The document discusses adolescent sexual and reproductive health (ASRH) and strategies for effectively addressing ASRH issues. It describes the physical, emotional, and developmental changes that occur during adolescence and associated health risks. A comprehensive, evidence-based approach is needed that provides adolescents with knowledge and services, creates an enabling environment, and addresses social and cultural norms. Interventions should be tailored to adolescents' diverse needs and involve stakeholders at all levels including adolescents themselves. The goal is to enable adolescents to protect their sexual and reproductive health and rights.

1. Managing adolescent sexual
reproductive health issues: cope
with best evidence based practice
Rosnah Sutan
Community Health Department,
UKMMC

2. Adolescent sexual and reproductive health (ASRH) refers to
the physical, mental, and emotional well being of adolescents, and
includes freedom from:
 unwanted pregnancy
 unsafe abortion
 sexually transmitted infections (STIs), including HIV/AIDS
 all forms of sexual violence and coercion
Early adolescence(10 -13yrs):
Spurt of growth of development of secondary sex.
Middle adolescence(14-16yrs):
Separate identity from parents, new relationship to peer groups, with opposite
sex and desire for experimentation.
Late adolescence(17-19yrs):
Distinct identity, well formed opinion and ideas

3. Adolescence is special
(Transient from childhood to adulthood)
• Rapid physical and psychological (cognitive and
emotional) growth and development.
• New capacities and identities are developed.
• Shows changing social relationships, expectations,
roles and responsibilities.
• Still lack autonomy, which means unable to
control their sexual experiences leads increasing
RH risk

4. Addressing ASRH is important and challenging.
• Adolescents are a diverse group and with changing needs
 Adolescents aged 10-19 constitute approximately 20% of the world pop
 The fertility level for this age group is decreasing but decreasing more
slowly than for other age groups resulting in an increasing proportion of
births being to adolescent mothers.
 Pregnant adolescents resort to abortion more often than pregnant women
of other age groups
 Reproductive health programs have traditionally been accessible
only to married adolescents and overlooked the needs of unmarried
adolescents.

5. A comprehensive Toolkit needs to design to cover several overlapping
approaches to increase ASRH knowledge and improve their sexual
behaviours.
 Certain social norms, cultural practices and religious beliefs that may prevent
young people from accessing the information and services they need to protect
themselves from STIs/HIV, pregnancy, unsafe abortion, childbirth, sexual abuse
and sexual violence.
 In many societies, sexual activity among young people prior to marriage remains
stigmatised and even talking about sex is taboo.
Need to have an implementer in creating a strong partnership
Emphasized the importance of diversifying the information base and designing
strategies tailored to the distinctive needs of adolescents based on their:
Age, Gender, Marital status, Schooling status, Residence, Living arrangements
(with one, two, or no parents)

6. Targeted group
3 main reasons for focusing young adolescent
i. sexual maturation begins between the ages of 10-14.
ii. Attitudes and behaviors not yet hardened.
iii. still attending as venues to reach a large adolescents group
Young adolescents lack the knowledge and skills to reduce risks associated with
puberty.
Vulnerable to violations of their sexual rights by peers and adults, including
members of their own families.

7. Challenges
 Many teachers do not have the skills, time or motivation to adequately
teach sexuality education and are often uncomfortable teaching about SRH.
 Parents can have difficulty clearly communicating with their children about
SRH issues and thus expect teachers to do this for them.
 Community members are often unsupportive of sexuality education
projects.
 Health workers can scold youth instead of giving them the SRH services they
need, making health centres the last place young people want to go.
Target group:
pupil, parent, teacher, community
members, healthcare worker

8. pupil Peer group club (pembimbing rakan sebaya, Doktor Muda)
teacher Family life education
parent Lack of parenting class / improve communication skills
community Lack of awareness on the community’s understanding of the
issues involved with sexual and reproductive health and rights
Healthcare worker youth-friendly and accessible.

9. Program design related to Adolescents’ Needs
Goal: to enable adolescents to have their sexual and
reproductive rights
 provide adolescents with knowledge and services
 sexual and reproductive health care for all including the
adolescents
 create an enabling environment to reinforce
 preventive interventions and services specific to adolescent

10. Information, education and communication
Initiate before adolescents engage in sexual activity
Focus on giving adolescents the skills
 to postpone the onset of sexual activity
 to engage in safer sexual practices once sexual activity begins
 For sexually active adolescents, IEC and services
 raise the level of contraceptive use
 increase condom use

11. IEC and advocacy initiatives should address:
 parents, teachers and local leaders
 religious leaders
 national level policy-makers
Research is important to understand ASRH problems
and the underlying socio-cultural, economic and other
development factors

12. • Networking
Involvement of all stakeholders
networking at all levels
Involving Adolescents in programming

13. • The Religious environment influence
sexual attitudes and sexual guilt.
• The education level and work experience
of the parents may influence attitudes
and present opportunities for sexual
activity if parents are away.

14. Adolescent Development Areas
Physical
Cognitive
Sexual
Spirituality
Emotional/
Social
Values/
Morals
Identity
Source: McNeely and Blanchard (2009)

15. 5 C’s of Positive Youth Development
Competence Confidence Connection
Character Caring
Source: Lerner, et. al (2005)

16. Politicians
Journalists
Bureaucrats
Relatives
Friends
Family friends
Teachers
Sports coaches
Healthcare providers
Religious leaders
Traditional leaders
Parents
Brothers/Sisters
Adolescents
Musicians
Film stars
Sports figures
Source: UNFPA

17. Key health problems in adolescence.
Sexual & reproductive health
- Too early pregnancy
• risks to mother
• risks to baby
- Health problems during pregnancy &
child birth (including unsafe abortion)
- ST Infections including HIV
- Harmful traditional practices e.g. female
genital mutilation
- Sexual coercion
Source: United Nations. World Youth Report 2005. Young people today, and in 2015. United Nations. 2005. ISBN
92-1-130244-7.
Other issues
- Injuries from accidents & intentional
violence
- Mental health problems
- Substance use problems
- Endemic diseases: malaria,tuberculosis
- Under/over-nutrition

18. Healthy Relationships
Emerging Issues:
• Teen Dating Violence/Adolescent Relationship
Abuse
• Normalizing of risky behaviors
• Digital Abuse
– Cyberbullying
– Sexting and ‘Textual’ harassment
• Commercial sexual exploitation/sex trafficking
Futures Without Violence (2011), The National Campaign to Prevent Teen and Unplanned Pregnancy (2008),
Stewart, et. al (2012)

19. Reproductive Health
Emerging Issues:
• Sexual and reproductive coercion
– Intentional exposure to STIs
– Contraceptive tampering/control
– Threats/acts of violence about
reproductive decision-making

20. • Ignorance about sex and sexuality
• Lack of understanding
• Sub optimal support at family level
• Social frustration
• Inadequate school syllabus about adolescent health
• Misdirected peer pressure in absence of adequate
knowledge
• Lack of recreational, creative, and working opportunity

21. Reasons for adolescent reluctant to seek help
• Fear
• Uncomfortable With Opposite Health Worker
• Poor Quality Perception
• Lack Of Privacy
• Confidentiality
• Cumbersome Procedure
• Long Waiting Time
• Parental Consent
• Operational Barrier
• Lack Of Information
• Feeling Of Discomfort

22. Public Health is one of the efforts organized by society to protect,
promote, and restore the peoples’ health.
Public health is the combination of sciences, skills, and beliefs that is
directed to the maintenance and improvement of the health of all the
people through collective or social actions.
(source: John M. Last’s Dictionary of Public Health (2001)

23. Essential Public Health Functions
1. Monitor health status to identify community health problems.
2. Diagnose and investigate health problems and health hazards in the
community.
3. Inform, educate, and empower people about health issues.
4. Mobilize community partnerships to identify and solve health problems.
5. Develop policies and plans that support individual and community health
efforts.
6. Enforce laws and regulations that protect health and ensure safety.
7. Link people to needed personal health services and assure the provision of
health care when otherwise unavailable.
8. Assure a competent public health care workforce.
9. Evaluate effectiveness, accessibility, and quality of personal and population-
based health services.
10. Research for new insights and innovative solutions to health problems.

24. Public Health Approach
• Define the health problem.
• Identify risk factors associated with the problem.
• Develop and test community-level interventions to control or
prevent the cause or the problem.
• Implement interventions to improve the health of the
population.
• Monitor those interventions to assess their effectiveness.
Solutions informed by Evidence

25. Public
Health
Approach
Problem Response
Surveillance:
What
is the
problem?
Risk Factor
Identification:
What is the
cause?
Intervention
Evaluation:
What
works?
Implementation:
How do you
do it?

26. Public Health Approach
• The potential for prevention or control frequently requires:
–A plan
–A champion
–A strategy
–A method
–The will
–Funding

27. Service providers:
- are non judgemental &
considerate in their dealings with
adolescents
- deliver the services in
the right way
Planning a quality health service provision to
adolescents.
Community members support
the provision of health
services to adolescents.
Adolescents
- are aware of what services are being
provided
- are (& feel) able &
willing to obtain the health services
they need
Healthcare service delivery:
- enable adolescents to obtain the health services
- appealing to adolescents &
respectful of them
- provide the health services that
adolescents need
Source: UNFPA

28.  Involve young people as key decision-makers in
program design, implementation, and evaluation
 Provide comprehensive, accurate information in
a manner appropriate to their age group and sex
 Address barriers to accessing health and
information services
 Empower adolescents to make life choices that
are best for them
Adolescent sexual and reproductive
health education for adolescents must:

29. Early Adolescence: Ages 10 - 14
Critical Interventions:
1. Sexuality Education
2. Mass Media
3. Parent-child Communication
4. Strengthening the protective environment

30. Older Adolescence: Ages 15 - 19
CriticalInterventions:
1. Sexuality Education and Sexualand Reproductive Health
2. Harm Reduction and risk reduction through prevention of initiation
3. Mass Media and technology
4. Engaging young people and the community to change socialnorms
5. Cash transfers to change
6. Addressing stigma, discrimination and legalbarriers to access

31. Young Adults: Ages 20 - 24
Critical Interventions:
1. Biomedical interventions
2. Condom provision and uptake
3. Sexual and reproductive health, family planning and PMTCT
4. Reaching young people in the workplace

32. • Health Education
• Skill Based Health Education
• Life Skill Education
• Family Life education
• Counseling For Emotional Stress
• Nutritional Counseling
• Early Diagnosis & Management Of Medical And Behavioral
Problem
Prevention By Healthcare System

33. Focus areas
• Boys and girls have different experiences, particularly during puberty.
• To assure acceptability and sustainability, local stakeholders and
community leaders must be involved in program planning.
• Monitoring and evaluation should not be afterthoughts—research,
observation, and documentation are processes that should be built into
programs from the beginning
• Program plans should take into account the role that new social and
economic options might play in assisting adolescent boys and girls in
achieving good sexual and reproductive health
• Importance of working outside the health sector and forming
partnerships with organizations that have expertise in community
mobilization, livelihoods development, or other types of interventions that
build skills.

34. • Effective sexuality and reproductive health education requires
participation and support of stakeholders at all levels (e.g.,
national, local, teacher, parent, and student)
• Livelihood programs may serve the dual purpose of offering
adolescents opportunities to attain a better standard of
living, become self-motivated, and achieve mobility while
reducing risky behavior that often results from social and
economic vulnerability.

35. Criteria
Input
Process
Output
The things that need to be in place in a health
service-delivery point.
The way in which staff at a health service-
delivery point deal with adolescents & with
other community members..
The desired effect on adolescent users of the
health service delivery point & other community
members.

36. Input Criteria Process Criteria Output Criteria
display a sign board welcoming adolescents &
informing them about the availability of quality
health services.
No process criterion. Adolescents are well
informed about the
availability of quality
health services from
Service Delivery Points.
A plan is in place for staff to visit educational
institutions in the catchment areas to inform
adolescents about the availability of quality health
services.
staff are visiting educational
institutions to inform adolescents
about the availability of quality health
services.
A plan is in place to engage organizations (e.g.
NGOs) working with children/adolescents on the
street) to inform the adolescents they come into
contact with about the availability of quality health
services.
staff are meeting these organizations
to brief them about the availability of
quality health services, and to request
them to communicate this message.
A plan is in place to engage local performing
groups to provide information about the availability
of services through media.
staff are meeting with local performing
groups to engage them in
communicating information about the
availability of services through media.
Information about the availability of quality health
services has been posted in pharmacies and
shops in the area.
No process criterion.
Information about the availability of quality health
services has been provided in the mass media.
No process criterion.

37. National level
•Providing directions
•Providing methods & tools
•Providing human & material support
District level
•Acting as a bridge between the national level &
the district
•Playing a facilitating role in the district
•Supporting the service delivery points
•Supporting community action
Local level
Different but complementary actions at
national, district & local levels.

38. Service Delivery
Points
District Level National or state
level
INPUT CRITERIA
Display a sign board welcoming adolescents &
informing them about the availability of quality
health services.
Develop sign board, and
put up signs.
Design sign board.
A plan is in place for staff to visit educational
institutions in the catchment areas to inform
adolescents about the availability of quality health
services.
- Map the educational
institutions.
-Make a plan to visit
them.
- Implement the plan.
Send a letter informing
principals about the
initiative.
A plan is in place to engage organizations (e.g.
NGOs) working with children/adolescents on the
street) to inform the adolescents they come into
contact with about the availability of quality health
services.
-Support and monitor the
work of these
organizations.
Organize meetings to
brief organizations
which come into
contact with
adolescents.
A plan is in place to engage local performing
groups to provide information about the availability
of services through media.*
Support and monitor the
work of these
organizations.
-Identify & engage
groups.
- Develop a plan for
their performance.
- Support them in
conducting their
performances.
- Develop messages &
scripts and have them
approved.
Information about the availability of quality health
services has been posted in pharmacies and
shops in the area.*
- Map the pharmacies
and shops.
-Make a plan to go and
post posters.
- Implement the plan.
-Prepare a list of
selected pharmacies &
shops.
- Send them posters for
display.
- Develop posters and
send them to the districts.
Information about the availability of quality health
services has been provided in the mass media.*
Contribute to mass
media programmes If
possible)
- Publicize the
availability of quality
health services through
local mass media.
- Carry out a mass media
campaign.
Adolescents are well informed about the availability of quality health services

39. Service Delivery
Points
District Level National
or state
level
PROCESS CRITERIA
staff are visiting educational institutions to
inform adolescents about the availability of
quality health services.
Plan and monitor these
visits.
staff are meeting these organizations to brief
them about the availability of quality health
services, and to request them to communicate
this message.
Plan and monitor these
visits.
staff are meeting with local performing groups
to engage them in communicating information
about the availability of services through folk
media.
Support these groups and
monitor their work.
OUTPUT CRITERIA
Adolescents are well informed about the
availability of quality health services
Adolescents are well informed about the availability of quality health services

40. Specify ways and means to verify the achievement of the criteria
How will we know that the elements contributing to the quality of health service
provision are in place?

41. Adolescents are well informed about the availability of
quality health services
INPUT CRITERIA
display a sign board welcoming adolescents & informing them about the
availability of quality health services.
A plan is in place for staff to visit educational institutions in the catchment areas to
inform adolescents about the availability of quality health services.
A plan is in place to engage organizations (e.g. NGOs) working with
children/adolescents on the street) to inform the adolescents they come into
contact with about the availability of quality health services.
A plan is in place to engage local performing groups to provide information about
the availability of services through media.*
Information about the availability of quality health services has been posted in
pharmacies and shops in the area.*
Information about the availability of quality health services has been provided in
the mass media.*
Verifying achievement
of criteria.
What to verify ? How to verify ?
Is there a sign board ? Observation.
Interviews with staff from
selected educational
institutions.
Have SDP staff
visited educational
institutions ?
Interviews with heads of
selected organizations.
Have organizations working
with adolescents on the
street informed them ?
Interviews with leaders of
selected performing groups.
Observation.
Articles in the press.
Have articles been
published in
The local press ?
Are there posters ?
Have the groups done
this?

42. Adolescents are well informed about the availability of
quality health services
PROCESS CRITERIA
staff are visiting educational institutions to inform adolescents about
the availability of quality health services.
staff are meeting these organizations to brief them about the availability of
quality health services, and to request them to communicate this message.
staff are meeting with local performing groups to engage them in
communicating information about the availability of services through folk
media.
OUTPUT CRITERIA
Adolescents are well informed about the availability of quality health
services
Verifying achievement
of criteria.
What to verify ? How to verify ?
Is this being done ? Observation of visits by staff to
edu. Institutions.
Observation of the groups in
action.
Is this being done ?
Observation of selected
performances.
Is this being done ?
Focus Group Discussions with
adolescents in the area.
Are they well informed ?

43. Outline the preparatory work that needs to be done at the
national level before the quality standards can be applied
What groundwork needs to be done in order for all these ideas can be translated
into reality?

45. Design your SBM intervention
• Step 1: Needs assessment
• Step 2: Developing the matrices for the target group-specific
interventions
• Step 3: Linking the change objectives to theoretical methods
used in the interventions
• Step 4: Creating a coherent program for intervention
• Step 5: Specifying the adoption and implementation plan for
intervention
• Step 6: Generating an evaluation plan

46. INTERVENTIONPersonal competent
and resources
Socioeconomic and cultural
resources
Social resources
Health resources
Improve skills
and
recognize
benefits
Information to
improve
health
Motivation
and support
Active
participation in
community
development to
improve health
statusStrong
community
networking
and
coordination
SBM intervention theoretical framework

47. Business Model Canvas -
Key Partners
Collaborations with other
organization to deliver
services
• Academic institutions
• Institute of
gerontology
• Ministries of social
welfare
• Health Ministries
• Local council
• Physical Rehabilitation
centres
• Hospitals,hospies
• Pusat Pungutan Zakat
• Community fitness
centres
Key Activities
Activities required
to deliver services.
Youth
• Module development in
social business
• Module development in
specific skills for the
wellness, rehabilitation
and healthcare services.
• Nominating volunteers
among students
• Training of the SB
modules and specific
skills.
Aged citizen
• Identifying the location
• Design and layout of
space
• organize the services
• meeting relevant
authorities to crate
awareness on the project
Value
Propositions
Customer pain to be
addressed
Youth
• Career potential
among students of
multi discipline in a
new multi disciplinary
area.
• Trained workforce in
a new business of
aging. (healthcare
workers)
Aged citizens
• Physical healthcare
(body rehabilitation
and reconditioning
after recovery of
illness)
• Individual wellness
(mental, motional,
physical exercise and
nutrition and cooking
classes)
• Community wellness
(event management
involving community
members)
• Home visits for
rehabilitation services
Customer
Relationships
Activities and plans to build
customer relationship.
• Initial interviews among
youth and aged citizens
in the urban dwellings on
the need and prospects
of a place for the
wellness and healthcare
facilities.
• Awareness event among
youth and aged citizens
on the new center.
Customer Segments
The identified
customers needed to be
relief of the pain.
• Unemployed Youth
with mismatched skills
and qualifications.
• Challenged and affluent
senior citizens
• Affluent children of the
aged citizens
Channels
Touch points to reach
customers
• Community centers
• Universities,colleges and
vocational institues.
• Old folk homes
• Club houses
Key Resources
Infrastructure required
• Training and lab space
• Trainers for SB
• Trainers for specific
skills in healthcare
rehabilitation, exercise
programs and
nutritionist.
• Volunteers
Cost Structure (The costs involved to create the activities).
Space rental, module writers, trainers fees, training materials, assets to be
acquired and pre-operating expenses.
Revenue Streams (The sources of revenue for the services offered).
Membership fees for services, rentals of equipments, training of
trainers and delivery sales of food.

48. Key
Partners
Key Activities
1. Module preparation
-Social business skills
-Specific skills training
-IPR for modules
2. Approval from relevant authorities
3. Household survey
4. Mapping and layout of location
5. Incorporation of company
6. Training certification (endorsement by
relevant agencies)
7. Business development
8. Focus group workshop
9. Sponsorship and tax exemptions
incentives
10. Website development & IPR
Value Propositions
1. Youth
-Resource Centre
-Certified by Department
of Skills Development,
Ministry of Human Resource
-Employment/Career
development
2. Ageing population
-One Stop Centre (OSC)
-Resource centre, skill
training (emotional,
physical fitness & social
support)
-Health screening
-Counselling
-Homecare
3. Care giver
-Resource Centre
-Certified by Department
of Skills Development,
Ministry of Human Resource
-Employment/Career
development
Customer
Relationships
Setup
UKM-CASB
GSihat
Customer
Segments
COMMUNITY
1. Youth
(students/une
mployed)
2. Ageing
population
3. Care giver
INDUSTRY
1. Government
2. Corporations
Channels
1. Flyers
2. Brochures
3. Campaigns
4. Retail
outlets
5. Newspape
rs
6. Social
media
7. Bulletin
Key Resources
1. Space , Experts, manpower
2. Module writers
3. Trainers
4. Community heads
5. Transportation & lodging
6. ICT, appliances,
7. Equipment providers
Cost Structure
Rental space, expert fees, module writers, trainers, community
heads, transportation & lodging, management cost, equipment,
ICT, incentives, business development, event management
Revenue Streams
Revenue from healthcare, fees from training and
certification, homecare, membership fees, and
sponsorship
Social & Environmental Cost
1. Reduce government cost on handling social and health problems
2. Reduce medical cost
3. Reduce welfare cost in managing youth and ageing problems
Social & Environmental Benefit
1. Employed youth
-Reduce social problems, disability and improve longevity
2. Healthy population
3. Productive ageing
1. HUKM
2. HOSPIS MALAYSIA
3. KK CHERAS
4. DBKL (Jabatan
Perancang Bandar,
Jabatan Pembangunan
Komuniti)
5. MASJID CHERAS
6. BOMBA*
7. DEPARTMENT OF
SKILLS DEVELOPMENT
8. WELFARE
DEPARTMENT
9. PPZ SELANGOR
10. PERSIAP
11. LPPKN
12. FRHAM
13. PPPPM/FSSK
14. NURSING HOMECARE
15. NGO
16. KLINIK GUAMAN UKM
17. UKPK UKM

49. • THANK YOU