Implementation objectives for this ingredient:

An evidence and planning base for programming

Participation of adolescents

Priorities for adolescent programming

Priorities for early childhood development programming

Supporting every woman, child and adolescent to realize their individual potential requires specific attention to programming for adolescents and for early childhood development – two areas that are often neglected in national strategies. Optimizing the demographic dividend from the world’s 1.2 billion adolescents (aged 10-19) requires investment in strategies to prevent adolescent deaths (“Survive”), support improved adolescent health (“thrive”) and expand enabling environments (“transform”) for programming for and with adolescents. An estimated 200 million children younger than 5 years are not achieving their developmental potential. Much greater investment in early childhood development is required with inputs from all key sectors. Care and nurture during the first 1000 days of life is a core intervention that promotes healthy development, linking both the targets for “Survive” and “Thrive.”

7.1 An evidence, advocacy and planning base for programming

Given the relative lack of attention to areas around individual potential, national partners should consider a number of strategic steps to build the evidence, advocacy and planning base for action including:

  • a situation analysis, focusing on demographic, epidemiologic, social and other health and well-being indicators (for example, to define the most at risk adolescent and early child groups, gaps and opportunities)
  • identifying the mix of health, non-health and structural interventions (policies and laws) required
  • developing national plans and programmes to implement interventions with efficient coordination and monitoring mechanisms
  • building data systems and implementing disaggregation by age and sex (including separating early and late adolescence), starting with secondary analysis of available survey data to obtain age-disaggregated estimates and supporting special studies (including modelling)
  • advocating for investment using local data as well as evidence and good practices from other countries, also highlighting the costs of inaction
  • leveraging partnerships with civil society, adolescent and youth groups to enhance commitment of national governments across sectors
  • forging partnerships with private sector groups willing to participate in reporting and accountability frameworks
  • securing the technical expertise needed by governments to identify priority issues and plan appropriate interventions
  • committing publicly to action, mobilizing resources and commencing action.

7.2 Participation of adolescents

Adolescents are agents of their own development and can influence movements for social change. Initiatives that involve the meaningful participation of adolescent girls and boys in their design, implementation and evaluation tend to be more relevant and effective. To that end, mobilizing adolescents and engaging them in the formulation and roll out of the national health plan will help ensure that their issues are adequately represented at country and community level. This involves:

  • establishing adolescent-responsive structures and processes to institutionalize adolescent participation in relevant public policy dialogue and programme implementation
  • empowering adolescents and youth by providing them with the information and skills needed to enable their meaningful participation and contribution, as well as raising awareness of their rights and avenues for redress
  • supporting fora for adolescents to share their experiences, good practices and models of successful adolescent-led interventions.

7.3 Priorities for adolescent programming

Priorities for adolescent programming include:

  • addressing the common determinants underlying key health problems for adolescents, including legal, policy, environmental and behavioural elements as well as harmful social norms and gender stereotypes, across sectors
  • providing comprehensive sexuality education for adolescent girls and boys
  • developing health systems with provision of adolescent- and youth-responsive health information and integrated health services (including sexual and reproductive health services, linked with HIV services, immunization and psychosocial support)
  • tackling financial and legal barriers to health care
  • promoting partnerships between schools, health centres, adolescent and youth groups to enhance commitment and understanding of adolescent needs
  • eliminating harmful practices such as early and forced marriage, female genital mutilation and violence against women and children
  • controlling exposure to unhealthy products including tobacco, alcohol, illegal substances and unhealthy foods and beverages
  • improving the nutritional status of adolescent girls, with adequate assessment of status and research to assess needs and interventions
  • assessing and treating mental health and preventing suicide.

7.4 Priorities for early childhood development programming

Priorities for early childhood development programming include:

  • addressing greater integration between sectors to promote nurturing care and protection for every young child to improve developmental outcomes
  • recognizing and advocating for solutions to the emerging issue of children at increased risk of neurodevelopmental and social-emotional difficulties
  • addressing the common determinants underlying poor child-rearing practices in the first years of a child’s life (including stressors affecting the caregiver’s ability to promote child health and development)
  • promoting packages of core interventions aimed at vulnerable adolescent parents including improved quality prenatal care and support and counselling through the 2nd year of life of their children
  • promoting local demand for parent/caregiver support services and early childhood development services.


India: Adolescent Health Strategy for Sustainable Inclusion and Growth

Recognizing the potential of adolescents for a demographic dividend, in 2014 the Government of India launched a national strategy, “Rashtriya Kishor Swasthya Karyakram” (RKSK) that proposes a multi-level, multisectoral solution to enhance adolescent health. Based on the principles of participation, rights, inclusion, gender equity and strategic partnerships, RKSK takes a comprehensive approach to adolescent health and wellbeing and situates adolescence in a life-span perspective within dynamic sociological, cultural and economic realities. While building linkages to a wider RMNCAH agenda through the continuum of care and health systems strengthening, it represents a shift from a clinical approach to effective community-based health promotion and preventative care.

In 2013, the Government of India shepherded a multisector process with the Ministries of Health, Youth, Education, and Women and Children to develop a holistic adolescent health programme that goes beyond clinical services. The process engaged young people from diverse backgrounds to share their needs and concerns from existing programmes, and proposed solutions to address the gaps. The Ministry of Health and Family Welfare worked with leading NGOs and young people to develop detailed implementation plans for the strategy’s launch and rollout.

The strategy prioritizes six areas of adolescent health identified through a situation analysis: nutrition; sexual and reproductive health; mental health; injuries and violence; substance misuse; and non-communicable diseases. The interventions are planned at distinct layers in the adolescent universe: individual, family, school and community thus entailing integrated action of different sectors. Though the strategy is within the Ministry of Health and Family Welfare, engagement of other sectors is ensured through multisectoral steering committees that operate on national, state, district and village levels. One of the innovations to increase accountability was to use participatory monitoring where the adolescents themselves are involved. The monitoring mechanism also complements data gaps in the HMIS which has limited age-disaggregated, adolescent-specific data.

Given its planned scope (total 676 districts), the RKSK programme is being implemented in a phased manner. After the first year of implementation in 213 districts, the programme improved access to health services and counselling, strengthened outreach and referrals through peer educators, enhanced nutrition by iron/folic acid supplementation and supported menstrual hygiene management. During the programme’s second year in 2015, an estimated 84 million adolescents will be reached.

Source: Global Strategy Adolescents Working Group