were within the location. During the focus group discussion one research assistant facilitated discussions while the other took notes and recorded the general consensus of the discussion on provided paper. Parental consent was obtained for the interviews of adolescents and the focus groups. The rationale for the study was explained and the seeking of permission to participate were done verbally and parents agreed and supported the idea of soliciting adolescents’ views about health service delivery for the adolescents. The nurse that accompanied research assistants had focus group discussions with 5 to 10 parents at the village level. The village leaders had already been informed that people from the Ministry of Education and Social Welfare would come to the village and discuss some health issues with his/her subjects. Therefore, there were more than 10 people at the chief’s place waiting for Ministry of Health and Social Welfare, it was explained that the study needed only 5 to 10 participants and people simply complied. The discussion was also held at the chief’s place in the open but again like with adolescents it was only participants who were allowed to be at the place of focus group discussions. Three were vehicles were hired and used for this study and three teams were formed where each team was assigned 2 districts. Each team was made up of two research assistants accompanied by one experienced nurse in issues of adolescents. The consultant accompanied a team that went to Mafeteng and Maseru districts. All teams had an introduction letter from the Ministry of Health and Social Welfare which explained that the study was authorised by the Ministry of Health and Social Welfare. The respondents were assured of confidentiality and it was clearly indicated that they were free to participate in the study. Data Analysis Data collected were in two forms namely simple descriptive of the scenarios as stated by the various responses from the questions. In this case the analysis simple reported information as sated by various respondents. The general observation made about the state of the art in
Policies and Procedures are in Place that Guarantee Client Confidentiality Facility managers and health care providers reported in almost one voice and said there were policies or procedures in place that guaranteed the confidentiality of adolescent clients in their facilities. When asked to mention what the policies said the following responses were common: the oath of the nurse is that she/he shall not disclose information about client health problems rather than for the purpose of assisting the client to get a better health; they had guidelines that guarantee confidentiality regarding clients health issues; patients rights charter; it is the facility policy that no member of staff shall disclose patient information without a reason and permission of the authority; every patient has a right to confidentiality and privacy; posters showing rights of clients; HIV and AIDS manual; declaration and dedication of confidentiality were signed by all members of the staff; it is general code of conduct among all members of our staff; reproductive health policy; clients rights policy and sexual reproductive rights. The above responses showed that respondents did not exactly know what the policies said, but rather mentioned the names of various policies and declaration charters related to confidentiality. This showed that in order to improve confidentiality and confidence of clients in health services providers and facility managers, there should be a serious effort to educate the health personnel about the contents of various policies and declarations that they seem to know by names only. When asked if there were specific action/procedures to protect the confidentiality and how they were applied the facility managers mentioned the following issues: reference was made to confidential procedures all the time; consultative meetings were held with staff where an appeal was always made to members of the staff to ensure confidentiality of the clients; frequent reminders of the staff about how critical it was to keep clients health issues confidential; all our staff were frequently exposed to in-service training and the emphasis was on observing confidentiality about clients health issues; finally a serious effort was made to ensure that clients were consulted on individual and private environment. All service providers reported that there were circumstances where they would not observe the policies of health facility confidentiality, for example, if an adolescent was pregnant one of the critical issues would be to call a parent in order to council both. Secondly if an adolescent needed a special service and in the judgement of the provider that adolescent needed parental concession the confidential code would be violated.
Respondents who reported that they were given reasons for referral raised the following issues: 3 said they needed X ray and it was not available within the health-facility; 5 said the medication needed was found at a place of referral and 6 said the services needed were at the major health facility (hospital); 6 said the service health provider was also sick and unable to function. Most of the adolescents who were referred said that they were told where and when to go as 25 (73%) reported so and only 9 (26%) said they were not informed about where and when to go. The point of Health Service Delivery has an Appealing and Clean Environment When asked if they found the health facility a welcoming place, the general picture was positive as 89 (78%) indicated that surroundings were clean and welcoming while 25 (22%) felt the surroundings were relatively poor; 98 (86%) said the receptionist area was clean 16 (14%) said it was not clean; 87 (76%) reported that the waiting room was clean and welcoming 27 (24% were not sure about the status of the waiting room and the toilets were also reported as clean by 68 (60%) while 46 (40%) felt that the toilets were not clean and all respondents said the consultation rooms were welcoming. The point of Health Service Delivery Provides Information and Education through a Variety of Channels Adolescents were asked if they saw information/educational materials on topics of interest to them during their visit to the health facility. The results showed that 86 (80%) saw the pictures while 21 (20%) reported that they did not see any pictures in the facilities that they visited and 7 were missing. Adolescents who had seen the pictures were asked if the materials were useful. The results showed that 88 (95%) felt that the materials were useful, 5 (5%) said materials were not useful. When asked if the materials were easy to read, 88 (95%) said yes and 5 (5%) said they were not easy to read. The materials were also interesting for adolescents to read as 88 (95%) said they were interesting to read and only 12 (13%) felt that they were not interesting to read. The information/education materials at the health facility were highly appreciated by most adolescents. They were as good sources of learning for adolescents who visit the health facilities. It could be encouraged that all facilities display such materials for adolescents to view and read when they visit the health facilities.