ARSH PROGRAMME BY THE STUDENTS OF AIMSR MBBS BATCH 2012

2. PRESENTATION : INCLUDE
• Introduction
• Characteristics
• Why pay attention to the health of adolescents?
• Health problems of adolescents
• ARSH – PROGRAMME (Main)
• RMNCH+A - PROGRAMME

3. INTRODUCTION:
• The term adolescence is derived from the Latin word “adolescere”
meaning to grow, to mature.
• It is a time of physical and emotional change as the body matures
and the mind becomes more questioning and independent.
• These are the formative years of life of an individual when major
physical, psychological & behavioral changes takes place.
• Period of preparation for undertaking greater responsibilities
including healthy responsible parenthood.
• Adolescents (10-19 years) constitute about one fourth of India's
population and young people (10-24 years) about one third of the
population

4. DEFINITIONS:
• Adolescence: 10 – 19 years
• Early Adolescence: 10 – 13 years
• Middle adolescence: 14 – 16 years
• Late adolescence: 17 – 19 years
• Youth: 15 – 24 years
• Young people: 10 - 24 years

5. CHARACTERISTICS:
• A – Aggressive, Anaemic, Abortion
• D – Dynamic, Developing, Depressed
• O – Overconfident, Overindulging, Obese
• L – Loud but lonely & Lack information
• E – Enthusiastic, Explorative & Experimenting
• S – Social, Sexual, & Spiritual
• C – Courageous, Cheerful, & Concern
• E – Emotional, Eager & Emulating
• N – Nervous, Never say no to peers
• T – Temperamental, Teenage pregnancy

6. WHY PAY ATTENTION TO THE HEALTH OF
ADOLESCENTS?
• To reduce death and disease in adolescents:
• An estimated 1.7 million young people aged from 10 to 19 die
each year due to accidents, violence, pregnancy related
problems or illnesses.
• To reduce the burden of disease in later life:
• Malnutrition in adolescence can lead to lifelong health problems
• Failure to care for the health needs of young pregnant women
damage their own health and that of their babies.
• Some of the highest infection rates for sexually transmitted
infections are in adolescents.
• Diseases of late middle age, such as lung cancer, bronchitis and
heart disease, are strongly associated with smoking habit.

7. HEALTH PROBLEMS OF ADOLESCENTS:
 General health problems
• Adolescent never recognize symptoms, and mostly underestimate their problems
and they do not know where to go for help.
• As a result adolescents are the least likely section of the population to go for early
treatment.
• They may leave diseases untreated because they are afraid of the outcome,
worried about the stigma.
 Malnutrition:
• Inadequate diet can delay or impair healthy development. Stunting during
adolescence.
• Anemia is also one of the most important problem among adolescents due to
malnutrition
• Obesity and eating disorders exist along side malnutrition.

8.  Mental health problems:
• Depression is common, especially for young people who have low self-esteem
• Depression can also lead to the ultimate tragedy — almost 90,000 young people
commit suicide each year across the world
 Early & unprotected sex:
• Many young people become sexually active without planning the sexual
relationship or thinking about the consequences.
• This results into the high number of unwanted pregnancies and unsafe abortions
and the steep rise in HIV infection.

11. 3. Curative services:
• Treatment for common RTI/STIs
• Treatment & counselling of menstrual disorders sexual concerns of males and
female adolescents
4. Referral services:
• Integrated Counselling and Testing Centre
• Prevention of Parent to Child Transmission
5. Outreach services:
• Periodic health checkups and community camps
• Periodic health education activities
• Co-curricular activities

12. Level of
care
Service
provider
Target group Flow of
service
delivery
activities
Services
Sub-
centre
HW(F) Unmarried
male&
female
Married
male&
female
During
routine
Subcentre
clinic
•Enrollment of newly married couples
•Provision of spacing methods
•Routine ANC care & institutional
deliveries
•Referral for early & safe abortion
•Education on prevention of RTI/STIs
•Nutritional counselling on anemia
prevention & menstrual hygiene
•Immunization for pregnant adolescent
mothers

13. Level of
care
Service
provider
Target
group
Flow of service
delivery
activities
Services
PHC/CHC/
DH
HA(F)LHV or
MO
Unmarried
male&
female
Once a wk teen
clinic at PHC for
2hrs
•Contraceptive condom
programming
•Management of menstrual
disorders
•Education on prevention of
RTI/STIs and their
management
•Counselling & services for
pregnancy termination
•Nutritional counselling &
counselling for sexual
problems
•Immunization for pregnant
adolescent mothers

14. • Vision
 Improve availability of quality healthcare 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 -30/1000 live births
 MMR – 100/1000 live births
 TFR -2.1

15.  Objective is to contribute to RCH II goals of
reduction of IMR, MMR and TFR by:
• Reducing teenage pregnancies
• Meeting unmet contraceptive needs
• Reducing number of teenage maternal deaths
• Reducing incidence of STIs
• Reducing proportion of HIV positive in 10 – 19
years age group

16. • Services for adolescents to cover preventive ,
promotive ,curative and counseling services
• Capacity building of on meeting needs of
adolescents
• Communication activities to be undertaken
• Inter-sectoral linkages with NACP and NRHM

18. Orientation programme for MOs and ANMs(AWW
and counselors)
“How to treat differentially a client who is 16 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

19.  Strengthen RCH frame work
 Communication strategy for ARSH
 Establishing / strengthening inter sectoral convergence
 Quality assurance of framework
 Developing institutional and service linkages within ARSH
framework to address HIV concerns

20. RMNCH+A
1. This is a comprehensive strategy for improving the maternal and child health
outcomes , under NRHM
2. It is based on the evidence that maternal and child health cannot be improved in
isolation as adolescent health and family planning have an important bearing on
the outcomes.
3. This strategy encompasses various high impact interventions across the life cycle.
4. The strategy is based on the concept of ‘CONTINUUM OF CARE’
What is RMNCH+A Strategic approach?

21. PLUS DENOTES
(1) Inclusion of adolescence as a distinct ‘life stage’
(2) Linking of Maternal and Child Health to Reproductive
Health and other components like family planning.
(3) Linking of community and facility-based care as well
as referrals between various levels of health care
system.

22. WHAT DOES RMNCH+A STANDS FOR
• Reproductive, Maternal, New-
born, Child & Adolescent
Health : Links maternal and
child survival to other
components (family planning ,
adolescent health, gender & PC
& PNDT)
• Plus denotes
• inclusion of adolescence as a distinct ‘life
stage’ in the overall strategy
• Links community and facility based
care as well as referrals between
various levels of health care system
Under five
child health
pacakge