Evaluating the implementation fidelity of national standards for adolescent- and youth-friendly sexual and reproductive health services in Tanzania: a descriptive cross-sectional survey.

Background: Adolescents and youth require age-appropriate, comprehensive sexuality education and health services to support healthy growth and development. This study evaluated the coverage and fidelity of implementation of the National Standards for Adolescent- and youth-friendly Sexual and Reproductive Health (SRH) Services across types of health facilities in Tanzania.

Methods: A descriptive cross-sectional study was conducted from November,1st - 30th, 2022, in eleven purposely selected health facilities across three Tanzanian regions: Dar es Salaam, Dodoma, and Kigoma. Facilities were stratified by ownership (government versus faith-based) and type (Dispensary, Health Center, Hospital). Data were collected using an observation checklist adapted from the Tanzanian Ministry of Health and analyzed with an International Business Machine (IBM^®) Statistical Package for Social Sciences (SPSS™) version 26, and the findings are presented in frequencies (n) and percentages (%).

Results: Of the 11 health facilities assessed, 9(82%) were government-owned and 2(18%) fatith-based; 3(27%) were Dispensaries, 55% (n = 6) Health Centers and 18% (n = 2) Hospitals. Findings revealed that all facilities (100%) offered adolescent- and youth-friendly SRH services. However, the average implementation fidelity of the National Standards of SRH services was 65%, of which none achieved full compliance with the National Standards. Health centers, including Tandale health center (73%), Kigogo health center (71%), Ujiji health center (67%), Baptist Council Designated Hospital, and Magomeni (60%) health center had the highest coverage and fidelity implementation of the adolescent-and youth-friendly SRH national standards, while Murufiti dispensary was the lowest (43%). Nevertheless, government-owned facilities achieved the highest coverage and fidelity in implementing adolescent- and youth-friendly SRH services compared to faith-based facilities.

Conclusion: The study revealed suboptimal coverage and incomplete implementation fidelity of National Standards for adolescent- and youth-friendly SRH services in Tanzanian health facilities. Enhancing infrastructures, strengthening healthcare worker capacity, and improving access to SRH education and associated services are critical to advancing the quality and reach of these services across the country.