Evaluating the implementation fidelity of national standards for adolescent- and youth-friendly sexual and reproductive health services in Tanzania: a descriptive cross-sectional survey.
Kihwele G, Mbele M, Millanzi W • Reproductive health • 2025
The study revealed suboptimal coverage and incomplete implementation fidelity of National Standards for adolescent- and youth-friendly SRH services in Tanzanian health facilities, with an average implementation fidelity of 65% and no facility achieving full compliance.
Key Findings
Results
All assessed health facilities offered adolescent- and youth-friendly SRH services, but none achieved full compliance with the National Standards.
100% of the 11 health facilities assessed offered adolescent- and youth-friendly SRH services
Average implementation fidelity of the National Standards of SRH services was 65%
None of the 11 facilities achieved full compliance with the National Standards
Study conducted from November 1–30, 2022, across three Tanzanian regions: Dar es Salaam, Dodoma, and Kigoma
Results
Health centers had the highest coverage and fidelity of implementation of adolescent- and youth-friendly SRH national standards among facility types.
Tandale health center achieved the highest fidelity at 73%
Kigogo health center achieved 71% fidelity
Ujiji health center achieved 67% fidelity
Baptist Council Designated Hospital and Magomeni health center both achieved 60% fidelity
Murufiti dispensary had the lowest fidelity at 43%
Results
Government-owned facilities achieved higher coverage and fidelity in implementing adolescent- and youth-friendly SRH services compared to faith-based facilities.
Of the 11 facilities assessed, 9 (82%) were government-owned and 2 (18%) were faith-based
Government-owned facilities outperformed faith-based facilities on coverage and fidelity metrics
Faith-based facilities represented only 18% of the sample, limiting direct comparison
Facility types included 3 (27%) dispensaries, 6 (55%) health centers, and 2 (18%) hospitals
Discussion
The study identified suboptimal infrastructure, healthcare worker capacity, and access to SRH education as key gaps limiting implementation fidelity.
Enhancing infrastructures was identified as critical to advancing quality and reach of services
Strengthening healthcare worker capacity was cited as a key recommendation
Improving access to SRH education and associated services was also highlighted as critical
Data were collected using an observation checklist adapted from the Tanzanian Ministry of Health
Methods
The study used a descriptive cross-sectional design with purposive facility selection across three regions with varying urbanization levels.
11 health facilities were purposely selected across Dar es Salaam, Dodoma, and Kigoma regions
Facilities were stratified by ownership (government vs. faith-based) and type (dispensary, health center, hospital)
Data were analyzed using IBM SPSS version 26 and presented in frequencies and percentages
The study was conducted over a single month: November 1–30, 2022
What This Means
This research suggests that while all health facilities studied in Tanzania officially offer sexual and reproductive health (SRH) services for adolescents and youth, the quality and completeness of those services fall well short of national standards. Across 11 facilities in three regions, the average rate of meeting national standards was only 65%, and not a single facility fully complied with all requirements. Health centers tended to perform better than dispensaries, and government-run facilities outperformed faith-based ones.
The study found meaningful variation between individual facilities, with the best-performing center (Tandale health center) meeting 73% of standards and the worst (Murufiti dispensary) meeting only 43%. This suggests that local factors such as infrastructure, staffing, and resource availability play an important role in how well these services are delivered to young people.
This research suggests that Tanzania's adolescent SRH services need significant investment in physical infrastructure, training for healthcare workers, and improved delivery of sexuality education. These gaps are important because adolescents and youth who lack access to quality SRH services are at greater risk for unintended pregnancies, sexually transmitted infections, and other health challenges. Addressing these shortfalls could meaningfully improve the health and wellbeing of young Tanzanians.
Kihwele G, Mbele M, Millanzi W. (2025). Evaluating the implementation fidelity of national standards for adolescent- and youth-friendly sexual and reproductive health services in Tanzania: a descriptive cross-sectional survey.. Reproductive health. https://doi.org/10.1186/s12978-025-02118-7