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INDIA AT A GLANCE

India Ministry of Health and Family Welfare Adolescent Reproductive and Sexual Health Strategy under RCH Programme Implementation of approved standards. INDIA AT A GLANCE. AREA=3,287,240 SQ KM RURAL %=94.86 No. of States/UTs: 35 No. OF DISTRICTS=609 No. OF VILLAGES=638588

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INDIA AT A GLANCE

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  1. IndiaMinistry of Health and Family WelfareAdolescent Reproductive and Sexual Health Strategy under RCH ProgrammeImplementation of approved standards Bali: India Presentation

  2. INDIA AT A GLANCE AREA=3,287,240 SQ KM RURAL %=94.86 No. of States/UTs: 35 No. OF DISTRICTS=609 No. OF VILLAGES=638588 Population Density=312 Bali: India Presentation

  3. Community Health Centers Primary Health Care System In India Bali: India Presentation

  4. Health system Bali: India Presentation

  5. Reproductive and Child Health Program (RCH II) – Adolescent Reproductive and Sexual Health (ARSH) Strategy Overall objective of ARSH Strategy is to contribute to the RCH II goals of reduction of IMR, MMR TFR and Reducing incidence of STIs and HIV Objective to be met by: (i) Reducing adolescent pregnancies (ii) Meeting unmet contraceptive needs (iii) Reducing number of adolescent maternal deaths by increasing access to adolescents for pregnancy, childbirth and safe abortion services (iv) Linkage with National AIDS Control Program Bali: India Presentation

  6. Key interventions under ARSH • Existing services to be reorganized for adolescents to cover preventive, promotive, curative and counselling services • Capacity building of on meeting service needs of adolescents • Communication activities to be undertaken for awareness and demand generation • Incorporate ARSH indicators in routine MIS • Linkages with National AIDS Control Programme Bali: India Presentation

  7. RCH-II ARSH Strategy Development of National Standards • National Consultation: September 2005 • Consultative process involved: National and State Program Managers, NGOs, INGOs, Professional Associations, AH Experts, UNFPA, WHO Development of Training package • Orientation Programme based on WHO-OP • Separate OP for Health Workers Bali: India Presentation

  8. Launch of National Standards and Training Package • Launched by Secretary, Health on 9 May 2006 • Dissemination to State programme managers, CBOs, NGOs, Professionals…. Bali: India Presentation

  9. Standard 1: Service Package Bali: India Presentation

  10. Implementing approved national standards Regional Workshops: Covered 28 states so far Objectives: • Orientation of the state managers to National ARSH Strategy and Operational Guidelines • Sharing the steps in implementation of providing good quality adolescent-friendly health services as proposed in the ‘Implementation Guide’ • Understand the stakes and role of the health sector in promoting Inter-sectoral collaboration • Review / draft State implementation Plan for ARSH and developing an action plan for operationalization of adolescent friendly health services Bali: India Presentation

  11. Planning Matrix 1: Service PackageIn reference to the Menu of Services detailed in the Implementation Guide Bali: India Presentation

  12. Regional WorkshopsOutcomes • Better understanding of the strategy, approved standards and operational guidelines • Realize the importance of demand generation for the proposed services and promoting inter-sectoral co-ordination • Decided to implement ARSH in only a few (2-5) districts in the first phase Better Quality of Plans for implementation Bali: India Presentation

  13. Standard 4: Training Package Bali: India Presentation

  14. Training of Health Providers National level Training: • Five batches completed: 125 Trainers available State level Trainings: • Goa,Maharashtra, Rajasthan, Madhya Pradesh, Orissa Involving private sector through professional associations: IAP, FOGSI • Contribution in capacity building of healthcare providers • Provision of adolescent friendly health services from private clinics (Public Private Mix) Distance education (IGNOU): Strengthen adolescent health component in existing PG Diploma in Maternal & Child Health Bali: India Presentation

  15. Standard 2, 5, 6Developing IEC Material on Adolescent Issues • Wall posters • Pamphlets • Media messages Bali: India Presentation

  16. Monitoring & Evaluation (Standard 7) • Incorporating ARSH in routine MIS • Incorporating ‘M & E Guide’ Indicators in National AIDS Control Program • Piloting tools for assessment of cost and quality of services:Pilot completed at three adolescent friendly sitesNational / Sub-national Surveys • Secondary analysis of national survey dataObtaining age disaggregating data from National Family Health Survey and District Level Household Survey: 15-19 years and 20-24 years • YP Behaviour survey: 6 States Bali: India Presentation

  17. Facilitating factors • Supportive policy environment: National Population Policy, National Youth Policy, Recognition of rights of young people in RCH programme • Infrastructure strengthening: National Rural Health Mission Hindrances • Competing priorities • Variable system capacity at state and district level Bali: India Presentation

  18. Lessons • Participatory process: Involve all key stakeholders / sectors: • Consensus building among stakeholders • Ownership • Take cultural sensitivity into account • Partnership in implementation • Assess local needs and system’s capacity • Provide handholding for down stream facilitation of implementation: • New programme: Closer monitoring is needed • Supportive supervision – problem solving Bali: India Presentation

  19. Supporting District Level Implementation Bali: India Presentation

  20. Implementation at district level • Identification of districts for implementation in the first phase • Orientation of district managers in state planning meetings • Facilitation of developing district action plans to implement services under ARSH Bali: India Presentation

  21. District level training plan • State level training of trainers by national facilitators • District level trainings by state trainers supported by at least one national trainer • Translation and printing of Health Worker (ANM) OP • Monitoring quality of training Bali: India Presentation

  22. Bali: India Presentation

  23. Support for Implementation of approved standards • State MOH and District management • Mentoring: • NGOs: Haryana • Medical College: West Bengal • Development partners/Donors • WHO: • Technical assistance: planning matrices • Financial assistance for piloting Bali: India Presentation

  24. Quality Assurance Manual(Under development) • Process: problem solving • Manual and tools / checklists • Field test • Institutionalization within the public health system Bali: India Presentation

  25. Operationalization of AFHS using ARSH Implementation Guide Pilots supported in 2 rural districts • Haryana: Ambala • West Bengal: Midnapur Objectives: • Gaining experience from the ground • Promote local innovations • To demonstrate ‘do-ability’ Bali: India Presentation

  26. Objectives • Increasing the use of services through awareness generation • Improving the quality of services rendered at multiple facilities using RCH-ARSH Implementation Guide Bali: India Presentation

  27. Baseline assessment of health facilities 11 PHCs, 8 private facilities,16 sub-centers and 62 AWW centers In more than 90% facilities mapped, • No provider trained in AFHS, no training material available • Supplies (IFA, contraceptives) available but not provided to adolescents • No provisions for privacy and confidentiality • Records available but no disaggregated data • No special clinics for adolescents Bali: India Presentation

  28. Description of the selected location • Covers 2 PHCs and 16 subcenters and 72 villages with about 70,000 population in district Ambala, Haryana • Project implemented within the scope of national and state policy framework (RCH-ARSH) • Used locally applicable innovations • Duration 1 year Bali: India Presentation

  29. Interventions and innovations • Capacity development through a model of ongoing training – staggered, modular training • Reaching the un-reached adolescents through peer educators and providers from other sectors (AWW) • Branding of AFHS • Assessment of outputs • Review of lessons learnt and challenges ahead Bali: India Presentation

  30. AFHS Packaging and Branding Logo for the Clinic I Card for a ‘Friendly Provider’ Bali: India Presentation

  31. Criteria for designating a facility as adolescent friendly • At least one provider trained on AFHS • Training material and IEC material available in the facility • Display of signboard indicating that AFHS norms are being practiced • Clinic held regularly at least once a week for adolescents • Supplies are available and adolescents are given the supplies according to needs • Records are maintained (age and sex disaggregated) Bali: India Presentation

  32. AFHS-Use of services Bali: India Presentation

  33. Reasons for increased utilization of services by adolescents • Increased capacity of providers and supportive attitudes of staff • Awareness generation by PGEs, AWWs and ANMs • An enabling environment relating to AFHS • Referral by PGEs, AWWs, ANMs • Availability of services e.g TT, IFA, contraceptives • Provision of AFHS through ‘Special clinics’ Bali: India Presentation

  34. AFHS- Peer Group Educators December 2006-August 2007 Total: 68 Active: 50 Males: 16 Females: 34 Total number of adolescents who contacted PGEs for problems and concerns1507 Bali: India Presentation

  35. Problems and concerns reported to PGEs Body image (Pimples, Hair, circles): 310 Menstrual (Pain, excess, scant, nil): 253 Psycho social concerns: 191 (tension, frustration, school, financial…) Nutrition (Anaemia, Height, Weight): 172 Sexual (Nightfall, Masturbation, vaginal: 129 discharge) General health and others: 442 Bali: India Presentation

  36. Challenges ahead • Sustaining training, capacity development and motivation of providers • Increased collaboration within health sector- RCH, HIV/AIDS, Nutrition • Inter-sectoral collaboration- education, women and child development, youth groups, village health and sanitation committees • Sustaining PGEs, especially males • Un-interrupted adolescent-specific supplies • Age and sex disaggregated data in routine MIS Bali: India Presentation

  37. So Far…… • Supportive Policies: • Adolescent Health & Development Strategy under RCH-II • National Standards and Guidelines: ‘Implementation Guide’ • Support States in Planning for Implementation • Strategic Information: • Using existing mechanisms and available data • Monitoring: Quality, Coverage and Cost assessment • QA Process: under development • Adolescent Friendly Services: • Capacity Building of providers • IEC Materials • Demonstration models in districts • Strengthening other Sectors: • HIV/AIDS and Young People initiative • Deptt. of Women and Child Development, Youth, Education Bali: India Presentation

  38. THANK YOU Bali: India Presentation

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