Investing In The Needs Of Adolescents Through A Comprehensive Approach
Today, 1.2 billion adolescents stand at the crossroads between childhood and the adult world. Of those, 243 million live in India, representing a huge amount of untapped potential. India must ensure that we help create the conditions that would allow adolescents to fulfil their aspirations and to break the deeply entrenched vicious cycles of inequity and poverty.
Research has shown that adolescence is a critical stage in human development. When boys and girls enter adolescence, they are on the brink of maturity and adulthood, and at the same time undergoing several physiological and psychological changes that are influenced by social, cultural and gender norms and practices. For example, cultural practices and gender norms often define the expectations from a girl as to who she should be when she grows up, what role she should play as a daughter, wife or a mother vs. what is expected from a boy.
These cultural practices and social expectations manifest in more than one ways, including girls dropping out of school, early marriage for both girls and boys, pressure to bear children at an early age; restriction of mobility due to concerns around girls safety and chastity, various forms of violence, as well as lack of opportunity to voice thoughts or opinions. These expectations are exacerbated by adolescents inability to access critical services, like health, education, psycho-social support.
In order to fulfil their potential, we must ensure that adolescents unique needs are met, and that they have a smooth transition to adulthood. While there is no quick fix for this complex problem, we know that a few things can work to improve adolescents lives.
Providing the much needed support: convergence of services as a solution?
The concept of multi- sectoral collaboration and coordination is not new. The relevance and efficiency to undertake multi-sectoral collaboration has been well documented for example, efforts to coordinate delivery of maternal, newborn and child health services by the Indian Governments -national and state level, health and family welfare department and women & child development department; or, the coordination between women & child development department and ministry of Panchayati Raj Institutions (PRI) to coordinate efforts of Self Help Groups (SHGs) of women.
In order to make the convergence of services more effective and scale-able, certain key issues need further discussions, debate and implementation.
Convergence of services: the essential ingredients for success
Perspective building shared vision, understanding and goals across sectors
As the first step, convergence of services needs perspective building across relevant sectors that need to provide adolescent focussed services in a coordinated manner i.e. Ministries or departments of Health and Family Welfare, Women and Child Development, Social Welfare, Human Resources Development (Education), Panchayati Raj Institution, Ministry of Youth Affairs and Sports.
Most often than not, the goals and priorities for each of the ministries are set in isolation with a narrow perspective and understanding of adolescents needs. The collaboration with other ministries or departments is then from a perspective of achieving a single ministrys goals i.e. from a health perspective alone, or education perspective alone. Such narrow perspective can exclude specific (and possibly large) population, or not take into account various underlying factors or causes that impede progress on certain indicators. For example, not addressing issues of early marriage and early pregnancies, can impact the goal of continuing education, or addressing issue of school drop outs can impact the health specific goals for adolescents. Similarly, only addressing health issues through schools can leave out a large population of girls who have dropped out of school or never enrolled.
Thus each of these Ministries or Departments should have a shared vision drawing from an indepth understanding of the unique needs and challeges faced by the adolescents, which should guide setting of the goals for their respective ministries. This would further inform the implementation of the existing initiatives and schemes such as the Rashtriya Kishore Swasthya Karyakram (RKSK), Beti Padhao Beti Bachao, Apni Beti Apna Dhan, and leverage initiatives of each department to ensure strengthening of overall policies and programmatic approaches.
Resource convergence State and district level PIPs
With a shared common perspective, the relevant government departments need to develop common Project Implementation Plans (PIPs) at the state and district levels to ensure that the meagre resources allocated for adolescents under each department, are utilized in a thoughtful and strategic manner.
The resource convergence by developing state specific action plans or district level action plans should also bring in other actors such as Civil Society Organizations including NGOs, as well as private sector partners to ensure further leveraging of resources financial, technical, and human resources. The development of joint project implementation plans should also incorporate effective mechanisms for monitoring and tracking of activities, platforms for review and reflection using the evidence for mid-course correction, and not be used as a mechanism for resource or budget allocation only.
Convergence at the points of service delivery: leveraging the existing platforms for systems level convergence at the institutional level state, district, village or community level.
Several existing platforms and service delivery channels at the state, district, village or community level can be further leveraged in a contextually relevant and holistic way:
Institutions for convergence of services: By way of examples, one could potentially look at - Health Centres for providing general as well as sexual and reproductive health services as well as psycho- social support and counselling services to the adolescents; Anganwadi centres (AWC) for providing comprehensive services including nutritional services through mid-day meals, or AWC as centre to bring adolescents together; Schools for awareness raising, capacity building of school going adolescents on issues of health, gender equitable norms and behaviour, achieving their aspirations through continued education, violence prevention; Self Help Groups or SHGs for reaching the women or mothers of the adolescents in the community, for raising their awareness on the harmful effects of child marriage, early pregnancy, and promoting the importance of continued education for their daughters; Mens groups for ensuring participation and support from men.
Service delivery agents: Convergence of services and reaching the adolescents could also be undertaken along with and with support from -Front Line workers (ASHAs, AWW), teachers, community leaders, who are already reaching the community members and households.
For example, in a recent discussion in Rajasthan, India, the state and district government officials, in support of a project PanKH (Promoting Adolescents Engagement Knowledge and Health), outlined several potential platforms of collaboration. PanKH is a joint initiative of ICRW (International Center for Research on Women), and PRADAN the implementation organization. The platforms discussed for collaboration included self help groups (SHGs), AWCs (Anganwadi centers) in Dholpur, Rajasthan, where the relevant government officials agreed to jointly host awareness and service provision activities to ensure comprehensive services and reach to the adolescents.
Use of data and research findings for decision making and enhancing program effectiveness
The convergence approach that brings different sectors and actors together will necessitate the development of common set of indicators that are shared across, based on the overarching common vision to help guide the indicator and milestone setting process.
With the technological advancements and reach across various levels and actors, there exists easy access to real time data to help guide not only the planning processes but also periodic and frequent reviews to understand why and where services are being reached, or not! This real time data analysis can then help inform the discussion on the gaps in providing these services but in a constructive and supportive manner to aid mid-course correction of the implementation activities and approaches.
Use of data for review, reflection and monitoring, will require joint and periodic reflection meetings across levels and government departments with the approach of solving problems and supportive supervision.
Thus a well conceptualized, and well implemented convergence of services approach for adolescents, can go a long way in ensuring that we reach all adolescents with the appropriate, and timely services and support to help them achieve their aspirations and develop into mature and healthy adults.
(The article is authored by ICRWs Regional Director (Asia)- Dr. Ravi Verma and Former COO-Madhu Deshmukh)