RASHTRYA KISHOR SWASTHYA KARYAKRAM (RKSK)

The Ministry of Health and Family Welfare has launched this programme for adolescent, in the age group of 10-19 years. RKSK mainly focuses on their nutrition, reproductive health and substance abuse, among other issues.

The key principles of this programme are adolescent participation and leadership, equity and inclusion, gender equity and strategic partnership with other sectors and stakeholders. The programme envisions enabling all adolescents in India to realize their full potential by making informed and responsible decisions related to their health and well being and by accessing the services and support they need to do so. RKSK comprehensively address the health needs of adolescents, it also introduces community-based intervention through peer educators.

Adolescents constitute about one fifth of India’s general population and represents a huge opportunity to transform the social and economic fortunes of the country. Investments on this target population will have an immediate, direct and positive impact on India’s Health Goal – Reduction of Infant Mortality Rate (IMR) & Maternal Mortality Rate (MMR).

RKSK focuses on age group 10 -14 years & 15 -19 years with universal coverage i.e., males & females, urban & rural, in school & out of school, married & unmarried, vulnerable and underserved.

Goal of RKSK

Improve adolescent health and well-being.

Objectives of RKSK

1) Improve Nutrition

• Reduce the prevalence of malnutrition including overweight/obesity
• Reduce the prevalence of iron deficiency anaemia (IDA)

2) Enable Sexual and Reproductive health

• Improve knowledge, attitudes and behavior in relation to Sexual Related Health Issues (SRH)
• Reduce teenage pregnancies
• Improve birth preparedness, complication readiness & provide early parenting support for adolescent parents

3) Enhance Mental Health

• Address mental health concerns of adolescents

4) Prevent injuries and violence

• Promote favourable attitudes for preventing injuries and violence (including Gender Based Violence) among adolescents

5) Prevent substance misuse

• Increase adolescents’ awareness of the adverse effects and consequences of substance misuse.

6) Address conditions for NCDs (non communicable diseases)

• Promote behaviour change in adolescents to prevent NCDs such as cancer, diabetes, cardiovascular diseases and strokes.

Strategies

The followings are the strategies of RKSK

1) School & Community based Intervention

• Peer Education (PE).
• Quarterly Adolescent Health Day (AHD).
• Weekly Iron Folic Acid Supplementation Scheme (WIFS).
• Menstrual Hygiene Scheme (MHS).

2) Facility Based Intervention

• Strengthening of Adolescent Friendly Health Clinic (AFHC).

3) Convergence

• Within the Department- RBSK, RCH, National Mental Health Programme, National Tobacco Control Programme.
• With other departments & Schemes – Social Welfare Department, School Education Department, Mizoram State Aids Control Society.

1. School and Community based Intervention:

Peer Education (PE)

Peer Education programme will be implemented in selected 5 RKSK districts v.i.z., Champhai, Lawngtlai, Lunglei, Mamit and Saiha during last quarter of 2014-2015. Currently, Peer Educator (PE) selection is on the process in consultation with CMOs from selected districts. Peer Educators are expected to be on board and functioning during the 4 ^th Quarter of the financial year 2014 – 2015.

Training of Peer Educator will be conducted in 5 selected districts – Champhai, Lawngtlai, Lunglei, Mamit and Saiha by ASHA Mobilizer who have been trained at the district level. Each ASHA mobilizer will give training at Block Level – i.e at PHC/CHC level and ASHA Coordinator has to give training at Main Centre level. Moreover, as it is not possible for Peer Educators to take leave from school, training is supposed to be conducted every Saturday for 6 (six) consecutive weeks.

Adolescent Health Day

Target for Adolescent Health Day include AHD organizers - ANM, ASHA, AWW, Peer Educator, FNGO, MO i/c, Counselors and adolescents of age group 10 – 19 years including married adolescents, parents of adolescents, VHSNC members and local bodies. AHD will be organized in selected 5 RKSK districts.

Weekly Iron Folic Acid Supplemenation (WIFS)

Anaemia, a manifestation of under nutrition and poor dietary intake of iron is a public health problem in India, not only among pregnant women, infants & young children but also, among the adolescents. According to National Family Health Survey (NFHS) – 3, over 55% of adolescent boys & girls are found to be anaemic. Thus, in order to address this issue, the Ministry of Health & Family Welfare, Government of India has launched Weekly Iron Folic Acid Supplementation (WIFS) programme to reduce the prevalence and severity of nutritional anaemia in adolescent population.

WIFS objective

To reduce prevalence and severity of nutritional anaemia in adolescent population (10-19 years).

WIFS Target Group

• 1)Adolescent boys and girls of government /government aided/municipal schools from 6^th – 12^th standard.
• 2)Adolescent girls who are not in school. WIFS programme also covers married adolescent girls.

WIFS Strategy

• Administration of WIFS. Each IFA tablet contains 100mg elemental iron and 500µg folic acid for 52 weeks in a year.
• Bi-annual de-worming with Albendazole 400 mg, six months apart (August and February) for control of worm infestation.
• Screening of target groups for moderate/severe anaemia and referring of these cases to an appropriate health facility.
• Information and counseling for improving dietary intake and for taking actions for prevention of intestinal worm infestation.

WIFS TARGET

Total No. of schools covered	1489
No of Anganwadi Centres	1,980
No. of school going boys & girls (M/S – HSS)	1,04,620
Out of school girls	14,460
Target adolescent population	1,19,080
School Teachers (M/S – HSS)	11850
Anganwadi Workers	1980
Anganwadi Helper	1980
Total Target population (for 2014-15)	1,34,890

2. Facility based Intervention

Adolescent Friendly Health Clinic

AFHC is also known as Youth Clinic in Mizoram. The clinic serves mainly as counseling centre for the Youth regarding nutrition, menstrual disorders, personal hygiene, menstrual hygiene, sexual concerns, depression, mental health concerns, sexual abuse, substance misuse, etc.

Till date, 49 Youth Clinics have been established at CHCs and PHCs in 5 selected districts wherein trained counselors provide services to adolescents clients. It is planned to establish new AFHC/Youth Clinic in the remaining 4 districts during 2015-2016.

4 Officers - Paediatrician, Gynaecologist, Psychiatrist and SMO i/c AH (Senior Medical Officer) from 5 selected districts (Champhai, Lawngtlai, Lunglei, Mamit and Saiha) have been trained at National Level for State Level Training of AFHS.

All M.Os from PHCs, CHCs, Sub District & District Hospitals from the 5 selected RKSK districts will undergo training in Adolescent Friendly Health Services for better implementation and smooth functioning of the Programme. Trainings will be conducted phase-wise.

ANM Training is to be conducted in each district at the district headquarter by district level RKSK ToTs.

New counselors (22 nos.) are proposed in the FY 2015-16 to work in 8 district hospital, 3 sub district hospitals, 11 CHCs for the selected 5 RKSK districts.

3. Convergence

Within the Department, RKSK programme has a good coordination and network with other line programmes such as RBSK, RCH, National Mental Health Programme and National Tobacco Control Programme and Mizoram State AIDS Control Society as well.

State and District Level Adolescent Health Committee is formed for better convergence amongst the stakeholder departments – Health Department, School Education and Social Welfare Department and also as a part of monitoring the programmes under Adolescent Health.