Operationalizing Adolescent Health Services at Primary Health Care Level in India: Processes, Challenges and Outputs

Abstract

Background: Ministry of Health, Government of India developed the Ado-lescent Reproductive and Sexual Health (ARSH) strategy and operationalized adolescent health services up to district and sub-district hospital level. Objec-tives: To operationalize adolescent health services at primary health care level in a block of Maharashtra; assess impact of need based interventions on qual-ity of services; and understand potential for scalability in the state. Methods: Adolescent and Youth friendly centers were established at primary health care settings and interventions such as health system strengthening, sensitizing ga-tekeepers, involving Accredited Social Health Activist (ASHAs), developing inter and intra-sectoral linkages, improving monitoring and evaluation were tested. Results: Over a period of 2009-2014, there was a steady increase in the number of clients attending the Adolescent and Youth Friendly Health Cen-ters (A&YFHCs). Attitude of providers to address adolescents' needs improved significantly. Successful interventions were networking with schools, colleges and Non Government Organization (NGOs), linkages with HIV program and Integrated Child Development Services (ICDS), and involvement of ASHAs. Conclusions: The study demonstrates that although health system has the primary responsibility of addressing health issues among adolescents; it has limitations in terms of its reach to adolescents and generating demand for services. There is a need to network with education sector, ICDS, NGOs wor-king for adolescent health and development to work as a team and address the multifaceted needs of the adolescents. Such a strategy will be crucial while im-plementing the recently launched Rashtriya Kishor Swasthya Karyakram—