In his welcome message, Dr. Sunil Mehra, Chair of the national organizing committee, said this congress would provide an opportunity to learn and share from the vast range of experience gathered in Delhi to discuss and consider future directions. The scientific program for the World Congress had been put together by a “galaxy” of international and national experts and reflected both global and regional health needs of adolescents.

Anthony Costello, Director of the WHO Department on Maternal, Newborn, Child and Adolescent Health aptly stated in his opening speech that it’s time to strike a balance between instructing adolescents and engaging them in the process. He came up with a rather interesting acronym of his own email address: adolescent programs should be “Country-led, (show) Ownership, Systems, Teams, Equity/evidence, Leadership, Learning Operational science”, in short costello@who.int   – Now adolescents from around the world can start spamming him:)

The conference also brought in some new research and debates on topics such as mental health, nutrition, interactive media, adolescents in humanitarian settings, SRH/HIV taking into consideration adolescent brain development. Vikram Patel talked about a few new theories while re-thinking mental health in adolescents, based on neuroscientific and psychological observation. Adolescents are biologically and evolutionarily “primed” to behave the way they do, he said (if you have teenagers at home, you probably know what Vikram was referring to). While these developmental characteristics offer survival advantages they also present unique vulnerabilities. The social settings that teenagers live in are key to understanding “risk” behaviors and poor mental health. Mental and substance use disorders and injuries are leading causes of death and disability in both genders, and across the youth age spectrum in all countries (irrespective of their development index). 75% of mental disorders start before the age of 24, that is one good reason why the world should bother.

¨Social media, sexting, addiction, Oh My, adolescent Health in the digital world¨ (we admit this session title sounds a bit like a blog from our famous & very media-savvy EV colleague Shakira) was also a popular discussion, and co-chaired by our own Caroline Crosbie, Vice President of Pathfinder International. Dr. Michael Rich, `Mediatrician’ from the Centre on Media and Child Health (CMCH)  said that many teenagers are now suffering from “Fear of Missing Out” (FOMO), hence they are always online. Research shows that teenagers are spending much more time online than on homework (surprise surprise : ) ) and other activities.  Half of the teenagers surveyed by Dr. Rich felt they were `addicted’ to social media and 30% of the parents felt the same. Maybe it’s contagious. Given the advantages of (using) social media and the fact that media abstinence is rather difficult (like all forms of abstinence), striking a good balance between utilization of social media and other activities should perhaps be the aim. Parents should use media with the kids, learn from them (if need be), help them develop critical thinking, prioritizing and managing time, and create and be present.   Now if you think this sounds like parents “too good to be true”, you’re probably right. Which is why much of this typically ends up on schools’ plates.

Current countries’ policies do not target adolescents in humanitarian settings. In our world in turmoil, various reasons spark adolescent migration such as displacement, wars, the search for better opportunities and so on. However, when they reach host countries, they are often confined to prison-like places. In many of these countries, they fail to seek health care due to fear of deportation as they might be regarded as illegal immigrants, leading to challenges such as depression. At the World Congress, countries were advised to revise their policies. It might take masses of adolescents shouting this aloud before countries will actually listen.

¨Young, married and powerful, building momentum toward a brighter future¨ organized by Pathfinder International, was one of 9 satellite symposia sessions. An interesting discussion on successes and challenges in SRH programming for young married and unmarried adolescents, involved one emerging voice for Global Health 2016. In case you want to know more about this session, do get in touch with us. (but good to know perhaps: we’re already young, married and powerful!  )

Speaking of young people, how did they fare at the conference? Well, for the past three days, 150 energetic young people delegates were mainstreamed into the conference, had an opportunity to sit together, gather ideas and draft their own new charter that focused on 8 priority areas; rights based sexual and reproductive health, comprehensive sexuality education, gender based violence, mental health and suicide, adolescent and young people in humanitarian settings, sexual identification, gender identity, HIV/AIDS and non-communicable disease. After presenting their charter they urged donors, policy makers, countries and partners to prioritize young people’s concerns. This charter will make a case for young people to be recognized as equal stakeholders in decision making at all levels. One of the youth ambassadors insisted, “if you don’t have a space on the table, just sit on the floor, be engaged!”

As you might know, Adolescent Health has been gaining momentum on the global health policy agenda in recent years. A bit belatedly, perhaps, but better late than never. Now it’s time to step out of these high-level airconditioned rooms (even if we were grateful that the conference venue had air-conditioning, given the temperature in Delhi) and take action. We need political will and commitment; we need to align the guidelines with national priorities, engage young people throughout the process, turn the spotlights to adolescents and bring (more) visibility to the issue.

THE FUTURE IS NOW!

Nigerian Ibo Proverb

Between 21^st and 23^rd February 2017, the Makerere University School of Public Health (MakSPH) hosted the first International Symposium on Community Health Workers (CHWs) in Kampala, Uganda. This symposium brought together over 450 delegates from over 20 countries across Africa, Asia, Europe and America. Themed “Contribution of Community Health Workers in Attainment of the Sustainable Development Goals”, the event comprised 3 keynote addresses, 5 plenaries, 127 oral presentations, 27 posters, 13 panel discussions, 2 capacity building workshops and a book launch. On the sidelines of this symposium, World Vision in collaboration with CHW Central hosted a blog series on CHW work. Alongside this, Healthcare Information For All (HIFA), with support from the Health System Global (HSG) Thematic Working Group on CHWs hosted an online thematic discussion on CHWs between 16^th January and 24^th February 2017. This editorial synthesizes the debates during the 3-day event in Kampala.

Opening speeches given by policy makers – the Honorable Minister of State for Primary Health Care and the Honorable First Deputy Prime Minister – were fairly gung-ho about how committed the government of Uganda is to ensure that CHWs programmes lead to the attainment of the health related SDG goal 3, and other health related SDG targets. These commitments are echoed in most policy statements in low and middle income countries (LMICs). So policy makers came up with flowery statements, as they usually do, but a somewhat different picture was painted in the presentations and panel discussions. Community Health programmes still face pervasive challenges, among others: insufficient supportive supervision, high attrition rates, lack of incentives and essential supplies, low morale. Therein lies the disconnect between the zealous policy statements on CHW programmes and reality in many LMIC settings. In the spirit of the Ibo proverb “If one tells of a place where the rain met him, he is given a place to warm up by the fire”, this symposium provided a platform for researchers and program managers (among others), to bring these issues to the surface and seek solutions.

As Dr Polly Walker – the community health programming advisor at World Vision, UK – aptly stated in her key note address, it’s time to move on from the same old discussions on performance and functionality. We need to get out of the survival mode. She added, “We need to shift focus in this SDGs era from vertical non-governmental organization (NGO) programs to Ministry of Health (MOH) driven multi-sectoral CHWs programs”.

For LMICs to achieve health related SDG targets and Universal Health Coverage (UHC), Professor Francis Omaswa from the African Centre for Global Health and Social Transformation (ACHEST) emphasized: “LMICs have lost ownership and have become cases of global pity needing money and ideas, they need to develop home grown ideas and technical leadership”. A common thread from the discussions was that there’s no need to reinvent the wheel, rather we should strengthen the existing community health structures. It is imperative for policy makers and Ministries of Health to deliberately allocate sufficient resources and political support to ensure the success of community health programmes.

All along, we have asked what community health workers can do for the health system. We feel it’s an opportune time now to ask what the health system is actually doing for the community health workers. We all know what to do, so let’s do it together!