Adolescents require sexual and reproductive health services that are both accessible and of high quality. Nonetheless, there is still limited evidence on how leadership affects the quality of these services in Ethiopia, where adolescents represent a considerable segment of the population. When adolescent-friendly services are poorly delivered, their utilization tends to decline, potentially leading to higher occurrences of unintended pregnancies and sexually transmitted infections. This study, therefore, investigated the influence of leadership and assessed the quality of adolescent-friendly health services in the pastoral areas of the East Guji Zone, Ethiopia. This research used in-depth interviews and focus group discussions involving eight key informants and fifty participants. Study design: a programmatic qualitative approach was applied. Data collection was carried out using 22 semi-structured interview questions, and analysis was performed using ATLAS.ti7. Limited leadership engagement in the health sector and generally poor-quality adolescent-friendly sexual and reproductive health services were revealed. The inability to adequately fulfill key quality-of-care dimensions—such as accessibility, equity, availability, acceptability, and appropriateness—was identified as a major factor contributing to the weak service quality. The study found that insufficient leadership commitment within health facilities negatively affected the quality of adolescent-friendly sexual and reproductive health services in the pastoral communities of East Guji Zone. It is recommended that improvements be made in organizational preparedness and provider capacity, equity in service delivery be strengthened, and service models be redesigned through stronger leadership involvement, which is essential for enhancing service quality. The Ministry of Health, Ethiopia, and relevant stakeholders are advised to incorporate these recommendations to improve adolescent-friendly health services nationwide.
