Adolescent mental, sexual and reproductive health and wellbeing policy, program and primary care implementation priorities in West Africa

青春期是身体、认知、社交、情感和性快速发展的时期。在全球范围内，青少年死亡的主要原因包括道路伤害、艾滋病毒、自杀、下呼吸道感染和人际暴力。最常见的残疾减寿(YLD)原因包括单相抑郁障碍、缺铁性贫血、哮喘、背部和颈部疼痛、焦虑症，以及在年龄较大的男性青少年中，酒精使用障碍。造成青少年发病率和死亡率的原因存在性别和区域差异，包括非洲地区，该地区的青少年伤残调整寿命年损失率最高。在全球范围内，青少年怀孕和分娩的人数正在下降，同时入学人数、避孕需求和初婚年龄也在增加。然而，在西非部分地区，考虑到早孕和分娩的医疗和社会风险以及并发症，发病率仍然高得令人无法接受。因此，除心理健康外，性健康和生殖健康是西非青少年健康和福祉干预措施的优先关注事项。我们的目标是产生证据，为改善西非青少年心理、性和生殖健康和福祉的国家和次区域一级的政策倡导、优先事项确定、执行(和取消执行)提供信息。我们的主要研究问题是：“西非国家的青少年福利政策和方案的优先事项是什么？为什么？在初级保健一级(分区/保健中心和社区)为青少年的健康和福祉提供了哪些心理、性和生殖健康服务；这些服务是否被证明是有效的；这些服务的供资机制是什么以及为什么；提供这些服务的可用资源的使用效率如何”。在这些问题的背景下，我们的研究目标是：(1)绘制和分析国家和次区域行为者及其想法、意识形态、利益和权力、优先事项和机构环境/背景以及与西非青少年健康和福祉政策和计划有关的决策；哪些政策和优先事项已付诸实施(或未付诸实施)，以及为什么。(2)分析分区和社区一级优先提供哪些服务的决策过程，并寻找和分配初级保健一级的可用资源，以向青少年提供健康和福祉服务(3)综合现有证据，证明正在实施的与青少年心理、性和生殖健康和福祉有关的政策优先事项和方案的有效性(或其他)，并产生证据，支持执行和取消执行(4)描述分配给分区和初级保健中心初级保健、心理、性和生殖服务提供的各个组成部分的资源数量。(5)评估现有初级保健中心在提供青少年心理、性和生殖健康服务方面的效力和技术效率。(6)分析解释初级保健中心在向青少年提供心理、性和生殖健康服务方面所观察到的技术效率的因素。我们的研究设计是在三个选定的国家进行的多国个案研究：加纳(讲英语)和尼日尔和布基纳法索(讲法语)。数据收集和分析将涉及与我们提出的问题相关的一系列公共卫生学科的定性和定量方法；特别是政策分析、卫生经济学、社会学和人类学。我们的研究结果将有助于就如何配置初级保健、精神、性和生殖健康服务以更好地满足西非青少年的需求提出建议。

Adolescence is a period marked by rapid physical, cognitive, social, emotional and sexual development. Globally, leading causes of death among adolescents include road injury, HIV, suicide, lower respiratory infections and interpersonal violence. The most common causes of years lost to disability (YLD) include unipolar depressive disorders, iron deficiency anemia, asthma, back and neck pain, anxiety disorders, and in older male adolescents, alcohol use disorders. There are gender and regional differences in the causes of morbidity and mortality in adolescents including in the African region which has the highest rates of disability-adjusted life years lost among adolescents. Globally adolescent pregnancy and childbirth is declining alongside increases in school participation, demand for contraception and age at first marriage. However, in parts of West Africa, rates remain unacceptably high, given the medical and social risks and complications of early pregnancy and childbirth. Therefore, apart from mental health; sexual and reproductive health is a priority concern for adolescent health and wellbeing interventions in West Africa. We aim to generate evidence to inform country and sub-regional level policy advocacy, priority setting, implementation (and de-implementation) for improved adolescent mental, sexual and reproductive health and wellbeing in West Africa. Our principal research question is: "what and why are adolescent wellbeing policy and program priorities in countries in West Africa, what mental, sexual and reproductive health services are available at primary health care level (sub-district /health centers and community) for adolescent health and wellbeing; are they proven effective, what and why are the mechanisms by which these services are funded and how efficiently are available resources used to deliver these services". In the context of these question our research objectives are to: (1) Map and analyze country and sub-regional actors and their ideas, ideology, interests and power, priorities and institutional environment /contexts and decision making in relation to adolescent health and wellbeing policies and programs in West Africa; which policies and priorities are moved into implementation (or not) and why. (2) Analyze sub-district and community level decision making processes of prioritizing which services to deliver and finding and allocating available resources at primary care level to provide adolescents health and wellbeing services (3) Synthesize the existing evidence on the proven effectiveness (or otherwise) of policy priorities and programs related to mental, sexual and reproductive adolescent health and wellbeing being implemented and generate evidence to support implementation and de-implementation (4) Describe the amounts of resources allocated to the various components of primary care mental, sexual and reproductive service provision for adolescent health and wellbeing at sub-district and primary health centers. (5) Assess the effectiveness, and technical efficiencies of available primary health centers in providing adolescents' mental, sexual and reproductive health services. (6) Analyze the factors that explain the technical efficiencies observed in primary health centers in providing Adolescents mental, sexual and reproductive health services. Our study design is a multi-country case study in three selected countries: Ghana (Anglophone) and Niger and Burkina Faso (Francophone). Data collection and analysis will involve qualitative and quantitative methods across a mix of public health disciplines relevant to the questions we are asking; specifically policy analysis, health economics, sociology and anthropology. Our findings will help to inform recommendations as to how primary care mental, sexual and reproductive health services can be configured to better respond to the needs of adolescents' in West Africa.