National Adolescents Health Strategy (2017-2030): Progress Scenario and Future Direction

Participants

Nurun Nahar Begum: Line Director, Clinical Contraception Services Delivery Program Unit, Directorate General of Family Planning

Quazi Suraiya Sultana: Executive Director, RHSTEP

Md. Monjur Hossain: Program Manager (A and RH), MCH-Services Unit, Directorate General of Family Planning

Nandalal Sutradhar: Deputy Program Manager, National Nutrition Services

Fariha Haseen: Associate Professor, Dept. of Public Health and Informatics, BSMMU

Mohammad Zahirul Islam: Senior Health Advisor, Development Cooperation Section, Embassy of Sweden, Dhaka

Mushfiqua Zaman Satiar: Senior Adviser – Social Sector; Focal Point for SRHR, Gender and Youth; Coordinator- SCS Partnerships in Bangladesh Embassy of the Kingdom of the Netherlands (EKN)

Muhammad Munir Hussain: Program Analyst - Adolescent & Youth, UNFPA Bangladesh

Fatema Shabnam: Adolescent and Youth Specialist, Pathfinder International

Md. Masudur Rahman: National Coordinator, RHRN-2, BRAC

Elvina Mustary: Deputy Director (Program), RHSTEP

Observers:

Shashwatee Biplob: Programme Head and In-Charge of Social Empowerment and Legal Protection Programme (SELP), BRAC

Nazia Zebin: Executive Director, Oboyob

Joyeeta Hossain: Project Coordinator, RHRN 2, Nagorik Uddyog

Sharmin Kabir: Founder & Chairman, Wreetu

Shamima Chowdhury: Ex-Consultant, UNICEF

Shamayla Mahbub: Project Lead, RHRN-2, YPF

Md Mahbubul Haque: Director (Program), RHSTEP

Abdul Quayum: Associate Editor, Prothom Alo

Moderator:

Firoz Choudhury: Assistant Editor, Prothom Alo

Adolescent health is a significant issue. Good physical health will boost their mental health. They will be able to become ideal citizens and contribute in building the nation. For that they need nutritious food, sports and entertainment. Adolescence is the time when the mind and body develop among the young boys and girls. If we can provide care for them during this period, their overall health condition will improve.

Issues like COVID19, wars and misuse of technology adversely affect the society. Many of the adolescents develop addictions to drugs and get involved in crimes. The policy-makers must take effective measures to stop that from happening.

The first phase of the RHRN project in Bangladesh took place during 2016 to 2020. Its second phase started in 2021 and will continue till 2025. Its key objective is youth empowerment so that they can enjoy sexual and reproductive health rights. 

We are collaborating with 7 organisations that include RHSTEP, BRAC, Naripokkho, Nagorik Uddyog and three youth lead partners Oboyob, Youth Policy Forum (YPF) and Wreetu. BRAC is leading the project.

We are working with around 10 thousand youth in 25 districts. We are working on increasing their efficiency. We are working with the schools and health centers at district and sub-district level. We are also collaborating with other stakeholders in national level UNICEF, UNFPA, Plan International, BAPSA, PSTC and others CSOs who works on adolescent health. We work also with the Directorate General of Family Planning, Directorate General of Health Services and the Ministry of Education in Bangladesh.

This project is part of global movement. This project is being implemented in total 10 countries. Main Donor is the ministry of foreign affairs Netherlands. And the project RHRN in 10 countries are being facilitated by Rutgers International. Rutgers mainly renowned worldwide for working on Sexual and Reproductive Health and Rights (SRHR) and it is mainly youth focused.

What we expect is our discussions today will come up with the measures regarding how the NGOs can work more efficiently and collaboratively with the government.

The Ministry of Health and Family Welfare, along with 17 other ministries of Bangladesh has been working throughout the country to improve health services for the youth with the theme `We are with you from your 10 to 19’. One fifth of the total population of the country is adolescents. We are working on to prevent violence against them, and to improve the state of their reproductive health, nutrition and mental health. We developed a strategy in 2017 with support from the Embassy of the Kingdom of the Netherlands, UNICEF and others. It included four thematic areas, two cross-cutting issues and one special issue. We work in the health services sector. We have to ensure health services to the adolescents. For that we have to strengthen our efforts in this regard.

Bringing change in social behavior is important. We believe that it is impossible to change social behavior of 36 million adolescents and provide proper healthcare to them. That is why we are implementing this strategy through multi-sectoral collaboration and cooperation. Physically abled teens can reach out to receive the services, but 10 to 15 per cent of the total youths are not able and we chalked out plans for them also.

Ministry of Health and Family Welfare, Ministry of Women and Children Affairs and Ministry of Social Welfare, along with others, have been working on realising this strategic plan. Usually, we take care of three issues to improve the health condition of the adolescents. We provide information and service. And we implement referral programs where our service providers cannot reach out for them.

We are concerned much about the youths aging between 10 and 19 because around 50 per cent of them got married before reaching to 18. And many of them even became pregnant. We all know how dangerous it can be. 40 per cent of maternal death is the outcome of these two reasons. Demand for contraceptives among those aged between 10 to 19 is 17 per cent.

We are working on these issues. Not only us but the whole world is giving attention to this age group. We know that the Global Strategy for Women’s, Children’s and Adolescents’ Health (2016-2030) provides a roadmap for what to be done by the countries. We have developed a strategic plan for Bangladesh. We have formulated detailed work-plan and financial plan for implementing this strategy. We are hopeful that this plan will get approved. We will be able to implement it then. Bangladesh government has taken this adolescents’ health issue seriously. Measures have also been taken to ensure providing health services to them.

We are providing services to our best through 1,253 service centers. We try to provide healthcare to the youths following the WHO guidelines. We are trying to provide services through satellite clinics, family planning centers, adolescent clubs and garment factories – wherever these youths are. We are also trying to provide improved services in the schools. We are optimistic that he adolescent health condition will improve further in future.

We have been talking about sexual and reproductive health of the adolescents for long. Activities related to sexual and reproductive health started soon after the independence of Bangladesh. At that time, reproductive health basically it was meant for the married adolescents. Child marriage was very common then and many of those youths were married.

Number of the adolescents significantly increased in the ’90s and many of them fell out of the coverage of such health service concerns. Many organisations including the NGOs started working on sexual and reproductive health issues and that led to the development of National Strategy for Adolescent Health on adolescent health. The progress is slow. The benefits we are enjoying of demographic dividend we have now will not sustain for long. If we cannot provide education and health services to the adolescents, they will not be empowered. We have to collaborate with schools, industries and training centers to reach out to them and provide services. This issue has been given importance in the curriculum also.

There are more than 5 million teachers in around 33 thousand secondary schools. Most of them lack adequate knowledge on sexual and reproductive health issues. Thus, they cannot teach these issues well. They receive a 5-day training only which is not enough. Government support is necessary here to improve the scenario.

Development partners have limited their support. NGOs, youth organisations, the government and the civil society should work together.

The Embassy of the Kingdom of the Netherlands has been working seriously on sexual and reproductive health and rights (SRHR) issues since 2011. We also believe that more need to be done in this regard. UNICEF has developed national strategy on this issue with support from the Netherlands Embassy and Directorate General of Health Services. We should comply with this plan.

We have to adopt scalable projects because development partners will stop providing supports at some point. Thus, after few years, nothing significant will be achieved. All issues addressed in the strategy paper must be covered to get expected results.

Mental health of the youths, menstrual health management of young girls and accurate information are of utmost importance. Young girls and boys have to know about their rights and where to go when support is needed. If there is a health service center nearby but they are not aware of it, then it will be of no use. Thus, having correct information is important.

Young girls and boys are available on social media. We can utilise this fact. Talking about sex related issues were a taboo earlier but now the scenario is changing. Many are talking about such issues now. A study showed that 55% young girls said that they were victims of violence by their fellow students; why is this happening? This is because we keep girls and boys separated and do not provide adequate information about themselves. In some cases, curiosity instigates harassment.

Projects should be devised in alignment with the requirement of the youths.

I think we should start from within our homes. Who takes the decisions for the young girls and boys? Education, health or marriage – can the youths decide for themselves in regard to such issues? Parents and other guardians have important roles to play there. Guardians are taking it positively that letting their children know about their sexual and reproductive health issues is necessary. This is an important factor.

There have been good number of studies in Bangladesh on the adolescents. Findings of these studies must be shared with them. They need to actively participate in projects regarding their sexual and reproductive health issues, and nutrition. Our youths are very creative and they want to take their own decision. We have to think about those youths who are unmarried, and those who are physically disabled. We have to ensure bringing them under coverage while working on such issues.

Girls, among the youths, face more challenges in our country. Usually, they do not want to know about their body from their parents and rather rely on their friends. So, it is a big concern whether the friends know accurately about those issues or not. We should also consider formulating a guideline on how parents, teachers and others can talk about such issues to the youths.

I have been working on nutrition issues of the adolescents since 2017. This issue should be given importance. Adolescence is an important phase of life. During this period, families and the whole society should be friendly to them. Families should teach the adolescents members the appropriate use of mobile phones rather forbidding it. Strategy paper should address issues like reproductive health, nutrition, child marriage and dropping out from school. Multifaceted initiatives are necessary to address these issues. Ministry of Women and Children Affairs, Ministry of Education and the media – all need to work together. This young age needs to be given importance for building ‘Smart Bangladesh’.

We are directing our projects since 2018. We are following the National Adolescent Health Strategy and Operational Plan formulated by the Ministry of Health and Family Welfare. The first activity under the strategy paper was on sexual and reproductive health services. We worked on improving the skills of the healthcare providers. We have to take the matter of nutrition for the youths seriously. We did not address this issue in our projects directly but it has been covered in our training manuals.

We are helping out newly married couples by providing information boxes in regard to sexual and reproductive health so that they can take the right decisions. We also provide services before and after pregnancy.

We have worked on mental health with the health department of the government. We tried to make connections with schools and health centers as well as the community and FM radios. We worked for the marginalised people like the transgender and tea-garden workers.

Different measures have been taken for these people. Several public and private organisations are contributing from their ends. I think that they should work with coordination.

The National Adolescent Health Strategy is a 13-year strategy. So, an intermediary evaluation is necessary. I believe, adolescent health issues are being addressed because I personally attended a few discussions on that issue recently. Our strategic investment plan has been improved. UNFPA has been considering appointing reproductive Health Officers at district level. Many organisations are there who are working on adolescent health issues. But coordination among them is necessary.

UNICEF has proposed to hold a conference on adolescent issues at the end of 2023. Many organisations have apps on their websites but there is no continuation of proper services in most of the cases. Young boys and girls are not the same in all cases; rural and urban or English and Bangla medium – factors like these make a big difference. Then, how will we proceed? We have to choose between targeted approach and universal approach.

Operational plan is yet to be finalised. We have to keep working until we have the operational plan. Family Planning Strategy is also incomplete, I believe. I would conclude saying this: we have to accept whatever is complete and we have to achieve what could not be completed yet.

I am involved with training the service providers. Duration of the strategy is 2017 to 2030. Services are being provided for the adolescents through 1253 healthcare centers. When I meet the service providers at those centers and ask them about SRHR, I find that many of them have not even heard of this term.

When asked about the four points of adolescent health issues, they could not answer. Basically, they are not primarily responsible for that. Maybe we, the trainers, are failing to make them understand these issues properly. Another problem is, the same person is being selected for providing healthcare and counseling. There should be an ideal environment where the young girls and boys will be able to talk freely.

21 per cent of our total population are young boys and girls. 10 to 20 per cent of them are suffering from mental health problems. All of them need social counseling. Standard nutrition is also very important for them.

What we want for the youths is that they will be able to live in a beautiful country. They will become honest and ethical citizens. The scenario is not the same in rural, urban and remote areas. We did not have strategy papers before 2017. We used to work on such issues before without proper planning in that time. Now, we are following the National Adolescent Health Strategy. We have to evaluate now and find out where we are lagging behind. And we have to recover it in the next phases. We need to chalk out our plans considering the total number of schools and madrassas. We have to decide whether we will collaborate with colleges or not. We do not know how much it will cost us financially to provide care for all of our youths. We will not be able to make progress if we do not have a financial plan.

The government alone will not be able to provide all the services required. Non-government organisations have to collaborate for this purpose. Children are growing up watching violent cartoons. And this affects their mentality negatively. Parents should intervene here and guide them properly. We are talking about young boys and girls aged between 10 and 19. I believe, we must protect the children. And we have to understand that only providing food is not enough for the children; we also need to provide opportunities for sports and entertainment.

There are locked toilets for teachers and doctors in schools and hospitals but no such facilities for the students or the patients. We tell the children to dream big but seldom tell them to become ideal human beings.

If the children grow up as good human beings, they will be able to fulfill big dreams.

Whatever our profession is, we have to serve all with care.

We have had a great discussion today. All of you have talked sincerely. If we can implement all the things that you have proposed today in our social, family and personal life, it will help us to progress a lot. Maybe we cannot do much but we can hope that our children will grow up as ideal human beings.

Most of the families now-a-days prefer one or two children. Bringing such little number of children up to become good persons is not very difficult. We do not welcome our children among the grown-ups. We do not involve them in the decision-making process. Such strict restrictions are not good as this does not do any good to them. If parents fight in front of their children, they also adopt such behavior and lose respect for their parents. Parents should keep the family environment children-friendly.

Today from all the learned people here we heard that how many efforts are being taken by governmental and non-governmental organisations to aware the next generation about one self and the nation. It is true that the whole world now considering this new generation as future leaders. Initiatives are being taken to facilitate young people to know about themselves, about their nation, culture etc.

Among them knowing about SRHR and Comprehensive Sexuality Education (CSE) is one significant to mention. Breaking the existing prejudices and trying to step forward towards a tolerant society. In tune with the times, we have to let our youths grow up properly through preventing social degradation.

We have to march forward keeping pace with all other countries. We hope that we will be able to achieve our goals soon with support from the government and non-government organisations, and the donor agencies. I thank Prothom Alo on behalf of RHSTEP for their sincere cooperation.

The youths are going to represent Bangladesh in near future. Their reproductive health is a very important issue. We have received a good number of advice and directions from the discussion today. We hope that these will be considered seriously at policy-making levels. I thank you all and express gratitude on behalf of Prothom Alo.

·         Mental health of the adolescents should also be taken seriously along with their sexual and reproductive health.

·         Awareness among the parents is necessary in menstrual health management of teen girls.

·         Ensuring accurate information to the youths regarding their mental, sexual and reproductive health is important.

·         Projects should be planned in accordance with the needs and expectations of the youths.

·         Issues of the youths who are married along with those who are physically challenged should be considered here while providing healthcare services to the adolescents.

·         Young girls and boys need nutritious food, opportunity for sports and healthy entertainment.

·         It is necessary to bring teachers under long-term training programs on mental, sexual and reproductive health issues.

·         Adolescent health issues should be taken seriously in order to build ‘Smart Bangladesh’.

·         It is necessary to build hygienic toilets for the young girls and boys in their educational institutions.

·         Those who are providing health services and counselling to adolescents and youths, need more training.