Ministerial Roundtable: An adolescent-responsive health system
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World Health Organization. Regional Office for South-East Asia
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The unique physical, cognitive, social, emotional, and sexual development during adolescence necessitates special attention to this community in national health and development policies, plans and programmes. However, this age group (10–19 years) has often been neglected in health and social policies and programmes, resulting in fewer health gains compared with other age groups. The case for investment in adolescent’s health and well-being is much stronger now with evidence of a ‘triple dividend’ of immediate, future,and intergenerational benefits, and an estimated 5–10 times return in benefits for every dollar invested.The WHO South-East Asia Region accounts for 29% of the world’s total adolescent population, the highest for any region. Adolescents in the Region face both shared and gender-specific health challenges, with significant mortality and morbidity from mainly preventable causes. Nearly 620 adolescents are dying every day, with the top five causes of mortality in 2021 being road injury, COVID-19, self-harm, diarrhoeal diseases, and drowning. Various conditions and diseases responsible for morbidity of adolescents include communicable diseases along with maternal, perinatal and nutritional conditions (33%), noncommunicable diseases (27%), mental, neurological conditions along with self-harm and substance abuse (25%), and other injuries 15% (other than self-harm).Globally and regionally, there have been significant political, strategic and scientific advances to prioritize and focus on health and well-being of the adolescent population.Results from the recent SRMNCAH policy survey (2023) and regional assessment (2019–2020)show that most countries of the Region have formulated favourable policies, developednational programmes, established dedicated units with nodal officers, national action plans and annual budgets, and started delivering adolescent-friendly health services. Key challenges are related to poor funding, inadequate accountability, fragmented implementation with poor coverage and quality, limited data and weak participation of adolescents and parents/community.There is strong evidence that adolescents face multiple barriers in accessing health care and information. Even if they do access care, they lack confidence and face greater humiliation, disrespect, and stigmatization, and receive poorer quality care than adults. The health systems and service delivery platforms are primarily oriented for specific age groups (mothers, children and adults) or towards management of specific diseases and conditions, and only partly able to respond to the specific health, development and psychosocial needs of the adolescent populations, including the application of an appropriate ‘gender lens’. Over the past decade, countries in the Region have implemented adolescent-friendly health services (AFHS) but the focus has been on individual health facilities rather than on institutionalizing adolescent friendly elements into health systems. Countries have also prioritized adolescent sexual and reproductive health service provision over other areas, and promoted curative services compared with comprehensive packages.An adolescent-responsive health system includes adolescents in the overall health system strengthening efforts. It is a framework that prioritizes the unique health needs and rights of the adolescent population aligned with the context of delivering comprehensive primary health care based on a life-course approach. Adolescent-responsive health systems comprise strategies to achieve the vision and goals for UHC as it will ensure adolescents can access high-quality, inclusive and respectful health services they need and have a right to, anywhere they choose to go and without any restrictions including financial ones. This will ensue access to a comprehensive package of health services contextualized to respond to adolescents’ specific developmental stages, needs and preferences, as well as addressing the recognized public health priorities. Additionally, it aligns with the tactical approaches defined under the WHO South-East Asia Regional Roadmap for Results and Resilience.This Working Paper was presented to the High-Level Preparatory (HLP) Meeting, held in New Delhi on 2–4 September, for its review and recommendations, and the following recommendations were made by the HLP Meeting for consideration by the Seventy-seventh Session of the Regional Committee:Action by Member States (1) Participate in the preparation of the Roundtable and development of the Ministerial Declaration. Actions by WHO (1) Include comments from Member States to further highlight the significance of key recommended topics in the technical report to the Seventy-seventh Session of the Regional Committee for South-East Asia and the discussion stated above, including mobilizing political commitment, enhanced resources, strengthened capacity, partnerships, and meaningfully engage adolescents, families and communities to strengthen primary care systems and achieve the vision and goals of UHC. (2) Facilitate discussions, under the leadership of the Government of India as the host country, among Member States to prepare and develop the Ministerial Declaration for smooth adoption through consensus at the Roundtable. This Working Paper and the HLP Meeting recommendations are presented to the Seventy-seventh Session of the WHO Regional Committee for South-East Asia for its consideration and decision.