Collaborative Adolescent Health Program Shows Promise in Bihar

We know that effectively reaching adolescents with health information and services requires tailoring programs to meet the unique needs of those we are serving. In this Q&A, Mini Kurup, Technical Specialist for Adolescent Health in our India Country Program, explains how we are applying that approach in a unique adolescent health initiative in the State of Bihar.

Please describe your role and function within the Adolescent Health and Development Project (AHDP).

Mini Kurup

Mini Kurup, Technical Specialist for Adolescent Health in our India Country Program

I work as an Adolescent Health Specialist and provide technical support to the Government of Bihar to strengthen the planning and implementation of Rashtriya Kishore Swasthya Karyakram (RKSK), India’s national adolescent health program. As the team lead, I am responsible for the overall management of the project and liaise with district health, education and social welfare officials as we seek to leverage funding and support for adolescent health. Through our project, we have created a partnership whereby EngenderHealth provides technical support to the government as they operationalize this program.  I work closely with the State’s Program Office for RKSK and help them in preparing the Annual State Program Implementation Plan for RKSK, and I am responsible for the implementation of the program in the Sitamarhi district.

You mentioned the national adolescent health program called Rashtriya Kishore Swasthya Karyakram (RKSK). Can you describe what this program does?

To promote the holistic health and well-being of adolescents, the Government of India launched the RKSK program in 2014. The program expands the scope of adolescent health programming in India—getting away from isolated, vertical programming and instead promoting integrated services. In the past, when the government implemented separate programs to address adolescent health needs, those programs had differing levels of success, and adolescents who needed multiple services rarely sought out all the different ways to access them. RKSK integrates six priority health areas into one program to better serve the needs of adolescents: nutrition, sexual and reproductive health, mental health, injuries and violence (including gender-based violence), substance misuse, and non-communicable diseases.

Our support to the government through the project has focused on supporting the sexual and reproductive health component of the program. Specifically, we work with our government counterparts to ensure the availability of high-quality, gender-equitable, and adolescent-friendly health clinics and SRH services. In addition to addressing the availability of services, we have prioritized the need to engage adolescents in promoting their own health and well-being. We work with ASHAs—frontline health workers—to select and train four adolescents (two boys and two girls) in each community as peer educators and leaders. These peer educators are trained on the six RKSK health components and facilitate safe spaces to share and learn about various health topics, ranging from anemia to menstrual hygiene.

Why do EngenderHealth and the AHDP project partner with the Government of Bihar to strengthen the implementation of the RKSK program?

We believe that working through our government counterparts is the most cost-effective and sustainable way to strengthen health information and services for adolescents in Bihar. RKSK started in Bihar in 2014 but lacked dedicated support and capacity to be fully implemented, and that is why the AHDP was envisioned–to work hand-in-hand with our government partners! Our collaborative NGO–government model of implementation of RKSK is more effective in reaching more adolescents and improving their health and wellness than programs implemented solely by the government or solely by civil society, because we can leverage the talents, expertise and resources of both civil society and the government to achieve greater impact. As a result of the project’s deployment of adolescent health counselors—a critical and missing group of human resources—and close coordination with government counterparts, funds allocated by the State’s existing budget for adolescent health were leveraged to ensure adolescent friendly health clinics (AFHCs) were functional and peer educator trainings were held regularly.

What makes the AHDP project different from other adolescent health initiatives in Bihar and across India?

This project and partnership between the Government of Bihar and EngenderHealth makes this initiative unique in that we are squarely focused on strengthening existing systems and processes. We do not create parallel service delivery channels or structures outside of the existing health system, but instead focus on mentoring and building the capacity of all those within the health system who provide information and services to adolescents. An important characteristic of this project is that it is a part of a broader health and wellbeing initiative that looks at the holistic needs of adolescent girls and boys. We provide the government sexual and reproductive health technical assistance, with the needs of the adolescent girl and boy at the center, so that when they seek information and health services, they receive one comprehensive package of services. By working with and through a broader health initiative, we are also able to use other important health and wellness topics, such as nutrition, as entry points into more sensitive topics, such as sexual and reproductive health.

In India, there are more than 243 million adolescents. How does this project engage with adolescents themselves and ensure that their voices are heard?

Engaging with adolescents is at the core of what we do. Not only do adolescents have a right to be meaningfully involved in programs and initiatives that are meant to serve them, but we believe that engaging adolescents is fundamental to ensuring our programs are designed in the most effective way! We work with our government counterparts to engage with over 2,300 peer educators that are both in and out of school to build their understanding and leadership skills and support them as they form groups within their communities. The peer educators meet once a month to share what they are learning and to ask for support from each other, as well as from ASHAs, counselors, and mentors in their health facilities and communities.  In addition, our project has created platforms for adolescents to meaningfully engage with service providers and government counterparts during Adolescent Health Days (AHDs). AHDs raise the overall awareness and importance of adolescents’ health in communities with parents, guardians, and community leaders. During these days, we work to create safe spaces and support peer educators and other adolescents to participate in discussions about their own health. Through our project and support to peer educators, 819 groups have been formed thus far, and a total of 16,000 adolescent girls and boys have participated in these meetings!

The Government of Bihar has requested EngenderHealth’s support in expanding the scope of this project to more communities and districts. What do you hope to achieve with this expansion?

Working with more communities alongside our government colleagues will allow us to begin taking this collaborative NGO–government model of implementation of RKSK to scale. To more effectively support adolescents to achieve their hopes and dreams, we must work more collaboratively with adolescents and across the public and private sectors to ensure they can live healthy and safe lives. With this pilot project, we have been able to leverage government funds to improve adolescent health in Bihar and bring in additional partners, including funding from the Packard Foundation and district level health budgets. We hope that this model can serve as an example for how government and civil society can work better and smarter together and with adolescents to improve the health and well-being of all adolescents in India!

If you’d like to learn more about our efforts underway in Bihar to improve the health and well-being of adolescents, reach out to