Rashtriya Kishor Swasthya Karyakram (RKSK) overview
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Rashtriya Kishor Swasthya Karyakram (RKSK)
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Rashtriya Kishor Swasthya Karyakram (RKSK) overview
- 1. Rashtriya Kishor Swasthya Karyakram (RKSK) State RMNCH+A Unit, J&K Tapas Chatterjee
- 2. Contents Adolescent Health Programme (RKSK) Need for AHP Target Population Strategy Components IMPORTANT PROGRAMMES-Adolescent Health Programme (RKSK) & NCDs Convergence State RMNCH+A Unit, J&K
- 3. Introduction • Core Area of RKSK-Health promotion and community based approach. • Expanded scope – Nutrition, Sexual and Reproductive Health, Injuries and Violence, Non Communicable Diseases, Mental health and Substance Misuse. • Launched on 7th Jan 2014,in 231 districts in country State RMNCH+A Unit, J&K
- 4. Objectives of RKSK • Improve nutrition • Enable Sexual and Reproductive Health. • Enhance Mental Health. • Prevent Injuries and Violence (Gender Based Violence ) • Prevent Substance Misuse. • Address conditions for Non Communicable Diseases. State RMNCH+A Unit, J&K
- 5. Strategies Facility based interventions • Adolescent Friendly Health Clinic (AFHC). Community based interventions • Peer Education. • Quarterly Adolescent Health Day. • Weekly Iron and Folic Acid Supplementation Program(WIFS). • Menstrual Hygiene Scheme. State RMNCH+A Unit, J&K
- 6. Strategies…………..contd. Convergence • Within Health Sector. • With ICDS and Department of School Education. Social and behavior change communication • IEC, IPC and BCC etc. State RMNCH+A Unit, J&K
- 7. • In absolute numbers, India has the largest adolescent population in the world: • Almost double the total population of Mexico Adolescent Population (10-19 Years): World and India Source: World Population Prospects: The 2012 Revision 17% INDIA’s CONTRIBUTION 14% INDIA’s CONTRIBUTION 253 million State RMNCH+A Unit, J&K
- 8. of aged 15 and over are insufficiently active 31% Physical inactivity- 6% of deaths , main cause for 21–25% of breast and colon cancers, 27% of diabetes, 30% of ischaemic heart disease adolescent boys use tobacco 18% 50% continue to smoke 7% deaths 30% NCDs due tobacco use adolescent are obese 11% Overweight & obesity - 44% of diabetes, 23% of ischaemic heart disease and 7-41% of certain cancers of adolescents experience a mental health problem 20% Antisocial personality disorder- greater than 50% of first diagnoses across the life course are ONLY by age 25 years 47% experience alcohol dependence of adolescent girls and 14% of boys reported use alcohol. 18% 9% of all deaths in 15 and 29 age group due to alcohol-related causes Behaviors Formed In Adolescence Influence Health & Morbidity Across Life continue to be overweight 50% Source: WHO 2008; WHO 2009; WHO 2011 State RMNCH+A Unit, J&K
- 9. Why invest in adolescents? Demographic Dividend: 253 million adolescents represent a huge opportunity that can transform the social and economic profile of the country only if substantial investments in their education, health and development Shifting burden of disease: 53.5% of total deaths in India are now due to non-communicable diseases compared with 40% in 1990 Adolescent vulnerabilities: sexual & reproductive health, violence and injuries, self harm, substance misuse and gender based violence State RMNCH+A Unit, J&K
- 10. Rationale for RKSK Vulnerabilities of adolescents : • Malnourished and anaemic • Unintended and unwanted pregnancies/unsafe abortions • Maternal mortality higher in adolescents • Infant mortality higher amongst young mothers • Incidence of STIs including HIV/AIDS among adolescents • Sexual abuse/violence and unwanted sexual activity • Prone to accidents, injuries and violence • Suffer from mental health problems State RMNCH+A Unit, J&K
- 11. The Paradigm Shift and Key Thematic Areas Healthy Lifestyle Violence free living Improved nutritional status Substance misuse prevention Reproductive and Sexual Health Mental and Emotional Well Being RKSK Objectives State RMNCH+A Unit, J&K
- 12. RMNCH+A-India’s Response Unless we engage with adolescents, we can’t achieve improved health outcomes Comprehensive strategy based on a life cycle approach Underpinned by the concept of ‘continuum of care’ +A denotes focus on adolescents, linking community and facility based care Life Cycle and Continuum of Care Approach in RMNCH+A Reproductive, Maternal, Newborn and Child + Adolescent Health The RMNCH+A Strategy
- 13. State RMNCH+A Unit, J&K
- 14. RKSK Implementation Framework: 7 Cs
- 15. RKSK Implementation Framework: 7 Cs
- 16. RKSK Implementation Framework: 7 Cs
- 17. RKSK Implementation Framework: 7 Cs
- 18. RKSK Implementation Framework: 7 Cs
- 19. RKSK Implementation Framework: 7 Cs
- 20. RKSK Implementation Framework: 7 Cs
- 21. The 7 Cs Coverage Content Communities Clinics Counseling Convergence Communication Communication is an integral part of each ‘C’
- 22. Unpacking Rashtriya Kishor Swasthya Karyakram (RKSK) Adolescent Friendly Health Clinics •Establishment of walking Clinics at Sub-centre and dedicated clinics at Primary Health Centre level, Community Health Centre, District Hospital and Medical colleges •Provision of acceptable, accessible, comprehensive, effective, equitable and appropriate health services to all adolescents – a dedicated counselor for adolescents CHC onwards Weekly Iron and Folic Acid Supplementation Programme •Weekly IFA supplements and biannual De-worming for in-school girls and boys in 6-12th class of govt. / govt. aided and municipal schools and out-of-school girls in 10-19 yrs •Information and counseling to improve dietary intake and actions for prevention of worm infestation • Management and referral for those diagnosed with mild to sever Anemia Scheme for Promotion of Menstrual Hygiene •Increase awareness about menstrual hygiene among rural adolescent girls •Increase access to & normalize use of quality sanitary napkins at affordable prices in rural adolescent girls •Ensure safe disposal of sanitary napkins in an environment friendly manner Peer Educator programme •Formation of group of 15-20 boys or girls from community and conducting 2 hour sessions per week, organizing and participating in the quarterly Adolescent Health Day •Referring adolescents to Adolescent Friendly Health Clinics for counseling and clinical services Quarterly Adolescent Health Day •Organized in every village once every quarter to disseminate information and create awareness •Peer Educators, ASHAs, and AWWs to mobilize adolescents, parents and other stakeholders
- 23. Thank You State RMNCH+A Unit, J&K
Editor's Notes
- India related data (Source: WHO Global Youth Tobacco Survey, 2009; WHO Global Report Mortality Attributable to Tobacco 2012) Tobacco BEHAVIOR 19% of in-school boys in India and 8.3% of in-school girls in India between the age of 13-15 currently use some form of tobacco An additional 15.5% of adolescents who have never smoked are likely to initiate smoking next year 24%/13.4% of adolescents think that boys/ girls who smoke have more friends 21.1% /15.6% of adolescents think that boys/girls who smoke are more attractive ASSOCIATED MORTALITY OUTCOME Physical activity 7% of all deaths among Indians over the age of 30 are attributable to tobacco 15.6% of population above the age of 15 in India is physically inactive* For females, the proportion of physically inactive is substantially higher: 18.4% of females are physically inactive against the figure of 15.6% of males in the same cohort
- for point two: Lifestyle and behaviour are linked to 20-25% of the global burden of disease. By 2020, non-communicable diseases are expected to account for 7 out of 10 deaths in the developing regions. More than 33% of the disease burden and almost 60% of premature deaths among adults can be associated with behaviour or conditions that began or occurred during adolescents. For Point 3: 1.4 million die from traffic accidents, suicide, gang-related violence, AIDS, childbirth complications among other causes. Some 430 young people (10-24) lose their lives every day due to interpersonal violence. 20 % of adolescents experience mental health challenges, Close to a quarter of a million of adolescents die from alcohol-related causes, around 150 million young people are active smokers, while substance abuse is used by many to cope with unemployment, neglect, violence and sexual abuse. Worldwide, obesity continues its growth as public health concern among adolescents driving up health care costs, often in the very same countries where poor nutrition for others drives illness, stunting and low educational performance. Globally some 2.2 million adolescents live with HIV yet most do not even know they are infected. Around 41 % of all new HIV infections are among adolescents and youth, with girls and young women outnumbering young men by almost two to one. nearly one in seven cases of young women acquiring HIV could have been prevented had they not been subjected to intimate partner violence. An AIDS-free generation will not be achieved without adolescents and yet they are the only age group in which AIDS related deaths have increased. Discrimination, poverty, inequalities, and harsh laws will continue to prevent adolescents from seeking and receiving testing, health care and support. A recent (2013) UN multi-country study on Men and Violence in Asia and the Pacific found that nearly half of the 10,000 men interviewed reported using physical and/or sexual violence against a female partner; a quarter reported perpetrating rape against a woman or girl with half reporting their first perpetration as occurring when they were teenagers, and some even younger than 14. Adolescent pregnancy is a major contributor to maternal and child mortality, and to the vicious cycle of ill-health and poverty. Early marriage is followed by early pregnancy. Around 11 per cent of all births worldwide, or an estimated 16 million, are to girls aged 15–19 -amongst these 16 million births, 2 million are to girls under the age of 15. Girls aged 15 or younger are five times more likely to die from pregnancy complications and have a higher risk of adverse maternal and birth outcomes, including stillbirths, neonatal deaths, preterm births, Low Birth Weight, and complications during birth than do those older than 19 years. Complications related to pregnancy and childbirth account for the deaths of some 70,000 adolescent girls (24 % of all maternal deaths) each year and are among the leading causes of death in girls of this age group. Adolescent girls also have higher levels of unwanted pregnancy with more than 3.2 million having unsafe abortions. Young age and lack of appropriate services results in high maternal mortality. Maternal mortality rates for this group are twice as high as the rates for women aged 20-29 years. In India 46% of all maternal deaths take place among those women aged 15-24 years - with 7% mortality reported in the age group of 15-19 and 39% being reported in the age group of 20-24. Neonatal mortality rates, hugely influenced by maternal health, is as high as 54/1000 among those aged 15-19, compared to 34-38/1000 among women aged 20-29 and 30-39 respectively. Rural adolescents are particularly at risk: neonatal mortality among them is as high as 60/1000 (compared to 31 among urban adolescents). Contrary to our assumptions, 90 % of births to adolescent mothers occur within marriage and on an average, each day, 39,000 girls get married, without their prior, informed and free consent and in violation of their basic human rights.