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Explain
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This image is a page (page 544) from an Indian public health/community medicine textbook, covering Health Programmes in India - specifically focused on Adolescent Health. Let me break down each section clearly:
Health Programmes in India - Adolescent Health (Page 544)
Adolescent Health Programme (AHP)
The page opens by noting that most NRHM (National Rural Health Mission) interventions have been part of improving survival. The Adolescent Health Programme was developed to address the comprehensive and diverse nature of adolescent health needs.
Taking cognizance of:
- Communicable diseases and substance use
- Sexual and reproductive health, mental health, nutrition, gender-based violence, non-communicable diseases
The programme proposes a set of interventions (health promotion, prevention, diagnosis, treatment, and referral) across four levels:
- Individual level - building protective factors to help adolescents resist negative behaviours
- Family level - providing information and services
- School and community level - working together
- Facility level - providing a comprehensive package of information, commodities, and services
Priority interventions include:
- Adolescent nutrition (iron, folic acid supplementation)
- Facility-based adolescent sexual and reproductive health clinics (ARSH)
- Information and counselling on adolescent sexual and reproductive health issues
- Menstrual hygiene
A. Adolescent Reproductive and Sexual Health (ARSH) Programme
ARSH focuses on reorganizing the existing public health system to ensure improved service delivery for adolescents. Steps being taken to ensure service availability on fixed days and timings at sub-centre, community health clinics, and hospitals.
The programme promotes a package of services including:
- Preventive, curative, and counselling services - married and unmarried, girls and boys - through adolescent friendly clinics at Primary Health Centres, Community Health Centres, District/Core/Hospital levels
- Facility-based services - Adolescent Friendly Health Clinics
- Counselling - Dedicated ARSH and ICTC counselling
- Community-based interventions - Outreach activities
- Capacity building for service providers
Adolescent Friendly Health Clinics (AFHC): Through AFHCs, routine check-up services, information, and commodities are provided to more than 2.5 million adolescents across the country at fixed-day clinics. At present, 6,302 AFHCs are functional at primary, secondary, and tertiary levels of care including for menstrual problems, contraceptives, and RTI/STI management.
B. Weekly Iron and Folic Acid Supplementation (WIFS) Programme
Launched by the Ministry of Health and Family Welfare, WIFS provides:
- Weekly Iron-Folic Acid supplements to target groups (girls and boys) for moderate/severe anaemia
- 500 µg folic acid + 100 mg elemental iron using a fixed-day approach
- Supervised weekly distribution
Key interventions:
- Administration of supervised weekly iron-folic acid supplements to 10.25 crore adolescents
- Screening for moderate/severe anaemia and referring these cases to appropriate health facilities
- Biannual de-worming (Albendazole 400 mg) every 6 months, for control of helminth (intestinal worm) infestation
Goal: Break the intergenerational cycle of anaemia among adolescent girls and boys. The long-term goal is to improve human capital - both in rural and urban areas.
C. Menstrual Hygiene Scheme
Launched by the Ministry of Health and Family Welfare, this scheme focuses on:
- Ensuring that girls in the 10-19 age group in rural areas have adequate knowledge and information about menstrual hygiene and access to high-quality sanitary napkins
- Key activities:
- Community-based health education and outreach to target population to promote menstrual health
- Ensuring regular availability of sanitary napkins to adolescents
- Sourcing and procurement of sanitary napkins
- Storage and distribution of sanitary napkins
- Training of ASHA and nodal teachers in menstrual health
- Safe disposal of sanitary napkins
II. Facility-Based Counselling Services
Facility-based services for adolescents include counselling on:
- Important issues such as puberty, RTI/STI prevention and management, nutrition, delayed marriage and childbearing, contraception, abortion, sexual abuse, marital concerns, substance misuse, and mental health problems
- Sexual and reproductive health services are provided through dedicated counsellors who provide comprehensive counselling to adolescents
- At present, 881 dedicated counsellors are being provided across 23 States/UTs, and 1,439 ICTC counsellors are also trained to provide adolescent sexual and reproductive health counselling
Outreach activities: Being conducted in schools, colleges, teen clubs, vocational training centres, during Village Health Nutrition Day (VHND), and through Self-Help Groups (SHGs) in collaboration with adequate and appropriate spaces where they normally congregate. The programme provides adolescents information to help groups in spaces where they congregate.
Summary Table
| Programme | Focus | Key Feature |
|---|---|---|
| AHP | Comprehensive adolescent health | 4-level interventions |
| ARSH | Sexual & reproductive health | Adolescent Friendly Clinics (6,302 AFHCs) |
| WIFS | Anaemia prevention | Weekly iron-folic acid + biannual deworming |
| Menstrual Hygiene Scheme | Menstrual health | Sanitary napkin distribution + education |
| Facility Counselling | Counselling services | 881 dedicated + 1,439 ICTC counsellors |
These programmes together form India's national strategy for adolescent health under the NRHM/NHM umbrella, addressing both preventive and curative aspects of health for the 10-19 age group.
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