Unesco Health Facility Assessment O3 Zambia Report

Protecting data confidentiality
We have put up steps to protect the information we will get from you. Firstly, only members of the study team will be able to
see the information. Secondly, we will not put names on any information collected from you. Instead, we will use numbers for
identification. Thirdly, we will destroy all tapes within 5 years after typing the information. Soft copy data will be stored on a
password protected computer in a locked office for a minimum of 5 years.

How will confidentiality and anonymity be ensured for the study?
What you will write or tell us is confidential and only the researchers would be able to have access to the information you
will provide. You will not be identified by name in any research data or any reports to come out of the research. No individual
information will be reported on. Any data will be reported in an aggregate way. Information will remain as confidential as the
law allows.

What happens if you do not want to participate or decide to leave the interview early?
You are free to decide whether you want to take part in this study, and you are free to leave at any point during the interview.
You are also free not to answer any questions that you are not comfortable with, and this will not bring any problem to you. If
you wish to withdraw, data will be deleted at your request.

Thank you for taking time to read the information sheet.
Your willingness to participate in this study is greatly appreciated.
Who to call for questions or problems?

You can call the Lead consultant or assistant Lead consultant.

If you have any matter which you feel is not adequately explained in this leaflet, do not hesitate to phone the principal
investigators, Dr. Choolwe Jacobs

Dr. Jacobs Choolwe
University of Zambia School of Public health,
Department of research and epidemiology
P.O. Box 50110, Lusaka
Phone: 0975977164

You can also call or contact the University of Zambia, Biomedical Research Ethics Committee (UNZABREC) office of the School
of Medicine, University of Zambia, if there are questions about your rights. You can contact the UNZABREC if you have not been
treated fairly or if you have other concerns. The UNZABREC contact information is:

The Chairperson
Biomedical Research Ethics Committee
School of Medicine
P.O. BOX 50110, Lusaka
Telephone No: 211256067

CONSENT TO PARTICIPATE

I have been fully informed of the purpose of the study. The benefits, discomforts, risks and confidentiality and I agree to
participate willingly. I further understand that if I take part in this study, I can withdraw at any time without having to give an
explanation. Taking part in this study is purely voluntary.

The opportunity to ask questions about the research was given and I have been answered to my satisfaction.
I therefore agree to participate in this study.

I…………………………………… (Names) hereby called the respondent understands the guidelines of this study and I agree
to take part in the study.

Signed/thumb …………………………………………. Date …………………. (Participant)

Signed/thumb print …………………………………………. Date …………………. (Witness)

You will be given a copy of this information to keep for your records.

THANK YOU

49

Annex 4

Qualitative Tools

Adolescents and Young People Discussion Guide
(1 Male IDI, 1 Female IDI, 1 male FGD, 1 female FGD per Institution)

Dear Participant,

Thank you for agreeing to have a discussion with me. My name is --------------- and I work for the University of Zambia, which
has been contracted by a UN agency called UNESCO to Health Facility Assessments across 10 higher and tertiary education
institutions (HTEIs) in Zambia. The purpose of this assessment is to establish existing policies and guidelines, the types of
services offered, the quality of the services being offered and establish whether these are in line with existing guidelines and
standards and to explore the perceptions of young people on the health services provided, perceptions of health providers
on health service delivery for young people in HTEIs. You have been selected to participate in this assessment because you
are a young person that should benefit from the services offered to young people in higher education health facilities. This
information will help to provide the situation for the analysis of other findings in the assessment.

Your positive response is highly appreciated. Do you agree to take part in this discussion?

(To be said at the start of each interview - My name is... I am here at... conducting and interview/discussion with...the date is ...
and the time is....)

Interviewer Name:
Location/institution:
Designation:
Date of interview:
Time of interview:

Introduction

1. What is your program?
2. How long have you been studying here?
3. How old are you?

Awareness and knowledge of services

1. Where do you access health services at this institution?
2. What services for young people are you aware about in at the health facility in this institution?
3. Who tells you about the available services?
4. Who would you like to tell you about these services?

Services Offered

5. Tell me about the health information you have received at the health facility? PROBE
a. Contraception (counselling, Emergency contraception, Oral contraception, Condoms, Injectable contraception, implant)
b. Safe motherhood (Pregnancy testing, ANC, SBA, PNC)
c. HIV/STIs (pre-exposure prophylaxis, post exposure prophylaxis, HIV testing, STI and TB screening, ART, and adherence
treatment)
d. Cancer screening (Breast and cervical cancer screening)
e. Abortion and post abortion care (counselling, treatment, induced medical abortion)
f. Sexual gender-based violence (Screening and management)
g. Mental Health (stress counselling and suicide risk screening)
h. Chronic health conditions (screening and treatment)
i. Alcohol, tobacco, and drug use (screening and counselling)
j. COVID 10 (Screening, testing, and counselling)
k. Sex and sexuality counselling

50

6. What services are offered to young people within the health facility at this institution? PROBE
a. Contraception (counselling, Emergency contraception, Oral contraception, Condoms, Injectable contraception, implant)
b. Safe motherhood (Pregnancy testing, ANC, SBA, PNC)
c. HIV/STIs (pre-exposure prophylaxis, post exposure prophylaxis, HIV testing, STI and TB screening, ART, and adherence
treatment)
d. Cancer screening (Breast and cervical cancer screening)
e. Abortion and post abortion care (counselling, treatment, induced medical abortion)
f. Sexual gender-based violence (Screening and management)
g. Mental Health (stress counselling and suicide risk screening)
h. Chronic health conditions (screening and treatment)
i. Alcohol, tobacco, and drug use (screening and counselling)
j. COVID 10 (Screening, testing, and counselling)
k. Sex and sexuality counselling

7. Which services have you accessed within the health facility at this institution? PROBE
8. Have you tried to access a service that is not offered/ not available? (For FGD, ask each participant)
9. Were you told you were not allowed to receive a particular service? (For FGD, ask each participant) PROBE which service.

Perceptions about the services

10. What are your thoughts about the health services provided in the health facility? PROBE
a. Infrastructure/space, health care providers, services, supplies, equipment

11. What do some young people say about the health services provided to young people in the health facility?

12. What are some of the factors that make it easier for you or other young people to access health services? PROBE
a. Infrastructure, space, health care providers, supplies, equipment
b. Tell me more about that [enablers]

13. What are some of the factors that prevent or make it hard for young people to access to health services at the health facilities
in this institution? PROBE
a. Infrastructure, space, health care providers, supplies, equipment
b. Tell me more about that [hindrance]

14. What can you say about the quality of these services?
a. Are the youths involved in providing these services to other young people?
b. Are there other places that provide high quality health services? Where? What are they like?

Recommendations

15. How can the health facilities be improved/strengthened to ensure effective health service provision to young people?

16. What resources or capacities are required i.e.?
a. Equipment?
b. Human resources?
c. Training?

17. Do you have any question or comment?

THANK YOU FOR YOUR TIME

Adolescents and Young People Discussion Guide

51

(Key Populations- 1 IDI-living with disability, 1 IDI-living with HIV, 1 IDI-LGBTIQ at each health facility)

Dear Participant,

Thank you for agreeing to have a discussion with me. My name is --------------- and I work for the University of Zambia, which
has been contracted by a UN agency called UNESCO to conduct Health Facility Assessments across 10 higher and tertiary
education institutions (HTEIs) in Zambia. The purpose of this assessment is to establish existing policies and guidelines, the types
of services offered, the quality of the services being offered and establish whether these are in line with existing guidelines and
standards and to explore the perceptions of young people on the health services provided, perceptions of health providers
on health service delivery for young people in HTEIs. You have been selected to participate in this assessment because you
are a young person that should benefit from the services offered to young people in higher education health facilities. This
information will help to provide the situation for the analysis of other findings in the assessment.

Your positive response is highly appreciated. Do you agree to take part in this discussion?

(To be said at the start of each interview - My name is... I am here at... conducting and interview/discussion with...the date is ...
and the time is....)

Interviewer Name:
Location/institution:
Designation:
Date of interview:
Time of interview:

Introduction

4. What is your program?
5. How long have you been studying here?
6. How old are you?

Awareness and knowledge of services

18. Where do you access health services at this institution?
19. What services for young people are you aware about in at the health facility in this institution?
20. Who tells you about the available services?
21. Who would you like to tell you about these services?

Services Offered

22. Tell me about the health information you have received at the health facility? PROBE
a. Contraception (counselling, Emergency contraception, Oral contraception, Condoms, Injectable contraception, implant)
b. Safe motherhood (Pregnancy testing, ANC, SBA, PNC)
c. HIV/STIs (pre-exposure prophylaxis, post exposure prophylaxis, HIV testing, STI and TB screening, ART, and adherence
treatment)
d. Cancer screening (Breast and cervical cancer screening)
e. Abortion and post abortion care (counselling, treatment, induced medical abortion)
f. Sexual gender-based violence (Screening and management)
g. Mental Health (stress counselling and suicide risk screening)
h. Chronic health conditions (screening and treatment)
i. Alcohol, tobacco, and drug use (screening and counselling)
j. COVID 10 (Screening, testing, and counselling)
k. Sex and sexuality counselling

52

23. What services are offered to young people [living with disability/living with HIV/LGBTIQ] within the health facility at this
institution? PROBE
a. Contraception (counselling, Emergency contraception, Oral contraception, Condoms, Injectable contraception, implant)
b. Safe motherhood (Pregnancy testing, ANC, SBA, PNC)
c. HIV/STIs (pre-exposure prophylaxis, post exposure prophylaxis, HIV testing, STI and TB screening, ART, and adherence
treatment)
d. Cancer screening (Breast and cervical cancer screening)
e. Abortion and post abortion care (counselling, treatment, induced medical abortion)
f. Sexual gender-based violence (screening and management)
g. Mental Health (stress counselling and suicide risk screening)
h. Chronic health conditions (screening and treatment)
i. Alcohol, tobacco, and drug use (screening and counselling)
j. COVID 10 (Screening, testing, and counselling)
k. Sex and sexuality counselling

24. Which services have you accessed within the health facility at this institution? PROBE

25. Have you tried to access a service that is not offered/ not available?

26. Were you told you were not allowed to receive a particular service? PROBE which service and why?

Perceptions about the services

27. What are your thoughts about the health services provided to young people [living with disability/living with HIV/LGBTIQ] in
the health facility?

28. What do some young people [living with disability/living with HIV/LGBTIQ] say about the health services provided to young
people in the health facility?

29. What are some of the factors that make it easier for you to access health services? PROBE
a. Infrastructure, space, health care providers, supplies, equipment
b. Tell me more about that [enablers]

30. What are some of the factors that prevent or make it hard for you and other young people like you [living with disability/
living with HIV/LGBTIQ] to access to health services at the health facilities in this institution? PROBE
a. Infrastructure, space, health care providers, supplies, equipment
b. Tell me more about that [hindrance]

31. What can you say about the quality of these services?
a. Are the youths involved in providing these services to other young people?
b. Are there other places that provide high quality health services? Where? What are they like?

Recommendations

32. How can the health facilities be improved/strengthened to ensure effective health service provision to young people like
yourself?

33. What resources or capacities are required i.e.?
a. Equipment?
b. Human resources?
c. Training?

34. Do you have any question or comment?

THANK YOU FOR YOUR TIME 

Health Care Providers Interview Guide

53

(1 IDI- Health Facility In-charges, 1 IDIs- Health Care Providers of Youth-Friendly Services at each health facility)

Dear Participant,

Thank you for agreeing to have a discussion with me. My name is --------------- and I work for the University of Zambia, which
has been contracted by a UN agency called UNESCO to conduct Health Facility Assessments across 10 higher and tertiary
education institutions (HTEIs) in Zambia. The purpose of this assessment is to establish existing policies and guidelines, the types
of services offered, the quality of the services being offered and establish whether these are in line with existing guidelines and
standards and to explore the perceptions of young people on the health services provided, perceptions of health providers
on health service delivery for young people in HTEIs. You have been selected to participate in this assessment because you are
contributing to the improvement of services offered to young people in higher education health facilities. This information will
help to provide the situation for the analysis of other findings in the assessment.

Your positive response is highly appreciated. Do you agree to take part in this discussion?

(To be said at the start of each interview - My name is... I am here at... conducting and interview/discussion with...the date is ...
and the time is....)

Interviewer Name:
Location/institution:
Designation:
Date of interview:
Time of interview:

Introduction

1. What is your current role?
2. How long have you been in this position?
3. What is your professional qualification?
4. How old are you?

Guidelines

5. What are the existing guidelines you use to provide services to Adolescents and Young People?
6. Do these policies align with WHO/ international/regional standards?
7. What is unique about providing services in tertiary institution-based health facilities?
8. Are these guidelines sufficient?

Administration of health facilities in HETIs

9. Which Ministry is responsible for the administration of this health facility?
10. Is there clear ownership and linkages of the health facility with district, provincial and national level Ministry of Health?
11. What are the major sources of funding for the health facility?

Services Offered

12. Tell me about the health information you provide at the health facility? PROBE
a. Contraception (counselling, Emergency contraception, Oral contraception, Condoms, Injectable contraception, implant)
b. Safe motherhood (Pregnancy testing, ANC, SBA, PNC)
c. HIV/STIs (pre-exposure prophylaxis, post exposure prophylaxis, HIV testing, STI and TB screening, ART, and adherence
treatment)
d. Cancer screening (Breast and cervical cancer screening)
e. Abortion and post abortion care (counselling, treatment, induced medical abortion)
f. Sexual gender-based violence (Screening and management)
g. Mental Health (stress counselling and suicide risk screening)
h. Chronic health conditions (screening and treatment)
i. Alcohol, tobacco, and drug use (screening and counselling)
j. COVID 10 (Screening, testing, and counselling)
k. Sex and sexuality counselling

54

13. What services do you provide to young people [including those living with disability/living with HIV/LGBTIQ] within the
health facility at this institution? PROBE
a. Contraception (counselling, Emergency contraception, Oral contraception, Condoms, Injectable contraception, implant)
b. Safe motherhood (Pregnancy testing, ANC, SBA, PNC)
c. HIV/STIs (pre-exposure prophylaxis, post exposure prophylaxis, HIV testing, STI and TB screening, ART, and adherence
treatment)
d. Cancer screening (Breast and cervical cancer screening)
e. Abortion and post abortion care (counselling, treatment, induced medical abortion)
f. Sexual gender-based violence (Screening and management)
g. Mental Health (stress counselling and suicide risk screening)
h. Chronic health conditions (screening and treatment)
i. Alcohol, tobacco, and drug use (screening and counselling)
j. COVID 10 (Screening, testing, and counselling)
k. Sex and sexuality counselling

14. Are there any particular services you are not able to provide to young people PROBE which ones and why?

Perceptions about the services

15. What are your thoughts about the health services you provide to young people in the health facility?

16. Are there specific health services provided to young people living with disability/living with HIV/LGBTIQ [PROBE for each of
these]?

17. What are some of the factors that make it easier for you to provide health services to young people? PROBE
a. Infrastructure, space, health care providers, supplies, equipment
b. Tell me more about that [enablers]

18. Now tell me about the factors make it easier for you to provide services to special young people living with disability/living
with HIV/LGBTIQ at the health facilities in this institution? PROBE for each of the key population
a. Infrastructure, space, health care providers, supplies, equipment
b. Tell me more about that [hindrance]

19. What are some of the factors that prevent or make it hard for you to provide services to young people at the health facilities
in this institution? PROBE
a. Infrastructure, space, health care providers, supplies, equipment
b. Tell me more about that [hindrance]

20. Now tell me about the factors that prevent or make it hard for you to provide services to special young people living with
disability/living with HIV/LGBTIQ at the health facilities in this institution? PROBE for each of the key population
a. Infrastructure, space, health care providers, supplies, equipment
b. Tell me more about that [hindrance]

Recommendations

21. How can the health facilities be improved/strengthened to ensure effective health service provision to young people like
yourself?

22. What resources or capacities are required i.e.?
a. Equipment?
b. Human resources?
c. Training?

23. Do you have any question or comment?

THANK YOU FOR YOUR TIME
 
Key Stakeholders Interview Guide

55

(Key Stakeholders- Ministry of Health- 2 IDIs- Headquarters, 3 IDI- Provincial, 3 IDI- District; 2 IDI- MHTEI, 2 IDI-HPCZ)

Dear Participant,

Thank you for agreeing to have a discussion with me. My name is --------------- and I work for the University of Zambia, which has been
contracted by a UN agency called UNESCO to conduct Health Facility Assessments across 10 higher and tertiary education institutions
(HTEIs) in Zambia. The purpose of this assessment is to establish existing policies and guidelines, the types of services offered, the
quality of the services being offered and establish whether these are in line with existing guidelines and standards and to explore the
perceptions of young people on the health services provided, perceptions of health providers on health service delivery for young
people in HTEIs. You have been selected to participate in this assessment because you are contributing to the improvement of services
offered to young people in higher education health facilities. This information will help to provide the situation for the analysis of other
findings in the assessment.

Your positive response is highly appreciated. Do you agree to take part in this discussion?

(To be said at the start of each interview - My name is... I am here at... conducting and interview/discussion with...the date is ... and
the time is....)

Interviewer Name:
Location and Interview Name:
Designation:
Date of review:
Time of review:

Introduction

7. What is your role?
8. How long have you been in this position?
9. What is your educational qualification?
10. How old are you?

Guidelines

35. What are the existing guidelines you use to provide services to Adolescents and Young People?
36. Do these policies align with WHO/ international/regional standards?
37. What is unique about providing services in tertiary institution-based health facilities?
38. Are these guidelines sufficient?

Administration of health facilities in HETIs

39. Are there any guidelines or minimum standards for infrastructure of health facilities in tertiary institutions?
40. Which Ministry is responsible for the administration of these facilities in HTEIs?
41. Is there clear ownership and linkages of the health facilities in HTEIs with district, provincial and national level Ministry of Health?
42. What are the major sources of funding for the health facilities in HTEIs?

Services offered

43. What types of services are offered in tertiary institution-based health facilities?
44. What type of services cannot be offered?
45. What can you say about the quality of these services?
46. Do the health facilities have the required resources to provide services? Are there any gaps- financial resources, human resources,

and infrastructure?

Recommendations

47. How can the health facilities be improved/strengthened to ensure effective health service provision to young people?

48. What resources or capacities are required i.e.?
a. Equipment?
b. Human resources?
c. Training?

49. Do you any comments or questions to make?

THANK YOU SO MUCH FOR YOUR TIME

56

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