The second thematic section presents economic analyses of youth-friendly sexual and reproductive health services. Young people have different healthcare needs and preferences than adults or children. It is important that healthcare systems offer youth-friendly SRH services that are accessible, acceptable and appropriate for young people. However, there is no single YFSRH service package that suits every country. Each country has to define its own package according to epidemiological, social and economic circumstances. This thesis supports these efforts by providing new evidence on costs of two YFSRH services programmes in Estonia and Moldova, and on cost-effectiveness of the latter programme. These programmes were selected, because former Soviet Union and Eastern European countries are one of the frontiers in developments in young people’s SRH.

The thesis demonstrates that YFSRH services can be produced at relatively low cost per patient. However, there is no clear answer to whether or not the YFSRH services are cost saving and cost-effective. This is highly dependable on epidemiological context, especially HIV, and quality of the services. Nevertheless, the thesis recommends countries to invest in YFSRH services, which are an essential part of efforts to improve young people’s SRH, and to implement them together with SBSE programmes.

Four chapters of this thesis include young people’s SRH programmes in Estonia. The country has become an internationally recognized success story on scaling up and sustaining national young people’s SRH programmes, with simultaneously improved SRH outcomes. A policy analysis summarizes the factors that contributed to successful scale-up of Estonian youth clinic network (YCN). First, Estonia had a favourable social and political climate for offering YFSRH services. Second, there was a clearly demonstrated need for the services. Third, there is a national professional organization, Estonian Sexual Health Association (ESHA), coordinating and representing youth clinics (YCs). Fourth, personnel of ESHA and YC’s played an important active role in advocating YFSRH services to policy makers. Fifth, the YCs receive sustainable funding through the national health insurance system. Sixth, the recognition of the improvements would not have been possible without development of national reporting and monitoring systems, and many studies and international publications.