During the transition from childhood to adulthood, adolescents establish patterns of behavior and make lifestyle choices that

affect both their current and future health. Adolescents and young adults are adversely affected by serious health and safety issues such as motor vehicle crashes, violence, substance use, and sexual behavior. They also struggle to adapt behaviors that could decrease their risk of developing chronic diseases in adulthoodbehaviors such as eating nutritiously, engaging in physical activity, and choosing not to use tobacco Environmental factors such as family, peer group, school, and community characteristics also contribute to the challenges that adolescents face. To have the most positive impact on adolescent health, government agencies, community organizations, schools, and other community members must ork together in a comprehensive approach. !roviding safe and nurturing environments for our nation"s youth can ensure that adolescents ill be healthy and productive members of society. Situation in India #ndia is the second most populous country in the orld ith total population of over $%&$ million. Adolescents '$%($) years* form a large section of population + about ,,.- percent, that is, about ,,- million. They are living in diverse circumstances and have diverse health needs. The total population of young people '$% + ,. /ears* is approximately 00$ million comprising nearly 0% percent of the total population of #ndia'1ensus ,%%$*. Adolescents are full of energy, have significant drive and ne ideas. They are a positive force for a 2ation and are responsible for its future productivity provided they develop in a healthy manner. 3ince mortality in this age group is relatively lo the adolescents are considered to be healthy. 4o ever, 5ortality is a misleading measure of adolescent health. #n fact, the adolescents do have a range of health problems that cause a lot of morbidity as ell as definite mortality. #n spite of definite health problems they may have, it is a common observation that adolescents do not access the existing services. #n #ndia there have not been any designated services for this age group so far, leading to substantial unmet service needs. Absence of friendly staff, orking hours that are inconvenient to adolescents and lack of privacy and confidentiality have been identified as important barriers in accessing health services by adolescents and young people. The health sector needs to respond by offering services to adolescents in a friendly manner and in a non(threatening environment.

Mental health
5any mental health problems emerge in late childhood and early adolescence. Enhancing social skills, problem(solving skills and self confidence can help prevent mental health problems such as conduct disorders, anxiety, depression and eating disorders as ell as other risk behaviours including those that relate to sexual behaviour, substance use, and violent behaviour. 4ealth orkers need to have the competencies to relate

to young people, to detect mental health problems early, and to provide treatments hich include counselling, cognitive(behavioural therapy and, here appropriate, psychotropic medication.

Substance use
#n addition to la s that limit the availability of illicit substances, tobacco and alcohol, interventions to reduce demand for these substances improve the conditions for healthy development. #ncreasing their a areness of the dangers of substance use, building their competence to resist peer pressure and to manage stress in a healthy manner is effective in reducing adolescents6 motivation for substance use.

Violence
7ife skills and social development programmes for children and adolescents are important for reducing violent behaviour. 3upporting teachers and parents to build skills in problem solving and non(violent disciplining is also effective in reducing violence. #f and hen violence does occur, actions to make health systems more responsive, and to build the empathy and competence of health orkers, can help ensure that adolescents ho experience violence, including sexual violence, get effective and sensitive care and treatment. 8ngoing psychological and social support can help adolescents deal ith the long term psychological effects of violence, and to reduce the likelihood of their becoming perpetuators of violence in the future.

Unintentional injuries
Approaches for reducing road traffic crashes, and the occurrence of serious in9uries if and hen crashes occur, are important for safeguarding adolescent health. These include:

enforcing speed limits; combining education ith la s to promote seat belt 'and helmet* use and to prevent driving under the influence of alcohol or other psychoactive substances; providing alternatives to driving by increasing the availability of safe and inexpensive public transport.

Actions to make the environment safer and to educate children and adolescents on ho to avoid dro ning, burns and falls can help reduce the likelihood of their occurrence. <hen someone is in9ured, prompt access to effective trauma care can be life saving.

Nutrition
1hronic malnutrition in earlier years is responsible for idespread stunting and to adverse health and social conse=uences throughout the life span. This is best prevented in childhood but actions to improve access to food could benefit adolescents as ell. Anaemia is one of the key nutritional problems in adolescent girls. !reventing too(early pregnancy and improving the nutritional status of girls before they enter pregnancy could reduce maternal and infant mortality, and contribute to breaking the cycle of intergenerational malnutrition. This ill involve improving access to nutritious food, to micronutrient supplementation and in many places to preventing infections as ell. Adolescence is a timely period to shape healthy eating

and exercise habits hich can contribute to physical and psychological benefits during the adolescent period and to reducing the likelihood of nutrition(related chronic diseases in adulthood. !romoting healthy lifestyles is also crucial to halting the rapidly progressing obesity epidemic.

Sexual and reproductive health

!rogrammes that aim to educate adolescents about sexual and reproductive health need to be combined ith programmes aimed at motivating them to apply hat they have learnt in their lives. They should also be combined ith efforts to make it easier for adolescents to obtain any preventive or curative health services they might need from competent and empathetic health orkers. 3exual coercion in adolescence needs to be fought at different levels. 7a s re=uiring severe punishment for this crime should be passed and energetically enforced, and public opinion should be mobilized to become fiercely intolerant of it. >irls and omen should be protected from sexual harassment and coercion in educational institutions, ork places and in other community settings. !reventing too early pregnancy may re=uire the enactment and enforcement of la s that specify a minimum age for marriage, as ell as actions to mobilize families and communities to give their daughters the additional time they need to gro and develop from girlhood into omanhood before becoming ives and mothers. Alongside this, health services should be ready to provide adolescents ho are pregnant ith the antenatal care they need, or to obtain a safe abortion here this is permitted by la . Effective care during child bearing is important to ensuring the survival of mothers and their babies, and the prevention of problems such as fistulas.

HIV
/oung people"s risk of 4#? infection is closely correlated ith age of sexual debut. Abstinence from sexual intercourse and delayed initiation of sexual behaviour are among the central aims of 4#? prevention efforts for young people. Decreasing the number of sexual partners and increasing access to, and utilization of comprehensive prevention services, including prevention education and provision of condoms, are essential for young people ho are sexually active. !rogrammes should also focus on prevention and early intervention in other health risk behaviours, such as substance use. /oung people need 4#? testing services that are accessible and appropriate. /oung people living ith 4#? need treatment, care, support and positive prevention services. All 4#? services for young people should involve young people living ith 4#? in their planning and provision. Piloting Adolescent Friendly Health Services <48 supported development of adolescent friendly health centers 'A@41s* in the country to demonstrate feasibility and generate local experience. #n all, fourteen such A@41s ere supported, many of hich have been sustained beyond the pro9ect phase ith the government support and institution"s o n efforts and continue to provide friendly health services to the adolescents. #n the process a sustained advocacy on the importance of adolescent health as realized and this encouraged scaling up of adolescent friendly health services in the country.

3afdar9ung 4ospital Adolescent 4ealthcare 2et ork '34A42* at 2e Delhi as the first initiative in this series. Their AEnd of term" report describes the process of implementation and lessons learnt .

Adolescent eproductive and Sexual Health Strategy under !H"II <48 assisted >overnment of #ndia in designing programmatic frame ork of adolescent health strategy for the 2ational !rogramme implementation !lan under the Beproductive and 1hild 4ealth+## 'B14 ##*. >overnment of #ndia has positioned Adolescent Beproductive and 3exual 4ealth 'AB34* 3trategy as one of the key technical strategies in B14 ## !rogramme under 2ational Bural 4ealth 5ission '2B45*. This strategy focuses on reorganizing the existing public health system in order to meet the service needs of adolescents. 3teps are being taken to ensure improved service delivery for adolescents during routine hours as ell as in the dedicated clinics on fixed days and timings at the 3ub( 1enter, !rimary 4ealth 1enter, 1ommunity 4ealth 1enter and District 4ospitals and also through the outreach activities. A core package of services ould include preventive, promotive, curative and counseling services for adolescents.

#evelop$ent o% &perational Strategy %or I$ple$enting A SH The >overnment of #ndia organized 2ational 1onsultation on B14 ##(AB34 3trategy ',(3eptember ,%%-* ith the support of <48 and C2@!A to develop operational guidelines for implementation of AB34 strategy. A team of experts from <48(4D, Begional 8ffice and 1ountry 8ffice and a team of experts from C2@!A Begional and 1ountry 8ffice orked together ith a range of experts from the country in this consultation to develop the standards based approach for implementation of AB34 strategy and in the process A#mplementation >uide" has been developed. This guide describes operational guidelines for the 3tate and District programme managers to implement AB34 strategy ithin the public health system.

MAPM Fra$e'or( and )* S+ Strategy, !onvergence o% !H and HIV progra$$es at district level 'ith a %ocus on young people <48 is supporting >overnment of Tamil 2adu in using 5A!5 frame ork in developing converged district action plans focusing on young people. The 5A!5 '5apping Adolescent !rogramming and 5easurement* @rame ork helps programme planners to focus on the most important interventions, determinants, and behaviours in order to achieve priority health and development outcomes. 5A!5 frame ork helps to design and implement more effective programmes and also to identify what to measure to demonstrate implementation of a programme and its impact on adolescent health and development. #t complements other tools and approaches to designing, monitoring and evaluating adolescent health and development programmes. 1onsidering the higher vulnerability of young people to ards 4#?EA#D3 the <48 strategy of FStrategic information, Services and supplies, Supportive environment and Strengthening other sectorsG '.3* outlines approaches for addressing the young people issues in B14 and 4#?EA#D3 programmes.

-valuation o% .H& Supported Adolescent Friendly Health !enters #t has been planned to assess the =uality and coverage of adolescent friendly health services at the <48 supported centers at 1handigarh, Delhi and Holkata to find out hether establishment of such centers has resulted in =uality improvement and increased access for adolescents. !resently, the tools for the assessment developed by the <48(4D are being adapted to match ith the 2ational standards of the country described in the A#mplementation >uide".