Technical Guidance for Prioritizing Adolescent Health

This technical guidance, developed by the United Nations Population Fund (UNFPA)- and World Health Organization (WHO)-led Adolescent Working Group of the Every Woman Every Child (EWEC) initiative, aims to support countries to both advocate for increased investments in adolescent health and to guide strategic choices and decision-making for such investments to be reflected in national development policies, strategies, or plans. It describes a systematic process for identifying the needs, priorities, and actions for adolescents as envisioned through the Every Woman Every Child Global Strategy for Women's, Children's, and Adolescents' Health (2016-2030), launched at the Sustainable Development Summit in September 2015. Data sources, resources, and tools for conducting a situation assessment and prioritisation exercise are also included.

After an overview of adolescent health on the global agenda, the guidance document briefly describes the rationale and arguments for why increased investments and prioritisation in adolescent health and development are needed. It is noted here that, in the EWEC framework, improving adolescent health and designing effective and appropriate interventions require adherence to a series of values and principles that encompass: human rights, gender equality, inclusion and recognition of diversity; equity and reaching the most vulnerable adolescents; country leadership, transparency, and accountability; multi-sectoral approaches and meaningful partnerships; alignment with evidence-informed practices; and adolescents' leadership, voice, and agency, including their safety and protection.

Part 3 outlines a process by which to make strategic choices in priority areas of adolescent health. In particular, this section outlines key steps for carrying out a needs assessment and prioritisation exercise that incorporates: (Step 1) a situation analysis on adolescent health and development, based on available country-level data; and (Step 2) a landscape analysis of existing policies and programmatic efforts underway. Following these steps, key issues and criteria are presented to guide the process for selecting adolescent health priorities (Step 3) and the key interventions to address them (Step 4). It is noted here that the strategy development should be done using an iterative decision making-process. For each health outcome to be achieved, one should identify: the adolescent actions and behaviours that most directly contribute to the health outcome; the factors that influence the actions and behaviours; the interventions to address these factors (that would be feasible to do and would build on what is being done); and the indicators and means of verification (that would be feasible to do and would build on what is being done). Part 3 also includes case studies of countries that illustrate the particular step. These countries have undertaken similar assessments that served as the basis for prioritising adolescent health at the national level or have incorporated adolescent health issues within national health plans.

For example, recognising the potential of investing in adolescents for a demographic dividend, the Government of India in 2014 launched Rashtriya Kishor Swasthya Karyakram (RKSK), a national strategy that proposes a multi-level, multi-sectoral solution to enhance adolescent health. Based on the principles of participation, rights, inclusion, gender equity, and strategic partnerships, RKSK takes a comprehensive approach to adolescent health and well-being and situates adolescence in a life-course perspective within dynamic sociological, cultural, and economic realities. In 2013, the Government of India and UNFPA shepherded a multi-sector process with relevant line ministries (e.g., Health, Youth, Education, Women and Children, etc.) to develop a holistic adolescent health programme that goes beyond clinical services. The process engaged young people from diverse backgrounds to share their needs and concerns from existing programmes and proposed solutions to address the gaps. The Ministry of Health and Family Welfare, supported by UNFPA, worked with leading non-governmental organisations (NGOs) and young people to develop detailed implementation plans for the strategy's launch and rollout. The strategy prioritizes 6 areas of adolescent health that were identified through a situation analysis. The interventions are planned at distinct layers in the adolescent's environment (individual, family, school, and community), thus entailing integrated action of different sectors. Though the strategy is within the Ministry of Health and Family Welfare, the engagement of other sectors is ensured through multi-sectoral steering committees that operate on national, state, district, and village levels. One innovation to increase accountability was to involve adolescents themselves in participatory monitoring. This monitoring mechanism is also complementing data gaps in the health management information systems (HMIS), which has limited age-disaggregated, adolescent-specific data.

Part 4 concludes with a brief overview of next steps in tracking progress, including indicators (core and complementary indicators for the Global Strategy). Table 1 presents a full set of 60 indicators as a technical resource for monitoring the Global Strategy, organised by the 3 Global Strategy axes and divided into 2 groups: (i) the proposed indicators for the 17 targets that are central to the Global Strategy; and (ii) those that are a priority for the Global Strategy but not proposed for the Sustainable Development Goal (SDG) process. Table 2 maps each indicator, by target, to the population or populations covered in order to illuminate the depth and breadth of coverage across these focal populations. It also notes where age-disaggregation is recommended. Part 5 includes annexes with data sources, resources, and tools for the situation assessment and prioritisation exercise. To support further advocacy efforts, a final annex articulates how adolescent and youth issues are critical in addressing the SDGs and select targets.