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

青春期是一个身体、认知、社会、情感和性发展迅速的时期。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。失能年数（YLD）最常见的原因包括单相抑郁症、缺铁性贫血、哮喘、背部和颈部疼痛、焦虑症，以及年龄较大的男性青少年的酒精使用障碍。青少年发病和死亡的原因存在性别和区域差异，包括非洲区域，该区域青少年残疾调整寿命年损失率最高。在全球范围内，少女怀孕和生育率正在下降，同时入学率、避孕需求和初婚年龄也在增加。然而，在西非部分地区，由于早孕和分娩的医疗和社会风险及并发症，这一比率仍然高得令人无法接受。因此，除了心理健康外，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切。我们的目标是提供证据，为国家和次区域一级的政策宣传、优先事项的确定、执行（和取消执行）提供信息，以改善西非青少年的心理、性和生殖健康和福祉。我们的主要研究问题是：“西非国家的青少年福利政策和计划优先事项是什么以及为什么是这样，在初级卫生保健一级提供哪些精神、性和生殖健康服务（分区/卫生中心和社区）青少年健康和福祉;它们是否被证明是有效的，这些服务的供资机制是什么和为什么，以及现有资源用于提供这些服务的效率如何”。在这些问题的背景下，我们的研究目标是：（1）映射和分析国家和次区域行为体及其思想，意识形态，利益和权力，优先事项和机构环境/背景和决策有关的青少年健康和福祉的政策和方案在西非;哪些政策和优先事项被移动到实施（或不），为什么。(2)分析分区和社区一级的决策过程，确定提供哪些服务的优先次序，并在初级保健一级寻找和分配可用资源，以提供青少年健康和福利服务（3）综合现有的证据，证明有效性（或其他）与心理有关的政策优先事项和方案，（4）说明分配给初级保健精神、心理和生殖保健各组成部分的资源数额，在分区和初级保健中心为青少年健康和福祉提供性和生殖服务。(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有效性和技术效率。(6)分析在初级保健中心提供青少年心理、性和生殖健康服务的技术效率的因素。我们的研究设计是一个多国案例研究，在三个选定的国家：加纳（英语）和尼日尔和布基纳法索（法语）。数据收集和分析将涉及与我们提出的问题有关的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为如何配置初级保健心理、性和生殖健康服务以更好地满足西非青少年的需求提供建议。

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.