Details for Reform Option "Adolescent Health Programme, Kerala"
Almost one-third of India’s population is young and faces significant risks related to sexual and reproductive health. It is therefore important to influence the health-seeking behaviour of adolescents in order for the next decade to witness rapid improvement in health indicators. The State Government in Kerala had noted that there was a low level of awareness regarding sexual and reproductive health among adolescents and a lack of proper facilities to deal with these problems in the State.
The State Government devised an Adolescent Health Care Project. The first step was to devise a project manual and teaching module which were completed by June 2005. See both in Documents and Illustrations (below).
The State Child Development Centre assessed existing data and reports on Adolescent Sexual and Reproductive Health (ASRH), mapped services available and prepared a directory of resource persons and materials.
The Family Life Education (FLE) Module covers Life Skill Education, AIDS Awareness and ASRH with the focus not just on subject content but on social acceptability and appropriateness of language.
The FLE components include:
(i) Adolescent nutrition – needs and issues relating to obesity.
(ii) Personal hygiene – relating to urinary or reproductive tract infections.
(iii) Identity crisis – body image, psycho-social competence.
(iv) Life skill development – capacity to say “no” to peer pressure.
(v) Avoiding alcohol, cigarettes, drug abuse and sexual abuse.
(vi) Sexually Transmitted Infections (STIs) and HIV/AIDS awareness, responsible sexual behaviour.
In addition, there is a FLE module for Plus-2 School adolescents. This module uses the name FLE rather than ‘sex education’ – a term which is unacceptable to many Indian parents.
It was also decided that it would be better for a doctor or counsellor to be present at the FLE class as pilot experiences found teachers had difficulty talking to their children about these issues.
FLE teachers should be experienced in teaching and in conducting adolescent clinics and have a PG Diploma in Clinical Child Development (DCCD) from the Child Development Centre.
The project plans to cover 20,000 students from Class-XI who will be tested before and after the course on their ASRH knowledge.
The project is planned for a five-year period and includes a number of other activities including:
(i) Reaching out-of-school adolescents through the Kerala State Literacy Mission Authority (KSLMA).
(ii) Formation of teen clubs for out-of-school boys.
(iii) Formation of Anganwadi-based teen clubs for out-of-school girls.
(iv) ASRH clinics at Taluk Hospitals
(v) Outreach approach by proving Adolescent Care, Counselling, Empowerment and Support Services (ACCESS) units at Taluk and private hospitals.
(vi) Establishing Adolescent Development Centres (ADC) at NYKS-affiliated Youth Development Centres.
(vii) Self employment for below poverty line adolescent girls through Kudumbasree.
For further details on each of these activities see Documents and Illustrations (below).
The project is planned over a five year period. It will be evaluated by an external agency who will prepare a report highlighting lessons learnt for dissemination at State and possibly National level.
Total cost for the proposed project in all 14 districts: INR 4,09,54,400.
This figure includes:
District level training for 14 districts: INR 53,34,000
Recurring expenditure for three years for one district: INR 288,34,400
Organisation of Apex training and Resource Centre: INR 41,86,000
Information, Documentation and Dissemination Unit: INR 19,00,000
Behavioural Paediatrics – Scholastic Backwardness Unit: INR 1.5 lakhs
Adolescent Care Counselling Unit: INR 1.5 lakhs
Guidance and Counselling Unit: INR 1.5 lakhs
Family Counselling Unit: INR 50,000.
For a detailed breakdown see budget chapter within manual.
The preparation of the project manual and the implementation of the Adolescent Health Programme in Trivandrum District is being funded by the European Commission’s Sector Investment Programme.
Kerala, intially in one district, Trivandrum.
It will be extended to other districts during RCH 2.
Programme began July 2004.
Preparation of the project manual and the adolescent health module: 6 months.
Implementation: 13 months.
Time and resource effective: It is envisaged that it will take a relatively short time to implement the project because it concentrates on making optimal usage of available resources.
None yet perceived.
A centre for child health or adolescent health: in this case the Child Development Centre, Thiruvananthapuram.
Development of Adolescent Health Modules.
Who needs to be consulted
Director of Health Services,
Child Development Centre.
The programme involves grassroots NGOs and the Panchayat Raj system which should make it acceptable to the community.
Included in RCH 2.
The Adolescent Care Clinics, counselling and training facilities and speciality services will all charge user fees in an effort to make them self sustaining.
External funding will be sought for research projects.
Chances of Replication
Dr K Sandeep, Technical Secretary, Sector Reform Cell, Directorate of Health Services, Kerala. September 2005.