients

3. Health facility procedures to Health facility staff apply the

ensure auditory and visual privacy procedures to ensure auditory and
for the adolescent and youth visual privacy for their adolescent
clients are in place. and youth clients

4. Orientation programme is All staff undergo training in

designed for all staff – both clinical appropriate procedures to ensure
and non-clinical categories – to that privacy and confidentiality are
ensure privacy and confidentiality ensured in the provision of services
in services provided to young to young people
people

14
Standard 7:
Service providers are motivated to provide health services to young people in adolescent/youth-
friendly manner

Input Criteria Process Criteria Output Criteria

1. Plan for training and re-training Service providers apply their skills Service providers are
of staff at least once in three years and competencies in providing motivated to provide
are in place to ensure their good quality care to young people services to young people
effectiveness in service delivery and feel valued for the
2. Mechanism to recognise and Good performance of health work they do
reward adolescent/youth health workers is recognised and
workers are put in place rewarded

15
Standard 8:
Management systems are in place to improve/sustain the quality of health services provided to
young people by the health service delivery facilities.

Input Criteria Process Criteria Output Criteria

1. Health management Health workers use HMIS to Data are collected,
information system is in place for monitor service performance and analyzed and used to
collection of service data to trend in utiilisation, and to identify improve the quality of
monitor service performance and needs for corrective/ameliorative health services being
utilisation actions. provided to young
people
2. Nationally approved data Health workers are trained in the
collection tools are available in use of tools, and apply them for
adequate amount in health monitoring and improving service
facilities performance

3. Mechanism for regular Supervisors are trained to develop

supportive supervision in place for competencies in supportive
AYFHS supervision, and apply the skills to
support service providers

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Standard 9:
Young people are actively involved in the design, the provision and monitoring of adolescent- and
youth-friendly health services.

Input Criteria Process Criteria Output Criteria

1. Mechanisms to involve young Young people are involved in Young people are
people in the designing of health designing health services to make actively involved in
services are in place them more accessible, acceptable, every stage of AYFHS
equitable, appropriate, and
programming, including
effective with regards to the health
needs of adolescents and youths the design, provision
2. Mechanisms to involve young Young people are involved in and monitoring of health
people in the provision of health provision of health services in services.
services, including serving as peer various capacities that match their
educators and community- comparative strength, experiences
resource persons, are in place and competencies including
facility-based, outreach and
referral services
3. Mechanisms to involve young Young people are involved in
people in the monitoring of health monitoring of health services to
services, including functioning as provide feedback that would
members of relevant management improve service/program
committees, are in place management

17
 2.2. Implementation Plan for the National Standard

Standard 1: An enabling environment exists in the community for health care providers to provide quality services to young people, and for young
people to appropriately utilise health services
HSDPs (Health service LGA STATE NATIONAL MEANS OF VERIFICATION
delivery points)
INPUT
I. A plan for advocacy Service Provider, PHC Political leaders-LG Political leaders-Governor, Political leaders-Senate
activities targeting Coordinator, Chairmen, Councillors, LG First Lady of the State, Committees on Health & Advocacy plan
influential community PHC Dept, Wife of LGA Relevant MDAs, Bilateral & Youth, Relevant MDAs-
members (including Chairman, Women group Multilateral Agencies, NPHCDA, Bilateral &
traditional and religious leaders, Artisan groups, State legislators Multilateral Agencies, Budget line on YFHS
leaders, educational Youth group leaders, National Legislators
authorities, ward/village CBOs & FBOs, NGOs, CSOs, Women group leaders, Letter of commitments
health committee Artisan groups, Youth group NCWS- any national Youth from Partners
members, and school leaders; group leaders, National
principals/heads) to secure Artisan- groups (NURTW ),
their support for AYFHS. Organized Private Sector CBOs & FBOs, NGOs, CSOs,
(OPS) e.g. SNURTW, Organized Private Sector
Banking, Network & food (OPS)
Industries/providers etc
2. A plan of activities
(including community
meetings, meetings with
parents, and school visits)
to be carried out in the
community to inform and
educate community
members about the
availability and benefits of
AYFHS to young people and
their community.

18
3. Procedures are in place
to communicate with all
adults visiting the health Written protocol on YFHS Periodic meeting with Periodic meeting with Minutes of meetings
facility as regards the displayed in the facility Periodic meeting with parents on YFHS parents on YFHS
availability and benefits of parents on YFHS Report of activities
AYFHS to young people. Periodic meeting with
3. parents on YFHS Photogragh/ Video Record
Attendance list at meetings
PROCESS
1. Implementation of the -Adapt the advocacy plan - Adapt the advocacy plan -Develop advocacy plan by
advocacy activities as per -media campaigns using - Adapt the advocacy kits by SMOH & Stakeholders FMOH & Stakeholders -Advocacy plan
the plan acceptable communication - conduct technical update -Conduct evidence-based -Develop advocacy Kits & -Advocacy Kits & BCC on
channels - Community Dialogue advocacy visit BCC on YFHS YFHS
- Documentary -Disseminate advocacy plan -Media campaign plan
presentation on YFHS & kits -Reports
-Facilitate evidence-based
advocacy visit

2. Implementation of the Community outreach -Acceptable communication -Acceptable communication

activities in the plan Using lifecycle events channels channels
-SMS blast -SMS blast

3. Service providers -Policy & guideline on YFHS.

communicate effectively Chart flow on interventions Periodic meeting -Produce,
about the value of for young people Chart flow on interventions -disseminate, YFHS policy & -Job Aids in use
providing health services to for young people Reprint & guidelines, Strategic Plan
adolescents and the type of Periodic meeting Disseminate Policy, and Training manuals
services available in their Periodic meeting guidelines and Job Aids on
interactions with adult Use of Job Aids Job Aids YFHS
patients and clients.
OUTPUT

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1. Community influential Availability of Resources, Budget line on YFHS Budget line on YFHS Budget line on YFHS -Budget line on YFHS at all
support the provision of logistics & supplies levels
services to young people A charter/ Plaque on A charter/ Plaque on
A charter/ Plaque on commitments commitments -A charter/ Plaque on
commitments commitments
-Clinic identification (Sign
post on YFHS)
2&3. Community members Report of Awareness Report of Awareness Report of Awareness Report of Awareness
are aware of the availability creation activities creation activities creation activities creation activities Increased number of
and convinced about the Functional YFHC across the
benefits of AYFHS, and Written commitment Written commitment Written commitment Written commitment nation
support the provision of
relevant health information Client Register for Young Availability of Support Availability of Support Availability of Support
and quality services to people accessing care
young people.

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Standard 2: Young people in the catchment area of the health facility are aware of the services it provides, find the health facility easy to reach and
obtain services from it
HSDPs (Health service LGA STATE NATIONAL MEANS OF VERIFICATION
delivery points)
INPUT
1. There is a well-defined -Implements and report to - Coordinates, monitors, -Adapt national framework Develop a national -Copies of the plan at
plan to inform young the LGA train health care providers and policies/ POA. framework, policies, plan of facilities.
people in the community as and report to State -use national SOP. actions (POA), Standard of
to the availability of quality -provide technical practice (SOP).
services from the facility assistance to LGAs. -provide technical
- ISS assistance to state.
- ISS
2. Health facility has well- Install in strategic places. -Support the production of -provide technical -NIL Availability of signboard in
written signboard(s) which the signboard (Design and assistance (provide front of the facility and
indicate the following with produce signboard in specifications for the strategic places.
regards to services aimed at collaboration with State). productions).
young people:
(a) the type of health
services that are provided
(b) when they are provided
(c) that young people are
welcome.

3. Print and other relevant Utilise and distribute the Coordinate the distribution Produce, disseminate, and Produce, disseminate, and Availability of informational
Informational materials are relevant informational of relevant informational distribute relevant distribute relevant materials at the facilities.
developed and distributed/ materials to schools, materials to service delivery Informational materials to Informational materials to
disseminated to young religious settings, and points. LGA and other stakeholders state and other
people and their significant community based within the state. stakeholders.
others in the community organisations and
(including at the facility, significant others.
schools, religious settings,
community meetings and
through electronic media)

21
about the type of services
available in the health
facility, their working days
and hours and that young
people are welcome

4. Flexible time schedule for Comply with the provided Recruit and train more Policy to promote 24hr Staff roaster , time book
adolescent and young policy. Ensure minimum required personnel for LGA service.
clients, is in place number of staff in health
facility (recruitment ).

Develop schedule for

supervision of activities in
health facilities.
5. Policies and procedures Provide affordable health Promote and support Adopt guidelines and Develop guidelines and Availability of policies and
to provide health services services to the young affordable health services policies for affordable policies for affordable Standard of Practice (SOP).
to young people at people. for young people. health service for the young health services for young
affordable rate are in place. Ensure regular availability Provide essential medicine people. people.
of essential medicine in for the health facilities
stock

6. Plan is in place to provide Conduct outreach Services, Create an enabling Create an enabling Create an enabling Outreach report and
outreach health services to environment (ensure environment (ensure environment ( ensure documentation.
young people, particularly adequate security ) Provide adequate security ). Provide adequate security)
those belonging to special logistics support . logistics support.
groups in the catchment
area of the health facility

7. Plan is in place to Implement activities as Ensure implementation of Adopt guidelines and Develop guidelines and Availability of guidelines
facilitate/ ensure the access stipulated in the guidelines. the adopted guideline and policies to promote access policies to promote access and policies, structures,
of young people with policies. Provide logistic of specially challenged of specially challenged equipments, special
special challenges (such as support. young people to quality young people to quality appliances and specially
physically challenged young health services. Provide health services trained personnel .
people) to quality health logistics.
services

22
PROCESS
1. Activities to inform -Implements activities. - Coordinates, monitors, -Conduct M&E Conduct M&E and ISS -Copies of the plan at
adolescents about the -supervision and reporting. and report to State. - ISS facilities.
availability of services from -supportive supervision.
the facility are carried out
as per the plan developed.
2. Well-written signboard(s) -Identify strategic places to -provide fund. -Monitoring and evaluation. -supportive supervision. -Contract (job order)
with required information install the signboard. -carry out Monitoring and - Visiting sites where
are placed conspicuously in -Install the signboard. evaluation signboards are installed.
the front of the health
facility

3. Print and other relevant -Orientation meetings for Facilitate the distribution of Disseminate, and distribute Produce, disseminate, and Availability of informational
Informational materials are staff relevant informational relevant Informational distribute relevant materials at the facilities.
developed and distributed -Utilise and distribute the materials to service delivery materials to LGA and other Informational materials to -Record of distribution.
widely through venues and relevant informational points. stakeholders within the state and other
channels that are attractive materials to schools, -Conduct M&E state. stakeholders.
to young people religious settings, and -Conduct M&E -Conduct M&E
community based
organisations and
significant others.

4.Health services are -Draw up a roster for 24hr -Recruit and train more Develop Policy to promote Staff roster , time book
provided as per the flexible service -Recruit minimum required personnel for LGA. 24hr service.
time schedule number of staff in health -Adapt National policy for -Conduct M&E
facility. 24hr service.
-Conduct ISS
-Develop schedule for
supervision of activities in
health facilities.

23
5. Service providers provide -Provide affordable health -Give support for affordable -Adopt guidelines and Develop guidelines and -Price list
young people with services services to the young health services for young policies for affordable policies for affordable -Financial Records.
free of charge or at people. people. health service for young health services for young
affordable prices rates in -Procure essential -Provide essential medicine people. people.
line with defined policies medicines for young people for the health facilities -Hold orientation meeting, -Produce, disseminate and
and procedures. -Monitor stock level -Disseminate policies and disseminate and distribute distribute guidelines and
procedures to health policies and guidelines. polices for affordable
service delivery facilities. health services.
-Conduct M&E
6. Outreach services are Conduct outreach Services, Organise and mobilise -Pay Advocacy visits to gate -Pay Advocacy visits to gate Outreach report and
being delivered to special relevant security outfits to keepers to discuss security keepers to discuss security documentation.
groups of young people as promote security of issues issues
per the plan developed. personnel and facility.
7. Provisions are made in Use the provided Develop and disseminate Hold meeting of Develop and disseminate Availability of guidelines
line with the plan to enable structures, equipment, work plan for stakeholders to adopt and guidelines and policies to and policies, structures,
specially-challenged young special appliances and implementation of the disseminate guidelines and promote access of specially equipment, special
people to access services at specially trained personnel. adopted guidelines and policies to promote access challenged young people to appliances and specially
the facility and/or through policies. Provide logistics of specially challenged quality health services. trained personnel.
referral and outreach support. young people to quality Conduct M & E at lower
services Conduct M& E at facility health services. Provide levels.
level. logistics.
Conduct M & E at LGA and
facility levels.
OUTPUT
1. Young people are aware - Awareness created among Number of copies of Number of copies of Number of copies of Number of copies of
about the type of services young people. guidelines and policies guidelines and policies guidelines and policies guidelines and policies
from the health facility, -Facility adhering to distributed distributed. distributed. distributed.
their working days and guideline. M & E being conducted. Total number of young
hours and know that they people visiting the facility in
are welcome. a given period of time as
evidenced by records..

24
4. Young people have Number of young people (1)Number of copies of (1)Number of copies of (1)Number of copies of Number of young people
improved access to quality satisfactorily utilising guidelines and policies guidelines and policies guidelines and policies accessing the facility in a
health services quality health services in a distributed distributed distributed given period of time.
given period of time.
(2)Number of M & E visits (2)Number of M & E visits
conducted at the facility conducted at the LGA and (2)Number of M & E visits
level. facility levels. conducted at the lower
levels.

25
STANDARD 3: Young people find the environment, setting, organisation and procedures of health facilities appealing and acceptable

HSDPs (Health service LGA STATE NATIONAL MEANS OF VERIFICATION

delivery points)

INPUT
1. Standard operating The HSDP have physical Local will distribute to the State will distribute to the National will produce and Copies of the SOP’S
protocols (SOP) to maintain a copies health service delivery local government distribute the STANDARD produced and the
good ambience for young points OPERATING PROTOCOL distribution list
people - including a clean
spacious waiting area, potable
drinking water, clean toilets
and educational material are in
place.

2. Separate waiting room that Responsible for providing The LG should provide The state should provide To provide guidelines for Monitoring report
are clean, adequate in space, separate waiting rooms recreational facilities for recreational facilities for developing educational
and have adequate seats, HSDP under their control HSDP under their control materials
indoor games, and also develop and also develop
adolescent/youth-appropriate educational materials educational materials
educational materials, or following guidelines from following guidelines from
young people’s corner are the federal government the federal government
provided for adolescent and
youth clients in facilities
serving general population.

26
3. Protocols for the staff to The HSDP have physical Local will distribute to the State will distribute to the National will produce and Copies of theProtocol
provide services in a friendly copies and use them health service delivery local government distribute the PROTOCOL produced and the
and appropriate manner are in points distribution list
place.

4. Mechanisms to involve Young people in the Include young people at all Include young people in Integrate youth Monitoring report
young people in the designing, management team of the levels including the the design/monitoring and involvement to the
provision and monitoring of HSDP at all levels design/monitoring and evaluation teams protocol
health services are in place. evaluation teams

5. Flow design of utilization of Produce and implement Supervision to ensure Regular supervision to Provide guideline/template Flow design produced per
services to keep the waiting the flow design compliance of HSDP. Ensure that LGs comply on flow-design HSDP
time short and informative is with the Flow-design
in place.

PROCESS
1. Facilities are maintained / Ensure proper care and Provide facilities for PHC as Provide facilities for Provide guidelines for Inventory of equipments
provided as per the SOP. maintenance of facilities contained in the guideline secondary level as minimum standard List of facilities.
contained in the guideline

2. Separate waiting room or Ensure separate waiting Inspection of HSDPs under Ensure compliance with Include in the Standard Inspection report
youth corner meeting the room is provided and their jurisdiction and the guideline as produced Operating protocol
specified criteria are provided maintained proper funding by National produced
and daily maintained.

27
3. Service providers follow the Ensure protocol is adhered Support the supervision Monitoring and inspection Monitoring and inspection Report of exit interviews
protocols to provide services to or followed. visits visits
to adolescents in a friendly and
appropriate manner. Conduct exit interviews

4. Young people are involved Youth as part of the Ensure compliance to Ensure compliance to Include young people in Minutes of management
in designing, provision and management team guideline guidelines the design of the guideline meetings
monitoring of health services.
Include youth in Include youth in
monitoring monitoring

5. The designed flow to keep Provide alternatives such Monitoring to ensure Ensure compliance to the Set the standard and
the waiting time short is as games and health compliance set standard include the SOP
followed. The waiting time is education sessions
filled in by holding appropriate
health education sessions.

OUTPUT
1-4. Young people feel Conduct exit interviews Regular inspection Periodic assessments Periodic assessments Report from the exit
comfortable when they visit involving young people interview assessments
health facility and find the
surroundings and procedures Provide suggestion box
appealing and acceptable.

5. Services to young people are Follow flow chat designed Ensure proper staffing of Ensure compliance Include in the Standard Report the exit interview
ideally provided within 30 HSDPs under their control Operating Protocol assessments
minutes of their arrival in the produced
facility. Sign in register

28
 STANDARD 4: All young people who visit health service delivery facilities are treated with respect, dignity and in equitable manner irrespective of their
health, socio-demographic or political status

HSDPs (Health service LGA STATE NATIONAL MEANS OF VERIFICATION

delivery points)
INPUT
1. The rights of young Display of developed Step down training to Step down training to Funding and Copies of the material
people to dignity, respect, material, provision of Service Provider and fund Service Provider and development of produced, report of
privacy and confidentiality quality services to clients provided where fund provided where innovative models for trainings organized.
are clearly written out and necessary. necessary. Distribution provision of services Photographs of
prominently displayed of the materials such as cue cards and participants. list of
within the health facility. algorithms to aid attendants
health care providers
and training
2. Protocols/ guidelines to Functional knowledge on Adaptation and Adaptation and Development, Copies of
provide services the use of dissemination of dissemination of approval and protocols/guidelines
competently in non- guidelines/protocols. guidelines/protocols guidelines/protocols distribution of
judgmental, caring, guidelines/protocols
considerate, gender- booklets
responsible and culturally-
sensitive attitude and
equitable manner are in
place.
3. Orientation Privacy and Step down training on Step down training to Orientation Trainin Copies of the material
programmes are designed confidentiality privacy and confidentiality local government and gprogrammes for produced, report of
for all staff – both clinical maintained in services in services provided to fund provided where state trainings organized.
and non-clinical categories provided to young young peopleto both necessary. Photographs of
– to ensure privacy and people. clinical and non clinical participants. list of
confidentiality in services categories in HSDPs. attendants
provided to young people.

4. programme is designed All staff both clinical and Ensure that all staff both Ensure and support Ensure and support Copies of organization Flow

29
for all staff – both clinical non-clinical categories clinical and non-clinical that all staff both that all staff both chart, reports of trainings
and non-clinical categories have functional categories have functional clinical and non-clinical clinical and non-
– to ensure privacy and knowledge on privacy knowledge on privacy and categories have clinical categories
confidentiality in services and confidentiality confidentiality functional knowledge have functional
provided to young people on privacy and knowledge on privacy
confidentiality and confidentiality

5. Provision of supportive Supportive Monitoring Ensure implementation of Ensure implementation Design and Ensures Copies of supervisory
supervision to ensure and supervision Supportive Monitoring of Supportive implementation of document.
effective implementation mechanism put in place and supervision Monitoring and Supportive Reports Monitoring of
of equitable and rights mechanism supervision mechanism Monitoring and supervision.
based health services for supervision
all young people mechanism
PROCESS
1. Health facility Display Posters, cue Effective distributions and Effective distributions Development of Copy of posters pamphlets,
conspicuously displays the cards, pamphlets stating ensure compliance (m&e) and ensure compliance Posters, cue cards, cue cards materials
rights of young people in translated into local (m&e) pamphlets stating produced
the context of health care languages translated into local
in the health facility. languages
2.Service providers follow Conform to the Effective distributions and Effective distributions Produce Protocols Protocols guidelines and
the protocols /guidelines guidelines and standards ensure compliance (m&e) and ensure compliance guidelines and standards of practice
to provide services of practice in delivering (m&e) standards of practice
competently and with a YFHS
non-judgmental, caring,
considerate, gender-
responsive and culturally
sensitive attitude and
equitable manner
3. All staff undergo Adherence to training in Local government Training State level training for National training for Training, list of participants
training in appropriate line with Protocols for non clinical and clinical non clinical and clinical non clinical and pictures
procedures to ensure that guidelines and standards staff staff clinical staff
privacy and confidentiality of practice in rendering

30
are ensured in the YFHS
provision of services to
young people.
4. Training, Involvement Adherence to training in Local government Training State level training for National training for Training, list of participants
and mentoring of on line with Protocols for non clinical and clinical non clinical and clinical non clinical and pictures of challenged
clinical and non-clinical guidelines and standards staff in provision of staff in provision of clinical staff in people
staff on YSH provision in of practice in provision of services for challenged services for challenged provision of services
relation to challenged services for challenged people people for challenged people
young people people
5. Monitoring and Supportive monitoring Adaptation of M&E tools Adaptation of M&E Provision of tools for
supervision of all YFHS and supervision tools supportive
programmmes implemented monitoring and
evaluation
Young people are involved
in supportive supervision
and monitoring on YFHS

Availability of supervisory
tools

OUTPUT
Young people are aware Young people are aware Young people are Young people are Report from feedback
Young people are aware of of their rights while of their rights aware of their rights aware of their rights mechanism from clients
their rights receiving services and are satisfied and are satisfied

Young people received quality and professional quality and professional quality and professional quality and Report from feedback
quality and professional services provided to services provided to services provided to professional services mechanism from young
services from providers young people young people young people provided to young clients
people
Staff trained to provide Staff have full knowledge Young people receive Young people receive Young people receive Report from feedback
private and confidential on private and private and confidential private and confidential private and mechanism from young

31
youth friendly health confidential youth youth friendly health youth friendly health confidential youth clients, reports of trainings
services friendly health services services services friendly health
services
clinical and non-clinical Clinical and non-clinical Challenged young people
staff trained on provision have functional are satisfied by services
on YFHS for young people knowledge on provision received from service
of providers
Client and service Service providers and Service providers and Service providers and Service providers and Report of monitoring and
providers involved in client involved in periodic client involved in client involved in client involved in supervisions
Supportive supervision Supportive supervision Supportive supervision Supportive supervision Supportive
and monitoring of YFHS and monitoring and monitoring and monitoring supervision and Reports from Feed back
ensuring monitoring from young people
Young people involved in Young people involved in Young people involved receiving services
Young people involved in supportive supervision supportive supervision in supportive Young people
supportive supervision and monitoring on YFHS and monitoring on YFHS supervision and involved in supportive
and monitoring on YFHS monitoring on YFHS supervision and
monitoring on YFHS
Supervisory tools

32
STANDARD 5: The services provided by health facilities to young people are effective and in line with the nationally defined package

HSDPs (Health service LGA STATE NATIONAL MEANS OF VERIFICATION

delivery points)

INPUT
1. A national defined Copies of the National Obtain copies from the Obtain copies of the Develop, produce and Distribution list
package of health services MPSS for young people in State and distribute to the National MPSS from FMoH disseminate/distribute
to be provided to young place SDPs and distribute to LGAs copies of the National MPSS
people is in place. documents to the state and
other stakeholders

2. A standard list of Equipment are available Obtain list and procure • Obtain list, procure and Update standard list of Equipment Inventory
equipment for health within the HFs equipment for use at the disseminate equipment to equipment for provision of
service provision for young HFs state owned HFs AYFHS and distribute to the
people is in place • Share list of states
equipment with the LGAs

3. A standard list of Essential commodities are • Obtain list and • Obtain list, procure and • Update standard Stock inventory record
essential commodities and available within the HFs procure essential disseminate essential list of essential
supplies is in place commodities for use at the commodities to state commodities for provision
HFs owned HFs of AYFHS and distribute to
• Distribute essential • Share list of the states
commodities to the HFs essential commodities with •
the LGAs
4. The nationally-approved Copies of job aids and Obtain copies from state Obtain copies of job aids Develop and disseminate Distribution list
clinical protocol and other national approved clinical and distribute to health and clinical protocol and job aids.
job aides are available in protocols are available at facilities distribute to LGAs Print and disseminate more
the facility for the the health facility and used copies of approved clinical
management of the health for management of health protocols
problems of young people problems of young people

33
 HSDPs (Health service LGA STATE NATIONAL MEANS OF VERIFICATION
delivery points)

5.The nationally-approved Copies of nationally Obtain copies from state Obtain copies of training Disseminate copies of the Distribution List
training manual is available approved training manuals and distribute to health manual and distribute to national training manual to
in the health facility for the are available at the health facilities LGAs the states
training/orientation and re- facility.
training of service providers
.

6. A focal person has been Designated focal person for LGAs appoints LGA focal Appoint the State focal Direct the appointment of List of Focal person in place
designated for the coordination of AYFHS in person person for coordination of state AYFHS focal persons at all levels.
oversight/coordination place at the health facility AYFHS program at State
provision of AYFHS in the level
facility.

7. Health workers trained Trained service providers Identify capacity building  Training of state Core  Training of Master Training Reports
in AYFHS are available in available at the health needs at the HFs and trainers on AYFHS trainers on AYFHS
number adequate for the facilities for provision of forward list to the State  Provide post training  Provide post training
level of health care for the quality health services to supportive supervision supportive Records of Pool of available
provision of quality health young people to trained participants supervision to the trainers by category at all
services to young people master trainers levels

8. A resource directory of Copies of directory of Obtain copies of directory Obtain copies of directory Work with the states to Inventory of available tools
organizations and referral health facility and referral of health facilities and of health facilities and develop and produce at the health facilities.
networks providing health networks available at the referral networks from the referral networks from the copies of directory of
services to young people health facilities State and distribute to the Federal health facilities and referral
that are not provided at the health facilities networks in each state
facility is available.

34
 HSDPs (Health service LGA STATE NATIONAL MEANS OF VERIFICATION
delivery points)

9. Appropriate forms for Copies of referral and Obtain copies of forms for Obtain copies of forms for Develop forms for referrals Copies of referrals and
referral and feedback are feedback forms available at referral s and feedback referral s and feedback and feedback and share feedback forms and
available the health facility and in from the State and from the Federal and Share with the states utilization records.
use. distribute to the health with the LGAs
facilities

PROCESS
1. Services provided / Services are being delivered Copies of approved Package Copies of approved Package Copies of documents on Copies of agreed health
delivered on site or through at all the health facility of service delivery of service delivery approved package of care package are available
referrals are based on the based on the agreed upon guidelines for young people guidelines for young people service delivery guidelines at the health facilities
agreed upon health health package for young obtained from the state and obtained from the Federal for young people
package for young people people distributed to the health level and distributed to the developed/and or updated,
facilities LGAs produced and distributed to
state
2. The essential health Essential health equipment Obtain copies of the SOP Obtain copies of the SOP to Finalize and distribute Copies of SOPs available at
equipment are available are available and in use at for AYFHS and distribute to guide equipment copies of the AYRHS SOPs the state, LGAs and HF
for service delivery to the health facilities based the health facilities procurement for to guide essential levels.
young people on the SOP requirements distribution to the LGA level equipment procurement at
the state level

3. The essential Essential health • Obtain the list of  Obtain the list of the  Procure and distribute Commodities inventory list,
commodities and supplies commodities are available the essential commodities essential commodities essential commodities distribution list and service
in line with the standard list and in use at the health from the State. from the National level. to the States delivery records
are available for service facilities • Distribute  Distribute commodities  Share the list of
delivery to young people commodities to the HFs to the LGAs essential commodities
to guide additional
procurement of
commodities at the
state level

35
 HSDPs (Health service LGA STATE NATIONAL MEANS OF VERIFICATION
delivery points)

4. Service providers follow Copies of clinical protocol Obtain copies of the clinical Obtain copies of the clinical Produce more copies, Distribution list
the clinical protocol for the are available and in use at protocol from the State and protocol from the National disseminate /distribute
provision of services for the health facilities. distribute to the Health and distribute to the LGAs copies of the clinical
young people. facilities protocol to the states

5. All health staff are Copies of the National Obtain copies of the Obtain copies of the Develop, produce and  Distribution list
trained/ oriented in AYFHS AYFHS manuals are National training manual on National training manual on disseminate copies of the  Training
based on the national available and used at the AYFHS and distribute to the AYFHS and distribute to the national training manual on reports/participants list
training manual health facilities for training HFs LGAs AYHFS
of all health staff.

6. The focal person The HF focal person  LGA coordinator • State coordinator  National coordinator Copies of reports on AYFHS
coordinates and oversees coordinates and oversees coordinates coordinates coordinates activities
service provision to young service provision to young implementation of implementation of activities implementation of
people people at the HF level and activities at the HFs at the LGA level activities at the state
forwards report to the LGA level • Monitors and level
Coordinator  Monitors and supervises activities at the  Monitors and
supervises activities of LGAs , NGOs, line ministries supervises activities at
LGA based NGOs, line and other stakeholders as the state level, NGOs,
departments and listed in the AHD policy line ministries and
other stakeholders as  State coordinator other stakeholders as
listed in the AHD policy forwards report to the listed in the AHD
 Forwards report to the National Coordinator policy.
state Coordinator  Collate AYFHS services
report from the state
and use for evidence
based decision making

36
 HSDPs (Health service LGA STATE NATIONAL MEANS OF VERIFICATION
delivery points)

7. Health facility staff Health facility staff provide Monitors and supervises Monitors and supervises National monitors and Monitoring and supervision
utilises their competencies effective health services to activities of the HFs to activities of the LGA to supervises activities of the reports
to provide health services young people ensure that services are ensure that services are state to ensure that
effectively and competently being provided in line with being provided in line with services are being provided
to young people competency based competency based in line with competency
standards. standards. based standards.

8. The resource directory is Resource directory is Monitor and supervise the Monitor and supervise the Monitor and supervise the Monitoring and supervision
utilized to refer the needy available and utilized to use of the resource use of the resource use of the resource reports
young person for the refer the needy young directory by the HFs directory by the LGAs directory by the states Utilization records at the
particular services that are person for the particular HFs
not available at the facility. services that are not
available at the facility.

9. The appropriate forms Appropriate forms for Monitor and supervise the Monitor and supervise the Monitor and supervise the Monitoring and supervision
are utilized for referral and referral and feedback are use of appropriate forms use of appropriate forms use of appropriate forms reports
feedback available and utilized for referral and feedback for referral and feedback for referral and feedback Utilized referral and
by the HFs by the LGAs by the states feedback forms from the
HFs.

OUTPUT
The services provided by Effective services are Monitor provision of AYFHS Monitor provision of AYFHS Monitor provision of AYFHS  Monitoring
the health facilities are provided by the health at the HF level to ensure at the LGA level to ensure at the state level to ensure reports.
effective and in line with facilities in line with the adherence to approved adherence to approved adherence to approved  HF statistics
the accepted package of accepted package of package of services package of services package of services  Clinic schedule.
services, and are provided services, and are provided
on site or through referral on site or through referral
linkages by well trained linkages by well trained
staff. staff.

37
STANDARD 6: Service providers are sensitive to the needs of young people, and maintain their privacy and confidentiality in service provision

HSDPs (Health service LGA STATE NATIONAL MEANS OF

delivery points) VERIFICATION
INPUT
1. The confidentiality Young people receive Confidentiality and Distribute confidentiality Designed and distribute Copies of confidentiality
and privacy policy of the confidential services privacy policy clearly and privacy policy confidentiality and and privacy policy
facility is clearly within the facilities displayed privacy policy
displayed in the clinic
and is clearly expressed
to all adolescent and
youth clients.
2. Health facility Health Facilities Ensures Health Facilities Ensures Health Facilities Ensures Health Facilities Copies of standard
procedures ensure procedures including procedures follows the procedures follows the procedures follows the operating protocols.
confidentiality of the standard operating Confidentiality and Confidentiality and Confidentiality and
adolescent and youth protocols follows the privacy policy privacy policy privacy policy
clients are in place. Confidentiality and
privacy policy
3. Health facility Health facility Ensures Health facility Ensures Health facility Design and distribute Copies of standard
procedures ensure procedures follows procedures follows procedures follows standard operating operating protocols for
auditory and visual auditory and visual auditory and visual auditory and visual protocols for auditory auditory and visual
privacy for the privacy in the standard privacy in the standard privacy in the standard and visual privacy privacy
adolescent and youth operating protocols for operating protocols operating protocols
clients are in place. the adolescent and youth
clients are in place.

38
4. Orientation Orientation programme Ensure the Ensure the Design and ensure the Report of orientation
programme is designed is carried out for all staff implementation implementation of an implementation of an programmes
for all staff – both – both clinical and non- effective orientation effective orientation effective orientation
clinical and non-clinical clinical categories – to programme for all staff – programme for all staff – programme for all staff –
categories – to ensure ensure privacy and both clinical and non- both clinical and non- both clinical and non-
privacy and confidentiality in services clinical categories – to clinical categories – to clinical categories – to
confidentiality in provided to young ensure privacy and ensure privacy and ensure privacy and
services provided to people. confidentiality in services confidentiality in services confidentiality in services
young people. provided to young provided to young provided to young
people. people. people.
PROCESS
1. Health facility displays Confidentiality and Ensures and supervise Ensures and supervise Design, disseminate, Copies of policies
the confidentiality and privacy policies are well the providers are the providers are supervise and ensure the produced.
privacy policy for displayed are well adhering to the adhering to the providers are adhering to
adolescent and youth adhered to at the confidentiality and confidentiality and the confidentiality and
clients. facilities. privacy policies privacy policies privacy policies

2.Health facility staff Procedures are applied Ensure and supervise Ensure and supervise Design and disseminate Copies of clinical
apply the procedures to and adhered to, to facility staff to adhere to facility staff to adhere to clinical protocols to protocols designed.
ensure the ensure the procedures and procedures and facility staff to ensure
confidentiality of their confidentiality of their protocols. protocols. procedures are adhered
adolescent and youth adolescent and youth to.
clients clients
3. Health facility staff Procedures are applied Ensure and supervise Ensure and supervise Design and disseminate Copies of auditory and
apply the procedures to and adhered to, to facility staff to adhere to facility staff to adhere to clinical protocols to visual privacy clinical
ensure auditory and ensure auditory and auditory and visual auditory and visual facility staff to ensure protocols designed.
visual privacy for their visual privacy of their privacy procedures and privacy procedures and auditory and visual
adolescent and youth adolescent and youth protocols. protocols. privacy procedures are
clients clients adhered to.

39
4. All staff undergo Periodic Trainings on Ensuring that trainings Ensuring that trainings Design and Develop Copies of training
training in appropriate privacy and are conducted are conducted content for training manuals developed
procedures to ensure confidentiality conducted service providers on
that privacy and for clinical and non- confidentiality and List of attendance of
confidentiality are clinical service providers. privacy. training and reports of
ensured in the provision trainings
of services to young
people
OUTPUT
1-4. All young people All young people that All young people that All young people that All young people that Report of feedback
that visit the health visit the health facility visit the health facility visit the health facility visit the health facility activities stating the
facility feel satisfied that feel satisfied having feel satisfied having feel satisfied having feel satisfied having young people’s
their privacy and received quality services received quality services received quality services received quality services satisfaction.
confidentiality is assured and their confidentiality and their confidentiality and their confidentiality and their confidentiality
assured assured assured assured

40
STANDARD 7: Service providers are motivated to provide health services to young people in adolescent/youth-friendly manner

HSDPs (Health service LGAs STATE NATIONAL MEANS OF VERIFICATION

delivery points)
INPUT
1. Plan for training and re- -Participate in training -Collaborate with state to -Capacity building using - Capacity building using -List of participants
training of staff at least -Deliver quality health build capacity of staff available manual. available training manuals. -Training materials
once in three years are in services. -Monitoring and evaluation -Monitoring and evaluation -Monitoring and evaluation
place to ensure their (M&E). (M&E). (M&E).
effectiveness in service -Advocacy visits to LGA. -Advocacy visits to state
delivery -Supportive supervision to and LGA.
LGA. -Supportive supervision.
-Active collaboration with
NGOs
2. Mechanism to recognise Identify and recommend To implement and report to Adopt policies and -Develop Policies and -list of outstanding workers
and reward outstanding workers for state. guidelines and ensure guidelines to provide rewarded.
adolescent/youth health reward on an annual basis. implementation. incentives to outstanding -photographs of award
workers are put in place. health workers. ceremonies.

PROCESS
1.Service providers apply Provide quality care that Orientate and disseminate Orientate and disseminate -Develop and disseminate Exit interview of young
their skills and meet the needs of young policies and guidelines to policies and guidelines to policies and guidelines on people who visit the facility.
competencies in providing people ensure provision of skilled, ensure provision of skilled, training to ensure provision
good quality care to young competent and quality care competent and quality care of skilled, competent and
people to young people to young people quality care to young
people

2. Good performance of Identify and recommend Set criteria for reward of Adopt and implement Develop guidelines for -list of outstanding workers
health workers is outstanding staff for high performance health guidelines for reward of reward of high performance rewarded.
recognised and rewarded reward on an annual basis. workers. high performance health health workers. -photographs of award
workers. ceremonies
OUTPUT

41
1-2. Service providers are Number of service Availability of policy and Availability of policy and Availability of policy and List of service providers
motivated to provide providers motivated in a guidelines for motivation of guidelines for motivation of guidelines for motivation of motivated.
services to young people given period of time. service providers service providers service providers. Records of type of
and feel valued for the motivation.
work they do

42
STANDARD 8: Management systems are in place to improve/sustain the quality of health services provided to young people by the health service delivery
facilities.

HSDPs (Health service LGA STATE NATIONAL MEANS OF VERIFICATION

delivery points)

INPUT
1. Health management Ensure availability and Distribute to HSDP Adapt to state realities, Provide the template for Used copies of the HMIS
information system is in regular usage of the HMIS produce and distribute to the HMIS forms
place for collection of LGs
service data to monitor
service performance and
utilisation

2. Nationally approved data Use data tools regularly Distribute and monitor its Adapt and circulate to LGS Develop templates of data Copies of data tools
collection tools are usage collection tools and available
available in adequate distribute to the state
amount in health facilities.

3. Mechanism for regular HSDP management ensure Distribute and undertake Adapt supervision tools and Develop guidelines and Supervision reports.
supportive supervision in regular supervision. regular supervision. include youth in supervision tools for supportive
place for AYFHS teams.. supervision of AYFHS.

PROCESS

43
1. Health workers use HMIS Use the feedback and data Ensure analysis informs Conduct data analysis and Conduct HMIS data analysis Copies of data collection
to monitor service analysis for corrective future programming. provide feedback to LGS. at national level.
performance and trend in purposes.
utiilisation, and to identify
needs for
corrective/ameliorative
actions.
2. Health workers are Improve service Monitor service performers Conduct step down training Conduct training of trainers Copies of tools and
trained in the use of tools, performance using the feed of HSDP using the tools to health workers and develop training guidelines developed
and apply them for back manuals and guidelines
monitoring and improving List of training beneficiaries
service performance

3. Supervisors are trained Co-operate with Monitor supervisors to Conduct step down training Conduct training of trainers Supervisory report.
to develop competencies in supervisors and provide ensure support is delivered to supervisors at LG of supervisors at the Training report
supportive supervision, and feedback on challenges to to service providers national levels. Develop List of trainers/trainees
apply the skills to support the supervisor supervisor training
service providers guidelines

OUTPUT
1-3. Data are collected, Collection of data from Collect data and send to Analysis of data collected Analyse data and provide Report of data analysis
analyzed and used to HSDP state and quality control trend for quality
improve the quality of improvement
health services being
provided to young people

44
STANDARD 9: Young people are actively involved in the design, the provision and monitoring of adolescent- and youth-friendly health services.

HSDPs (Health service LGA STATE NATIONAL MEANS OF VERIFICATION

delivery points)

INPUT
1. Mechanisms to involve Youth representatives in Youth representatives in Youth representatives in Youth representatives in Minutes on formation of
young people in the Facility Management Facility Management Facility Management Facility Management Youths’ representative in
designing of health services Committee Committee in LGA Committee in State Committee at Federal the management of YFHS at
are in place all levels

2. Mechanisms to involve Young people (male and Young people (male and Young people (male and Young people (male and
young people in the female) from different female) from different female) from different female) from different
provision of health services, young groups selected to young groups selected to young groups selected to young groups selected to
including serving as peer form part of the facility’s form part of the LGA’s form part of the State form part of the National Involvement of Youths in
educators and community- management advisory management advisory Technical working Group on Technical working Group on service delivery
resource persons, are in committee. committee. Adolescent Health Adolescent Health
place Development (STWG AHD). Development (NTWG AHD)
Trained Youths serving as Trained Youths serving as
peer educators and peer educators and Trained Youths serving as
community-resource community-resource peer educators and
persons. persons periodically community-resource
persons

45
 HSDPs (Health service LGA STATE NATIONAL MEANS OF VERIFICATION
delivery points)

3. Mechanisms to involve
young people in the Suggestion box supervisory checklist at Quarterly/Biannual Supervisory checklist for
monitoring of health bimonthly supervision Monthly supportive supportive supervision supportive supervision &
services, including supervisory checklist supervision monitoring
functioning as members of to ensure quality service
relevant management delivery
committees, are in place
PROCESS
1. Young people are
involved in designing health Established Advisory
services to make them Nomination of youth Nomination of youth Nomination of youth Nomination of youth Committee members for
more accessible, representatives in Facility representatives in LGA representatives in State representatives in Federal YFHS
acceptable, equitable, Management Committee Management Committee of Management Committee of Management Committee of
appropriate, and effective YFHS YFHS YFHS Strengthened Advisory
with regards to the health Committee members for
needs of adolescents and YFHS
youths
2. Young people are
involved in provision of Youth capacity built for Train the Youths that Facilitate the capacity Report of capacity
health services in various skilled service delivery provide services at YFHC development for the Strengthen the capacity development of Youths
capacities that match their involved youths development of Service service providers
comparative strengths, Young people deliver Young people deliver providers at all levels
experiences and services at YFHCs services at YFHCs Young people deliver Youths providing service
competencies including services at YFHCs
facility-based, outreach and
referral services

46
 HSDPs (Health service LGA STATE NATIONAL MEANS OF VERIFICATION
delivery points)

3. Young people are

involved in monitoring of Use supervisory checklist to Use supervisory checklist to Use supervisory checklist to
health services to provide Exit interview of conduct bimonthly conduct monthly conduct quarterly/ biannual Reports of monitoring &
feedback that would beneficiaries/ clients supervision supervision supervision supervision visit with youth
improve service/program involvement conducted at
management all levels

OUTPUT
1-3. Young people are Active involvement of YP at Active involvement of YP at Active involvement of YP at Active involvement of YP at Minutes of Youths
actively involved in every Planning, implementation & Planning, implementation & Planning, implementation & Planning, implementation & representatives’ meetings
stage of AYFHS supportive supervision of supportive supervision of supportive supervision of supportive supervision of in the management of YFHS
programming, including the YFHS YFHS YFHS YFHS at all levels.
design, provision and
monitoring of health Report of Periodic
services. supportive supervision
conducted with
involvement of young
people

47
4. MINIMUM SERVICE DELIVERY PACKAGE FOR ADOLESCENT- AND YOUTH-
FRIENDLY HEALTH SERVICES

4.1. Categories of health services organisations for young people’s health in Nigeria
Health services that are available for young people in Nigeria are broadly classified into two groups:
Facility-based health services, and Service points. The facility-based services are those that offer full
range of preventive, promotive, and curative services with formal static health facility set-up, while
the other category (service points) are other service outlets for young people that may not be based
in a static set-up or provide only partial services. The specified national standards indicated in this
document apply only strictly to the facility-based health services.

A. Facility-based Health Services

1. Primary Care Facilities for Young People

This facility caters for young people within the context of health-service provision to all segments of
the population (eg, a general practice, or a family-planning clinic).
This model consists of two sub-types:
 Units that are an integral part of the public sector health system (PHC facilities run by the
government).
 stand-alone units (which are generally run by NGOs or by private individuals or institutions)

2. Primary Care – Plus Facilities for Young People

These are centres that are not only health facilities, but also provides other services. These centres
provide health information and perhaps recreation or vocational centres and other skills-building
activities, or educational development facilities such as library.

3. Hospital-based Adolescent and Youth Health Services

The centre provides in-patient services as well. as a drop-in service to young people. Additionally, it
serves as a secondary or tertiary referral centre for nearby health facilities and provides professional
training and research agenda.

48
 B. Service Points

1. School-based/school-linked health services (those in/linked to primary, secondary, and

tertiary institutions)
This model offers a preventive and curative health service in or close to the premises of educational
institutions

2. Pharmacies and Patient Medicine Vendors (PMV)

These sell health products, such as condoms and post=coital contraception. They may also sell drugs
for reproductive health challenges such as Sexually transmitted infections and provide some level of
health education/counselling , but do not cover many health problems. This group also includes
social marketing programmes that use marketing methods to promote the use of condoms and
improve their availability as well as availability of other drugs such as anti-malaria.

3. Outreach-based Information and Services

These are programmes that are primarily outreach efforts that take health information, health
products, and health services to young people who might be marginalized and vulnerable. They may
be offered periodically or consistently and might have referral linkages to static health facilities.

4. Communication interventions only

These are programmes that primarily offer only communication-related interventions such as health
information, health counselling, behaviour change communication, including phone-in and online
programmes.

4.2. Minimum package of services for AYFHS in Nigeria

Based upon the priority health challenges of young people identified in the National Policy
on the Health and Development of Adolescents and Young People, the AYFHS will address
the following health challenges:

Service elements
 Physical and mental development
 Sexual and Reproductive Health
o Pregnancy prevention (sexual abstinence, and contraceptive use)

49
 o Pregnancy care
o HIV and other sexually transmitted infection
o Sexual violence
 Injuries and trauma
 Mental health
 Substance use and abuse
 Nutritional problems

Health Outcomes to be Achieved

1. Healthy Development
a. Promote healthy development
b. Reduce the health and social consequences when developmental problems
occur.
2. Healthy Nutrition
a. Improve healthy nutrition
b. Reduce under/over nutrition
c. Reduce the health and social consequences of over/under nutrition.
3. Sexual and Reproductive Health
a. Reduce too early, unwanted pregnancy
b. Reduce morality and morbidity during pregnancy, child birth,
c. Reduce Sexually Transmitted Infections/Human Immunodeficiency Virus
(STI/HIV)
d. Reduce health and social consequences of STI / HIV infection when they occur
4. Substance use
a. Reduce substance use
b. Reduce the health and social consequences of substance use
5. Injuries
a. Reduce injuries
b. Reduce health consequences (mortality and morbidity) and psychosocial
consequences when injuries occur.
6. Violence (All Forms)
a. Reduce all forms of violence
b. Reduce health consequences (mortality and morbidity) and psychosocial
consequences when violence occurs.
7. Mental Health
a. Improve mental health and well being
b. Reduce mental health problems
c. Reduce the health and social consequences when mental health problems occur.

Core Package of Services

50
 Key Services Objective of the Package

A. Basic Essential Health Package 1. To provide basic health care and management
to all adolescents
2. To identify the most common health concerns
and issues among adolescents
3. To screen all adolescents for risk-taking
behaviors
4. To render preventive health management and
counseling to all adolescents, including on
substance use, sexuality, violence and injury
prevention, and for improving mental health
B. Adolescent Pregnancy Package 1. To reduce rates of adolescent pregnancy
through comprehensive health package
2. To reduce mortality and morbidity brought
about by adolescent pregnancy and puerperium
C. Sexually Transmitted Infections/HIV 1. To reduce morbidity and mortality brought
Packages about by STIs and HIV
2. To prevent STIs/HIV and its complications

4.2.1. Service delivery components/approaches

The adolescent and youth friendly health package of services will consist of promotive,
preventive, curative and referral services, which shall be provided in complementary
manner.

A. PROMOTIVE AND CLINICAL PREVENTIVE SERVICES

The preventive service will include (a) community-based The clinical preventive services
aims at ensuring the health and well-being of adolescents and young people by offering
relevant preventive services, including health monitoring, health information and
behaviour change communication; immunisation services, counselling services and
mental health assessment.

 Health monitoring (such as risk assessment and counselling)

 Provision of health information and behaviour change communication activities
 Immunisation services relevant for young people

51
  Provision of skilled counselling on key adolescent and youth health concerns,
including pubertal concerns, sexual and reproductive health, nutrition, substance
use, mental health, violence prevention
 Provider-initiated HIV counselling and testing
 Provision of contraceptive counselling and services, including emergency
contraceptive services
 Promotion of proper nutrition and food education to young people
 Community mental health services, including mental health education and
counselling on substance abuse prevention
 Advice and counselling on oral care

Treatment and counselling for sexual concerns of male and female adolescents

Adolescents have several concerns regarding sex and sexuality. Clients may come to the
clinic with crypto orchidism or any other disorders. The clinic must be in a position to cater
to the specific concerns of boys and girls on these issues. Referrals may be needed in most
of these situations.

Management of sexual abuse among girls/boys.

Adolescent facilities are to offer services for management of sexual abuse, especially for
adolescent girls. A separate protocol needs to be developed for such clients, whereby they
will have access to emergency contraception pills, prophylaxis against STIs and PEP for HIV
along with counselling as per the National Guidelines.

Counseling and provision for emergency contraceptive pills

• Adolescent boys and girls and youth may also access these clinics for ECPs
(emergency contraceptives). Advance provision of emergency contraceptive pills must be

52
considered in situations where access is likely to be restricted. There is enough
programmatic evidence to demonstrate effectiveness of advance provision of ECPs in
preventing unwanted pregnancies.

• Opportunity must be used to emphasize safe sex practices and risk reduction
counselling.

• Information and counselling on regular contraception must be provided.

Counselling and provision of reversible contraceptives

Youth-friendly clinics are to provide services for Oral Contraceptive Pills (OCPs), condoms
and IUD insertion as per the national guidelines. Service providers are to be encouraged to
offer a package of contraceptives, so that young people can choose a particular method as
per their need/s. Providers are to also inform the young people about
re-supply provisions and sources for further supply. Non-clinical reversible contraceptives
could be made available with the community-based health functionaries and also through
social marketing channels.

Dual protection is to be an integral part of contraceptive counselling. Adolescents must have

information and access to methods that provide dual protection.

Information/advice on SRH and other issues

Providers must be able to address specific questions of male and female young people on
common sexual and reproductive health concerns. Adequate resource materials are to be
made available to providers in order for them to respond to questions posed by the
adolescents. Resource materials are to cover topics related to growth and development,
puberty, sexuality concerns, myths and misconceptions, pregnancy, safe sex, contraception,
unsafe abortions, menstrual disorders, anaemia, sexual abuse, RTIs/ STIs, etc.

53
Immunisation Services

As per the national guidelines, adolescents must be given immunization against tetanus.

Nutritional Services

Many adolescents suffer from a range of nutritional problems including vitamin and mineral
deficiency. Some adolescents may approach providers with specific concerns regarding
excess weight and obesity. Service providers are to offer appropriate advice to adolescents
to address these concerns.

Facilities are to provide the facility for screening of anaemia by offering routine
Haemoglobin estimation. For pregnant adolescents, the national guidelines need to be
adhered to. For non-pregnant adolescents, treatment is to be given in the form of iron
therapy. Service providers are to provide information on balanced diet and consumption of
green leafy vegetables and other iron rich foods. Worm infections have to be treated
accordingly.

Treatment for common RTIs/STIs

Adolescents are more vulnerable to genital infections on account of biological and social
factors.

Adolescent girls may find it difficult to negotiate condom use with their partners. The
following elements of quality of care deserve special attention:

• Privacy and Confidentiality - It is crucial that complete audio and visual privacy is
maintained during the client-provider interaction. Similarly, access to service delivery
register etc. is to be restricted to ensure
confidentiality. Though this applies to all interactions, it is being reiterated so as to ensure
maximum privacy and confidentiality while managing RTI/STI

54
• Treatment compliance - It is important to emphasize compliance with the drug
regimen prescribed for each adolescent. Non-compliance will lead to treatment failure. This
also includes advice on personal hygiene and
safe sex during treatment.

• Partner management - As per national guidelines, partner management should

constitute an integral component of services. Adolescents should be explained the
importance of the treatment of their partner in order to prevent reinfections.

• Follow-up visits and referrals for treatment failures – Adolescents are to be advised
to adhere to the schedule of follow-up visit. In case they do not respond to therapy, they are
to be referred to higher levels.

Treatment and counselling for menstrual disorders

Menstrual disorders are perceived to be very common amongst adolescent girls. Service
providers must be able to manage these problems in the following manner:

• Symptomatic treatment for pre-menstrual tension, dysmenorrhoea etc.

• Counselling for menstrual problems and hygiene

• Referrals for any investigations and for puberty-related problems

Services for management of post-abortion complications

Adolescents and Young people may also access these facilities with complications
attributable to unsafe abortions. Such clients are to be managed as per the Guidelines for
Management of Common Obstetric Complications. Post-abortion contraceptive counselling
is to be an integral component of services for those presenting with postabortion
complications.

55
Focused care during the antenatal period

Pregnant adolescents may more conveniently access youth-friendly clinics at dedicated

timings. It is generally considered that antenatal care should start early, preferably in the
first trimester. Evidence shows that adolescents either don’t seek care or that care is often
delayed and infrequent. Community-based functionaries and VHWs may also accompany
such pregnant girls from their respective villages to these clinics. Availability of female
service providers, staff nurses or ANMs, will help in winning the trust of pregnant girls, since
for many of them this may be the first contact with the public health system.

ANC protocol for pregnant adolescents is not different from the protocol for other pregnant
women. However, the following issues need to be reiterated:
• Ensure Institutional Delivery
• Nutritional counseling: Increased risk of nutritional deficiencies as adolescents enter
pregnancy with nutritional deficiency
• Contraceptive counseling
• Couple counseling
• Referral to be made for complications during pregnancy and the precautions to be
taken while the patient is carried in such cases.

B. COMMUNITY-BASED HEALTH OUTREACH SERVICES

Community outreaches are important to expanding access of young people to health

promotion activities and, in the spirit of PHC, meets the demand for taking services to
where young people live and engage in daily vocations such as schools. School health
services are particularly crucial in this regard, and the AYFHS team will conduct regular
outreaches to selected neighbouring schools (at least once a month) as well as explore
opportunities to build linkage with the school-based Family Life and HIV Education
(FLHE) programmes. Community outreaches to reach parents/guardians and community
stakeholders will also be carried out regularly at defined periods, using appropriate
community-based media and forums.

 At least one outreach to schools monthly

56
 Periodic and regular community mobilisation for adolescent health

C. TREATMENT/CURATIVE SERVICES
D. These services are primarily aimed at ensuring restoration of health and well-being,
and prevention of adverse outcomes and complications. They include history-taking,
physical assessment, management of common complaints/problems among young
people (such as menstrual health problems: treatment of sexually transmitted
infections; and, treatment of minor injuries and accidents), and pregnancy-related
care (antenatal services, delivery of uncomplicated pregnancies, basic emergency
obstetric care, and post-natal services);

 History-taking, risk assessment, and physical assessment

 Management of menstrual health problems and related pubertal concerns
 Treatment of sexually transmitted infections
 Treatment of common health problems
o Fever
o Diarrhoea
o Respiratory infections
o Skin diseases
o Worm infestation
 Treatment of minor accidents
 Pregnancy-related care
o Antenatal services
o Delivery of uncomplicated pregnancies
o Basic emergency obstetric care
o Post-natal services
 Basic laboratory services

E. REFERRAL TO OTHER SERVICE PROVIDERS AS NECESSARY

The PHC level of care provides basic health services, and would need to refer more
challenging clinically-related cases to higher level of care. Since the needs of adolescents

57
and young people are also not limited to health challenges, there will be the need to
refer clients to other appropriate adolescent/youth-servicing services, including
educational and spiritual counselling. In these regards, In this regard, it is important to
build linkages and partnerships with schools, community centres, faith communities,
private service providers, secondary health facilities, youth-serving civil society
organisations (CSOs) and services/programmes targeting young people and their
parents/guardians. It will important to compile a list of such organisations and identify
their areas of comparative competence, niche and strength so as to benefit maximally
from relationships with them. Among others, strengthening/establishing two-way
referral linkages with secondary healthcare facilities is crucial as part of continuity of
services. Appropriate counselling should be given to adolescents and young people
being referred to ensure that they are properly motivated to comply with the referrals.

 Effecting referrals for all cases above the level and following up (2-way referral)
 Counselling and motivation for referral

58
59
60
APPENDIX 1: Required National Minimum Resources and Infrastructure for
Primary Health Clinics in Nigeria3

A. Building and Premises:

 A detached building with at least 5 rooms

 Walls and roof must be in good condition with functional doors and netted windows
 Functional separate Male and Female toilet facilities with water supply within the premises
 Availability of a clean water source: at least a well
 Be connected to the national grid and other regular alternative power source
 Have a sanitary waste collection point
 Have a waste disposal site
 Be clearly signposted – visible from both entry and exit points
 Be fenced
 Staff accommodation provided within the premises or the community

The building must have sufficient rooms and space to accommodate:

 Client observation area

 Consulting area
 Delivery room
 First stage room
 Injection and dressing area
 Lying-in ward (4 bed)
 Pharmacy section
 Record section
 Staff station
 Store
 Toilet facilities (or Ventilated Improved Pit Toilet)
 Waiting/reception area

B. Furnishing
 Benches - 8
 Chairs - 10
 Cupboards - 2
 Curtains for windows and doors - all
 Delivery bed - 1
 Examination couch - 2
 Observation beds - 4
 Screen - 2
 Wash hand basin - 2
 Wheel Chair - 1
 Writing table - 3

3
National Primary Health Care Development Agency. Minimum Standards For Primary Health Care In Nigeria

61
 C. Medical equipment
 Adult weighing scale - 2
 Ambubag - 1
 Artery forceps - 2
 Baby weighing scale - 1
 Bed pan - 4
 Bed sheets, - 2 per bed
 Clinical thermometers - 2
 Cold boxes - 1
 Cord clamps - 1 pack
 Curtains - 1 per window
 Cusco’s speculum - 2
 Disposables (facemask, gloves, etc) - 1 pack each
 Dissecting forceps - 2
 Dressing forceps - 2
 Dressing trolley - 1
 Enema kits - 2
 Episiotomy scissors - 2
 Foetal stethoscope - 2
 Instrument tray - 2
 Kidney dishes - 4
 *Kidney dish - 2
 Lanterns, Buckets - 2 each
 Multistix test kits - 1 pack of 100
 Needle holding forceps - 2
 ORT Demonstration Equipment - * 1 set
 *Cup, jug, wash basin, towel, bucket, standard beer or/and soft drink bottles
 Refrigerator - 1
 Scissors - 2
 Sims speculum - 2
 Solar Refrigerator - 1
 Sphygmomanometer - 2
 Stadiometer - 1
 Stethoscope - 2
 Sterilisation equipment - 1
 Stove - 1
 Suction machine or (mucus extractors) - 1
 Tape rule - 1
 Urinary catheter - 2 of each size
 Geo Style Vaccine Carriers (GSVC) - 2
 Ice Packs - 4 per GSVC

D. Personnel
 Midwife or Nurse Midwife - 2
 CHEW (must work with standing order) - 2
 Junior Community Health Extension Worker (JCHEW) - 4
 Support staff

62
 o Health attendant/Assistant - 2
o Security personnel - 2

E. Hours of operation
 The facility should run 24 hours services
o CHEWs/ JCHEWs will distribute their working time as follows;
o JCHEWs: 60% in the health facility and 40% in the communities
o CHEWs: 80% in the facility and 20% in the communities

F. Standing Order
 CHEWs and JCHEWs must work with the Standing Order

G. Other Requirements
 Means of communication; e.g. mobile phone or communication radio (1)
 Motorcycle (1)
 Bicycle (1)
 Small motor boat for riverine areas (1)

H. Essential drugs
The following complete Essential Drug List is to be utilised at this level;

Group Formulation

I. ANAESTHETICS, LOCAL

Lidocaine - Topical, injection

II. ANALGESICS

Acetylsalicylic Acid* - Tablet

*Not for children

Paracetamol - Oral liquid, tablet

III. ANTI-ALLERGICS

Chlorphenamine - Oral liquid, tablet

Epinephrine (Adrenaline) - Injection

Promethazine - Tablet, oral liquid

IV. ANTICONVULSANTS

63
Diazepam - Injection

Paraldehyde** - Injection

Phenobarbital - Tablet

V. ANTIDOTES

Atropine - Injection

Charcoal (activated) - Powder

VI. ANTI-INFECTIVE DRUGS

Antibacterial drugs

Amoxicillin - Capsule

Benzathine Penicillin - Injection

Benzylpenicillin - Injection

Co-trimoxazole - Tablet, oral liquid

Erythromycin - Tablet

Gentamicin - Injection

Nitrofurantoin - Tablet

Phenoxymethylpenicillin - Tablet

Streptomycin - Injection

Tetracycline* - Capsule

*Not recommended for children and pregnant women

Antileprosy drugs

Clofazimine - Capsule

Dapsone - Tablet

Rifampicin - Capsule or tablet

Amoebicide

Metronidazole - Tablet

Anthelmintics

Mebendazole - Tablet

Praziquantel - Table

64
Pyrantel - Oral liquid, tablet

** Marked for deletion

Antifilarial

Diethylcarbamazine - Tablet

Antimalarials

Artemether + lumefantrine - Oral liquid, tablet

Artesunate - Suppositories

Artesunate + amodiaquine - Tablet

Quinine - Injection*

*Intramuscular, for pre-referral treatment only

Pyrimethamine + sulfadoxine - Tablet, oral liquid

Anti-tuberculosis drugs

Ethambutol - Tablet

Isoniazid - Tablet

Pyrazinamide - Tablet

Rifampicin - Capsule, tablet

VII. ANTISEPTICS AND DISINFECTANTS

Benzoin - Compound tincture

Chlorhexidine - Solution

Iodine - Solution

Methylated spirit - Solution

Sodium hypochlorite - Solution

VIII. DERMATOLOGICAL DRUGS

Benzoic acid+salicylic acid

(Whitfield's) - Ointment

Benzoyl peroxide - Cream or gel

Benzyl benzoate - Emulsion

Calamine - Lotion

65
Gentamicin - Ointment

Methyl salicylate – Ointment

Neomycin+Bacitracin - Ointment, powder

Nystatin - Ointment, cream

Zinc oxide - Ointment

IX. DRUGS AFFECTING THE BLOOD

Ferrous salts - Oral liquid, tablet

Folic acid - Tablet

X. DIAGNOSTIC AGENT

Tuberculin - Injection, PPD

XI. DRESSINGS AND MEDICAL DEVICES

Absorbent gauze bandages

Cotton wool (absorbent)

Disposable gloves,

Disposable syringes - 5 mL with needles (19, 21 Gauge)

Disposable syringes - 2 mL with needles (19, 21 Gauge)

XII. EAR, NOSE AND THROAT DRUGS

Chloramphenicol - Ear drops

XIII. GASTRO-INTESTINAL DRUGS

Hydrocortisone + lidocaine - Suppository

Hyoscine N-butylbromide - Tablet

Magnesium Sulphate - Injection

Magnesium trisilicate - Compound tablet, oral liquid

Misoprostol - Tablets

66
Oral Rehydration Salts

Senna - Tablet

Zinc - Oral liquid, tablet

XIV. HORMONES AND SYNTHETIC SUBSTITUTES

Barrier methods - Condoms with or without spermicide

Oral contraceptives - Tablet

Essential Medicines List (Fifth Revision 2010

67
APPENDIX 2: Required National Minimum Resources and Infrastructure for
Primary Health Centres in Nigeria4

A. Building and Premises

 A detached building of at least 10 rooms

 Walls and roof must be in good condition with functional doors and netted windows
 Functional separate Male and Female toilet facilities with water supply within the premises
 Have a clean water source from a borehole
 Be connected to the national grid and other regular alternative power source
 Have a sanitary waste collection point
 Have a waste disposal site
 Be clearly signposted – visible from both entry and exit points
 Be fenced
 Staff accommodation provided within the premises or the community

The building should have sufficient rooms and space to accommodate;

o Waiting/Reception areas for Child Welfare, ANC, Health Education and ORT corner
o Staff station
o 2 consulting rooms
o Adolescent health service room
o Pharmacy & Dispensing unit
o 2 delivery room
o Maternity/lying-in section
o In-patient ward section
o Laboratory
o Medical records area
o Injection/Dressing area
o Minor procedures room
o Food demonstration area
o Kitchen
o Store
o Toilet facilities (Male and Female)

The premises should;

 Have a waste disposal site

 Be fenced and provided with staff quarters or accommodation within the community.
 Be connected to the national grid and provided with alternate power sources.

4
National Primary Health Care Development Agency. Minimum Standards For Primary Health Care In Nigeria

68
 B. Furnishing and Medical equipment

S/N Item description Qty S/N Item Description Qty

FEMALE WARD INFANT AND CHILD WELFARE

1. Angle poised lamp 1 1. Basket with lid for ORS 2

2. Artery forceps (Medium) 4 2. Ceiling fan 1

3. Bed pan (stainless steel) 2 3. Plastic Chairs 2

4. Bowls stainless steel with stand 2 4. Stainless covered bowl for cotton wool 1

5. Ceiling fan 2 5. Dressing Trolley 1

6. Plastic chair (President) 2 6. Cup, medicine, graduated 4

7. Stainless covered bowl for cotton wool 2 7. Dust bin (pedal) 2

8. Graduated medicine, cup 2 8. Stainless Galipot (medium size) 1

9. Dissecting forceps 2 9. Table infant weighing scale (Seward) 3

10. Dressing scissors 2 10. Stainless instrument tray 1

11. Dressing trolley 1 11. Stainless kidney dish (medium size) 1

12. Drinking mug 2 12. Wooden long benches 1

13. Dust bin (Pedal) 2 13. Plastic bowls 1

14. Galipot (medium) 1 14. Refrigerator, gas/kerosene 1

15. Gloves, disposable pack of 100 2 15. Spoon measure 3

16. Hospital bed, mattress and Macintosh 6 16. Wooden tables 2

17. Stainless Instrument tray 1 17. Thermometer, rectal 4

18. Forceps Jar 1 18. Tongue depressor 2

19. Kerosene pressure lamp 1 19. Vaccine cold box 5

20. Kidney dishes (large) 4 20. Length measure for babies 3

21. Length measure for babies 1 21. Bowls stainless steel with stand 1

22. Long benches 1 22. Wall clock 1

23. Mercurial Sphygmomanometer 6 23. Door name plate 1

(Acossons)
FIRST STAGE ROOM

69
24. Hand Breast Pump, rubber bulb 4 1. Stainless bedpan 3

25. Refrigerator (kerosene) 1 2. Bowls stainless steel with stand 1

26. Screen 1 3. Ceiling fan 1

27. Mackintosh sheet 1 4. Plastic chairs 3

28. Stethoscope (Littman) 1 5. Stainless covered bowls for cotton wool 2

29. Stitch removal/suture scissors 1 6. Dressing trolley 1

30. Writing Table 1 7. Stainless steel drinking mug 2

31 Tape measure 1 8. Pedal dust bin 1

32 Thermometer, oral 2 9. Foetal stethoscope 1

33 Thermometer rectal 2 10. Stainless galipot (medium) 1

34 Tongue depressor 2 11. Latex gloves, disposable pack of 100 2

35 Vaginal speculum, Sims, set of 3 2 12. Hospital bed, mattress and mackintosh 2

LABOUR 13. Mercurial Sphygmomanometer 1

(Acossons)
1. Artery forceps (Medium) 4

2. Bed pan, adult stainless steel 2 14. Jar, forceps 2

3. Stainless Bowls with stand 1 15. Kerosene pressure lamp 1

4. Ceiling fan 1 16. Stainless kidney dish (median) 2

5. Plastic Chairs (president) 1 17. Mackintosh sheet 4

6. Covered bowl for cotton wool 1 18. Nail scrubbing brush, box of 12 1

7. Delivery couch 2 19. Stainless instrument tray with stand 1

8. Dissecting forceps 1 20. Sponge holding forceps 2

9. Dressing trolley 1 21. Stethoscope (Littman) 1

10. Dust bin (Pedal) 1 22. Office table 1

11. Enema can 2 23. Thermometer, oral 2

12. Episiotomy scissors 2 24. Tongue depressor 2

13. Foetal stethoscope (Aluminium) 2 25. Weighing scale (Seward) 1

14. Stainless Galipot 1 26. Chart holder 4

15. Gloves, disposable pack, pack of 100 4 27. Bedside cabinet 2

70
16. Instrument tray 1 28. Over-bed cabinet 2

17. Forceps jar 1 29. Thermometer jar 4

18. Kerosene pressure lamp 1 30. Soap/disinfectant dispenser 1

19. Kidney dish 2 31 Urinal, female 2

20. Length measure for babies 1 32 Drip stand 1

21. Mackintosh sheet 2 33 Oro-pharyngeal airway (set of 7) 2

22. Nail scrubbing brush, box of 12 1 34 Wall clock 1

23. Needle holder 2 35 Door name plate 1

24. Scalpel blade, pack of 100, 4 sizes 3 ANTENATAL/INTERVIEW ROOM

1. Ceiling fan 2

25. Scalpel handle, set of 2 2 2. Plastic chairs 3

26. Catheter tray with cover 1 3. Stainless covered bowl for cotton wool 2

27. Mercurial Sphygmomanometer 1 4. Dust bin 2

28. Sponge holding forceps 4 5. Examination couch 1

29. Stethoscope (Littman) 1 6. Foetal stethoscope 2

30. Suture needle 1 7. Stainless galipot (medium) 1

31 Syringes & Needles (100)2cc, 5 8. Latex gloves, disposable pack of 100 20

32 Syringes & Needles (100) 5cc, 5 9. Hammer, reflex 1

33 Syringes & Needles (100) 10cc, 1 10. Height measuring stick 1

34 Thermometer, oral 1 11. Wooden long benches 3

35 Vaginal speculum, Sims set of 3 2 12. Mackintosh sheet 2

36 Wall clock 1 13. Nail scrubbing brush, pack of 12 1

37 Water container with tap 1 14. Pen torch 1

38 Screen 2 15. Mercurial Sphygmomanometer 1

(Acossons)

39 Soap/disinfectant dispenser 1 16. Stethoscope 1

40 Scrub brush dispenser 1 17. Tables 2

41 Nursery costs 1 18. Thermometer, oral 2

71
42 Angle poised lamp 1 19. Tongue depressor 6

43 Vacuum extractor, manual 1 20. Soap/disinfectant dispenser 1

44 Suction pump 1 21. Thermometer jar 1

45 Weighting scale, baby 1 22. Angle poised lamp 1

46 Instrument cabinet 1 23. Bowls stainless steel with stand 1

47 Tape measure 1 24. Dressing trolley 1

48 Thermometer jar 1 25. Urine dipstick for sugar and albumin, 20

pack of 100

49 Urinary catheter 3 26. ANC gowns for patients 50

50 Umbilical cord clamp, pack of 100 1 27. Wall clock 1

51 Drip stand 2 28. Door name plate 1

52 Suture kit 1 NUTRITION

1. Spoon 10

53 Oro-pharyngeal airway, set of 7 1 2. Stainless drinking mugs 10

54 Plastic apron 10 3. Gas cylinders 2

55 Auvard’s speculum 1 4. Knives 4

LABORATORY 5. Gas cookers 1

1. Kidney dish (medium) 1

2. Box, microscope slide (x100) 1 6. Weighing scale (Seward) 1

3. Centrifuge, manual 1 7. Blender and mill 2

4. Clam, test tube 1 8. Stainless tray 1

5. Container, sputum screw capped 50 9. Plates 10

6. Container, sputum, snapped on lid 50 10. Water container 4

7. Microscope, binocular 1 11. Bucket wit lid 4

8. Refrigerator, kerosene 1 12. Chopping board 2

9. Scalpel handle 1 13. Cooking spoons 6

10. Slides rack 3 14. Kerosene stove 2

11. Spirit lamp 1 15. Utility table 2

72
12. Stop watch 1 16. Cooking pot (A set of 6) 1

13. Test tube rack 1 STERILIZATION

1. Bucket autoclave 1

14. Tray test tube 2 2. Tape dispenser 1

15. Tray test tube 2 3. Scrub brush dispenser 1

16. Waste receptacle 1 4. Autoclave tape 1

17. Microscope cover slides pack of 1000 1 5. Storage cabinet 2

18. Bunsen burner 1 6. Sterilizing drums, set of 3 6

19. Tripod stand 1 7. Soap/disinfectant dispenser 1

20. Wire gauze 1 8. Nail scrubbing brush, pack of 12 1

21. Laboratory glass ware 1 9. Wall clock 1

22. Blood lancets, pack of 200 1 10. Door name plate 1

23. Tourniquet 1 CLEANING AND UTILIZATION

1. Brooms 10

24 Urine dipstick (multistix) 10 2. Mops 10

26 Stool specimen bottles, pack of 100 1 3. Mop buckets 3

27 Urine specimen bottles, pack of 100 1 4. Dusters 20

28 Wall Clock 1 5. Buckets 10

29 Door name plate 1 6. Aprons 10

30 Haemoglobinometer (sliding type) 1 7. Wellington boots 3

DRESSING/ INJECTION ROOMS 8. Latex gloves 10

1. Artery forceps (medium size) 2

2. Stainless Bowl with stand 1 9. Kerosene pressure lamp 2

3. Ceiling fan 2 10. Hurricane lamp 4

4. Plastic chairs 2 11. Apron, utility 8

5. Stainless covered bowl for cotton wool 1 12. Flash light – 24 box batteries 4

6. Dissecting forceps (medium) 2 13. Nail scrubbing brush, pack of 12 1

7. Dressing scissors 2 14. Fire extinguishers 2

73
8. Dust bin (pedal bin) 1 15. Soap box 5

9. Stainless Instrument tray 2 LINEN STORE

1. Linen cupboard 2

10. Latex gloves (size 71/2) pack of 100 1 2. Pedal dust bin 1

11. Stainless instrument tray 1 3. Table 1

12. Jar, forceps 1 4. Plastic chair (President) 2

13. Kidney dish (medium) 2 5. Bed sheet 32

14. Long benches 1 6. Draw sheet 16

15. Needle holder 2 7. Pillow case 32

16. Plastic bowls 1 8. Bath towel 24

17. Scalpel blade, pack of 100, 4 sizes 3 9. Hand towel 24

18. Scalpel handle 2 10. Theatre gown 10

19. Stainless catheter tray with cover 1 11. Lithotomy leggings 10

20. Spencer wells artery forceps 2 12. Perineal sheet 1

21. Small sterilizer 1 13. Standing fan 1

22. Sponge holding forceps 4 14. Wall clock 1

23. Mercurial Sphygmomanometer 1 CONSULTING CUBICLE

(Acossons)
1. Ceiling fan 2

24. Stethoscope 1 2. Plastic Chairs 3

25. Stitch removal/suture 2 3. Stainless covered bowl for cotton wool 2

26. Stretcher trolley 2 4. Dust bin 2

27. Suture needles 1 5. Examination couch 1

28. Syringes & needles (100) 2cc, 5 6. Hammer, reflex 1

29. Syringes & needles (100) 5cc 5 7. Height measuring stick 1

30. Syringes & needles (100) 10cc 1 8. Macintosh 2

31 Table 1 9. Pen torch 1

32 Tape measure 1 10. Mercurial Sphygmomanometer 1

(Acossons)

74
33 Thermometer, oral 2 11. Stethoscope 1

34 Thermometer, rectal 2 12. Snellen’s chart 1

35 Tongue depressor 4 13. Tables 2

36 Scrub brush dispenser 2 14. Thermometer, oral 2

37 Weighting scale, adult 1 15. Tongue depressor 6

38 Height measuring stick 1 16. Weighing scale (child) 2

39 Stainless dressing trolley 2 17. Bowls stainless steel with stand 1

40 Tourniquet 1 18. Wall clock 1

41 Pen torch 1 19. Diagnostic set 1

42 Instrument cabinet 2 STAFF ROOM

1. Examination couch 1

43 Medicine cupboard 1 2. Chair 5

44. Wheel chair 1 3. Table 5

45. Angle poised lamp 2 4. Dust bin 2

46. Filling cabinet 1 5. Filling cabinet 2

47. Suction pump 1 6. Standing fan 1

48 Filling cabinet 1 7. Refrigerator, kerosene 1

49 Refrigerator, kerosene 1 8. Wall clock 1

50 Tissue forceps 4 RECORDS

1. Table 2

51 Dressing forceps 4 2. Plastic chairs 2

52 Sterilizing forceps 4 3. Safe (daily cash sales) 1

53 Bandage scissors 2 4. Standing fan 2

54 Soap/disinfectant dispenser 2 5. Dust bin 1

55 Examination couch 1 6. Filling cabinet 2

56 Foot step 1 7. Wall clock 1

57 Swivel stool 1 MALE WARD

1. Angle poised lamp 1

75
58 Incision and Drainage kit 10 2. Artery forceps (medium) 2

59 Suture kit 4 3. Stainless bedpan 2

60 Stainless ear syringe 2 4. Bowls stainless steel with stand 2

61 Wall clock 5 5. Ceiling fan 2

FAMILY PLANNING 6. Mercurial Sphygmomanometer 6

(Acossons)
1. Ceiling fan 1

2. Plastic chairs (president) 2 7. Covered bowl for cotton wool 2

3. Stainless covered bowl for cotton wool 1 8. Cup, medicine, graduated 2

4. Dissecting forceps 1 9. Dissecting forceps (medium) 2

5. Stainless galipot (medium) 1 10. Dressing scissors 2

6. Gloves, disposable pack, box of 100 1 11. Stainless drinking mug 2

7. Instrument tray 1 12. Pedal dust bin 2

8. Stainless kidney dish (medium) 1 13. Stainless galipot (medium) 2

9. Mercurial Sphygmomanometer 1 14. Latex glove, disposal pack of 100 2

(Acossons)

10. Small size sterilizer 1 15. Hospital, mattress and mackintosh 6

11. Syringes & needles 100 16. Stainless instrument tray 1

12. Table 1 17. Jar forceps 1

13. Thermometer, oral 1 18. Kerosene pressure lamp 1

16. Swivel stool 1 19. Kidney dishes (medium) 4

17. Foot step 1 20. Length measure for babies 1

18. Screen 1 21. Mackintosh sheet 6

19. Stethoscope (Littman) 1 22. Nursery cots 4

20. Angle poised lamp 1 23. Pump, breast, hand rubber bulb 2

21. IUD Kit 1 24. Refrigerator 1

22. Pedal bin 1 25. Screen 1

23. Thermometer jar 1 26. Plastic chairs 1

24. Bowls stainless steel with stand 1 27. Spoon, measure 2

76
25. Stainless instrument trolley 1 28. Standing fan 1

26. Gynae couch 1 29. Littman stethoscope 1

27. Auvards speculum 1 30. Stitch removal/suture scissors 1

28. Tenaculum forceps 1 31 Syringes & needles (100) 2cc, 5

29. Kick about 1 32 5cc 5

30. Wall clock 1 33 10cc 1

31 Door name plate 1 34 Tables 1

OTHERS 35 Tape measure 1

1. Communication facility; e.g. mobile 1 36 Thermometer, oral 2

phone or radio

2. Motorcycle 1 37 Thermometer, rectal 2

3. Bicycle 6 38 Tongue depressor 2

4. Solar Refrigerator 1 39 Tourniquet 1

40 Vaginal speculum, Sims, set of 3 2

41 Weighing scale 1

C. Personnel
 Medical officer if available - 1
 CHO (must work with standing order) - 1
 Nurse/midwife - 4
 CHEW (must work with standing order) - 3
 Pharmacy technician - 1
 JCHEW (must work with standing order) - 6
 Environmental Officer - 1
 Medical records officer - 1
 Laboratory technician - 1
 Support staff
o Health Attendant/Assistant - 2
o Security personnel - 2
o General maintenance staff - 1

D. Hours of operation:
 24 hours (Twenty-four hours)

E. Other Requirements
 Ambulance Vehicle (1)

77
  Bicycle (1)
 Communication facility; Mobile phone or Communication Radio (1)
 Computer (2)
 Internet services
 Motorcycle (1)
 Small motor boat for riverine area (1)

F. Essential drugs:
The complete Essential Drug List below is to be utilised at this level.

78
Group Formulation

ANAESTHETICS, LOCAL

Lidocaine - Topical, injection

ANALGESICS

Acetylsalicylic Acid - Tablet

Paracetamol - Oral liquid, tablet

ANTI-ALLERGICS

Chlorphenamine - Oral liquid, tablet

Epinephrine (Adrenaline) - Injection

Promethazine - Tablet, oral liquid

ANTICONVULSANTS

Diazepam - Injection

Paraldehyde** - Injection

Phenobarbital - Tablet

ANTIDOTES

Atropine - Injection

Charcoal (activated) - Powder

ANTI-INFECTIVE DRUGS

Antibacterial drugs

Amoxicillin - Capsule

Benzathine Penicillin - Injection

Benzylpenicillin - Injection

Co-trimoxazole - Tablet, oral liquid

Erythromycin - Tablet

Gentamicin - Injection

79
Nitrofurantoin - Tablet

Phenoxymethylpenicillin - Tablet

Streptomycin - Injection
*
Tetracycline - Capsule

**
Antileprosy drugs

Clofazimine - Capsule

Dapsone - Tablet

Rifampicin - Capsule or tablet

Amoebicide

Metronidazole - Tablet

Anthelmintics

Mebendazole - Tablet

Praziquantel - Table

Pyrantel - Oral liquid, tablet

Antifilarial

Diethylcarbamazine - Tablet

Antimalarials

Artemether + lumefantrine - Oral liquid, tablet

Artesunate - Suppositories

Artesunate + amodiaquine - Tablet

***
Quinine - Injection

****
Pyrimethamine + sulfadoxine - Tablet, oral liquid

Anti-tuberculosis drugs

Ethambutol - Tablet

Isoniazid - Tablet

Pyrazinamide - Tablet

Rifampicin - Capsule, tablet

*
Not recommended for children and pregnant women
**
Marked for deletion
***
Intramuscular, for pre-referral treatment only
****
for Intermittent presumptive treatment of malaria

80
ANTISEPTICS AND DISINFECTANTS

Benzoin - Compound tincture

Chlorhexidine - Solution

Iodine - Solution

Methylated spirit - Solution

Sodium hypochlorite - Solution

DERMATOLOGICAL DRUGS

Benzoic acid+salicylic acid

(Whitfield's) - Ointment

Benzoyl peroxide - Cream or gel

Benzyl benzoate - Emulsion

Calamine - Lotion

Gentamicin - Ointment

Methyl salicylate – Ointment

Neomycin+Bacitracin - Ointment, powder

Nystatin - Ointment, cream

Zinc oxide - Ointment

DRUGS AFFECTING THE BLOOD

Ferrous salts - Oral liquid, tablet

Folic acid - Tablet

DIAGNOSTIC AGENT

Tuberculin - Injection, PPD

DRESSINGS AND MEDICAL DEVICES

Absorbent gauze bandages

Cotton wool (absorbent)

81
Disposable gloves,

Disposable syringes - 5 mL with needles (19, 21 Gauge)

Disposable syringes - 2 mL with needles (19, 21 Gauge)

EAR, NOSE AND THROAT DRUGS

Chloramphenicol - Ear drops

GASTRO-INTESTINAL DRUGS

Hydrocortisone + lidocaine - Suppository

Hyoscine N-butylbromide - Tablet

Magnesium Sulphate - Injection

Magnesium trisilicate - Compound tablet, oral liquid

Misoprostol - Tablets

Oral Rehydration Salts

Senna - Tablet

Zinc - Oral liquid, tablet

HORMONES AND SYNTHETIC SUBSTITUTES

Barrier methods - Condoms with or without spermicide

Oral contraceptives - Tablet

VACCINES

Poliomyelitis vaccine - Oral liquid

Rabies immunoglobulin - Injection

Tetanus vaccine - Injection

OPHTHALMOLOGICAL DRUGS

Chloramphenicol - Eye drops, ointment

Chlortetracycline - Eye ointment

OXYTOCIC

Oxytocin -

82
Ergometrine - Tablet, injection

83
PSYCHOTHERAPEUTIC DRUG

Chlorpromazine - Injection

RESPIRATORY DRUGS

Beclomethasone - Inhaler

Salbutamol - Tablet, inhaler

VITAMINS AND MINERALS

Ascorbic Acid (vitamin C) - Tablet

Calcium gluconate - Injection

Calcium salts - Tablet

Folic acid - Tablet

Vitamin A - Capsule

MISCELLANEOUS

Water for injection - Injection

Spatulas

84