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Adolescence is a time when a young person develops his or her identity, acquires greater autonomy and independence, experiments and takes risks and grows mentally and physically. To successfully navigate these changes, an accessible and health system when needed is essential.

We assessed the structure and content of national primary care services against these standards in the field of adolescent health services. The main criteria identified by adolescents as important for primary care are as follows: accessibility, staff attitude, communication in all its forms, staff competency and skills, confidential and continuous care, age appropriate environment, involvement in health care, equity and respect and a strong link with the community.

We found that although half of the Models of Child Health Appraised countries have adopted adolescent-specific policies or guidelines, many countries do not meet the current standards of quality health care for adolescents. For example, the ability to provide emergency mental health care or respond to life-threatening behaviour is limited. Many countries provide good access to contraception, but specialised care for a pregnant adolescent may be hard to find.

Access needs to be improved for vulnerable adolescents; greater advocacy should be given to adolescent health and the promotion of good health habits. Adolescent health services should be well publicised, and adolescents need to feel empowered to access them.

In order to assess the state of health of Europe’s children, or to appraise the systems and models of healthcare delivery, data about children are essential, with as much precision and accuracy as possible by small group characteristic. Unfortunately, the experience of the Models of Child Health Appraised (MOCHA) project and its scientists shows that this ideal is seldom met, and thus the accuracy of appraisal or planning work is compromised. In the project, we explored the data collected on children by a number of databases used in Europe and globally, to find that although the four quinquennial age bands are common, it is impossible to represent children aged 0–17 years as a legally defined group in statistical analysis. Adolescents, in particular, are the most invisible age group despite this being a time of life when they are rapidly changing and facing increasing challenges. In terms of measurement and monitoring, there is little progress from work of nearly two decades ago that recommended an information system, and no focus on the creation of a policy and ethical framework to allow collaborative analysis of the rich anonymised databases that hold real-world people-based data. In respect of data systems and surveillance, nearly all systems in European society pay lip service to the importance of children, but do not accommodate them in a practical and statistical sense.

The Models of Child Health Appraised (MOCHA) project identified the different models of primary care that exist for children, examined the particular attributes that might be different from those directed at adults and considered how these models might be appraised. The project took the multiple and interrelated dimensions of primary care and simplified them into a conceptual framework for appraisal. A general description of the models in existence in all 30 countries of the EU and EEA countries, focusing on lead practitioner, financial and regulatory and service provision classifications, was created. We then used the WHO ‘building blocks’ for high-performing health systems as a starting point for identifying a good system for children. The building blocks encompass safe and good quality services from an educated and empowered workforce, providing good data systems, access to all necessary medical products, prevention and treatments, and a service that is adequately financed and well led. An extensive search of the literature failed to identify a suitable appraisal framework for MOCHA, because none of the frameworks focused on child primary care in its own right. This led the research team to devise an alternative conceptualisation, at the heart of which is the core theme of child centricity and ecology, and the need to focus on delivery to the child through the life course. The MOCHA model also focuses on the primary care team and the societal and environmental context of the primary care system.

Given that the workforce constitutes a principal resource of primary care, appraisal of models of care requires thorough investigation of the health workforce in all Models of Child Health Appraised (MOCHA) countries. This chapter explores this in terms of workforce composition, remuneration, qualifications and training in relation to the needs of children and young people. We have focused on two principal disciplines of primary care; medicine and nursing, with a specific focus on training and skills to care for children in primary care, particularly those with complex care needs, adolescents and vulnerable groups. We found significant disparities in workforce provision and remuneration, in training curricula and in resultant skills of physicians and nurses in European Union and European Economic Area Countries. A lack of overarching standards and recognition of some of the specific needs of children reflected in training of physicians and nurses may lead to suboptimal care for children. There are, of course, many other professions that also contribute to primary care services for children, some of which are discussed in Chapter 15, but we have not had resources to study these to the same detail.

This study aims to explain the emergence and development of the concept of “Policy Networks” as a unit of analysis in the realm of public policies and their role in formulating a comprehensive policy for health insurance. The developments that took place over the past few decades had impacted a shift in the state’s role in shaping public policies, from a sole, key actor to one among other actors, both governmental and non-governmental, working interdependently through a set of networks.

The present study adopts the social network analysis as an approach and the social policy network as a tool to analyze public policymaking. The approach suggests the presence of a number of actors and interest groups that are actively involved in public policy and decision-making. These groups may vary from a cause to another and also from time to time. This research investigates and juxtaposes a selected sample of members of the health insurance policy network in Egypt.

In light of the study findings, one can see the existence of a policy network for the comprehensive health insurance system in Egypt. The study reveals the interrelations among a number of official and non-official key actors. The network has gone through several phases; the pre-establishment phase during the early stages of policymaking; the official establishment phase during the formative stage; and finally, the network operation phase during the implementation stage. The study also concludes that the policy network has influenced the different stages of policymaking through several tools and strategies. Moreover, the roles of different actors varied within the network; international organizations were the primary influencer in the early stages of policymaking; syndicates dominated the formative stage; and the public sector played the leading role in the implementation stage.

Serious attempts were made to benefit from policy networks with a particular focus on using the strengths of each actor while establishing an official institutional framework that consolidates coordination and cooperation among the involved parties. This framework should keep pace with global changes and developments. It should also have an official meeting venue. Above all, all parties should be listened to and their demands should be considered seriously as long as they are not actualized at the expense of the public interest nor do they undermine the sovereignty of the state. The study also enhances researchers to use policy networking as a unit for analyzing public policy and their effect on these policies.

Public policymaking in Egypt can become more responsive to people’s demands and more democratic once it was made through informative and interactive policy network. This pattern of policymaking will enhance both efficient and responsive.

Practical Implications: public policy making in Egypt can become more responsive to people demands and more democratic once it was made through informative and interactive policy network. This pattern of policymaking will enhance both efficient and responsive.

In addition to its practical contributions to the field of policymaking, this research fills a gap in the literature on the theoretical level.

Models of Child Health Appraised (MOCHA) defines school health services (SHSs) as those that exist due to a formal arrangement between educational institutions and primary health care. SHSs are unique in that they are designed exclusively to address the needs of children and adolescents in this age group and setting.

We investigated SHSs have been provided to schools and how they contribute to primary healthcare services for school children. We did this by mapping the national school health systems against the standards of the World Health Organization, and against a framework measuring the strength of primary care, adapting this from an existing, adult-focused framework.

We found that all but two countries in the European Union and European Economic Area have SHSs. There, however, remains a need for much greater investment in the professional workforce to run the services, including training to ensure appropriateness and acceptability to young people. Greater collaboration between SHSs and primary care services would lead to better coordination and the potential for better health (and educational) outcomes. Involving young people and families in the design of SHSs and as participants in its outputs would also improve school health.