Government of India Initiatives

on developing ARSH Strategy:

Integrating SRH with HIV
prevention
 Young People in India: An
underserved population
• Large numbers
• Early marriage and early
pregnancies
• Unmet needs of adolescents
• Contribute to MMR,TFR and IMR
• HIV: 35% new cases in the age
• group15-24
• Malnutrition and anaemia
rampant
• Limited use of existing resources
 Why Invest….

Investments in Young People will yield

dividends in terms of delaying age of marriage,
reducing incidence of pregnancies, meeting
unmet contraceptive needs and reducing
incidence of STI/HIV/AIDS

“Catch them young”

10-19 years - a critical Phase
Health Risks:
• Inadequately prepared for life
• Enter Adulthood in poor health
• Unintended unwanted pregnancy/unsafe
abortion
• Maternal mortality higher for young Women
• Infant mortality higher for young mothers
• Sexual abuse/violence and unwanted sexual
activity
• STIs including HIV/AIDS
 Policy scenario
National Population Policy 2000 recognizes health needs
of adolescents as ‘underserved group’

Tenth Five Year Plan identifies adolescents as a distinct

target group for policy & prog focus

National AIDS Prevention & Control Policy II recognizes

youth as one of the segments for prevention programmes
NACP III has a special focus on young people

National Youth Policy 2003 promotes access for all young

people to health information and services. Articulates
need for HIV/AIDS and sexual health education.
 Programs for Adolescents
MOHFW:
Adolescent Reproductive & Sexual Health
(ARSH) Strategy in RCH Program Phase II

Other Sectors:
MOYAS: Initiatives on awareness and life skills,
UTA and Adolescent Empowerment Scheme
Department of Education: Adolescence Education
Program
DWCD: KISHORI SHAKTI YOJANA –To improve
the health and nutritional status of girls
BALIKA SAMRIDHI YOJANA –To Delay the age of
marriage
Inter-Sector Convergence
No duplication of work
Only Complementarities
Each sector may take a lead role
At the same time it can help / enable
other sectors to deliver adolescent
interventions
Health Sector to take lead
 NRHM
Vision
Improve availability of quality health care in
rural areas
Synergy between health and determinants of
good health
Community ownership of health facilities
Undertake architectural corrections of the
health system
Expected Outcomes
IMR reduced to 30/1000 live births by 2012
MMR reduced to 100/100,000 live births by
2012
TFR reduced to 2.1 by 2012
 MOHFW RCH II ARSH
Strategy
Overall objective of ARSH Strategy is to contribute to
the RCH II goals of reduction of IMR, MMR and
TFR. Objective to be met by:
(i) Reducing teenage pregnancies
(ii) meeting unmet contraceptive needs
(iii) reducing number of teenage maternal deaths
(iv) reducing incidence of STIs and
(v) reducing proportion of HIV positive in 10- 19
years age group
 Interventions for RCH II
ARSH
Services for adolescents to cover
preventive, promotive, curative and
counselling services
Capacity building of on meeting service
needs of adolescents
Communication activities to be undertaken
MIS indicators identified as per specific
objectives
Inter-sectoral linkages with NACP and
NRHM interventions
 MOHFW: Progress so far
RCH-II ARSH Strategy approved as part of
National RCH-II PIP
Strategy incorporated in State RCH-II PIPs
Self learning module for rural youth and
health care providers
MOHFW RCH-II ARSH Training Sub-Group
constituted & developed a training design
document. Members included NIHFW,
UNFPA, WHO-India, & Experts
 ARSH Training Package
Orientation Programme for MOs and ANMs
(AWW, Counselors)
“How to treat differently a client who is 16 –
and not 6 or 26”

 Developing sensitivity towards adolescent clients

 Non-judgmental, friendly, competent provider

“How to deliver friendly services within

public health system”
Training of ASHA: Adolescent Health included
 ARSH Training
National level Training:
Two batches completed
One more batch: in Feb 07
State level Trainings:
Goa
Maharashtra
Rajasthan
Madhya Pradesh
Mainstreaming in RCH training Framework:
Training Division
NIHFW, SIHFW
 Training Package for Medical
Officers
Duration: 3 Days
Contents: 10 Modules
– Introductory Module
– Adolescent Health and Development: Public
Health Impact
– Communicating with Adolescents
– Adolescent Friendly Health Services
– Adolescent Sexual and Reproductive Health
– STIs/RTIs, HIV/AIDS
– Nutrition and Anemia
– Adolescent Pregnancy and Abortion
– Contraception for Adolescents
– Concluding Module
 Implementation Guide
PART ONE: BACKGROUND
– Purpose of the Implementation Guide
– ARSH in RCH II
PART TWO: WHAT TO IMPLEMENT?
– Standards for Adolescent Friendly Reproductive and
Sexual Health Services
PART THREE: HOW TO IMPLEMENT?
– Service Delivery Package
– Organizing Effective Services
– Conducive environment at health facilities
– Capacity Building of Providers
– Environment Building
– Communication with adolescents
– Monitoring and Supervision
Sample implementation plan
PART FOUR: MOVING AHEAD
Conclusion
 HIV/AIDS and Young People in
India
• India has the second largest population of HIV
infected individuals which is estimated at 5.2
million
• About 30-35% of all reported HIV infections in
India occur among young people in age group 15-
24 years, indicating young people are highly
vulnerable.
• The epidemic has become “feminized” with more
women becoming infected
• Challenge is how to keep the young population
free from HIV
• Ref: www. nacoonline.org
 Convergence between
SRH & HIV for ARSH
Addressing common challenges
Understanding the need to address common risk
factors
Utilising capacity for optimum utilisation of
resources
Pro-active participation of key stakeholders to
mainstream programme within the Public Health
System
Common communication strategy for access to
services
Preventing overlap of interventions – avoid
duplication
 Convergence between
SRH & HIV for ARSH
Establishing linkages with regard to
services
Institutional linkages critical for roll
out
Preventing overlap of interventions
with regard to target groups and
services
Balancing the preventive and care
strategies in both programme
 Next steps
Strengthen RCH MIS Framework
Communication Strategy for ARSH
Establishing / Strengthening Inter-
Sectoral Convergence
Quality Assurance Framework
Developing institutional and service
linkages within ARSH framework to
address HIV concerns