ARSH scheme

The Adolescent Reproductive and Sexual Health (ARSH) Strategy is a key initiative launched by the Government of India under the Reproductive and Child Health (RCH) Programme – Phase II and later integrated with the National Rural Health Mission (NRHM). The scheme was designed to address the diverse and often neglected health needs of adolescents, with a special focus on their reproductive and sexual health. It represents the first structured national effort to promote adolescent-friendly health services across India.

Background and Rationale

Adolescents, defined as individuals between the ages of 10 and 19 years, constitute a significant portion of India’s population. This age group faces unique health challenges, including early marriage, teenage pregnancy, malnutrition, menstrual hygiene issues, sexually transmitted infections (STIs), and mental health concerns.
The ARSH Strategy was formulated to recognise and respond to these challenges, ensuring adolescents have access to accurate information, counselling, and confidential healthcare services. Improving adolescent health is crucial not only for the wellbeing of young people but also for broader national goals such as reducing the Maternal Mortality Rate (MMR), Infant Mortality Rate (IMR), and Total Fertility Rate (TFR).

Objectives

The primary objectives of the ARSH Scheme are:

• To provide adolescents with accessible, equitable, and gender-sensitive health services.
• To promote responsible sexual behaviour and awareness of reproductive health.
• To enhance knowledge and attitudes about nutrition, hygiene, and mental wellbeing.
• To delay early marriage and prevent early pregnancies.
• To create an enabling environment for adolescents to make informed health decisions.

Components of the ARSH Strategy

The ARSH Strategy offers a comprehensive package of promotive, preventive, curative, and counselling services, delivered through adolescent-friendly healthcare platforms.
1. Promotive Services

• Life-skills education to promote self-confidence, communication skills, and decision-making.
• Nutritional awareness programmes to prevent anaemia and malnutrition.
• Education on menstrual hygiene and personal care.
• Campaigns on delaying marriage and responsible family planning.

2. Preventive Services

• Screening and counselling for reproductive tract infections (RTIs) and sexually transmitted infections (STIs).
• Immunisation drives and health check-ups.
• Distribution of iron-folic acid supplements to prevent anaemia.
• Education on contraception and prevention of HIV/AIDS.

3. Curative Services

• Treatment for reproductive and sexual health problems, including infections and menstrual disorders.
• Counselling and management of emotional and psychological issues.
• Referrals for specialised medical care where needed.

4. Counselling and Referral Services

• One-to-one and group counselling sessions for adolescents to discuss issues confidentially.
• Referral systems for higher-level healthcare facilities in case of complex or sensitive medical needs.

Implementation Mechanism

The implementation of the ARSH Scheme is carried out through the following key measures:

• Adolescent Friendly Health Clinics (AFHCs): Specialised clinics established at Primary Health Centres (PHCs), Community Health Centres (CHCs), and District Hospitals where adolescents can access confidential health services.
• Trained Personnel: Doctors, nurses, and counsellors receive special training to ensure non-judgmental, youth-friendly, and gender-sensitive service delivery.
• Community Outreach: Peer educators and community workers engage with young people, families, and schools to raise awareness and encourage utilisation of ARSH services.
• Intersectoral Coordination: Collaboration with departments such as Education, Women and Child Development, and Youth Affairs to integrate adolescent health into wider developmental programmes.
• Monitoring and Evaluation: Regular assessment of service delivery, utilisation rates, and quality of care through data collection and supervision mechanisms.

Achievements

The ARSH Strategy marked a major step forward in mainstreaming adolescent health in India. Key achievements include:

• Establishment of a wide network of Adolescent Friendly Health Clinics across the country.
• Introduction of structured counselling and education programmes on reproductive and sexual health.
• Increased awareness among adolescents about hygiene, nutrition, and responsible sexual behaviour.
• Integration of adolescent health priorities into district and state-level health planning.

Challenges

Despite its achievements, the ARSH Strategy faces several challenges:

• Low Awareness and Utilisation: Many adolescents, particularly in rural areas, are unaware of the existence of ARSH services.
• Social and Cultural Barriers: Stigma surrounding discussions on sexuality and reproductive health restricts open communication and access to services.
• Inadequate Infrastructure: Limited privacy, lack of trained counsellors, and shortage of dedicated facilities affect service quality.
• Gender Disparities: Girls face greater barriers due to societal restrictions and limited mobility.
• Funding and Coordination Issues: Resource constraints and uneven implementation across states slow progress.

Transition to the RKSK Programme

In 2014, the ARSH Strategy was expanded into a broader framework known as the Rashtriya Kishor Swasthya Karyakram (RKSK). The RKSK extended the ARSH focus beyond reproductive and sexual health to include areas such as:

• Nutrition and anaemia control.
• Mental health and substance abuse prevention.
• Non-communicable diseases and injuries.
• Violence prevention and gender equality promotion.