India has the largest population of adolescents in the world, accounting for a quarter of the country's population. Their health and well-being today will define the future course of growth and development. There continue to be, however, large sections of adolescents who are yet to reap the benefits of the numerous mainstay investments being made for their education, health and economic empowerment. And for those who are being reached, such services are being made available only sporadically.
Health alone has many dimensions. During adolescence, in particular, it is often influenced by factors that lie far beyond the current mandate of the health sector. Preventable and treatable health and health-related problems such as unsafe sex, HIV/AIDS, early pregnancy, depression, injury and violence continue to pose serious threats to the health and well-being of adolescents, according to the Lancet Commission on Adolescents.
The period of adolescence marked by specific needs, require a health system that is responsive and holistic, addressing not just physical health but also biological, emotional and social development. The challenges faced while growing up and the accompanying social risk factors deserve the same level of attention as medical treatment and care. To ensure their access to quality and equitable health services, the role of other sectors comes into play, assuming a powerful role in streamlining existing health programmes.
Ideal situation
The four key sectors - education, nutrition, water and sanitation, and child protection - each have direct implications on health attainment for adolescents. In an ideal situation, the education sector should carry out in-school awareness campaigns and age and culturally appropriate sexuality education that empowers adolescents to make important life decisions. Similarly, keeping in mind the well-established linkage between recurrent diarrhoea and malnutrition, the responsibilities of the water and sanitation, and nutrition sectors should be harmonised to ensure the availability of clean and potable water, functional toilets and hand washing facilities. At the same time, the child protection unit should work in tandem with the education, health and law enforcement agencies. However, the momentum needed to reap benefits through convergence seems to be missing at all levels. The departments are working in silos, rarely sharing data and learnings on adolescents with each other. There is an urgent need to break such barriers.
Inter-sectoral convergence (ISC) holds the key to the health and well-being of the 253 million adolescents who come from diverse backgrounds with different needs. When sectors converge for a common goal, the benefits become manifest at multiple levels. Nevertheless, the concept of ISC may seem simpler in theory. At the macro level, ISC is a recognised relationship between sectors to take action on an issue to achieve health outcomes in a way which is more effective, efficient or sustainable, that might be achieved by the health sector working alone. There is a practical narrative as well, wherein different functionaries and the community work together for efficient service delivery. While many may argue that such an arrangement may lead to duplication of work and the dilution of responsibilities, it could also be a way to optimise on each-others' strengths.
The larger question on how to make sectors converge remains unanswered. There are some good examples of collaboration between health and school systems in the administration of weekly iron-folic acid and de-worming tablets to students. Sectoral partnerships to address child marriage show how a strong leadership at the district level can mobilise departmental collaboration to strengthen voices of dissent in communities. However insignificant they may seem, such small efforts have huge potential to accelerate joint actions to enhance coverage, transform social norms and strengthen sector-specific services for the vulnerable. Leadership is important to sustain interest and commitment across the sectors.
The National Adolescent Health Programme also is known as Rashtriya Kishore Swasthya Karyakram (RKSK) is designed to meet the diverse needs of adolescents. For RKSK to be successful, inter-sectoral convergence should hold centre-stage. The key sectors will have to come together to ensure that our adolescents not only survive but also thrive and lead the transformative processes for global communities.
(The writers are Deputy Directors of MAMTA Health Institute for Mother and Child)
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