From policy to practice: perspectives on youth-friendly sexual and reproductive health service delivery in Southeast Nigeria

Abstract

Young people in Nigeria face significant barriers in accessing sexual and reproductive health (SRH) services, resulting in unmet needs. This study explores the perspectives of young people and SRH service providers on the delivery of these services to young people at primary health centres (PHCs) in Ebonyi State, Southeast Nigeria. A qualitative research approach was used, involving 20 in-depth interviews with SRH service providers and 10 focus group discussions with young people (ages 15–24) across six communities. Data collection was guided by semi-structured interview guides that focused on the types of SRH services available and the processes involved in their delivery. Transcripts were coded and analysed thematically using NVivo. Three key themes emerged: (1) Types of services – including sex education, counselling, contraception, sexually transmitted infections prevention and treatment, maternal and childcare, and support services for survivors of gender-based violence; (2) Attributes of providers and users - highlighting, respectful, empathetic, and support for informed choices and privacy, while also noting challenges such as limited provider availability and young people’s reluctance to seek care; and (3) Processes of service delivery - describing structured stage including reception, registration and payment, consultation, waiting time, operating hours and relational aspects within the health system. Despite efforts to offer youth-friendly SRH services, delivery remains constrained by workforce shortages, inadequate infrastructure, high service costs, and judgmental attitudes from health workers. While PHCs provide essential SRH services, systemic barriers hinder young people’s access to youth-friendly care. Policy reforms are needed to strengthen youth-centred service delivery, including expanding the healthcare workforce through employment and task shifting, upgrading health infrastructure, and subsidising SRH services by integrating them into basic healthcare packages. These actions are essential to advancing young people’s SRH rights and improving service delivery.