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Operationalizing Adolescent Health Services at Primary Health Care Level in India: Processes, Challenges and Outputs

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Health 2017年第1期9卷 1-13页

作者： Beena Nitin Joshi Sanjay Laxman Chauhan Ragini Nitin Kulkarni babita kamlapurkar Rajesh Mehta Department of Operational Research National Institute for Research in Reproductive Health (ICMR) Mumbai India Department of Operational and Clinical Research National Institute for Research in Reproductive Health (ICMR) Mumbai India Health and Family Welfare Bureau Government of Maharashtra Pune India Child and Adolescent Health WHO SEARO Office New Delhi India

Background: Ministry of Health, Government of India developed the Adolescent Reproductive and Sexual Health (ARSH) strategy and operationalized adolescent health services up to district and sub-district hospital level. Objectives: To operationalize adolescent health services at primary health care level in a block of Maharashtra;assess impact of need based interventions on quality of services;and understand potential for scalability in the state. Methods: Adolescent and Youth friendly centers were established at primary health care settings and interventions such as health system strengthening, sensitizing gatekeepers, involving Accredited Social Health Activist (ASHAs), developing inter and intra-sectoral linkages, improving monitoring and evaluation were tested. Results: Over a period of 2009-2014, there was a steady increase in the number of clients attending the Adolescent and Youth Friendly Health Centers (A&YFHCs). Attitude of providers to address adolescents’ needs improved significantly. Successful interventions were networking with schools, colleges and Non Government Organization (NGOs), linkages with HIV program and Integrated Child Development Services (ICDS), and involvement of ASHAs. Conclusions: The study demonstrates that although health system has the primary responsibility of addressing health issues among adolescents;it has limitations in terms of its reach to adolescents and generating demand for services. There is a need to network with education sector, ICDS, NGOs working for adolescent health and development to work as a team and address the multifaceted needs of the adolescents. Such a strategy will be crucial while implementing the recently launched Rashtriya Kishor Swasthya Karyakram— the new national adolescent health programme in India.

关键词： Adolescent Sexual and Reproductive Health Adolescent and Youth Friendly Health Services Quality of Care Standards Linkages

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