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.