Youth Friendly Services? Using simulated clients to evaluate sexual health services in urban South Africa

Few studies have evaluated whether youth-friendly health services improve young people’s experiences of using services, and none in South Africa have done so since the Department of Health took over management of the Youth Friendly Services program. This study investigated whether clinics providing Youth Friendly Services in Soweto, South Africa delivered a more positive experience to young people requesting advice on condom reliability or contraceptive methods than those not providing this program, using a simulated client method. 15 randomly selected primary healthcare clinics each received 3-4 simulated client visits. After each visit semi-structured debrief interviews were conducted with simulated clients. Multi-level linear regression was used to investigate associations between Youth Friendly Services provision and visit outcomes. Framework analysis of qualitative data was conducted. There was no evidence that clinics providing Youth Friendly Services delivered a more positive experience (difference in mean clinic visit score -0.18, 95% CI: -0.95, 0.60, p=0.656) than those not providing this program. More positive experiences were categorised by positive healthcare worker behaviour and less positive experiences by unnecessary protocols, negative attitudes to information seeking and lack of information or of privacy.