Table of Contents

Acknowledgments ..................................................................................................................................... 1
List of Acronyms ....................................................................................................................................... 5
Foreword ................................................................................................................................................... 7
Executive Summary ................................................................................................................................. 8
Section I: Background............................................................................................................................. 10
I. Introduction .................................................................................................................................... 10

II. Situational Analysis ....................................................................................................................... 12

1. Geography and Demography ....................................................................................................... 12

2. Socio-economy ............................................................................................................................ 12
3. Health .......................................................................................................................................... 17
III. Purpose of the Document ............................................................................................................ 19

IV. Intended Audience and Beneficiaries .......................................................................................... 19

V. Guiding Principles for Youth-Friendly Services at Workplaces .................................................. 20

Section II: Goal, Objective and Outcome ...............................................................................................22

I. Goal and Objectives of the MSP .....................................................................................................22

II. Expected Outcome ........................................................................................................................22

Section III: The Ethiopian Health System .............................................................................................23

I. Functional Health System ..............................................................................................................23

Section IV: Health Literacy.....................................................................................................................25

I. Capacity Building Training for YFS Providers ............................................................................25
II. Peer Education............................................................................................................................25
III. Health Education ..................................................................................................................... 26
IV. Use of Digital Technology for Adolescent and Youth Health ................................................... 27
Section V: Standards of Youth-Friendly Services ................................................................................. 28
I. Information and Counselling on Adolescent and Youth Health Issues ....................................... 30

II. SRH Services ................................................................................................................................. 31

1. Comprehensive HIV Testing, Counselling, Treatment, Care, and Support ............................... 31

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 2. Testing Services for HIV (Voluntary Counselling and Testing – VCT Services)........................32
3. STI Screening, Management, and Follow-up .............................................................................33
4. Testing Services for Pregnancy, PMTCT, ANC, Delivery and PNC Care ....................................34
5. Comprehensive Abortion Care ....................................................................................................36
6. Contraceptive and Family Planning Services ............................................................................. 37
7. Condom Promotion and Provision (Female and Male Condoms) ............................................ 38
III. Nutritional Screening and Counselling .......................................................................................39

IV. Psycho-social Support Services.................................................................................................... 41

1. Counselling and Psycho-social Support on Substance Abuse..................................................... 41

2. Mental health and Psycho-social Support ..................................................................................42
V. Injuries and Non-Communicable Diseases ...................................................................................43

1. Prevention and Management of Injuries.....................................................................................43

2. Prevention, Diagnosis and Treatment of Non-Communicable Diseases (NCDs) ..................... 44
VI. Gender-Based Violence (GBV) ..................................................................................................... 47

1. Violence ........................................................................................................................................ 47
2. Management of Sexual Violence in Adolescents and Youth at Workplaces ............................. 49
VII. COVID-19 and Other Epidemics at Workplaces: Prevention, Control, and Management ...... 50

1. Activities to Engage in to Control COVID-19 Pandemic ............................................................ 50

2. Activities to Engage in to Control Other Communicable Diseases ............................................ 51
Section VI: Outreach Services ................................................................................................................ 52
Section VII: Corporate Social Responsibility (CSR) .............................................................................. 53
Section VIII: Monitoring and Evaluation of the Services ...................................................................... 54
I. Performance Tracking Systems ...................................................................................................... 54

II. Integrated Supportive Supervision and Program Monitoring ..................................................... 54

III. Review Meeting............................................................................................................................ 54

IV. Performance Measurement Methods .......................................................................................... 55

1. Continuous (Routine) Data Collection ........................................................................................ 55

2. Population-based Health Surveys ............................................................................................... 55
3. Periodic Data Collection .............................................................................................................. 55
4. Planning and Reporting .............................................................................................................. 55

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Implementation Arrangement/Guide .................................................................................................... 57
Contributors ............................................................................................................................................58
References ............................................................................................................................................... 59

4
List of Acronyms
AIDS Acquired Immunodeficiency Syndrome
ANC Ante-Natal Care
AYH Adolescent and Youth Sexual and Reproductive Health
BCC Behavioural Change Communication
CAC Comprehensive Abortion Care
CORHA Consortium of Reproductive Health Associations
CSR Corporate Social Responsibilities
DMPA Depot-Medroxyprogesterone Acetate
ECPs Emergency Contraceptive Pills
FMOH Federal Ministry of Health
FP Family Planning
GBV Gender Based Violence
HIV Human Immunodeficiency Virus
HMIS Health Management Information Systems
HSTP Health Sector Transformation Plan
HTPs Harmful Traditional Practices
IEC Information Education Communication
ILO International Labour Organization
IPDC Industrial Park Development Corporation
IPPFP Immediate Postpartum Family Planning
IUCD Intra-Uterine Contraceptive Devices
LDCs Least Developed Countries
MCAYH Maternal, Child, Adolescent and Youth Health
MCAYHD Maternal, Child, Adolescent and Youth Health Directorate
MoH Ministry of Health
MSP Minimum Service Package
NPC National Plan Commission
PAFP Post Abortion Family Planning
PMTCT Prevention of Maternal to Child Transmission
PNC Post-Natal Care
PPFP Postpartum Family Planning
PWD Persons with Disability
RHB Regional Health Bureau
RTI Reproductive Tract Infection

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SBCC Social and Behavioural Change Communication
SDG Sustainable Development Goal
SDP Service Delivery Point
SGBV Sexual and Gender-Based Violence
SRH Sexual and Reproductive Health
STIs Sexually Transmitted Infections
UNFPA United Nations Population Fund
WHO World Health Organization
WoHO Woreda Health Office
YFS Youth Friendly Service
ZHD Zonal Health Department

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Foreword
The young segment of the population of Ethiopia constitutes the majority of the workforce
engaged in mega-projects such as industrial parks, large scale farms, Horticulture and
floriculture farms, … across the nation – a significant bulk of this group being women and
young girls who face significant challenges including sexual and reproductive health (SRH)-
related problems.

One of the most effective interventions to address the rapid population growth in the country
has been to empower adolescent and youth to exercise their reproductive health rights.
Exercising reproductive rights and making informed choices, in turn, require empowerment
in economic status.

Guided by the Sustainable Development Goals (SDGs), the National Population Policy of
Ethiopia, the National Reproductive Health (RH) and Adolescent and Youth Sexual and
Reproductive Health (AYH) Strategies, the Family Planning (FP) National Guideline, and
other related documents, the Federal Ministry of Health (MoH) has developed this
“Minimum Service Package for Adolescent and Youth Health at Workplaces in
Ethiopia” to address major problems endured by adolescents and youth in workplaces.

This document is intended to create a healthy workplace for adolescents and youth
– one in which they strive together towards social and organizational conditions that protect
and promote health and safety in workplaces such as industrial parks, floriculture and large-
scale irrigation farms, factories and large-scale business industries, and other mega-projects
such as sugar factories, road construction sites, dry ports, and hydroelectric power plants.

The document outlines the overall activities to be undertaken in order to create a supportive
environment, generating awareness among adolescents, organizing and delivering quality
Youth-friendly Services (YFS) services, improving capacity of service providers, and
monitoring service provision and utilization.

Hence, I would like to call upon all parties who are directly or indirectly responsible to the
implementation of this document to give due emphasis to the overall development of
adolescents and youth at workplaces.

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Executive Summary
Youth unemployment and under-employment have become a growing concern worldwide.
According to the International Labour Organization (ILO), the challenge of youth
unemployment is especially immense in countries in Sub-Saharan Africa, where young people
aged 15 to 24 accounts for 36% of the working-age population. In Ethiopia, the young
population between ages 10 to 29 accounts for 42% of the total citizenry.

To improve the health status of its growing population, the Government of Ethiopia has adopted
far-reaching policy environments such as the Health Sector Transformation Plan-II (HSTP - II),
the RH strategy, the AYH strategy and FP guideline, the National Youth Policy, and the Youth
Development Package.

With the intention of creating additional job opportunities for its increasing young population,
Ethiopia has invested heavily on mega-projects which have now employed tens of thousands of
workers – of which a significant majority are poorly educated young females from rural areas.
Despite the many socioeconomic benefits they present, adolescents and youth working in these
mega-projects face unique sexual, reproductive and other health risks.

This document is divided into seven sections, and discusses, among others, the background of
adolescent and youth populations in Ethiopia at large, and at workplaces in particular; the
guiding principles, intended audiences, and the minimum service packages. The goal of this
minimum service package (MSP) is “to enhance comprehensive health and well-being among
adolescents and youth at workplaces in Ethiopia,” with particular emphasis on furnishing
information and counselling on adolescent and youth health issues such as:

§ Comprehensive Sexual and Reproductive Health (SRH) services;

§ Nutritional screening and counselling;
§ Gender-based violence (GBV);
§ Psycho-social support services;
§ Injuries and non-communicable diseases;
§ COVID- 19 and other epidemics.

Outreach services, competent service providers, capacity building trainings, referral linkage,
and the monitoring and evaluation (M&E) of the minimum service standards are also discussed
in the document.
M&E is also discussed in regard to performance measurement methods, including supportive
supervision and program monitoring. Continuous (routine) data collection mechanisms including
Health Management Information Systems (HMIS), patient records, observation, and periodic
data collection methods such as client exit interviews, providerinterviews, and simulations of
care are also discussed in this document.

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Section I: Background
I. Introduction
Globally, there are over 1.8 billion adolescents and youth aged 10 to 24 years, 90% of whom
live in developing countries. In Africa, 32% of the population belongs to the age group of 10
to 24 years. In Ethiopia, this age group accounts for 33% of the population, over three-quarters
of who live in rural areas. (1)

The population of Ethiopia has remained predominately young, with 44.9% under the age of
15, and over half (52%) of the population in the age group between 15 and 65 years. Only three
per cent of the total population ages over 65 years, while 42% of the population falls in the
age range 10 to 29 years. The ratio of male-to-female populations in Ethiopia is almost one-
to- one, and women of reproductive age account for 23.4% of the population. Women of
child bearing age make up 57% of the female population and 30% of the total population. (2)
The economy of least developing countries (LDCs) in general is highly dependent on
agriculture, and most people in LDCs live in rural areas and absolute poverty. Industrial
parks/mega-project corridors are then the contemporary strategy for rapid industrialization
in developing countries, and it is considered as one of the major policy directions which can
provide opportunities for investment, increase exports to earn foreign currency, and pave
avenues for job opportunities for young and poor people in a given country.
With a vision of becoming a manufacturing hub in Africa, and on a global scale at large, by
2025, Ethiopia has embarked on establishing and expanding mega-project corridors. Thus,
exploiting the advantages of the conducive economic factors, including the wide-ranging
incentives packages for priority sectors and export-oriented investments, private developers
are working on the development of industrial parks in different parts of the country in addition
to similar efforts by the Government of Ethiopia. These development efforts have attracted a
large volume of workers to the workplace, including adolescents and youth, where more than
80% of workers in industrial parks are below the age of 24. (3)

Despite the many socioeconomic benefits, however, recent studies suggest that the health and
safety of adolescents and youth at workplaces in Ethiopia are at a higher risk. (4)

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Working Definitions and Scope of the document:
Adolescents – According to the World Health Organization (WHO), adolescents are individuals in
the age group of 10 to 19 years; however, adolescents targeted in this minimum package are those
between ages 15 and 19 years.

Youth – According to the WHO, youth are individuals from 15 to 24 years of age; however, youth
targeted in this minimum package are those between the ages of 15 and 29 years, as per the youth
policy of Ethiopia (2004).

Decent Work – refers to “productive work for women and men in conditions of freedom, equity,
security and human dignity.” In general, work is considered as “decent” when: it pays a fair income,
guarantees a secure form of employment, and safe working conditions. (5)

Workplace: For the purpose of this document, Workplace is defined as –

“Those places where many adolescents and youth are hired to work whether they are living there
or not”

Scope of the Document: Hence, the scope of the term workplace in this document includes
(but not limited to) the following:

• Industrial Parks
• Floriculture farms
• Horticulture farms
• Sugar Factories
• Hydropower Dam projects
• Dry ports
• Factories /Industries
• Large-scale Irrigation farms
• Agro-industries
• Coffee plantations
• Large scale husbandry farms
• Poultries farms
• Dairy farms
• Other mega projects which fulfil the nature of the organization as stated in the document

Healthy Workplace – According to the WHO, a “healthy workplace” is a place where everyone
works together to achieve an agreed vision for the health and well-being of workers and the
surrounding community, which provides all members of the workforce with physical, psychological,
social and organizational conditions that protect and promote health and safety. It also enables
managers and workers to increase control over their own health and to improve it, and to become more
energetic, positive and contented. (6)

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Standard – a statement of desired quality.

Accessible – readily accessible services are provided.

Acceptable – healthcare that meets the expectations of service users

Appropriate – required care is provided; unnecessary and harmful care is avoided.

Comprehensive – care provision covers prevention, counselling, treatment, care, and support.

Effective – healthcare produces positive change in the health status of adolescents and youth.

Equitable – services are provided to all adolescents and youth who need them (including those
belonging to low socioeconomic status, vulnerable, marginalized, difficult-to-reach groups).

Equality – providing services equally without partiality in terms of quantity, degree, value, rank, or
ability, colour, race, etc.…

Efficiency – providing quality service for adolescents and youth by performing tasks successfully and
achieving goals with minimal resource utilization.

Respect – service should be provided for caretakers with high regard and in an honourable manner,
with good interaction in a friendly approach.

Sustainable – service provided to adolescents and youth should not be interrupted.

Safe – the workplace should be free from any fears and threats to reduce negative impacts on the
environment, and the health and comfort of the care seekers.

Inclusive – giving equal access and opportunities, and getting rid of discrimination and intolerance
(removal of barriers).

II. Situational Analysis

1. Geography and Demography
Located in the Horn of Africa, Ethiopia covers an area of 1.1 million square-kilometres with
rich geographical diversity, including rugged mountains and deep river valleys, that ranges
from 148 meters below sea level (Dallol in the Danakil Depression) to 4,620 meters above sea
level (Ras Dashen of the Siemen Mountains).

According to a World-meter estimation based on UN data, Ethiopia’s 2020 mid-year

population was estimated at 114,963,588 people, which makes the country the second-most
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populous in Africa, and ranked it 12th in the world.

The population density is 115 persons per square-kilometre calculated from the total land area
of 1,000,000 square-kilometres. The estimated urban population of the country in 2020
constituted 21.3% of the total population, and the median age of Ethiopians was 19.5 years.
(7)

Ethiopia is also characterized by a rapid population growth rate (2.6%), a young age structure,
a high dependency ratio, and a declining average fertility trend. Total fertility rate is 4.1 births
per woman, with a high rural-urban disparity (2.3 in urban and 5.2 in rural areas), and a
corresponding crude birth rate of 32 per 1,000 in 2016. Life expectancy at birth for both sexes
combined in Ethiopia is 67.8 years.

2. Socio-economy
The Government of Ethiopia has implemented a comprehensive economic reform program
over the past few decades, during which period the economy has registered a rapid average
annual growth of 10.9%. The Gross Domestic Product (GDP) growth rate of Ethiopia in 2017
was 10.25%, with a Real GDP of $57,710,624,012, while GDP per capita was $542 for the same
year. (7)

Consequently, there has been an improvement in the labour market in Ethiopia over the last
decades, which in turn has resulted in a significant increase in wages, and the level of
unemployment has also decreased from 18% in 2004 to 14.4% in 2013. (8)

Ethiopia’s youthful population is a tremendous asset and untapped resource for positive
growth. Of Ethiopia’s population, estimated at 104 million, 41% is under the age of 15. More
than 28% is aged 15 to 29.

Nonetheless, youth unemployment is estimated at nearly 27%. One reason for the high youth
unemployment rate is low literacy (68%). Ethiopia’s secondary school gross enrolment rate
is 39.8% — far too inadequate for a country with Ethiopia’s natural resources, economic
potential and global ambitions. Technical and vocational education and training reached
352,000 students in 2015, and female enrolment continues to be higher than male
enrolment. (3)

Despite these facts, adolescents and youth still face precarious conditions in the labour
market. Almost three-quarters of the youth in the workforce earn below the average monthly
wage. Moreover, the majority of employed young people work in the informal sector or as
unpaid family workers. Nearly one-quarter of the employed youth, particularly young people
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aged 15to 19 years who have no bargaining power, worked in the informal sector in 2013. (8)

The Impact of Education on Health and Economy

The participation of adolescents and youth in the labour force is strongly determined by
geographical, socioeconomic and gender disparities. Ethiopian young women are more than
twice as likely to be unemployed as compared to their male counterparts. Besides the high
gender inequality, youth employment in Ethiopia is characterized by a strong duality between
rural and urban locales. In addition, the vast majority of young Ethiopians suffer from a lack
of access to high-quality education, decent formal sector employment, and governmental
employment programs. As the skills acquired in the Ethiopian school system do not satisfy
the needs of the national labour market, there is a high demand for technical and vocational
education and training programs.

In rural areas, young people leave school at a very early age and start to work in subsistence
agriculture: low labour income, large underemployment, and limited chances to enter the
formal sector mark their working life. On the other hand, in urban areas, the youth face higher
rates of unemployment, strong disadvantages compared to adults, and a school-to-work
transition that is more than twice as long as in rural areas. This reflects the realities of the
rural-urban migrations of unskilled young workers, as well as new graduates seeking job
opportunities in urban economic centres. (9)

Regarding the health of society, education is known to be one of the most important social
determinants of health. People are observed to have differences in health status, exposure to
health risks, access to health services, and healthcare seeking behaviour due to the
differences in their educational status. The relationship between education and the health of
women, youth and adolescents is especially significant, where women’s educational
attainment has a strong effect on their awareness of RH issues such as family health,
reproductive behaviour, fertility, attitude, and use of family planning, infant and child
mortality and morbidity. (10)

Educational Status of Adolescents and Youth at Workplaces

According to UNICEF Ethiopia’s “Education Advocacy Brief, for Every Child, an Education,”
Ethiopia has made remarkable progress in education over the past decade with primary school
enrolment tripling between 2000 and 2016, and youth literacy rate (for ages 15 to 24)
improving from 49.9% (2004) to 69.5% (2015).

Although a cross-sectional study conducted on 30 horticulture and industrial parks in five

regions (Addis Ababa, Amhara, Oromia, SNNP and Tigray) in Ethiopia has shown that nearly
13
85% of women and 95% of men have attended formal education, it also indicated that a higher
proportion of them attended only primary school. The majority of these subjects (both male
and female) have never been married. Seventy per cent of the workers interviewed were aged
25 years or less, and the majority of the respondents were single/never been in a marital
relationship, and literate. (11)

The Impact of the COVID-19 Pandemic on Adolescents and Youth at Workplaces

in Ethiopia

A research conducted to provide timely information to the government and related

stakeholders about the impacts of COVID-19 on Ethiopia’s industrial parks, and the potential
policy implications thereof has shown that the COVID-19 pandemic poses a grave set of
challenges for Ethiopia’s industrialization agenda, with medium and long-term persistent
adverse effects on industrial parks. While some firms in these industrial parks have been able
To re-purpose their production towards personal protective equipment, many had to put
theirlabour force on temporary leave.

To quantify the impacts of COVID-19 on firms in Ethiopia’s export processing industrial park
zones, the World Bank Group, in cooperation with the Government of Ethiopia, had
administered a phone survey of industrial park firms that reached about 70% of eligible firms
(11 out of 14 parks). The survey data suggested that the pandemic severely impacted the ability
of firms to produce and sell their output. Firms reported that they expected orders to decrease
by an average of 20%, and employment by 17% in the next six months, compared to the same
period the previous year.

Overall, firms in industrial parks in Ethiopia have been significantly impacted by the COVID-
19 pandemic. About 10% of interviewed firms reported temporarily closing due to COVID-19.
Over three-quarters of firms have seen a decline in sales and their production volumes. On
average, sales decreased by 42% and production by 40%. (12)

The Ethiopian Labour Force Proclamation

This Proclamation, cited as the “Labour Proclamation No.1156/2019” was initiated due to “...
the need to create [a] favourable environment for investment and achievement of national
economic goals without sacrificing fundamental workplace rights by laying down well-
considered labour administration; and determine the duties and responsibilities of
governmental organs entrusted with the power to monitor labour conditions; occupational
health and safety; and environmental protection together with bilateral and tripartite social
dialogue mechanisms; political, economic and social policies of the Country ”

14
It has also defined “Condition of Work” as “... the entire field of labour relations between
workers and employers, including hours of work, wage, leave, payments due to dismissal,
workers’ health and safety, compensation to victims of employment injury, dismissal because
of redundancy, grievance procedure and any other similar matters ” (13)

Despite this fact, forced overtime, wage withholding, and abusive work conditions have been
documented across the board, with women being most at risk given their lower status jobs
and more limited communication skills. With low wages, high cost of living and almost
uniformly difficult working conditions, it was found that only one in six workers made it
through their first year. (14)

Workplaces in Ethiopia

There are a number of workplaces in Ethiopia that accommodate a large group of urban and
semi-urban youth. These include industrial parks, large-scale farms, mega-projects,
development corridors and others.

Industrial Parks

In order to create new job opportunities for its increasing young population, meet the SDG
goals, and fulfil its aspiration of becoming a middle-income country by 2025, Ethiopia has
invested heavily in different mega-projects including export-oriented manufacturing
industrial parks ranging from textile industries to floriculture farms. (15) Each of these
industrial parks now employs tens to hundreds of thousands of workers – nearly all young
and mostly poorly educated female migrants from rural areas. (16)

Hence, targeting an annual investment of one billion U.S. dollars in industrial parks over the
next decade, and boosting exports to rank Ethiopia as Africa's top manufacturer, the
Government of Ethiopia has prepared the legal ground under the “Industrial Parks
Proclamation N0. 886/2015” that allows any profit-making, public, public-private, or private
enterprise to develop industrial parks in the country

Inspired by the full support of the government, the Ethiopian Industrial Park Development
Cooperation (IPDC) was established in 2014. Currently, the IPDC is becoming an engine for
rapid industrialization that nurtures manufacturing industries to accelerate economic
transformation, promote and attract both domestic and foreign investors through availing
industrial land, and making accessible pre-built shades equipped with all-encompassing
utilities and infrastructural facilities that meet international standards. (17)

Horticulture/Floriculture Farms

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The Ethiopian horticultural industry is composed of over 130 investments in the sector. The
sector provides employment for approximately 183,000 people and has been growing
exponentially. (18)

Mechanized Agricultural Farms

In a study conducted on “Agricultural Investment and the Role of Commercial Farming in

Benishangul Gumuz Region,” it was found that 221 functional projects have created job
opportunities for 42,186 employees at the regional level.

In countries like Ethiopia with limited access to farm machineries and mechanized farms,
commercial farms may provide direct employment opportunities that enable generating
income to individuals hired at the farms, with indirect engagement afforded to additional
individuals in grain and seed marketing and processing jobs. (19)

The Grand Ethiopian Renaissance Dam (GERD)

The 1,780 meter long and 145 meter high gravity dam on the Blue Nile River is located in the
Benishangul-Gumuz Regional State, at about 45 kilometres off the border of Sudan. The
Roller-Compacted Concrete (RCC) saddle dam is constructed using the most up-to-date
construction technology, with a water retention capacity of 74 billion cubic meters upon its
completion. With the primary purpose of hydroelectric power generation as high as 6,000
megawatts to relieve Ethiopia’s acute energy shortage and export electricity to neighbouring
countries, it has been under construction since 2011. The project, which is fully funded by the
people and Government of Ethiopia, is expected to benefit not only Ethiopia, but also its
neighbours. Currently, the overall construction progress has reached more than 84% and
has started generating 375 megawatts of power from one of its turbines.

Up to 12,000 jobs, a significant number of which are taken up by both male and female youth
and adolescents, have been created in the construction of the dam; and it is expected that the
dam will create more and more employment opportunities for adolescents and youth.

3. Health
Health is defined by the WHO as “a state of complete physical, mental and social well-
being, and not merely the absence of disease or infirmity. The enjoyment of the highest
attainable standard of health is one of the fundamental rights of every human being without
distinction of race, religion, and political belief, economic or social condition.”

Although Ethiopia has made significant progress regarding access to basic health facilities,

16
young people still face a number of health challenges, including inadequate access to sexual
and reproductive health information/services, malnutrition, prevalence of HIV/AIDS,
substance abuse (particularly khat, tobacco, alcohol and narcotics), and persistent gender
inequalities. Young women represent a high-risk group in Ethiopia, being especially
vulnerable to gender-based violence, female genital mutilation, early marriage, and other
harmful traditional practices.

In order to tackle the current health and health-related problems of adolescents and youth in
the country, the Adolescent and Youth Health Strategy (2021-2025) framework employs eight
strategic priorities for positive health development.
Moreover, this MSP document is developed by the MoH to tackle the significant challenges
endured at workplaces by adolescents and youth that cannot be easily addressed through the
National AYH strategy.

Health Status of Adolescents and Youth at Workplaces

The socioeconomic benefits of establishing industrial parks in Ethiopia aside, recent research
suggests that the health and safety of young workers in these establishments are at risk. For
instance, adequate training and protective gear are sorely lacking for workers in the
floriculture industry that they are exposed to toxic agrochemicals, leading to high rates of
illness and mortality. (20)

Unsafe sexual practices among workers, limited awareness on available services at workplaces
and surrounding facilities, and unavailability of sufficient toilets and sanitary materials for
female workers have significant effects on their health. All forms of physical, verbal, and
psychological harassment are common at most workplaces. Moreover, there are weak sexual
and gender-based violence (SGBV) reporting and response mechanisms, and a lack of support
from the surrounding community. (21)

For young girls in particular, low levels of knowledge and confidence around SRH issues,
combined with the abrupt transition from living in traditional home settings to living alone in
areas with more men, create a higher potential for risks such as sexually transmitted
infections, HIV, SGBV and unwanted pregnancy. This is because they work in an environment
where awareness/information on sexual and reproductive health is inadequate, vulnerability
to sexual and gender-based violence is high, access to SRH services is limited, and gender
roles and norms prohibit women from accessing those limited services.

The SRH risks to adolescents and youth in general, and the risk to young girls at workplaces
in particular, include: exposure to unprotected sex, engaging in sex work for additional
17
income that supplements their meagre earnings from their occupations; increased exposure
to sexually transmitted infections (STIs) and HIV contractions, unwanted pregnancies, and
abortions. In terms of health service response, sex workers have a day-to-day exposure to SRH
risks and have peculiar service needs in information, counselling, contraceptive services, and
other SRH support. (22)

Young and adolescent males/boys are also at higher risk of contracting STIs and HIV since
their new working environment is one where awareness/information on SRH is deficient, and
access to services is limited. Hence, one important factor that should be properly addressed
in this regard is the lack of a contextualized and standardized SRH service package at
workplaces.

For these reasons, providing quality and sustainable reproductive health services to
adolescents and youth at workplaces will significantly and positively impact their lives by
preventing unwanted pregnancies, sexual and gender-based violence, exposure to HIV/AIDS,
and other related health problems. (14)

Service-level Challenges: Some of the current service-related challenges at workplaces

include:

• Unavailability of health facilities;

• Absence of comprehensive SRH services;
• Competing priorities for AYH services;
• Lack of YFS-trained service providers;
• Lack of functional linkages to public health institutions outside the workplace;
• Inconvenient working hours of public health facilities;
• Resistance from workplace managers to get service during working hours.

III. Purpose of the Document

Many adolescents and youth are working with limited access to SRH and other health services
in different mega-projects including:

• Industrial parks
• Floriculture and large-scale irrigation farms
• Factories and large-scale business industries
• Other mega-projects such as sugar factories, road construction sites, dry ports, etc.

18
Hence, this document calls for immediate tailored and targeted interventions to meet the
diverse needs and realities of adolescents and youth at workplaces. With the aim of improving
access, quality, and utilization of appropriate health services, the document specifies the
minimum service package and the standard of health services for adolescents and youth at
workplaces in Ethiopia. The document is specifically 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 adolescents and youth at workplaces.

In addition, the service package will ensure that service quality is uniform across all health
service delivery points at workplaces. Overall, it is expected that adhering to the MSP and
specified national standards will appropriately improve the access and utilization of services
by adolescents and youth at workplaces.

IV. Intended Audience and Beneficiaries

The primary intended beneficiaries of this document are:

• Adolescents and youth at workplaces in Ethiopia;

• Service providers at workplaces (government, non-government, and private sectors);
• Health sector offices at all levels (FMoH, RHBs, ZHDs, WoHOs);
• Local/international development partners;
• Donors supporting YFS programs;
• Civil society and community-based organizations and associations;
• Academic institutions and professional associations;
• Policy/decision makers and program managers;
• Media institutions;
• SRH communicators and advocates;
• Training providers;
• Community members;
• Law enforcement agencies;
• Other government sector offices at all levels, including the Ministry of Women and
Social Affairs (MoWSA), and the Ministry of Labour and Skills.

V. Guiding Principles for Youth-Friendly

Services at Workplaces
19
The following principles are critical to the implementation of this national standard and MSP
for adolescents and youth at workplaces:

• Rights-based Approach – to protect, promote and fulfil their rights to information

and healthcare.
• MCC – Motivated, Compassionate and Caring service providers.
• Comprehensive and Integrated Care – along with support with referral services.
• High-level Quality Practice – Compliance with accepted ethical standards.
• Equity and Inclusion – with a gender-transformative approach.
• YFS – Youth-friendly quality health services.
• Accountability

In addition, there is a need to:

• Define a comprehensive package of health services to be provided to adolescents and

youth from specified Service Delivery Points (SDPs).
• Provide quality health services through “youth-friendly health services” during routine
working hours and off-service hours convenient to adolescents and youth.
• Improve services through training and maintaining staff skills in YFS delivery.
• Develop mechanisms for supportive supervision and on-going capacity building.
• Recognize the diversity of youth and align segment interventions by age, sex, schooling,
marital and socioeconomic status, and disability and vulnerability conditions.
• Recognize the socioeconomic and cultural environment of adolescent RH.
• Address the needs of youth through a holistic approach.
• Collaborate with relevant partners from the public, private and non-profit sectors.
• Understand that gender considerations are fundamental to adolescents and youth as
they are important determinants of access to social services and opportunities.

20
SWOT Analysis

Strengths and Opportunities T Challenges/ Threats

• Commitment at the national level • Financial shortage

• Physical facilities are already there • Impact of emergency
• The workplaces are already providing minimal services situations: (eg. Covid
• National document already developed pandemic, conflict and
• National and regional Legislations for work forces are in climate change)
place • Difficulty of Coordinating
• MOH is willing to take the overall leadership and Multiple actors
coordination role • Shortage of Supply &
• IPDC owns the program Financing
• CSR - Issue of providing SRH service by investors
• Respective RHBs, Zones, Woredas
• and City administrations had been part of the document
development process

Stakeholder Analysis

Governmental Stakeholders:
• MOH and its sector offices
• IPDC, Workplace service/facilities
• Service providers at work places,
• Other ministries and their sector offices

Implementing and development partners

• Development partners, donors,

Other Stakeholders
• Service users (Young people, Community Based Organizations
• Academic institutions, professional associations,
• Training providers, SRH communicators and advocates
• Media institutions; Community members

Future potential partners for the implementation of the program

Stakeholder current Future engagement
engagement Planning Resource Implementation/
mobilization
Coordination
MOH and Its Sector
Offices
Different Ministries and
21
 Their Sector Offices
RHBs and their sector
Offices
IPDC

Donors and
Implementing
Partners
Other interested
stakeholders

22
Section II: Goal, Objective and Outcome
This document specifies the minimum service standards of health services to be provided at
health service delivery points for adolescents and youth at workplaces, by improving the
quality, access, and utilization of appropriate and comprehensive health services.

I. Goal and Objectives of the MSP

Goal:

The goal of this Minimum Service Package is to improve the health status of adolescents and
youth at workplaces in Ethiopia.

Strategic Objectives:

• To enhance the health literacy of adolescents and youth at workplaces.

• To increase access to comprehensive health services.
• To improve utilization of quality health services.
• To contribute to better productivity through investing in health.

II. Expected Outcome

The implementation and operationalization of this Minimum Service Package are “to achieve
quality and friendly adolescent and youth health services at workplaces.”

Hence, the following outcomes are expected:

• Harmonized SRH/GBV service standards with other health Facilities
• Improved/integrated SRH & GBV with other health services
• Increased access to quality, comprehensive health information, services, products

23
Section III: The Ethiopian Health System
I. Functional Health System

The chart above depicts the three-tier structure of the Ethiopian health system.

The primary care level of Ethiopia’s healthcare system is established at the local district level
(or ‘Woreda’ level in Amharic) and includes a primary hospital, local health centres, and rural
health posts. The secondary and tertiary levels are comprised of general and specialized
hospitals, and the coverage of each extends to larger portions of the population. The
management, coordination, and distribution of technical support in each and every level are
the responsibility of Woreda/District Health Offices and Regional Health Bureaus, whereas
policy and significant decision making are in the hands of the Federal Ministry of Health. (23)

According to the Ethiopian health tier system, the primary care level serves the following
groups: a health post for every 3,000 to 5,000 people; a health centre for 25,000 to 40,000
people (25,000 at rural and 40,000 at urban levels); and primary hospitals serve 60,000 to
100,000 populations. The secondary level healthcare system includes general hospitals and
each level serves one million to 1.5 million people. The tertiary level healthcare systems
include specialized hospitals where each of them serves 3.5 million to five million people.

24
However, there are segments of the population – including adolescents and youth at
workplaces – that cannot be covered within the three-tier system. Hence, this document is
developed to address the needs of these segments of the society.

The WHO Health System Building Blocks

The WHO Health Systems Framework (24)

1. Service Delivery – Good service delivery is comprised of quality, access, safety and
coverage.
2. Health Workforce (HRH) – A well-performing workforce consists of human
resources management, skills and policies.
3. Health Information System – A well-performing system ensures the production,
analysis, dissemination and use of timely and reliable information.
4. Medical Products, Vaccines and Technologies – Procurement/supply programs
need to ensure equitable access, assured quality and cost-effective use.
5. Financing – A good health financing system raises adequate funds for health,
protects people from financial catastrophe, allocates resources, and purchases goods
and services in ways that improve quality, equity, and efficiency.
6. Leadership and Governance – Effective leadership and governance ensure the
existence of strategic policy frameworks, effective oversight and coalition building,
provision of appropriate incentives, and attention to system design, and
accountability.

25
Section IV: Health Literacy
Social and behaviour change (SBC) is a collaborative and transformative process that
empowers individuals, households and communities, and improves knowledge through
shifting norms and perceptions, and modifying structures and policies to facilitate positive
collective and individual behavioural changes.

Currently, available approaches for SBC for AYH Services include:

1. Capacity building trainings

2. Peer education

3. Health education

4. Use of digital technology for adolescent and youth health services

I. Capacity Building Training for YFS Providers

Capacity building trainings will be provided to health service providers and supervisors at
workplaces. Adolescents and youth at workplaces and managers of business firms will be
given orientations proportional to the gaps in their knowledge identified during preliminary
needs assessments. These trainings are provided so that healthcare providers are technically
competent to offer health promotion, prevention, treatment, and care relevant to each
adolescent and youth’s level of maturity and their social circumstances.

Providers should have interpersonal and communication skills, be non-judgmental and

considerate, treat all young people with equal care and respect, and provide information and
support that enable adolescents and youth to freely decide on the right choices for his or her
unique needs. Service providers who are trained on AYH should be able to respond to the
needs of adolescents and youth, address their fears, respect their concerns, and provide the
services within an environment that suits their preferences.

II. Peer Education

Peer education for adolescents and the youth works best when it is participatory and involves
them in discussions and activities whereby they share information and experiences with each
other. It creates a relaxed environment for them to ask questions without fear of being judged
and/or teased even on subjects that are considered taboo by the society. Hence, it is essential
to establish a peer education system that could fill the information gap among adolescents
and youth at workplaces.

26
Peer educators who engage in this system should undergo a series of trainings so that they are
equipped with effective communication and knowledge transfer skills. Moreover, peer
education should not necessarily be a one-on-one interaction; it can be done in groups, either
with one or more peer educators and several learners, or with a group of co-learners. “Who an
educator is,” and “who a learner is” may change in the course of a session depending upon
what is being discussed or taught. The whole relationship may be created as a reciprocal
arrangement, with each participant teaching and the other, in return, being taught something
else. Another possibility is that once the learner masters whatever is being taught, she/he will
then become a peer educator in their turn.

Youth dialogue provides an opportunity to raise awareness among adolescents and youth at
workplaces on the importance and benefits of a comprehensive AYH education. It will also
help gain the support of managers/leaders on these key issues while encouraging people,
including adolescents and youth themselves, to discuss their concerns and come up with
solutions together.

Creating these opportunities for open and honest discussion and dialogue around
comprehensive AYH issues is important in: building consensus; getting support; engaging
community members and workplace decision makers; and creating more spaces for sharing
concerns about comprehensive AYH education.

III. Health Education

Information, Education and Communication (IEC), Behavioural Change Communication
(BCC), and Social and Behavioural Change Communication (SBCC) are powerful tools
proved for bringing social change and development. These strategies are research-based
consultative processes designed for addressing knowledge, attitudes and practices to bring
positive changes in the behaviours and attitudes of adolescents and the youth. They define
the needs of adolescents and youth, create awareness, promote health education, and guide
them on how to exercise their health rights.

Information, Education and Communication is one of the strategies to spread awareness using
different communication channels that target audiences to achieve desired positive results. It
is a strategy that involves sharing information through broadcast or print media such as
posters, flyers, leaflets, brochures, booklets, radio broadcast or TV spots, or interpersonal
communication in a manner appropriate to the target group’s culture and values. It is
intended to instil positive knowledge for appropriate behaviour in the community which will
promote preventive health measures and development.

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IV. Use of Digital Technology for Adolescent and Youth
Health
Healthcare is increasingly being delivered through digital channels such as the internet,
mobile phone messaging, social media platforms, apps, voice, video messaging, and
telemedicine. This trend has been facilitated by the proliferation of mobile technology and
rapid advances in artificial intelligence. Digital communication channels have great potential
to enhance the delivery of healthcare information to adolescents and youth as they offer wide
coverage and allow targeted messaging to particular groups or individuals. Such kinds of
technologies should be introduced and promoted to adolescents and youth at workplaces to
increase access and utilization of available health services.

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 Section V:
Standards and Service Packages of
Youth-Friendly Services
Service Standards
Standard 1: Adolescent and Youth Health Literacy – implies the cognitive and
social skills that determine the motivation and ability of adolescents and youth to gain
access to, understand, and use information in ways that promote and maintain good
health. Healthcare delivery outlets ensure that adolescents and youth are knowledgeable
about their own health, know how to protect themselves from health problems, and know
where and when to obtain health services.

Standard 2: Comprehensive Service Package – Appropriate healthcare services that

cater to the health needs of adolescents and youth are available and accessible at all time.
The services provided are well aligned with the standards and the minimum service
package included in this guideline.

Standard 3: Health Facility Characteristics – All service outlets must have an

adolescent- and youth-friendly environment – convenient operating hours, a welcoming
and clean environment, and one that maintains privacy and confidentiality. It should be
equipped with the necessary medicines, supplies, and technology needed to ensure
effective service provision to adolescents and youth, including young people with
disabilities.

Standard 4: Provider Competency – Service providers in all service delivery outlets

provide the services with technical competency as per the national protocol and
guidelines to the various adolescent and youth health problems. Both healthcare
providers and support staff respect, protect and meet adolescent and youth rights to
information, privacy, confidentiality, non-discrimination, non-judgmental attitude, and
respect.

Standard 5: Adolescent and Youth Participation – Adolescents and youth are

involved in the planning, implementation, and monitoring and evaluation of healthcare
information and service provision, and in decisions regarding their own care.

Standard 6: Community Support – Health facilities implement systems to ensure

parents, guardians, community members and organizations recognize the value of
providing health services to adolescents and youth, and support provision and service
utilization.

Standard 7: Equity and Non-discrimination – Health facilities provide quality

29
services to all adolescents and youth irrespective of their ability to pay, age, and
disability
Status, sex, marital status, education, ethnic origin, creed or other socio-demographic
characteristics

Standard 8: Data and Quality Improvement – AYH data is collected, analysed,

distributed and used regularly. Likewise, the data quality of AYH services should be
assured by data quality assurance mechanisms.

Standard 9: Inter-sectoral Collaboration – Every sector implicitly contributes to

adolescent and youth health through the sector's core business. General quality
improvements in healthcare should benefit adolescents and youth – adequately
addressing adolescent- and youth-specific concerns (such as concerns about accessibility
and acceptability). As social protection sectors implement policies and interventions to
address the needs of vulnerable families, adolescents and youth benefit as well.

Nature of the organizations included as workplace:

Organizations that have a significant number of employees such as 100 employees are included
in the definition of “Workplace” and they are abiding by this document.

Category of the workplaces:

In order to propose what type of facility has to exist in which workplace to provide the service
packages, the workplaces has to be categorized. Hence, For the purpose of this program,
workplaces categorized based on their number of employees.

Each of the workplaces will be evaluated by the health regulatory sector of MOH in regard to the
national standard. All will be assessed according to the four Ps (Premise, person, product, and
place). Then they will be categorized in to three major categories with sub-categories.

Category I -

Those workplaces having 100 – 1,000 employees: they are required to:

• Have an agreement with a nearby health facility to provide the services packages
specified in this document to their employees OR
• Have their own Primary clinic in their premises

Category II
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Those workplaces with more than 1,000 but less than 25,000 employees: they are required to
have medium /higher clinic inside their compound based on their sub-category (See Sub
Category 2.1 & 2.2)

Sub Category 2.1

Those workplaces with more than 1,000 but less than 10,000 employees: they are required to
have medium clinic within the premise of their company/organization.

Sub Category 2.2

Those workplaces with more than 10,000 but less than 15,000 employees: they are required to
have HIGHER clinic within the premise of their company/organization.

Category III

Those workplaces with more than 15,000 up to 50,000 employees: they are required to have
Health Centres or Hospitals within the premise of their company/organization (See sub
Category 3.1 and 3.2).

Sub Category 3.1

Those workplaces with more than 15,000 but less than 25,000employees: they are required to
have a Health Centre within the premise of their company/organization.

Sub Category 3.2

Those workplaces with more than 25,000 employees: they are required to have either of the
following whichever is feasible /convenient for them within the premise of their
company/organization

• One Health Centre for every 25,000 employee

• A primary Hospital for every 1.000.000 employee

Standards of the workplace facilities:

The standard of the health facilities and the services provided will be according to the national
standard set for any other governmental, private or Not-for-profit facilities.

Premises – will be according to the national standard to each level of health facility

31
Personnel - The requirements of man power to the workplace facilities is as per the national
standard (refer to national standards for different health facilities)

Properly trained professionals and graduates from a recognized higher institutions

Capacity building - Training on the areas of the Minimum service package included in this
document has to provide to the service providers as per the recommended standard

Providing training to the service providers shall be the joint responsibility of the workplace
facility, the nearest catchment PHCU (with in the same Woreda), the Woreda Health Office,

Products - Supplies and commodities - the nearest catchment PHCU / Woreda has to provide
supplies and commodities the same way it provides to its catchment facilities

These facilities will also have the advantage of getting commodities and supplies directly from
EPSA like other health facilities provided that they fulfil the pre-requisites and reach a bilateral
agreement.

The Minimum Service Packages

The MSP delivery for adolescents and youth at workplaces is categorized into seven
packages as follows:

I. Information and Counselling on Adolescent and Youth Health Issues

II. SRH Services
1. Comprehensive HIV Testing, Counselling, Treatment, Care, and Support.
2. Testing Services for HIV (Voluntary Counselling and Testing).
3. STI Screening, Management, and Follow-up.
4. Testing Service for Pregnancy, Ante-natal and Post-natal Care, including
PMTCT.
5. Comprehensive Abortion Care.
6. Contraception and Family Planning Services.
7. Condom Promotion and Provision (both female and male condoms).
III. Nutritional Screening and Counselling
IV. Psycho-social Support Services
1. Counselling and Psycho-social Support on Substance Abuse.
2. Mental Health and Psycho-social Support.
V. Injuries and Non-communicable Diseases
1. Prevention and Management of Injuries.
2. Diagnosis, Treatment, Prevention, and Control of Non-communicable
Diseases.
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 VI. Gender-based Violence (GBV)

VII. COVID-19 and Other Epidemics: Prevention, Control, and Management

I. Information and Counselling on Adolescent and Youth

Health Issues

Service Objective: To equip adolescents and youth with quality health information
and counselling services on different health issues to attain sustainable behavioural
change.

Health facilities should provide to adolescents and youth tailored and age-appropriate
promotional services on themes including:

• Physical, physiological, psycho-social, and/or emotional changes;

• Available services at service delivery points including referrals and procedures;
• Risks associated with early and unprotected/unsafe sexual intercourse including
STIs and HIV/AIDS;
• Menstrual hygiene management (MHM) and personal hygiene and sanitation;
• Contraception and family planning services;
• Promotion of condom use (both female and male);
• Harmful traditional practices (HTPs) such as early marriage, marriage through
abduction, etc.;
• Risks of early pregnancy including fistula;
• Prevention of cervical cancer;
• Pregnancy testing, focused ante-natal care, delivery, post-natal care, and
comprehensive abortion care (CAC) services;
• Substance abuse and mental health;
• Nutrition, injuries and other non-communicable chronic diseases (NCDs);
• Gender-based violence;
• Prevention and control measures for COVID-19 and other epidemics.

Hence, focused counselling services have to be provided on the following topics:

Counselling on SRH and Other Health Issues – Adequate resource materials that
cover topics related to growth and development, puberty myths and misconceptions, safe
sex and contraception, unwanted pregnancy and unsafe abortions, menstrual disorders,
33
anaemia, sexual abuse, Reproductive Tract Infections (RTIs)/STIs, injuries, mental
health, immunization, and other issues must be available to providers to address
common health concerns of adolescents and youth at workplaces.

Counselling on Reversible Contraceptives – Provide counselling services on the

benefits, side effects and characteristics of oral contraceptive pills (OCPs),
depotmedroxyprogesterone acetate (DMPA), implants, condoms (female and male), and
Intrauterine Device (IUD) insertion as per the national guidelines. Dual protection is to
be an integral part of contraceptive counselling. Workplace adolescents and youth must
have information and access to methods that provide dual protection.

Counselling on Emergency Contraceptive Pills – Every opportunity must be

utilized to emphasize safe sex practices and risk reduction counselling. Apart from
regular contraception methods, information and counselling on emergency
contraceptivepills (ECPs) must be provided.

Counselling on Menstrual Disorders – Menstrual disorders are common among

adolescent and youth girls. Service providers must be able to manage these problems in
the following manner: Providing counselling for menstrual problems and hygiene, and
referrals for any investigations and puberty-related problems.

Service Methods of Service

Types of Services
Providers Delivery
Physical, physiological, and psycho-social changes
occur during the time of adolescence and youth. Printed and electronic SBCC
Trained Information and counselling services on early sexual materials, health education
Counsellors, initiation, contraception and condom use, HTPs like through mini-media, coffee
Volunteers, Nurses, early marriage, Fistula, Cervical Cancer Prevention, ceremonies, individual and
HOs, Physicians, MHM, CAC, ANC including PMTCT, STIs including group counselling, peer to
etc.… HIV/AIDS, Substance Use, Nutrition, Mental Health, peerdiscussions, signboards
NCD, Injuries, Gender-Based Violence, etc.… in thehealth facility.
Refer to the next level as appropriate.

II. SRH Services

1. Comprehensive HIV Testing, Counselling,
Treatment,Care, and Support

Service Objective: To ensure adolescents and youth at workplaces know their HIV
status by offering HIV testing and counselling services so that they protect themselves,
34
their partners, and others from HIV/AIDS and related risks.

Service Characteristics of Comprehensive HIV Testing and Counselling Care

(CHTC) for Adolescent- and Youth-friendly Services at Workplaces
• Privacy shall be respected in all situations involving HIV counselling and
testing.
• Test results shall not be disclosed to third parties unless for the clear benefit of
tests.
• No adolescent and youth shall be discriminated against because of their HIV
status.
• Peer education, a peer support system, and interpersonal communication skills
among adolescents and youth shall be promoted at the health centre.
• Abstinence, faithfulness, and condom use must be promoted, and condoms
provided.
• Education materials that focus on adolescent and youth issues should be made
available.
• Providers and counsellors should be trained on YFS and how to be
youth-friendly.
• “Youth-friendly” services should be provided in a safe, non-threatening
environment.
• Providers and counsellors should be non-judgmental, and use language
easilyunderstood by adolescents and youth.
• Respect the dignity and confidentiality of adolescents and youth.
• The service should be accessible to adolescents and youth with disabilities as
well.

2. Testing Services for HIV (Voluntary Counselling

andTesting – VCT Services)
Service Objective: To ensure that adolescents and youth at workplaces know their HIV
status voluntarily so that they protect themselves, their partners and others from
HIV/AIDS and related risks.

Voluntary counselling and testing services are the gateway to prevention and care for
HIV/AIDS so that sexually active adolescents and youth are communicated for pre-test
counselling to get voluntary testing services. Voluntary Counselling and Testing (VCT)
sites need to facilitate access to antiretroviral therapy (ART) if required.

Post-Rape Services: These are services provided to sexual violence survivors (post-
rape care) and physical and emotional violence services.

35
 Post-Rape STI/HIV Services:
The following represents post-rape STI/HIV care services that must be
in place:
• Rapid HIV testing with referral to care and treatment as appropriate.
• HIV post-exposure prophylaxis (PEP) or service linkage – if within 72
hours.
• STI screening/testing and treatment; referral when necessary for care and
treatment.
Referral to a Social Protection Centre:
• Referral for psycho-social support and legal service provision.

Service Providers Types of Services Methods of Service Delivery

Trained Pre-test Information, Testing, Treatment and Printed and Electronic SBCC
Counsellor/Health Care and Support, Post-test Counselling, Materials, Mini-media, One-to-
Professionals on CHTC Condom Demonstration and Provision, and One and Group Counselling
Referral

3. STI Screening, Management, and Follow-up

Service Objective: To ensure that adolescents and youth have adequate access to STI
services including information, diagnosis, and treatment.

Treatment of Common STIs

Adolescents and youth are more vulnerable to genital infections on account of biological
and social factors. Adolescent and youth 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 – Complete audio and visual privacy must be

maintained during the client-provider interaction. Although this applies to all
interactions, it is crucial in ensuring maximum privacy and confidentiality while
managing STIs.

• Treatment Compliance – It is important to emphasize compliance with the

drug regimen prescribed for each adolescent and youth. Noncompliance will lead
to treatment failure. This also includes counselling on personal hygiene and safe
sex during and after treatment.

36
 • Partner Management – As per national guidelines, partner management
should constitute an integral component of services. Adolescents and youth
should be informed about the importance of treatment for their partners in order
to prevent reinfections.

• Follow-up Visits and Referrals for Treatment Failures – Adolescents and

youth should be counselled to adhere to the schedule of follow-up visits. In case
they do not respond to therapy, they are to be referred to higher levels.

Sexual Violence (Post-rape Care): The following represents the minimum package
of post-rape care services:
• Counselling (other than for HIV counselling and testing);
• Provision of clinical services for STI screening/testing and treatment;
• Rapid HIV testing with referral to care and treatment as appropriate;
• Referral to legal and social protection.

Methods of Service
Service Provider Types of Services
Delivery
Trained Health Carry out a physical examination and provide Facility-based service,
Professionals: Nurses, counselling, appropriate treatment based on SBCC materials, on-site
HOs, Laboratory thetreatment guideline for STIs. and to take, individual
Technicians, and Plus: counselling, provide
Physicians, etc.… Laboratory investigation, culture sensitivity test, therequired treatment.
partner notification and treatment, and feedback.

4. Testing Services for Pregnancy, PMTCT, ANC, Delivery

and PNC Care

Service Objective: To ensure that adolescents and youth have access to testing
services for pregnancy and ante-natal care (including PMTCT).

Characteristics of Providers for Youth-friendly Pregnancy Testing, ANC,

PMTCT:
• Service providers should be trained on ANC, PMTCT, delivery, and PNC services
and need to have the skills on how to be youth-friendly, and how to care for young
people.
• Provide youth-friendly services in a safe, non-threatening environment as most
clients are first-time mothers and may be nervous about physical and pelvic
examinations.
• Providers should be able to explain every step of the procedures during ANC,

37
 PMTCT, etc.
• Providers should respect the dignity and confidentiality of adolescents and youth.

Focused Care during the Ante-natal Period

Pregnant adolescents and youth access the service more conveniently at dedicated
timings. It is generally considered that ante-natal care should start early, preferably in
the first trimester. Evidence shows that adolescents either do not seek care or that care
is often delayed and infrequent. The ANC protocol for pregnant adolescents and youth
Does not differ from the protocol for other pregnant women However, the following
issues need to be reiterated:

• Nutritional Counselling: there is an increased risk of nutritional deficiencies

asadolescents and youth enter pregnancy with an existing nutritional deficiency.
• Couple’s Counselling
• ANC Follow-up
• Conduct and/or refer for Institutional Delivery
• Post-partum Contraceptive Counselling
• Referral: should be made for complications during pregnancy.

Prevention of Mother-to-Child Transmission (PMTCT) of HIV,

Hepatitis B Virus (HBV), and Syphilis

HIV, Syphilis and HBV Testing for Pregnant Mothers

Ideally, access to PMTCT is to be an integral component of focused ANC services.
Adolescents and youth are to be counselled about the risk of HIV infections during
pregnancy, and must be encouraged to undergo testing and therapy to prevent infection
transmission to the foetus/new-born. Adolescents are to be referred to appropriate
facilities in their catchment for access to ART. Early testing and counselling services for
HIV, syphilis and HBV during pregnancy enable pregnant adolescent and young girls
living with HIV to benefit from HIV prophylactic and therapeutic services.

Types of Types of Services Methods of Service

Providers Delivery
Health Officers, Pregnancy testing, haemoglobin, blood type, Facility-based service, SBCC
Midwives, Clinical RHfactor. materials, (educational
Nurses, Physicians, HIV testing, testing for syphilis, testing for materials that focus on youth
Public Health HBV. issues) in a health facility, or
Nurses, Laboratory General physical and pelvic examination, off-site to provide individual
Technicians. administer antibiotics and IV fluids, anti- counselling, and the
hypertensives for those who need them. required clinical care.
On-couch counselling including for PMTCT
Services.
38
 5. Comprehensive Abortion Care
Service Objective: To ensure all adolescents and youth at workplaces receive standard,
consistent, and safe termination of pregnancy, and post-abortion care services within the
legal framework and as per the national guideline.

Early and Safe Termination of Pregnancy and Management of Post-abortion

Complications

All health facilities in Ethiopia are required by the law of the land to be fully equipped
for the provision of early and safe abortion services to adolescents and youth within the
legal framework. However, evidence suggests that younger adolescents are more likely
to delay seeking termination of pregnancy: Hence, such clients need to be managed as
per the Guidelines for Management of Common Obstetric Complications. Post-abortion
contraceptive counselling is to be an integral component of abortion services.

Service Eligibility for Safe Abortion Care:

• The pregnancy is a result of rape or incest; or
• The continuation of the pregnancy endangers the life of the mother, or where the
birth of the child is a risk to the life/health of the mother; or
• The foetus has an incurable and serious deformity; or
• The pregnant woman, owing to a physical or mental deficiency she suffers from,
or from being that she is underage, or that she is physically as well as mentally
unfit to bring up the child.

For further details, please refer to the Technical and Procedural Guidelines for
Safe Abortion Services (MoH: 2014).

Types of Providers/ Types of Services Methods of Service Delivery

Healthcare Personnel
Available/ Required
HOs, Midwives, Clinical Counselling, manual vacuum Facility and outreach-based
Nurses, Public Health aspiration (MVA) for up to 12 prevention intervention; printed and
Nurses and Physicians, completed weeks ofpregnancy; electronic IEC/SBCC materials;
Laboratory Medical abortion for up to nine completed individual and group counselling;
Technicians/Technologists weeks of pregnancy, administer antibiotics provide the required clinical and
and IV fluids (if necessary), post-abortion surgical care in the health facility.
FP counselling and service.

39
6. Contraceptive and Family Planning Services

Service Objective: To enable adolescents and youth to have access to a range of

contraceptive information and methods.

Range of Services and Activities to be offered – The following services and

activities are offered at different levels of the national healthcare delivery system:
● Contraceptive and FP counselling;
● Provision of contraceptive methods (emergency contraceptive, short-term and
long-term methods);
● Counselling and referral for infertility management;
● Counselling and linkage to other SRH services including for sexual dysfunction;
● Referral and follow-up.

Contraception and FP Counselling

Counselling should be an interactive process between the service provider and the
client. Healthcare professionals/service providers should have basic skills in counselling
techniques and should provide adequate information, along with a balanced and updated
counselling service to assist clients in making informed and voluntary decisions. In
cases whereby clients have additional needs, service providers need to link the client to
the next level of Service Delivery Point (SDP). Similarly, service providers working in
different units across a health facility should be able to counsel clients for contraceptive
and family planning services to avoid any missed opportunities.

Provision of Contraceptive Methods for Adolescents and Youth at

Workplaces
The following contraceptives and FP methods (among the contraceptive mix available in
Ethiopia) should be available and provided to adolescents and youth at
workplaces:
l Male (and female) condoms;
l Emergency contraceptive pills;
l Progestin-only pills, and combined oral contraceptive pills;
l Injectable contraceptives;
l Implants of different types; and
l Intrauterine contraceptive device (IUCDs).
While respecting clients’ rights and supporting full, free, and informed choice, ensuring
method-mix is central to quality contraception and FP services. The safety of the method
40
also needs to be weighed, along with the benefits of preventing unintended pregnancies.

Type of Providers/
Service Delivery Method
Health Personnel Types of Service
Available/ Required
Trained Providers and Long-acting reversible contraceptive (LARC) Facility-based Service,
Counsellors (Medical method (Implant and IUCD, including removal Outreach,
Doctors, Health Officers, services); Combined Oral Contraceptive Pills SBCC (educational materials
and Nurses, etc.…) on (COC) ; Progestin-only Pills; Emergency that focus on adolescent and
contraceptive technology Contraceptive Pills (ECPs); Injectables; Male youth health issues) on-site
and counselling. and Female Condoms; FP Counselling, and off-site, individual and
includingPost-partum FP Methods; Education; group counselling and
Screeningand Treatment of STIs and HIV; testing.
Referral
Linkages; and Pregnancy Testing.

7. Condom Promotion and Provision (Female and Male

Condoms)

Service Objective: To ensure that adolescents and youth at workplaces have access to
quality condoms (both male and female condoms) to protect themselves and their
partners from HIV/AIDS, unintended pregnancy, and other STIs.

In general, knowledge of condoms and their role in preventing HIV/STI transmission is

limited among adolescents and youth. STIs are a co-factor for HIV transmission and
useful markers for unprotected sex; however, knowledge about other STIs is even much
more limited than that of HIV.

To empower adolescents and youth at workplaces to make healthy transitions to

adulthood, and to decrease risks and vulnerability, the following strategies need to be
adopted:

• Provide clear, tailored and age-appropriate messages;

• Provide information and skills that help them to protect themselves from HIV
infection and unwanted pregnancy;
• Counsel on delaying sexual debut if not sexually active (abstinence), and on
limiting the number of sexual partners (faithfulness);
• Counsel and provide dual protection (consistent use of condoms and
contraception);
• Counsel adolescents and young women about their health;

41
 • Engage adolescents and youth in evaluating their risks;
• Provide counselling and VCT services to young married couples so that young
married girls know their own, as well as their husbands’ HIV status;
• Strengthen linkages to referral facilities that provide services for GBV cases; and
• Provide counselling and referrals to the next level of service for medical and
psychological support.

Types of Providers/ Health

Personnel Available/ Types of Services Methods of Service Delivery
Required
Trained Counsellor Counselling, STI Screening and Provision of IEC materials and
(adult,youth), and Health Testing, Condom Demonstration and condoms,
Professionals Provision face to face discussions,
using models

III. Nutritional Screening and Counselling

Service Objective: To improve access to a range of comprehensive nutritional
information and services to improve nutritional status and prevent inter-generational
malnutrition.

Adolescents and youth always should have continuous physical and economic access to
sufficient, safe and nutritious food that meets their dietary needs and preferences for an
active and healthy life.

Nutrition Security – demands the utilization of food to generate optimal nutritional

status, well-being, productivity, and longevity. Hence, food security alone is insufficient
to ensure nutrition security. Several other complementary factors relating to how the
food is utilized must also be in place if all adolescents and youth must enjoy a healthy
and active life resulting from proper nutrition. Thus, access to clean water, a hygienic
environment, and adequate healthcare services are central components of attaining
nutrition security.

Many adolescents and youth suffer from a range of nutritional deficiencies, including
micro-nutrient deficiencies such as iodine, calcium, iron, folic acid, and other vitamin
deficiencies, mainly due to intakes below recommended values.

42
Nutrition and Dietary Habits during Adolescence and Youth

Adolescence and youth are a period of rapid physical growth, with a corresponding
increase in nutritional requirements to support increases in body mass and brain
development.

Hence, health facilities need to provide screening for anaemia by offering routine
haemoglobin estimation. For pregnant adolescents and youth, the national guidelines
need to be adhered to for haemoglobin testing as part of the ANC service. For non-
pregnant adolescents and youth, treatment is to be given in the form of iron therapy.
Health service providers are expected to provide information on a balanced diet. Worm
infestations also have to be treated.

The daily intake of nutritional requirements increases/varies in line with the following
factors:

Age, gender, pregnancy, breastfeeding, post-natal period, physical exercise,

•
infection with parasitic diseases, and in areas where micro-nutrient deficiency
exists.
Common Nutritional Problems among Adolescents and Youth:

• Under Nutrition – results from the consumption of an inadequate quantity and

quality of food (that is, less than the daily requirement) over an extended time
period. This is very common among economically challenged persons with limited
knowledge and skills on nutrition, which ultimately leads to chronic infections
such as tuberculosis, parasitic infestations, and inter-generational malnutrition.

• Micro-nutrient Deficiency – results from a relative or absolute lack of a

nutrient, such as iron deficiency anaemia. More than one-third of adolescents and
young girls in Ethiopia suffer from nutritional anaemia. (Deficiency means a
severelack that might have a pathological effect).

• Over Nutrition – is a result of the consumption, over an extended period, of

unbalanced and excessive quantities of food, especially starches, sugar and fat.

• Increased Needs Related to Heavy Physical Work – such as working in

farmlands, loading and unloading, maintenance, and store management where
daily nutritional requirements increase.

• Iron Deficiency Anaemia – can occur due to decreased intake of the nutrient,
or parasitic infestations such as a hookworm infestation. Iron deficiency anaemia
can be prevented by nutrition counselling, deworming, or treated with iron
and

43
 Iron foliate medications depending on individual cases. However, if there is severe
anaemia, it may need treatment with a blood transfusion.

• Iodine Deficiency – Iodine deficiency leads to goitre due to hypothyroidism

that causes mental retardation and complicates pregnancy with abortion.
Although iodine is a micro-nutrient that the body needs in small quantities, the
need for iodine increases during adolescence and youth. Iodine deficiency can be
prevented by using iodized salt or taking iodine pills during pregnancy and
breastfeeding.

Health Service Methods of Service

Nutrition Services
Providers Delivery
Health Officers, Nutrition screening, assessment, and intervention Health facility and outreach-
Midwives, Nurses, counselling (Promotion of a healthy lifestyle, personal based services, Printed and
Physicians. and environmental hygiene, food sanitation, and electronic IE/SBCC
physical activity); and referral for further care and materials, counselling, and
Support. Clinical care.

44
IV. Psycho-social Support Services

1. Counselling and Psycho-social Support on

SubstanceAbuse
Service Objective: To ensure that adolescents and youth lead a substance-free life
through taking measures that prevent drug use at the individual and community level

The use of substances such as alcohol and tobacco has become one of the rising major
public health and socioeconomic problems worldwide. The rapid economic, social, and
cultural transition that most countries in Sub-Saharan Africa are now experiencing
creates a favourable condition for increased and socially disruptive use of drugs and
alcohol.

As in many developing countries, substance misuse is becoming a growing problem in

Ethiopia, where alcohol and khat are the most frequent substances of abuse. Studies
indicate that substance use among Ethiopian adolescents and youth is considerably
rising, with college and university students being at the highest risk. Even if substance
use has become a common problem among university students in Ethiopia, only scant
information is available about its magnitude and factors contributing to its use in this
segment of the population.

Methods of Service
Types of Services
Service Providers Delivery
Trained Counsellor (adult, Prevention through health education; SBCC, Counselling
youth, health professionals), Treatment; Recovery (rehabilitation); (Individual, family, and
Psychiatric Nurses. And Referral. Group), local media.

2. Mental health and Psycho-social Support

Service Objective: To ensure that all adolescents and youth have access to appropriate
information, counselling, diagnosis, treatment, and follow-up services on mental
healthcare as per their needs.

According to the World Health Organization (WHO), mental health is “a state of well-
being in which an individual can realize his or her abilities, interact positively with

45
Others, cope with the stressors of life and study, work productively and fruitfully, and
contribute to his/her family and community.” It should be noted that the definition does
not refer exclusively to the absence of “mental illness,” but also addresses the concept of
“mental wellness.”

Mental illnesses which are associated with a high burden due to GBV, economic
problems, disability, and mortality are common in Ethiopia, where they constitute an
important, but largely unrecognized barrier to achieving the SDG goals. Despite the
existence of affordable and effective treatments, less than one in ten severely affected
persons receive the treatment they need.

Mental health is an integral component of any efficient, well-functioning structure of

healthcare. The core components of mental health strategy take into account
accessibility, the need to protect human rights, efficiency and sustainability, and
community involvement and participation.

According to the WHO, “there is no health without mental health.” It should also be
noted that mental health is relevant to many of the health-related strategic development
goals (SDGs). As per WHO recommendation and successful experiences of many
developing countries, the National Mental Health Strategy of Ethiopia mandates that
mental health be integrated into the primary healthcare system. It also ensures that those
who require services have access to treatment as close to their home as possible, and in
the least restrictive environment. Hence, in keeping with the overall health services
development plan, the strategy promotes a decentralized approach in which mental
health services are available at different levels of health facilities from tertiary facilities
down to health centres.

A critical requirement for mental health promotion is to have information, increase

trained skilled workers and quality mental health services, nurture self-confidence to
access available services, and promote a community support system.

Service Providers Types of Services Methods of Service Delivery

Psychiatrists and Mental health information, Facility-based health information,
Psychologists, Nurse, sensitization, health education sensitization, and awareness creation
Trained MD, HOs, (HE), counselling, psycho- activities, counselling, management,
Clinical Nurses. socialsupport, and referral. psycho-social support, follow-up and
Referral.

46
V. Injuries and Non-Communicable Diseases

1. Prevention and Management of Injuries

Service Objective: To ensure that all adolescents and youth at workplaces obtain
preventive and promotive services, as well as diagnosis, treatment and rehabilitation
care for injuries and complications that arise from injuries.

Injury is defined as physical damage resulting from exposure to sudden energy that
exceeds the threshold limit of human physiological tolerance.

Burden of Injuries in Ethiopia

Injuries in general – like drowning, falls, fire, heat and hot substances, mechanical forces
– And road traffic accidents in particular are a growing national concern in Ethiopia. The
overall age-standardized mortality from all injuries in Ethiopia was 69.4 per 100,000
persons in 2017.

Service
Injury Management Services Methods of Service Delivery
Providers
Physicians, Promote workplace safety through outreach Facility-based services based on
Health Officers, programs; treatment protocols (management of
Nurses, First Emergency care (first aid services until referral); minor, major injuries, and mental
Aid Care Sensitization/Counselling; disorders);
Providers Psycho-social Support; SBCC materials, awareness creation,
Management of minor injuries; personal protection equipment (PPE),
Screening and management of injured patients for injury control, and prevention training;
mental health problems; Outreach activity;
Follow up (rehabilitation); Manage cases of mental illnesses,
Referral for psycho-social support and other follow-up, and referral.
supports.

2. Prevention, Diagnosis and Treatment of Non-

Communicable Diseases (NCDs)
Service Objective: To prevent the occurrence of NCDs during adolescence and youth
and prevent premature death in adulthood through the promotion of a healthy lifestyle.
2.1 Risk Factors for NCDs – Risk factors associated with increased or decreased
occurrence of NCDs:

47
Behavioural Risk Factors – They can be eliminated or reduced through healthy
lifestyles or behavioural changes. Behavioural risk factors include:
• Tobacco smoking and excessive alcohol consumption;
• Unhealthy diet and physical inactivity;
• Insufficient vaccination;
• Unprotected sexual activity.

Biological Risk Factors – They develop from behavioural risk factors sustained over
time, and may be influenced by a combination of genetic, lifestyle, and other factors such
as:
• Raised Blood Pressure;
• Raised Blood Sugar;
• Raised Blood Lipids.

Overweight/Obesity – is affected by:

• Age – 81% of all deaths from stroke occur in ages 75 and over.
• Sex – Pregnancy and Oral Contraceptive Pills (OCPs) increase a woman’s chances
of breast cancer.
• Early menarche, late menopause, and late first childbirth have been shown to
increase the risk of breast cancer.

Environmental and Occupational Risk Factors – Some diseases may result

entirely from an individual's genetic make-up; many others arise from the interaction
between genetic make-up and environmental factors such as:
• Pollution, smoke, coal tars, radiation, altitude, water.
• Industrial chemicals – Asbestos, radioactive substances.
• Herbicides, pesticides, insecticides, etc.

Infectious Risk Factors – Highly prevalent in developing countries Examples

include:
• Hepatitis B and C – Liver cancer;
• Human Papilloma Virus – Cervical cancer;
• HIV;
• Kaposi’s sarcoma and other opportunistic malignancies.

Early Life Factors – It is hypothesized that disease in future adults is “programmed”

during foetal life and infancy. This is called the latency model that emphasizes the role
of early environments on subsequent life trajectories. Abuse and neglect, childhood

48
Infections, low birth weight, maternal health and peri-natal events appear to exert effects
that are independent of environmental risk factors in adults, or may be amplified by
other risk factors. (20)

Psycho-social Factors – These are social determinants of health ("societal risk

conditions") rather than individual risk. They are the economic, social, and psychological
conditions under which people live that determine their health. Examples: Resilience
and emotional well-being or stress; sense of control; and social support or exclusion.

2.2 Common NCDs in Adolescents and Youth

Non-communicable diseases (NCDs) include:

• Cardiovascular diseases (like heart attacks and stroke);
• Cancers and diabetes mellitus;
• Chronic respiratory diseases (chronic obstructive pulmonary disease and
asthma).

It is estimated that cancer kills over 7.9 million people every year globally, constituting
close to 13% of total deaths worldwide. While communicable diseases still remain the
leading killers in many developing countries, the incidence of, and mortality from, non-
communicable diseases is rising rapidly. Breast and cervical cancers are the leading
cancers among women in developing countries, with estimated annual new cases of
882,900 and 444,500 respectively. More than 324,300 and 230,400 women die from
these cancers every year, respectively. (21)

In Ethiopia, cancer accounts for about 5.8% of the total national mortality. Although
population-based data are very limited, it is estimated that the annual incidence of
cancer is around 60,960 cases and the annual mortality is over 44,000. The most
prevalent cancers in Ethiopia among the adult population are breast cancer (30.2%),
cervical cancer (13.4%) and colo-rectal cancer (5.7%). About two-thirds of reported
annual cancer deaths occur among women. (22)

Reproductive Organ Cancers (ROCs) – Limited available data on the national

prevalence of reproductive organ cancers (ROCs) in Ethiopia estimates that breast and
cervical cancers in women, and penile and prostate cancers in men are the most
prevalent ones.

Prevention and Screening for Reproductive Organ Cancers

Contraceptive and family planning services offer a unique opportunity to screen for
cervical cancer and to teach the client to perform self-examinations for breast cancer.

49
 Where health facilities exist, women should be encouraged to get an annual Pap smear,
or visual inspection of the cervix using acetic acid (VIA) or Lugol’s Iodine Solution
(VILI). Health workers should educate women and their families about reproductive
organ cancers (ROCs) and the benefits of screening. Women found to have ROC should
receive treatment either in the same facility or be referred as urgently as possible.

HPV – Nearly 100% of cervical cancers are attributed to a persistent human

papillomavirus (HPV) infection. Most of the factors that increase the persistence of HPV
infection and development of cervical cancer – early sexual debut, teenage pregnancy,
multi-parity, co-infection with other sexually transmitted infections (STIs) such as HIV,
herpes simplex virus (HSV) type 2 and Chlamydia trachomatis – are potentially
preventable. (WHO, 2007)

Another method of preventing cervical cancer is providing HPV vaccines for girls and
boys at ages between nine and 14 years, which has been proven to offer the best
protection from cervical cancer in their later age. Chemotherapy services, again with
limited capacity, are also available in government and private health facilities. With the
on-going scale-up of specialty trainings, the surgical treatment of ROCs is expected to
improve markedly.

Pelvic Organ Prolapses (POP) – It is one of the common gynaecologic problems

that usually become symptomatic later in life. Although the exact prevalence in Ethiopia
is unknown, it is expected to be among the highest in the world due to the presence of
multiple risk factors: Early marriage and child birth, high fertility, high proportion of
home delivery, high incidence of obstructed labour, high prevalence of malnutrition,
and engagement in heavy physical work. With that understanding, the current RH
strategy of Ethiopia primarily aims to clear the backlog by identifying women with POP,
and linking them to treatment sites. In parallel, preventive actions will be promoted by
integrating with other RH schemes.

Methods of Service
Service Providers Types of Service
Delivery
Trained providers Promotion of physical activity, healthy diet, cessation of Facility-based Service;
and counsellors tobacco, alcohol, and khat use, etc.… Community outreach
(Midwives, Health Counselling on healthy living for patients with NCDs such (schools) to provide SBCC
Officers and Nurses, asdiabetes. on NCDs and their
and Physicians, Screening for hypertension and diabetes mellitus. modifiable risk factors;
Gynaecologists). Prevention, diagnosis, and treatment of STIs and HPV Different media such as
vaccination to reduce risks for cervical cancer. mass media;
Screening patients with NCDs for common mental health Management, follow up
Problems/disorders. and referral of mental

50
 Referral service for individuals screened for common NCDs. Health problems.
Provide follow-up care for patients with NCDs including
drug refills.

VI. Gender-Based Violence (GBV)

Service Objective: To ensure adolescents and youth have adequate access to
information on GBV, assessment, diagnosis, treatment, psycho-social and legal support,
and rehabilitation through follow-up counselling with all forms of gender-based
violence.

1. Violence
Violence includes emotional, social, or economic force, coercion or pressure, as well as
physical harm. It can be overt, in the form of a physical assault or harassment, deception
and other forms of psychological, emotional, or social pressure. It takes place within a
variety of settings, including at home, the workplace, schools, and the community. In
many cases, it begins in childhood, adolescence and young age.
Violence may be physical, sexual, economic, emotional, and psychological, occurring in
or outside the family, including sexual exploitation, sexual abuse, sexual harassment,
female genital mutilation, and other harmful traditional practices.

Incident Type of Violence: We need to use consistent words/definitions to enable

proper data collection, tracking of incident data, monitoring, and evaluation. The
following types of GBV are characterized as incident types:
Attempted Rape – An act of non-consensual sexual intercourse (the invasion of
any body part of the victim with a sexual organ, by force, or coercion)
Rape – Any such vaginal or anal penetration is considered rape; efforts to rape
someone which do not result in penetration are considered attempted rape.

Rape or attempted rape may include:

• Rape of adolescents and youth;
• Rape of a minor (male or female), including incest;
• Gang rape, if there is more than one assailant;
• Male rape, sometimes known as sodomy.

Sexual Abuse – refers to other non-consensual sexual acts, not including rape or
attempted rape. Sexual abuse includes acts performed on a minor – even if the child has
51
given consent, sexual activity with a minor is sexual abuse as she/he is considered unable
to give informed consent.

Sexual Exploitation – Sexual exploitation includes sexual coercion and manipulation

by a person in a position of power who uses that power to engage in sexual acts with a
person who does not have power. Examples include:
• Humanitarian worker requiring sex in exchange for assistance/privilege;
• A teacher requiring sex in exchange for grades or admission;
• A soldier or security worker requiring sex in exchange for safe passage;
• Workplace managers/supervisors asking for sex in exchange for some favour.

Trafficking for Sex or Labour – Trafficking, as defined by the International

Organization for Migration (IOM), occurs when “a migrant is illicitly engaged (recruited,
kidnapped, sold, etc.), or moved either within or across borders… Intermediaries during
any part of this process obtain economic or other profit using deception, coercion, and/or
other forms of exploitation under conditions that violate fundamental human rights of
migrants.”

Women and girls are at primary risk of trafficking for forced prostitution, and marriage.

Other Gender-based Violence – This includes physical, mental, emotional, or social

abuse directed against a person because of his/her gender role in a society or culture.

2. Management of Sexual Violence in Adolescents and

Youth at Workplaces
Health facilities that provide services for the management of sexual abuse, especially for
adolescents and youth girls, should create access to emergency contraception pills,
compressive abortion care (CAC), prophylaxis against STIs, and Post Exposure
Prophylaxis (PEP) for HIV along with psycho-social counselling, follow up and referral
tosocial and legal services.

Sexual Violence (Post-rape Care): the minimum package of post-rape care services
should always begin with an assessment of the client’s specific needs. The following
services must be in place at each service delivery point at workplaces:
• Provision of clinical services
• Rapid HIV testing, care, treatment, and referral to appropriate service
• Post-exposure prophylaxis (PEP) for HIV or service linkage – if within the first 72
52
 hours
• STI screening/testing and syndromic management
• Emergency contraception and counselling if a person reached in the first 120 hours

For both sexual violence and physical and/or emotional violence:

• Longer-term psycho-social support (for example: individual/group counselling),
• Legal counsel, police, child protection services, or referral

Methods of Service
Service Providers Types of Services
Delivery
Health care providers History taking and examination; Printed and electronic
and counsellors trained Testing for pregnancy, STI/HIV; IEC/SBCC materials,
inthe management of Treatment including first aid, TAT, Hepatitis B psychotherapy and
gender-based violence vaccination, ECP, PEP; physiotherapy,
(Medical Doctors, Health Psycho-social support counselling, documenting rehabilitation,
Officers, Nurses, evidence, and support to access legal service. physical injury
Midwives, Social Screen for mental illness, substance use disorders, treatment, follow up,
Workers, Psychiatry and refer to specialty facilities. and referral.
Nurses, etc...)

VII.COVID-19 and Other Epidemics at

Workplaces: Prevention, Control, and
Management

Service Objective: To ensure adolescents and youth have access to information and
service on the prevention and control of emerging epidemics including COVID-19.

Although the elderly and those with pre-existing health conditions are known to be the
most vulnerable, COVID-19 affects all segments of the population including adolescents
and youth who are also at risk of contracting and transmitting the coronavirus.

COVID-19 has become a pandemic due to widespread community transmission across

countries and communities. It is transmitted through droplets (coughing) and
unprotected close personal contact with an infected person (touching, shaking hands,
touching eyes, nose and mouth). Anyone with COVID-19, including adolescents and
youth, can become seriously ill or die at any age. The different control and prevention
measures should be seriously practiced at workplaces.

1. Activities to Engage into Control COVID-19 Pandemic

Principles to follow during the COVID-19 era at workplaces:
Protect the safety and well-being of adolescents and youth, and others at workplaces.
53
Interrupt the impact of the virus in the workplace by using protection mechanisms.

Maintain essential AYH services including COVID-19 prevention.

Shield adolescents and youth in workplaces from socioeconomic shocks.

MCC (Motivated, Compassionate, and Caring): avoid stigma and discrimination

that may arise from healthcare providers, other work colleagues, and the community.

To minimize the impact of COVID-19 and other epidemics at workplaces, implement the
following activities:

• Health Education – Educate the workforce at workplaces on COVID-19: Avoid

touching eyes, nose, and mouth with unwashed hands; Keep physical distance;
Maintain hand hygiene and throw used tissues and clothing in the bin or trash
can; Cover mouth and nose with a tissue or use the inside of a flexed arm when
sneezing or coughing; Practice a healthy lifestyle including adequate rest while
maintaining good nutrition with moderate amounts of vitamin C, D, and E.

• Physical Distancing – Avoid gatherings to ensure physical distancing at

workplaces.

• Hand Hygiene and Sanitization – Enhance hand hygiene in workplaces by

installing hand washing facilities with soap and water.

• Using Face Masks – Cover nose and mouth with a mask. Avail face masks.

• Open Facilities Full Time, and establish a proper queue control system.

• Vaccination – Vaccinate all adolescents and youth at workplaces.

2. Activities to Engage into Control Other Communicable

Diseases
• Reporting of increasing caseloads of malaria in different parts of the country, as
the rainy season continues.
• On-going response to other disease outbreaks like cholera and measles.
• Response to the consequences of floods.

54
Service
Types of Services Methods of Service Delivery
Providers
Trained Counsellor Information and counselling on prevention Printed and electronic IEC/SBCC
And All and control measures of COVID-19 and other Materials; PPE and hygiene and
Health outbreaks, screening, management, care, and sanitation practicing materials like
Professionals. support; soap and water, and washbasins; mini-
Vaccination, and referral for further care and media; and group counselling;
Treatment. Community education.

55
Section VI: Outreach Services

The primary purpose of community health outreach programs is to offer services to

educate residents on what resources are available to help them take control of their
health. Public health outreach programs can make a difference through education on,
and screening for, potential health concerns.

Mobile health outreach services help to close the divide between advantaged and
disadvantaged communities. These services can help to close the gap and improve the
quality of life in these areas.

Workplace site visits are provided by health workers, and sometimes by nearby Health
Offices. There is a need to make these services more regular and productive. The
outreach services could also be used as a mechanism for demand generation for
adolescent- and youth-friendly service delivery points. During outreach services,
working environments, status of workers, exposures to hazards and chemicals could be
assessed well, and interventions provided. The outreach service will also focus on
residences of the workers if they live in close proximity to their workplaces.

Periodic Health Education Activities and Co-curricular Activities

Health education and health promotion activities for adolescents and youth are to be
organized in industrial parks, mega-projects, and development corridors. The service
provider, in cooperation with these sectors, can conduct health education sessions on
health-related issues to increase awareness about adolescent and youth health issues and
availability of adolescent and youth health services.

Periodic Health Check-ups

In collaboration with the Industrial Park Development Corporation (IPDC) and other
relevant partners, periodic health check-ups can be organized for adolescents and youth
at workplaces.

56
Section VII: Corporate Social
Responsibility (CSR)
Corporate social responsibility (CSR) is fast becoming a benchmark in the business
world. Companies are not just expected to stimulate the economy and provide products
and services to the community — they are also expected to “do good” as well.

From environmentally sustainable and ethical labour practices to volunteering and

philanthropy, businesses of today need to show both the public and their employees that
they are positively contributing to society.

Trends in Corporate Social Responsibility – The ways companies give back to

society vary and often reflect the issues that matter most to their investors and
consumers. In the last few years, ethical practices and sustainability have risen to the
forefront of CSR. Globally, 72% of companies publicly report their CSR efforts. (23)

Hence, investment companies (workplaces) in Ethiopia need to provide such services

strictly following the four basic steps to CSR success:

• Understand Stakeholders – Who their customers are; who their staff are;
what is important to each of them; what social and environmental issues have
affected them; what issues they care about;
• Keep the Values of Their Customers in Mind – When making business
decisions, businesses need to consider possibilities to address a CSR issue that is
important to their stakeholders.
• Keep Up the Talk – They need to understand what issues matter to them most:
What can businesses do to give back to the community; what can they do better.
• Show Accountability – Businesses need to report their CSR initiatives — the
good or the bad.

57
Section VIII: Monitoring and Evaluation of the
Services

I. Performance Tracking Systems

Measuring performance against set targets in the YFS program is crucial to generating
essential information, tracking progress of the implementation, and achieving results.
Also, process monitoring will allow for corrective and preventive actions and also for
planning and coordination. Monitoring and evaluation of quality services will rely on
routine and periodic data sources, which will be collected for several categories and levels
of indicators. The indicators for monitoring and evaluation of a quality program are built
into the framework of four core sequential domains: Inputs/Processes, Outputs,
Outcomes, and Impact.

II. Integrated Supportive Supervision and

Program Monitoring
Supervision will be essential at and between various levels of the health system. Frequent
and regular joint supportive supervisions will be conducted to help identify problems
early on and take immediate remedial actions using integrated supervisory mechanisms
and checklists.

The MoH, through the AYH case team, will organize a bi-annual joint supportive
supervision in collaboration with the workplaces and Regional Health Bureau (RHBs). A
bi-annual progress review meeting to assess against targets the progress of YFS
implementation in workplaces will also be conducted among different stakeholders
including the MoH, IPDC and RHBs.

The meetings will, therefore, serve to assess SRH program outputs/outcomes as a key
accountability mechanism to assess implementation.

III. Review Meeting

Conducting regular review meetings in collaboration with RHBs, Zonal health
departments, Woreda health offices and health facilities at all levels. The MoH and
other federal sectors like IPDC are also included.

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IV. Performance Measurement Methods
1. Continuous (Routine) Data Collection
§ Health Management Information Systems (HMIS): HMIS and DHIS2
provide routine monthly information on AYH service utilization at workplaces.
§ Patient Records: provide more detailed information on YFS services provided.
§ Record Review: helps to assess quality of documentation and adherence to
standards of care.
§ Client Questionnaires: structured questionnaires can provide information
about client priorities for care, and experiences of care.
§ Client Interviews and Focus Group Discussions: help to gather and review
qualitative/quantitative information about clients’ priorities for care, experiences
of care, and future care-seeking intentions.
§ Observations: help to assess provider performance and adherence to standards
of care.

Reporting and recording

The reporting mechanism should follow the standard DHIS2 and HMIS reporting of the
Ministry of Health and regional health bureaus.

• Reporting and recording of services provided will be done Using the national standard
reporting format
• Reporting will be to the nearest catchment PHCU (with in the same Woreda)
• Supportive supervisions will be conducted using the check list of the nearest catchment
PHCU (with in the same Woreda)
• Supervisions shall be conducted jointly in an integrated manner. Supervision team will be
composed of experts from the nearest catchment PHCU (with in the same Woreda),
IPDC, the workplace (service provider/head of health facility)
• The workplace facility has to participate in Review meetings organized by the nearest
catchment PHCU (with in the same Woreda), zone and region

2. Population-based Health Surveys

The Ethiopian Demographic and Health Survey (EDHS) provide information on YFS
coverage, service-seeking behaviour, and patient self-reported practices and experiences
of care at workplaces.

3. Periodic Data Collection

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 • Client Exit Interviews: assess experience of care and user satisfaction.
• Provider Interviews: assess provider knowledge, self-reported practice and
training.
• Simulations of Care: assess provider competence and skills for discrete
tasks.

4. Planning and Reporting

There should be common planning for all health activities of adolescents and youth at
workplaces from both sides; that is from the workplaces and the respective government
bodies within the catchment of the workplace. Plans on activities should be aligned in
the same way as any other health SDP within the catchment. Joint planning, reporting,
supervision and capacity building trainings have to be in place.

Leadership, Integration and Coordination

Leadership:
Overall Leadership - The overall leadership and implementation of the program is to be held by
MOH

Human Resources
At the national level:
} The technical aspect will be led by the assigned Senior National SRH and AYH Advisor
who will coordinate the activities of regional focal persons, development partners,
donors, IPDC, and other sector organizations

At Regional level
} There will also be leadership and service Integration at the regional level who will in-turn
cascade the implementation to the lower levels

Integration
Integration at national level:
Ø The MCH directorate with the FP/AYH/SRH desk will coordinator the implementation at
federal level

Ø A senior advisor will be assigned to coordinate the activities of regions, donors, IPDC,
and other development partners
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 Ø IPDC, and other sector organizations and decision makers at the federal and regional
level

Integration at regional level

Ø Regional HB will coordinate the implementations of the program in their respective
regions
Ø Cascade the implementation and follow up to the lower administrative levels
Ø Report to the national level

Roles and responsibilities:

• MOH – implement the program and oversees the overall implementation of the program
at the National and Regional level
• The assigned National Advisor – follows the implementation of the program, conducts
RM, ISS, Mentoring, reporting, resource mobilization
• Regional HBs - follow the implementation of the program, conducts Review Meetings,
ISS, Mentoring, reporting, resource mobilization - oversees implementation at their
respective level
• IPDC – facilitate the implementation of the program in collaboration with sector
organizations and partners
• Implementing partners, donors, and other development partners – provide financial,
technical and other supports as required for the implementation of the program at all
levels

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Implementation Arrangement/Guide
The implementation arrangement for the MSP document requires joint collaborative
efforts with and by the workplace/industrial park, the health sector, partners, and the
engagement of young people as well. Therefore, there needs to materialize an
establishment of a coordinating body, working in collaboration with development and
implementing partners, determining the duties and responsibilities of different
stakeholders such as the MoH, IPDC, RHB, development partners, donors,
implementing partners, and other stakeholders.

Hence, once the document is finalized and launched for implementation, the following
activities need to be undertaken:
§ Dissemination – The document has to be disseminated to all relevant
government bodies, and other stakeholders working in the sector.

§ Assignment of Human Resources for Health (HRH) – The effective

implementation of the project requires highly qualified and experienced personnel to
be deployed at the national and regional levels including assignment of Senior National
Advisor

§ Joint planning exercise–need concerted efforts of stakeholders

§ MOU preparation –signed between MOH and IPDC, DP/IP

§ Technical teams – incorporating the MSP activities as part of the existing National
TWGs

§ Resource mobilization – Advocating for government at all levels to allocate adequate

finance,

§ Monitoring, Evaluation & Learning- Conducting regular follow up and scale up of

best practices

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Contributors
Dr. Eden Fisseha MoH, MAYCHN Directorate - AYH Case Team
Eyob Getachew MoH, MAYCHN Directorate - AYH Case Team
Haregewoin Tadesse MoH, MAYCHN Directorate - AYH Case Team
Teshome Worke MoH, MAYCHN Directorate - AYH Case Team
Dejene Deme MoH, MCAYHN Directorate - AYH Case Team
Bethlehem Bezabih CORHA
Dawit Girma UNFPA
Walle Tseganeh RHB, Amhara Regional State
Lelise Melkamu RHB, Oromia Regional State
Shenkora Fikre RHB, Sidama Regional State
Worknesh Kereta Pathfinder International, Ethiopia
Hiwot Girma AMREF Health, Africa
Alazar Tesfaye DSW
Engidu Tsegaye IPDC, AA
Metasebia Fekadu APDC, AA
Selam Addisu IPDC, Bole Lemi Industrial Park
Abinet Alemu Hawassa Town Health Office, Sidama Regional State
Muluwork Asres FGAE
Misikir Gebeyehu MSIE
Dr. Abebe Abadi D i r a r
(Consultant) MoH, MCAYHN Directorate - FP Case Team, Senior Advisor

63
References

1. Monitor the health status; WHO regional atlas on Adolescent and Youth 2017
2. ((The Ethiopian Mini-Demographic and Health Survey (M-DHS) 2016).
3. ((Industrial parks Development Corporation-IPDC website); (IPDC report December 2020); (MoFeC,
2017)); (UNDP 2016); (ILO, 2016))
4. (Dibaba, 2019; Jones et al.; 2019)
5. (The International Labour Organization (ILO))
6. (WHO healthy workplace framework and model, 2010)
7. World-meter Ethiopia Population (2021)
8. (Ethiopian National Labour Force Survey - 2013)
9. Key Issues affecting Youth in Ethiopia – OECD.ORG
10. WHO, 2012
11. Need Assessment for Sexual and Reproductive Health (SRH) in Horticultural and Industrial parks in
Ethiopia, DKT Ethiopia- JANURARY 2019
12. Pramila Krishnan, Eduard Krkoska, Koen Maaskant, Andualem Mengistu, Christian Meyer - 23 Oct
2020 ; Policy brief ETH-20119 | October 2020 International Growth centre
13. The Ethiopian Labour Proclamation No. 1156-2019 - October 3, 2019
14. (T Amdeselassie- August 2020); (Earuyan Solutions, 2019; WRC, 2018); (Blattman et al. – 2019)
15. NPC, 2015;
16. (Barret and Baumann-Pauly, 2019; Blattman et al., 2019; Gonsamo, 2019; Earuyan Solutions, 2019;
UNDP, 2018))
17. IDPC website; (IPDC report December 2020) (MoFeC, 2017)), (UNDP 2016); (ILO, 2016))
18. Need Assessment for Sexual and Reproductive Health (SRH) in Horticultural and Industrial parks in
Ethiopia, DKT Ethiopia- JANURARY 2019
19. (Agricultural Investment and Role of Commercial Farming in Benishangul Gumuz Region: Evidence
from Ethiopia Article • April 2019)
20. (Dibaba, 2019; Jones et al.; 2019).
21. ((ILO, 2017); (MSIE, 2016); (UNFPA, 2019))
22. (Gender analysis report in IPs, UNFPA 2019)
23. (https://ethiopiahealth.blogs.wm.edu/ethiopian-health-system/).
24. (https://media.springernature.com/full/springer- static/image/ art% 3A 10. 1186% 2Fs13690-017-
02219/Media Objects/13690_ 2017_ 221 _Fig1 _HTML.gif?as =webp)

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