Exploring Barriers and Opportunities for Integrating Adolescent Sexual and Reproductive Health Services in Primary Health Care Facilities in Southern Ethiopia: Insights from a Qualitative Study

Abstract Background Unmet needs for Adolescent Sexual and Reproductive Health (ASRH) information and services remain high in low- and middle-income countries, particularly in Ethiopia. Integrating ASRH services into primary health care facilities is widely recognized as a cost-effective and sustainable strategy to enhance access, quality, and continuity of care. Although Ethiopia has committed to implementing comprehensive and integrated ASRH services, the rollout remains uneven and insufficiently studied. Inconsistent integration at the primary health care level limits adolescents’ familiarity with available services and results in missed opportunities for comprehensive care, suboptimal utilization, poor adherence, and persistent inequities. In Southern Ethiopia, there is limited evidence on the contextual barriers and enabling factors influencing effective service integration. Therefore, this study aimed to explore the barriers and opportunities for integrating ASRH services in primary health care facilities in Southern Ethiopia. Methods A qualitative study design was conducted in selected primary health care facilities in Southern Ethiopia. Purposive sampling was used to recruit key informants, including health care providers and facility managers involved in ASRH service delivery. Data were collected through key informant interviews and facility observation using semi-structured interview guides. All interviews were audio-recorded, transcribed verbatim, and translated into English. Data were analyzed using thematic analysis, following a systematic process of coding, categorization, and theme development. Measures to ensure trustworthiness included triangulation, member checking, and maintaining an audit trail. Ethical approval was obtained from Arba Minch University Institutional Review Board, and written consent was secured from all participants. Result The findings of this study revealed key barriers to providing integrated ASRH services, including inconvenient service hours, infrastructure limitations, inadequate privacy and confidentiality, limited training opportunities for service providers, weak reporting and feedback mechanisms, ineffective health education approaches, reliance on externally funded Non-Governmental Organization (NGO) projects, and limited involvement of adolescents and youth in program planning. Conversely, opportunities identified included existing adolescent volunteer and community networks for potential peer navigation, as well as health professionals’ willingness to deliver integrated ASRH services through appropriate training and mentorship. Health professionals also emphasized the need to expand services to hotspot areas and underserved populations, and to address emerging issues such as mental health, substance use, suicidal behavior, and gender-based violence alongside ASRH. Conclusions The delivery of integrated ASRH services remains constrained by infrastructure limitations, inadequate provider training, weak monitoring systems, and limited adolescent and youth participation in program planning. Despite these challenges, the presence of active community and adolescent volunteer networks, coupled with the dedication of health professionals, offers a solid foundation for strengthening services. Strategic interventions that build provider capacity, actively engage youth, and harness community resources are critical to achieving sustainable, high-quality, and adolescent-centered ASRH service delivery.