Indian health professionals visiting a youth clinic at Roseum in Malmö.
Photo: Vandana Nair
Indian visit to learn about youth and sexual health
"If you are to approach young people in a better way when working with sexual and reproductive health, then you have to start by changing yourself. Sex is still a sensitive issue in India and many other countries of South Asia, and as long as the service provider thinks it is uncomfortable to talk about these issues, it will be hard to support the youth."
The words come from Dr Poonam Kattar who is responsible for education on health of youth at the National institute of Health and Family Welfare (NIFHW). Together with the Institute’s director Professor Jayanta K Das and adolescent reproductive and sexual health nodal officers from 19 states of India, she is in Sweden to learn from the Swedish colleagues at Lund University's department for Social Medicine and Global Health.
During group exercises, the participating public health professionals have had to discuss various issues and reflect upon their own attitudes towards sexuality. This has launched the internal change process that is necessary in order to change the way of working at home. The fact that the leader is Swedish, with roots in another culture, makes it easier to start talking about sensitive issues.
"We have learned a lot from our Swedish colleagues: to have a friendly attitude, not to judge young people but rather offer them information and let them make their own decisions. Privacy and confidentiality are also important in order to build trust; that they can feel confident that the doctor or nurse will not pass on the information," says Professor Jayanta K Das.
He does however stress that this work is in the beginning of a long process. It takes time to change traditional values, mind-sets and behaviours that are deeply rooted in a culture.
The initiative to create more youth-friendly health services started in 2008 when Lund University partnered with the MAMTA, Health Institute for Mother & Child in Delhi, India. Two years later NIFHW joined the programme, hence strengthening it as part of the government's focus on adolescent reproductive and sexual health. A total of 23 participants from 19 Indian states have so far participated in the programme, which is divided into different parts. After three weeks of initial training they have had to propose and implement a change project in their health care facility at home.
Young women important to reach
"One example of a successful change projects was conducted by a female gynaecologist in the state of Uttar Pradesh", says Dr Poonam Kattar. "She found it difficult to reach out with information to expecting young mothers. So during six months, she gathered all pregnant women between the age of 16 and 21 in a special group where in addition to medical check-ups, they received counselling and watched information films on the issues of adolescent pregnancy – one of the significant contributors to maternal mortality in developing countries."
Young girls are a particularly important group to reach according to Professor Jayanta K Das. These future mothers need to become aware of the importance of good nutrition during pregnancy. Or what to do when they get their menstrual period. Many young girls do not even know what menstruation is, the first time they realize they’re bleeding.
"A survey conducted on menstrual hygiene reveals a huge ignorance. When we asked what they use as sanitary protection, many of the answers were beyond our imagination: unclean rags, sand and even ashes are being used," says Professor Jayanta K Das.
Young men also need to improve their knowledge. They rarely get to learn about sex and sexual health at home or at school, but the information rather comes from media and peer buddies. If they get a wrong understanding of how girls can become pregnant or how venereal diseases are transmitted, the notion is difficult to change afterwards.
The cooperation between Sweden and India is not funded through traditional aid, but it is part of Sida's work with Partner Driven Cooperation. The purpose is that there should be a mutual benefit and interest to cooperate, which Dr. Anette Agardh at Social Medicine and Global Health at Lund University is willing to confirm:
"We have learned a lot about how the health service system works in India. We have also been able to use the network we have developed with MAMTA and the Institute in order to offer students internships in India, and for exchange of post graduate students," she says.
About the collaboration:
The National Training Program on Youth Friendly Health Services is a collaboration between the Lund University, the organisation Health Institute for Mother & Child (MAMTA) and the National Institute of Health and Family Welfare (NIFHW). The programme runs between 2010 and 2013 and falls under the MoU (agreement) on Health between India and Sweden to promote cooperation of mutual benefit, and with funding from Sida through its Partner Driven Cooperation initiative.
The purpose of the training programme is to educate health care providers and managers from India in how to better provide youth friendly health services, with a focus on sexual and reproductive health.
The programme is part of India's National Rural Health Mission launched in 2005, which aims to provide effective healthcare to rural population of India. Particularly young people's sexual and reproductive health is a key strategy in this work.
The four weeks training programme are carried out in India and in Sweden, and includes participatory discussion exercises and study visits in Swedish youth clinics. Participants will also have to initiate and develop a change project that will be implemented at the local health facility with mentoring support from the experts of three institutions.
All participants are physicians, including program managers for the National Rural Health Mission in the state or district level. They will in their turn train other healthcare professionals in their health service facilities.
Sida contributes a total of 10 million over 3 years. When the funding from Sida and Lund University runs out in 2013, NIFHW will take over and continue the initiative.