Navigate the sub-sections
5.2.1 Two pathways for programming for adolescent well-being
5.2.2 Approaches to multisectoral action
5.2.3 Build leadership within the ministry of health and across the government
5.2.4 Ensure meaningful adolescent and youth engagement
5.2.5 Secure financing for adolescent well-being programmes
5.2.6 A renewed attention to school health and mental health programmes
5.2.7 Addressing adolescent health and well-being in humanitarian and fragile settings
5.2.8 Gender-transformative approaches in programming
5.2.1 Two pathways for programming for adolescent well-being
Translating national goals into actions and plans can happen in either of two ways. One is to establish an adolescent-specific programme - a coordinated and comprehensive set of planned, sequential health strategies, activities and services designed to achieve well-defined objectives and targets.
Features of an institutionalized adolescent health and well-being programme
A national programme for adolescent health and well-being is a comprehensive set of planned and sequential strategies, activities and services designed to achieve well-defined objectives and targets. (The terms project, initiative and programme are often used interchangeably.) Successful small-scale projects and initiatives
may mature into institutionalized national programmes.
In this guidance we focus on institutionalized adolescent health and well-being programmes.
Their common features are:
- statements in policy documents that support programme efforts
- a line item in a permanent health or education departmental budget
- a place on the organization chart
- permanent staff assigned to specific programme roles (for example, national, subnational and local coordinators)
- descriptions that specify functions and levels of effort
- facilities and equipment for programme operations
- an institutional memory for important agreements and understandings.
The second way of programming for adolescent health and well-being, in the absence of a specific programme, can take place as part of the sector’s strategic and operational planning cycles.
Programming efforts can achieve sustainable results only if efforts are made to strengthen the systems response, for example, by building adolescent-responsive health systems or health-promoting education systems.
Two friends in Ethiopia
To find out more about principles of programming for adolescent health and well-being, read the AA-HA! full document.
5.2.2 Approaches to multisectoral action
Multisectoral action includes two types:
- One is actions within multiple single sectors (for example, health, education, water and sanitation, environment or nutrition), all of which advance adolescent health and well-being.
- The second approach is intersectoral action, a joint action across and between sectors (for example, between health and education sectors or between environment and water and sanitation sectors). In some situations, especially if the programme goals cut across domains of well-being, an intersectoral approach can achieve outcomes in a way that is more effective, efficient or sustainable than might be achieved by the health sector alone. In contrast to single-sector actions, intersectoral actions require public policies that involve two or more ministries performing different and complimentary roles to achieve a common purpose.
Types of multisectoral action (click to enlarge the image)
5.2.3 Build leadership within the ministry of health and across the government
Implementation strategies to step up leadership for adolescent well-being within the ministry of health and across the government
1. Establish a national-level mechanism, or use existing platforms, to oversee and coordinate efforts for adolescent health and well-being across sectors and government ministries. Such a mechanism would facilitate the engagement of relevant agencies and civil society organizations, including adolescents themselves. It would also identify and periodically review priorities for intersectoral collaboration, create incentives to expedite the work, coordinate action across government ministries and promote accountability at all levels.
2. Appoint an adolescent health focal person in the ministry of health with the responsibility to:
- Work across departments within the ministry of health – for example, financing, workforce, primary care and hospital care – to ensure that all health programmes have an appropriate focus on adolescent health and well-being.
- Coordinate adolescent-specific programmes within the health sector or across sectors, depending on the mandate.
- Work with other sectors during their routine strategic and operational planning cycles to ensure Adolescent Health in All Policies (see section 5.2.2).
- Liaise with other sectors through an intersectoral platform and advocate strong leadership for adolescent health and well-being across the government and collaboration in pursuit of jointly owned health targets.
- Plan and manage intersectoral action.
3. Build national and subnational (for example, district-level) political and administrative capacity and leadership for adolescent health and well-being through:
- Developing decision-makers’ competence to use data for decision-making for adolescent health and well-being
- Applying skills in advocacy, negotiation, budgeting, building consensus, planning and programme management
- Collaborating across sectors
- Coordinating multi-stakeholder action
- Mobilizing resources
- Ensuring accountability
The more that decision-makers at the national level highlight adolescent health, the more that young people will be informed about SRH, family planning and the fight against gender-based violence.
To find out more about leadership within the ministry of health and across the government for adolescent health and well-being, read the AA-HA! full document.
5.2.4 Ensure meaningful adolescent and youth engagement
Engaging adolescents in decisions affecting their lives brings multiple benefits.
• From a pragmatic perspective, adolescent participation ensures better decisions and policies.
• From a developmental perspective, meaningful engagement has an essential positive influence on adolescents’ social and emotional development.
• From an ethical and human rights perspective, children’s right to participate in decision-making is protected in the United Nations Convention on the Rights of the Child
Key recommendations, based on the 771 responses, for enhancing meaningful adolescent involvement in health and well-being initiatives (click on the image to enlarge).
Governments can create an environment that values young people’s contributions and perspectives by recognizing their skills, knowledge and experiences. This can be achieved by providing training and resources to young people and ensuring that their input is taken seriously and incorporated into programmes and policies.
What are the modalities and principles for effective and ethical adolescent and youth engagement?
Adolescent participation can take several different forms including:
- Informing adolescents with balanced, objective information.
- Consulting, whereby an adult-initiated, adult-led and adult-managed process seeks adolescents’ expertise and perspectives in order to inform adult decision-making.
- Involving, or working directly with, adolescents in the communities on certain decisions and activities.
- Collaborating by partnering with affected adolescents in communities in each aspect of a decision, including the development of options and identification of solutions.
- Empowering by ensuring that adolescents in communities have ultimate control over the key decisions that affect their well-being.
The five basic principles of meaningful engagement are
Rights-based: Young people are informed and educated about their rights and empowered to hold
duty bearers accountable for respecting, protecting and fulfilling these rights.Transparent and informative: Young people are provided with full, evidence-based, accessible,
age-appropriate information that acknowledges their diversity of experience and promotes and
protects their right to express their views freely. There is clear mutual understanding of how young people’s information, skills and knowledge will be shared, with whom, and for what purpose.Voluntary and free from coercion: Young people must not be coerced into participating in actions
or expressing views that are against their beliefs and wishes, and they must always be aware that they can withdraw from any process at any stage.Respectful of young people’s views, backgrounds and identities: Young people are encouraged
to launch ideas and activities that are relevant to their lives and that draw on their knowledge, skills and abilities. Engagement will actively seek to include a variety of young people according to the relevant needs or audience. Engagements will be culturally sensitive to young people from all backgrounds and recognize that young people’s views are not homogeneous. They need to be appreciated for their diversity and be free from stigma.Safe: All adults and those in positions of authority working directly or indirectly with young people have a responsibility to take every reasonable precaution to minimize the risk of violence, exploitation, tokenism or any other negative consequence of young people’s participation.
Resources bank for adolescent participation in programming for well-being
5.2.5 Secure financing for adolescent well-being programmes
Implementation strategies for funding intersectoral programmes
Prepare a strategic and compelling plan for intersectoral investments in adolescents, making a strong case based on the triple dividend argument. Engage in negotiations with the ministry of finance over resource allocations.
Consider various financial mechanisms to implement a co-financing approach, such as pooled budgets, aligned budgets, joint commissioning, cross-charging and transfer payments. Implement those that are best suited to the context (for example, the existence of enabling legislation, the maturity of partnerships between sectors, grant conditions). The table entitled "Description of financial mechanisms used to implement the co-financing approach" describes the key features of intersectoral co-financing models and gives examples of their application in countries.
Before deciding and implementing a co-finance model, anticipate barriers and enablers to uptake, implementation and continuation of the co-financing and plan remedial actions from the outset. The table entitled "Barriers and enablers to uptake, implementation and continuation of co-financing models" available in the full document, describes key barriers and enablers for co-financing.
Invest in programme managers’ specific skills that are required in the development stage of co-financing, including negotiation, resource mobilization, effective communication and public financial management.
Implementation strategies for financing adolescent health and well-being priorities in national health plans
Prepare an investment case for a defined and costed national package of interventions for adolescent health and well-being and use it as a guide to purchasing decisions and benefit packages, giving particular attention to preventive services and adolescents’ rights to confidentiality. Estimate resource needs for implementation of the priority package of interventions and associated programme costs, using tools such as the One Health Tool.
Ensure that adolescents and their advocates are represented in the process of developing national health financing strategies and defining the essential benefit package, and that their needs are well-articulated and advocated.
Participate in, and advocate for adolescents in, the budgeting process at national and subnational levels, starting from the planning stage and throughout budget preparation, the release of funds and the monitoring of expenditures.
Ensure that adolescents’ needs are well articulated and advocated in discussions about strategic purchasing of services in order to achieve the government’s strategic objectives related to adolescent health and well-being:
Build the capacity of adolescent health focal points in the ministry of health to make evidence-based arguments for addressing adolescents needs in essential health benefit packages.
Build the agency and capacity of district and community managers to address priorities for adolescent health and well-being when making local adjustments to central budgets.
Build the capacity of national and district project managers to leverage external funds for adolescent health and well-being priorities, taking advantage of opportunities offered by the Global Financing Facility and strategic investments by the Global Fund and GAVI, the Vaccine Alliance, among others.
To find out more about how to secure financing for adolescent well-being programmes, read the AA-HA! full document.
5.2.6 A renewed attention to school health and mental health programmes
Investing in school health systems is a smart way for countries to improve both the health and the education of today’s learners and tomorrow’s leaders. Looking after the health and well-being of learners is one of the most transformative and cost-effective ways to improve education outcomes and make education systems more inclusive and equitable.
While governments in many countries are already investing in school health programmes, more needs to be done to ensure that these programmes are comprehensive and embedded in education systems to make them sustainable and to serve every learner in every school.
The UNESCO and WHO Global Standards for Health Promoting Schools is one important vehicle through which countries are being supported to build health-promoting education systems. The standards promote a holistic and sustained approach to school health and support the Make Every School a Health Promoting School initiative.
Global standards for health-promoting schools and their relationship
Access to
To find out more about to school health and mental health programmes, read the AA-HA! full document.
5.2.7 Addressing adolescent health and well-being in humanitarian and fragile settings
A recovery programme in a humanitarian and fragile setting should be guided by development principles that seek to generate self-sustaining, nationally owned, resilient processes for early post-crisis recovery. Therefore, the core implementation strategies outlined in the logical framework are the same in humanitarian and fragile settings as in other settings.
1. Coordinate
- Establish a child and adolescent health working group to integrate child and adolescent health priorities into the humanitarian response plan and to actively engage partners from key sectors to ensure an integrated multisectoral response.
- Advocate on behalf of child and adolescent health and well-being with health and humanitarian authorities.
- Participate in humanitarian response coordination structures to integrate child and adolescent health and well-being into humanitarian action.
- Identify key humanitarian actors, reach out to potential partners and work to establish common systems and avoid duplication.
2. Engage
- Establish systems for adolescent participation in decision-making (especially for girls and those with disabilities and other vulnerabilities) for developing and implementing responses at the community, provincial and national levels.
- Ensure that mechanisms for adolescent participation span the humanitarian programme cycle, including needs assessment and analysis, strategic planning, resource mobilization, implementation, monitoring and peer review and evaluation.
3. Communicate
- Develop a communication strategy for child and adolescent well-being. Communicate urgent messages without delay to the affected population.
- Implement, update and coordinate internal, multisectoral and multiagency communications and advocacy policies and processes to ensure that all messages support children’s and adolescents’ needs for protection and well-being. Avoid messages that re-traumatize children and adolescents or create fear, division or violence.
4. Assess and prioritize
- Ensure a systematic, objective and ongoing assessment of the context and its impact on child and adolescent health, nutrition and well-being. Assess the safety and security of affected, displaced and host populations of children and young people to identify threats of violence and any forms of coercion, denial of subsistence or denial of basic human rights.
- Assess and address gaps in existing resources and capacity to ensure access of children and young people to critical interventions and services.
- Prioritize child and adolescent health and well-being interventions, confronting the biggest causes of death and morbidity with the most cost-effective tools. Give extra attention to populations at high risk.
5. Train staff
- Train staff, including clinical staff (community health workers, nurses, midwives, doctors, paramedics, national and international volunteers). to provide care that respects adolescents’ right to information, dignity, best interests, safety, autonomy, self-determination and participation.
- Develop the capacity of child protection workers and all health and humanitarian workers to prevent, detect and respond appropriately to child protection issues.
6. Provide health services
- Adapt, improve or establish adolescent-responsive service delivery structures such as flexible and integrated adolescent-friendly health services or temporary/mobile community clinics. Provide comprehensive one-stop SRH services for adolescents, home-based care, education and outreach through non-health facilities and safe spaces.
- Use innovations to enhance the capabilities of existing service delivery platforms:
- social media to provide quality health information and share information;
- flexible outreach strategies, including transportation budgets sufficient to reach adolescents in insecure environments and otherwise hard-to-reach areas.
- Provide services to tackle key health concerns in adolescents:
- preventive care: contraception, condoms, emergency contraception, prevention of sexual and gender-based violence, mental health, sexuality education, life skills, maternal health care including family planning counselling, voluntary counselling and testing for HIV, iron and folic acid supplements;
- treatment: treatment of traumas and orthopaedic surgery, emergency obstetric and neonatal care services, nutrition, comprehensive abortion care, clinical care for survivors of sexual violence, treatment of STIs, emergency skilled birth attendance, postnatal care including for postpartum depression and antiretroviral treatment;
- supplies: ensure the availability and provision of menstrual hygiene kits (dignity kits), post-rape kits, STI kits, contraception kits.
7. Education and recreation
- Ensure safe spaces for education that are disaster-resilient, safe, dignified and accessible to all children and adolescents.
- Address barriers to school enrolment and issues related to school retention for specific groups at greatest risk, such
as girls, young mothers, and children and adolescents with disabilities. - Provide targeted support for schooling options (for example, safe passage, financial support to families, cash and voucher assistance), vocational training and access to life skills and comprehensive sex education in and out of schools.
- Ensure safe spaces for recreation and play, especially for girls. Remove barriers that might exclude adolescents with disabilities.
- Ensure safe access to and use and maintenance of toilets. Ensure availability of materials and facilities for menstrual hygiene management.
8. Nutrition
- Ensure safe, adequate and appropriate nutrition services, especially for pregnant and lactating women and girls.
- Implement integrated response interventions for households at risk of malnutrition.
- Develop and implement child- and adolescent-friendly multisectoral referral mechanisms and standard operating procedures for malnutrition cases.
9. Protect
- Map existing protection services. Identify and address gaps.
- Support the most at-risk children and adolescents.
- Sexual violence. Recognize that sexual violence is common. Seek to understand local perceptions and reactions. Disseminate sexual violence prevention messages. Educate health and allied staff to look for, recognize and respond sensitively to sexual violence. Report information as specified by national laws and international norms.
- Armed forces. Assess involvement of
children and adolescents in armed forces, community perceptions, and demobilization and reintegration activities. Support schools and other institutions protecting children. Share prevention, reporting and survivor
care information. - Survivors. Develop age-appropriate survivor assistance that includes medical care, physical rehabilitation, psychosocial support, legal support and economic, educational and social inclusion. Provide non-stigmatizing support for those who need additional attention (for example, those involved in armed forces, pregnant girls, sexually exploited children and adolescents, and girls who are pregnant as a result of rape).
- Child labour. Prioritize action against the worst forms of child labour, including forced/bonded labour, armed conflict, trafficking, sexual exploitation, illicit work and unsafe work. Involve affected families and other local stakeholders in responses.
- Unaccompanied and separated children. Assume all children have a caring adult with whom they can be reunited until tracing proves otherwise. Review existing legal systems and procedures for family tracing and reunification. Assess the scope, causes and risks of family separation. Take practical steps to prevent separation (for example, reception registers, identity cards). Re-establish community support networks and structures for orphans and vulnerable children. Ensure that adolescents who have lost their parents or carers have consistent, supportive care. Avoid unintentionally encouraging abandonment (for example, advertising special assistance to unaccompanied and separated children).
- Justice system. Strengthen child-friendly spaces in courts and police stations. Identify children in detention (especially arbitrary detention) and patterns of violations. Promote diversion activities to resolve issues without the trauma of the justice system. Diversion activities are referrals of matters away from the formal criminal justice system, usually to programmes or activities.
- Establish procedures for informed consent/assent.
- Support participants’ ownership of their personal information and control of its use.
- Prevent possible conflicts of interest between data collectors and respondents.
10. Monitor and evaluate
- Monitor programme quality, outputs, outcomes and, where possible, impact. Monitor changes in the adolescent well-being situation and adjust programme implementation accordingly.
- Collaborate with children and adolescents and other stakeholders to design, implement and monitor information-gathering mechanisms that are adolescent- and child-friendly, confidential and sensitive to gender, age, disability and culture to gather and process feedback and reports from children, families and communities.
- Build flexibility into the programme design so as to incorporate M&E feedback in a timely manner and immediately address any safeguarding issues.
- Share findings and learning from assessments, monitoring, feedback and accountability mechanisms with all stakeholders, including children and families. Ensure that they recognize how their efforts have contributed
to programmes.
Efforts should be made to reach young people from different contexts, especially those in humanitarian settings and hard-to-reach areas and not forgetting the disabled. With that, a holistic approach can be assured.
To find out more about gender-transformative approaches in programming, read the AA-HA! full document.
5.2.8 Gender-transformative approaches in programming
Gender is a powerful determinant of adolescent well-being, as sex and gender intersect with other drivers of inequalities. These include gender-based violence, stigma, discrimination and child marriage as well as discrepancies in income and age, all of which exacerbate the vulnerability and susceptibility of adolescent girls and boys to health and social risks. Sex and society, nature and nurture, genetics and environment all interact in complex ways to determine adolescent well-being.
To achieve the goal of gender equality, programmes need to apply the process and strategy of gender mainstreaming.
Gender mainstreaming and why it matters
Gender mainstreaming is a process of assessing the gender implications for both adolescent boys and girls of any planned action, including legislation, policies and programmes in all areas and at all levels. The starting point for gender mainstreaming is gender analysis. As a strategy it involves recognizing and taking into account the sometimes-differing concerns and experiences of girls and young women, on one hand, and boys and young men, on the other, in the design, implementation and M&E of adolescent well-being policies, budgets and programmes. This matters not only because diverse adolescent boys and girls have different needs but also because the different roles and expectations of a society for boys and girls dictate what it means to be male and female. These roles and expectations shape the context and the situation in which programming is conducted. By applying gender mainstreaming, programmes are more effective in promoting equality and not perpetuating inequality.
Without gender mainstreaming, programmes risk being gender unequal or gender-blind. Adolescent health and well-being programmes and interventions should, at a minimum, be gender-specific and, ideally and when possible, gender-transformative.
Gender-responsiveness scale
Resource bank for gender mainstreaming into adolescent health and well-being programmes
