Adolescent Friendly Health Clinics in India – Don’t We Need Respectful Adolescent Health Care?

Abstract

India has the largest adolescent population in the world (253 million, Census 2011). Although considered healthy phase of life, adolescents do have several issues requiring medical care. In this age the mortality and morbidity patterns begin to resemble more like adults as accidents, injuries, and violence become important causes of deaths. The adolescents in India suffer from common infectious diseases, nutritional deficiency diseases like anemia (more than half girls and one-third boys have anemia), and also mental health problems (1 in 5 adolescents have one or more mental health problems). Adolescence is a habit forming age and many of them develop risk factors for future non-communicable diseases like diabetes, hypertension, and cancers, etc. Developmentally too, adolescents are different than children and adults. On one hand they require supervised independence and on the other hand, they need privacy and confidentiality in health care. Thus, the needs of adolescents in health care system are very different than those of children or adults. The national health program for adolescents i.e., Rashyriya Kishor Swasthya Karyakram (RKSK) has been envisaged to fulfill these needs of adolescents in health care system. This program deals not only with health care during illness but also deals with macro level factors influencing the health of adolescents. More than 7500 Adolescent Friendly Health Clinics (AFHC) have been established in public health system (i.e., in primary health centers, community health centers, district hospitals, and medical college hospitals). However, the utilization of these clinics remains very poor. Mahalakshmy et al. [1] evaluated AFHC in Puducherry using mixed research methods and found several interesting issues. About half of studied adolescents were aware of the clinics but only 2–10% used the services for routine illnesses. This is a very low utilization of services as about 15% of girls used them and no boy utilized these services. Girls too came mainly for receiving free sanitary napkins. Although the reasons found for low utilization of the services (like lack of trust and privacy, poor awareness of services, and undesired branding as girls’ clinic) are not unique, they are important to document in order to make the services at AFHC popular among adolescents. The five key characteristics of adolescent friendly health services include equitable, accessible, acceptable, appropriate and effective services. Dignity and quality of services are also considered important for successful delivery of these services. The new national health program, LaQshya focuses on quality of neonatal and maternal care. Respectful maternity care and quality improvement are major components. Adolescent friendly health services also revolve around the concept of respectful, dignified and quality care. Several studies have been conducted in India and other countries to understand what adolescents need in health care system. Privacy is a big issue with adolescents and mystery clients are used to study the health care services. A recent systemic review found, that the mystery clients had overall good experiences with friendly staff and reported good practices and barriers too. Willingness of facility to provide services to adolescents, provision of information and of services for adolescents and for youth having different sexual orientations were reported as ‘good experiences’. Lack of privacy and confidentiality, inappropriate behavior of health care providers, timing constraints, recurrent staff shortages and inadequate service provisions were the barriers reported in various studies [2]. In order to provide respectful care, the adolescents and youth should be involved in routine management of AFHCs. * Harish K. Pemde [email protected]