Abstract
BACKGROUND: In Ethiopia, adolescents and youth continue to experience a high burden of morbidity and mortality related to reproductive health problems. However, the implementation of the adolescents and youth health program in Woliso Town has not yet been evaluated. Therefore, this study aimed to evaluate the process of the program implementation in the primary healthcare facilities of Woliso Town, Oromia Regional State, Ethiopia. METHODS: A convergent parallel case study design with a formative evaluation approach was employed from May 21 to June 20, 2023. The evaluation focused on three key dimensions: the availability of required resources, the compliance of healthcare providers with recommended practices, and the satisfaction of service users - measured using a total of 30 indicators. Data were collected from 411 adolescents and youth through exit interviews. Additionally, direct observations of service delivery, resource inventory, and key informant interviews were conducted. Quantitative data were analyzed using descriptive statistics and multivariable linear regression methods. A p-value of < 0.05 and a 95% Confidence Interval (CI) were used to determine statistically significant factors associated with adolescents' and youth's satisfactions. Qualitative data were transcribed in the language of the interview, translated into English, coded, and analyzed thematically. The overall process of the program implementation was evaluated based on predetermined judgment criteria. RESULTS: The overall process of adolescents and youth health program implementation was 69.6%, with contributions from resource availability (81.1%), healthcare providers' compliance with the guidelines (51.3%), and adolescent and youth satisfaction (75.7%). Factors associated with adolescents and youth satisfaction were being served at a youth center (β = 0.084, 95% CI: 0.049, 0.119); having previous experience with adolescents and youth health services (β = 0.031, 95% CI: 0.004, 0.058); getting the needed service free of charge (β = 0.060, 95% CI: 0.029, 0.090); and obtaining all the services they demanded (β = 0.099, 95% CI: 0.065, 0.132). CONCLUSION: The overall process of adolescents and youth health program implementation was evaluated to be fair. Healthcare providers demonstrated low compliance with the adolescents and youth health service guidelines. To improve the process of adolescents and youth health program implementation and enhance the satisfaction of service adolescents and youth, it is recommended that the concerned stakeholders and health facility managers need to explore alternative financing mechanisms to ensure these services are provided either free of charge or at reasonable prices considering the income level of the adolescents and youth. Furthermore, strengthening healthcare providers' adherence to the national guidelines, and ensuring the availability of all essential services across health facilities are of paramount importance to improve adolescents and youth satisfaction, thereby increase service utilization. LIMITATIONS: The role of chance, information bias, and social desirability bias is likely, as adolescents and youth were interviewed within the health facility compound, which might have led to an overestimation of the findings.