Since the launch of Rashtriya Kishore Swasthya Karyakram (RKSK), India’s flagship programme for adolescent, UNFPA has been working closely with the central and state governments and other key stakeholders to incubate innovate and replicate various strategies for successful implementation of the programme. Under the RKSK programme, Adolescent Friendly Health Clinics (AFHCs) have been set up to provide counseling and curative services to adolescents from vulnerable and marginalized communities at primary, secondary and tertiary level. Commodities such as Iron & Folic Acid tablets and non-clinical contraceptives are also made available in the clinics for young adolescents.
Earlier, UNFPA state office helped the state government in branding of the AFHC clinics as “Shraddha Clinics”, in mapping of trained service providers and capacity building of counselors.
However, an assessment carried out by UNFPA in 2017 revealed an unimpressive footfall of young people at Shraddha Clinics (varied from 60 to 90 clients per month).The report also highlighted the lack of display and unavailability of any IEC materials for information on services offered at Shraddha Clinics. Further, most of the adolescents and young people interviewed were unaware of the services available at these Shraddha Clinics.
Under this context, UNFPA signed an agreement with VIIEWS to organize sensitization cum awareness programs in educational institutes of Gajapati and Rayagada districts for dissemination of information on the services available at the Shraddha Clinics. This program aimed to increase foot fall of adolescents to the clinics. As part of the project implementation process, the team from VIEWS mobilized adolescents and teachers from various educational institutions. District health department offered technical assistance for smooth implementation of the workshops.
The 2nd workshop titled “District level sensitization workshop cum exposure visits to Shraddha Clinic” was organized in collaboration with District Swastya Samiti in Gajapati. In addition, resource and communication materials like posters and leaflets on Shraddha Clinic in local language were developed and distributed for wider dissemination.
The detailed workshop report is as follows;
UNFPA, VIEWS and the Gajapati District Swastya Samiti jointly organized a one day “District level Sensitization Workshop cum Exposure Visit to Shraddha Clinics” on 11th December 2018 at DTU Hall, DHH, Paralakhemundi to disseminate information on the services available at the Shraddha Clinics among the adolescents and teachers from educational institutes in the district.
- Key objectives of the workshop
- Create sensitization on Adolescent Friendly Health Clinics (AFHCs) facilities among adolescents, head of the educational institutions, local NGOs and other stakeholders in Gajapati district of Odisha
- Facilitate exposure visit to Adolescent Friendly Health Clinics (AFHCs) to demonstrate the facilities available at Shraddha Clinics.
- Dissemination of IEC materials like posters and leaflets on Adolescent Friendly Health Clinics (AFHCs) facilities among adolescents, head of the educational institutions for wider out reach.
3. Participants Profile
53 participants from 11 colleges of 6 blocks including Gumma, Gosani, Mohana, Rayagada, Nuagada participated in the workshop cum exposure visit. The participants included 19 girls, 24 boys and 10 teachers.
Table 1: List of colleges that participated in the workshop
|Sl. No.||Name of the college||Place|
|1||Hill Top Higher Secondary School||Mohana|
|2||Meena Ketan Higher Secondary School||Gurandi|
|3||Binodini Science Higher Secondary School||Padmapur|
|4||Sriram Junior Higher Secondary School||Kasinagar|
|5||Government Vocational Higher Secondary School||Chandiput|
|6||Baba Saheb Ambedkar Higher Secondary School||Khajuripada|
|7||Sri Jagannath Science Residential College||Kasinagar|
|8||Women’s Higher Secondary School||Paralakhemundi|
|9||Government Vocational Higher Secondary School||Paralakhemundi|
|10||Sanskrit Higher Secondary School||Paralakhemundi|
|11||Parsuram Gurukul Higher Secondary School||Sevakpur|
Table 2: List of guest, resource persons and staff who attended the programme
|1||Dr. M. Ali||DPHO||District Health Dept|
|2||Dr. Pradeep Kumar Padhi||ADPHO (FW)||District Health Dept|
|3||Dr. V.L.N Raju||ADPHO (DC)||District Health Dept|
|4||Mrs. Soumya Rani Gouda||DPM||NHM, Gajapati|
|5||Mr. Sai Prasad Das||RKSK & RBSK Manager||DHH-Gajapati|
|6||Mr. Shakti Prasad Pattnaik||Counselor||DHH-Gajapati|
|7||Ms. Tikili Panigrahi||Counselor||Shraddha Clinic|
|8||Dr. Pradeep Kumar||District Consultant||UNFPA|
|9||Mr. S. Bheema Rao||Secretary||VIEWS|
4. Proceedings of the Workshop
4.1. Inauguration of the workshop: The workshop started with the song “ Vande Utkal Janani” by a group of adolescent girls at 10.30 A.M as per the schedule. Mr. Sunil Kumar Ghadei, welcomed all the guests, resource persons and participants and shared a brief background of the program, objectives of the workshop and expectation from the participants. All the participants introduced themselves and shared their expectations from the workshop.
After that, Mr. Sunil Kumar Ghadei invited all the guests and resource persons to the dais. Dr. Pradeep, District Consultant-UNFPA, Gajapati interacted with the participants and gave a brief presentation on Rashtriya Kishore Swasthya Karyakram (RKSK), while sharing the context and objectives of the workshop. He presented the status of adolescent population and India and stated that in absolute numbers, India has the largest adolescent population in the World “253 million/25.3 crore” as per the report of World Population Prospects 2012.
He stated that “the overview and rationale of the intervention is to create demand for adolescent health services specifically AFHC/Shraddha Clinic services through sensitization of teachers in educational institutions”. He stated that the workshop will create awareness among the youths; sensitize them of their potential and help them in making informed and responsible decisions related to their health and well-being by accessing available services. It will contribute to enhance the knowledge and understanding of the teachers on adolescent health issues and various other services available at AFHC. This will contribute to increase the referral of adolescents to AFHC from educational institutions.
The key topics shared were as follows
- Overview of Rashtriya Kishor Swasthya Karyakram(RKSK)
- Adolescent Population in world and India
- Child Marriage
- Role of Shradda Clinics
- Reach out to the every pocket of Gajapati
As many as six ministries in the country are working on adolescent health. Govt. of India recognizes that adolescents play a major role in reducing the Maternal Mortality Rate and Child Mortality Rate and hence takes special focus on the area of adolescent health,he said adding that he every adolescent has right to access and avail the benefits of Shraddha clinic for their well being.
4.2. Overview on Shraddha Clinics:
Dr. Pradeep Kumar Padhi, ADPHO (FW), Gajapati interacted with the participants and explained the various benefits available at Health and Family welfare department of NHM for different age groups including newborn health care, Infant care, female health care. He shared about adolescents and changes they undergo during adolescence
Hormonal changes bring about changes in the body, habits and mind, he said. A global study indicated that 3000 adolescents die everyday due to accident, drug addiction, suicide and diseases related to sex, and violence.
This is because adolescents find it difficult to take proper decisions due to their aggressiveness in this age. They lack proper guidance and are self conscious. The idea behind establishment of Shraddha Clinic under Health and Family Welfare Department, GoO as an Integrated Counseling & Management Centre for Adolescent health, family planning, infant and young child feeding, gender based violence and non communicable diseases was to meet this gap and offer a solution. He suggested that all the adolescents’ aged between 10 to 19 years should access the benefits available at the Shradda Clinic located at various place of the district. He informed that trained counselors were available to provide timely counseling & referral services to the adolescents and maintain privacy of clients at the Shraddha clinics.
4.3. Important of Adolescent Health : Dr. V.L.N Raju started his interaction with the question “ What is Shraddha Clinic” & “ Who knows about Shraddha clinic”. He said that adolescents undergo different physical and mental changes but ind it difficult to share it anybody. They are shy even for a discussion before doctors.
To address this issue the Government of India initiated the concept of Adolescent friendly Health Clinic in every health department. The Shraddha clinic facilities available in the room no. 104 at DHH, Paralakhemundi, he informed. The adolescents in our district can meet and discuss with the assigned counselors in a friendly manner and shut out their problems for their overall well being. These are all very natural process of human being. So, he motivated the participants not to feel shy and nervous in front of the counselor and access the maximum benefits of Shraddha Clinic.
4.4 Reflection on Shraddha Clinic in Gajapati : Mrs. Soumya Rani Gouda, DPM, NHM, Gajapati interacted with the participants on the topic of Shraddha Clinic in an interactive mode with questions to participants. She shared that adolescents in this age avoid discussing issues with others about their problems. Ultimately, they end up getting stressed and tensed.
To address such issues, “Shraddha Clinics have been established with trained counselors to provide the counseling services and provide treatments while maintaining the privacy of the clients at the clinics. The Shraddha clinics facilities are available in all CHC and District Headquarter Hospital of Gajapatri district.
As on today, 8 Shraddha clinics have been established in Gajapati district, but only one of them running at the District Headquarter Hospital is functional. The remaining Shraddha clinics have remained not in functional due to shortage of man power. She ensured that the department will try to make it functional as soon as soon possible for the benefit of adolescents in the areas.
4.5 Facilities of Shraddha Clinic : In this session Mr. Sunil Kumar Ghadei, Sr. Program Manager of VIEWS gave a power point presentation on the facilities available at Shraddha Clinics in Odia language. During this session, he clearly discussed the various elements that led to establishment of Shraddha clinics and the benefits available at these clinics including counseling and sharing information, curative services, and commodities available at the clinks. The participants raised questions on the commodities available and timings of the clinics.
4.6 Benefits of Shraddha Clinic: In this technical session, Mr. Sai Prasad Das, Manager RKSK & RBSK interacted with the participants and shared the benefits of Shraddha Clinics in a participatory mode with live examples to create interest among the adolescents as well as to help them gain better understanding on the topic of Shraddha Clinics. The leaflets and posters on the benefit of Shraddha Clinics prepared in Odiya language were also distributed. He also informed the participants about the UNFPA developed app “ Kishoresathi” available in Odiya and English for more information and understanding on adolescents issues and concerns.
During the session, the participants raised various questions related to adolescent health and Shraddha Clinics to which he responded patiently while sharing various tips related to the following topics required for adolescent health.
- Nutrition, carbohydrate, protein, fat, & Minerals requirements
- Calculation of Body Mass Index (BMI) and its check up,
- Hemoglobin check, Anti Natal Check up
- Referral services
- Menstrual Hygiene & irregularity
- Non- Communicable disease
- Gender violence
- Aggressive & Depression
- Learning and understanding problem
4.7. Interface with Adolescents and Educational Institutions: Mrs. Tikili Panigrahi and Mr. Shakti Prasad Pattnaik, -counselors of Shraddha Clinic facilitated the session and covered the following topics
- Why Shraddha Clinic
- Clients and target group for shraddha clinics
- Levels of services available at district hospitals, sub-divisional hospitals and Community Health Centers (CHCs)
- Counseling , referral and linkages with other treatment service provision are available for target groups including adolescents
- HIV and AIDS
Mrs Tikili shared the timings of Shraddha clinic in Paralakhemundi from Monday to Saturday and requested all the adolescents should avail the benefits of AFHCs near to their place.
4.5. Focus Group Discussion: AFGD was organized by Dr. Pradeep on the problems and issues faced by adolescents in relation with Shraddha Clinics.
Three different groups comprising boys, girls and teachers respectively were formed. The FGD came up with the following outcomes
Table 3: Focus Group Discussion among Adolescents Issues
|Group||Situation||Answered given by Group Member|
|Group-1||Reena, a 17 years old, college going girl is in relationship with a boy. Last night she had sex with her boy friend. She belongs to a tribal family & is continuing her study with much difficulty. She knows that if her family would come to know about the situation they would stop her study. What will she do now?||Talk with best friend on this issue Discuss with the Doctor openly Treatment as per doctors advice|
|Group-2||Sabina is 19 years old, unmarried girl. She is doing a course from Paralakhemundi. She has missed her periods and is tensed about it. What will Sabina do now?||Take advice from the best friendConsult with Shraddha ClinicTake suggestions from eldersPregnancy check up Discuss with the parents|
|Group-3 (A)||Peter is 19 years, is struggling with problem of wet dreams. He is in tension. He has a group of friends, who spend most of the time together in body building or in having fun. But he does not know whom to ask as he fears that others will laugh at him in the same way as they together mock other boys who don’t follow their ways. What will Peter do now?||Go to Shraddha ClinicDiscuss with doctor|
|Group-3 (B)||Peter is 19 years, is struggling with problem of wet dreams. He is in tension. He has a group of friends, who spend most of the time together in body building or in having fun. But he does not know whom to ask as he fears that others will laugh at him in the same way as they together mock other boys who don’t follow their ways. What will Peter do now?||Discussed with family doctorGo to Shraddha clinicShare with parentsDiscussed with the friendsStop thinking negative thoughts|
|Group-4 (Teacher Group)||Dheeraj is 19 years old and is studying in class 12th. His family wants him to secure good marks in exams. His father always gives examples of other children who have cracked competitive exams. His father keeps an eye on his time schedule and does not let him spend time playing or go anywhere with his friends. He is scared of what would his father do if he doesn not clear the exams. The mental pressure is causing him sleepless nights and he has lost his appetite. He wants to spend time alone and has stopped interacting with others in family & friends. What is your role in this situation?||Counsel the student regarding the problemsAnalyze the student’s ability and views in that fieldGiving suggestion to reach goalParents to be advice not to pressurize the childAnalyze the situation after motivating the parentsVisit to Shraddha Clinic to take further suggestions and counseling|
After the group presentation, Dr. Pradeep and Staff from District health departments responded to all the questions and queries from the participants in connection with Shradda Clincks. They provided various practical suggestions and solutions to overcome the health issues faced by students during the adolescent period
Mr. S. Bheema Rao, Secretary-VIEWSshared the outcomes and way forward of the workshop and gave a vote of thanks to the guests, resource persons and participants of the workshop. He motivated the students spread the information of Shradda Clinics. All students agreed to sentisitize 20 more students about Shraddha clinics . The teachers from the respective educational institutions were requested to organize similar workshops at college and high school level for sharing of information about the facility.
. 5. Exposure visit to Shraddha Clinics: After the lunch break, the participants were divided into 6 groups and taken for exposure visit to Shraddha Clinic. The adolescent groups visited the Shraddha clinics located inside the DHH Parlakhemundi.
The counselor at the Shraddha Clinic interacted with the students and showed them facilities available in the clinic. She distributed some of IEC materials to the adolescents and explained the significance and benefits of the Clinics. The adolescents interacted actively with the counselor on various issues related to adolescent health and menstrual hygiene. After this workshop, a feedback regarding the workshop was collected from the participants. The exposure concluded at 4.30 P.M with a vote of thanks from team VIEWS to officials of the health department and participants from the educational institutions.