India: How did young people get access to care during the lockdown?

Opinion

As the pandemic evolves, it will be crucial to ensure that young people have access to quality counseling services and other tools for psychosocial support. | Image Courtesy: Sanlaap

November 6, 2020 (IPS) – COVID-19 has turned into an unprecedented public health crisis, the impact of which has been seen on global health systems and services. As the crisis continues to evolve in India, it is necessary to examine the impact of the pandemic and the resulting nationwide closure on the lives of young people, particularly their experience of mental illness.

The Dasra Adolescents Collaborative conducted a survey of 111 youth service organizations, working with over 3,200,000 young people, to better understand their perspectives on the experiences of the people they serve.

The survey asked organizations whether one or more of the boys and girls they work with had reported health problems, difficulties in obtaining services, and variations in the incidence of these challenges, both before and after the pandemic began. He also asked for information on any action taken to improve the situation.

This article builds on the survey results, with a focus on the program’s implications for health and access to care while on lockdown.

Mental disease

The United Nations has reported a rapid global increase in mental health problems since the start of the pandemic. Additionally, research has indicated that prolonged quarantine periods can have a lasting negative impact on psychological well-being and, for teens and young people, an increased risk of post traumatic stress disorder (PTSD), as well as anxiety and depressive symptoms. Our study agrees with these trends:

• Panic and anxiety: Sixty-seven to seventy-four percent of the organizations surveyed reported that teenage boys and girls approached them with feelings of panic and anxiety. 46% of organizations reported that they were first contacted during the blockade by young people exhibiting these symptoms.
• Sadness and depression: 74% of organizations that worked with girls and 67% of those that worked with boys reported that young people had experienced sadness and depression for an extended period. In addition, 43% of organizations working with girls and 36% of those working with boys reported that mental health problems only emerged among teenagers during the lockout period.
• Suicidal ideation: As many as 5-6% of organizations reported that an episode of suicidal thoughts or attempted suicide first came to their attention during the lockdown. In comparison, 2-3% reported being approached by a young man who was contemplating or attempting suicide both before and during the lockout period.

To address young people’s need for mental health counseling, the organizations surveyed took a number of actions:

• Referral to a professional: 75% ensured that field staff provided appropriate counseling and referrals to young people in need; 48 percent referred the young person to a mental health care line run by themselves or a partner; and 26 percent referred the young man to another facility. Only 3% of organizations reported that no action could be taken.
• Stress prevention and management: 68% supported peer educators / leaders in their community in providing relevant information and conducting activities with groups of young people. Furthermore, 51% sought to strengthen the capacities of frontline workers to better recognize and address the concerns of young people. Other interventions included the preparation and distribution of written material (35%) or apps (25%) on stress management and other mental health issues for young people.
• Other strategies: 7% of organizations have adopted other strategies, such as setting up a mentoring program, chatbot or information center, referrals and outreach at Panchayati Raj institutions and community stakeholders. Responding organizations also elaborated on the use of various COVID-19 specific toolkits for children and young people, such as this one, created by UNICEF and ChildLine India.

Access to health services

Large proportions of responding organizations indicated that young people encountered difficulties in accessing health care during the lockdown:

• Diseases not related to COVID-19: 61% found that young people had difficulty accessing health care for injuries and illnesses unrelated to COVID-19 (89% of these organizations were able to support those who needed access to treatment timely or reach a facility or frontline worker).
• Menstrual health tablets and iron and folic acid (IFA): 74% indicated that young people were unable to access or had difficulty accessing sanitary pads. Additionally, between 35 and 54 percent indicated a shortage in weekly supplies of iron and folic acid (WIFS) supplements. Many of these organizations noted that such shortcomings were first experienced by young people during the blockade.
• Contraceptives and pregnancy-related health care: Twenty-six to thirty percent received reports that young people were unable to access contraceptives during the lockout period, while 52 percent reported that pregnant girls had had difficulty accessing antenatal care, childbirth and / or postpartum. What is noteworthy is that many organizations have reported that the difficulty in obtaining these services was only encountered in the aftermath and not before. Access to safe abortions has been particularly difficult, with 12% of organizations receiving reports of difficulties obtaining abortion services while being locked out.

Organizations have taken various actions to combat the aforementioned challenges.

1. Of the 81 organizations that received reports of limited access to sanitary pads or IFA tablets:

• 42% were able to advise authorities to provide supplies and 27% assisted officials in distributing supplies.
• 43% trained young people to hygienically use menstruation wipes and 40% tried to procure and distribute these supplies themselves. One responding organization also managed to get a free supply of sanitary pads from the manufacturer for distribution.
• However, 14% of organizations were unable to take any action to support obtaining sanitary pads or IFA tablets.

2. Among those who receive reports of limited access to contraceptives or pregnancy-related services:

• 49% alerted authorities, 30% assisted healthcare workers in distributing contraceptives at the community level, and 15% procured contraceptives and distributed them to the young people they served.
• Ninety-five percent took action to expedite the delivery of maternal and pregnancy-related care, and 37 percent warned frontline workers and other health care workers to take action.
• Finally, every organization that received reports of a girl having difficulty accessing a safe abortion was able to facilitate the provision of appropriate services.

What needs to be done in the future

As civil society organizations continue to address this crisis, some key recommendations include:

• Restoring the supply of sexual and reproductive health (SRH) supplies and services: It is crucial to expand service delivery mechanisms for young people, including the identification of alternative pathways to provide health services. This includes enabling health services to access private supply chains and enabling peer educators to identify young people in need and coordinate access to supplies and services for them.
• Strengthen existing platforms for healthcare delivery: Existing platforms, such as the community activities of Rashtriya Kishor Swasthya Karyakram (RKSK) and the links with Adolescent Friendly Health Centers (AFHC), need to be strengthened to ensure that frontline workers are able to continue providing SRH information , make referrals and distribute supplies.
• Create and implement emotional resilience programs: As the pandemic evolves, it will be crucial to ensure that young people have access to quality counseling services and other tools for psychosocial support, as well as virtual peer groups and social interactions. RKSK’s AFHC network and qualified consultants are also a key resource in this regard.
• Providing training and capacity building for professionals: There is an urgent need to train health professionals, including counselors and frontline workers, as well as school and university teachers, to use technology to deliver services digitally and identify early warning signs for young people at risk.
• Involve and train peer educators: Training peer educators already engaged in programs such as Ayushman Bharat and RKSK, as well as organizations’ youth champion networks, can play a vital role in identifying the early warning signs for physical and mental health problems among their groups refer to relevant facilities or suppliers.
• Investing resources in digital or telephone interventions: Developing new tools and maintaining existing accessible resources, such as hotlines, telemedicine resources, Find a Clinic services and other similar tools will ensure that young people and their families are able to access services as required .
• Creating awareness and raising awareness among parents: Training and raising awareness of parents about the needs of adolescents is essential, ensuring that they are able to communicate in an open and non-judgmental way, thus supporting young people to meet their sexual and reproductive health and mental health needs.

The information gathered by this study indicates that the health of young people has been severely affected by the pandemic and needs urgent attention from all stakeholders. There is a fundamental need to act on these recommendations, making sure we work to protect and address the needs of young people, to ensure that teenagers and young people across the country meet and live to their full potential.

Sucharita Iyer works on Dasra’s knowledge creation and dissemination team.

Shireen Jejeebhoy he is Director at Aksha Center for Equity and Wellbeing.

Nitya Daryanani is part of Dasra’s Adolescents Collaborative team, where she leads thought leadership efforts by bringing together a range of views on adolescents in India.

This story was originally published by India Development Review (IDR)