Rashtriya Kishor Swasthya Karyakam

The Union Ministry of Health and Family Welfare (MoHFW) has launched Rashtriya Kishor Swasthya Karyakam (RKSK) to address the health problems of adolescents in a comprehensive manner. RKSK has been introduced under the National Rural Health Mission.

• RKSK is based on the fact that Adolescence is the most important stage of the life cycle for health interventions
• Adolescents aged 10 to 19 years constitute about one-fifth of India’s population and young people (aged 10-24 years) about one-third of the population. The large and increasing share of adolescents and youth in India’s population can translate into a demographic dividend only if policies and programmes focus on the health and wellbeing of this 243 million strong, yet very vulnerable adolescent population.

Background:

Eight years ago, the same ministry had launched an Adolescent Reproductive and Sexual Health (ARSH) programme. This programme was mainly aimed at improving sexual and reproductive health of the adolescents. Since the programme did not look beyond reproductive health, this new programme has been crafted, so that it may bring into new dimensions such as mental health, nutrition, substance misuse, gender based violence and non-communicable diseases. Thus, the new scheme includes the six key focus areas as follows:

• Sexual and reproductive health
• Nutrition, injuries and violence (including gender-based violence)
• Non-communicable diseases
• Mental health
• Substance abuse.

Target Group

The Rs. 250 Crore RKSK targets adolescents; defined as children between 10 and 19 years of age; boys and girls; rural and urban; poor and affluent; married or unmarried; in school or out of school. According to census 2011, around 243 million or 21% of India’s population are covered in this target group. This broad definition will lead to coverage of adolescents across the socio-economic spectrum and across all regions.

Interventions

The programme emphasis six ‘Cs”- coverage, content, communication, counselling, clinics and convergence. The programme introduces community based interventions through peer educators, and is strengthened by collaborations with other Ministries and State governments, and knowledge partners. The programme is an effort to move away from a ‘doctor-driven’ effort towards a holistic and participative programme. It recognizes that all adolescents need attention even before the occurrence of any disease or problem, in order to make informed decisions and choices.

The services to adolescents will be delivered through a variety of service delivery points and outreach activities. These service delivery points will be the Primary Health Centres and other service providers such as Auxiliary Nurse Midwives (ANMs), Accredited Social Health Activists (ASHAs), Anganwadi Workers (AWWs), and other such service providers.

Also, the approach of this programme is different as it adopts an “adolescent friendly approach”. This approach means respecting the confidentiality, privacy of the adolescents and providing them services with a non-judgemental and non-discriminatory attitude.

Adolescent Peer Education Programme

Under the RKSK, the GoI has introduced a special programme called “Adolescent Peer Education Programme”. This will facilitate the following things:

• Promote support seeking among adolescents from the trained peers
• Reduce the fear and shame among adolescents to ask for information and tell about their health problems

These peer educators will be trained adolescents between 15 and 19 years of age, from the community itself. They will be selected by ASHA and will be the most important link between adolescents in the community and service providers for the success of RKSK.

Reasons for focus on Adolescent health

One of the primary reasons for this new focus on adolescent health is due to recognition of the fact that maternal and child health outcomes will never be fulfilled unless attention is paid to adolescent health. Also, if India wants to reap the much celebrated demographic dividend, it has to improve the health of its present adolescent population, who will form a bulk of its demography in future years. Further, a multitude of lifestyle and behaviour related disorders such as substance abuse, mental disorders, gender based violence, physical inactivity are starting to afflict people in this age group and are also becoming a major cause of mortality.