Improving Adolescent Health Services across High Priority Districts in 6 States of India: Learnings from an Integrated Reproductive Maternal Newborn Child and Adolescent Health Project

The strategy recommends investments in policies and programs to address adolescent health issues. In response, the Global Accelerated Action for the Health of Adolescents was initiated to institutionalize integrated solutions for adolescent health. India has been at the forefront of designing adolescent health policies, with the National Adolescent Reproductive and Sexual Health policy launched in 2006, the Reproductive, Maternal, Newborn Child, and Adolescent Health strategy in 2013, and the Rashtriya Kishor Swasthya Karyakram (RKSK) in 2014. However, despite these policies, adolescent health outcomes in India require improvement through the operationalization of focused and need-based interventions. The objectives of this study were to improve services for RKSK interventions across select geographies of India. The USAID's VRIDDHI Project provided technical support at the national level and in six focus states to improve the uptake of evidence-based high-impact reproductive, maternal, newborn, child, and adolescent health interventions. Two approaches were implemented to improve adolescent health services and outcomes: strengthening the functioning of adolescent-friendly health clinics in 95 high caseload health facilities in 26 high-priority districts across six states, and demonstrating other operational strategies outlined in the RKSK program. The project was successful in improving adolescent health services in the intervention facilities through an integrated approach that is replicable, sustainable, and scalable for driving the adolescent health program in India. The project's technical team, comprising senior government officials and project staff, reviewed the findings and developed four models to address systemic gaps and positively influence adolescent health services and delivery. The models included strengthening adolescent-friendly health clinics at L2 and L3 health facilities, demonstrating other operational strategies outlined in the RKSK program, and developing adolescent-focused communication materials. The implementation frameworks for the interventions included a baseline assessment of 95 adolescent-friendly health clinics located across high caseload L3 and L2 government health facilities in 26 high-priority districts. The assessment identified areas that needed strengthening for optimization of service delivery, and an implementation framework was developed through a consultative process to inform decision-making for reorganization of institutional processes at the clinics. The project team engaged in a training, mentorship, and quality improvement framework to improve the functioning of the clinics, including training and mentoring of service providers, concurrent monitoring of service delivery quality, and establishing review mechanisms. The project's efforts were guided by the Global Accelerated Action for the Health of Adolescents, which provides an action framework to assist national governments in deciding what they plan to do and how they plan to do it to respond to the health needs of adolescents in their countries. India has led efforts in designing and implementing adolescent health policies and programs, with nearly 243 million adolescents in the country. The Ministry of Health and Family Welfare, Government of India, has launched multiple initiatives for improving adolescent health services, including the Adolescent Reproductive and Sexual Health policy in 2006, the Reproductive Maternal Newborn Child and Adolescent Health strategy in 2013, and the RKSK in 2014. However, despite these policy initiatives, traditional challenges such as early marriages, teenage pregnancy, anemia, and high incidence of maternal mortality among young mothers continue to persist in India. The project's findings highlight the need for evidence on the functionality of adolescent health interventions and the level of integration of ongoing programs within the broader reproductive, maternal, newborn, child, and adolescent health context. The project's technical assistance to the national government and state governments in six focus states aims to improve the uptake of evidence-based high-impact reproductive, maternal, newborn, child, and adolescent health interventions.