Are facility service delivery models meeting the sexual and reproductive health needs of adolescents in Sub-Saharan Africa? A qualitative evidence synthesis

Background. Adolescents in Sub-Saharan Africa (SSA) face signifcant health and social challenges related to sexual and reproductive health (SRH), including unwanted pregnancies, unsafe abortions, and sexually transmitted infections (STI). Barriers to information and services are compounded by lack of access to appropriate information, fear of being

judged, health provider attitudes and contextual factors such as culture, religion, poverty, and illiteracy. Facility-based service delivery models for adolescents ofer a structured environment and provide an opportunity to deliver such information and services. The review critically examined how well these models meet the SRH needs of adolescents in SSA.

Methods. A systematic search was conducted using five databases: Web of Science, MEDLINE, Scopus, PubMed, and Google Scholar. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to maintain transparency and completeness. Covidence software was used for screening and data

extraction, and NVIVO 12 PRO was used to manage the analysis. A narrative synthesis using Thomas and Harden’s thematic analysis was used to identify themes.

Results. The search yielded 14,415 articles, and 20 papers met the inclusion criteria and were included in this review. From the fndings, adolescents expressed the need for comprehensive SRH information, adolescent-friendly facili�ties, parental and male involvement, and respectful healthcare providers. Three facility-based adolescent-friendly SRH delivery models are used in SSA: Stand-alone clinics, Youth-friendly corners, and Integrated/mainstreamed models. Adolescent-friendly interventions, friendly staf, and accessibility were reported as facilitators to services meeting the needs of adolescents and promoting positive experiences. However, several barriers were identifed: negative

attitudes of health workers, fnancial constraints, transportation challenges, waiting time, intimidating environments, and lack of confdentiality pose a challenge to the efectiveness of the model.

Conclusion. Facility-based SRH service delivery models can improve access to information and services when com�plemented with community-based interventions, adolescent-friendly providers, and assurance of service accessibility. However, signifcant gaps, such as healthcare providers’ negative attitudes and behaviours, concerns about privacy