Photo: Priyanka Parashar/Mint
Photo: Priyanka Parashar/Mint

Adolescent girls as agents of change in communities

Empowered with knowledge and training, young girls can reinforce health vital messages

Two years ago, in a remote Rajasthan village, I attended a women’s meeting to understand how they thought about health issues. We found misconceptions and gaps in their understanding, and it was difficult to have a focused discussion.

Tinkle, 15, was keenly observing the chaotic proceedings and approached us at the end. “The women will go home and forget what you said, you need to keep giving them the right messages," she said confidently.

Despite the conservativeness of communities in many such villages, we found that there are girls like Tinkle brimming with energy, passion and huge aspirations. The incident sparked the idea for what is now our fledgling adolescent girls’ initiative.

Large public health programmes often focus on fixing components on the supply side such as quality of healthcare, access to facilities and adequacy of manpower. These are undeniably important. However, from a health perspective, creating an active, aware and empowered community is equally significant. Examples of the community’s crucial role go way back to India’s smallpox eradication programme in the early 1970s. Throngs of community volunteers mobilized citizens and educated them. The people in turn came out in large numbers to report smallpox cases and that proved instrumental in its rapid eradication. Community involvement has been a vital factor in the national polio eradication programme and in Avahan, the Gates Foundation’s India HIV-prevention initiative.

Health-seeking behaviour is a function of awareness and adherence to methods prescribed to deal with the health condition. Consider the fact that more than half the pregnant women in rural India are anaemic. Anaemia during pregnancy drastically increases the chances of low birth-weight newborns, leading to compromised immunity of the babies. Broad awareness about the issue of anaemia is largely assured through the efforts of front-line health workers. Despite this, only 26% of pregnant women adhere to the simple protocol of consuming iron and folic acid (IFA) tablets for the required 100 or more days.

Empowered with basic knowledge and training, adolescent girls like Tinkle reinforce simple, but vital messages in their immediate neighbourhoods. They act like a younger sister to the pregnant or lactating mother, ensuring she takes the required medications such as IFA tablets. The girls ensure adherence by continuously emphasizing its importance, becoming both guide and friend to the community. They also become essential links between front-line health workers and beneficiaries. Layers of community, starting from ultimate consumers to adolescent girls living among them, and leading up to community health workers, together become a powerful force.

There are many good programmes in India that educate and empower adolescents. The government’s Rashtriya Kishor Swasthya Karyakram has innovative elements such as peer educators, dedicated adolescent health days and initiatives to tackle anaemia among adolescents.

However, hardly any programme taps into adolescent girls as agents to empower the larger community. Our experiments in Rajasthan in creating the adolescent girls-community link have been encouraging. We are finding groups of highly motivated and altruistic girls. The task demands minimal effort from girls, they learn themselves and feel a sense of pride. The community is welcoming and values advice from their young health guides.

We are hearing heartening stories from the field. Earlier this year, Radha, a grade 11 student from village Danta, Rajasthan, visited a woman in an advanced stage of pregnancy and noticed her lifting a heavy weight. When Radha cautioned her, the woman retorted saying her mother-in-law dictated terms. Radha determinedly approached the village auxiliary nurse midwife and together they counselled the woman and her mother-in-law. Radha eagerly keeps a tab on the newborn’s health now.

The scalability of this innovation remains a challenge. The school system is the most conducive means of facilitation. But the school curriculum is usually crowded and teachers are overburdened. Front-line workers, who are essential stakeholders, have little time to spare. Without constant motivation from these influencers, sustaining the interest of girls is difficult. Despite teething problems, there is no question about the huge scope to channel the power of adolescent girls, even beyond maternal and child health. As we continue evolving our design, we welcome more ideas.

Ashok Alexander is founder-director of Antara Foundation. His Twitter handle is @alexander_ashok.

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