Distict Name: Uttar Pradesh

Consultant: Afaq Ullah

Data theme: Entitlements, Health and Nutrition

Objectives: Improve coverage of Rashtriya Kishor Swasthya Karyakram (RKSK) and ensure access to essential services and commodities for adolescents at Village Health and Nutrition Days (VHND) and Adolescent Friendly Health Clinics (AFHCs). 

Key Outcomes:  This strategic intervention organized several meetings and workshops with the community, specifically local adolescents and shared insights and factsheets from the UDAYA survey, reaching out to more than 100 adolescents with information about Weekly Iron Folic Acid Supplementation (WIFS) and the importance of Iron Folic Acid tablets.

A letter demanding better service delivery of VHNDs and AFHCs with over 400 signatures from adolescents and members of the community was accepted by the Medical Officer In-Charge, Chief Medical Officer and the RKSK Nodal Officer. 

The intervention influenced local officials to organise five Adolescent Health Days, where over over 200 adolescents received information and entitlements as per the Rashtriya Kishor Swasthya Karyakram (RKSK) program.  

The consultant also organised meetings with the media, resulting in at least five media reports being published at the local level with information about the UDAYA study. 

Process: The meetings and events organised with adolescent groups and the wider community provided information and the subsequent discussions about the RKSK program implementation at local level revealed that one of the key entitlements long overdue was the supply of IFA tablets. 

Over a span of a few months, five Adolescent Health Days were organised, with engaging activities like street plays, slogan writing competitions, signature campaigns etc. Over a 100 adolescents attended these events, and participated in awareness sessions on the various schemes they were entitled to. District and block level officials like RKSK nodal officers were also invited to these events, and the events included health check ups, anemia screenings and counseling. 

Of the 11 Adolescent Friendly Health Clinics (AFHCs), only four existed, and were understaffed. Following the community meetings, groups of adolescents began regularly visiting the AFHC to demand  improved service delivery. These efforts were combined with continued meetings and conversations with concerned officials, including the RKSK nodal person, Rashtriya Bal Swasthya Karyakram nodal person, Child Development Project Officer (CDPO), District Project Officer, AFHC Counselors as well as the media to share ground realities. 

A letter containing recommendations to strengthen service delivery of VHNDs and AFHCs was drafted. Over 400 adolescents and parents were signatories. The letter was submitted to the District Program Officer and other relevant officials. While the recommendation letter has been accepted by the Medical Officer In-Charge, Chief Medical Officer and the RKSK Nodal Officer, there are no written orders yet to ensure continued supply of IFA tablets, or further clarity on actual improved service delivery. 

COVID-19 proved to be a great challenge for RKSK program implementation, with staff and budgets being diverted towards COVID-19 treatment and relief

Consultant: Rajdev Chaturvedi 

Data theme: Entitlements, Health and Nutrition 

Objective: Improve counseling for adolescents on health and nutrition issues by strengthening existing platforms such as Village Health and Nutrition Days (VHNDs), Adolescent Friendly Health Clinics (AFHCs), and Swasthya Manch (school level).  

Key Outcomes: 

This strategic intervention organised several meetings and workshops with the community, specifically local adolescents and shared insights and factsheets from the UDAYA survey, reaching out to more than 100 adolescents with information about Weekly Iron Folic Acid Supplementation (WIFS) and the importance of Iron Folic Acid tablets.

The intervention influenced local officials to organise four Adolescent Health Days, where nearly 100 adolescents received information and entitlements as per the Rashtriya Kishor Swasthya Karyakram (RKSK) program. 

The intervention also organised adolescent girls to visit and report on the quality of VHNDs. A letter demanding better service delivery of VHNDs and AFHCs with over 100 signatures from adolescents and members of the community was accepted by the Medical Officer In-Charge, Chief Medical Officer and the RKSK Nodal Officer. 

The consultant also organised meetings for the adolescent delegations with various authorities involved in service delivery, like block level service providers, government officials, school principals etc to discuss their needs, suggestions and service availability gaps in both Atrauliya and Ahraula blocks of Azamgarh. 

Process: 

The meetings with the adolescents introduced and discussed the insights from the UDAYA data. Azamgarh has a high rate of malnutrition and the community monitoring exercise revealed multiple reasons for it – anaemia, poverty and lack of access to nutrition as well as early marriage and pregnancy. There was also a gap in service delivery of WIFS, deworming and vaccinations among the adolescents. While there were two AFHCs, the adolescents had only attended a few meetings there. A report was compiled with these findings, and included recommendations for improving service delivery. 

The intervention then organised a series of meetings between the adolescents and frontline workers (FLWs) and block level services providers in both blocks to discuss the needs, suggestions and service availability gaps which led to the sanction to organise health camps in four schools in the two selected blocks. Over 100 adolescents attended these health camps, and received information about RKSK, and an activity report was submitted to district level program authorities to regularise this platform in all blocks.  

Alongside, a signature campaign was conducted to request better service delivery for adolescent health issues. Data insights and recommendations from the community monitoring were shared with members of the community, especially adolescents, women and youth. The signature campaign was hugely successful, as the demand letter was endorsed not only by the local community, but also staff associated with the hospital and AHFCs. Over 100 people signed the demand letter issued by the adolescents. The letter with recommendations was formally accepted by block level officials. A youth delegation also visited the District Program Manager – National Health Mission office, where the adolescents presented their needs, gaps and recommendations. A similar presentation and discussion also took place at the District Health Society to raise the issues emerging. The recommendations submitted were accepted at the District Health Society meeting. Follow up visits are required to ensure that the recommendations are incorporated in the quarterly plan for implementation. 

COVID-19 and the subsequent lockdowns hugely hampered the efforts of this intervention. All resources – including financial and human, were diverted towards managing the rate of COVID-19 infections. While officials were willing to support the adolescents’ demands and recommendations, the state level authorities are yet to sanction anything.

Consultant: Devyani Chaturvedi 

Data theme: Entitlements, Health and Nutrition 

Objective: Ensuring regular supply of sanitary napkins and IFAs in Anganwadi Centers (AWCs), and making Village Health and Nutrition Days (VHNDs) adolescent friendly, with a specific focus on ensuring availability of adolescent specific services like anemia screening, counseling, distribution of commodities and referrals.

Key Outcomes: This strategic intervention organized several meetings and workshops with the community, specifically local adolescents. 100 adolescent girls from 10 villages of Nawabganj block of Bahraich district were selected and trained to be ‘Local Champions’. 

The girls were trained in digital advocacy, to raise their issues through various established helplines and portals like the Chief Minister Helpline-1076, Childline-1098, IGRS Portal, Jan Sunvayi application, CUG Numbers of Govt. Officials and writing applications to Govt. Officials etc. The adolescents made applications through the portals, and learnt how to track the status and follow up on the same.

The intervention also facilitated meetings between the Champions and district level officials like the District Magistrate, Chief Medical Officer, District Probation Officer, District Project Officer-ICDS which enabled them to raise their issues recommendations at District Health Society meetings as well. 

Process: The meetings organised with adolescent girls across the 10 villages in Nawabganj block introduced them to the UDAYA data and insights. Insights on themes like health and nutrition were used to provide information about the prevalence of malnutrition and anaemia, and the importance of programs like VHNDs which have a specific focus on adolescent health. Four batches of 25 girls each participated in these initial meetings.

Later meetings also included adolescent boys, and they discussed issues like anaemia in their own community, or whether anaemia screenings were done regularly, or availability of IFA tablets. They drafted a status report and suggested recommendations in a letter addressed to block and district level officials. The adolescents were also trained in using digital tools to forward their demands for better service delivery. They selected 10 ‘girl champions’ between the ages of 12-20 to represent them.

The Champions raised the issue of irregular supply of IFA tablets and sanitary napkins at the AWCs with block and district level officials, including the District Magistrate, Chief Medical Officer, District Probation Officer, District Project Officer-ICDS. They also used existing channels like the Chief Minister Helpline-1076, Childline-1098, Integrated Grievance Redressal System (IGRS) Portal, the Jan Sunvai application and Closed User Group (CUG) Numbers of government officials. They also sent written applications to officials and tracked the status of the online applications made. The issues and recommendations suggested by the adolescents were also raised at the District Health Society (DHS) meeting. Verbal commitments have been issued by the DHS to ensure regular supply of sanitary napkins at AWCs across the block. The supply of IFA tablets has already improved. Officials have also made verbal commitments to improve and ensure more adolescent friendly health services at VHNDs in the block.

One of the biggest challenges has been to introduce topics like menstrual health and hygiene to the wider community. While the initial meetings only invited adolescent girls, the boys were included in subsequent meetings. Several months, and several sessions later, now the girls are freely sharing their experiences, and the boys are taking initiative in the adolescent delegations.

Consultant: Bindu Singh

Data theme: Entitlements, Health and Nutrition

Objectives: Improve service availability and quality at Adolescent Friendly Health Clinics (AFHCs) in the district combined with improving counseling and information dissemination on menstrual hygiene to adolescent girls.

Key Outcomes: This strategic intervention organized several meetings and workshops with adolescent groups in the community, including a visit by the adolescents to the AFHCs with demands for regular and quality service provision. 

The intervention also worked with adolescent girls in 20 villages of two blocks in Chandauli to monitor VHNDs and the report compiled was submitted as a letter, demanding better service delivery at AFHCs and VHNDs. This letter was submitted to district officials like the Chief Medical Officer, Medical Officer In-Charge, the RKSK Nodal Officer as well as at District Health Society meetings. The District Magistrate has made verbal commitments towards improving services. A small room has been allotted for counseling at the AFHCs, and a local NGO has been requested to support with the provision of a voluntary female counselor on a weekly basis.

The intervention also influenced local panchayat election winners to follow up on their commitments on Adolescent Health and prepare a plan of action. The Panchayat has committed to installing an incinerator at the local school. 

The consultant also organised meetings with the media, resulting in several media reports being published at the local level with information about the UDAYA study. 

Process: The meetings and events organised with adolescent groups and the wider community provided information and the subsequent visit to the AFHCs revealed that there were no female counselors, and no room allotted for counseling. 

Alongside, adolescent girls from 20 villages of two blocks in Chandauli collected data on the status of service delivery of Village Health and Nutrition Day (VHNDs) with a specific focus on menstrual hygiene. This community monitoring exercise revealed that there were no available resources to conduct vaccinations, distribution of iron folic tablets or sanitary napkins. They compiled a report with their findings. 

Prior to the recent Panchayat elections, several electoral candidates had made various campaign promises towards better service delivery for adolescent health programs. Post elections, the intervention organised meetings with the candidates who had won. The Panchayat members learnt their role in aiding service delivery and have committed to installing an incinerator at the local school. 

Copies of the UDAYA data, RKSK guidelines and the community report were also submitted to the District Health Society, Medical Officer In-Charge, District Magistrate and the media. The adolescents also regularly visited the AFHCs with the information, to present to the frontline workers engaged in service delivery of the program. At present, the letters have been accepted at the various levels of government departments, and verbal commitment has been made by the DM to ensure improved service delivery. A small room has also been allotted for counseling at the AFHCs, and a local NGO has been requested to support with the provision of a voluntary female counselor on a weekly basis. There has also been significant interest from sections of the media and several reports have been published in local newspapers, highlighting the status of AFHCs in the district, the status of menstrual hygiene at the state and district level, gaps in program implementation and important insights from the UDAYA data

Consultant: Devendra Gandhi 

Data theme: Entitlements, Health and Nutrition 

Objectives: Improve coverage of Rashtriya Kishor Swasthya Karyakram (RKSK) and ensure access to essential services and commodities for adolescents at Village Health and Nutrition Days (VHND) and Adolescent Friendly Health Clinics (AFHCs).

Key Outcomes:  This strategic intervention organized several meetings and workshops with the community, specifically local adolescents and shared insights and factsheets from the UDAYA survey, reaching out to more than 100 adolescents with information about Weekly Iron Folic Acid Supplementation (WIFS) and the importance of Iron Folic Acid tablets.

A letter demanding better service delivery of VHNDs and AFHCs with over 400 signatures from adolescents and members of the community was accepted by the Medical Officer In-Charge, Chief Medical Officer and the RKSK Nodal Officer. 

The intervention influenced local officials to organise five Adolescent Health Days, where over over 200 adolescents received information and entitlements as per the Rashtriya Kishor Swasthya Karyakram (RKSK) program.  

The consultant also organised meetings with the media, resulting in at least five media reports being published at the local level with information about the UDAYA study. 

Process: The meetings and events organised with adolescent groups and the wider community provided information and the subsequent discussions revealed that most of the adolescents had never heard about the RKSK program, and were very excited to learn of specific provisions that were centred around their health and wellbeing. The intervention also organised a visit by the adolescents to the AFHCs. 

Over a span of a few months, five Adolescent Health Days were organised, with engaging activities like street plays, slogan writing competitions, signature campaigns etc. More than 200 adolescents participated and received provisions. Soon after, the camps were paused due to another wave of COVID-19 infections, and the subsequent lockdown. However, the initiative took this opportunity to conduct a community monitoring effort, which revealed that the adolescent girls were no longer receiving a supply of sanitary napkins. Usually, these provisions were made available via the schools, but with lockdown, none of the girls were going to school, nor had the State authorities sanctioned the procurement and distribution of sanitary napkins. 

A letter containing recommendations to strengthen service delivery of VHNDs and AFHCs was drafted. Over 400 adolescents and parents were signatories. The letter was submitted to the District Program Officer and other relevant officials. The letter was accepted by the Medical Officer In-Charge, Chief Medical Officer, as well as the RKSK nodal authority. 

Currently, district and block level authorities are aware of gaps in service delivery, and have accepted several of the recommendations forwarded by the community in public meetings. Furthermore, they have issued verbal assurances to follow up on better implementation of the RKSK program.

Lucknow, Uttar Pradesh 

Consultants: Raajni & Shraddha  

Data theme: Entitlements, Health and Nutrition

Objective:  Improve coverage of Rashtriya Kishor Swasthya Karyakram (RKSK) and ensure access to essential services and commodities for adolescents at Village Health and Nutrition Days (VHND) and Adolescent Friendly Health Clinics (AFHCs). 

Key Outcomes: This strategic intervention organised several meetings and workshops with the community, specifically local adolescents and shared insights and factsheets from the UDAYA survey, reaching out to more than 100 adolescents with information about Weekly Iron Folic Acid Supplementation (WIFS) and the importance of Iron Folic Acid tablets.

The intervention also facilitated adolescents visits to Adolescent Friendly Health Clinics (AFHCs); groups of 10-15 adolescents visited AFHCs three times to understand the quality of services. A letter demanding better service delivery of VHNDs and AFHCs with over 400 signatures from adolescents and members of the community was accepted by the Medical Officer In-Charge, Chief Medical Officer and the RKSK Nodal Officer. 

The intervention influenced local officials to organise five Adolescent Health Days, where over over 200 adolescents received information and entitlements as per the Rashtriya Kishor Swasthya Karyakram (RKSK) program.  

The consultant also organised meetings with the media, resulting in at least five media reports being published at the local level with information about the UDAYA study. 

Process: The meetings organised with adolescent groups and the wider community provided information and the subsequent discussions about the RKSK program implementation at local level culminated in a monitoring exercise on the status of RKSK implementation at the village level, as well as the condition and service delivery available at the AFHCs.  

The community monitoring exercise included visits by the adolescent girls to the Community Health Centre, Public Health Centre and anganwadis. This exercise revealed that while adolescents knew about the existence of frontline health workers (FLWs) like ANMs and ASHA workers, many had never met any in their area. Currently, the girls are regularly approaching the FLWs and are receiving regular vaccines, calcium tablets and anaemia screening.   

The girls also visited the AHFCs. There are currently two in Lucknow, at the Balrampur Hospital and Queen Mary’s Medical College. Neither AFHC had counselors available. The clinics are nearly 20 kilometers away from the areas the girls live in, and accessing the AFHCs easily, or discreetly, was a problem for the adolescents. The staff at the AFHCs were helpful,  supportive and participated in several meetings with the girls. Despite being understaffed and juggling multiple responsibilities, the AFHC staff have now organised a female counselor who now visits the adolescents in the community. 

Several community events were also conducted to raise awareness about RKSK program implementation in the wider community. The events included fun and engaging activities like street plays, slogan writing competitions, and competitions. A letter containing recommendations to strengthen service delivery of RKSK, VHNDs and AFHCs was drafted. Over 400 adolescents and parents were signatories. The letter was submitted to the District Program Officer and other relevant officials who had been invited to the events. 

The intervention also organised adolescent visits to different local and block level officials in charge of RKSK implementation. They presented the officials with the UDAYA data as well as the recommendation letter that was endorsed by the wider community. The recommendation letter has been accepted by the Medical Officer In-Charge, Chief Medical Officer and the RKSK Nodal Officer.

COVID-19 and the subsequent lockdowns was one of the greatest barriers in availability of provisions and service delivery. One of the immediate effects of the lockdowns had been a larger gap in procurement of supplies and availability of staff. For example, there hasn’t been any provision of IFA tablets, deworming tablets, sanitary napkins or anaemia screening for nearly two years. However, this intervention has motivated the local adolescents and district authorities to work closely with the local service delivery providers in the near future to assess and improve VHNDs and make them more adolescent friendly.     

Consultant: Neeti

Data theme: Entitlements, Health and Nutrition 

Objective: Improving focus on adolescent sexual and reproductive health counseling at Village Health and Nutrition Day (VHNDs) in consultation with counselors, frontline health workers and block level officials.

Key Outcomes:  This strategic intervention organised several meetings between the front line health workers and the adolescents in the community, where the conversations focused on understanding the adolescents’ needs, demands and recommendations. 

Youth led delegations also met with various block level officials to submit a letter demanding better service delivery of VHNDs and AFHCs with over 100 signatures from adolescents and members of the community. The adolescents visited officials like the Medical Officer In-Charge and Chief Medical Officer and requested them to visit the VHNDs in their panchayats and see the situation for themselves. Following this, officials did visit the VHNDs and have issued verbal commitments to improve focus on adolescent health and reproductive rights at the VHNDs.

The intervention also organised various programs to facilitate meetings and advocacy opportunities with district officials. A Village Health and Nutrition Day (VHNDs), several medical camps for adolescents and celebration of International Youth Day were organised. 

Local adolescents received information and entitlements as per the Rashtriya Kishor Swasthya Karyakram (RKSK) program at the VHND. At the medical camps, adolescent girls met with the gynecologist. At the International Youth Day celebration, at least 50 adolescents and youth participated and raised awareness on the need for better adolescent health services. 

Process:  Segments of UDAYA data relevant to the existing work on adolescent health and reproductive rights were presented in meetings with groups of adolescents from four panchayats in one block of Varanasi district. The data validated the on-ground reality and in the discussions that followed, the adolescents decided to focus on violence, early and forced marriage, and access to services and entitlements available under existing adolescent health programs like VHNDs.

The adolescents began with understanding the current status of services available in their immediate community, and then drafted a report with recommendations. The groups then met with frontline health workers (FLWs) to present and discuss their report and recommendations. 

The intervention also organised adolescents to present the data to the wider community, combined with a signature campaign to gain endorsement for their demand for improved counselling. Over 100 members of the community endorsed the adolescents’ recommendations.

The adolescent groups also visited various block level government officials in-charge of health service delivery like the Medical Officer In-Charge, the Chief Medical Officer etc. to present their letter. They requested officials to visit the VHNDs in their panchayats and see the situation for themselves. Following this, officials did visit the VHNDs and have issued verbal commitments to improve focus on adolescent health and reproductive rights at the VHNDs.

Various programs were also organised to facilitate meetings and advocacy opportunities with district officials, including a Village Health and Nutrition Day, several medical camps for adolescents and celebration of International Youth Day. The adolescents received information and entitlements, including opportunities to meet with a gynecologist. At least 25 girls received routine check ups, and for many, it was the first time meeting with a health professional. At the International Youth Day celebration, at least 50 adolescents and youth participated and raised awareness on the need for better adolescent health services. Several officials and FLWs have expressed support to improve the quality of services and service delivery.