Every day, our health and our ability to access health services are influenced by gender norms, roles and relations, and other conditions in which we are born, grow, work, live, and age. The wider the disparities between different social groups, the greater the inequities in their ability to obtain health care.
Take adolescents living in Nepal, for example.
If you are a poor, rural Nepalese adolescent girl, you are more likely to have dropped out of school, married, and become a mother before age 18 than your urban counterparts. If you live in a mountainous region, chances are you have to walk up to 4 hours to receive health services. You may not be able to pay when you arrive and you may receive services of lesser quality.
While an adolescent sexual and reproductive health programme, a law banning child marriage before age 20, and legalized abortion may seem like answers to improving the health of the 1 in 4 people who are adolescents in Nepal, it is not that simple.
The country already has each of these measures in place. However, none of them fully addresses the inequities adolescents face.
“When we first developed the National Adolescent Sexual and Reproductive Health Programme it was a blanket approach,” said Ghanashyam Pokherel from the Family Health Division, Nepal Ministry of Health. “We realized to further improve adolescent health we needed to understand the gaps in our services and the differences between adolescents.”
The challenge of reaching every adolescent
In 2015, the Nepal Ministry of Health worked with the World Health Organization (WHO) to redesign the country’s Adolescent Sexual and Reproductive Health Programme. Utilizing the Innov8 Approach – an 8-step review process geared towards helping health programmes better address equity, gender, human rights and social determinants of health – a 15-person review team worked to uncover the gaps. The team comprised representatives from national and subnational authorities, bilateral partners, NGOs and civil society, and research institutes.
“Our aim was to identify the adolescent subpopulations being missed, strengthen the programme’s ability to reduce inequities, and improve the overall health of adolescents,” says Dr Jos Vandelaer, WHO Representative to Nepal.
Nepal’s original adolescent sexual and reproductive health programme did not account for specific barriers experienced by different subpopulations such as distance and cost of travel, inability to come during opening hours, lack of privacy and confidentiality, adverse gender norms, among other factors.
To help tackle these barriers identified by the Innov8 review team and ensure no adolescent is left behind, the Nepal Ministry of Health is now working to expand adolescent-friendly services to hard-to-reach groups. Measures include an increased focus on outreach services (in particular in disadvantaged areas) and enhanced community engagement.
Other steps are the integration of Adolescent Sexual and Reproductive Health into other services, alongside capacity building of health workers on adolescent-friendly and gender-responsive services, and ensuring that adolescent representatives participate in local decision-making processes on health.
The programme will also further engage other government departments, such as education, to tackle the causes of early marriage and pregnancy, and address the stigma associated with adolescent reproductive health.
“Adolescents are the future of our country,” said Pokherel. “Without them our country will not be socially or economically sound in the future. We are integrating what we learned from the Innov8 review into the new National Adolescent Health and Development Strategy, which will be an umbrella for all programmes.”
Addressing global inequities and promoting a human-rights based approach to health
Around the world, national health programmes are striving to meet the 2030 Sustainable Development Agenda and the targets set out in the Global Strategy for Women’s, Children’s and Adolescents’ Health, which are rooted in making sure no one is left behind.
To help countries with adolescent health planning, WHO is also developing the Global Accelerated Action for the Health of Adolescents (AA-HA!) Implementation Guidance document, which features Innov8 as one of the resources for programming. In the past year, WHO presented its new approaches to nine other countries in the South-East Asia Region working to improve adolescent health. The Innov8 approach can be used to eliminate inequities in any health programme. As of mid-2016, the approach has been piloted in the Americas, Eastern Mediterranean, Europe and South East Asia on health programmes ranging from communicable diseases to environmental health.