Details for Reform Option "Health education of adolescents, Maharashtra"
Although the district of Satara in Maharashtra has relatively better health indicators, there is still a low age of girls at marriage, a high number of home deliveries by untrained persons, low awareness levels among adolescents on reproductive health issues and a lack of technical and communication skills amongst paramedics to address these issues.
Giving adolescents health education would go a long way towards preventing possible health hazards and changing the community’s behaviour which will have a long term impact on Reproductive Child Health (RCH) indicators.
The Health Department of the Zilla Parishad (district level government office) at Satara has initiated a component on adolescent health as part of the Sector Investment Programme in the district. This includes providing health education, medical examinations and treatment for all adolescents (11-17 years).
Activities undertaken included
(i) Sensitisation workshops and training of its staff including Medical Officers (MOs), Auxilary Nurse Midwives (ANMs), Anganwadi workers (AWWs) and headmasters and teachers at schools.
(ii) Health check-up camps.
(iii) Preparation and distribution of health check-up cards and booklets on adolescent health education. Booklets include information on growth patterns of male and female, diet and exercise.
While teachers are trained to give health education to adolescents attending school, the AWWs are trained to educate those not in school. MOs conduct the health check-ups and follow up.
It was decided that in one block, trainings would be undertaken by an NGO- Parivarthan. They have now completed trainings in two rural blocks (Koregaon and Jawali) and are in the process of training teachers in Satara block.
Along with this component, various other activities are undertaken to increase the age of girls at marriage. These include meetings with parents at the village level by ANMs and MOs, meetings with Sarpanchs at block level and meetings with priests and printing press owners. The ANMs keep a check and maintain a register of all girls in the age group 15-18 years in their locality. Information Education and Communication (IEC) activities such as distribution of hand bills and slogan displays are undertaken. Newly weds who have waited for the legal age at marriage are felicitated every year on World Population Day.
In 2000, the percentage of girls married before the age of 18 was 21.9%. This has decreased to 5.4% by March 2004.
Approximately 40 marriages of girls below 18 have been avoided due to the spread of information. Now it is common practice to ask for age certificates before a marriage can take place.
586 secondary schools were covered under the adolescent health education programme.
Approx. INR 25 lakhs in the first plan of 18 months (September 2001-March 2003). The second plan (April 2003-Dec. 2004) had a budget of INR18 lakhs .
Approx. INR 8.4 lakhs and INR18.1 lakhs budgeted for the first and second year respectively, for the component on raising age at marriage.
Satara District, Maharashtra since September 2001.
Intersectoral coordination: Between health, ICDS staff and school teachers.
Educational: Addresses the need for basic knowledge on health and sex issues which adolescents would otherwise never get.
Behaviour change: All adolescents are possible future parents and so awareness would definitely reduce problems such as early age at marriage and home deliveries.
Possible Opposition: Reluctance by teachers to talk to students about sex related issues. In Satara for instance, teachers were initially wary but were more comfortable after the first training. A number of re-orientations have since been conducted.
Good communication between AWWs and school teachers.
Public Private Partnership with NGOs to provide training.
Who needs to be consulted
Health and Family Welfare department officials at state, district and sub district levels, school principals and teachers, ICDS workers-AWWs, NGOs with ability to provide health education trainings.
Needs initial support in terms of conducting training, preparation and printing of health cards and booklets.
Chances of Replication
Good provided proper situational analysis, planning, monitoring and evaluation is undertaken.
Sara Joseph, Researcher, ECTA, New Delhi, February 2005.