India Toolkit: AYSRH Services & Supply

Establishing Urban Primary Facilities as Adolescent-Friendly Health Clinics to Meet the Health Needs of Adolescents and Youth

Purpose: This tool is a guide on establishing urban primary health facilities as adolescent-friendly health clinics (AFHCs) to provide accessible, equitable, comprehensive and high-quality health services, including sexual reproductive health (SRH) services, to adolescents and youth (AY). This tool codifies the learnings from layering  of adolescent-friendly services to urban primary health centers’ (UPHCs’) service offerings.


  • Additional Director/Joint Director/Divisional Program Manager
  • General Manager (GM)/Deputy GM, Rashtriya Kishor Swasthya Karyakram (RKSK)
  • Chief Medical Officers (CMO)
  • Divisional Urban Health Consultant
  • District RKSK Consultant
  • RKSK Nodal Officers/Managers
  • Nodal Officers – Urban Health, Family Planning, National Urban Health Mission (NUHM)
  • Urban Health Coordinator/Assistant Program Manager, NUHM
  • Medical Superintendent of Urban Community Health Centres
  • Medical Officer-In-Charge (MoIC) and Staff Nurse of UPHC
  • District RKSK Counsellor

Background: Adolescents are stereotypically perceived as the healthiest population and often marginalized from mainstream healthcare services. An increase in the age of marriage coupled with the fact that the age at first sex has remained unchanged means that India now has a large and increasing cohort of unmarried sexually active adolescents, with low access to sexual and reproductive health services. Close to 20% of adolescents live in urban slums and are one of the more vulnerable populations within the target group of all adolescents between the ages of 10 and 19 years.

While analyzing the health management information system (HMIS) data on service delivery, it is evident that the common problem faced by most health facilities in India is the underutilization of health services by adolescents due to many reasons, such as lack of knowledge on the part of adolescents; legal, cultural and logistical barriers; high costs; and most prominently, poor quality of clinical services and unwelcoming facility environment. The recognition that adolescents have specific health needs and face various barriers in seeking and receiving healthcare has led the Rashtriya Kishore Swath Karyikram (RKSK), Government of India’s flagship program on adolescent health, to introduce criteria for initiating adolescent-friendly health services (AFHS) in both primary and higher-order facilities. As per RKSK’s mandate, AFHS are delivered through trained MoIC, ANM and counselors located at Primary Health Centers, Community Health Centers, District Hospitals and Medical Colleges.

In urban areas,  AFHCs were nestled in higher-order facilities, which are well-equipped with a multidisciplinary team, more staff available than other facilities and a dedicated adolescent counsellor. However, the distance and crowding of these sites from the slums often limit young adolescent girls and boys from accessing the services. Adolescent services must be made accessible, closer to the area where this vulnerable population lives and works, specifically primary health care facilities in urban areas should offer AFHS.

Evidence of Impact

Data reported in the Government of India’s HMIS portal for adolescent-friendly health services revealed increased footfall (i.e., adolescent clients availing services) for the three-year period among the 96 UPHCs in the five TCI-supported cities of Uttar Pradesh, where UPHCs had started offering adolescent-friendly services with TCI’s coaching support. The footfalls were examined using three different indicators—number of adolescents registered, number received counseling and number received clinical services captured separately for adolescent boys and girls. With AFHS being offered at UPHCs, there is a marked improvement in the adolescent health services data being recorded and uploaded from the 96 UPHCs into the HMIS from the five demonstration cities (Firozabad, Varanasi, Gorakhpur, Allahabad, and Saharanpur). This reporting of adolescent health services in HMIS started in July 2018. Before the start of the program implementation among unmarried adolescents, only 43 boys and 319 girls were registered for AFHS in the five demonstration cities. However, the number of adolescents registered greatly improved during the program implementation period. A total of 6,369 boys and 10,059 girls were registered for AFHS in the first year of implementation, i.e., from April 2019 to March 2020. This further increased by 7% (6,788 boys) and 19% (11,970 girls) in the second year of implementation from April 2020 to March 2021. Out of the total registered, 94.5% of boys and 92.2% of girls reported having received clinical services. Data also reflected an increase in adolescents seeking counseling services (89% out of total 18,758 adolescent registrants).

Later, TCI supported government in scaling AFHS to 238 UPHCs in 10 additional cities of Uttar Pradesh. The number of adolescents visiting the UPHCs across the 10 additional cities and registering themselves for services increased by 288% from 5,240 in April-September 2020 to 20,307 registrations in April-September 2021 according to HMIS data. Among the 20,307 registered adolescents, 89% voluntarily sought counselling services on nutrition, SRH and hygiene, while 91% of them also availed clinical services, for example , haemoglobin and body mass index (BMI) screenings and/or availed iron and folic acid supplements (WIFS) and albendazole pills. The evidence from these 15 cities provided a chronology of steps, which could transform an UPHC into a adolescent-friendly health clinic. The guidance steps are listed below.

Guidance on Establishing Urban Primary Health Centers as AFHCs

The following steps lead to transforming UPHCs into AFHCs and increasing AY access and utilization of health/SRH services:

Roles and Responsibilities

General Manager RKSK/Deputy General Manager RKSK
Chief Medical Officer
RKSK District Consultant/Nodal Officers/Managers
Medical Officer In-Charge
Auxiliary Nurse Midwife
  • Include urban AY health/SRH services as an agenda in the NUHM/FP/Divisional review meeting.
  • Ensure regular review of AFHCs in NUHM/FP/Divisional review meeting.
  • Issue guidance to all the cities to refer this AFHC tool as one of the guidance documents to establish UPHCs as AFHCs.
  • Participate/ensure participation of RKSK and other relevant departments in the CCC meeting.
  • Ensure AY services are mentioned in the UPHC’s citizen charter.
  • Issue directive to train UPHC service providers on RKSK’s AFHS curriculum.
  • Issue a directive to UPHCs to conduct WSO on AFHS.
  • Issue a directive to designate a day in a month for F-AHD at UPHCs.
  • Ensure smooth supply of AY logisticts, commodities and equipment to UPHCs.
  • Review the progress of each UPHC based on AY HMIS data and RKSK’s AFHC checklist assessment reports.
  • Proactively engage with CMO/NUHM department for selecting ready-to-start UPHCs for establishing as AFHCs.
  • Coordinate with CMO for the release of all necessary AY directives related to training, organizing AY events and supplies.
  • Participate in CCC meetings and leverage support of other departments for strengthening AY health/SRH services.
  • Lead in organizing training of service providers on AFHS, WSO for all UPHCs staff and training of ANMs on C-AHD with the support of District RKSK Counsellor and trained MoIC.
  • Proactively plan and organize facility and community adolescent health day in urban areas by taking all necessary measures into account in the district.
  • Arrange for AY-related IEC materials and job aids for UPHCs and ANMs.
  • Arrange for AY-related IEC materials and job aids for UPHCs and ANMs.
  • Coordinate with the stakeholders of other departments, community leaders/key influencers, youth organizations of the catchment area of UPHCs for motivating adolescents to participate in C-AHD and F-AHD.
  • Create a visit roster for District Quality Assurance Committee (DQAC) members, RKSK officials and NUHM officials to periodically monitor C-AHD and F-AHD services.
  • Lead implementation of periodic AFHC facility assessments of UPHCs.
  • Share the report of the AFHC facility assessments with MOICs for the course correction.
  • Provide supportive supervision to UPHCs based on AY service data and gaps identified in facility assessment reports.
  • Ensure WSO of all facility staff with the support of District RKSK Officials and RKSK Counsellor.
  • Lead management and execution of F-AHDs by coordinating with facility staff, ANMs and ASHAs.
  • Ensure supplies, commodities, contraceptives and equipment for F-AHDs and supervise facility readiness.
  • Ensure availability of AY-friendly job aids, IEC materials and condom box at UPHC.
  • Ensure services provided to AYs are in line with RKSK’s six domains and follow set norms.
  • Assign responsibilities to staff for providing AY services, such as lab technicians for haemoglobin screening, pharmacist for sanitary pads, WIFS and albendazole pills distribution and staff nurse for BMI screening and counselling services.
  • Ensure that AYs receive appropriate counselling and clinical services.
  • Ensure SRH services provided to AYs with respect, maintaining privacy and confidentiality and as per their choice.
  • Ensure AYs who need further clinical investigation or treatment are referred to appropriate specialty clinics.
  • Ensure correct record keeping of AY services data, timely reporting in HMIS and data review.
  • Conduct refresher coaching sessions of UPHC staff on AFHS, as per need.
  • Lead management and execution of C-AHDs.
  • Ensure record keeping of C-AHDs.
  • Coach ASHAs to prepare AY list from their UHIR survey data, create awareness about community and facility adolescent health day and refer AYs to higher order facilities.
  • Use IEC materials to provide information about health and SRH issues to AYs.

Monitoring & Evaluation

The CMO, state and district officials of RKSK, NUHM officials and DQAC members while visiting UPHCs must monitor and evaluate service provisions for adolescents. The AY data of UPHCs can be monitored as a regular agenda item for discussion in the district and divisional level meetings and monthly meetings of MoICs convened by CMOs. The following indicators should be reviewed:

  1. Number of UPHCs established and functional as AFHCs
  2. Number of Medical Officers (MOs) and staff nurses of UPHCs trained on AFHS
  3. Carder wise number of UPHC’s clinical and non-clinical staff trained through AFHS WSO
  4. Number of ANMs trained on executing C-AHD
  5. Number of C-AHD organized by ANMs
  6. Number of F-AHD organized by UPHCs
  7. Number of girls and boys participated in UPHC’s F-AHDs (refer HMIS section- 12.1.1.a and 12.1.1.b girls and boys registered in AFHC)
  8. Percentage of girls and boys received clinical services out of the total number of registration (refer HMIS section- 12.1.2.a and 12.1.2.b girls and boys received clinical services out of total number registered in AFHC)
  9. Percentage of girls and boys received counselling services out of the total number of registration (refer HMIS section- 12.1.3.a and 12.1.3.b girls and boys received counselling services out of total number registered in AFHC)

Cost Elements

The elements required for ‘establishing UPHCs as AFHCs’ are mentioned in the table along with their PIP codes for easy reference. They may be covered under existing budget line items, but if not, they should be incorporated through the PIP in the next cycle. Besides, any additional support can also be sought from the flexi-pool.

Cost elements/PIP Budget Head
AFHS training for MOs (only for 25 High Priority Districts (HPDs))
AFHS training for ANM/LHV (only for 25 HPDs)
Outreach activities by RKSK Counsellor (57 districts)
Kishore Swasthya Diwas (AHD) (Quarterly) (25 HPDs)
Kishore Swasthya Manch in Inter college (75 districts)
District level RKSK review meeting (75 districts)
ASHA incentive for mobilizing adolescent and community for AHD (25 HPDs)
ASHA incentives for ‘Health Promotion Day’
FMR Code

Source: Approved activity under RKSK guideline FY 2019-2020

*Note: The table above is indicative and illustrates the manner in which cost elements are provided in a government PIP, thus giving guidance on where to look for elements related to a particular task.


This approach can be sustained by ensuring trained and sensitized providers of UPHCs provide AFHS to AYs, irrespective of their age, gender and marital status. Moreover, the rising demand among unmarried AYs for health/SRH services will indicate sustenance of this approach.

Also, analyze and present the AY data in national and state level meetings and advocate for provisioning adequate funds in Program Implementation Plan (PIP) for urban adolescent program. Apart from the data review, ensuring facility assessment of UPHCs as part of government’s periodic evaluation ensure continuous quality improvement and ensures sustenance of these services.




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