Download - 10th- 11th August 2011
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Minutes of the National Workshop on Adolescent Health
New Delhi
10th
- 11th
August 2011
The Ministry of Health and Family Welfare in association with the World Health Organisation
(WHO) India Country Office and the United Nations International Children‟s Emergency Fund
(UNICEF) organized a National Workshop on Adolescent Health in New Delhi from 10th
- 11th
August 2011. The objectives of the workshop were to:
1. Establish a common understanding of the Adolescent Reproductive and Sexual Health
(ARSH) strategy of Ministry of Health and Family Welfare as well as programmatic
approach adopted by various stakeholders on adolescent health;
2. Take stock of the existing situation in each state;
3. Explore linkages, both existing and possible, with the programmes of other stakeholders;
4. Introduce new guidelines on weekly Iron & Folic Acid supplementation;
5. Discuss thematic issues like IEC/BCC and monitoring and evaluation for ARSH.
Joint Directors/State Programme Officers and Consultants in charge of ARSH/RCH programme
from 27 States attended the workshop. Refer Annexure -1 for the list of the participants.
Inaugural Session:
Dr. Suresh K. Mohammed, Director (RCH), MoHFW welcomed the participants and gave an
overview of the schedule for the two day workshop and discussed session wise details. He
described Adolescent Health as the very heart of Reproductive and Child Health Services and
exhorted the participants to focus on the ARSH strategy. Dr. Henri van den Hombergh, Chief of
Child Health Section from the UNICEF India Country Officer supported the need for up scaling
of ARSH programme and touched upon the importance of adolescents as a group which needs
focused attention. Further, he emphasized the need for a multi-sectoral approach to address
issues of adolescents. He stressed the need for a life cycle approach viz. „healthy mothers-
healthy child- healthy adolescents- healthy mother‟. Dr. Paul P. Francis, The National
Professional Officer (Medical Epidemiology), WHO-India Country Office, underscored the
importance of using existing public health systems to address the issues of adolescent health and
development in India, considering the limitations on resource in a country like India. He noted
that the rate of implementation of the ARSH Programme varied from State to State and stressed
the need for sustained efforts across the country in order to achieve the goals of NRHM.
Mr. P.K. Pradhan, Special Secretary and Mission Director, NRHM from the MoHFW in his
inaugural address described adolescents as a neglected group who are integral to the success of
the RCH programme. The data from NFHS-3 had indicated clearly that adolescents are a
vulnerable group. He noted with concern the fact that neither the States nor the Central
Government had given ARSH the required focus. He stressed the importance of convergence
with the Ministry of HRD and MWCD, not just at National and State level but also at the District
and Sub District level. The Village Health and Nutrition Day (VHND) is an ideal platform to
focus on adolescent groups and this was underscored by the SS & MD. He also touched upon the
need to expand the scope of the SHP to include both school going and out of school adolescents.
He briefly explained the scheme for promotion of Menstrual Hygiene which has been launched
by the Ministry recently to reach out to adolescent girls. He said that under this scheme sanitary
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napkins would be made available to adolescent girls in 152 districts across 20 states in the first
phase. Out of these 107 districts will be supplied sanitary napkins as part of central supply from
the GOI, while in 45 districts, the State Governments will procure the napkins from Self Help
Groups (SHGs).
Dr. Amarjeet Singh, Joint Secretary in charge of Elementary Education from the Ministry of
Human Resources Development Ministry impressed upon the participants the need to raise their
level of passion for the implementation of programmes for adolescents including ARSH. He
described the enormous success of the School Health Programme (SHP) in Gujarat which had
reached a population of 1 crore in the State (i.e. 20% of the population of the whole State)
through synergetic efforts of both government and private doctors. He underscored the
importance of a dedicated cell for ARSH at the State and District levels. He informed the
participants and officials of the Ministry that about 12 crore children were getting meals under
the midday meal scheme across the country and offered this as a platform for the Ministry of
Health and Family Welfare for any programme that would improve the health and nutrition of
adolescent boys and girls.
Ms. Anuradha Gupta, Joint Secretary (RCH) from the Ministry of Health and Family Welfare, in
her keynote address, expressed concern about the variable performance of the ARSH programme
across the country. The need for a uniform definition for adolescents was highlighted and she
emphasized that the age group of 10-19 should be accepted as adolescents universally by all
Departments and Ministries and Development Partners. She stressed on a comprehensive „5 Cs‟
approach for addressing adolescents which includes Coverage, Counselling, Communication,
Clinics and Convergence. While discussing coverage the need to look at in school and out of
school, married and unmarried as well as rural and urban youth was underscored. Under
counselling, not just reproductive and sexual health issues but the need for a strong network of
counselling centres which provided services for the psychological, emotional and behavioural
needs of adolescents was discussed. She further emphasized the importance of effective
communication as the main key for the success of the programme. As part of this, a
multidirectional approach through teachers, peers, parents and adolescents themselves, was
highlighted. States, especially the low performing ones, were exhorted to upscale the number of
adolescent clinics in order to provide services to the adolescents such as screening and services
for various diseases etc and counselling. Lastly, the importance of convergence with WCD,
Youth Affairs, HRD, Mental Health and NACO was stressed. She said that a core team was
required at the State and District level to focus on Adolescent Health and ensure the place it
deserves, i.e. at the very heart of the RCH programme. In this regard, a management structure
should be put in place at the State and District level wherein ARSH, School Health and
Menstrual Hygiene Scheme (MHS) are under one comprehensive Adolescent Health team. She
also stressed the need to form an e-group of all members/participants for further sharing of ideas,
information and best practices.
Session-1 Implementation of ARSH – An Overview:
Director (RCH), Dr. Suresh K. Mohammed gave an overview of the problems/issues faced by
adolescents which made them an extremely vulnerable group and underscored the importance of
focused efforts in this regard. A situational analysis of the current level of implementation of the
ARSH programme was presented. The identified indicators were (a) number of Medical Officers
(MOs), ANM/Nurses and Counsellors trained on Adolescent Friendly Health Services (AFHS),
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(b) the number of functional ARSH Clinics and client load at the clinics and (c) outreach services
through either the clinics or peer based approach. It was noted with concern that some states
were unwilling/ hesitant to share data on ARSH services with the Ministry while the data
reported from many States were unreliable and of low quality. States were requested to ensure
that accurate data is compiled and transmitted in a timely manner each quarter. It was
emphasised that the system of routine reporting for the ARSH programme needs to be
strengthened. In this regard all states were requested to share the quarterly report on the ARSH
programme as per formats which would be shared with States. Refer Annexure 2 for the details
of medical providers, including MO and ANM/Nurse/LHV/MPW/Counsellor etc trained on
AFHS, Annexure 3 for data on operational ARSH Clinics in States with monthly client load and
annexure 4 for state wise details of outreach activities.
This was followed by a presentation by Dr. Kiran Sharma, National Programme Officer,
Adolescent Health and Development, WHO-INDIA on ARSH strategy and opportunities for
strengthening its implementation in the form of adolescent friendly health services. She
mentioned that adolescents are diverse group with diverse needs since their situation varies by
age, sex, class and socio-cultural settings. ARSH covers adolescents in the age group 10-19
years, yet special emphasis needs to be given to the very young adolescents in the age group of
10-14 years. The rationale of ARSH is embedded in the fact that nearly one fourth of India‟s
population is adolescents, maternal mortality is likely to be more 2-5 times more among
adolescents (15-19 years), unmet need of contraception, prevalence of under nutrition and
incidence of new HIV infections among adolescents. ARSH strategy addresses all these issues as
one of the pillars of RCH II.
While focusing on the steps required to be taken for effective planning and implementation of
interventions under ARSH, she deliberated upon the 7 Standards frame-work formulated and
adopted by Government of India, to provide adolescent friendly heath services to adolescents
within the existing public health system. She informed the participants that the state specific
need based service package may be developed ranging from Promotive, preventive and curative
to referral services. The field experiences have reflected that predominantly adolescents need
counselling service followed by Preventive, curative and referral services. Furthermore, to
ensure optimal utilization of servicers the it is pertinent that the adolescents are well aware of the
availability of services and find environment at the health facility conducive to seek services, the
heath service providers including the support staff are competent, motivated, sensitive and non
judgmental and socially enabling environment at the community level. Finally, it is also
important that the management information system is in place to monitor the quality of services
provided to adolescents.
She emphasized that we are faced with many challenges, while planning and implementation of
adolescent heath activities, namely the competing priorities maternal and child health. The
planners and administrators give inadequate focus on ARSH. Moreover, there is variable system
capacity both at the state and district level to plan and implement since it is an emerging
programme. In addition, since different ministries address different adolescent concerns,
convergence and coordination of activities becomes a challenge. So the need of the hour is to
explore effective convergence mechanism so that the potential strengths of each programme are
harnessed to address the most productive age group. Last but the not the least, it was
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emphasized that adequate attention needs to be given to build the capacity of the SPMUS and
DPMUs to plan, implement and monitor ARSH in an effective manner.
Post Session Discussions:
This session was followed by an intensive discussion with the state representatives on the present
structure of the ARSH programme and strategies for strengthening the same. The most notable
concerns expressed by the participants were;
Branding the AFHC by giving them a name which attracts adolescents
Broadening the coverage of AFHS by giving equal weightage to both school going and
out of school adolescents including girls as well as boys
Addressing the sexual and reproductive needs of unmarried adolescents
Coverage of all adolescents under cash incentive schemes irrespective of their age and
marital status
JS, MHRD suggested that the Adolescents clinics should have a catchy “Hindi Name”, which is
meaningful for the adolescents and is also self explanatory. While signifying the role of teachers
and counsellors he emphasized that for creating enabling social environment the community
based approach should be adopted, for which common service centers should be effectively used
at the village level, where counsellors, peer educators and teachers can play a vital role. These
service centers would not only generate awareness among adolescents but would also strengthen
out reach services.
Chief- Child Health-UNICEF took the discussion a step-further and identified that the peer-
educator approach should not remain focused upon school going adolescents alone; rather, it
should be utilized for educating and reaching to out-of-school adolescents. While addressing the
SRH needs of Adolescents he further emphasized that the sensitivity and non- judgmental
attitudes of health care professionals is pertinent for preventing both early-pregnancies and
unsafe-abortions amongst young girls. He stated that the contraceptive services and related
information should be readily available for both married and unmarried adolescents. The health-
care personnel should be oriented about the SRH needs of adolescents. With enhanced Inter
Personal communication skills health providers should build trust and provide the required
services including counselling on sensitive issues to make right decisions instead of burdening
the adolescent girl with dangers of early pregnancy and unsafe abortion.
This issue was further reiterated by District Family Welfare Officer (DFWO), Chandigarh.
She stated that, Chandigarh being an educational hub has large number of migrating residential
students in the city. A lot of young adolescents are having “live-in” relationships. In the recent
years the number of unmarried adolescent girls seeking abortion services has increased in
Chandigarh. Thus, opined that guidelines to provide safe abortion services and contraception to
avoid early pregnancies among unmarried, should be formulated under ARSH. NPO-AHD
(WHO) further identified that orientation and sensitization programmes together with
establishment of condom vending machines at selected desirable places is one of the options,
which the states may adopt. She also informed the participants that MOHFW is in the process of
developing a training package for peer educators tom address these issues.
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In order to ensure quality service delivery to adolescents, Maternal & Women’s Health
Specialist, UNICEF raised the policy issue related to cash linked schemes. She reported that
under the Indira Gandhi Scheme of the MWCD, cash compensation is provided to mothers from
18-24 years of age. However, the out-of school girls between 16-18 years of age have not been
included. She advocated that policy needs to address such issues and to standardize the age
criteria for various programmes and also there is a need to discuss such concerns with
representatives from all ministries. Medical Officer-AHD, WHO-SEARO clarified that the
Supreme Court of India though prohibits marriage below 18 years of age; however, it does not
identify such a marriage as illegal once it has already commenced. He further stated that the
larger issue within this discussion is the serious societal and public(s) understanding concerns
which affect the decision making bodies as well as implementation machineries equally. He
supported that clear policy guidelines would also improve the age-reporting mechanism for both
marriage and pregnancy registries. He reinstated that there is a need for sensitization of both
health personnel and policy-making officials for up-scaling the ARSH programme and avoiding
such serious ethical implications.
The other issues raised by the participants were development and inculcation of life-skills (LSE)
and adaptation of fun based approach for opening up multiple channels of communication with
adolescents. State Nodal Officer, Kerala suggested that the adolescent health strategy should
essentially focus upon LSE as the adolescent are self esteem, image-conscious, impressionable
and sensitive group. He further identified that these skills should be imparted at an early age i.e.
10-14 years to prepare the adolescents for negotiating the challenges and opportunities within
their fast changing environment. Since the mandate of MOHFW is more on health services,
coordination with other sector like SCERT is required. Further on communication strategy, BCC
Specialist-JHUCCP was of the opinion that a participatory “fun-based” approach should be
adopted while mobilizing young people. She supported the teen-clubs, red-ribbon clubs and peer-
educator based approaches by highlighting the successful UTTRAKHAND – UDAAN strategy.
She suggested that the life-skills education and all relevant SRH based information should be
communicated to the adolescents through this approach.
Lastly, addressing some of the issues raised by participants, Director, RCH responded that
though the peer-educator approach has been successful, the efforts have been fragmented. More
states should adapt and implement this approach. He further highlighted that the concern
concerns of unmarried needs to be addressed and ARSH strategy provided much needed
flexibility to the states to develop need based programmes. MO-AHD, WHO summarized this
session by identifying that up-scaling the programmes would need focused and concerted efforts
from multiple stake-holders. Moreover, peer-educator strategies and life-skills approach are
opportunities to be improvised upon. Also, basic provision of health-care services through
multiple channels i.e. AFHS, community based services etc are essential and must be focused
upon.
Session 2: Linkages with Other Programmes for Reaching Out to Adolescents
Chairperson – Dr. Suresh K. Mohammed, Director (RCH), MoHFW and Dr. Rajesh Mehta,
Medical Officer – Child and Adolescent Health, WHO/SEARO
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Adolescents are the target audience for programmes of various Ministries and Departments
including Health, Education and Women and Child Development. To ensure comprehensive
services for adolescents, it is imperative to ensure convergence at the national, state, district and
sub-district level. The second session focused on linkages with programmes within the Ministry
of Health and Family Welfare and schemes and programmes of allied ministries and departments
for scaling-up the ARSH programme. This session included the following presentations:
SABLA (Rajiv Gandhi Scheme in India for Empowerment of Adolescent Girls-
RGSEAG) Scheme, MWCD;
Integrated Counselling & Testing Centre (ICTC), NACO;
Adolescent Education Programme (AEP), MHRD
Menstrual Hygiene Scheme (MHS), MoHFW;
School Health Programme (SHP), MoHFW
SABLA – Scheme and Opportunities for Convergence with ARSH
Speakers – Ms. Lopamudra Mohanty, MWCD and Ms. Kajali Paintal, UNICEF
The first presentation in this session was by Ms. Lopamudra Mohanty, Deputy Secretary;
MWCD supported by Ms. Kajali Paintal, UNICEF on the SABLA Scheme and possible linkage
with the Adolescent Health programme of Ministry of health and Family Welfare. She stated that
the objective of the scheme is to improve nutrition and health status of girls, upgrade life skills,
promote awareness about health, hygiene and ARSH issues, preparing for availing public
services and mainstream out-of-school girls into formal/non-formal education for adolescent
girls in the age group of 11-18 years with focus on out-of-school girls. Out of the seven services
to be provided to adolescent girls, 4 services namely IFA supplementation, health check-up and
referral, nutrition and health education and counselling on ARSH will be provided in
convergence with Health Department. She further elaborated upon the frame-work for service
delivery through the ICDS system and constitution of Kishori Samooh where a group of 15-20
AGs would be led by 2 peer-leaders, called the the „sakhis‟ and „sahelis „ identified through the
ANMs/AWWs in each Anganwadi.
She further highlighted that since both the programmes (SABLA and ARSH) envisage
empowering adolescent girls through creating an enabling environment and promoting better
health services seeking behaviour they must converge to effectively meet the needs of the
adolescent girls. For instance Kishori Samooh could be used as a platform to mobilize girls to
avail ARSH services and Kishori Diwas for disseminating information and providing
counselling. Currently AWWs are referring AGs to PHCs and CHCs; now they can refer these
girls to AFHCs for better service and care. The Director state that the programmes should
converge using a bottoms up approach and training of ANMs and AWWs should be universally
conducted in order to avoid duplication of efforts.
Post Session Discussions:
The session was opened by the moderators for discussion post the session. Queries from the
participants included:
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Mismatch of the SABLA districts with adolescent health focus districts: In response to the
queries raised Director, RCH suggested that convergence between ARSH programme and
SABLA scheme could be initiated in the districts where there are functional AFHCs. He
emphasized that states should give priorities to SABLA districts for strengthening of ARSH
services in order to have an effective service delivery. Further DS, MWCD, SABLA supported
this and stated that the proposed frame-work for the convergence for the programmes can be
achieved.
Participation and referral for out-of-school adolescents: Director, RCH suggested that in order to
reach out to out-of-school adolescents /difficult to reach populations, mobile AFHS from the
existing mobile health services can be utilized. The states were also advised to formulate and
implement an outreach strategy to address this issue. He also highlighted that the mobile van
services provided for pregnant women to aid in facility-based deliveries can also be utilized for
this purpose.
Key recommendations of the session were:
SABLA platform would be instrumental in demand generation/ increasing of existing
client base and as such should be utilized by all states. States should ideally begin work
in SABLA districts were AFHCs are already functional.
States to develop an out-reach strategy around existing mobile health vans in order to
reach out of school adolescents and hard to reach population.
Integrated Counselling and Testing Centres (ICTC) and ARSH - Opportunities for
Convergence
Speakers – Dr. Raghuram Rao, NACO and Dr. Sudha Balakrishnan, UNICEF
The ICTCs established by NACO have a wide presence in many states across the country and
adolescents and young people offer an opportunity for convergence. The presentation by Mr.
Raghuram Rao, NACO and Dr. Sudha Balakrishnan, UNICEF focused on strengthening linkages
between existing ICTCs for reaching out to adolescents. The participants were oriented about the
focus areas of ICTCs – early detection of HIV, prevention of HIV and generating awareness
about transmission so as to promote behaviour change and reduce vulnerability. At present, there
are three models of ICTCs – Stand alone ICTCs including mobile ICTCs, Facility Integrated
ICTCs (NRHM) and Facility Integrated ICTCs (Public Private Partnership). The Stand Alone
ICTCs are located at FRUs /CHCs and some of the PHCs offer the maximum opportunity for
convergence since a full time trained Counsellor is posted at each ICTC. The counsellors can be
oriented on offering ARSH services and ensure a comprehensive approach to service delivery.
This is also a more sustainable option for both ICTCs and AFHCs. The long term benefits of this
convergence include delaying age of marriage, reducing incidence of teenage pregnancy,
prevention and management of obstetric complications including access to early and safe
abortion services, and reduction of unsafe sexual behaviour.
Dr. Rao, also shared the case study of Maharashtra, where 140 Maitry Clinics are running
successfully across the states. To further strengthen the programme, it has been agreed that in
addition, all ICTCs will offer exclusive ARSH services from 3-5 pm. This has significantly
improved the coverage and outreach of the programmes. Similar models of convergence between
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the AFHC and ICTC in low prevalence states can be leveraged to strengthen the services for
HIV/AIDS prevention and treatment as well. The presentation ended with a request to all states
to take the lead in ensuring convergence in this area for maximizing the services for adolescents.
Post Session Discussions:
Uttarakhand and Delhi shared their experiences of integrating ICTCs and AFHC. In Uttarakhand,
64 ICTCs are in the process of being oriented to also offer AFHS during afternoon from 3-5 pm.
Efforts are underway to strengthen the demand generation activities at the community level for
the services. Additional Director, SHP (Delhi) shared that the state is in the process of utilizing
the services of ICTC counsellors for providing ARSH Services since Delhi is formulating a plan
of action to up-scale the ARSH programme.
Director, RCH encouraged the states especially the states in the north east and other difficult
terrain areas to utilize the ICTC services as has been done in Maharashtra for scaling up the
ARSH programme. He further emphasized that the training of ICTC counsellors on ARSH
modules would be pre-requisite for effectively addressing the SRH needs of the adolescents.
Adolescent Education Programme:
Speakers – Dr. Saroj Yadav, NCERT and Mr. Bilal Ahmed, NACO
Dr. Saroj Yadav, Programme Coordinator Adolescent Education Programme (AEP), NCERT-
MHRD made a presentation on linkages between the AEP and ARSH. The AEP framework is
based on the concept of participatory learning and inculcation of life-skills. The AEP approach
works on the principle that life-skills need to be reinforced for adolescents through experiential
learning and the main goals of the AEP are to empower young people and promote healthy
attitudes. The main component of AEP is to promote physical, psychological and social
development of adolescents, prevention of HIV and AIDS, and prevention of substance abuse.
Additionally, the programme promotes health seeking behaviour amongst adolescents and
facilitates linkages with AFHS. She also informed the participants that under the umbrella of the
National Population Education Programme (NPEP), 30 states and union territories are
implementing AEP.
Mr Bilal Ahmed, Technical Officer, NACO further elaborated that the AEP programme is been a
joint effort of MHRD and NACO. The programme was operationalised to achieve inter
ministerial co-ordination down to the district level. District task forces have been established in
both high-prevalence and low prevalence states. The programme was however suspended in 8
states including Rajasthan, Madhya Pradesh, Chhattisgarh, Maharashtra, Karnataka, Gujarat,
Kerala and Uttar Pradesh since 2007. He highlighted the importance of this programme and the
need for concentrated efforts from all departments and ministries to ensure that this programme
is implemented in a focused manner. He requested the states to ensure linkages with the AEP
programme such that a mechanism for referral for students covered under AEP to AFHCs is
established.
Post Session Discussions:
The discussion following this session was regarding establishing linkages with the AEP
programme for strengthening ARSH services and improving sexual and reproductive health of
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adolescents. It was suggested that there should be provisions under the ARSH programme for
health professionals to visit the schools on a pre-determined day where the teachers can pool the
adolescents for providing health education and counselling. Director (RCH) requested the states
to establish contact with SCERT Directors of the state and identify areas for convergence to
ensure age appropriate information and life skills for adolescents as well as for establishing link
between the AEP and Adolescent Friendly Health Clinics in Government Health Facilities to
generate demand for these services.
Scheme for Promotion of Menstrual Hygiene:
Speaker – Ms. Medha Gandhi, Consultant (ARSH), MoHFW
The Ministry of Health and Family Welfare is launching a scheme for promotion of menstrual
hygiene among adolescent girls (10-19 years) in rural areas. This scheme is an effort to reach out
to adolescent girls both in-school and out-of-school as part of the ARSH programme. A
presentation was made by Ms. Medha Gandhi Consultant (ARSH), MOHFW on the scheme
modalities and the opportunities offered to reach out to adolescent girls with a bouquet of
services and interventions in 152 districts.
As part of this scheme, Government of India will ensure supply of Freedays sanitary napkins
upto the block level in 107 districts and in the other 45 districts; states are in the process of
procuring sanitary napkin packs from women SHGs. She further informed the participants that
the ASHA workers would be provided with the sanitary napkin packs to be sold to adolescent
girls at Rs. 6 for a pack of 6 napkins. As part of this scheme, the ASHA will receive an incentive
of Re. 1 on sale of each pack and Rs. 50 for organising a monthly meeting with adolescent girls
on issues of menstrual hygiene.
An update on the current status of activities for operationalising the scheme at the national and
state level was also shared. The states were requested to ensure completion of the ASHA training
in all 152 districts by September 2011 and facilitate the state and district steering committee
meetings to plan the logistics and aid in developing a system for management of revenue
generated from sale and record of stocks of the sanitary napkins. States were also requested to
plan for an effective disposal system for maintaining environmental hygiene such as deep-burials
etc.
Post-Session Discussions:
Disposal of Sanitary Napkins - The issue of disposal of sanitary napkins at the village level was
raised for discussion. It was shared that deep burial as proposed in the operational guidelines for
the scheme is an option which should be propagated. Incinerators for disposal were also
discussed but it was felt that this may not be a viable option especially in the community.
However, it may be considered in the schools in convergence with the Total Sanitation
Campaign.
Procurement of Sanitary Napkins from Women’s SHGs - States raised concerns about
procurement from SHGs, and if they could receive supply from Government of India for all
districts. It was reiterated that the supply from Government of India is scheduled only for blocks
in the identified 107 districts and in the other 45 districts; procurement may be undertaken by the
state governments at the rate of Rs. 7.25 per pack of 6 napkins from women SHGs. In case the
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states intend to procure at a higher cost, the difference would need to be met out of the State
funds.
Redistribution of Supply of Sanitary Napkin Packs - Another issue discussed was the supply
schedule and if the states can redistribute the boxes within the identified blocks based on
requirement. It was shared with the group that based on the consignee list for 1091 blocks
received from the states and the population estimates from Statistics Division, the supply
schedule and requirement has been consolidated. Consignments will follow in the coming
months in a similar pattern. However, if the states feel a need to shift excess supplies from one
block to the other, they may do so at their own cost and ensure proper recording of supplies and
sales.
Quality Monitoring - Another important issue raised was about the quality monitoring procedure
for these napkins. Consultant, ARSH informed the participants that BIS Standards and NABH
laboratory checks would ensure quality of sanitary napkins which would be distributed.
Director, RCH closed the discussion by highlighting that the menstrual hygiene scheme is an
entry point for the adolescent girls and urged the states to plan activities to leverage the same. He
also emphasized the importance of convergence with other departments for the successful roll-
out and implementation of this scheme and requested the states to strengthen these linkages and
formalise the same through the state and district level.
School Health Programme – Opportunities for Addressing In-School Adolescents
Speaker – Dr. Sheetal Rahi, Medical Officer, MoHFW
Dr. Sheetal Rahi, Medical Officer, AH & SH, MoHFW presented the session. The session
focused on establishing linkage between School Health and ARSH programme. The presentation
highlighted that currently almost 10 Crore adolescents are enrolled in classes VI-XII and by
establishing linkage between SHP and ARSH a large number of adolescents can be reached out
to. This will also ensure health equity and formation of healthy habits among adolescents based
on „catch them young‟ principle.
It was stated that to establish this linkage the existing SHP needs to be equipped/strengthened to
address adolescent health needs by screening them for reproductive and sexual health problems,
behavioral problems and substance abuse. Further, schools should be utilized as platforms to
reach out of school adolescents through identification of in-school peer educators who would in
turn link out-of-school adolescent to ARSH services. Schools could also function as information
centres for disseminating information about HIV/AIDS, sexual problems, mental health
problems and availability of ARSH services. The presentation, further elaborated that human
resources required for this convergence already exist in the form of trained teachers under School
Health Programme and Medical Officers trained in ARSH modules and this could be strengthen
by training the service providers (teachers and MO) in counseling.
The states were advised on the necessity to ensure that health personnel responsible for screening
under School Health Programme should refer adolescents to ICTC, RTI/STI and AFHC clinics at
an appropriate facility as and when required and; health education activities in schools should
include age appropriate topics for adolescent students. The presentation reiterated that overall
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goal of this linkage is to improve reproductive and sexual health of adolescents and to improve
their health seeking behavior.
Session 3: Innovations by States
States are in the process of implementing the ARSH programme involving varying strategies to
address adolescents. This session was designed to hear about the state innovations on ARSH and
move further from what has worked well. Four states were invited to present their models for
reaching out to adolescents – Gujarat, Maharashtra, Uttarakhand and Haryana.
Gujarat
Dr. S.C. Vashishta, JD-MCH (Gujarat) made a presentation on the innovative community
based intervention strategy of the State Health Department to reach out to out-of-school
adolescent girls through the Mamta Taruni Abhiyan (MTA). This programme draws significantly
on convergence with the SABLA scheme. The MTA was initiated in 2009-2010 and 9 (non-
SABLA) districts were included to avoid duplication of efforts. The ASHAs, ANMs and AWWs
have been trained on issues of adolescents and for identifying female peer-educators at the
village level. The peer educators are being trained on Hum-Tum module, which has been
specially designed for this programme with the help of Chetna (a Gujarat based NGO with
extensive experience of addressing adolescent issues). ASHAs/ANMs/AWWs and peer-
educators are incentivized at the rate of Rs. 50 and Rs.25 per month respectively for mobilizing
adolescents and facilitating sessions on various topics with them. Data shows that the response to
the scheme has been extremely encouraging and the parents are also supportive of the girls
attending the Mamta Taruni sessions regularly.
As part of this scheme, sessions on various issues are facilitated by the ASHA/ ANM/ AWW.
During these sessions, weekly IFA supplementation, i.e. 1 tablet 100 mg tablet per week is
ensured and HB estimation is done twice a year. Registers are maintained to track attendance and
BMI of the member adolescent girls. Routine monitoring visits are undertaken by the state and
district authorities for the smooth roll-out of the scheme. He also shared that efforts are
underway to ensure linkages for the adolescent girls enrolled under MTA with the AFHCs.
Maharashtra
The second presentation was on a state-wide network of effective ARSH clinics - MAITRY
Clinics. Dr. Smita Ganu, Assistant Director, NRHM informed the participants that there are
140 functional MAITRY clinics in primary, secondary and tertiary level health facilities in the
state as well as at women‟s hospitals and rural hospitals. The clinics have a dedicated space in
the facilities and to ensure effective services, trained staff has been deputed. Further, the state has
taken the lead to appoint ARSH Counsellors in each district. She highlighted that 75% of the MO
have already been trained and remaining would be completed by December 2011. 7 Sensitization
workshops have been conducted across the state to operationalise the ARSH programme. She
also shared that the clinics offer OPD services to both male and female clients and outreach
sessions at schools, colleges are also facilitated by the AFHC teams. In addition, Community
Based Activities have been initiated in 6 districts and 18 blocks through peer educators. She also
shared that the recommendations from the external evaluation by IIHMR Jaipur are also in the
process of being incorporated. She further informed all participants that they have been
12
successful in ensuring convergence with SACS for strengthening the ARSH programme. ICTC
counsellors have been oriented to ARSH issues and are being involved for counselling
adolescents in the afternoons from 3-5 pm. Linkages with NSS, NYKS, SABLA and AEP
programmes have been established and are being constructively utilized to up-scale adolescent
health services.
Uttarakhand
The third presentation Uttarakhand showcased a comprehensive model for implementing the
ARSH programme. Dr. Sushma Datta JD-RCH (Uttarakhand) briefly presented the innovative
model “Uttarakhand Understanding and Delivering to Address Adolescent Needs (UDAAN),
which is a multi-stakeholder module. It is designed to ensure convergence with MHRD, MHS,
ICTC and non-governmental organizations working in the field of adolescent health and
development. She further elaborated that the UDAAN module provides a comprehensive
package of service delivery as per the ARSH guidelines. Promotive Services provide information
regarding menstrual hygiene, counselling on RSH issues, RTI/STI/HIV and information and
availability of contraceptives. Preventive services provide nutritional counselling, IFA
supplementation and de-worming. Curative services provide for treatment of menstrual
disorders, RTI/STI, ANC services for pregnant adolescents etc.
This strategy includes a clinical as well as community based intervention to address adolescents.
AFHCs have been established at select PHC/CHCs and DHs. Trained providers are posted at
these clinics to offer services. To ensure linkage with the community, adolescent friendly clubs
involving peer educators have been established at the village and block level. The clubs meet
periodically where the trained peer educators facilitate sessions using the interactive modules
provided to them. In addition, the state has a comprehensive BCC strategy designed for
adolescents which is in the process of being rolled-out. Necessary provisions for the same have
been ensured in the state annual PIP for 2011-12.
These programmes were appreciated by the moderators of the sessions and the participants. The
chairperson for the session, Dr. Dinesh Aggarwal, UNFPA summarised the UDAAN module as a
hybrid module involving a comprehensive peer-based and NGO partnership approach coupled
with the clinical intervention. Maitry clinics in Maharashtra offer an example of systematic
planning and implementation of the clinic based approach. These clinics are providing quality
care and attracting the adolescents to come and seek services. The Mamta Taruni Abhiyan in
Gujarat is an interesting example of a community based intervention to provide services with a
focus on out-of-school girls and as a referral mechanism to the ARSH clinics. The common
strategies identified in these successful models were that each of the models was:
a. appealing adolescent friendly brand name
b. innovative peer-educator approach for community mobilisation.
c. multi-sectoral convergence has ensured in all 3 initiatives.
The session ended with a positive observation from the chairpersons that the implementation
guide for the ARSH programme offers opportunities to the states to design innovative strategies
for addressing adolescents in the community and at the clinic. The 3 examples from Gujarat,
Maharashtra and Uttarakhand provide evidence to the fact that adolescents require friendly
services and if the programme is designed well, they will come forward to seek services.
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Day II – Session 4 – Adolescent Anaemia and IFA Guidelines
Dr Sheila Vir (Nutrition Specialist) made a presentation on demography of adolescent anaemia
in our country including state-wise prevalence. Adolescent anaemia is a major public health
problem in our country and adolescent across the wealth index are affected by it. Consequences
of adolescent anemia include: irregular menstruation, fatigue, increase vulnerability to infection
and poor pre-pregnancy iron stores as iron requirement reaches peak during adolescent years
especially between 13-16 years of age. The presentation stated that a three pronged strategy for
addressing anaemia comprising dietary diversification, food fortification and IFA
supplementation is required for address the high prevalence of adolescent anaemia. A matrix of
various state level and international studies of weekly IFA consumption and evidence of their
efficacy was discussed.
Post Session Discussions:
In the discussion following the session state shared details of their respective on-going
adolescent IFA supplementation programme such as Saloni Yojana in Uttar Pradesh, school
based and out-of-school programme in Orissa, school based programme in Tamil Nadu and
programme in Maharashtra funded by Tribal department, WCD and School education
department. The queries regarding weekly IFA supplementation included: procurement,
additional budget, role of ANM, capacity building of personnel, IEC/BCC activities and
monitoring formats.
Procurement and Additional budget
JS (RCH) advised that states could propose supplementary budget for Weekly Iron and Folic
Acid supplementation under RCH-PIP. The guidelines for specification of IFA tablets and
packaging are will be developed by MoHFW and will soon be shared with the states. The
requirements of IFA tablets in the WIFS programme could be included under the procurement of
RCH drugs at the State level. Further procurement could be staggered in two 6 monthly
installment to avoid wastage and to maintain quality taking cognizance of IFA tablets short shelf
life. There was emphasis on uniform procurement and supply throughout the state for effective
implementation of the programme. The states were asked to work towards universal coverage
(adolescents in government/government aided rural and urban schools)
Capacity Building
For sensitization of personnel belonging to health, education and ICDS department involved in
implementation of WIFS programme resource at national level will be developed. These
materials could be based on functional supplementation programme in the states as well as
resources available with UNICEF. The states could also engage services of MHW (M), Block
Extension Educator and Mitanin for further strengthening of programme. The network of Nehru
Yuva Kendra could also be utilized for engaging out of school boys at state level.
IEC and BCC activities
To have a uniform implementation it was suggested to have Monday as the national WIFS day in
addition to having an intensive IEC/BCC strategy for the programme. It was also suggested that
Individual compliance card may be used for for providing health messages related to nutrition,
14
iron rich foods such as green leafy vegetables, jiggery, red meat, bengal gram and prevention of
worm infestation. The information regarding benefits of cooking in iron utensils and about iron
rich culturally acceptable diet should also be disseminated.
Guidelines on consumption of WIFS
The MoHFW should provide guidelines on consumption of IFA tablets including management of
side-effects. The need for diversified diet along with IFA supplementation was identified as
being crucial for addressing high prevalence of anaemia. It was also suggested that during school
vacations holiday package of supplements can be given to all adolescents for that time period to
ensure compliance
Role on ANM
It was suggested that ANM should undertake quarterly school visit for verification of WIFs
tablet consumption by students and document positive effects noted by beneficiary and also to
supervise the AWW.
Monitoring
The states were advised to establish a uniform monitoring mechanism for reporting and
assessment of programme and simultaneously upscale the use of HMIS for this purpose.
Suggestion by states in this regard included focus on positive effects of supplementation,
inclusion of batch number and expiry date of IFA in the format. In addition to this, formation of
state level Quality Control Committee to ensure quality of supplementation was also discussed.
Reaching adolescents in urban areas
During the discussion it noted that evidence suggests that once the adolescents form a habit of
taking these supplements they continue to do so without direct supervision thus it may be
assumed that adolescents out-of-school at the age of 17 years would continue with the
supplements if this habit was formed at the school level. The role of Anganwadi Centre in slum
areas and Urban Health Centres for covering adolescent in urban areas was emphasized.
Key Recommendations
MONDAY to be established as national weekly iron and folic acid supplementation day.
There is a need for guidance to states on specification and packaging of WIFS tablets.
Resource material/module is required for capacity building of personnel.
An intensive IEC/BCC strategy for positive positioning of IFA tablets and demand
generation is required.
Comprehensive monitoring and reporting formats are required to be developed before the
roll out of this scheme.
ANM will be involved in supervision of both school based and out-of school WIFS
supplementation programme.
The draft incorporating all the suggestions will be circulated via the e-group to the participants
for comments.
15
Review of implementation of ARSH programme in States:
An important component of the national workshop on adolescent health was a review of the
ARSH programme in the states, financial utilisation and identifying next steps. The review was
based on the quarterly report submitted by all states as per the format developed by MoHFW.
Please refer annexure -5 for the quarterly reporting format. States were divided in 4 groups for
review. The key findings from the state review are as follows:
Group 1: Moderators: Director, RCH and Health Specialist UNICEF
States: Chattisgarh, Sikkim, Assam, Madhya Pradesh, Delhi, Daman & Diu
CHATTISGARH - Dr. Alka Gupta Deputy Director, Department of Health and Family
Welfare, Chattisgarh who is also the focal person for ARSH, informed that ARSH is a weak
component of the programme. The allocation for ARSH activities under the current is only Rs.
10 lakhs and that too for IEC activities. She further stressed the need for a State Programme
Officer/Lead Consultant in order to further up-scale the ARSH programme. Dr. Meera Baghel,
Consultant- Obstetrics and Gynecology from Chattisgarh, was identified as the Master Trainer
and the key resource person for conducting state training of trainers (TOTs) and also districts
TOTs in the State.
Director (RCH) from the MoHFW suggested that UNICEF could explore strengthening the
programme in the state by providing a State Programme Officer/Lead Consultant as Chattisgarh
is one of the UNICEF target states. The need for convergence with SABLA in 5 districts of the
State and with NACP/SACS was stressed. As regards training of staff, the State was given a
deadline of completing the State level TOT by 15th
August and the District TOTs by the 2nd
week
of September. Moreover, the State was asked to ensure training of at least 75 MOs and 250
ANMs before the next review meeting which is scheduled in November 2011. The fact that the
State does not have even a single AFHS clinic was noted with concern. Overall the ARSH
programme in the State is performing poorly and there is need for concerted and dedicated
efforts to improve the same.
ASSAM - The State was represented by Dr. Bidyawati Das, Joint Director (MCH) and Mr.
Sanjeev Ranjan, Programme Officer (ARSH). During 2011-12, the State‟s allocation for ARSH
has declined to Rs. 38 lakhs against the previous year‟s allocation of Rs. 56 lakhs. This reflects
the low priority for the programme in the State. The state reported 32 AFHCs and 12 more are
planned for the current year. The need for collaborating with SACS for utilizing the services of
existing ICTCs was stressed. As regards training, State was asked to conduct State level TOT
before the 15th
of September. It was agreed that the State would complete training of MOs and
ANM/LHVs as per target by November 2011. The State has initiated outreach activities in a few
blocks through peers who are identified through the NYKS programme (named as „Saathi‟).
These peer educators are given a 2 day training, through a locally developed module and they
then conduct monthly meetings. It was discussed that the model would be assessed and then the
scale-up plan would be designed.
DELHI - The State was represented by Dr. G.P. Kaushal, the State Programme Officer for RCH
& Child Health, Dr. A.K.Gupta (additional Project Director, DSACS), Dr. Kapoor (Additional
Director and Health SHP), and Dr. Chetal, SPO (SAG). During the meeting it was decided that
16
Dr. Kaushal would be the nodal officer for AH for NCT Delhi and all the components of the
programme including ARSH, SHP and MHS would be coordinated by him. The budget for
ARSH in Delhi has reduced from Rs. 51 lakhs in 2010-11 to Rs. 29 lakhs in 2011-12 which
reflects the low priority accorded for ARSH. The State team informed about an ARSH
Counseling Centre cum Clinic which is being established in Jamia Milia Islamia University as a
model centre. State was asked to explore the possibility of developing more of such stand alone
ARSH clinics in urban slums of East Delhi where the population is high and adolescents who are
not enrolled in institutions can also avail service. The State informed that it has 92 AFHCs
located in various health facilities across Delhi. However, functionality of the same is doubtful as
client load is very low. The State informed that training of MOs and ANM/LHVs is being done
and so far 330 MOs and 425 ANMs have been trained. State was asked to ensure that all training
is as per AFHS training modules of the MoHFW. Further, convergence with the Department of
Public Instructions on the Adolescent Education Programme was stressed.
MADHYA PRADESH - The State was represented by Dr. K.L. Sahu, Joint Director and Dr.
Nidhi Patel, Deputy Director, in-charge ARSH and MHS. The State had started services for
Adolescents in 1996. At present, there are 67 functional AFHCs in the state (27 in District
Hospitals and 40 in CHCs/PHCs). During 2011-12, the state has a target for increasing the
number to 32 AFHCs in District Hospitals and 54 in CHCs/PHCs. The client load in these
AFHCs is satisfactory. So far 97 MOs and 263 ANMs have been trained under the AFHS
training module. This year the target is to train 200 MOs and 200 ANMs. State has developed
IEC materials for the ARSH programme under the theme “Naye Umang Ki Naye Tarang‟. The
need for convergence with the SABLA programme in the State was stressed. The State could
utilize the „Yugal Mandal Kendras‟ under the Atal Bal Mission to reinvigorate client load in the
AFHCs, especially of adolescent boys.
DAMAN & DIU – The UT was represented by DPMs - Dr. Devesh Tripathi and Ms. Shailesh
Ambria. ARSH programme has not yet been started in the UT. However, there is a plan to
establish 4 AFHCs during 2011-12. As regards training, a total of 22 MOs and 86 ANM/LHVs
have been trained on the AFHS module. Outreach sessions have been taking place in VHND and
in Schools/Colleges. The UT did not provide any information to the MoHFW for this review
meeting and in future the UT is requested to give accurate and timely data as and when requested
by the MoHFW.
SIKKIM - The State was represented by the Dr. M.L. Lepcha, Joint Director NRHM and Dr. C.
Yethenpa, Additional Director, NRHM. The State has a total of 29 operational AFHCs of which
4 are in District Hospitals and 25 are in PHCs. However, client load in many of the clinics is
very low. The State team informed that 1 batch of MOs and 4 batches of ANM have been trained
so far. Further counselors have been appointed in all the AFHCs at the District Hospitals. The
State requested for an increase in salary of the ARSH counsellor. State was asked to review this
plan and send a separate proposal as a supplementary PIP with justification for the same. The
State has already initiated a bi-weekly IFA supplementation plan for adolescents in schools. The
state was asked to share comments on the national WIFS guidelines and redesign the programme
in line with the same. It was also suggested that convergence must be ensured with SABLA
programme for community outreach and with SACS to better utilize the ICTCs as AFHCs.
17
JHARKHAND - The State was represented by Dr. Jaya Prasad, Deputy Director and Ms. Rafat
Farzana, Consultant ARSH & PC-PNDT. State informed that 133 AFHCs have been established
in the State of which 122 are functional. However, low client load remains an area of concern.
This year the State has a target of establishing 61 more AFHCs. The State was asked to have a
fixed timing and fixed day approach for the AFHCs. The State reported that so far 27 MOs and
535 ANM/LHVs have been trained. Training in the State is being imparted with technical
assistance from an NGO - EngenderHealth and the Institute of Public Health as per the MoHFW
training modules. State has done some commendable work in terms of development of IEC
material for ARSH. State was asked to improve convergence with the SABLA programme in the
7 SABLA focus districts and strengthen the community outreach and also plan for wider
publicity of the AFHCs.
Group 2 Moderators: Dr. Soumya Mohanty, Consultant RCH, MoHFW and Dr. Sudha
Balakrishnan, UNICEF
States: Goa, Maharashtra, Arunachal Pradesh, Uttarakhand, J & K, Kerala, Manipur
GOA: ARSH is presently not a focus area in Goa. An Expenditure of Rs. 36,000 against a
sanction of Rs. 1 lakh for 2010-11 for ARSH was reported. The state has 2 DH, 5 CHC, 19 PHC
and 4 UHC which are functioning and reporting. Of the 2 District Hospitals, AFHC has been
established at one but it is not functional. They have two more AFHC, one in RMD (Rural
Medical Dispensary) and one in Rural Health training centre and two more need to be
established. In terms of training, MOs are trained but not counsellors. For LHV/ANM, module
was not followed but their sensitization has been done. Number of MOs trained till 1st of August
was 18 and target for 2011-12 is 60. The target number for the training of LVH/ANM for 2011-
12 is 90 and 17 have been trained. Sessions for adolescents are facilitated on Village Health and
Nutrition Day. Till now, total 76 sessions were completed and target for the 2011-12 is 250.
Total 15 schools/colleges were covered against a target of 100. ARSH in charge shared that in
2010-11 16,361 beneficiaries were covered. It was suggested by in future state should collect the
disaggregated data for boys and girls.
The state representatives informed that they have identified two ARSH nodal teachers per school
for counselling and Rs. 2000 (i.e. Rs.500/week) paid to them. In the 2011-12 PIP, Rs. 1.71 lakh
was proposed for training and activities but not approved. It was shared by the ARSH in charge
that existing MOs, HOs, CMOs and state programme manager will be part of the training. The
preferred language for the module as suggested will be English and Konkani. As a part of
IEC/BCC- pamphlets, posters on adolescent nutrition were developed. Only ARSH in charge
monitors the activities. With regard to referral services, the cases are referred from AFHCs to
DH of south GOA but the data is not available. MOs and HOs maintain the data and its
confidentiality. In terms of convergence with other department, Red Ribbon Club involved in
schools (Higher secondary) and colleges and for women and children discussions with SABLA
are at initial phases. It was suggested by the consultant UNICEF, to share the information on
number of Red Ribbon Club in Goa. There were no separate counsellors from ICTC for ARSH.
For the year2011-12, 11 counsellors will be trained for ARSH i.e. 1 counselor / Taluka. ARSH in
charge has shared the HR pool which will be trained i.e. HOs- 30, MOs- 156, ICTC- 11, EE- 17,
ANM- 225, LHVs- 25, MPHW - 150. She further shared that all the HOs were trained in 2006
but again refresh training needs to be done for them. ANM and Extension educators will do the
18
Community mobilization. She also added immunization- Rubella, Tetanus vaccination given
during mobilization for adolescents.
It was agreed that the programme in charge would ensure collation of disaggregated data for on
number of Red Ribbon Club in Goa and segregated data in terms of beneficiaries, separately for
boys and girls. It was also agreed that the budget and activities would be reviewed and any
discrepancy reported.
ARUNACHAL PRADESH: The ARSH focal person from the State reported that the activities
were not initiated last year as there was no budget but this year (2011-2012) the budget (2.5
Lakh) is only for sanitary napkin training and procurement i.e. for 1 district (As pilot). As per the
information shared by the ARSH representative there are 16 districts, 14 DH, 2 General hospitals
and 31 CHCs. The facilitators suggested that focus should be on convergence with SABLA and
ICTCs for up-scaling the ARSH programme and developing multi-stakeholder steering and
monitoring committees for ARSH in all districts.
UTTARAKHAND: ARSH focal person from the state reported that a comprehensive PPP
model including a community and clinic based approach is followed. There are 13 districts in the
state but the ARSH programme has been initiated only in four districts. In four districts, there are
four DH out of which one DH is functional and three are target for the next year. Similarly, it
was also shared that 16 CHCs are functional and 7 are target, 1 PHC is functional and 3 are
target, in terms of training on ARSH 76 MOs are trained and 135 are target, and 381 ANM were
covered. All counsellors at AFHS are ICTC counsellors. The community outreach target is 324
and 273 School/ colleges were covered but a need was felt to check the target again for the next
year. ARSH representative shared that number of beneficiaries covered were 5726 (cumulative)
out of which 3323 were girls and 2403 were boys. For the implementation of the programme,
multiple NGOs are involved like NGO- Samarpan is state nodal agency for training and
monitoring. The training of all the NGOs was completed. The preferred language for the module
is Hindi. The representative is responsible for the monitoring of ARSH, all the RCHs training
and activities. Programme UDAAN also has a strong BCC strategy for reaching out to
adolescents. All the DPM have been oriented to the programme. As per the shared information
the flow of Referral is as follows- AFC to Adolescent friendly clubs/ block (10 in number and
100 peer educator/ Block i.e. 50 boys and 50 girls) at NGO level, where 270 AFC are functional,
135 more to be added this year then to the AFHS at PHCs and DH level but out referral is not yet
established. As convergence with other department- All Diet teachers, PRI members are
sensitized and ICTC are proposed for this year. The discussions with SABLA are at initial
discussion as ARSH districts are different from SABLA districts. All ASHAs are sensitized,
NYKS and red Ribbon clubs under NACO for colleges are proposed for 2011-2012.
JAMMU & KASHMIR: The ARSH focal person from the State informed that there are 22
districts in J&K out of which 10 are in Jammu and 12 are in Kashmir. The programme initially
started in seven districts and in 2010-2011 it was extended in four districts in Jammu and four
districts in Kashmir. It was also shared that there are 22 DH out of which 15 are functional also
there are 78 CHC, 375 PHC, two maternity hospitals and two ARSH centres are functional in
medical college. In terms of training, 123 MOs are trained in 2010-2011 and 65 are target for the
year 2011-2012, 136 staff nurse are trained and 110 ANM/LHVS are target for the year 2011-12.
Also, 4316 ASHA workers need to be trained. Through VHND, community based sessions on
19
ARSH issues shall be started from this year. As outreach activities 576 School/college are
covered but to further extend it, budget is not allocated. In terms of number of beneficiaries,
2357 are covered out of which 1925 were girls and 432 were boys (1st Quarter). When it was
asked that the number of girls is more than boys, it was shared that as all the counsellors are
female, therefore more girls approach the centre. At one point of time all counsellors were in
place but has rapid turnover (seven positions are vacant) because of less salary as shared by the
representative but need to recheck number again. In terms of Convergence with other
department, ICTC to be initiated this year but there is no discussion till date for the SABLA
involvement. For the out referral cases, it is from ARSH clinic to the department within the
hospital and higher institution but data is not available. The preferred language for the module is
Urdu. For training there are two nodal institutions -1 Medical college in Jammu and Department
of PSN. It was agreed that the state should focus on completing the State TOTs and District
TOTs for MOs and ANMs and ensure convergence of ARSH with parallel programmes in the
state.
KERALA: The state ARSH representative reported that they have mobile ARSH clinics. There
are 14 districts but ARSH clinics are functional in three districts. It is proposed for 2011-2012 to
initiate the fixed up clinics in SABLA districts i.e. in four districts. Out of all the districts only
one district is overlapping between SABLA and ARSH districts. It was shared by the ARSH
representative that in mobile ARSH clinic there are four doctors, two counsellors and four
nurses. In terms of training, 50 MOs were trained and 420 (14X30) are proposed to scale up the
programme similarly 60 staff nurses were trained and 420 are (14X30) proposed, 60 ANM were
trained and 420 (14X30) are proposed and 70 ICTC are proposed for 2011-2012. In community
outreach 79 schools/ colleges and approx. 13,000 beneficiaries were covered out of which 50%
were boys and 50 % were girls. RCHOs and DPMs have been oriented. Monitoring of the mobile
ARSH clinics is done by DPMs. The preferred language for the module is Malayalam (as shared
by the ARSH representative, material is almost ready and translation is ongoing) and also radio
spot based on ARSH is under process. The Convergence with other department is not yet
established. Help lines to be started to access the information related to services. For the referral
cases, DPMs compile the data. It was agreed that age and sex disaggregated data would be
collected in future and efforts would be made to ensure convergence. It was also discussed that
the state would take necessary steps to initiate a helpline for adolescents.
MAHARASHTRA: The state ARSH focal person from Maharashtra informed that in terms to
scale up the programme the State does not want to increase the number of clinics but would
instead focus on improving the quality of existing 140 clinics. More than 75% of the MOs were
trained already. Data for the referral cases will be shared. In terms of convergence with other
department, NYKS is not responding. SABLA is in 11 districts and discussions are underway.
For the monitoring, a supervisory checklist has been prepared. RMO outreach it in urban areas
and DRCHOs in rural areas. They have developed video CDs, posters and distributed to the
clinics. All the programme officers have been sensitised. The preferred module language is
Marathi. The state has a well established system for AHFCs. The community outreach aspect is
in the process of being established and the state should ensure convergence with programmes by
other departments. It was agreed that the state would maintain a record of out-referrals from the
clinics in future.
20
MANIPUR: The state representative informed that there was no budget for 2010-11. It is
proposed in the 2011-2012 budgets that 61 TOTs will be done and 71 ICTC counsellors will be
trained. The state was advised to ensure convergence with programmes by other departments for
effective implementation of the ARSH programme.
Group 3 – Moderators: Dr. Kiran Sharma, NPO-AHD (WHO, India) and Ms. Anshu Mohan,
Consultant-RCH, MoHFW
States: Bihar, Haryana, Orissa, Andhra Pradesh, Rajasthan, Mizoram and Gujarat
BIHAR: The SPO, ARSH (Bihar) informed the moderators that most of the budget has been
spent on IEC activities and currently there is only one AFHC functional in Danapur, Bihar.
Training status stands at 81 MO and 308 ANM and the state plans to train 132 ANM/LHVs in
2011-2012. The State was asked to develop state specific strategy for ARSH programme. This
would include operationalization of AFHC as proposed in the PIP (state has proposed
operationalization of 21 clinics in the PIP). It was also discussed that there is a need for out-reach
activities in Bihar in order to reach out-of-school adolescents. VHNDs could be effectively
utilized for this purpose. Further, for effective implementation of the training, translation of
ARSH Module in Maithali must be completed by end of August, 2011. Agreed timeline for the
one day sensitization for programme managers is August 2011. State to organize TOTs at for the
state and district level in order to train both MOs and ANMs by Sep-Oct, 2011. It was also
agreed that an exposure visit for the ARSH team in the state could be planned to other better
performing states like Maharashtra, Karnataka and Gujarat.
HARYANA: The State has 36 AFHC operationalized in 9 DH, 9 CHCs and 18 PHCs and plan
on operationalizing 105 more (this is the revised target). 67 MO have been trained and the target
is 210 (revised). One day sensitization of 21 Programme managers has been completed. Sakshar
Mahila Samuh undertaking dedicated IEC for ARSH from 1 to 15th
of every month. 6 districts
identified for SABLA. Recommendations to the state included appointment of a Consultant
ARSH /State Programme Officer at the earliest (by September/ October). It was also discussed
that the State should plan for scale IEC activities such as Health Mela at CHCs for distributing
IFA supplements and engaging with out-of-school adolescents. Further, orientation programme
for all district programme managers need to be facilitated.
ORISSA: State has 30 AFHC operationalized and plans to operationalize 64 more in 2011-12.
90 MOs and 540 ANMs/LHVs have already been trained. Also, the ARSH module has been
translated into the local language. Moreover, state-specific BCC material has been designed but
it was not extensive as of other high-performing states like Gujarat. The state assured the
moderators that using the best-practice examples from other states and their BCC/IEC material
they would further up-scale the programme. The recommendations to the state were that there is
a need to engage with NYKS teen-clubs etc. to address the concerns for adolescent boys as well.
That would facilitate linkage of adolescent boys with the AFHCs. At present, majority of clients
at the AFHCs are adolescent girls. There is also a need to strengthen convergence mechanisms
and community based outreach activities.
ANDHRA PRADESH : The state has no functional AFHC but has planned to operationalize 45
in 2001-12. Currently they have 82 MOs trained and plan to train 400 MOs, 200 ANM and
21
LHVs each in the 2011-12. One day sensitization programme for programme managers has been
completed in 4 districts; IEC material in local language is available (one booklet). The
recommendations to the state were that there is a need to appoint a Consultant ARSH /State
Programme Officer at the earliest (by September/ October). AP is one of the few states that has
not operationalised the ARSH programme. There is a need to speed up operationalization of
AFHC as proposed in the PIP. School could serve as a focal point for outreach activities. State
waas advised to establish convergence with the ICTC Clinics for operationalizing AFHCs.
Convergence with AEP through regular meetings with SCERT officials for updates on the
programme and engaging them with the ARSH efforts was also suggested.
RAJSATHAN: The state has 434 AFHC operationalized but most of these are not functional
(as informed). The state has now discontinued further operationalization of AFHCs. 631 MOs
have been trained and the state plans to train 196 more on 2011-12. To strengthen the
programme, it was recommended that the state should ensure appointment of an officer in charge
for ARSH. This needs to be addressed at the earliest. Instead of having large number of non-
functional clinics the state should focus upon required number of functional and quality service
providing clinics. But this must be reported through the revised/ supplementary PIP justifying
their reasons for decreasing the number of clinics.
MIZORAM: The state has operationalized 5 AFHC and aims to operationalize 3 more. 99 MO
and 637 ANM/LHVs have been trained and the state plans to train 60 more. The state
representative attending the state review session has not been actively linked with the ARSH
programme so she had limited knowledge regarding the state review report. As informed by the
representative the state has planned for convergence of ARSH with SHP. Further, 540 schools
have been identified where SCERT and SACS will impart life skills education training using a
peer educator approach - 25 colleges Red Ribbon Clubs have been identified and peer-leaders
would be selected from these clubs. These efforts would aid in engaging both out-of-school and
in-school adolescents. It was emphasised that the state should appoint a nodal officer/ officer in-
charge for ARSH on priority.
GUJARAT: The state has 55 functional AFHC and plans to strengthen the same instead of
operationalizing new AFHCs. 228 MO have been trained against a target of 990 in 2010-11. For
the current year the state plans to train 900 MOs. 1189 LHV/ANM/PHN have been trained and
the state plans to train 1500 more in 2011-12. 158 One day sensitization programme for
programme managers have been completed in addition to this, the state has 99 ICTC counsellors
in place. Training material is available in the local language and training of peer educators is
likely to start by September. 34 AFHC are located in the ICTC and 46 AFHC have doctors
trained in MTP. The state has Hum Tum Module for LSE as well as leaflets designed for Mamta
Taruni Abiyan.
During the discussion Mamta Taruni Abiyan was identified as a successful model for
implementation of ARSH programme. Since the Mamta Taruni Abiyan is for girls only the state
plans to initiate the Tarun Sampark programme for out-of-school adolescent boys.
It was suggested that the state should undertake an evaluation of the Mamta Taruni Scheme and
disseminate the best practice. There is a need to streamline and expedite the training of MOs.
The efforts of the state were appreciated.
22
Group 4- Moderators – Dr Aboli Gore, Maternal Health Officer, UNICEF and Dr Sheetal Rahi
MO-ARSH, RCH Division, MoHFW
States: Tamil Nadu, Chandigarh, Himachal Pradesh, Karnataka, Punjab and Dadar and Nagar
Haveli
TAMIL NADU: The discussion started with the planned budget for the ARSH trainings. During
the year 2010-2011(till March, 2011), state has only used 10 % of the total allotted budget for
trainings and workshops. The trainings are only given to the VHN and PHN whereas despite of
7 available regional institutes‟ trainings for medical officers and counsellors still not conducted.
State level workshops will be conducted in September, 2011. The moderator identified that the
untrained medical officers, counsellor and other staff might be a reason of the under expenditure
of the allotted budget. There are 5 regional training institute and SIHFW conducting ARSH
training. TOT have been completed and training of MO planned from September 2011. ARSH
modules available in local language (Tamil). State level workshop will be conducted in
September.
There are 14 AFHC at Medical colleges and 7 at DH level, but the DH clinics not fully
functioning .The attendance at district hospitals clinics is very poor. The data from these clinics
is not available due to poor linkages with Medical board and lack of effective monitoring. A
booklet on school health program and anaemia control for adolescents has been developed and
modified; it will be distributed through VHN. It has been highlighted in the discussion that
outreach activities are doing well in the state. They have started health education through active
learning programme (HEAL) which is targeted towards the students from 6th
to 8th
class and
covers all health related topics. Anaemia control programme under which the adolescent girls are
given IFA tablets irrespective whether they are school going or non school going. SHP is running
well and there is convergence with SHP by training teachers to cover health education topic once
a week. This is being piloted in 10 districts under Modified School Health Programme.
It was suggested that the state would share the targets for the medical officer training at the state
and the district level . Training of ICTC counsellors would be facilitated and linkage established.
Further, the need for strengthening outreach activities was discussed. It was also suggested that
ARSH clinics need to be set-up in other facilities besides the 7 at district hospital at PHC and
CHC level.
CHANDIGARH: As per the state representative, there are 8 well established AFHC clinics (2
at CHC; 1 at DH and 5 civil dispensaries), 2 clinics at dispensary level are planned for 2011-12.
The client load is reported to be good at these clinics. The trainings have been provided to 25
ANMs; 20 MPH doctors and 10 counsellors. But the target is to increase the number depending
on the population load on ARSH clinics.
As regards outreach activities, 10 counsellors are posted at school, DH/CHC/CD, AWC level.
LHV and MPW (M) are conducting outreach activities at village level. For 22 villages and 16
slum areas – 4 LHV and 4 MPW are appointed to cover one topic on health education (including
ARSH issues). Plans for convergence with SACS are being worked out.
23
It was suggested that the state should plan to ensure IFA supplementation to all adolescents girls
not just the ones who are anaemic. Focus on IEC/BCC activities has to be ensured, especially for
the urban areas. It was also suggested that convergence with School Health Programme must be
established.
HIMACHAL PRADESH: The discussions started with the brief introduction about the existing
functional ARSH clinics in the state. State is having only one functional clinic at the medical
college level, there is no awareness among the people about these clinics and services. The state
representative also highlighted that the state has two training institutes located at Shimla and
Kangra. Trainings of the ANMs, MO and counsellors are done at these institutes. A total of 206
ANMs‟ and 14 counsellors have been trained by now deputed at the district hospitals and
medical college. Training target for 2011-2 is 175 M.O. Total of 14 ICTC centers; 12 at district
hospital and 2 at medical college. The state is conducting ARSH camps to increase awareness
regarding AFHC clinics and services. Out of a target of 5222 camps in 2011-12, 200 camps have
already being organized. For outreach activities the state has trained 24 male and 36 female peer
educator and they are give Rs 500 to mobilize adolescent for camps. As the state has only one
functional clinic at the medical college reporting and monitoring is an issue as of now.
The state was requested to ensure that a dedicated nodal officer is appointed to coordinate the
ARSH activities in the state. Further, there is a need to give priority to operationalizing AFHC
clinics at CHC and PHC level as trained staff is available. Monitoring mechanism to be
established simultaneously and Start regular review meetings so that the programme gets the
necessary impetus. Routine reporting from the Medical College should be strengthened. The
state needs to work on a convergence mechanism with SACS to involve the ICTC counsellors
for counselling adolescents.
DADAR AND NAGAR HAVELI: The discussion started with the basic functioning of the
activities as D&N is a union territory with a very small beneficiary population so all the school
health programmes are planned by the state ministry majorly of Gujarat. All the trainings of
ANMs and MO are done by the different societies of the state like state AIDS society. During the
last year, 6 MO, 72 ANMs were sensitized by the NACO cell of Gujarat but no specific ARSH
training was given. As a part of the outreach activities, weekly IFA supplements and yearly
dosage of immunization is being given to all school going and out of school adolescent‟s girls.
The SHP is reaching upto 66,000 children.
As the UT is very small they are facing the issues of establishing separate ARSH clinics and
even utilizing the ICTC counsellor as ARSH counsellors so the UT demands a Joint signature aid
from the Director of the RCH and state ministry to set up these clinics as separate entities.
To strengthen the programme in the UT, it was discussed that focus would be laid on
establishing ARSH clinics at CHC level and utilizing the trained staff. The platform of SHP
would be utilised to link the clinics and the clients. Convergence would be established with
ICTC to link the services. Ensuring regular supply of IFA tablets as WIFS is already going on
well in the UT.
KARNATAKA : The discussion between the moderator and state representative started with
the utilization of the allotted budget for the last year. As stated by the state representatives,
56.5% of allocated budget was utilized. Budget for IEC has not been utilized completely. For the
year 2011, 43.8% the budget was allocated for trainings. An amount of Rs.31 lakhs has been
24
utilized. The state has 1255 functional ARSH clinic with every Thursday being AFHC clinic day.
Data regarding service utilization from district level is available but the authenticity of the data is
not certain as there is lack of compilation of data at PHC level. There are 19 district training
Centre, 4 regional training centre and SIHFW. The state has sensitized all District RCH officers,
District Nursing Officers and District Health Education Officers regarding ARSH. ARSH
modules are available in local language as well. As a part of the outreach activities, 9 districts
have been selected for SABLA. The counselling will be done by the ANMs for the outreach
sessions. .The state has a successful radio programme „Vasant Aagman‟ running on FM every
week at prime time as part of the BCC activities and posters have been distributed at PHC level.
State is planning the radio jingles and TV spots. For RCH regular monitoring report to review
the program every week. In order to increase awareness about AFHC clinics, schools are given
instructions to put SNEHA clinic boards.
To further strengthen the ARSH programme, it was suggested that the state should improve
outreach activities by utilizing platform of SABLA and Menstrual Hygiene Scheme. Provision of
IFA to all adolescents must be ensured either through SHP or through Mid Day Meal scheme.
The platform of School health Programme should be leveraged for increasing awareness
regarding AFHC. The state also needs to ensure convergence with ICTC and AEP.
PUNJAB: The discussion between the moderator and the state representative started with the
brief introduction about the existing functional AFHC in the state.-21 AFHC at DH are
functional. 1063 MO and 2398 ANM/LHV were trained till March 2011. The post of ARSH
coordinator is currently vacant. There is no outreach activity under ARSH programme at present
but state is coordinating with NGOs at Mohali, Amristar and Muktsar and Nawashehar for
planning the same. The state has 4 Regional training centres and SIHFW, with training for
ARSH being conducted at all 5 of them. The orientation sessions have been conducted for
School Health coordinator and community mobiliser. Translation of module into local language
is complete. Radio and TV spots are not a part of IEC/BCC strategy. However, posters are being
displayed and Focus Group Discussions are being conducted. State is integrating the School
health programme, Sabla and ICDS. IFA tablets are being distributed to the adolescent girls
twice a week under the state SHP to cover students from class 6th
-10th
. The monitoring
mechanism for ARSH activities is very poor with no flow of data from DH/CHC/PHC to state
level. A community helpline has been established which needs strengthening for ARSH issues.
The state has already initiated the process of convergence with ICTC clinics.
To further strengthen the programme, it was suggested that the ARSH nodal officer position
should be filled as a priority. State needs to coordinate with NGO‟s for outreach activities.
Monitoring mechanism must be established on priority. Data on utilization of services in AFHC
clinics to be collected and shared.PIP for ARSH is non-specific at present. The state should plan
specific activities under ARSH from next year.
Session on Behaviour Change Communication (BCC) for ARSH
Speakers – Ms. Heer Chokshi, Communication Specialist, JHUCCP/USAID and Ms. Medha
Gandhi, Consultant (ARSH), MoHFW
25
Communication is an integral aspect of health programmes. In order to reach out to adolescents
and young people, it is important that various mediums of information are utilised effectively as
an integral aspect of the programme. A session on Behaviour Change Communication (BCC) for
ARSH was facilitated by Ms. Medha Gandhi, Consultant (ARSH) and Ms. Heer Chokshi, BCC
Specialist, JHUCCP/ USAID. This session provided an insight on the concept of BCC,
components of a BCC strategy including Information Education and Communication (IEC)
material, importance and effectiveness of a comprehensive BCC strategy with specific focus on
adolescents. The concept of BCC strategy was explained using the Uttarakhand BCC strategy for
adolescents as an example of a comprehensive strategy for communicating on health issues with
adolescents. The various materials as part of the larger strategy were explained in this light.
The presentation was followed by an intensive discussion. There was agreement that
communication is an integral aspect of a health intervention for adolescents. Suggestions were
received to use communication material, especially entertainment mediums like films, cartoons,
events, interactive websites and activities to promote health seeking behaviour and correct
information. It was also discussed that there should be national BCC strategy for ARSH and that
may be adopted by the states while ensuring that it would not be diluted to stand alone IEC
materials. It was also felt that comprehensive materials with information on various issues are
required for adolescents at clinics and during out-reach sessions and there should be some
standardisation in the same. States have already initiated the process of developing stand alone
IEC materials for adolescents. Most of the materials developed by the states including Kerala,
Karnataka, Jharkhand, Uttarakhand, Maharashtra, Gujarat, Orissa, Tripura, Puducherry and MP
were displayed during the workshop. This was evidence to the fact that BCC and IEC are
integral components of the ARSH programme. There is now a need to streamline the efforts for a
focussed BCC strategy for ARSH.
Session on Monitoring and Supportive Supervision
Speakers – Dr. Soumya Mohanty, and Ms. Anshu Mohan, Consultant RCH, MoHFW
To strengthen the monitoring mechanisms for the ARSH programme, registers, reporting and
monitoring formats have been developed at the national level. During this session, the facility
registers and monitoring formats were shared with the group for discussion. Detailed discussion
on each aspect of the facility level register; facility to district level reporting format; district level
aggregated formats to be sent to the state and; state level formats to be sent to GoI followed and
the comments from the participants were noted for review and incorporation.
Exhaustive comments were received from all states on the registers and reporting formats. It was
agreed that the formats would be reviewed at the national level in light of the comments received
and revised formats would be shared with all state representatives for field testing and comments
before finalization.
Session on Management Structures for ARSH:
The last presentation of the workshop by Ms. Medha Gandhi, Consultant ARSH focused on
management structure for strengthening the implementation of the ARSH programme. A brief
presentation was made identifying the key programmes that address adolescents – ARSH, School
Health Programme, WIFS and MHS. It was reiterated that one officer at the state level must be
in-charge of all these 4 programmes to ensure effective implementation and convergence. Efforts
26
need to be made to ensure linkages with the programmes for adolescents by other Ministries like
MHRD, MoYAS and MWCD.
It was also reinforced that the programme structure needs to be strengthened at the block level
and regular reports must be maintained at the facility as well as routine reporting should be
ensured from the community based initiatives. The states were requested to ensure that due
importance is given for the implementation of the ARSH programme to achieve the NRHM
goals.
Director RCH reminded the group that the monitoring formats including the facility level
formats would be revised as per the comments and shared with all states for their comments and
piloting in the districts. He also shared that the revised draft of the WIFS guidelines would be
shared for comments. The group was informed that the next quarterly review will be held in
November 2011 and shall continue as a periodic activity in an effort to strengthen the
programme.
Conclusion:
The national workshop was a very successful with thematic presentations and active discussion
with state representatives. The key recommendations for strengthening the ARSH programme
were:
Strengthening Implementation of ARSH:
States to appoint dedicated programme mangers exclusively for Adolescent Health and
plan a management structures for effective planning and implementation of ARSH.
Standard operational guidelines, giving step by step easy to follow instructions to be
developed at the national level and shared with the States.
An e-group to be formed for Adolescent health. This will comprise Programme
Officer/nodal officer/ Consultant for ARSH in the states, MOHFW team and key
development partners like WHO and UNICEF
Strengthening Service Delivery under ARSH:
States to develop need based plan for ARSH which should be reflected in the PIP
with adequate financial allocation.
Develop institutional mechanism for capacity building/ training at the state and
district level, by forming state and district level teams of trainers and preferably by
engaging institutions such as SIHFW, HFWTC, DTC etc.
Ensure adequate supplies for adolescents like IFA, contraceptives , OCPs as integral
component of procurement and supply chain management
Develop standard operating procedures for AFHS for easy registration procedures,
privacy and confidentiality etc
Strengthening outreach services through ASHAs, AWWs and VHNDs and other
platforms
27
Strengthening Management Information System and Monitoring of ARSH activities
A robust system to be developed for data capture on ARSH. Formats for Clinic
Register and Monthly Reporting at Facility and District Level to be developed and
shared with the states for their comments and experiences. Monthly/ quarterly
reports to be collated and reviewed at both State and National level. Indicators to
be included in the HMIS for effective monitoring and evaluation.
Developing mechanism for supportive supervision and feed back
Review of /workshop on Adolescent health to be held every quarter. The next
workshop is tentatively scheduled for November 2011
Strengthening Convergence and partnership under ARSH
Develop a frame work for strengthening convergence mechanism with stakeholders
at the national level as well as the state, district and sub-district level
Ensuring linkage between the AFHC and ICTC. ICTC counselors and services in
stand-alone facilities be utilized for ARSH during the afternoon hours of 3-5 pm.
Synergize planning with SACS for HIV services for young people, especially in high
prevalence states
States should examine the existing convergence mechanism with platforms/
schemes/interventions SABLA, AEP etc.
Implementation of WIFS Policy
States to fix MONDAYS for weekly IFA supplementation and de-worming
Comments on the IFA guidelines will be incorporated and these too will be circulated
for comments via the e group
States to ensure adequate supply of IFA
ASHAs/ANMs & AWW to promote the consumption of the supplementation
provided to the adolescent girls.
The workshop ended with a vote of thanks by the Director (RCH).
28
Annexure 1
List of Participants
S.No State/Organization Name of the Official Contact No/ Email-id
1) ANDHRA
PRADESH
Ms. Uma Devi
Associate Professor
9848362297
Dr. Priya Darsini
Programme Officer, CHFW
9177865674
2) ARUNACHAL
PRADESH
Mrs. Hage Radha
DEE
9436897214
Dr. A Perme Ete
SPO (M&E)
9436059158
3) ASSAM Dr. Bidyawati
Jt. DHS (MCH)
9435014188
Mr. Sanjeev Ranjan
PO, ARSH
9957720796
4) BIHAR Dr. M.P. SHARMA
SPO
09470003023
5) DADAR & NAGAR
HAVELI
Mr. Kumar Manish
SPM, ARSH
9913700207
6) DAMAN & DIU Dr. Devesh Tripathi
DPM, ARSH
08758081382
Mr. Sailesh Ambria
DPM, ARSH
09099322322
7) DELHI STATE
AIDS CONTROL,
DELHI
Dr. A.K. Gupta
Additional Project Director,
DSACS
9718513002
SCHOOL HEALTH
SCHEME, DELHI
Dr. J.P. Kapoor
Additional Director & Head 9654100321
DELHI STATE
HEALTH MISSION
Dr. S.C. Chetal
State Programme
Officer(SAG)
9650391002
Dr. G.P. Kaushal
SPO-RCH
9868394885
8) GOA Dr. Dipak Kabadi
Dy. Director(PH) DHS,Goa
Nodal Officer, NRHM
09011025026
Ms.Medha M. Rivonkar
Social Scientist
ARSH, RCH Programme)
09226265428
9) GUJARAT Dr. S.C. Vashistha
Joint Director (MCH)
COH
07923253306
Dr. Gautam Nayak
State Nodal Officer,
Nutritional Cell, Gujarat
074023245357
29
S.No State/Organization Name of the Official Contact No/ Email-id
10) HARYANA Dr. A.P. Sodhi
Dy. Director, ARSH
DGHS, Haryana
08968999398
Dr. Jasjit Kaur
Dy. Director, ARSH
09815509076
11) HIMACHAL
PRADESH
Dr. A.R. Raghu
ED, NRHM
9418028999
Dr. Nisar Ahmed
OSD, RCH
08894958552
Email: [email protected]
Dr. Rakesh Bhardwaj
Consultant, NRHM
9418485259
12) JAMMU &
KASHMIR
Dr. Manoj Bhagat
State Facilitator, ARSH
09419115413
Dr. Mushtaq Ahmed Dar
Divisional Nodal Officer
9419441180
Dr. Harjeet Rai
Divisional Nodal Officer,
NRHM
9419134458
13) JHARKHAND Dr. Jaya Prasad
Dy. Director, Health & Nodal
Officer, ARSH
9431166257
Ms. Rafat Farzana
Coordinator ARSH & PC-
PNDT
09905335452
14) KARNATAKA Dr. B.V. Karur
Joint Director DGHS Health
9448795058
Mr.V.S.Uppin
Dy. Director(S.H)
9449843133/ 9886315343
15) KERALA Dr. Amar Fettle
Head Programme, GHNM &
State Nodal Officer
09447451846
Dr. Rani Kr
State Nodal Officer
9447084909
16) MADHYA
PRADESH
Dr. K.L. Sahu
Jt. DHS NRHM
Dr. Nidhi Patel
Deputy Director, NRHM
9425027352
17) MAHARASHTRA Dr. Smita Ganu
Assistant Director, NRHM
9665020093
18) MANIPUR Dr. H. Ibemcha Devi
DD, NRHM
9862838563
Email: [email protected]
Shri Khailng Milan
Additional SPM
9862583275
19) ORISSA Dr. B. Dash Mohapatra
JD (RH) & SEPIO
09437002720
30
S.No State/Organization Name of the Official Contact No/ Email-id
Dr. B.K. Panda
Joint Director, NRHM
9439996553
20) RAJASTHAN Ms. Vaidehi Agnihotri
Coordinator, NRHM
9413345429
Dr. Nupur Atherya
JD (RCH)
9828019814
Email: [email protected]
21) SIKKIM Dr. M.L. Lepcha
Jt. Director (NRHM)
09434129943
Dr. C. Yethenpa
Additional Director, NRHM
9434023841
22) TAMIL NADU Dr. K. Jayakumar
Additional Director (NRHM)
09894108910
Dr. Vadivelan
Joint Director Of Public
Health
09443435870
23) UTTARAKHAND Dr. Sushma Datta
Joint Director, RCH
9412055564
Dr. Geeta Khanna
Program Manager
State Nodal Agency, ARSH
9412058970
24) MIZORAM Dr. Hmingthangi
CMO (IEC)
9436350524
25) CHANDIGARH Dr. Soma
DFWO, UT, Chandigarh
0946005595
26) PUNJAB Dr.Meenu Lakhanpal
PO, NGO-PPP
09417019041
27) CHATTISGARH Dr. Alka Gupta
DD-DHS, Raipur
9425212251
28) Dr. Meera Baghel
Gynecologist
Participants from MOHFW, MWCD, NACO, NCERT & Development Partners
29) MOHFW
Ms. Anuradha Gupta,
Joint Secretary – RCH
011-23062157
30) MOHFW
Dr. Suresh K. Mohammed
Director- RCH
9868951933
Email: [email protected]
31) MOHFW Dr. Sheetal Rahi
Medical Officer- AH & SH
9810814964
32) MOHFW
Ms. Medha Gandhi
Consultant -ARSH
9810225544
33) MOHFW
Ms. Anshu Mohan
Consultant -PM
9958475130
Email: [email protected]
34) MOHFW
Dr. Soumya Mohanty
Consultant -M&E
8882221022
Email: [email protected]
35) MWCD Ms. Lopamudra Mohanty
Deputy Secretary
011-23074215
31
S.No State/Organization Name of the Official Contact No/ Email-id
36) NACO Dr. Raghuram Rao
PO-ICTC, NACO
9555113213
Email: [email protected]
37) NACO Bilal Ahmed
PO (Youth)
9818688224
Email: [email protected]
38) NCERT-MOHRD Dr. Saroj Yadav
Professor
9911079287
Email: [email protected]
39) WHO - SEARO Dr. Neena Raina
Regional Advisor - CAH Email: [email protected]
40) WHO-INDIA Dr. Paul Francis
NPO
981825387
Email: [email protected]
41) WHO - INDIA
Dr. Kiran Sharma
NPO- ADH Email: [email protected]
42) WHO - INDIA
Dr. Rajesh Mehta
MO-CAH
Email: [email protected]
43) UNICEF Dr. Henri van den Hombergh
Chief- Child Health
011-24690401
44) UNICEF Mr. Kimberly Allen
Health Specialist, Maternal &
Women‟s Health
9717197827
45) UNICEF Dr. Aboli Gore
Health Officer 9771211162
Email: [email protected]
46) UNICEF Dr. Sudha Balakrishnan
Specialist HIV/AIDS
9818955222
47) SOLUTION
EXCHANGE
UNICEF
Ms. Meenakshi Aggarwal
Research Associate 9899265453
48) UNFPA
Dr. Dinesh Aggarwal
Programme Officer, UNFPA
9868884942
Email: [email protected]
49) JHUCCP Ms. Heer Chokshi
Bcc Specialist
9811971810
Email: [email protected]
50) JHCHIP Dr. Bulbul Sood
Contry Director 9810096914
51) HMRP Parag Gupta, MD 9899710882
52) PHN
Dr. Sheila Vir
Director, PHN
9873680247
Email : [email protected]
32
Annexure 2
Adolescent Friendly Health Clinics (AFHCs) and Caseload
Sl. No. State Clinics Operational as of
March 2011
Target for
Clinics for
2011-12
Total
Operational
Clinics
Average
Caseload at
Clinics
DH CHC PHC Boys Girls
1 A&N Islands
2 Andhra Pradesh 19 93 288 NA 400 - -
3 Arunachal Pradesh 1 0 0 13 1 - -
4 Assam 0 0 0 0 0 0 0
5 Bihar 0 1 0 2 1 0 0
6 Chandigarh
7 Chhattisgarh 0 0 0 0 0 0 0
8 Dadar & Nagar
Haveli 0 0 0 0 0 0 0
9 Daman & Diu - - - - - - -
10 Delhi 8 6 65 250 92 17 6
11 Goa 0 5 23 2 28
12 Gujarat 25 12 18 0 55 15 10
13 Haryana 9 9 18 84 36 0 0
14 Himachal Pradesh 0 0 0 0 1 0 0
15 Jammu & Kashmir 15 0 0 22 15 2 11
16 Jharkhand 19 114 0 61 122 4 7
17 Karnataka 0 0 2193 0 1255 14 21
18 Kerala 4 0 0 6 4 300 160
19 Lakshwadeep 0 0 0 0 0 0 0
20 Madhya Pradesh 27 40 198 490
21 Maharashtra 26 114 0 140 22 14
22 Manipur 0 0 0 19 0 0 0
23 Meghalaya
24 Mizoram 5 0 0 3 0 - -
25 Nagaland
26 Orissa 4 16 64 20 9 52
27 Puducherry 0 4 39 43 3 57
28 Punjab
29 Rajasthan 0 0 434 366 434 - -
30 Sikkim 4 0 25 29 3 4
31 Tamil Nadu 0 0 0 0 0 0 0
32 Tripura 2 22 0 24 2 12
33 Uttar Pradesh
34 Uttarakhand 1 16 1 31 18 11 15
35 West Bengal 15 341 356 15 18
TOTAL 184 753 3144 923 3074 614 877
Source: Report upto July 2011 as per the quarterly report submitted by the state
33
Annexure 3
Status of Training on Adolescent Friendly Health Services
Sl. No. State
MO
Trained
as of
March
2011
Target
for
2011-12
Trained
in 2011-
12
ANM/LHV/
AFHC/ICTC
Counsellor
Trained as of
March 2011
Target
for
2011-12
Trained in
2011-12
1 A&N Islands
2 Andhra Pradesh 24 80 0 7800 0
3 Arunachal Pradesh 0 16 0 0 0 0
4 Assam 140 300 0 72 912 0
5 Bihar 81 22 0 308 132 0
6 Chandigarh
7 Chhattisgarh 0 0 0 0 0 0
8 D& N Haveli 6 0 0 72 0 0
9 Daman & Diu
10 Delhi 330 100 35 567 0 0
11 Goa 18 60 0 0 178 17
12 Gujarat 762 900 0 1189 3000 20
13 Haryana 67 168 0 144 202 0
14 Himachal Pradeash 206 175 0 1164 0 0
15 Jammu & Kashmir 123 65 39 136 110 0
16 Jharkhand 217 120 0 535 600 0
17 Karnataka 956 0 210 3517 0 675
18 Kerala 30 420 30 60 840 60
19 Lakshadweep
20 Madhya Pradesh 97 200 - 263 200 0
21 Maharashtra 199 81 34 2067 1270 7
22 Manipur 29 61 0 77 0 0
23 Meghalaya
24 Mizoram 99 0 0 637 60 0
25 Nagaland
26 Orissa 90 150 90 1860 9350 90
27 Puducherry 687 0 0 637 0 0
28 Punjab
29 Rajasthan 631 196 0 0 906 0
30 Sikkim 98 30 0 180 30 0
31 Tamil Nadu 345 8085 599
32 Tripura 24 28 0 144 260 0
33 Uttar Pradesh
34 Uttarakhand 76 135 0 387 725
35 West Bengal 0 341 19 359 1014 540
TOTAL 4990 3568 537 14720 35674 2008
Source: Report upto July 2011 as per the quarterly report submitted by the state
34
Annexure 3
Outreach Services
S.No State Outreach
Approach
No of Peer
Educators
Identified
No of Peer
Educators
Trained
No of
Group
Meetings
VHND/ School &
College
M F M F
1 Assam PE 100 100 100 100 80
2 D&N
Haveli
PE and
VHND
48 48 48 48 4 585 sessions on VHND
3 Gujarat MTA 19000 384412
4 Haryana PE 1307 1315
5 HP PE 24 36 0 0
6 Puducherry VHND 1394 sessions with AG
7 Rajasthan VHND 3.65 Lakh girls reached
8 Sikkim PE 460 350 460 350 1018 VHND sessions &
1066 school
9 Uttarakhand PE 1350 1350 1350 1350 20711 1106 VHND & 273
school
10 WB PE 0 1842 0 4150 1395 5976 AG & AB in schools
Source: Report upto July 2011 as per the quarterly report submitted by the state