By Sara Hasan
Health Posts in Urban India are primary health centres offering preventive and promotive health services to the local population. The National Adolescent Health Programme, implemented by the Ministry of Health and Family Welfare has outlined the following objectives: improve nutrition, improve sexual and reproductive health, enhance mental health, prevent injuries and violence (gender-based) and substance misuse. Society for Nutrition Education and Health Action (SNEHA), a Mumbai-based non-profit organisation working across the life-cycle to improve health outcomes among vulnerable women and children in urban areas, implements a programme targeted at adolescent health and empowerment. Implemented across three sites in Mumbai and Thane, namely, Dharavi, Kandivali and Kalwa, the programme aims to strengthen access and quality of public health systems, to respond better to the needs of adolescents.
In its years of working with adolescents on health and sexuality education, SNEHA was aware that the public health system could be more responsive and sensitive to the unique health needs of young people, between the ages of 10 and 19 years. Enabling Health Posts, primary care centres that are easily accessible to low-income communities, to deliver better quality adolescent health services would also encourage better uptake and more usage, among adolescents from these communities. “We strongly believe in collaborating with public health systems rather than creating parallel service structures,” says Rama Shyam, Programme Director, Empowerment, Health and Sexuality of Adolescents (EHSAS), SNEHA. “While Municipal Health Posts have always been supportive of SNEHA’s work in adolescent health, our focus is on mainstreaming the adolescent health agenda in their system,” Rama adds.
To begin with, the SNEHA team met and consulted with the staff in several Health Posts across the three sites. The consultations allowed the teams to assess the awareness of the staff on adolescent health issues. Each consultation began with small exercises that encouraged Health Post Staff to recollect their adolescent days and understand the various physical, emotional and psychological challenges faced by adolescents. These interactions helped to build rapport with the Health Post staff and to start dialogues on adolescent-friendly services and gender sensitisation.
Exposure and access visits for adolescents from the local communities to these clinics were also planned. “Our goal is to be an intermediary between the adolescents and the public health system and enable a fair and meaningful dialogue between the two parties,” says Rama. Over 50 exposure visits have been completed so far, and more than 500 young girls and boys have received services such as Tetanus (TT) injections, deworming tablets, IFA tablets and informative talks on nutrition and reproductive health. Rama says this is only the beginning of a long and fruitful journey of regularising adolescent-friendly health clinics across the public health system.
The access and exposure visits enabled adolescents to understand what kind of services were available to them – knowledge that seemed to come as a surprise, as they generally were aware only of the presence of “a place in the neighbourhood where children get injections.”
Being a mixed gender session, the sessions were also an opportunity to pack gender biases and harmful socio-cultural mores surrounding a natural and universal phenomenon such as monthly periods. SNEHA’s interesting and easy-to-understand behaviour change communication material was used as a basis for the discussions. The experiential sessions ranged from practical concerns about period pain to issues related to stigma and shame. Why do you think pads are packed in black packets, girls were asked. “Most shopkeepers are men, and people feel shy while buying and selling pads,” a girl answered. The answer was a segue to explore the imposed culture of disgust surrounding menstruation, in a patriarchal society. In line with this, various myths regarding menstruation were shared and debunked. The girls’ experiences varied, some immediately describing restrictions when asked what happens when a girl gets her period; while some claimed to have faced no restrictions after her first period. The restrictions mentioned were food-related: from not being allowed to cook, to even being disallowed spicy food. This followed a confirmation by the girls that these exclusions were based on misconception and that such contamination was scientifically unviable.
The Health Post staff also explained sanitary hygiene for cloth and pads and proper disposal methods for period products. Also, the adolescents learnt about which foods would increase the iron content in their bodies. They were informed of the family planning services and contraceptives available at the health posts and were willing to share this information with their friends and classmates.
Talking about general health, the Health Post staff discussed symptoms and treatments of common, dangerous diseases, with context-specific examples. Malaria, dengue, fever and even tuberculosis and leptospirosis were discussed, images of physical symptoms were shown, and preventive advice was given. When asked about what services are available at the Health Post, Dr Sunil of the Shastri Nagar Health Post said “This place gives many medical services like treatment for TB, common cold and fever. Information for pregnant women, family planning, is also given, and we also provide contraceptives such as copper T, condoms, and injections.”
By June, Health Posts in Kalwa, started referrals to the adolescents OPD facility at Chhatrapati Shivaji Maharaj Hospital, Kalwa for cases beyond their capabilities, such as irregular and scanty periods, vaginal infection and the likes. The overall response from the health posts has been productive, resulting in adolescents developing an interest in further engagement.
The next phase will see adolescents leading engagements with Health Posts. “It is an opportunity for adolescents to take this initiative forward by democratically deciding what issues they would like the Health Post doctors to discuss,” said Rama.