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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.

13

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

drumadevi@yahoo.com

Dr. Priya Darsini

Programme Officer, CHFW

9177865674

drpriya631@gmail.com

2) ARUNACHAL

PRADESH

Mrs. Hage Radha

DEE

9436897214

hageradha@gmail.com

Dr. A Perme Ete

SPO (M&E)

9436059158

dramp_23@yahoo.co.in

3) ASSAM Dr. Bidyawati

Jt. DHS (MCH)

9435014188

bidyawatidevi@gmail.com

Mr. Sanjeev Ranjan

PO, ARSH

9957720796

nrhmsanjeev@gmail.com

4) BIHAR Dr. M.P. SHARMA

SPO

09470003023

mmu@statehealthsocietybihar.org

5) DADAR & NAGAR

HAVELI

Mr. Kumar Manish

SPM, ARSH

9913700207

21.kumar@gmail.com

6) DAMAN & DIU Dr. Devesh Tripathi

DPM, ARSH

08758081382

drdeveshtripathi_1@yahoo.com

Mr. Sailesh Ambria

DPM, ARSH

09099322322

shaileshmsw@gmail.com

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

dshmspmu@gmail.com

Dr. G.P. Kaushal

SPO-RCH

9868394885

gpkaushal2005@gmail.com

8) GOA Dr. Dipak Kabadi

Dy. Director(PH) DHS,Goa

Nodal Officer, NRHM

09011025026

nuldcpgoa@hotmail.com

Ms.Medha M. Rivonkar

Social Scientist

ARSH, RCH Programme)

09226265428

umademelucky@rediffmail.com

9) GUJARAT Dr. S.C. Vashistha

Joint Director (MCH)

COH

07923253306

scvasista@redifmail.com

Dr. Gautam Nayak

State Nodal Officer,

Nutritional Cell, Gujarat

074023245357

snc.gujarat@gmail.com

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

divisionbec@gmail.com

11) HIMACHAL

PRADESH

Dr. A.R. Raghu

ED, NRHM

9418028999

Dr. Nisar Ahmed

OSD, RCH

08894958552

Email: nisarahmedosd@gmail.com

Dr. Rakesh Bhardwaj

Consultant, NRHM

9418485259

12) JAMMU &

KASHMIR

Dr. Manoj Bhagat

State Facilitator, ARSH

09419115413

drmanojbhagat@gmail.com

Dr. Mushtaq Ahmed Dar

Divisional Nodal Officer

9419441180

dnokashmir@gmail.com

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

rafat.dietician@gmail.com

14) KARNATAKA Dr. B.V. Karur

Joint Director DGHS Health

9448795058

karur_bv@yahoo.com

Mr.V.S.Uppin

Dy. Director(S.H)

9449843133/ 9886315343

dddhs@gmail.com

15) KERALA Dr. Amar Fettle

Head Programme, GHNM &

State Nodal Officer

09447451846

amarfettle@gmail.com

Dr. Rani Kr

State Nodal Officer

9447084909

shnrmkerala@gmail.com

16) MADHYA

PRADESH

Dr. K.L. Sahu

Jt. DHS NRHM

drkllsahu2011@gmail.com

Dr. Nidhi Patel

Deputy Director, NRHM

9425027352

nidhipatel2005@gmail.com

17) MAHARASHTRA Dr. Smita Ganu

Assistant Director, NRHM

9665020093

rchh.jsy@gmail.com

18) MANIPUR Dr. H. Ibemcha Devi

DD, NRHM

9862838563

Email: ibemchanrhm@gmail.com

Shri Khailng Milan

Additional SPM

9862583275

19) ORISSA Dr. B. Dash Mohapatra

JD (RH) & SEPIO

09437002720

dr.bdashmohapatra@gmail.com

30

S.No State/Organization Name of the Official Contact No/ Email-id

Dr. B.K. Panda

Joint Director, NRHM

9439996553

drbkpanda@rediffmail.com

20) RAJASTHAN Ms. Vaidehi Agnihotri

Coordinator, NRHM

9413345429

Dr. Nupur Atherya

JD (RCH)

9828019814

Email: nupuratherya@yahoo.co.in

21) SIKKIM Dr. M.L. Lepcha

Jt. Director (NRHM)

09434129943

Dr. C. Yethenpa

Additional Director, NRHM

9434023841

nrhmsikkim@gmail.com

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

drsushmadatta@gmail.com

Dr. Geeta Khanna

Program Manager

State Nodal Agency, ARSH

9412058970

geeta_dawar@yahoo.com

24) MIZORAM Dr. Hmingthangi

CMO (IEC)

9436350524

tchmingthangi@yahoo.com

25) CHANDIGARH Dr. Soma

DFWO, UT, Chandigarh

0946005595

dfwochd@yahoo.co.in

26) PUNJAB Dr.Meenu Lakhanpal

PO, NGO-PPP

09417019041

ngo.ppp123@gail.com

27) CHATTISGARH Dr. Alka Gupta

DD-DHS, Raipur

9425212251

alka_mhurhmcg@yahoo.com

28) Dr. Meera Baghel

Gynecologist

drmeerabaghel@gmail.com

Participants from MOHFW, MWCD, NACO, NCERT & Development Partners

29) MOHFW

Ms. Anuradha Gupta,

Joint Secretary – RCH

011-23062157

anuradha-gupta@hotmail.com;

30) MOHFW

Dr. Suresh K. Mohammed

Director- RCH

9868951933

Email: suresh.mohammed@nic.in

31) MOHFW Dr. Sheetal Rahi

Medical Officer- AH & SH

9810814964

sheetal.mohfw@gmail.com

32) MOHFW

Ms. Medha Gandhi

Consultant -ARSH

9810225544

arshconsultantgoi@gmail.com

33) MOHFW

Ms. Anshu Mohan

Consultant -PM

9958475130

Email: anshu.mohan@nic.in

34) MOHFW

Dr. Soumya Mohanty

Consultant -M&E

8882221022

Email: msoumya7@gmail.com

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: drraghuramrao@gmail.com

37) NACO Bilal Ahmed

PO (Youth)

9818688224

Email: bnaqati@gmail.com

38) NCERT-MOHRD Dr. Saroj Yadav

Professor

9911079287

Email: saroj.npep@gmail.com

39) WHO - SEARO Dr. Neena Raina

Regional Advisor - CAH Email: rainan@searo.who.int

40) WHO-INDIA Dr. Paul Francis

NPO

981825387

Email: paulf@searo.who.in

41) WHO - INDIA

Dr. Kiran Sharma

NPO- ADH Email: sharmaki@searo.who.int

42) WHO - INDIA

Dr. Rajesh Mehta

MO-CAH

Email: mehtara@searo.who.int

43) UNICEF Dr. Henri van den Hombergh

Chief- Child Health

011-24690401

hvdhombergh@unicef.org

44) UNICEF Mr. Kimberly Allen

Health Specialist, Maternal &

Women‟s Health

9717197827

kiallen@unicef.org

45) UNICEF Dr. Aboli Gore

Health Officer 9771211162

Email: agore@unicef.org

46) UNICEF Dr. Sudha Balakrishnan

Specialist HIV/AIDS

9818955222

sbalakrishnan@unicef.org

47) SOLUTION

EXCHANGE

UNICEF

Ms. Meenakshi Aggarwal

Research Associate 9899265453

48) UNFPA

Dr. Dinesh Aggarwal

Programme Officer, UNFPA

9868884942

Email: dinesh.agarwal@unfpa.org.in

49) JHUCCP Ms. Heer Chokshi

Bcc Specialist

9811971810

Email: hchoksi@jhuccp.in

50) JHCHIP Dr. Bulbul Sood

Contry Director 9810096914

51) HMRP Parag Gupta, MD 9899710882

52) PHN

Dr. Sheila Vir

Director, PHN

9873680247

Email : sheila.vir@gmail.com

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