YOUTH FRIENDLY HEALTH CENTRE

JAMIA MILIA ISLAMIA

NEW DELHI

STANDARD OPERATIVE PROCEDURE

&
IMPLEMENTATION GUIDE

By
Dr. Anil Kumar Gupta
Additional Project Director cum Technical lead
Delhi State AIDS Control Society
Department of Health & Family welfare
Govt. of Delhi

Preface
Young people aged between 10 and 24 years represent 30% of Indias total
population. They represent a resource for the future whose potential can
either be wasted or nurtured in a positive manner. Sexual and reproductive ill
health is one of the major causes of morbidity and mortality in young people.
In a conservative society where reproductive and sexual health related issues
are taboo for discussion, young people are hindered from actively seeking
counsel for their needs.
Even though programs and policies directed towards improvement of
adolescent reproductive health exist, under ARSH subcomponent of RCH-II
programme, there is a paucity of Adolescent /Youth Friendly Health Services
(AFHS/YFHS) in the country. The significant features of an Adolescent/Youth
Friendly Health Centre encompass provision of reproductive sexual & health
services, nutritional counseling and life skills education. It is a kind of 'onestop' shopping approach which means that the different needs of adolescents
can be met under one roof, by a team of professionals who understand their
needs and are trained to address them effectively.
I congratulate the officers of Jamia Millia Islamia, Directorate of Family
Welfare, Integrated District Health Society (South District) and Delhi State
Health Mission for enabling DSACS set up this facility for the first time in Delhi
as a youth centre based model and a noble example of integration of NRHM
and NACP III.
Faizi O Hashmi
Project Director, DSACS

Acknowledgement
DSACS is thankful to Dr. Sunil Mehra, Executive Director, Dr. Deepti
Aggarwal, Deputy Director & Dr P.K. Goswami Senior Advisor, MAMTA Health
Institute of Mother

& Child for providing technical support to DSACS to

prepare the basic framework for Standard Operative Procedure for YFHC,
Jamia Millia Islamia. DSACS is also grateful to following officers from Jamia
Millia Islamia, Department of Health & Family Welfare, Govt. of NCT of Delhi
for attending consultation meeting to finalize the document: :
1. Dr. Keerti Bhushan, OSD (RCH), Dte.of Family Welfare, Govt. of Delhi
2. Dr. Meera, CDMO (South District), Govt. of Delhi
3. Prof. A.S.Kohli, Department of Social Works & NSS Coordinator, Jamia
Millia Islamia
4. Dr.Lily Chopra, Additional CDMO (South District), Govt. of Delhi
5. Dr. Rajni Chakravarty, CMO (NFG),Programme Officer RCH (South
District), Govt of Delhi
6. Dr. M.Y. Shareef, CMO, Ansari Health Centre, Jamia Millia Islamia
7. Dr. Shaista Farhien, M.O. Ansari Health Centre, Jamia Millia Islamia
8. Prof. Anjali Gandhi, HOD, Department of Social Works,

Jamia Millia

Islamia
9. Prof. Dr Waheeda Khan, HOD, Department of Psychology, Jamia Millia
Islamia
10. Prof Dr. Aizaz HOD, Physiotherapy, Jamia Millia Islamia
11. Prof Viquar H Siddiqui, Faculty of fine Arts, Jamia Millia Islamia
12. Dr. K.K.Kaushik,Deputy NSS Coordinator, Jamia Millia Islamia
13. Dr. Abid, Counselor, ICTC/ YFHC, Jamia Millia Islamia

Dr. A.K. Gupta

Addl P.D., DSACS

Contents

S.No

Topic

1. ARSH Strategy of Ministry of Health and Family Welfare,

Page No.
5

Govt. of India
2. Vulnerability of Young people of India (NFHS -3)

6-9

3. Vulnerability of Young people of Delhi (NFHS-3)

10-12

4. Main Issues that need to be addressed to promote

Young peoples health

13

5. Concept of Youth Friendly Health Services (YFHS)

14

6. Service Package

15

7. Facility Characteristics

16-17

8. Components of the Package

18-19

9. Standard Operative procedure

20-27

10. Privacy and Confidentiality

26-28

11. Supplies, Record Keeping and M&E

29

ARSH Strategy of Ministry of Health and Family Welfare, Govt of India

According to the WHO adolescents are defined as 10-19-year-olds, youth
as 15-24 year olds, and young people as 10-24 years
India has identified adolescent reproductive and sexual health (ARSH) as a
key strategy under the Reproductive and Child Health Programme Phase II
(RCH II) and the National Rural Health Mission (NRHM). The Ministry of
Health and Family Welfare has developed an Implementation Guide to help
key resource persons at the state and district level in implementing the broad
framework of the ARSH National Strategy. In his presentation, Dr Mehta
highlighted the core attributes of ASRH services as accessible, equitable,
acceptable and comprehensive. Based on these the Implementation Guide
has outlined seven standards which will guide the effective implementation of
the ARSH strategy
Adolescent Health under Reproductive Child Health Programme (RCH-II)
Adolescent Health has been prioritized significantly in the Reproductive Child
Health Programme (RCH-II) under the National Rural Health Mission
(NRHM). For monitoring of the RCH programme several demographic health
surveys have been commissioned by the Ministry of Health and Family
Welfare. These include: National Family Health Survey (NFHS) for national
and state level data; and District Level Health Survey (DLHS) for the district
level data. These surveys collect data primarily from married women of 15-49
years age group. In NFHS-3 (2005-06) unmarried women and men have also
been included. The first two rounds of both NFHS and DLHS did not report
age disaggregated analysis, for example, for 15-19 and 20-24 years age
groups. However, NFHS-3 has reported age dis-aggregation to a limited
extent.

Vulnerability of Young people of India (NFHS -3)

1. Early Marriage and Early Pregnancy

More than 49 lakhs of adolescents under the age of 18 years are marriedApproximately 21% of boys and 28% of girls still get married below the
legal age of marriage.

Nearly 20 percent of the 1.5 million girls married under the age of 15 years
are already mothers.

Maternal mortality and morbidity of teenage mothers is a cause for

concern. Mortality in female adolescents of 15-19 is higher than
adolescents 10-14 years.

In case there is sexual relationship, it takes place by the age of 16,

especially in case of girls. These sexual contacts are usually without
condoms and for some adolescents, such relationship is a result of force.

2. Unmet need of Contraception

11 million abortions take place annually and around 20,000 women die
every year due to abortion related complications.

At least one half of unmarried women seeking abortions at facilities are

adolescents, many of who are below 15 years of age.

Amongst currently married women there is an unmet need of

contraception, being the highest in the age group 20-24 followed by 15-19
years. In 15-19 age group 25% have reported unmet need for limiting and
2 % for spacing.

Some 15 % births to adolescents aged 15 to 19 in India have been

reported to be unplanned.

Adolescent mothers in the age group of 15-19 years constitute age

specific fertility rate (ASFR) of 0.090.

Adolescent mothers in the age group of 15-19 years contribute to TFR by

19%.

3. Malnutrition

More than 70 percent girls in the age group of 10-19 years suffer from
severe or moderate anemia.

Increasing number of adolescents especially in the towns and cities are

falling prey to lifestyle diseases like obesity, diabetes, etc

4. Mental Health and Substance abuse

Young people have a high rate of self-harm and suicide is a leading cause
of death in young people.

In adolescents (15-19 years) 3.5 % of girls chew; and 0.1 % smoke

tobacco while in 28.6% of boys chew and 12.3% smoke tobacco. 11% of
boys of the same age group drink alcohol.

5. Crime

Incidences of vagrancy; delinquency, alcoholism, drug addiction, truancy

and crime amongst adolescents have seen a sharp increase in the last
few years. Boys outnumber girls and most of them are illiterate or have
studied upto the primary stage (41 percent primary, 29 percent illiterates);
a large number are school drop-outs.

53.2 % of children have reported facing one or more forms of sexual

abuse.

In 50% of cases, the abusers were either known or in the position of trust
and responsibility and most children do not report the matter to anyone

Adolescent boys are equally at risk

Most rape victims are in the age group of 14-18 years. In 82 percent of
rape cases, the victims knew the offenders and 32 percent were
neighbors.

Unfortunately, social taboos prevent these crimes from being registered.

Even when registered, prosecution rarely takes place. Incase of sexual

abuse of boys (12-17 years), they are mainly victims of homosexual

abuse.

6. Misconceptions about transmission of STI and HIV

Compared to the awareness of HIV/AIDS, the awareness regarding STDs

was significantly lower among the youth.

However, the awareness about STDs has significantly increased from 29

percent in BSS 2001 to 36 percent in BSS 2006.

Nearly two-thirds of the youths aware of STDs, knew that there is a

linkage between STDs and HIV/AIDS.

Among youth aware about HIV/AIDS, only two-thirds reported that the
disease can be prevented by consistent condom use and by having one
faithful uninfected sex partner.

Higher proportion of females (6%) reported any STD symptom as

compared to males (4%). Further, STD prevalence was observed to be
marginally higher in rural areas (5 %) than urban areas (4 %).

At the national level, 48 percent of the youth reporting STD prevalence in

the last one year, visited any health institution during last episode of any
STD symptom. The proportion was higher among male respondents at 55
percent as compared to females (43%).

Only 22 percent (males 23%, females 20%) received interpersonal

communication on STD/HIV/ AIDS in last one year preceding survey.

Among respondents aware of HIV/AIDS, only around one-third (males

39%, females 30%) reported to be aware of any HIV/AIDS testing facility
in their area. The awareness was observed to be higher among
respondents from urban areas (43%) than those from rural areas (31%).

7. HIV prevalence among youth

The HIV prevalence among youth (15-24 years) is 0.1 percent.

The prevalence among men aged 15-24 years is 0.09% and 0.11% among
women (NFHS-3).

HIV prevalence among youth was found to be higher in urban areas

(0.14%) as compared to rural (.09%) and higher among women in both the
areas.

Early marriage, early sexual activity, lack of knowledge and exposure to

HIV related information and limited access to health care services and
condoms, make young women more vulnerable to HIV risk.

Among young women HIV prevalence is higher for those whose first
sexual partner was more than 10 years older.

The proportion of women (15-24 years) who have heard of HIV/ AIDS and
those who know how to prevent HIV has increased significantly over time
(from NFHS-2 to NFHS-3).

Although, a large majority of adolescents were aware of HIV/AIDS but the

awareness level of adolescents and youth is much lower when it comes to
knowledge of prevention and transmission of HIV. Comprehensive
knowledge about HIV/AIDS is also found significantly related to the
educational level; wealth and exposure to media and residence in urban
areas among both young men and women.

Higher percentage of condom use was reported by unmarried men than

women. Younger men and women (15-19 years) reported more high risk
sexual activity and low condom use compared to those in the 20-24 years
age group.

The utilization of services provided under HIV prevention programme are

not reported to be inadequately utilized or accessed by the adolescents,
as only a very small percentage of youth went for HIV testing in the past
12 months preceding the survey.

Vulnerability of Young people of Delhi (NFHS-3)

1. Age at first marriage
The median age at first marriage is 19.7 years among women age 20-49
and 24.4 years among men age 25-49. On average, men get married five
years later than women. More than one-fifth of women (23%) age 20-24
years got married before the legal minimum age of 18, and 19 percent of
men age 25-29 years got married before the legal minimum age of 21.
2. Teenage pregnancy
Among young women age 15-19 in Delhi, 5 percent have already begun
childbearing, much lower than the national average of 16 percent. One in
four women with no education are already either mothers or pregnant with
their first child, compared with only 2 percent of women with at least 10
years of education
3. Unmet need
Unmet need for family planning is defined as the percentage of currently
married women who either want to space their next birth or stop
childbearing entirely but are not using contraception. According to this
definition, 8 percent of currently married women have an unmet need for
family planning (3% for spacing and 5% for limiting), down from 13 percent
in NFHS-2 and 15 percent in NFHS-1. Currently, 90 percent of the
demand for family planning is being satisfied, having risen from 80 percent
in NFHS-1 and 83 percent in NFHS-2.
4. ANC care-

one in four pregnant women did not receive at least three antenatal care
visits for their last birth The percentage of institutional births in the three
years preceding the survey increased from 45 percent in NFHS-1 and 59
percent in NFHS-2 to 61 percent in NFHS-3. Only 48 percent of women
and 62 percent of men have comprehensive knowledge of HIV/AIDS.

5. Age at first sexual intercourse

Half of the women age 25-49 in Delhi have had sexual intercourse by the
time they are 19 years of age, while half of the men in that age group have
had sexual intercourse by the time they are 24 years of age. Among youth
15-24 years of age, women are much more likely than men to have ever
had sex. The earlier age at sexual intercourse for women than men is a
consequence of the fact that first sexual intercourse largely occurs within
marriage and women marry at younger ages than men.
6. Higher-risk sex and multiple sex partners
Higher-risk sex is sexual intercourse with someone who is neither a
spouse nor a cohabiting partner. Among those who had sex in the past
year, only 0.1 percent of women and 8 percent of men reported having
had higher-risk sex during the year. Two percent of male respondents said
they had multiple sex partners in the past year, but a negligible percentage
of female respondents reported having multiple partners.
7. Use of condoms during higher-risk sex
More than three out of five men (63%) who had higher-risk sex reported
using a condom the last time they had higher-risk sex.
8. Tobacco and alcohol use
Forty percent of men and 3 percent of women use some form of tobacco.
One-third of men, but only 0.4 percent of women, drink alcohol. 2.9 %
bear child before 18 years of age,6.6% at 18 yrs age and 15..8% at 19 yrs
of age..
9. Knowledge of contraceptive method

Aged

15-19

yrs-

any method-

24.7%,any

modern

method-18%,

steriloization-0, pill-0.IUD-2.6%, injetables-0,condom-15.4%,

10. Condom Protects against pregnancy
Percentage of men 15-19 yrs who say that if a male condom is used
correctly, it protects against pregnancy:-57.8%, 20-24 yrs -74.9%
11.

Unmet need of family planning

Aged 15-19 yrs -21.7%, 20-24 yrs- 19.2%

12.

Marital status of Youth - 8.6% married girls between 15-19 yrs age,
52.3% married b/w 20-24 yrs age.

13

Anemia- Girls 15-19 years - 49.7%, 20-24 years- 44.4%, Boys both age
groups -18%

Main Issues that need to be addressed to promote young peoples

health
1. ARSH

Body Image.

Menstruation.

Teenage Pregnancy.

Abortion.

Personal Relationship.

Lack of self confidence / low self esteem.

2. Diet

Balanced diet

Junk Food.

3. Substance Abuse

Pear Pressure.

Family Background.

4. HIV/AIDS & STI/RTI

Lack of knowledge.

5. Violence

Domestic violence

Sexual Violence

6. Stress

Studies.

Family Pressure.

7. Mental Health

Anxiety

Depression

Mania

8. Others

Cell Phone.& Internet.

Concept of Youth Friendly Health Services (YFHS)

Provides a broad range of preventive, promotive and curative services
observing privacy and confidentiality under one roof are scanty in the country.
The World Health Organization (WHO) describes Youth Friendly Health
Services (YFHS) as Services that are accessible, acceptable and
appropriate for adolescents/ youth. They are in the right place, free where
necessary and delivered in the right style to be acceptable to young people.
They are effective, safe and affordable. They meet the individual needs of
young people who return when they need to and recommend these services
to friends.
There are three models of YFHS- the clinic/hospital -based model, youth
centre model, and school-based peer youth programs.
Five YFHS standards for Youth Centre Based Model
Facility-The facility is accessible and acceptable to young people. It is
well managed and has the required equipments to deliver services.
Service provider and support staff-have the required competencies and
positive attitude to handle the young people effectively.
Service package-The basic health service package is provided in an
effective manner..

 Information system-YFHS centres gather, analyze, maintain records and

use data to improve service provision
Demand

generation

activities-Publicity, outreach

and

community

participation activities

Service Package
Capacity Building & Peer Education Programme
IEC on ARSH, RTI/STI & HIV/AIDS
Adolescent Health
Information on Healthy Life style, balanced diet & Yoga
Counseling on Reproductive & Sexual Health issues
Integrated Counseling & Testing Services (ICTC)
Advice on Contraception/ Emergency Contraception/unwanted pregnancy/
Psychosocial support & PEP in sexual assaults
Information on Family Planning methods
Promotion of Voluntary Blood Donations
Counseling on Substance and Drug abuse
Mental Health
Diagnosis & treatment of Sexually Transmitted Infections
Promoting outreach activities through RRCs
Referral Linkages with Health Centre, JAMIA MILLIA ISLAMIA; Red
Ribbon Clubs; NGOs
Service Facility Characteristics

1. Manpower- Specially trained male & female counselors shall be available

from 9 AM to 4 PM on all working days. One dedicated Youth Consultant

will supervise the activities of the centre and ensure follow up of the clients
and referral linkages. One LDC will manage data entry and record
keeping. The staff has been trained to be understanding and sensitive to
the health concerns of the youth and have appropriate skills
2. Location-The YFHC is located in heart of Student Counseling & Guidance
Centre of JAMIA MILLIA ISLAMIA with comfortable secure surroundings,
adequate seating arrangement, Informal and youthful environment with
posters and literature on concerns of youth displayed conveniently in the
facility.
3. Adequate space and sufficient privacy4. Respect for Young People- Staff of YFHC JAMIA MILLIA ISLAMIA is
committed to foster positive attitudes towards the youth seeking services.
5. Privacy and Confidentiality Honored- Staff of YFHC and Health Centre
JAMIA MILLIA ISLAMIA will assure young people that their right to
privacy and confidentiality will be respected at all costs.
6. The staff will ensure adequate time for Client and Provider
Interaction
7. Drop-in/Phone in Clients Welcomed and Appointments Arranged

Quickly with Medical Officers (male doctor, female doctor) and

Clinical Psychologist. Appointments can be taken from Youth Consultant
by dialing 011-26981293 in convenient (afternoon) hours / Special days.
8. Peer Counselors Available- The existing 20 Red Ribbon Clubs 100 peer

educators will be trained as peer counselors for outreach activity to deal

with the aspects of youth concerns that do not require technical or clinical
skills and to mobilize youth and community support for the YFHC.
9. Group Discussion Available- Group discussions and talks on various

aspects of health particularly those related to sexual and reproductive

health shall occur routinely to build peer social support mechanisms. A
schedule of topics and times will be publicized on web site & notice Board
of YFHC to invite 20 young people per session for the programme. The
discussions shall be accompanied with relevant audiovisual material.

10. Necessary Referral Mechanisms Available Clinical services available

in the Health centre, JAMIA MILLIA ISLAMIA have been linked to YHFC.
The services not available in JAMIA MILLIA ISLAMIA shall be arranged
through the CDMO, Integrated District Health Society (South District) by
linkage with Govt, facilities.
11. Utilizing available Toll Free help lines- Youth can call toll free 1800-11-

6555 for pregnancy-puberty reproductive and sexual health related

issues and 1097 for HIV/AIDS related issues.
12. Education Material Available on Site and to Take Away - Information,

Education and Communication (IEC) materials, particularly those on

critical issues in sexual and reproductive health, is available at Youth
Friendly Health centre. The materials will be available to read and some
on request can be taken away for youth who would like to read more on
their own.
13. Publicity/Recruitment that Informs and Reassures Youth- JAMIA
MILLIA ISLAMIA will publicize the location of services, the times they are
available, and assure that privacy and confidentiality are maintained.
14. Draft Standard Operative Procedure & Monitoring & evaluation

system has been prepared by DSACS with help of NGO MAMTA and is
being shared with the service providers for its implementation.

Components of the PackageYFHC will provide following package of health services that adolescents/
youth need:
a. Promotive services

Information & advice on Sexual Reproductive Health issues

Peer Education programme

Information on methods of family planning

Counseling & provision for EC pills

Counseling & provision of contraceptives

Focused care during ANC

Voluntary Blood donations

b. Preventive services

ICTC services

Condom promotion

Advise for tetanus immunization:

Services for prophylaxis against Nutritional Anemia

Nutrition counseling

Counseling & referral linkage for early & safe termination of pregnancy

c. Curative services

Syndromic management of RTIs/ STIs

Treatment & counseling for menstrual disorders

Treatment & counseling for sexual concerns of male & female

adolescents

Counseling & referral linkage for cases of sexual abuse among girls:

d. Referral Services:

Anasari Health centre, Jamia Millia Islamia

Red Ribbon Clubs

ART centers for HIV/AIDS

Obstetrics & Gynae units, Govt Health facilities

e. Outreach services:

Peer educators

Red Ribbon Clubs

Community reach activity

Standard Operative Procedure

1. Type of clients

15-24 years boys & girls, however, no client outside this age group
shall be denied services.

Students studying anywhere in India /Delhi can access the services

Out of school /College youth will also be mobilized by outreach activity

& will be able to access the services.

All services available are free from any charge.

2. Timings of the centre- 9 AM to 4 PM on working days

3. Client Flow: Client will first report to the counselor for registration after
consent. Any client not willing to register can avail the IEC services at the
resource centre and can take-away IEC material or can access the IEC
through audiovisual aids.
4. Counseling wiling clients will be counseled by male/female counselors. It
is estimated that client may have to pay 30-40 minutes for adequate
counseling and approximately 8-10 clients can be counseled in a day.
Counselor will fill form O for consent and form 1a for counseling on RSH
issues and if required refer the client for consultation with the doctor for which
client may be required to pay another visit in the afternoon. Counselor may
ask the client to visit the resource centre to read / or take-away IEC material.
5. Doctor- One doctor will be available from Ansari Health centre for twice a
week between 2-4 PM. This includes male & female doctors. They will submit
their monthly duty roster to YFHC Nodal Officer. Doctor will examine and fill
form 1 b. In additional mental health issues will be dealt by psychologist
appointment basis. Doctor may utilize Ansari Health Centres resources

(Hemoglobin estimation, general medicines etc) by calling the client at the

health centre if medical problem need to be addressed. However, Syndromic
management of STI/RTI, treatment of anemia, advise on oral contraceptives
shall be undertaken at the YFHC. Doctor can refer the client to any linked
hospitals for ANC care, MTP, ART etc as per requirement of the case.
However, all efforts will be made by the YFHC to ensure follow up of referred
cases.
2. Staff and Job responsibilities of each staff
The personnel of the centre have the following staff-specific roles and
responsibilities:
A. Youth Consultant
Overall supervision and management of the centre and its activities - Being
present at the centre full time
Helping with keeping the patient-flow smooth
Helping filling in the forms
Checking that all the forms have been correctly filled in
Keeping a daily diary of activities/changes at the clinic
Supervising and undertaking research activities such as FGDs and IDIs
Analyzing the collected data, Compiling the monthly report
Infrastructure maintenance
Ensuring that the patient-flow is smooth
Helping in pharmacy, if needed
Identifying & keeping in touch with and supervising the peer educators
(PEs)
Arranging Capacity Building Programme of PEs (5 / department X all
departments of Jamia Milia Islamia)
Planning Out reach activity through PEs and monitoring the same

 If needed, accompanying clients to/from the centre and referral facilities

Undertaking research activities under the supervision of Nodal Officer
Helping the clerk for infrastructure maintenance
In-charge of resource centre /library keep account of logistics including
books/journals/IEC material etc
Maintaining records of expenditure (
B. Clerk
Ensuring cleanliness and infrastructural functionality of the centre
Maintaining stock of and procuring required materials (patient files,
stationary, cleaning materials etc.)
Keeping reading materials, notice boards etc. organized
Reporting any problems in the infrastructure to the Youth Consultant
Maintaining the client files and the file storage cabinet in order
Entering all client data to the computer
Keeping record of the persons visiting the centre on other than clinic timings
Taking care of the AV-equipment and showing films/documents as
requested by the clients
Manning the telephone and keeping a register of telephone calls. Fixing
appointments of clients for doctors as per their availability.
C. Counselors

Present at the centre full time (female counselor & male counselor)

Providing counseling to clients based on the problems or concerns

expressed by the client or by

the doctor (referral to the counselor), but

also on issues agreed to be inquired from every client as listed in the

counseling forms

Inquiring about and discussing sexual and reproductive health (SRH)

problems and concerns (like changes in body, sexual orientation,
relationship issues, sexual intercourse, sexual abuse etc.) and knowledge
about STI-prevention and condom use with every client

Screening all first-visit clients for psychological / behavioral / social / SRHrelated problems and concerns

Providing follow-up and referral services

Filling in counselors data collection form and logbook for each client

4. Laboratory assistant

Being present at the centre full day

Conducting laboratory tests as suggested by the counselor / doctor

Distributing and explaining the STI drugs prescribed by the doctor

Maintaining records of medicines and reagents, reporting these monthly

and maintaining appropriate stock by taking care of procurement

5. Doctors

Part time service twice a week from 2-4 PM

Attending to and treating general health problems and concerns

expressed by the client, but also issues agreed to be inquired from every
client as listed in the doctor's forms

Inquiring about and discussing sexual and reproductive health (SRH)

problems and concerns (like menstruation problems, concerns about
normality of sexual organs, masturbation, wet dreams, reproductive tract
infection (RTI) -symptoms, sexual intercourse, usage of contraceptives
etc.) with every client

Attending to and treating SRHproblems and concerns including

contraceptive information and services (pills, condoms and emergency
contraceptives). Pregnancy care is provided only for

adolescent

pregnancies (when the pregnant woman is below 18 years of age)

Counseling about issues related to growth and development, personal

hygiene, nutrition, general health, SRH etc.

Requesting for needed laboratory tests

Prescribing needed drugs

Providing follow-up and referral services

Filling in doctor's data collection form.

All staff members

-Being punctual and available during agreed timings
-Creating and maintaining a youth-friendly atmosphere with special emphasis
on confidentiality and privacy
-Treating and attending to clients as specified in the other guidelines
concerning treatment of clients, confidentiality and privacy etc.
-Helping, discussing cases with and supporting other staff from the same or
other staff group
-Attending mutually agreed trainings
-Attending orientation/staff meetings being organized from time to time and if
a need arises
-Assisting in developing/preparing IEC materials to promote the services of
the centre
Standardized package of services at the centre
The centre will provide the following standardized package of services at the
centre (a separate SOP exists for outreach activities):
A. Medical services
The medical services provided include:
- Attending and treating general health problems and concerns

- Inquiring about sexual and reproductive health (SRH) problems and

concerns (like menstruation problems, concerns about normality of sexual
organs, masturbation, wet dreams, reproductive tract infection (RTI)
-symptoms, sexual intercourse, usage of contraceptives etc.) from every
client
-

Attending,

and

treating

SRHproblems

and

concerns

including

contraceptive information and services (pills, condoms and emergency

contraceptives). Pregnancy care/ or referral linkage is given only in case of
adolescent pregnancies (pregnant woman below 18 years of age)
- Required counseling services by the doctor in issues related to growth and
development, personal hygiene, nutrition, general health, SRH etc.
- Supportive laboratory services including pregnancy test
- Identified package of drugs
- Follow-up and referral services
2. Counseling services
Counseling services by a qualified same-sex counselor are provided
minimum once a week (at the same time with the medical services) for both
females and males for a minimum duration of 2 hours (extendable according
to the number of clients on any given day but not to exceed 3 hours). The
counseling services provided include:
- Screening of all first-visit clients for psychological / behavioral / social / SRHrelated problems and concerns
- Counseling about above-mentioned problems and concerns as expressed
by the client or by the doctor (referral to the counselor) - Inquiring about
sexual and reproductive health (SRH) problems and concerns (like changes
in body, sexual orientation, relationship issues, sexual intercourse, sexual
abuse etc.) and knowledge about STI-prevention and condom use from every
client - follow-up and referral services
3. Information services- The services include:
- Written material to be read at the centre in Hindi on different issues such as
growth and

development, gender, general health, nutrition, sexuality, sex,

contraception, pregnancy, RTIs, HIV/AIDS, depression, school performance,

planning career etc.
- Carry-home written material in Hindi about the above-mentioned topics
- Educational posters on the walls of the centre
- Educational films and documents
- Possibility to discuss with the centre staff
All the above mentioned services are provided according to the other
guidelines concerning confidentiality and privacy, treatment of clients etc. This
package of services will be reviewed regularly and changed in case new
needs / further service possibilities arise.
Privacy and Confidentiality
Securing confidentiality and privacy is important when delivering health
services in general, and especially critical when dealing with young people.
Keeping confidentiality is part of the rights of the client as personal
information collected of an individual ultimately belongs to her/him. Preserving
privacy and confidentiality is an important way of showing respect to the client
and is the basis for trust in the client provider relationship. Without feeling
respected and being able to trust the service providers the clients might
withdraw personal information, which will hinder both provision of effective
interventions as well as collection of accurate information for research
purposes.
In order to ensure confidentiality and privacy of the clients of Friends-centre,
following procedures have to be followed and ensured:
1. All staff is bound by professional confidentiality / professional secrecy
which means that they will hold secret all information relating to a client (also
information obtained outside the clinic setting) unless the client gives consent
permitting disclosure.
2. The client has the right not to reveal personal information such as her/his
name, exact address, phone number, marital status etc.

3. The forms which contain any identity information (such as name, address
etc.) about the client will be kept separately in a locked place and only the
receptionist will have access to these forms. All the other forms and all the
registers will only contain the serial number and ID number as means of
identification.
4. The data collected during the client's visits to the centre will be handled
confidentially, i.e. not disclosed to persons not working at the centre without
the client's consent. Before using a client's data for research purposes, the
client's permission has to be obtained in a form of a signed informed consent.
5. While the client is consulting the doctor or counselor, measures have to be
taken so that outsiders can not overhear the conversation. These include:
- Keep the door of the consultation room closed
- Ensure nobody is sitting outside the consultation room (because of lack of
space the laboratory assistant/pharmacist has to sit outside doctor's
consultation room, but he is bound by the professional confidentiality
mentioned in point 2)
- Nobody (including the staff) is allowed to enter the room during consultation
without the consent of the client
- If the client comes with an accompanying person and insists that s/he
should be present in the consultation, the counselor/doctor should still get
some time with the client alone (i.e. first discuss with both in the room, then
ask the accompanying person to wait while discussing with the client).
6. While the receptionist, community worker or programme manager / officer
is interviewing the client for identity/background information or exit interview,
measures are taken to ensure maximum possible privacy. Because of lack of
space it is usually not possible to interview the client in a separate room but
other measures can be taken such as:
- In case a separate room is empty, it should always be used
- Only one client at a time should be discussing with the receptionist in the
reception area

- If the interview has to take place in a space where other clients are also
seated (for example in the waiting room), the interview should be conducted
as far away as possible from the others and with a low voice.
7. These guidelines have to be made visible and discussed with every client
so that they are aware of their right to privacy and confidentiality. These are
also discussed during outreach when informing the community about the
centre.
8. Ways of assessing whether these guidelines are followed include:
- Constant monitoring by the project staff
- Regular monitoring observations
- Results of exit interviews (which includes a question about privacy and
confidentiality

during the visit)

9. During the research and outreach activities confidentiality means agreeing

with the participant(s) that issues of personal nature discussed during the
activity (one-to-one discussion / meeting / focus group discussion / in-depth
interview etc.) will not be discussed by any of the participant(s)

or

facilitator(s) outside or after the activity.

10. Any breach of these guidelines is treated as a serious matter and
discussed with the whole team.

Service package and commodities supplies

Iron Folic acid, calcium tablets & STI /RTI drugs to be provided by the
NRHM /Ansari Health Centre

Oral Contraceptives/ EC to be provided by NRHM

Condoms to be provided by DSACS/NACO

IEC material DSACS/NRHM

Record keeping (Computer based retrieval)

Form O (consent form with name & address of the client) to be stored by
the clerk.

Form 1a (counselor form) & 1b (doctors form) data to be entered by the

counselor in the computer MIS (software need to be developed). Forms to
be kept properly filed in counselors room

Monitoring & Evaluation

Defining Monitoring Indicators-

Internal Monitoring- Generation of Monthly reports, Review by Nodal

Officer YFHC, submission of monthly report to DSACS & NRHM, ,
Monitoring of outreach programme of PEs by Youth Coordinator.

External Monitoring- Monthly visits for first 3 months of start of project.

Thereafter quarterly supervisory visits by CDMO Office (South District)/
DSACS /OSD (RCH)/Delhi State Health Mission.

Assessment of the centre at 6 months and 12 months by an expert

NGO ( may be MAMTA) , DSACS & DSHM.

2. Staff and Job responsibilities of each staff (Friends)

2. SOPs for privacy and Confidentiality (orientation of staff on guidelines)
(Friends)
3. Service package and commodities/supplies matching this package
(services at the YFHS and health centre can be described separately)
(Friends + NRHM implementation guide 11-16)
4. Decide when to refer clients from YFHS to health center and a system for
follow up (needs to be developed) Referral slip example given in Friends
6. Standard history taking formats (Friends)
7. Record keeping (Which records will be maintained? How and by whom?
Computer based retrieval) (to be decided by DSACS)
8. Drug inventory (DSACS, health center)
9. Quality Assessment at regular intervals (Client interview (MAMTA) and
direct observation (MAMTA))

References
1. Report of National Family Health Survey (NFHS-3) India, 2005-06,
Delhi published by Ministry of Health & family welfare, Govt. of India,
Feb 2009
2. National Standards and Implementation Guide for Youth Friendly
Health services, Ministry of Health Bhutan,
3. Friends A Youth-Friendly Health Services Project in Tigri slum, New
Delhi, India
4. National Guidelines for provision of Adolescent Youth Friendly Services
(YFS) in Kenya, Ministry of Health, Division of Reproductive Health,
Nairobi, Kenya , July 2005