Ten years from now, we will wake up to a world where today’s young people form the majority of the population. Their life stories will tell us how we have done on Ending Preventable Child and Maternal Deaths, Neglected Tropical Diseases, Ending Tuberculosis, the 90-90-90 goals targeted at eradicating HIV, and more.
With the epidemiological transition — the global shift from communicable to non-communicable diseases as the major cause of ill-health and mortality — this generation will also be the test case for our ability to beat Non Communicable Diseases and improve mental health. Approximately eight million deaths each year are attributable to mental illness.(Walker ER, McGee RE, Druss BG. Mortality in Mental Disorders and Global Disease Burden Implications A Systematic Review and Meta-analysis . JAMA Psychiatry. 2015;72(4):334–341.)
For India, every bit of this is crucial to our dream of reaping the ‘demographic dividend’ — the favourable phase where a greater proportion of the population is young.
In short, there’s a lot riding on today’s youth.
So how are we doing so far?
India’s adolescent health programme, the Rashtriya Swasthya Kishor Karyakram or RKSK, has been focused on six key goals in adolescent health:
- Improving nutrition
- Increasing informed decision-making around sexual and reproductive health
- Improving health behaviours that contribute to non-communicable diseases
- Tackling substance abuse
- Reducing injuries and violence (including gender-based violence)
- Strengthening mental health
RKSK has made significant improvements in quality of service delivery, provider attitudes and skills, and links with other stakeholders like schools and communities. It also provides for strengthening adolescent-friendly health clinics (AFHCs) at PHCs, CHCs, and district hospitals, where adolescents can go for counselling, and preventive and curative health services. However, engaging adolescents to demand and use health services remains a major challenge, and a very context-specific one — influenced by gender, socio-cultural milieu, and geography.
Engaging adolescents has been a long-standing issue. Prior to RKSK, the Ministry of Health, Government of India developed the Adolescent Reproductive and Sexual Health (ARSH) strategy and operationalised adolescent health services up to district and sub-district hospital level. In 2016, a study found:
“Although health system has the primary responsibility of addressing health issues among adolescents, it has limitations in terms of its reach to adolescents and generating demand for services. There is a need to network with education sector, ICDS, NGOs working for adolescent health and development to work as a team and address the multifaceted needs of the adolescents. Such a strategy will be crucial while implementing the recently launched Rashtriya Kishor Swasthya Karyakram.” (Joshi, B.N., Chauhan, S.L., Kulkarni, R.N., Kamlapurkar, B. and Mehta, R. (2017) Operationalizing Adolescent Health Services at Primary Health Care Level in India: Processes, Challenges and Outputs. Health, 9, 1-13.)
Human-centered Design: The approach to go for?
Human-centered design (HCD) is a design framework that comes up with solutions by involving the human perspective throughout the problem-solving process. The human involvement usually takes place through observing the problem within context, interviewing the community that would be affected by the outcome of the design process, and designing in collaboration with the people that one is serving. Together, this results in solutions that closely correspond with the needs of the target group.
Human-centered design appears to be a perfect approach to create adolescent-friendly spaces in healthcare, building the elements that engage adolescents to demand and use health services into its very DNA. Here is how:
Engaging in a co-creative process with adolescents and youth makes it easy to quickly identify what they find engaging and useful. Adolescents are more likely to visit health-care centres which they had a hand in designing, as these would be tailor-made to suit their needs and tastes. Adolescents will feel at ease opening up about sensitive issues such as sexual and reproductive health and mental health in a space where they feel comfortable.
Creating friendly spaces through Human-centered Design — when done with sensitivity that the process naturally demands — would especially empower those who are usually marginalised and excluded from the design process: adolescents from rural areas, those who are disabled, adolescents from the LGBTQAI+ community, or those who are simply suspicious of mainstream healthcare.
The continuous cycle of feedback and improvement of the spaces will result in adolescents feeling that the health centers are truly their own. This will also motivate them to invite their friends and fellow peers to make use of the centers. In India, where there are few spaces for adolescents to call their own, well-designed adolescent health resource centers could make a huge impact, going beyond the original objective of better health.
Oh wow! But does this work?
If this sounds too ambitious or a pipe dream, it’s important to note that the Human Centered Design approach to adolescent health has been tried, and is showing success in various contexts.
In Lusaka, Zambia, sexual and reproductive health centres in the guise of nail salons are effectively informing more young girls about the use of contraception. At these centres, young girls get manicures and spend time with their friends while having informal chats about contraception with a trained professional. When they are ready, they receive counselling as well as access to both short and long term birth control methods in a safe and non-judgmental environment from a trained professional. Among the girls who visit one of the three ‘Diva Centres’ in Lusaka, 82 percent opt for contraception services and 36 percent return for another visit.
In Benin, research revealed that sex among teenage girls was being used as a transaction to get books, pay school fees and to afford small luxuries. The Academie de L’Artisanat, a part of USAID-funded project Transform/PHARE, was developed based on these insights, using HCD. Academie de L’Artisanat helps young girls to create an alternative currency by helping them build skills such as beading and soap-making. Through these skills, the girls produce small products which they can then sell and earn their own income. The Academie occurs weekly and is structured like a workshop involving three components. The first one, She makes, involves teaching the girls a new craft, as well as learning how to sell what they have made. The second component, She learns, involves a health-care professional informing girls about the importance of contraception while they work on their craft. The final one, She is in control, occurs at the end of the workshop. Here the talents of the adolescent girls are recognised, and nurses are present to provide counselling as well as sexual and reproductive health services to those who want them.
Examples like the Diva Centres and the Academie de L’Artisanat point out that it’s difficult to predict what adolescents want, and the form in which they want it, without engaging with them in a substantial way. With the new Health and Wellness Centres, and the ongoing efforts to improve the Adolescent-Friendly Health Centres under RKSK, we have a unique opportunity to design more effective spaces for engaging adolescents and promoting health-seeking behaviours. And when we do successfully engage them — as partners, and not as patients — we will really be able to accelerate progress towards our common goals.
If you know of any other models of innovative design for adolescent-friendly spaces, drop us a line and we will feature it soon!