attainment of monitorable maternal and child health indicators in chandigarh through integrated...
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Attainment of Monitorable Maternal And Child Health Indicators
In Chandigarh Through Integrated Service Delivery Approach
like Prenatal Genetic Screening,
Support To HIV/AIDS Affected Pregnant Women/ Children & By involving
Officials, Scarce Grass Root Level Workers, Community Vis A Vis UN MDGs Timelines
Anil Kumar, (IAS)Secretary Health Cum Secretary Home,
U.T. Chandigarh
Monitorable IndicatorsSr. No Indicator India Chandigarh Chandigarh Chandigarh Source
Status 2011-12 2012-13 2013-14
1. IMR (SRS) 47 22 20 -- SRS 2011
2. MMR 212(MMR Bulletin)
18 (Total number of Maternal deaths)
15 (Total number of Maternal deaths )55.45
8(Total number of maternal deaths) till Nov-13
All delivery points and Registrar Birth and Death, Cremation ground.
3. TFR (SRS) 2.5 2.1 1.8 _ SRS-2007
4. % of Institutional Deliveries
61.5 92 94.3% _ HMIS differential figures available for all areas in Chandigarh.
5. Full Immunizations (%) (State HMIS)
86.03 89.23 % 94.41% 102.07 % (till Sep-13)
HMIS
Where Do We Stand !!!U.T. Chandigarh has bagged the following three prizes
as announced at SKICC, Srinagar on 4th July, 2013 during the National Summit on Best Practices &
Innovations by Various States / U.Ts.
• Award for Infant Survival (Small States )- ranked 3rd - IMR is the indicator used (SRS data)
• Award for Indoor and Surgical Services (small States) - ranked 1st - HMIS data on IPD+ Major Surgeries is the indicator used
• Award for Out-Patient Services (small states) - ranked 1st - HMIS data on OPD attendance is the indicator used.
Fwd: Awards won by ChandigarhMonday, 15 July, 2013 10:20 AM Mark as Unread Flag this messageFrom: "Nodal Officer" <[email protected]>To: "dfwochd" <[email protected]> "NehaPandey" <[email protected]>Full Headers Printable View---------- Forwarded message ----------From: sonalirawal<[email protected]>Date: Mon, Jul 8, 2013 at 4:43 PMSubject: Awards won by ChandigarhTo: "nrhmchd ."<[email protected]>, [email protected], [email protected]
Dear Sir/ Ma'am, The following are the awards for Chandigarh announced at Srinagar on 4th July, 2013:1. Award for Infant Survival (Small States )- ranked 3rd - IMR is the indicator used (SRS data)2. Award for Indoor and Surgical Services (small States) - ranked 1st - HMIS data on IPD+Major Surgeries is the indicator used3. Award for Out-Patient Services (small states) - ranked 1st - HMIS data on OPD attendance is the indicator used. Best Regards, Dr.Sonali RawalConsultant NRHM
-- Thanks & Regards
Nodal OfficerNRHMChandigarh
Our Achievements and Vision
1. Gender Equity• Effective screening/treatment /rehabilitation plans for the unborn, new born baby (with
genetically transmitted disorder/disease) and his/her family. • Assured treatment to HIV +ve pregnant women and her new born.• Attainment of 0 % Home delivery in Rural, Urban and Slum areas and huge reduction in
other vulnerable areas. • Effective involvement of male health workers. , lady health visitors.2. High Cost Containment.3. Administrative reform/Architectural correction for effective Scarce/scanty/skilled
manpower utilization through Change management .i.e. Mentoring, Leadership. Motivation for KAP. Supportive supervision. ---------------------of maternal and child health services at the
service delivery point. Time management Inbuilt monitoring into the documentation.4. Effective use of e -Office product / ICT for easy data retrievability.5. Quality data generation, triangulation and utilization for e.g. initiation of social
networking programme and two and fro referral mechanism to decongest the secondary and tertiary health centers.
6. Effective convergence and social networking.
Quality data generation, data triangulation and utilization
Basis of the initiative Outcome of the initiative Impact of the initiative
Data generation was not as per the requirement of various divisions of MoHFW , NHSRC (HMIS), MCTS, requirements by the Chandigarh Administration, 15 point programme etc. at Local level etc.
The current requirements under the programme are very vast.
• High Risk Pregnancy Detection.
• Anemia Tracking.• Assured contact with
decision makers & neighbors in peri-natal period (Social Networking Programme)
• Improvement in timely Health Seeking Behavior
• Increase in Institutional Delivery Rate .
• Differential Data is available for all areas
• Every worker is able to link one data element with other for self monitoring.
• Decentralization of delivery beds to avoid over crowding.
• Development of back referral system.
• Decrease in IMR & MMR
• Remarkable decrease in Home delivery rate in vulnerable areas (Home Delivery, Synopsis Institutional Delivery) zero%
• Timely postnatal, neonatal care • Easy data retrievability• Monitoring has been inbuilt into the system (PN Format, FP Format)• Differential Data is available for all areas
E- office / ICT
Based on quality data generation by reformulation of recording & reporting formats through participatory approach
with all heath workers, U.T. Chandigarh had achieved TOP RANK in the country by registering 100% children & 4th RANK
for registration of pregnant women around 96% on line within two months of initiation of the online registration
(MCTS) activity as per informatics.nic.in2012 April bulletin, page 6.
Effectiveness ALSO reveals through appreciation received in shape of Awards during
National Summit ON Best Practices at SKICCS, SRINAGAR ON 4th to 6th July 2013 :
• Award for Infant Survival (3rd Rank in small States and U.Ts - SRS data)
• Award for Indoor and Surgical services (1st Rank - HMIS data)
• Award for out patient services (1st Rank – HMIS data)
Increased efficiency of outputs/processes and effectiveness of outcomes
• 2nd Rank in Crude Death Rate in India
• 3rd rank in Infant Mortality Rate in India
Further, Based on the success of current computerized services ,(OPD registration, diagnostic test records,
discharge cards, birth & death registration, post mortem records, online national HMIS, MCTS, the e Office
facilities are being extended to HR management, e-filling etc. etc. to enhance transparency and time
management and reduce physical handling of the files)
Best Use Of available Technology
Basis of the initiative
E-office
Outcome of the initiative Impact of the initiative
Poor data retrievability & Poor flow of data & Poor data recording
1. Real Time Data Entry2. Better Recording & Reporting System
• Transparency.• Security.• Time management.• Decrease in physical handling of
files.• Easy retrievability of data
Currently.
Rs. 18 Lakhs have already been deposited for future edition of E-HR/Indoor/other filing System with NIC, U.T. Chandigarh.
Best Use Of Technology
Basis of the initiative Current Status/ Outcome Impact
So far the focus has been only on the curative aspect and the advanced technology for prenatal, perinatal screening has been under-utilizedPeri-natal & Neonatal Screening for Genetically Transmitted Diseases & Disorders on regular basis as the socio economic burden is much higher than screening for early action.
Genetic Center GMCH-32 •Chandigarh can soon be a down-syndrome free city
•Quality of Life of Survivors shall improve.
•Reduction in Financial, Mental, Social Burden on the Family, Society & the Nation.
i.e. high cost containment
Gender Equity
Basis of the Initiative taken
Methodology adopted and out come
Impact
Many a HIV positive pregnant women are denied hospital care during delivery.
HIV, NACO report
Assured care through sensitization of the stakeholders.
• Improvement in life of the Survivors.
• Dignity of the HIV +ve Mother and Child is saved.
• Social discrimination is reduced
Inequity in health care to a female child / declining Child Sex ratio
Medical audit frame work. There has been 45 point rise in the female child survival above 7 years of age as per census 2011.(Convergence)
JSY enrolment For the welfare of the BPL/SC/ST category without any certificate, special teams have been formulated for verification for eligibility JSY enrolment under mission convergence. (JSY).
Gender equity is being ensured
Gender Equity through cost effective behavior change communication within shortest possible period
Basis of the initiative taken
Methodology adopted and out come
Impact
Delay one is the major hindrance to achievement of Monitorable indicators So micro-Birth Plans are assured for all areas in differential manner.
• Improved peri-natal care, Ensured additional visits to low birth weight babies.
• The patient who has delivered at home is tracked many times on the same day.
• Increase in the Hospital Delivery Rate,
• Decrease in the MMR,IMR, adoption of PPIUCD and Post partum sterilization.
Male participation for population sterilization is poor.
• Bhushan factory Page IPage II• Services at the door step of the
beneficiary
Population stabilization.
We do not need to check for any maturing effect of the traditional methods of IEC. There is high cost containment and time management. Workers get a sense of achievement of targets .
Social Networking –AN OUT COME OF MATERNAL DEATH REVIEW
Basis of the initiatives Methodology adopted and Outcome
Impact
Many patients were not able to call the ambulance as they didn’t have telephone themselves, people didn’t seek help from the neighborhood to shift a pregnant women in emergency
Maternal death review
• Decrease in delay One in Health seeking behavior.
• Increase in Hospital Delivery rate
• Increase in Post-natal care in Hospital
• Early detection and Treatment of complication especially for the sick new born.
• Decrease in MMR.
• Decrease in IMR.
• Decrease in TFR.
Family Planning Counseling There has been discrimination in educating the male partners, so BCC/IC services have been started at the workplace/factories
Social Networking
Basis of Initiative Outcome Impact
The maternal deaths are being tracked from the cremation ground also and a community based death review is done even for the deaths occurring at the facility level and it has been observed that the socio-cultural determinants are a major hindrance to quality health seeking behavior for the pregnant women and the sick new borns.
• Mobilization of the decision makers for timely health seeking behavior.
• Never say die spirit.
• High cost containment.• Attainment of 0 % home
delivery in highly vulnerable areas.
• Decrease in absolute number of maternal deaths and early neonatal deaths.
• (Social Networking)
• Development of to and fro refferal mechanism to decongest higher refferal units . Promotion of critical care / research / education by PGIMER, GMCH -32
Change Management Administrative Reforms/Architectural correction
Basis of Initiative Methodology Adopted and Current Outcome
Impact
• Scarce/Scanty manpower at the field level.
• Negligible staff at headquarter.
• Vide gap between Chandigarh Administration, Headquarter, Workers at the community and the health center level resulting in poor co-ordination in quality service delivery
• Type of morbidity.• Ages old faith in health
centers.• Demand generation.
Evidence based strategies were applied :•Principals of OD/OB applied.•Mentoring, leadership.•Participatory approach.•Formulation supervisory teams out of the existing community workers as the staff responds to them without hesitation.•Frequent review meeting with all workers from community to tertiary level hospital by the Secretary Health and Director Health Services.
• Formulation of new formats and registers.
• Time management.• Availability of micro birth
plans, anemia tracking linked with MCTS.
• Promotion of PPIUCD and Post-Partum sterilization indirectly effecting IMR, MMR, TFR.
• skill building of health workers for postnatal care through micro teaching
Change Management Administrative Reforms/Architectural correctionInvolvement of Medical Officers/Specialist at various health centers/PGIMER/GMCH-32
Basis of Initiative Methodology Adopted and Current Outcome
Impact
• Since the doctors could not be taken out for meetings/trainings due to acute shortage and they could not be away from there work place.
• The minutes of the monthly meetings taken by the field workers are mandatorily signed by Medical Officer/In charge a very next day.
• Now the meetings are held with all stakeholders.
The initiative is self sustainable.
DEVELOPMENT OF TO AND FRO REFFERAL MECHANISM
• The sensitivity of the Chandigarh Administration has strengthened the Faith building, Team Building, Motivation, Supportive supervision, Accountability, Cost containment and time management.
• All stakeholders are at one platform. The initiative is self sustainable.• Meetings have been held frequently under the Chairmanship of Worthy Secretary Health
and director health services with all categories of workers at one platform to enhance mutual understanding between the ANMs, MOs, PGIMER/GMCH-32 stakeholders.
Time Management
Basis of Initiative Methodology adopted and Outcome
Impact
•There was no Consultant Training or any Data Entry Operator, the HQ staff has been very scanty.
•The traditional trainings have been imparted for 5 to 7 days each but workers were not clear about the action plans.
• Thee agendas of the monthly meetings are very well set.
• The action plan is dictated to the workers which is linked to the trainings imparted previously for e.g. The case definitions regarding Safe Adolescence marriage/sex/abortion/pregnancy etc. etc.
• there is an assured reorientation training regarding danger signs detection for early referral.
• Increased co-ordination.• Enhanced supportive
supervision.• Easy on the spot corrective
action by the MO’s.• Hierarchy of commands.• Earlier complaint by the
MO’s was that the field workers didn’t return to the health centers after field visits.
Cost Containment
•None of the initiatives mentioned here has any cost implication rather budget remained under utilized.
•Basically there was no staff to put up the file for purchase, procurements of modules, IEC material etc. etc.
The projections were made from time to time and now the infrastructure strengthening is the highest agenda to meet the demand we have generated.
Scope of the initiatives taken
• Is in alignment with the NHP, NPP, MDGS/12th five years GOI plan 2012-17.
• It is a scientific approach not only evidence based but also evidence generating with on going retrospective/prospective research.
• Addresses the most critical issue of effective utilization of scarce /skilled manpower as an administrative reform and management of change.
• The HQ/communication gap at various levels has been reduced remarkably.
• Team work/espirit-de-corps supportive supervision.
• Monitoring has been inbuilt into the system.
• Sustainable.
• Replicable. GOOD MODEL FOR MIGRATORY POPULATION
• High cost containment.
• Addresses the Socio-cultural determinant of health.
• Has been fully institutionalized.
• The finding of the internal monitoring matches with the observations of the external monitors (SPH PGIMER, MoHFW teams etc.)
Constraints
• Even a single home delivery in any area where 25 total deliveries have occurred in total will raise the home delivery rate by 4 %. Even if this delivery is a precipitate delivery within very short time and the patient can't be shifted to the hospital. Good model for migratory population.
• There has to be a consensus between the MoHFW and a department of health to shift from the traditional methods of training.
• The arrangements to meet the demand needs to be very very expeditious.
Thanks