1
HEALTH SERVICES DELIVERY
1.5
PROGRAMME FOR VULNERABLE POPULATIONS
1.5.4
Adolescent Health (As of October 2008)
A Focal Point
B Implementing Agencies
C Target Areas & Beneficiaries
DDG/PHS
Ministry of Health (D/YEDD / HEB / MCH / NCD
/ NIHS / Population Division / STD AIDS
campaign / PDHS, DPDHS / Health Institutions / MOH
& field staff), Ministry of Education / Dept. of
Education / NIE, Ministry of Youth Affairs & Sports,
NYSC, Ministry of Information & Media, Department of
Labour, Women’s bureau, Vocational Training
Authority, National Dangerous Drug Control
Board, Ministry of Defence, Ministry of justice,
Universities, ADIC, FPA, Sarvodaya, FHP & Other
related NGO / CBO
Primary Target Groups : All school children aged 10-19
years, out of school youth (employed/unemployed),
University students, Students of Technical Colleges &
Vocational Training Centres, Young armed personnel
Secondary Target Groups: Health personnel, Teachers &
school administrators, Youth Leaders of National Youth
Council Services, Politicians, Policy makers,
Administrators, members of Provincial councils,
Municipalities & pradeshiya sabha, Community leaders,
parents, members of NGOO / CBOO
Project Summary:
With Sir Lanka entering into the final stage of the demographic transition, there are a significant
proportion of adolescents who will have specific health needs and problems. Although the
health system as a whole is providing services for the all age groups of the population. Due to
the very specific nature of the problems among adolescents, it is argued that the existing health
care delivery system is not the most effective and efficient when providing health services for
adolescents.
However the last decade saw the emergence of adolescent-friendly health services in selected
institutions. The utility rates of these services clearly show that there is a concrete need to
develop and expand the adolescent-friendly health services in the country. The objective of the
project is to improve the quality of life of school youth by developing their knowledge, attitudes
and values, skills and behaviours regarding biological, psychological socio-cultural and
reproductive dimensions of adolescence
1.
Justification:
The population in Sri Lanka is 18.5 Million of which approximately 5.2 Million (29%)
comprise of young people between the age of 10 - 24 years.
Adolescents are generally thought to be healthy, as mortality in adolescence is lower than in
any other age group. Contrary to popular opinion not all adolescents are healthy.
However the period of adolescence is also a period in which behaviours, such as truancy,
unhealthy dietary and physical activity patterns, use of substances such as tobacco and alcohol
& drugs, unsafe sexual practices and engaging in violence, are initiated.
Though such behaviours cause morbidity and mortality in adulthood their roots can be traced
back to the adolescent period. Tobacco use, for example, typically starts before the age of 15
and frequently leads to premature death later in life. HIV infection, which is often
contracted in late adolescence, leads to AIDS in later years. The major cause of death in
young people are road traffic accidents, injuries, suicide, violence, pregnancy related
complications & HIV/AIDS that are either preventable or treatable.
Unwanted pregnancies and abortions, STD & HIV / AIDS, smoking, alcohol & drug abuse,
suicide, violence, accidents & injuries, nutritional problems, sexual abuse & school dropouts
encountered among the adolescents and youth pose a significant challenge to the well being of
this group.
In Sri Lanka there are multiple donors willing to support adolescent health. However for the
optimisation of resource allocation and utilization, it is important to have a policy
documentation specifying national priority and which provides a frame work for resource
allocation, collaboration & cooperation of all key funding & implementing stakeholders. The
policy will also help to enhance the image & credibility of the agencies involved in adolescent
health activities.
The existence of explicit policy provides vision, coordination, strategy & sustainability for
improve programming.
Amidst some services for adolescents which are being provided in an ad-hoc manner by both
government & non government sectors it is appropriate to establish a Comprehensive
National Programme in collaboration with all relevant government & non government
organizations to improve the well being and health of the adolescent.
2.
Important Assumptions/Risks/Conditions:
Becomes a priority concern of the Ministry of Health
Political support and support of policy makers gained
Adequate. Human resources. Funds & other resources allocated at Central Provincial District &
Divisional levels
 Improved collaboration of all sectors for implementation & monitoring
 Committed trained staff
 positive attitudes of Health personnel at all levels for serving unmarried youth especially
on improvement of Reproductive Health (RH)
 education, Health authorities, and NGOs continue to demonstrate their commitment
to improve ADH
 less resistance from the community for serving unmarried youth by the Primary Health
Care
 Workers especially on improvement of Reproductive Health (RH)
3.
Project Objective:
Objective
To improve quality of life of
school & out of school
youth by developing their
knowledge attitudes
values, skills & behaviours
regarding biological,
psychological, socio
cultural, & reproductive
dimensions of adolescence.
Indicators
Means of Verification
Rate of suicides among youth
Rate of
youth indulged
in substance abuse
 Rate of teenage pregnancies
 Rate of sexual abuse among
youth
 Rates of STD / HIV
AIDS
 among youth.
 Incidence of violence among
school & out of school youth
 Number of
youth
obtaining counselling services.


Registrar General
records
 Records and returns
 Periodical
survey.
Police reports
 Records
in
counselling centres

A reduction in the violence, accidents, smoking, alcoholism, drug abuse, suicide, sexual abuse,
teenage pregnancies, abortions, mental health problems, STD HIV AIDS, School dropouts will be
seen with improvement of adolescent & youth health.
4.
Project Output/Product:
Project output is aimed at health promotion as well as reduction of RH problems, alcohol & drug
abuse, violence among school & out of school youth etc. through provision of safe & supportive
environment, improving provision of information & skills & improving health
services including counselling.
Outputs
Indicators
Means of Verification
A national policy and
strategy on adolescents and
youth developed

The accessibility of youth
and adolescents enhanced to
Youth/Adolescent friendly
health services
The providers made skilled
and competent to provide
adolescent/youth friendly
health services
Youth and Adolescents are
made knowledgeable on
issues of their interest and
the availability of services.

Number of
youth/adolescents gaining
access to services

Records and returns
Number of providers who
are competent of providing
services to youth and
adolescents
 Percentage of
youth/adolescents who feel
that they are knowledgeable
in issues of their interest


Records and returns
Workshop reports

Surveys
5.
Availability of documents  Availability of the policy
on national policy and
and the strategy documents
national strategy in place

Related Projects:
Project No.
SRL CAH 001
Project Title
Improving life competencies of school & out of school adolescent & youth
SRL CAH 001
UNICEF
6.
Development of National Strategy on Adolescent & Youth Health
Development of National Policy for Adolescent & Youth Health
Relevant Agencies to be Coordinated:
Director YEDD / HEB / FHB / NIHS / Population Division / STD AIDS campaign
 Provincial Health Directors, DPDHS Medical Officers of Health & field staff Health
Institutions
 Ministry of Youth Affairs & Sports, NYSC Related NGO’s,
 Ministry of Education / NIE Department of Education Department of Labour
Women’s Bureau
 Ministry of Justice
 Ministry of Media & Information Vocational Training Authority NDDCB
 Donor agencies – WHO, UNICEF, UNFPA, UNAIDS, JICA, ILO, World Bank

7.
Monitoring & Evaluation:
1. Who?
DGHS, DG/Educational
of departments
&
NGO’s,
on adolescent health
2. When?
Services,
through
DG/NIE,
National
Other relevant heads
Steering
committee
Quarterly
3. What actions to be taken based on results of monitoring & evaluation?
 Improve planning and provision of services based on the identified gaps
 Improved resource allocation
8.
Activities:
The following activities will be, either school based, community based, work place based,
home based, hospital & clinic based or out reach.
Activities
1
2
3
4
Formulate a national policy
&
national
strategy
on adolescents,
youth
and legislation of policy
Expected Results
National
policy
&
National
strategy
on
adolescent health in
place
Identify and recruit human resource Human resources
needed
at all levels for
plan developed
improvement of adolescent & youth
health
Identify & supply of other
Other resources
resources needed at all levels for
identified
improvement of adolescent & youth
health
Carryout advocacy programmes for
Continued
Politicians, Policy makers,
political and other
Process Indicators
Identify the working
group Develop the TOR
Identify the working
group Develop the TOR
Develop the HR plan
Identify the working
group Develop the TOR
Identify the needs
Develop advocacy
material
stakeholder support
for
ADH
programmes
Develop the programmes
5
Administrators, officials of
educational sector, Community
leaders, Parents, Members of NGOO
and Media personnel
Conduct research pertaining to
problems among youth
Knowledge gaps
identified
6
Establish channels of coordination
between different sectors
Continued
inter-sectoral
participation
& collaborative
efforts regarding
implementation of
youth activities
IEC material mad
available
Identify research
priorities
Identify researchers
Identify the working
group Develop the TOR
7
8
9
10
Produce IEC material on health
promotion, prevention of adolescent
health problems & counselling
for
adolescent health problems
for different target groups
Establish youth friendly health
services
including information
provision, health screening, care,
rehabilitation & counselling services.
Clinics (PHC, Institutional), Out reach
services, Hot line, Centres caring for
victims of sexual abuse/rape,
Rehabilitation
centres
for
victims of drug abuse
Conduct awareness programmes to
educate Health personnel, Teachers,
NGO personnel, Youth leaders, Peers,
Health volunteers, Community
leaders, Media personnel
Conduct training in relation to AF
health services
11
Develop a life skills improvement
programme
12
Establish a Management Information
System for adolescent & youth health
& a continuous flow of monitoring
and evaluation.
Identify target groups
Identify IEC materials
Design IEC materials
Youth friendly
services established
Design the health service
package
Develop proposals
All stakeholders
made aware of the
services
Develop awareness
material
Develop the programmes
All service providers
are made competent
Identify training needs
Develop training
materials
Plan the training
programme
Identify training needs
Develop training
materials
Plan the training
programme
Life skills adopted
for health
promotion &
prevention of
adolescent
&
youth problems
MIS established
Identify the information
need
Design the MIS
Pilot test