How Health Care Providers Can Improve Adolescent Health Services

Adolescence is a phase of rapid physical, emotional, and social change, and the health choices made during these years often shape a person’s entire adult life. Yet a large share of adolescents hesitate to walk into a clinic, fearing judgment, lack of privacy, or simply not knowing where to go. This is where health care providers step in, not merely as doctors who prescribe medicines, but as counsellors, educators, and advocates. Their ability to deliver friendly, confidential, and comprehensive services determines whether young people grow into healthy adults or carry preventable conditions into the next generation.

Why adolescent health needs a special approach 🔗

Adolescents, defined by the World Health Organization as individuals aged 10 to 19 years, make up roughly one-fifth of the population. In India alone, they number close to 253 million, a demographic too large and too varied to be served by adult-oriented clinics. They face a unique mix of concerns: anaemia and undernutrition, early sexual debut, menstrual hygiene, substance misuse, gender-based violence, mental distress, and non-communicable diseases like obesity and hypertension.

Recognising this, the Ministry of Health and Family Welfare launched the Rashtriya Kishor Swasthya Karyakram (RKSK) in 2014. The programme expanded the focus from sexual and reproductive health alone to six thematic areas: nutrition, sexual and reproductive health, mental health, injuries and violence, substance misuse, and non-communicable diseases. Health care providers sit at the centre of this strategy because they translate policy into actual conversations and care.

Comprehensive health care services for adolescents 🔗

A comprehensive adolescent service is not a single consultation but a continuum of care that combines prevention, promotion, treatment, and counselling. Under RKSK, this care is delivered through Adolescent Friendly Health Clinics (AFHCs), often rebranded locally as Yuva Clinics, Saathiya Kendras, or DISHA clinics. These are staffed by trained Medical Officers, Auxiliary Nurse Midwives, and dedicated counsellors located at primary health centres, community health centres, district hospitals, and medical colleges.

The four pillars of adolescent-friendly services 🔗

For a clinic to genuinely serve young people, it must meet four core standards. Services should be equitable, reaching every adolescent regardless of gender, marital status, or schooling. They should be accessible, located in places where adolescents feel comfortable, and not, for example, next to labour rooms or sexually transmitted infection clinics. They should be acceptable, meaning providers behave in ways young people trust. And they should be effective, producing measurable improvements in adolescent well-being.

Privacy and confidentiality as non-negotiables 🔗

Privacy is the foundation of adolescent care. A teenager will not disclose menstrual irregularities, sexual concerns, or thoughts of self-harm in a room where other patients walk in mid-consultation. Unfortunately, a scoping review of AFHCs in India found that six of seven studies reported that privacy and confidentiality were not adequately maintained, with curtains missing, doors left open, or counselling rooms positioned too close to busy outpatient departments. Providers must therefore not only be trained clinically but also coached on how to physically arrange the consulting space, manage interruptions, and assure the adolescent that what is shared will not reach parents, teachers, or peers.

The role of trained counsellors 🔗

Counsellors are arguably the most important human resource in any adolescent service. They inform, educate, and counsel on diverse issues, and they refer clients to specialised services such as Integrated Counselling and Testing Centres or de-addiction units. Importantly, outreach activities by counsellors are expected at schools, colleges, and youth clubs at least twice a week, ensuring that information travels beyond the clinic walls. Where counsellors display a non-judgmental attitude, adolescents return; where they appear biased, especially towards unmarried girls seeking sexual health information, footfall drops sharply.

Importance of nutrition counselling 🔗

Nutrition is the single most powerful determinant of adolescent health, and yet it remains one of the most neglected. National survey data show that anaemia affects about 54% of adolescent girls aged 15 to 19 and 29% of adolescent boys, with serious consequences for school performance, immunity, and future maternal outcomes. Health care providers are the front line in tackling this through both supplementation and behaviour change.

Weekly Iron and Folic Acid Supplementation and Anaemia Mukt Bharat 🔗

The Weekly Iron and Folic Acid Supplementation (WIFS) programme delivers one IFA tablet per week to school-going and out-of-school adolescents for 50 weeks a year, along with biannual deworming using albendazole. This is nested within the broader Anaemia Mukt Bharat (AMB) strategy, launched in 2018, which follows a 6x6x6 framework covering six target groups, six interventions, and six institutional mechanisms. For adolescents, the strategy aims to reduce anaemia prevalence by three percentage points each year. The programme runs not just in schools but also through quarterly Adolescent Health Days at Anganwadi centres for out-of-school girls, ensuring no one is missed simply because they have dropped out.

What good nutrition counselling looks like 🔗

Handing out a tablet is not the same as nutrition counselling. Providers are expected to explain why the supplement matters, how to take it with food to reduce side effects like nausea, and what dietary practices to combine with it. Effective counselling addresses iron-rich local foods such as ragi, drumstick leaves, dates, jaggery, and green leafy vegetables; the role of vitamin C in iron absorption; the importance of avoiding tea or coffee with meals; and age-appropriate caloric needs during growth spurts. Without this contextual guidance, compliance remains poor and tablets are often discarded.

Beyond anaemia: obesity, eating disorders, and body image 🔗

Nutrition counselling today must also address rising rates of childhood obesity, fast-food consumption, and body image distress, especially in urban areas. Providers should be equipped to identify early signs of disordered eating, screen for non-communicable disease risk factors like waist circumference and blood pressure, and counsel adolescents about screen time, physical activity, and sleep. Adolescent Health Days organised once every three months are useful platforms for this kind of broader health education.

Mental and sexual health: the sensitive frontier 🔗

Mental health and sexual health are the two areas where stigma, silence, and lack of vocabulary make professional support most necessary, yet most difficult to deliver.

Recognising and addressing mental distress 🔗

Depression, anxiety, low self-esteem, digital addiction, and self-harm have become major concerns among Indian adolescents. The government’s response includes the National Mental Health Programme, the District Mental Health Programme, and the School Health and Wellness Programme under Ayushman Bharat, all of which converge with RKSK. Providers need to screen for distress using validated tools, normalise help-seeking, and refer onwards where required. Nearly 8,000 Adolescent Friendly Health Clinics now act as the first point of contact for mental health support, supported by close to one million peer educators who conduct weekly community sessions.

Sexual and reproductive health counselling 🔗

Conversations on menstrual hygiene, contraception, sexually transmitted infections, gender-based violence, and consent must happen without moral judgment. Female and male counsellors are typically deployed in pairs at higher-level facilities so that adolescents can speak with a provider of the same gender if they prefer. Free condoms, oral contraceptives, emergency contraception, and pregnancy testing are part of the service package, alongside referrals for safe abortion services when relevant. Providers must remember that confidentiality is especially fragile here: a leaked conversation can derail an adolescent’s education, marriage prospects, or family relationships.

Community-level health interventions 🔗

Clinics alone cannot reach the adolescents who need them most. Many young people in India never enter a health facility due to distance, school timings, household work, or social restrictions on girls’ mobility. RKSK therefore places equal weight on community outreach, marking what officials describe as a paradigm shift from clinic-based care to reaching adolescents in their own environments.

Peer educators as the bridge 🔗

Under the peer education programme, four peer educators, two girls and two boys, are selected for every village or per 1000 population covered by an ASHA worker. These peer educators are trained to lead weekly participatory sessions on the six RKSK themes and to refer adolescents who need clinical support to the nearest AFHC. Studies on peer-led sessions show that nutrition and non-communicable disease topics are discussed comfortably, while sexual health and mental health remain harder to talk about, especially in mixed-gender groups, highlighting the need for stronger training and expert backup.

Adolescent Health Days and school outreach 🔗

Quarterly Adolescent Health Days, organised at both health facilities and in the community, bring together parents, teachers, village health nurses, panchayat members, and medical officers. These events offer health screenings, distribute IFA tablets and sanitary napkins, and conduct group counselling. The School Health and Wellness Programme, run jointly by the Ministries of Health and Education, further extends services into classrooms through trained teachers who serve as health and wellness ambassadors.

Reaching marginalised adolescents 🔗

The programme deliberately prioritises married adolescents, out-of-school adolescents, urban slum residents, tribal youth, and adolescents with disabilities. Community Adolescent Health Days are organised in slums, with groups of around 25 girls or boys engaged through interactive games to discuss sexual and reproductive health, mental health, and nutrition. Without this active outreach, marginalised groups would continue to fall through the cracks of any clinic-based system.

Inter-sectoral collaboration: no department works alone 🔗

Adolescent health cannot be the responsibility of one ministry. Education, women and child development, youth affairs, social justice, and rural development all play roles. Inter-sectoral convergence is built into RKSK through joint planning at the district level, shared training of frontline workers, and linkages with programmes like POSHAN Abhiyaan, the SABLA scheme for adolescent girls, and the Menstrual Hygiene Scheme. International partners including WHO, UNICEF, UNFPA, and several NGOs support capacity building, supply chains, and monitoring. For health care providers, this means coordinating with school teachers, Anganwadi workers, ASHAs, ANMs, and police officers when handling cases involving violence or child marriage.

What still needs improvement 🔗

Despite significant progress, the system has visible gaps. Many AFHCs lack dedicated space, audio-visual privacy, updated IEC materials, and adequately trained counsellors. A cross-sectional assessment of AFHCs in Maharashtra and Madhya Pradesh found that most clinics needed improvements in basic amenities, functional equipment, items on display, and standard operating procedures, while accessibility and signage tended to score better. Provider attitudes also vary, and judgmental behaviour towards unmarried girls remains a documented barrier. Strengthening pre-service training, regular booster sessions, supportive supervision, and demand generation through community engagement are essential to closing these gaps.

What do you think? If you were to design an adolescent-friendly clinic for your own town, what is the one feature you would prioritise to ensure that young people, especially those from marginalised backgrounds, actually walk in and return? And how would you balance the need for confidentiality with parents’ desire to be involved in their children’s health decisions?

References

1. https://www.nhp.gov.in/rashtriya-kishor-swasthya-karyakram-rksk_pg
2. https://nhm.gov.in/showlink.php?id=180
3. https://nhm.gov.in/index1.php?lang=1&level=3&sublinkid=1247&lid=421
4. https://pmc.ncbi.nlm.nih.gov/articles/PMC10442587/
5. https://academic.oup.com/heapol/article/37/5/597/6539775
6. https://www.mohfw.gov.in/?q=en/pressrelease/indias-fight-against-anemia
7. https://www.nhm.tn.gov.in/en/nhm-programsrmncha/rashtriya-kishor-swasthya-karyakram-rksk
8. https://www.unicef.org/india/press-releases/government-india-unicef-and-partners-put-youth-voices-centre-mental-health-action
9. https://pmc.ncbi.nlm.nih.gov/articles/PMC11564149/
10. https://www.tandfonline.com/doi/full/10.1080/26410397.2023.2283983
11. https://pmc.ncbi.nlm.nih.gov/articles/PMC10868312/