Work Instruction for

Adolescent Health Care Services

Document No: AH/ HWC

Date of Issue:

HSCI...J..

Version/lssue No: 01

Effective Date:

Work Instruction

For

Adolescent Health Care Services

in

Page 1 of 26
Officer
Community Health
ieDabli HWC
Momoi BPHC, Goalpara
 Health and Wellness center

.Dabli

The signatures below certify that this procedure has been reviewed and approved, and

demonstrate that the signatories are aware of all the requirements contained herein and are

committed to ensuring their provision.

Name Position Signature

Sotina Yasmi
Page 2 of 26
Community Health Oficer
ile Dabli HWC
Mornoi BPHC, Co lnnra
Prepared By

Approved By

Amendment Note:

Page No.
Context
Revision Date

Note: Prior to use, ensure this document is the most recent issued

This procedure is reviewed to ensure its continuing relevance to the systems and process that it

describes. A record of contextual additions or omissions is given below:

Sabine yasmin

Page 3 of 26 Community Health Oficer

VeDabliHWC
Mornoi BPHC, Goalpara
S.No.
Content
Purpose, Scope,

2 Service Delivery
Frame Work

3 Role & Responsibility

4 Common Condition & Their Management

5 Activities to be undertaken

6 Referral and follow up

7 References

8 Annexures

I1.Purpose:
range of services to adolescents
a. To develop a system for the provisioning of mandated

(10-19age group)to cater to their health needs through

HWC while ensuring the quality

of services.
heain risks adoiescents, inciuding
comprenensive appr oach toprevent
for
b. lt inciudes a
and referral facilities
while curative services
prophylactic services as well as counselling

are also made available to them.

the catchment area of
(those aged between l0-|9 years) in

Scope: It covers adolescents

I.2.

the HWC

1.3. Responsibility:
CHO,ANM and other staff

Delivery Sabin Yas en

2.Platforms for Service
Community Health Oficer
Page 4of 26 i/e Dabli HWC
Momoi BPHC, Goalpra
 through
HWC
2.1. Service Delivery Framework for Adolescent Health Services
sites
Care atreferral
Care atCommunity level Care atSHC, AB-HWC for medical
health Screening treatment,
Counselling on: Adolescent and
disorders
Improving nutrition. counselling if required
of with referral
Sexual and reproductive Detection of cases of growth
referral
Management
health. substance abuse, and
abnormality
Enhancing mental health. and follow up with referral
disabilities,

Promoting Detection and Treatment

supportive
(nutritional
as required
attitudes for preventing of Anaemia including
and • Management
and
injuries and violence. and non-nutritional)
rehabilitation
in

Preventing substance abuse. other deficiencies services in

cOunselling
. Promote healthy lifestyle.
adolescents
and referral for
cases of substance
abuse
at
Personal hygiene Oral • Detection
Counselling
and Friendly
growth abnormality
Hygiene as Adolescent
& Menstrual hygiene. disabilities,
with referral (AFHC)
Health Clinics
Peer counselling. required

Identification and

management of anemia, with

referral if needed.
Provision of IFA tablets

and
(prophylactic

therapeutic) under Anemia

Mukt Bharat.

Bi-annual Deworming under

National Deworming Day.

|
2.2. Servicedelivery

based approach
framework for
RKSK

Community based approach

School based approach
of school
Facility
Weekly Iron Folic Acid• Strengthening
Friendly Health (School
•Adolescent health activities
(WIFS)
Supplementation
(AFHCs) providing Programme)
Clinics
National Deworming Day Health

clinical
and counselling
(NDD)
services
Satina Yasm
Page 5of 26 Community Health Officer
 of adolescents
Adolescent Health Provision of sanitary • Screening
Resource Centre at District napkins (MHS) for 4 Ds (RBSK)
Day
Hospital National
Deworming
•Peer Education Programme

(PE) (NDD)
of sanitary
Adolescent Provision
Quarterly
napkins (MHS)
Health Days (AHD)
Education Programme
ClubsPeer
*AdolescentFriendly
(PE)
(AFCs)

(MHS)
2.3. Service deliveryframework for Menstrua Hygiene Scheme
PHC (PHC
At Community Level At SHC-HWC level At level

account officer)
(ASHAI SHGs) (CHOsIANMS) MO/Block
Ensures that
ASHA training
•Maintain tracking register Training of the ASHA on •

hygiene takes
of adolescent girls menstrual hygiene booklet on menstrual

• Mobilise adolescent girls, and conduct periodicplace

storage of
conduct monthly meetings refreshers
• Ensure safe

and Monitor monthly sanitary napkins

provide health• the checks
Conduct spot
education meetings periodically
field visits
sanitary during regular
•Conduct women's group • Transport the
Maintain inventory,
stock from block
meetings napkin
and accounts
Ensure regular refill and PHC to SHC-HWC tracking

and register
supply of sanitary napkins to • Ensure safe storage

from the SHC- proper distribution of the

the village

HWC sanitary napkin

Supply requisite number

of
Distribute/sell sanitary

napkin packs to
and maintain sanitary
napkins
ASHA in her SHC-HWC
accounts
and area
Track supplies

for Provide transportation

estimate requirement
costs to ASHA
the following month
Conduct spot checks
• Submit progress report on
regular field and
during
key indicators
VHSND visits

• Review and validate ASHA

tracking system
and

accounts register

Sabin Yasmmin

Community Health Oficer

Page 6 of 26 ile Dabli HWC

Momoi BPHC,Goalpara
 Maintain
inventory.
tracking and accounts

register (Annexure 6)

Gabina Yesmen

Community Health Officer

Page 7 of 26
i/e Dabli HWC
 3. Role and Responsibilities of Staff
S.N. Staff Role and responsibilities

ASHA with
Enrol all adolescents (Girls & boys)
in consultation
Facilitation of selection of Saathiya (peer educator)
VHSNC lead in
and takes the
ASHA acts as the village level Saathiya cOordinator at the
out smoothly
ensuring that the peer education activities are carried

village level with

the
by adolescents
Ensure distribution of IFAtablets
& consumption

supportof AWW Anaemia

will be

with moderate/severe
Ensure referral of adolescent girls

referred to a nearby HWCs at HWVCs

tested for
Anaemia
• ASHA will encourage adolescents to be
Ensure distribution of sanitary napkins.
needs &
about adolescents
create awareness amnong adolescent girls

issues
to thereferral appointment.
• If possible, accompany the adolescent
of AHP successfully.
Support AWW & Teachers in implementation
such as AHD/kishori
2 MPW/ to run outreach programs smoothly
Ensure
session/
ANM diwas/School health programs/Peereducators'
& Teachers to identify

Capacity building of ASHA,AWW,peer educators

of
of comparing the color
adolescents through the simple method
anemic presence
those of adolescents for the
their own nail beds and tongue with

of pallor
for anaemia,BMI, NCD, mental health
Ensure screening of adolescents

probierms eLc.

as per the requirements

Ensure supplyof IFAto school
and Health Education on
MPW will undertake quarterly Nutrition
VHSND and Kishori Diwas

& bi annual de worming

Ensure IFA supplementation

Ensuring monthly reporting

quarterly visit to school

Ensuring
in adolescenthealth programs & campaign.
• Engage local sportclub, leaders
Referring Adolescents to HWCfor clinical management.

Sauine Yasmin
Page 8 of 26 Comunity Health Oficer
ie Dablii
 3 CHO .Clinical
management of RTI/STI, menorrhagia etc.
Tracking health
& follow for various
up of
adolescents (10-19 years)
services

Referring adolescents
timely to the higher centel
CHOs should leverage this
visit at leasttwo VHSNDs in a month and can
opportunity to provide adolescent health services.
• Detection of referring
them to
substance abuse, Mental health issues &

appropriate higher center

Counselling on various health issues of adolescents like substance abuse,

mental health,sexual of linking them

and reproductive health etc. as part

to RKSK, School Health Program (mentioned details above)

Facilitating Adolescent Health Club meeting

Adolescent
Ensuring adequate supply of essentially required to provide

services

along with MPWIASHA to schools or On

dUPporCIve supervision visits

VHND

4. Common Conditions and their management:

4.1. Key Health Problems of Adolescents

Sexual and ReproductiveHealth Other Issues

Teenage pregnancy Injuries from accidents/near-drowning

violence
• Risk tomother Intentional

• Risk to baby Mental health problems

Substance abuse such as tobacco, alcohol

• Health problems during pregnancy and

etc.
childbirth

Unsafe abortions • Malnutrition & micronutrients deficiency

tract infections, sexually

Worm infestations
Reproductive
transmitted infections & HIV Other infectious diseases

problems (scanty, irregular,

• Menstrual

painful, excessive)

Vaginal discharge

Management at HWC-HSC
level

4.2. Health Problems to an

the adolescent pregnant girl (married/unmarried)
• Refer
Teenage pregnancY where gynaecologist is available (irrespective
FRU/higher facility

Sabin Yasmn
Page 9of 26 Comnunity Health Officer
ie Dabli HWC
Momoi BPHC,Goalpara
 or wants
of whether she wants to continue with the pregnancy
an abortion).
birth
diet
and
Counselling on intake of balanced, nutritious
early pregnancy,
preparedness,breastfeeding. complications
of

Use of contraceptive methods in future.

•Follow-up care. the

of
• CHO should also try to counsel the parents/caregivers

teenage girls to avert early marriages.

MPVW ofthe
SHC-HWC
CHO should support the ASHA and and
Abortions risks
Unsafe regarding
to increase awarenessin the community unsafe
and
childbirth,
consequences of adolescent pregnancy,

abortions.
confidential
Provide e easily available,friendly,tnon-judgemental,

family planning, counselling,

and services.

signs and symptoms of abortion complications

Recognition of
clots, pallor
with or without
(heavy bright red vaginal bleeding

etc).
services.
site for safe abortion
Refer to appropriate referral
PHC-
refer to
abortion up to 7 weeks
For medical method of

8 weeks to 20 weeks.
is
MO andto CHC/DH if
pregnancy
medical practitioners,
approval of two
registered
With 20 to 24
can be done between
termination of pregnancies
up to 24 weeks will
of pregnancies
weeks. The termination
of women, as may be
apply to specific categories
only
guidelines.
prescribed by the government to
complications
and refer
post abortion
Follow up for any
if needed.
higherfacility
counselling.
abortion contraceptive
Provide post

on Ki/SI|among adolescentS
Create awareness to prevent
Tis and STIs the following topics
CHO should counsel on

RTI/STIs:
proper
hygiene. Maintaining
Maintaining proper genital

menstrual hygiene
sexual behaviour
Practicing responsible intercourse
Practicing safe
sex -using condom during STI
if either of the partnerhas an
Avoiding sexual contact
discharge
Unusualgenital and sexual partner
treatmentof self
Ensuring complete
delivery
Opting for institutional Sabin yasmin
26
Page 10 of Community Health Oficer
ile Dabli
 Availingsafe
abortion
services

Provide
counselling to
Virus adolescentson:
Practicing safe
Hman sex.
nodehCiency
Immuno- Avoid use of
unsterilised
HJAcquiredSyndrome
needles and other injecting
equipment.
oficiencyAdolescents Injectable
in Drug Users
AIDS) needles (Needle
(DUs) must
share syringes not Or

exchange
Avoid unsafe programme).
blood
transfusion.
Pregnant women
should have
access to ICTC (Integrated
Counselling and Testing
Centres).

Health: including Assess an

adolescent's mental health by:
Mental
and substance What the adolescentsays about their thoughts and feelings.
iyurriees
What the
abuse adolescentssay they do (self-reported behaviour).
Observing how the adolescent looks
(personal care) and
Sounds (toneof voice) -self-care
behaviour.
What others (e.g., parents, teachers, other adults, siblings,

peers)say the adoles cent does or says about his or her

thoughtsand feelings, if possible.
Observing the adolescent's interaction with other people
and behaviour.
• Medical records.

Use of HEADS framework'to obtain an adolescent's

psychosocial history

Prevention of Injury:

Counselling of adolescents about safe driving, promoting

nurturing relationships between parents and children early in

life, and reducing access to alcohol can help to prevent

injuries and deaths due to violence.

SubstanceAbuse:
harmful effects of
Counselling of adolescents regarding
Health Days and
substance misuse during Adolescent

VHSNDs at SHC-HWC.
open with
Counselling of parents to keep communication
and monitor
their children, try to
be a positive role model
closely.
children's activities
in adolescents
Nutrition Assessmentand Counselling
Non-Communicable part of evaluation
of an
is an important
(NCDs) Nutritional assessment
Diseases should be adopted.
A stepwise approach
adolescent.
Sabin yasn

26 Community Health Oficer

Page 11 of ilc Dabli HWC
MormoiBPHC,Goalpara
 Step I:
History-
Step 2: Nutritional
history in
Physical adolescence
Step 3: Examination
LaboratoryTest
Step 4:
Nutritional
Counselling
Counselling:

Consumptionof
healthy, Avoid
frequentconsumption
nutritious, and balanced diet.
of
Avoid consumption junk/unhealthy food.
of alcohol,
tobacco, and
Regular drugs.
physical actiity
is required for good
maintaining
metabolism so that the
and
food ingested is properly assimilated
utilised to
have a healthy
is also body. Regular physical activity
important forreducing
stress. Other activities like
yoga sessions etc.
also aid in
maintaining hormonal balance,
improvingflexibility of body,and reducing
mental stress.
Yoga Sessions:

Organise yoga sessions at HWC-SHC.

Support peer educator to discuss about nutrition and
nutritional requirement during adolescent friendly club
meeting.
Aware members of VHSNC on adolescent nutrition and
promote discussion on adolescent nutrition during VHSNC
meeting
Management of Nutritional anaemia
Prophylactic

Sabina Yas mu
Page 12 of 26 Community Health Oficer
ilcDabli HWC
Mornoi BPHC,
Goalpara
 Interverntion/dose
Regime
60 ma of elemental iron Service
and 500 Weekly, delivery
Ai mcg of folic
one IFA
(FA tablet For
school through
acid going boys and girls

entation teachers in the school

For out of school adolescent girls through
AWW in AWC.
A00 mg of Albendazole
Biannual Mobilisation by ASHA
(onetablet)
Under National
Day (10th February
and Deworming
10th
August):
*For school going children through teachers
in the school
For out of school adolescents through AWW
Mobilisation of out-of-school children by
of nutritional ASHA to the Anganwadi
anemia (Mild, centres
cmaanagement Moderate and
apeutk Anemia (Girls: Hb 11.9-7 Severe)
gm/dl; Boys
Moderate 12.9-9 gm/e
dand TNo IFA
tablets (each
with 60 mg
oftreatment months, orally after meals elemental iron and 500
vel mcg folic daily for 3
o ofcare) acid), once

alleves Line listing all

moderate anemic
designated area. cases to be
maintained by the ANM/LHV/MPWof the
Follow-upby
ANMMLHV/MPVW of designated
Encourage parents to area, as feasible
ensure follow-up for the State
nearest
Sub-HealthCentre/ adolescents after 60 days and -90 days at the
If the Health and Wellness
haemoglobin levels have Centre
continue with the improved to normal,
discontinue the treatmenl
prophylactic IFA dose

no improvement after three

If

nD improvement
level
of CHO/ANM of the nearest HWCmonths
to refer
of treatment (ie.. stillin
mild/moderate categ
hrst adolescents to oryl
terthe the First Referral Unit
Hospital (FRU)/District
tment
(Girls: Hb<7 gm/dl; Boys: Hb<9 gm/dl)
Anemia
Svere
severe anemia inadolescents is to be done
Management by the medical officer at the FRU/DH based on
estigation and subsequent diagnosis.

Blood Count
(CBC)should be done to ascertain
Complete the cause of anemia (nutritional andi non-nutritional).
is contraindicated din severe
inn supplementation anemia for patients with thalassemia
major and sickle cell disease.

e CHO in Prevention of Anemia

O should counsel adolescentand community on:
nnke of iron. rich food like green leafy vegetables, whole grains,meat,fish, jaggery, nuts
etd

Tannins in tea and caffeine in coffee and calcium supplementsshould be avoided with or
inmediately before or after meals as they reduce iron absorption.

Adding vitamin C rich foods (such as amla, lemon, tomato,guava etc) to regular diet can
inprove the absorption of iron.

Kcess to schemes of food supplementation(under ICDS scheme).

asire and encourage intake of weekly lFA supplementsby the adolescents seeking care
orany
ailments.

Ung awareness on adolescent's health nutrition issues through various platforms

le
VHND, convergent
meeting, village functions etc.

Sabin Yasm
Page 13 of 26 Community Hcalth Oficer
ilc Dabli
HWC
Mornoi BPHC.
 a Aiscussion or sesSion on
anemia in and
having adolescentsin VHSNC meeting
Ersure
meeetings.
village
anemic adolescents to
the linked
severely
PHCICHCIDH forfurther manageme
Review follow up of cases by
ASHAand ANM.
reatment for
ynd
haemoglobinopathies, sensitisation of
endemic the population on screening
pareas through CBC and
complianceto be
monitor treatment
arhaemoglobinopathies
byANM
Ansured cases of
theidentiied
haemoglobinopathies to higher centres for further
and rreatmentin areas endemic for malaria, with the
help of ASHA and
onfirmation
every household in the illage is
ensure provided with LLIN.
ANY
in your catchment area to supervise theIFA supplementation.
Vstschools
vailability IFA, Supply chain, adverse
of
the events reporting for the catchment
,Oersee
sharing about the gaps found, any, with MO of
if

and concerned PHC.

araz
with
AWW and provide her the details of unserved or underserved out of

Coordinate as well as the vulnerable AH group of out-

beneficiaries
to enhance the coverage
shool
girls.
l adolescent
ofschool

from worm infestations and promotion of sanitary practices.

Prevention

RSK Program

Friendly
• Sensitise adolescentsand the community on adolescenthealth
dlscent

(AFHCs) needs, common problems in adolescence and the services

th Clinics
available under RKSK with the help of primarycare team.
• Screening of adolescentclients and provide basic adolescent
health information and services.

• Ask ASHA to mobilise the adolescents to SHC-HWC once in

a month so that you can inform the adolescents regarding

Common health issues in adolescenceperiod and measures to

manage and prevent them.

•Refer the adolescents to the AFHCs in case they need clinical

and counselling/services by counsellor and do the follow-up

selection of peer educators by ASHA and

Education Ensure timely

ramme VHSNC.
• Supervise the selection of the peer educatorat the village level

entire process.
and help the ASHAs in the
out
• Ensure that Peer Educational (PE) sessions are
carried

level
smoothly at village monthly
one PE session during
• You should attend at least

understand and resolve any issues

meeting with ASHAs to

Sabin Yasme

26 Community Health
Page 14 of Officer
ieDDoh:
 raised by
ASHAs/Peer and
feedback. Educators and provide inputs

•Collect and
consolidate Peer Educator which
is monthly report
collected by ASHAs
• Monitor the
monthly
at Adolescent Friendly Club (AFC) meetings
SHC-HWClappropriate location convenient for peer
educators. The AFC
meeting should be moderated by
CHO/ANM withthe aim of

the skills of Peer Supporting and further developing

Educators.
Days • Support
Health conducting the quarterly Adolescent Day with
Health
the help the
oescent of
ANMs and involve the various stakeholders
adolescenthealth.

•Generate awareness in community regarding services provided

during AHD well in
advance.
•Ensure that the AHD is held: make alternative arrangemens m
case some of the service
providers are not available
•Ensure supplies of the commodities (IFA, Albendazole, sanitary
napkins and contraceptives) reach thesite before the AHD.
• Ensure that all instruments. drugs. and other materials are in

place.

Ensure that ANM should carry communication material

including pamphlets.
• The ASHA would maintain a monthly record of sanitary napkin
estrual
Hygiene
packs sold to adolescent girls and keep accounts of funds
(MHS)
heme
recovered. The register and accountswould be co-signed by a

designated female member of the VHSNC.

• The CHOIANM and the VHSNC will do the monitoring at

the village level to ensure proper access to all adolescent girls.

• CHO in coordination with ASHA will oversee that adequate

supply of sanitary napkins is available with her and the

targeted population is covered every month.

•CHO should attend at least one monthly meeting per quarter.

She/he will pay the ASHA the incentive for holding the

of the report.
meeting only after the verification

need-based sessions depending on

ool based
adolescent • CHOs can conduct as many
the number of students in the
ice (Health
and the number of schoolsand
anes to thesame schoolcan also be
Ambassador schools. Multiple visits

But once a week he/she must

visit
tive)
conducted if required.
area. CHOs can conduct sessions
schools of their catchment
Sabi na Yasmi
Community Health Oficer
26 HWC
Page 15 of i/e Dabli
Mornoi BPHC,
Goalpara
 on
identified
adolescent health
prevalent issues themes focusing on locally
. This
platform
if
requested by the school
can also be
principal.

appropriatefacility.
utilised for referral of cases to the
.The trained
HWA (teacher)
and school for will act salink
as between HWC
all AH
• CHOs will
activities.
also be
trained to
children provide support to school-going
on mental
health and
• CHOIMO sexualand reproductive issues.
partnering with the
school can ensure that
wellness principal
activities are being
basis. conducted at school on a weekly

•If need be, HWA can refer the children to the CHOs who if
required can refer the
children to the
AFHCs and DEICS.
.CommonBlock review meeting shouldbe held whereboth the
MOICHO and principal from the schoolunder the
may AB-HVWA
participate.
• CHO can support
the question box replies in the schoo
visited.

• CHO should inform the schoolabout the

services available ror
adolescentsat HWC.

immunization Under Universal ImmunizationProgram (UIP),

descent adolescents aged
TO years and l6 years are to be vaccinated with
Tetanus and
adult Diphtheria (Td) vaccine as per national immunization
schedule using the below strategy:
Convergence with Rashtriya Bal Swasthya Karyakram (RBSK)
programme to improve Tdl0 and Tdl6 coverage mainly at
schools.

Using VHSNDs and UHSNDs to provide Tdl0 and Tdl6

vaccination for out of school children.

Organize Td immunizationweek (s) to improve Tdl0 and

Tdl6 coverage.

School-goingadolescents of class 5 and class 10 can be

vaccinated using platforms like School Health program (SHP),
RBSK as well as by carrying out Td adolescent immunization
week once every year. Out of school adolescents can be
vaccinated by strengthening the existing routine immunization

platforms under VHSND.

Sabin smin
eral and continuity of
care
Comnunity Health COffcar
icDabli HWC
Page 16 of 26 Momai BiPAC,
Goalpara
 under
conditions adolescenthealth
services
referral
ol
st
Referral
Condition
to Severe Anaemia
Moderate
HWC-PHC/UPHC
ldisabilities
Abnormalities SDH/DH
Growth

fdrug/substance abuse (DH/SDH)

Case
of De addiction center

PHC/UPHC-HWC
PMS/Menorrhagia
Issues
Mental
Health A-HRC (District)

of RTIUSTI HWC-SHC/UPHC/PHC
Management

or late appearance of
secondary sexual|SDH/DH
Early

character

Unsafe abortion
CEmONCfacility/SDH/DH

factors
(BP, BMI, Random blood sugar, PHC/UPHC-HWC
Risk
9
family history of NCD etc.)
of physical violence and sexual CHCISDH/DH
10Management
abuse

Falow-Up
of the
Primary Health Care is the assurance
e the key components of Comprehensive
instance also, care must be ensured
tznism 'Continuum of Care'. In every adolescent's
when
different levels of health care
facilities

m level of the familyl community through the

quality services, continuity
e referred. To maintain the trust of adolescentsand to provide

ices one of the primary focuses.

should be
ensure that the
Gammunity/Household:The
ASHAWould undertake home visits to
and
for risk-factor modification, provide counselling and support
oescent is taking actions
medications if
at AB-HWC and for collection of
Sereminders forfollow up appointments
the community whenever the
visit and counsel parents and
Red. The CHO should also
among the
is perceived. The service providers should also spread awareness
Friendly Health Services
under the RKSK
cents and community
regarding Adolescent
programmes
health clinics and the school-based
mme, psychological support services,
Rder
RBSK. Sabin asm
Comnunity Health Oficer
i/c Dabli HWC
26
Page 17of Mornoi BPHC,Goalpara
 dispensation of medicines, repeat
n AB-HWC of
investigations/diagnostiS
complications and facilitating referrals to a higher-levet
dentification with a
tion specialist asrequired needs proper
to be underrtaken with
Adolescents is
should be referred to AFC if the need
pteleconsultao record for counselling
nce

The medical officer or specialists at the the adolescents

higher facilities
Facility
levrel develop/modify the treatment plan,
to would including instructions for the

as well
as anote to the HWCprovider, indicating the need for change.

on Adolescent Health Care Services for Community Health Officer at

Manual
Bharat
-Health and Wellness Centres

shnan
of RKSKNHSRC and MoHFW
by
for implementation
eelines I guidelines by NHSRC and MoHFW
Soperational and Wellness day guidance by NHSRC and MoHFW
Healch

nexure

Information that can be obtained from a HEADS Assessment

Where they live,
with whom they live
their home situation
there have been recent changes
in
Whether
perceive their home situation
How do they
Whether they studylwork.
aonlEmployment

Sabin Yasmi
Page 18 of 26
Community lHealth Oficer
ie Dabli HWC
Mornoi BPHC,
Goalpara
 Howthey
perceive.
how they are
How do they doing.
perceive their
fellow
students/ relationship with their teachers and
employers and
Whether
there colleagues!
What they do have been any recent changes in their situation.
during their
How many meals breaks.
they have
What they eat at on a normal
each meal day!
What they think
and feel
What abouttheir
activities bodies
they are
What they involved in outside
dointheir study/ work
free time -
Whether they during weekdays and on holidays
spend some time
Whether they use with family membersand friends.
tobacco, alcohol, or
they inject other substances Whether
any
substances Ifthey how much do
they use; use any substances,

when, where and

with whom do
they use them
Their knowledge
aboutsexXual and
Theirknowledge reproductive healtn.
abouttheir
menstrual periods.
Any questions and concerns
that they bave about their
periods. menstrual

Their thoughts
and feelings about Whether they are
sexuality
sexually active; if so, the
nature and context of
their sexual activity
Whether they are
taking steps to avoid sexual and
reproductive
health problems.

Whether they have in fact encountered such problems (unwanted

pregnancy, infection, sexual coercion)
If so, whether they have received any
treatment for this Their
sexual orientation

Whether they feel safe at home, inthe community, in their place

of study or work; on the road (as drivers and as pedestrians) etc.
If they feel unsafe, what makes them feel so
ression
Whether their sleep is adequate.
Whether they feel unduly tired

Whether they eat well.

How they feel emotionally.

Whether they have had any mental health problems (especially

depression).

• If so, whether they have received any treatment for this Whether
they have had suicidal thoughts Whether they have attempted
suicide.

Sauina Yasmi

Comnunity IHealthOfficer
ile DabliIO
Mor para
Page 19 of 26
 2
Annexure
approach for counselling
GATHER
The
the Put them at ease, show respect and trust

G- Greet of the discussion

Emphasize the confidencenature
adolescents

can I • Ask how can help you!

how I
help
I

worries
A-Ask their anxieties,
to bring out
O Encourage them help
their access
to support and
you? and needs,determine
in their family and community.
taken to deal

• Find out what steps

they have already

with the situation. in

his/her feelings
person to express
Encourage the
their own words. and do
to what they say
respect and tolerance
Show
not pass judgemen.t you are paying
attention
and show that
• Activelylisten

language.
through your body
questions.
with helpful
Encourage them
in reply to
and specific information
Provide accurate
T-Tell them any relevant
need
their questions.
can do to remain
information they on what they
Give information they need
information
any background
healthy. Explain health issue.
particular
to know about the points and
simple, repeat important
Keep the language points are
if the important
to check
ask questions
understood
in the form
of a leaflet if

information
Provide important
they can take away.
possible that

make Explore various alternatives. of, Be

H-Help them to
may not have thought
they
Raise issues which
views, values
and
decisions
careful of not letting your own
influence the adviceyou give.
prejudices
their own decision and not the one
Ensure that it is

you have imposed.

a plan of action.
• Help them make

on
Ask questions to check their understanding
E- Explain any
important points.
misunderstandings
Sabim Yasme
Page 20of 26 Conunity Health Oficer
icDabli HWC
Mornoi BPHC,Gonlnra
 Ask the clients to repeat the key points in their own
words.

Return
for follow-up O Make arrangements for a follow-up visit or referral to

other agencies.
orReferral name of
lfafollow-up visit is not necessary, give the
any need in future.
Someone they can contact for

Annexure
3

Sabina smen
Health Oficer
21 of 26 Comunity
Page
i/e Dabli HWC
Gonlnara
MornoiBPHC,
 Monthly Report
rEducator
Feer

Peer Educator Monthly Reporting Form

Month/ Year:
Name of Peer Educator:

Phone:

Parent name and address:

Village name:

Block:

District:

monthlymeeting attended (Yes/No)

Adolescent Friendly Club

Number of adolescents enrolled:

thismonth:
Number of Peer Education Sessions conducted

in each session:
Average attendance

ofadolescents that attended

Please specify dates and times ofPeer Number session
peer education
Education sessions

2
3

Number of adolescents reterred to AfHC:

conducted e.g. Adolescent Health Day dates and times:

Please list any other activities

Sabin sme
Health Officer
Community
Page 22 of 26 /e Dabli HWC
 4
Annexure
Hygiene Scheme (for sale to
Menstrual beneficiaries)

4.A
Annexure

CHA tracking Register for Adolescent

girls-month-wise reporting

Name of Number of Month Month 2

ASHA adolescent
No of packs No of AGs No of packs
No of AGs
girls
of napkins of napkins attending
attending
sold sold meeting
meeting

Annexure4.B

ASHA Monthly Reporting Format

Name of ASHA

2 Name of Village

3 No of napkin packs at the month beginning

4 No of napkin packs at the month end

5 Transportation cost (if any)

6 Storage cost (if any)

Annexure4.C

Monthly monitoring format/Register for Sub-Centre

Incentive paid to
Amount
me of Name No of Sanitary napkins packs
ASHA recouped
age of Adolescent
to HSC
ASHA Girls

No Balance For sale of For

No
received sold napkin monthly

from packs meeting

Block

Sabinu Yeus

Community Health Oficer

Page 23of 26 iVc Dabli HWC
Annexure-5

Enrmat for Basic Data Collection during AHD

B. Coverage Format for

BasicData Collection during AHD
A Basiknformaton
Date of AHD
Name of the village
Venue:
Block: Date:
Name of the servlce providers who attended the AHD

Name ofthe heath providers who attended the AHD

(MOIn charge)
(ANM)
(Block Adolescent Health Coordinator/ Counsellor)

Other organizers

(ASHA)

(AVW]
(PE male)

(PE emalej

AHD attended by: (Parents/ Teachers/ PRis/ NGOs/Others

E.Coverage

1. iota viiage opuiatior:

In the village and attendance In the AHD:
2.Total Adolescentpopulation
3. Total number of parents who atteded the AHD:

Attendance at AHD
Total Population

Girls (Unmarried)

Boys (Unmarrled)
Marrled Adolescents (Women)

Married Adolescents (Men)

Total Numbers of Adolescents

Sabina Yasmn
Comnunity Health Officer
24 of 26
Page ilc Dabli HWC
Mornoi BPHC, Gealpara
 C. Services
Unmarrled
Married
Parents Other Total

Female Stakeholders
Male Female Male
10 75 10 15 10
-1419 15 10
Ys
-14
1914 19 14 19
Yrs Yrs Yrs Yrs Ys

L.BMI Sceening

2.Anemie Testing

3. No. of adolescent peovide

A tablets

4. Na of dolescent provided
Albendazoie tabiets

S. No. of adoiescert provided

contraeptives

3 Condom

OCP

6. No. of adoiescent prodd

sanitary rapkins

7. POOientation Discussiorc

Nutritian

b SRH

Mertal Health

GEY

NCD

SubstarCE MiSUse

Total Na of zdiescent

refered:

To AFHC for clinical

Service

To AFHC for counseling

Servces

To ather health faaitis

D. Ramark(indudeperfomanca, challangas atc

Signstura

ANW
MO
ASHA
Courseller

PRi representative
AWW
PE (Male!
PE(Fermale

Sasina Yasmn
Ofiicer
ComwnunityHealth
Dabli HWC
Page 26 of 26