ADOLESCENT HEALTH

Objective

At the end of the session you will be able to understand:

• Adolescent health and its Importance

• Rashtriya Kishor Swasthya Karyakram (RKSK) Key Thematic Areas

• WIFS programme

• Linkages between School & HWCs

 Why Adolescents Matter?
• Adolescents make up one-fifth of India’s population

• Globally, adolescents carry 11% of the global disease burden, however, they received only 1.6%
of development assistance for health in 2015

• Comprehensive Primary Health Care is a backbone for UHC- Health and Wellness Centers can
provide a critical vehicle to reach adolescents

• Investment in this age group can derive a “triple dividend”, fuel economic growth , reduce health
expenditure and the interruption of intergenerational transmission of poor health, poverty and
discrimination*.

*Source: Li Z, Li M, Patton GC, Lu C. Global Development Assistance for Adolescent Health from 2003 to 2015. JAMA Network Open. 2018;1(4):e181072
 Situation of Adolescent Health in India

ANEMIA EARLY TEENAGE

54% 29.1% MARRIAGE20.3%
OF GIRLS AGED OF BOYS AGED
26.8% PREGNANCY
15-19 YEARS OF WOMEN AGED OF MEN AGED
15-19 YEARS
HAVE ANEMIA HAVE ANEMIA
20-24 YEARS
ARE MARRIED BEFORE
25-29 YEARS
ARE MARRIED BEFORE
7.9%
18 YEARS OF WOMEN AGED
21 YEARS
15-19 YEARS
BEGUN CHILD BEARING PREGNANT OR
ALREADY MOTHERS

CONTRACEPTIVE SUBSTANCE SUICIDES*

USE 14.9% MISUSE
OF CURRENTLY MARRIED WOMEN 8-12% 10.61SUICIDES (PER LAKH
POPULATION)
AGED 15 - 19 YEARS USE TOBACCO & ALCOHOL
USE ANY METHOD OF
CONTRACEPTION TOBACCO CONTRIBUTES TO 30% NCDs 7%
OF SUICIDES ARE BELOW 18 YEARS OF AGE
 Rashtriya Kishore Swashtya Karyakram (RKSK)

Sexual and Paradigm

Mental Reproductive shift
Health Health
Injuries & Continuum
Violence of Care
approach
Nutrition
Convergent
Action
Substance
misuse Launched in
Non Communicable Diseases
2014
Strategic interventions under RKSK

A. Facility based B. School based

approach C. Community based
approach approach
1. Adolescent 1. School Health
Activities under 1. Peer Education
Friendly Health Programme
Clinics (AFHCs) Ayushman Bharat
2. WIFS (in School 2. Adolescent Health
2. Resource Centre at Day and Adolescent
District level beneficiaries)
Friendly Clubs
3. Adolescent Health 3. Health Screening
through RBSK teams 3. WIFS and MHS
Counselor(AH (Out of School
Coordinator at Block) 4. Menstrual Hygiene beneficiaries)
Scheme
Weekly Iron Folic Acid Supplementation
• MoHFW has launched Weekly Iron Folic Acid Supplementation
(WIFS) programme to reduce the prevalence and severity of
nutritional anaemia in adolescent population
• It is implemented as supervised weekly ingestion of IFA
supplementation (100mg elemental iron and 500µg folic acid) &
biannual helminthic control program with Albendazole 400 mg

Target Group:
• Adolescent boys and girls of government /government
aided/municipal schools from 6th – 12th standard
• Adolescent girls who are not in school
• Married adolescent girls
 Guidelines on organizing AHWDs
• AHWDs will be organized on a quarterly basis preferably at AB-HWCs* for all adolescents
• Series of activities for about four hours, (one hour -group counselling)
• The AB-HWC team including Community Health Officer (CHO), Multi-Purpose Workers (MPW-
Female and Male), ASHAs and Anganwadi Workers (AWWs) should be present
• CHO will be responsible for providing general information on adolescent health issues.
• Community level representatives from departments of Rural Development, Youth Affairs and
Panchayati Raj and Self-Help Groups (SHGs) should be encouraged to participate in the event.
 Roles and Responsibilities
• Community Health Officer
 Planning and conducting activities during AHWD with the help of CPHC team, local leaders,
teachers, PEs and NGOs (if present)
 Ensure the availability of all instruments, commodities (IFA, Albendazole, sanitary napkins and
contraceptives), communication materials beforehand on AHWDs
 Generate awareness in community regarding services provided during AHWD well in advance
 Wellness (Yoga, sports etc.) activities by coordinating with trainers of Yoga, sports and wellness
activities
• ANM
 Taking weight measurements, testing of hemoglobin etc. during AHWD
 Ensure reporting of AHWD to the MO in-charge
 Coordinate with local CSOs (if present), ASHA and AWW

• ASHA: Coordination with CPHC team, PE (if present), AWW and local leaders before AHWD to mobilize
adolescents and their parents and organizing AHWDs
 Roles and Responsibilities
• Peer Educators (if present)
 Help ASHA in listing adolescents and work closely with ASHAs to organize meetings with gatekeepers
and other major stakeholders to mobilize adolescents (through Adolescent Group Meetings and
monthly AFC meetings), organize village sensitization events
 The PEs are expected to attend all the PE trainings to be better informed on how to interact with
adolescents and provide support in conducting AHWDs

• Anganwadi Workers (AWWs):

Help ASHAs and PEs to mobilize adolescents, and coordinate with CPHC team, PEs, NGOs in organizing
AHWDs

• Village Health Sanitation and Nutrition Committee

 Ensure AHWDs are held on a quarterly basis at a proper venue with the required facilities
 Utilize VHSNC meeting platform for AHWD when AB-HWC are not available
 Organize local collective action for health promotion as a whole
Linkages between Schools and HWCs

Schematic diagram for

establishing linkages
between schools and AB-
HWCs
 Activities at HWCs
Health screening and provision of commodities
 On dedicated days/ week and AHWDs, special adolescent health clinics providing services
related to screening of Anaemia, Communicable diseases, NCDs (esp. those who were not
screened by RBSK teams)
 IFA, Albendazole, Dicyclomine, sanitary napkins, contraceptives
Referral services
 For adolescent girls who are pregnant where a gynaecologist is available
 Referral for safe abortion services
 Post-abortion complications
 Management of severe anemia
 Management of STIs/RTIs including HIV/AIDS to STI/RTI Clinics /ICTCs
 Visible signs and symptoms of mental health issues to AH Counsellors/ clinical Psychologist/
Psychiatrist)
 Substance misuse to de-addiction centres/ appropriate health facilities
 Violence to one stop crisis centers/ women and child helpline centers
 Treatment of injuries and provide adequate referral
 Activities at HWCs
Counselling services on:
 Intake of balanced and nutritious diet
 Safe-sex practices, using contraception, maintaining proper genital hygiene, menstrual hygiene,
signs and symptoms of RTIs/ STIs including HIV/ADS
 Birth-preparedness, breastfeeding, complications of early and repeated pregnancies, family
planning etc. to teenage pregnant girls (along with their family members) or opting
 Post-abortion contraceptive services
 Harmful effects of substance-misuse; involving parents to keep an open communication with
their children and be a positive role model for them
 Improving mental health and identifying early signs and symptoms of mental health issues
 Promoting favorable attitudes for preventing injuries & violence, identification of early signs of
violence
 Importance of completion of school education
 Promote healthy lifestyle and importance of wellness in day to day life
 Activities at HWCs
Awareness generation: Capacity building of CPHC Team to increase
awareness in the community regarding major AH issues
Follow-up:
 Follow-up of ANC check-ups of pregnant adolescent girls and those with any
post-abortion complications.
 HWAs will coordinate with CHOs in follow-up of referred students
Routine Monthly Outreach activities on:
 Handholding HWAs in conducting sessions in schools & preparing
question box replies
 Conducting wellness sessions by engaging with local clubs
 Adolescent friendly services available at HWCs and AFHCs/ DEICs
 Work with youth groups/ champions for providing community level support
 AFHS like counselling sessions, health camps etc. during VHNDs/ AFC meetings
 Awareness generation on adolescent issues during VHSNC meetings, village fairs etc.
 Activities at other levels
At referral facility level
 Screening for medical disorders and treatment, with referral if required
 Management of growth abnormality and disabilities, with referral as required
 Management, rehabilitation & counselling services for substance misuse, mental health, SRH
issues, NCDs etc
 All cases will be referred by CHO or RBSK teams during health screening at schools
At school level:
• HWAs will coordinate with CHOs & refer students for accessing AFHS at HWCs
• HWAs will help CHOs in following up students who had been referred
• HWAs will support in organizing AHWDs and mobilizing students
• HWAs will seek help from CHOs in taking technical sessions related to adolescent

health and conducting wellness/ other health camps

At community level: PRI members & other important members with the help of
FLWs and peer educators can help in raising awareness about various AH issues and
the range of services available at AB-HWCs
 Reporting and Recording

• For ensuring the monitoring of linkages between schools and HWCs are
functioning properly, a set of indicators focusing on SHWP are proposed to be
included in the U-DISE (Unified District Information System for Education)
portal.

• Additionally, checklists and data collection formats have been developed for:
 monitoring AHWDs
 enlisting PEs for AHWDs
 basic data collection, supportive supervision, and on feedback from participating
adolescents
Thank You

THANK
YOU