Perception of public health midwives on adolescent and youth friendly health service: Sri Lankan experience

Introduction: One fourth of the Sri Lankan population consists of adolescents and youth. Public health midwife (PHM) is the grassroot level key health care provider in the field for adolescents. Objectives: To explore PHMs' perceptions on their role and the need of improving adolescent and youth friendly health services (AYFHS) in Sri Lanka Methods: Four focus group discussions (FGDs) were conducted among 38 PHMs in Gampaha District with 9-10 midwives for each discussion. Two experts conducted the FGDs ensuring privacy and confidentiality after obtaining informed verbal consent using FGD guide. Discussions were audio-recorded and non-verbal responses were noted down. Each session lasted 60-90 minutes. Recordings of FGDs were transcribed. Thematic analysis was conducted by coding and identifying categories and themes with constant comparison. Results were presented in a narrative form. Results: All PHMs identified the need for providing AYFHS in the field ensuring easy accessibility. However, opinion on their role on AYFHS was substandard. Domiciliary care provided by PHM was identified as a major strength. Perceived workload of PHM, inadequate training, lack of supportive supervision, insufficient facilities in centres, poor health seeking behaviours and lack of awareness on available services among adolescents were identified as challenges. Reducing of PHM workload, capacity building on AYFHS, centres with improved facilities, a better monitoring mechanism with supportive supervisions and inter-sectoral coordination were recommended. Conclusions & Recommendations: Interventions focused on supporting PHMs on AYFHS and strengthening quality AYFHS in the field with increased client demand were identified as priorities.