Finding gaps in meeting adolescent health needs in Nepal
Every day, our health and our ability to access health services are influenced by gender norms, roles and relations, as well as other conditions in which we are born, grow, work, live and age. The greater the disparities between different social groups, the greater the inequalities in their ability to obtain health care.
Take teenagers living in Nepal, for example.
If you are a poor Nepalese teenager living in rural areas, you are more likely to have dropped out of school, married and given birth before the age of 18 than your urban counterparts. If you live in a mountainous area, chances are you will have to walk up to 4 hours to receive health services. You may not be able to pay upon arrival and may receive lower quality services.
Although a sexual and reproductive health program for adolescents, a law prohibiting child marriage before the age of 20 and the legalization of abortion may seem like answers to improving the health of 1 adolescent out of 4 in Nepal, it’s not that simple.
The country has already implemented each of these measures. However, none of them fully address the inequalities that adolescents face.
“When we first developed the National Adolescent Sexual and Reproductive Health Programme, it was a comprehensive approach,” said Ghanashyam Pokherel from the Family Health Division of Nepal’s Ministry of Health. “We realized that to further improve adolescent health, we needed to understand the gaps in our services and the differences between adolescents.”
The challenge of reaching every adolescent
In 2015, Nepal’s Ministry of Health collaborated with the World Health Organization (WHO) to revamp the national adolescent sexual and reproductive health program. Using the Innov8 approach – an 8-step review process aimed at helping health programs better address equity, gender, human rights and the social determinants of health – a team of review of 15 people worked to discover the shortcomings. The team included representatives of national and sub-national authorities, bilateral partners, NGOs and civil society, as well as research institutes.
“Our goal was to identify missing adolescent subpopulations, build program capacity to reduce inequities and improve overall adolescent health,” says Dr Jos Vandelaer, WHO Representative in Nepal.
Nepal’s original adolescent sexual and reproductive health program did not take into account specific barriers faced by different sub-populations, such as distance and cost of travel, inability to come during opening hours, lack of privacy and confidentiality, adverse gender norms, among other factors.
To help overcome these barriers identified by the Innov8 review team and ensure that no adolescent is left behind, Nepal’s Ministry of Health is currently working to expand adolescent-friendly services to hard-to-reach groups. Measures include an increased focus on local services (particularly in deprived areas) and increased community engagement.
Other steps are integrating adolescent sexual and reproductive health into other services, alongside building the capacity of health workers on adolescent-friendly and gender-sensitive services, and ensuring that adolescent representatives participate in local health decision-making processes.
The program will also further engage other ministries, such as education, to address the causes of early marriage and pregnancy and to address the stigma associated with adolescent reproductive health.
“Teenagers are the future of our country,” Pokherel said. “Without them, our country will not be socially or economically healthy in the future. We are integrating what we learned from the Innov8 review into the new National Adolescent Health and Development Strategy, which will underpin all programs. »
Addressing global inequalities and promoting a human rights-based approach to health
Around the world, national health programs are striving to achieve the 2030 Agenda for Sustainable Development and the goals set out in the Global Strategy for Women’s, Children’s and Adolescents’ Health , which aim to ensure that no one is left behind.
To help countries plan for adolescent health, WHO is also developing the Accelerated Global Action for Adolescent Health (AA-HA!) implementation guidance document, which features Innov8 as one programming resources. Over the past year, WHO has presented its new approaches to nine other countries in the South-East Asia Region that are working to improve adolescent health. The Innov8 approach can be used to eliminate inequalities in any health program. Since mid-2016, the approach has been tested in the Americas, Eastern Mediterranean, Europe and Southeast Asia on health programs ranging from communicable diseases to environmental health.