Strengthening health systems to respond to the sexual and reproductive health needs and rights of adolescents: Experiences in Ethiopia, Chile, and Republic of Moldova

Globally the sexual and reproductive health of adolescents is improving, but progress is uneven and many adolescents experience poor sexual and reproductive health outcomes. This is driven, in part, by persistent barriers to accessing and using health services. Efforts to address these barriers have often been fragmented and disconnected from the broader health system. An adolescent-responsive health system shifts the emphasis from creating adolescent-friendly services to ensuring the entire health system responds to the needs and rights of adolescents. This paper aims to fill the gap in evidence about how adolescent-responsive health systems can be implemented and their impact. We analyze the experience of three countries, Chile, Ethiopia, and Republic of Moldova, using two validated frameworks: Shiffman’s political prioritization framework and the World Health Organization health systems strengthening framework. Our analysis identifies factors that enabled these countries to prioritize adolescent-responsive health systems, specific actions taken to integrate adolescent-friendly elements into each health system building block, and observed changes in contraceptive use and related adolescent health indicators. Findings demonstrate that making health systems responsive to the needs and rights of adolescents is feasible across diverse low- and middle- income contexts. Implementation requires political prioritization, often catalyzed by a high-profile event or policy process, and sustained changes across leadership and governance, health workforce, service delivery, health information, and health financing. Adolescent-responsive health systems can meaningfully expand access to person-centered care, contributing to universal health coverage and the realization of adolescents' sexual and reproductive health and rights.