Preventive and Social Medicine

1. Adolescent
Health
Programme

2. ADOLESCENCE
• The term "adolescence" has been defined as including those aged
between 10 and 19, and "youth" as those between 15 and 24;
"young people" is a term that covers both age groups, i.e. those
between the ages of 10 and 24.
• True adolescence-being the period of physical, psychological and
social maturing from childhood to adulthood.
• The development that takes place in adolescence is generally
uneven.

3. WHY ADOLESCENTS?
• More than 33% of the disease burden and almost 60% of premature deaths among
adults can be associated with behaviours or conditions that begin or occur during
adolescence – Eg. tobacco and alcohol use, poor eating habits, sexual abuse and
risky sex
• Limited awareness about sexual and reproductive health matters-Only 15% of
young men and women (15–24 years) reported receiving any family life or sex
education
• Prominent causes of disability and death in the 10 to 14 age group:Injuries and
communicable diseases,
• In the 15 to 19 years age group: Outcomes of sexual behaviours and Mental health
• Psychological disorders such as depression and anxiety start becoming evident in
early adolescence with the onset of puberty.
-13% of suicides in the country occur in the age group of 15-29 years
• Gender-based violence (especially in females)
One out of every three (31%) ever-married female adolescents, in 15–19 age
group, reported having experienced physical, sexual or emotional violence
perpetrated by their spouse

4. WHY ADOLESCENTS?
• Recognizing the importance of influencing health-seeking behavior of
adolescents is Key. Healthy adolescents are an important resource for the
economy.
• The health situation of this age group is a key determinant of India’s overall
health, mortality, morbidity and population growth scenario.
Investments in adolescent reproductive and sexual health will yield dividends in
terms of :
• Delaying age at marriage
• Reducing incidence of teenage pregnancy,
• Meeting unmet contraception need,
• Reducing the maternal mortality,
• Reducing STI incidence and reducing HIV prevalence,

5. The RMNCH+A strategy is built upon the continuum of care concept and is holistic
in design, encompassing all interventions aimed at reproductive, maternal,
newborn, child, and adolescent health under a broad umbrella, and focusing on
the strategic lifecycle approach.
ONE of the important initiatives under the RMNCH+A is the
Adolescent Health programme

7. WHAT IS RKSK?
RKSK(Rashtriya Kishor Swasthya Karyakram) was a new initiative launched in
January 2014 to Broaden the focus of the Adolescent Health programme beyond
reproductive and sexual health
It focuses on the following:
• Life skills
• Nutrition
• Injuries
• Violence( including Gender-based violence)
• Non communicable diseases
• Mental Health
• Substance Abuse

8. Interventions under the Adolescent health programme
Health Promotion, Prevention, Diagnosis ,Treatment ,Referral Across levels
of care
It operates at four major levels:
• Individual
• Family
• School
• Community
Priority interventions are:
1. Adolescent nutrition; Iron and folic acid supplementation
2. Facility-based adolescent reproductive and sexual health services (Adolescent
health clinics)
3. Information and counselling on adolescent sexual reproductive health and
other health issues
4. Menstrual hygiene

9. ARSH (Adolescent Reproductive and Sexual Health
Programme)
• Services includes promotive, preventive, curative and counselling services being
made available for all adolescents - married and unmarried, girls and boys
through adolescent friendly health clinics.
• It focusses on creating an enabling environment for adolescents to seek health
care services through a spectrum of programmatic approaches:
- Facility based health services-Adolescent Friendly Health Clinics;
- Counselling-Dedicated ARSH and ICTC counselling;
- Community based interventions-Outreach activities; and
- Capacity building for service providers.

10. AFHCs
 Routine check-up at primary, secondary and tertiary levels of care is provided on
fixed day clinics
 6,302 AFHCs are functional across the country
 Coverage: > 2.5 million adolescents
 Services:
• Contraceptives Provision
• Safe abortion services
• Management Of Menstrual Problems,
• RTI/STI Management,
• Antenatal Care
• Anaemia.

11. Facility-based Counselling services
Facility-based clinical and counselling services for adolescents, which are:
•Equitable—services are provided to all adolescents who need them.
•Accessible—ready accessibility i.e. AFHC should be established where adolescents can go without hesitation
eg: Not to be placed near labour rooms, integrated counselling and treatment centres, Sexual and
Reproductive Transmitted Infections (STI/RTI) centre etc.
•Acceptable—Meet the expectation of adolescents who use the services.
•Appropriate—the required care is provided and any unnecessary and harmful practices are avoided.
•Effective—healthcare produces positive change in the status of the adolescents; Efficient and high quality
services.
•Comprehensive—care provision covers promotive, preventive and curative aspects.
Important issues covered are:
• Nutrition,
• Puberty, RTI/STI Prevention And Contraception,
• Delaying Marriage And Childbearing,
• Concerns Related To Contraception, Abortion Services,
• Pre-marital Concerns
• Substance Misuse
• Sexual Abuse And Mental Health Problems

12. Facility-based Counselling services
• 881 dedicated ARSH counsellors are providing comprehensive counselling
services to adolescents across the country.
• In 23 States/Uts: 1439 ICTC counsellors have been enrolled to provide sexual
and reproductive health counselling to adolescents.
Outreach activities
• Conducted in schools, colleges, teen clubs, vocational training centres, during
Village Health Nutrition Day(VHND), health melas and in collaboration with self
help groups to provide adequate and appropriate information to adolescents in
spaces where they normally congregate.

13. Weekly Iron and Folic Acid Supplementation (WIFS)
by the Ministry of Health and Family Welfare
• Coverage :approximately 10.25 crore adolescents
• Key Interventions are:
- Administration of supervised weekly iron-folic acid supplements of 100 mg
elemental iron and 500 μg folic acid using a fixed day approach.
- Screening of target groups for moderate/severe anaemia and Referral to an
appropriate health facility.
- Biannual de-worming (Albendazole 400 mg once in 6 months)- for control of
Helminths infestation.
- Information and counselling for improving dietary intake and for taking actions
for prevention of intestinal worm infestation.

14. Menstrual Hygiene Scheme
by the Ministry of Health and Family Welfare
To promote menstrual hygiene among adolescent girls in the age group of 10-19
years in rural areas.
AIM:
• Adequate knowledge and information about menstrual hygiene
• Access to high quality sanitary napkins with safe disposal mechanisms
Key activities under the scheme include :
• Community based health education and outreach
• Ensuring regular availability of sanitary napkins to the adolescents;
• Sourcing and procurement of sanitary napkins;
• Storage and distribution of sanitary napkins
• Training in menstrual health: ASHA and nodal teachers
• Safe disposal of sanitary napkins.