Government of India Initiatives on developing ARSH Strategy: Integrating SRH with HIV prevention

1. Government of India Initiatives on developing ARSH Strategy: Integrating SRH with HIV prevention Chaitanya Prasad Director MoHFW

2. Young People in India: An underserved population • Large numbers • Early marriage and early pregnancies • Unmet needs of adolescents • Contribute to MMR,TFR and IMR • HIV: 35% new cases in the age • group15-24 • Malnutrition and anaemia rampant • Limited use of existing resources

3. Why Invest…. Investments in Young People will yield dividends in terms of delaying age of marriage, reducing incidence of pregnancies, meeting unmet contraceptive needs and reducing incidence of STI/HIV/AIDS “Catch them young”

4. 10-19 years - a critical Phase Health Risks: • Inadequately prepared for life • Enter Adulthood in poor health • Unintended unwanted pregnancy/unsafe abortion • Maternal mortality higher for young Women • Infant mortality higher for young mothers • Sexual abuse/violence and unwanted sexual activity • STIs including HIV/AIDS

5. Policy scenario • National Population Policy 2000 recognizes health needs of adolescents as ‘underserved group’ • Tenth Five Year Plan identifies adolescents as a distinct target group for policy & prog focus • National AIDS Prevention & Control Policy II recognizes youth as one of the segments for prevention programmes • NACP III has a special focus on young people • National Youth Policy 2003 promotes access for all young people to health information and services. Articulates need for HIV/AIDS and sexual health education.

6. Programs for Adolescents MOHFW: • Adolescent Reproductive & Sexual Health (ARSH) Strategy in RCH Program Phase II Other Sectors: • MOYAS: Initiatives on awareness and life skills, UTA and Adolescent Empowerment Scheme • Department of Education: Adolescence Education Program • DWCD: KISHORI SHAKTI YOJANA –To improve the health and nutritional status of girls • BALIKA SAMRIDHI YOJANA –To Delay the age of marriage

7. Inter-Sector Convergence • No duplication of work • Only Complementarities • Each sector may take a lead role • At the same time it can help / enable other sectors to deliver adolescent interventions • Health Sector to take lead

8. NRHM Vision • Improve availability of quality health care in rural areas • Synergy between health and determinants of good health • Community ownership of health facilities • Undertake architectural corrections of the health system Expected Outcomes • IMR reduced to 30/1000 live births by 2012 • MMR reduced to 100/100,000 live births by 2012 • TFR reduced to 2.1 by 2012

9. MOHFW RCH II ARSH Strategy Overall objective of ARSH Strategy is to contribute to the RCH II goals of reduction of IMR, MMR and TFR. Objective to be met by: (i) Reducing teenage pregnancies (ii) meeting unmet contraceptive needs (iii) reducing number of teenage maternal deaths (iv) reducing incidence of STIs and (v) reducing proportion of HIV positive in 10- 19 years age group

10. Interventions for RCH II ARSH • Services for adolescents to cover preventive, promotive, curative and counselling services • Capacity building of on meeting service needs of adolescents • Communication activities to be undertaken • MIS indicators identified as per specific objectives • Inter-sectoral linkages with NACP and NRHM interventions

11. MOHFW: Progress so far • RCH-II ARSH Strategy approved as part of National RCH-II PIP • Strategy incorporated in State RCH-II PIPs • Self learning module for rural youth and health care providers • MOHFW RCH-II ARSH Training Sub-Group constituted & developed a training design document. Members included NIHFW, UNFPA, WHO-India, & Experts

12. ARSH Training Package Orientation Programme for MOs and ANMs (AWW, Counselors) • “How to treat differently a client who is 16 – and not 6 or 26” • Developing sensitivity towards adolescent clients • Non-judgmental, friendly, competent provider • “How to deliver friendly services within public health system” Training of ASHA: Adolescent Health included

13. ARSH Training National level Training: • Two batches completed • One more batch: in Feb 07 State level Trainings: • Goa • Maharashtra • Rajasthan • Madhya Pradesh Mainstreaming in RCH training Framework: • Training Division • NIHFW, SIHFW

14. Training Package for Medical Officers • Duration: 3 Days • Contents: 10 Modules • Introductory Module • Adolescent Health and Development: Public Health Impact • Communicating with Adolescents • Adolescent Friendly Health Services • Adolescent Sexual and Reproductive Health • STIs/RTIs, HIV/AIDS • Nutrition and Anemia • Adolescent Pregnancy and Abortion • Contraception for Adolescents • Concluding Module

15. Implementation Guide • PART ONE: BACKGROUND • Purpose of the Implementation Guide • ARSH in RCH II • PART TWO: WHAT TO IMPLEMENT? • Standards for Adolescent Friendly Reproductive and Sexual Health Services • PART THREE: HOW TO IMPLEMENT? • Service Delivery Package • Organizing Effective Services • Conducive environment at health facilities • Capacity Building of Providers • Environment Building • Communication with adolescents • Monitoring and Supervision • Sample implementation plan • PART FOUR: MOVING AHEAD • Conclusion

16. HIV/AIDS and Young People in India • India has the second largest population of HIV infected individuals which is estimated at 5.2 million • About 30-35% of all reported HIV infections in India occur among young people in age group 15-24 years, indicating young people are highly vulnerable. • The epidemic has become “feminized” with more women becoming infected • Challenge is how to keep the young population free from HIV • Ref: www. nacoonline.org

17. Convergence between SRH & HIV for ARSH • Addressing common challenges • Understanding the need to address common risk factors • Utilising capacity for optimum utilisation of resources • Pro-active participation of key stakeholders to mainstream programme within the Public Health System • Common communication strategy for access to services • Preventing overlap of interventions – avoid duplication

18. Convergence between SRH & HIV for ARSH • Establishing linkages with regard to services • Institutional linkages critical for roll out • Preventing overlap of interventions with regard to target groups and services • Balancing the preventive and care strategies in both programme

19. Next steps • Strengthen RCH MIS Framework • Communication Strategy for ARSH • Establishing / Strengthening Inter-Sectoral Convergence • Quality Assurance Framework • Developing institutional and service linkages within ARSH framework to address HIV concerns

20. Thank You