Jamui, Bihar

Consultant: Shiv Shankar

Data theme: Health and Nutrition

Objectives: 

1. Regularize Adolescent Friendly Health Clinic services and allocate dedicated trained counselors  in six Primary Healthcare Centers
2. Improve coverage of sanitary napkin provision through budget advocacy at the district level 

Key Outcomes: In Jamui,  the intervention conducted a series of discussions with adolescents, their parents, and frontline workers like ASHAs, anganwadi workers  to increase awareness about Adolescent Friendly Health Clinics. A group of 60-70 adolescents from an area served by six primary healthcare centers signed a demand letter asking for regular AFHCs to be set up. 

Six primary healthcare centers designated dedicated rooms for AFHCs. This was a huge win, which would ensure that the adolescents who come to the clinic can talk about their concerns privately and confidentially. A board showing the services was put up at the clinics, which were equipped with condoms, IFA tablets, contraceptives, sanitary napkins, and government pamphlets on SRHR, etc. Each AFHC has also been designated an RKSK-trained ANM to act as a counselor.

To increase the use of sanitary napkins, adolescent girls and their parents were made aware of the Direct Beneficiary Transfer (DBT) scheme. Simultaneously, the DBTs were regularized and now are put in adolescent girls’ accounts. An order was issued by the District Education Department to schools so that they ensure steady supply of sanitary napkins. A verbal commitment was  also made to increase budgetary allocation for sanitary napkin procurement in the district

Process:  This intervention focused on data related to access to Adolescent Friendly Health Clinics (AFHCs) and on sanitary napkin usage. The data related to access to AFHCs in the UDAYA study corroborated the on-ground experience that there are several gaps in the smooth running of AFHCs. Similarly,  many adolescent girls were not able to use sanitary napkins even though they were getting Direct Beneficiary Transfers (DBT) to buy them. This was largely because they didn’t know they were receiving this money or what it was for. Medical officers and the District Health Society (DHS) consulted at the beginning of the intervention also supported the use of UDAYA data to increase awareness about these services. 

Frontline workers like ASHAs and ANMs usually do not have the time to talk to adolescents about their health because they have several other responsibilities to fulfill in limited time. As a result adolescents and young people don’t have anyone to talk to about issues like menstrual hygiene, contraceptives, sexual health, nightfall, etc. Using the UDAYA data, the intervention engaged adolescents, frontline workers like ASHAs, anganwadi workers, and parent groups. The data were shared as diagrams on chart paper to start conversations, specifically on issues about sexual health that are treated with secrecy. A series of FGDs were also conducted, sometimes with parents and young people together, to share their issues and concerns related to adolescent sexual reproductive health and rights.

Eventually, 60-70 adolescents were mobilized as advocates. They put forward recommendations to make regular AFHC services available at 6 PHCs in Jamui district. The set up of AFHCS at six primary healthcare centers is a huge win for adolescents.  Three of these PHCs also have peer educators who sit at the clinic every Saturday. They will also encourage adolescents to visit the clinics. 

“We have started the conversations, now we must work hard to ensure access. For instance, it is still difficult for girls to come to AFHCs because they are often 10-20 kms away from their houses,” says Shiv Shankar, the consultant who supported the intervention.

Another advocacy focus was to increase the use of sanitary pads in the communities. Many girls continue to use cloth pads because they don’t have money to buy pads. However there are funds to make sure sanitary pads are available at subsidized rates through schools, and through Direct Beneficiary Transfers. Many adolescents were getting the Direct Beneficiary Transfers but they didn’t know it because the money was often clubbed with other schemes, like the cycle scheme. So girls and their parents weren’t aware what the money was for.

A crucial advocacy effort was to raise awareness about these transfers, and to make them regular and clear. Now when they don’t receive it, the girls are quick to ask for it. There are still some challenges. For example, one girl called the consultant  to tell him that her mother used the money to buy fertilizer. So, the conversation with the mother of the young girl was to negotiate these two needs, and to convince her that buying sanitary napkins was as important as fertilizer, because it was about her daughter’s health. 

Additionally, youth clubs are being formed at PHCs. This will encourage adolescents to continue to talk about their health issues with peer educators even after the project is over. Many of the adolescents involved in the current project have started talking about adolescent SRHR issues after understanding the data that was disseminated. This created a ripple effect because young people were excited to talk about these issues and to involve their parents in these discussions