Guidelines for

Training Under
ARSH
Medha Gandhi
Consultant (Adolescent Health)
MoHFW
14
th
July 2011
arshconsultantgoi@gmail.com
!resentation Structure
ARSH !rogramme under RCH
Objectives of the !rogramme
Training for ARSH
Modules
Methodology
Training to Service Delivery
Role of NHFW
3
AdoIescents - Target PopuIation
Age Group
10 -14 years (young adolescents)
15-19 years
$ex
Girls
Boys
ProfiIe
Rural
Urban
$tatus
Married
Unmarried
Education
n-School
Out-of-School
4
AdoIescence - A CriticaI Phase
Changing behaviours:
Growth - transition from childhood to adult
Peer pressure
Early sexual debut: Premarital sex
Substance use
Eating behaviours
Guiding Principles:
Adolescence - a time of opportunity and risk
Not all adolescents are equally vulnerable
Problems have common roots and are interrelated
5
Adolescence An age of exploration
An age of curiosity An age of curiosity
An age of excitement An age of excitement
6
Adolescents are considered healthy but have
specific needs and problems
EarIy Pregnancy:
EarIy marriage
PremaritaI sexuaI activity
High MaternaI MortaIity, and High Infant MortaIity
NutritionaI probIems:
Under-nutrition and anaemia
$TIs / HIV: 35 % of new HIV infections in young peopIe (NACO)
MentaI HeaIth ProbIems:
Depression, $uicide: About 4 miIIion suicide attempts take
Iives of 90,000 adoIescents every year gIobaIIy
Drug Use: Most aduIt smokers begin smoking during
adoIescence
VioIence, Injuries
Endemic diseases: TB, MaIaria.
7
W Over haIf (58%) of Indian women are married before they attain
18 years of age (NFH$ 3)
W 6000 adoIescent mothers die every year due to anaemia (NFH$
-3)
W 61.7% of aII deIiveries beIow 20 years of age are home
deIiveries (NFH$ -3)
W
W 47 per cent girIs in this age group are underweight (NFH$ -3)
W 45% of maternaI mortaIity is in the age group of 15-24 ($#$ -
2009)
W 50% higher risk of infant deaths among mothers aged beIow
20 years (NFH$ -3)
Compelling Facts about Adolescents
8
AdoIescent
HeaIth
ChiId
HeaIth
MaternaI
HeaIth
FamiIy
PIanning
#CH
Immunisation
#EP#ODUCTIVE & CHILD HEALTH #EP#ODUCTIVE & CHILD HEALTH
9
ADOLE$CENT
HEALTH
AdoIescent
HeaIth
AFH$ / cIinics
AdoIescent
Anaemia
Program
$chooI HeaIth
Capacity
BuiIding
MenstruaI
Hygiene
project
W An important opportunity for
achieving MDGs 4, 5, and 6
W mproved health of adolescents better
health outcomes, including for RCH,
through
Reduction in adolescent anaemia
and malnutrition
Delayed age at marriage and birth
spacing (reduced risk of maternal
and infant death)
Avoidance of lifestyle diseases
Better mental health to cope with
increased educational / career
competitiveness
Avoiding HV, RT/ ST, and unsafe
abortions
W Low focus on AdoIescent HeaIth
10
MOHFW RCH ARSH Strategy MOHFW RCH ARSH Strategy
A#$H $trategy aims to contribute to the #CH II
goaIs of reduction of IM#, MM# and TF#.
Objective to be met by:
(i) reducing teenage pregnancies
(ii) meeting unmet contraceptive needs
(iii) reducing number of teenage maternaI deaths
(iv) reducing incidence of $TIs and
(v) reducing proportion of HIV positive in 10-19 years
age group
11
nterventions for RCH ARSH nterventions for RCH ARSH
ARSH strategy focuses on reorganizing the existing pubIic
heaIth system in order to meet the service needs of
adoIescents.
!rovision of adolescent-friendly health services in established
institutions
!rovision of strategic information, accessibility to services and
enabling & adolescent-friendly environment
Strategic directions:
ncorporate adolescent issues in all RCH training
programmes and all RCH materials developed for
communication and behaviour change
Undertake special initiatives (e.g. Adolescent clinics) to
reorganize services at health facilities on dedicated days
and timings for adolescents
12
nterventions for RCH ARSH nterventions for RCH ARSH
$ervices for adoIescents to cover preventive,
promotive, curative and counseIIing services
Capacity buiIding of service providers to meet
service needs of adoIescents
Communication activities to be undertaken
MI$ indicators identified as per specific
objectives
Inter-sectoraI Iinkages with MoWCD, MH#D,
MoYA$, NACP and N#HM interventions
Understanding the ARSH !rogramme
Ownership of the programme with States
Systematic planning and implementation
Budget for ARSH as part of RCH !!
Dedicated and trained staff to manage and
implement the programme
Monitoring and supportive supervision
!eriodic reporting and analysis of reports
Convergence with existing progs of MoH
and other Ministries
Strengthening ARSH - Training
Training of Medical Officers and ANM/LHV
on ARSH as per Go Guidelines and
norms
Ensuring quality of training
Linkage of trained providers with service
provision at clinics and in O!D
Training of CTC counsellors and ensuring
their involvement in the programme
15
ARSH Training Strategy
ARSH Modules for Medical Officers and
ANM/LHV developed by MoHFW
mplementation Guide for ARSH !rogramme
developed and disseminated to the States
!ool of national trainers
Training of Trainers for State Master Trainers
facilitated in all states and UTs (3 days)
One day orientation for state and district
programme managers also facilitated
Training as per RCH norms
SHFW play a lead role in facilitating training
ARSH Training
!urpose of the training
Orient the service providers to offer adolescent friendly services
Make O!Ds adolescent friendly
Sensitivity to the needs of adolescents
Strengthen counselling skills
dentify latent health both physical and mental problems for
adolescents
nnovation in Training
Some states have developed state specific modules on
counselling for adolescents.
SHFW plays a lead role in the same
Quality of Training
NHFW and SHFW to take a lead role in monitoring quality of
ARSH training at the district level
Observations to be shared with MoHFW
Training of Trainers for ARSH
3 day ToT facilitated at State HQ
Usually at the SHFW
Master trainers include trainers from
SHFW, S!MU, SHSRC, technical
divisions of state
Focus on training methodology,
counselling skills, attitudes and behaviour
change alongwith technical skills
Training of Medical Officers on ARSH
3 day training for Medical Officers
Topics include
Counseling
growth and development
communication with adolescent clients
quality ANC, !NC
mmunisation
Contraceptives
RT/ST
HV/ADS
Training of ANM/ LHV on ARSH
5 Day training for ANM/LHV
Topics include
Counseling
growth and development
communication with adolescent clients
!regnancy and unsafe abortion
mmunisation
Contraception for adolescents
RT/ST
HV/ADS
Nutritional needs and anaemia
Community Outreach and Role of ASHA
ASHAs have the potential to play an
important role in reaching adolescents in
the community
Adolescent growth and development and
menstrual hygiene currently covered in
module 4
Strengthening ARSH - Clinics
Making services for adolescents available
through special clinics
Dedicated physical space with privacy for
AFHC
Availability of trained staff at AFHCs
EC material on adolescent health for
providers and clients
Outreach from clinics and linkage with
community based programmes
!eriodic reporting from clinics
23
Strengthening ARSH - Convergence
AdoIescents serviced by MoYA$, M/WCD,
M/H#D and MoHFW (incIuding NACO)
No dupIication of work
OnIy compIementarities
$ectoraI division of roIes but overIap
defined
HeaIth - to Ieverage interventions from
other departments for overaII
deveIopment
24
$Iow roII out of A#$H interventions across states:
need to strengthen training and cIinicaI services
Ensuring quaIity in training
$ervice orientation in training
Gaps in screening, diagnosis and services for
adoIescents
Need to mobiIise adoIescents in the community
and bridge the gap
Improve heaIth seeking behaviour
$trengthen referraI services
Inadequate convergence with other departments
Strengthening ARSH Strengthening ARSH
25
ARSH mplementation: Way Forward ARSH mplementation: Way Forward
Coverage Universal coverage of all adolescents in 10-19 age
group through clinical based and community outreach
Communication nvolvement of key stakeholders like teachers,
parents, community, media etc for effective communication for
adolescents and their families to facilitate positive change
Counselling Trained and professional services for nutrition,
RSH, contraception and family planning, growth and
developmental needs, peer pressure, substance abuse etc
Clinics Diagnostic and treatment, nutrition, RT/ST/HV,
menstrual hygiene etc
Convergence - nter-sectoral convergence for demand
generation and extension of services
26
WAY FORWARD
Dedicated Division to be Created in MoHFW for AdoIescent HeaIth
New integrated strategy to be Iaunched
10-19 years
COVE#AGE
Boys and
Girls
Unmarried
and Married
Rural and
Urban
CLINIC$
Community
linkages,
Screening &
Referral
Diagnosis &
Treatment
Nutrition
Supplements
Menstrual
Hygiene
RT/ ST/ HV
COUN$ELLING
Reproductive
and Sexual
Health
Nutrition
Family !lanning
Growth Needs
(emotional &
mental)
!regnancy and
Safe Abortion
RT/ ST/ HV
COMMUNICATION
Out-of-School
School
& College
MO, SN, ANM,
ASHA, AWW
Modes
Target Audience
Community
Teachers
Media
NYK Teen
Clubs
Civil Society
nitiatives
CONVE#GENCE
ARSH
Menstrual Hygiene
School Health
Mental Health
Anaemia Control
SABLA
CDS
HRD - AE!
Water & Sanitation
MoYAS - NYKS
Rural Development
AE!
Lifestyle
diseases