Health services delivery



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1

HEALTH SERVICES DELIVERY

1.5

PROGRAMME FOR VULNERABLE POPULATIONS

1.5.4

Adolescent Health (As of October 2008)




A

Focal Point

DDG/PHS

B

Implementing Agencies

Ministry of Health (D/YEDD / HEB / MCH / NCD / NIHS / Population Division / STD AIDS campaign / PDHS, DPDHS / Health Institutions / MOH & field staff), Ministry of Education / Dept. of Education / NIE, Ministry of Youth Affairs & Sports, NYSC, Ministry of Information & Media, Department of Labour, Women’s bureau, Vocational Training Authority, National Dangerous Drug Control Board, Ministry of Defence, Ministry of justice, Universities, ADIC, FPA, Sarvodaya, FHP & Other related NGO / CBO

C

Target Areas & Beneficiaries

Primary Target Groups : All school children aged 10-19 years, out of school youth (employed/unemployed), University students, Students of Technical Colleges & Vocational Training Centres, Young armed personnel
Secondary Target Groups: Health personnel, Teachers & school administrators, Youth Leaders of National Youth Council Services, Politicians, Policy makers, Administrators, members of Provincial councils, Municipalities & pradeshiya sabha, Community leaders, parents, members of NGOO / CBOO










Project Summary:
With Sir Lanka entering into the final stage of the demographic transition, there are a significant proportion of adolescents who will have specific health needs and problems. Although the health system as a whole is providing services for the all age groups of the population. Due to the very specific nature of the problems among adolescents, it is argued that the existing health care delivery system is not the most effective and efficient when providing health services for adolescents.

However the last decade saw the emergence of adolescent-friendly health services in selected institutions. The utility rates of these services clearly show that there is a concrete need to develop and expand the adolescent-friendly health services in the country. The objective of the project is to improve the quality of life of school youth by developing their knowledge, attitudes and values, skills and behaviours regarding biological, psychological socio-cultural and reproductive dimensions of adolescence




1. Justification:
The population in Sri Lanka is 18.5 Million of which approximately 5.2 Million (29%) comprise of young people between the age of 10 - 24 years.
Adolescents are generally thought to be healthy, as mortality in adolescence is lower than in any other age group. Contrary to popular opinion not all adolescents are healthy.
However the period of adolescence is also a period in which behaviours, such as truancy, unhealthy dietary and physical activity patterns, use of substances such as tobacco and alcohol & drugs, unsafe sexual practices and engaging in violence, are initiated. Though such behaviours cause morbidity and mortality in adulthood their roots can be traced back to the adolescent period. Tobacco use, for example, typically starts before the age of 15 and frequently leads to premature death later in life. HIV infection, which is often contracted in late adolescence, leads to AIDS in later years. The major cause of death in young people are road traffic accidents, injuries, suicide, violence, pregnancy related complications & HIV/AIDS that are either preventable or treatable.
Unwanted pregnancies and abortions, STD & HIV / AIDS, smoking, alcohol & drug abuse, suicide, violence, accidents & injuries, nutritional problems, sexual abuse & school dropouts encountered among the adolescents and youth pose a significant challenge to the well being of this group.
In Sri Lanka there are multiple donors willing to support adolescent health. However for the optimisation of resource allocation and utilization, it is important to have a policy documentation specifying national priority and which provides a frame work for resource allocation, collaboration & cooperation of all key funding & implementing stakeholders. The policy will also help to enhance the image & credibility of the agencies involved in adolescent health activities.
The existence of explicit policy provides vision, coordination, strategy & sustainability for improve programming.
Amidst some services for adolescents which are being provided in an ad-hoc manner by both government & non government sectors it is appropriate to establish a Comprehensive National Programme in collaboration with all relevant government & non government organizations to improve the well being and health of the adolescent.
2. Important Assumptions/Risks/Conditions:
Becomes a priority concern of the Ministry of Health

Political support and support of policy makers gained

Adequate. Human resources. Funds & other resources allocated at Central Provincial District & Divisional levels


  • Improved collaboration of all sectors for implementation & monitoring

  • Committed trained staff

  • positive attitudes of Health personnel at all levels for serving unmarried youth especially on improvement of Reproductive Health (RH)

  • education, Health authorities, and NGOs continue to demonstrate their commitment to improve ADH

  • less resistance from the community for serving unmarried youth by the Primary Health Care

  • Workers especially on improvement of Reproductive Health (RH)



3. Project Objective:


Objective

Indicators

Means of Verification

To improve quality of life of

school & out of school youth by developing their knowledge attitudes values, skills & behaviours regarding biological, psychological, socio cultural, & reproductive dimensions of adolescence.




  • Rate of suicides among youth

  • Rate of youth indulged in substance abuse

  • Rate of teenage pregnancies

  • Rate of sexual abuse among youth

  • Rates of STD / HIV AIDS

  • among youth.

  • Incidence of violence among school & out of school youth

  • Number of youth obtaining counselling services.

  • Registrar General records

  • Records and returns

  • Periodical survey. Police reports

  • Records in counselling centres


A reduction in the violence, accidents, smoking, alcoholism, drug abuse, suicide, sexual abuse, teenage pregnancies, abortions, mental health problems, STD HIV AIDS, School dropouts will be seen with improvement of adolescent & youth health.


4. Project Output/Product:
Project output is aimed at health promotion as well as reduction of RH problems, alcohol & drug abuse, violence among school & out of school youth etc. through provision of safe & supportive environment, improving provision of information & skills & improving health services including counselling.


Outputs

Indicators

Means of Verification

A national policy and strategy on adolescents and youth developed

  • Availability of documents on national policy and national strategy in place




  • Availability of the policy and the strategy documents

The accessibility of youth and adolescents enhanced to Youth/Adolescent friendly health services

  • Number of youth/adolescents gaining access to services

  • Records and returns




The providers made skilled and competent to provide adolescent/youth friendly health services

  • Number of providers who are competent of providing services to youth and adolescents

  • Records and returns

  • Workshop reports

Youth and Adolescents are made knowledgeable on issues of their interest and the availability of services.


  • Percentage of youth/adolescents who feel that they are knowledgeable in issues of their interest

  • Surveys





5. Related Projects:


Project No.

Project Title

SRL CAH 001

Improving life competencies of school & out of school adolescent & youth

SRL CAH 001

Development of National Strategy on Adolescent & Youth Health

UNICEF

Development of National Policy for Adolescent & Youth Health


6. Relevant Agencies to be Coordinated:


  • Director YEDD / HEB / FHB / NIHS / Population Division / STD AIDS campaign

  • Provincial Health Directors, DPDHS Medical Officers of Health & field staff Health Institutions

  • Ministry of Youth Affairs & Sports, NYSC Related NGO’s,

  • Ministry of Education / NIE Department of Education Department of Labour Women’s Bureau

  • Ministry of Justice

  • Ministry of Media & Information Vocational Training Authority NDDCB

  • Donor agencies – WHO, UNICEF, UNFPA, UNAIDS, JICA, ILO, World Bank



7. Monitoring & Evaluation:


  1. Who? DGHS, DG/Educational Services, DG/NIE, Other relevant heads of departments & NGO’s, through National Steering committee on adolescent health

  2. When? Quarterly

  3. What actions to be taken based on results of monitoring & evaluation?

    • Improve planning and provision of services based on the identified gaps

    • Improved resource allocation


8. Activities:
The following activities will be, either school based, community based, work place based, home based, hospital & clinic based or out reach.




          Activities

          Expected Results

          Process Indicators

          1

Formulate a national policy

& national strategy on adolescents, youth and legislation of policy




National policy & National strategy on adolescent health in place

Identify the working group Develop the TOR


          2

Identify and recruit human resource needed at all levels for improvement of adolescent & youth health

Human resources plan developed

Identify the working group Develop the TOR

Develop the HR plan



          3

Identify & supply of other resources needed at all levels for improvement of adolescent & youth health

Other resources identified


Identify the working group Develop the TOR

Identify the needs



          4

Carryout advocacy programmes for Politicians, Policy makers, Administrators, officials of educational sector, Community leaders, Parents, Members of NGOO and Media personnel

Continued political and other stakeholder support for ADH programmes

Develop advocacy material

Develop the programmes



          5

Conduct research pertaining to problems among youth

Knowledge gaps identified


Identify research priorities

Identify researchers



          6

Establish channels of coordination between different sectors


Continued inter-sectoral participation & collaborative efforts regarding implementation of youth activities

Identify the working group Develop the TOR


          7

Produce IEC material on health promotion, prevention of adolescent health problems & counselling for adolescent health problems for different target groups

IEC material mad available


Identify target groups

Identify IEC materials

Design IEC materials


          8

Establish youth friendly health services including information provision, health screening, care, rehabilitation & counselling services.

Clinics (PHC, Institutional), Out reach services, Hot line, Centres caring for victims of sexual abuse/rape, Rehabilitation centres for victims of drug abuse



Youth friendly services established


Design the health service package

Develop proposals




          9

Conduct awareness programmes to educate Health personnel, Teachers, NGO personnel, Youth leaders, Peers, Health volunteers, Community leaders, Media personnel

All stakeholders made aware of the services


Develop awareness material

Develop the programmes



          10

Conduct training in relation to AF health services


All service providers are made competent


Identify training needs

Develop training materials

Plan the training programme


          11

Develop a life skills improvement programme

Life skills adopted for health promotion & prevention of adolescent & youth problems

Identify training needs

Develop training materials

Plan the training programme


          12

Establish a Management Information System for adolescent & youth health & a continuous flow of monitoring and evaluation.


MIS established


Identify the information need

Design the MIS



Pilot test


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