Abstract

Observation of 418 consultations with clients 12-24 years of age at 38 health facilities throughout Zimbabwe and interviews with these clients and their 127 service providers suggested that young clients often face a lack of privacy, inadequate provider attention, and a narrow focus on reproductive health. Although providers had an average of 9 years of family planning experience, only 6% had received training on counseling young clients in the past year. 56% of consultations observed were for family planning, 20% were for antenatal care, and 18% were for HIV testing or treatment of a sexually transmitted disease (STD). Observers noted that 23% of sessions could be heard by other clients and 36% were interrupted by another staff member. Only 34% of clients were informed the session was confidential. Most providers thought parents should be notified if a young client was pregnant (89%), HIV-positive (74%), or engaged in sexual intercourse at "too young an age" (73%). Only 28% thought those under 16 years old--the legal age of consent--should be provided with contraception. Providers rarely addressed concerns such as physical and emotional changes of adolescence, alcohol and drug use, and family problems. Clients 12-16 years old seemed particularly shy and anxious in counseling sessions. Overall, 69% of clients simply responded to the provider's questions and with as few words as possible; 40% acknowledged they did not bring up pressing concerns and 22% stated they wished they had had more time to talk during the session. The reluctance of young clients (especially those 12-16 years old) to ask questions and raise concerns may limit the guidance they receive from reproductive health programs. Some of the obstacles identified in this study could be overcome by providing young clients with health services in a multipurpose youth center setting.

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• Quality of counselling of young clients in Zimbabwe