ADOLESCENT FRIENDLY HEALTH SERVICES (AFHS)
Adolescents, generally considered as healthy, are actually at higher risk for many nutritional, life-style, sexual and mental health as well as violence and injuries. Unfortunately, existing health facilities are neither adequate nor appropriate to provide adolescent-friendly services, who are also hesitant to utilize them due to concerns, e.g.
privacy, confidentiality, judgmental attitudes of staff as well as myths, misconceptions and lack of awareness.Concept of Adolescent Friendly Health Services (AFHS) was first coined by WHO (2000), to provide broad range of preventive, promotive and curative services, specially dedicated to this age group under one roof to improve availability, accessibility and utilization.
India adopted a two-pronged strategy to provide adolescent-specific services at public health facilities during routine hours as well as n dedicated days/ times since 2006 as Adolescent Reproductive Sexual Health (ARSH) Clinics, later expanded as AFHS clinics under Rashtriya Kishor Swasthya Karyakram (RKSK).
These services are delivered through trained service providers including health staff and counsellors at existing health centers, out-reach centers, e.g. schools/ colleges or through telemedicine or social media. Now, many governmental, private and voluntary health agencies run dedicated AFHCs, sometimes with different names, e.g. youth clinics, youth friendly center, Jagruti, Jigyasa, etc.
Objectives: AFHCs aims to provide whole gamut of clinical and counseling services on diverse adolescent health issues including: (a) sexual and reproductive health, (b) nutrition, (c) substance abuse, (d) injuries and violence, (e) non-communicable diseases, and (f) mental health.
Functions: AFHCs aim to provide following services:
• Promotion of healthy life-style by appropriate counseling regarding nutrition, sleep and avoidance of substance abuse.
• Information, education and communication/ counseling (IEC) for reproductive/sexual health issues, health concerns and life-style diseases as well as the availability of support system.
• Preventive services, e.g. growth assessment, immunization and identification of risky behavior for life-style diseases, mental health problems or social adjustment issues.
• Establishing a rapport to provide them a channel to discuss their concerns, including setting up of 24-hour help-lines.
• Curative services to diagnosis and management of health problems issues including age-specific problems,
• Referral to appropriate health facilities or other service delivery points, e.g. Integrated Counselling Testing Centre (for HIV), de-addiction centres, etc.
• Sensitize the caregivers and influencers on various adolescent health issues and apprise them of various available adolescent friendly health services.
Attributes: The concept “Friendlyquot; in AFHCs denotes that these services should be accessible, equitable, acceptable, appropriate, comprehensive and efficient. These clinics should also have further referral linkages with the higher facilities and specialty clinics.
AFHC staff is specially trained to: (a) show respect for adolescents with a non-critical approach towards issues, specially related to reproductive/sexual health,
(b) ensure privacy and confidentiality without sharing information provided by them with others, including parents, (c) spend adequate time and have patience to make the adolescent feel comfortable to discuss all issues related to puberty such as body image, relationships and sexuality.
BIBLIOGRAPHY
1. Indian Academy of Pediatrics: Pubery (Delay/Precocious). Standard Treatment Guidelines 2022.
2. Galagali PM, et al. Indian Academy of Pediatrics Consensus Guidelines on Prevention and Management of Suicidal Behavior in Adolescents. Indian Pediatr. 2022;59:553.
3. Indian Academy of Pediatrics: Substance Abuse in Adoescents. Standard Treatment Guidelines 2022.
4. Galagali P, et al. Indian Academy of Pediatrics Consensus Guidelines for Adolescent Friendly Health Services. Indian Pediatr. 2022;.59:477.