improving linkages between primary healthcare services … 3/mrunal shetye... · improving linkages...

© Bill & Melinda Gates Foundation | 1

Improving linkages between primary

healthcare services and the

community:

Overcoming the last mile delivery

challenges in Indian context

Dr. Mrunal Shetye

Country Lead, Maternal, Newborn and Child Health

India Country Office

Bill & Melinda Gates Foundation


340 million


1.36 billion 1.25 billion 340 million 316 million

CHINA INDIA UP + BIHAR USA


Maternal deaths Neonatal deaths Under five deaths

20,000 2,32,000 4,26,000

India burden

Global burden

44% 33% 36%

7% 9% 7%


50% children not immunized*

30%currently married women use

modern contraceptives

5% mothers receive full ante natal care

40% children exclusively breastfed*

*For Bihar the full immunization rates are 60% and children exclusively breastfed are 53%


Poor health infrastructure

plagues these two states

40% Shortage of Doctors at primary health

care centers

80% Shortage of Specialists at secondary

health care centers

50%Shortage of nursing staff at primary and

secondary health centers


In this scenario, is it possible to bring the basic preventive

services closer to the community?


ASHAs

Eligible

couple

Child

years<5Adolescent

girl

DeliveryPregnant

woman

ANMsVillage health &

nutrition day

Tertiary

Healthcare

CenterSecondary

Healthcare

Center

Sub-CenterAWWs

Primary

Healthcare

Center

VHND acts as a link between the community and facility

to provide easily accessible health services


WHAT HAPPENS AT A VHND?

Pre PostDuring

FLWs match due

lists, prepare micro-

plans


11


AAA meeting



Pre PostDuring

FLWs match due


plans


11



Pre PostDuring

FLWs match due


plans


Block level officials

ensure supply and

availability of

essential drugs and

equipment

11

22



Pre PostDuring

FLWs match due


plans



ensure supply and

availability of

essential drugs and

equipment

11

22

ASHAs, AWWs

responsible for

beneficiary

mobilization

33



Pre PostDuring

FLWs match due


plans



ensure supply and

availability of

essential drugs and

equipment

11

22

ASHAs, AWWs

responsible for

beneficiary

mobilization

33

ANMs responsible for

service delivery

VHND

44


GupShup Potli



Pre PostDuring

FLWs match due


plans



ensure supply and

availability of

essential drugs and

equipment

11

22

ASHAs, AWWs

responsible for

beneficiary

mobilization

33


service delivery

VHND

44



Pre PostDuring

FLWs match due


plans



ensure supply and

availability of

essential drugs and

equipment

11

22

ASHAs, AWWs

responsible for

beneficiary

mobilization

33


service delivery

VHND

44

FLWs fill in monitoring

checklists

55

Filled-in checklists

reviewed by block and

district level officials

66


152,550

How does one reach

villages?


495,000

How does one train

front-line workers?


2008

Predominantly

RI

New guidelines &

Government

Orders rolled out

VHND

strengthening

campaign

Training of

300,000 FLWs

initiated

VHND

launched in

UP

2008-2014

2015

Q1 2015

Q4 2015

UP example


INPUT TO IMPACT PATHWAY

INPUT OUTPUT OUTCOME IMPACT

Improved outcomes in terms of reduction in

maternal and infant mortality

Identification and

management of high

risk cases

Provision of quality health and

nutrition servicesVHNDs organized

every month at village

level

IMPROVED AVAILABILITY AND SERVICE DELIVERY OF ANC SERVICES

48

90

38

81

0

50

100

Q1'15 (58) Q4'16 (47)

Weight Measurement

Equipment Available Service Delivered

14

94

10

88

0

50

100

Q1'15 (58) Q4'16 (47)

BP Measurement


36

92

24

83

0

50

100

Q1'15 (58) Q4'16 (47)

Blood test to measure Hb


14

88

3

58

0

50

100

Q1'15 (58) Q4'16 (47)

Urine test to measure glucose & albumin


UP example

Source: External evaluation survey conducted by Sambodhi


IMPROVED FP, NUTRITION AND RI SERVICES

2934

12

56

63

52

0

50

100

Condoms available OCPs available ECPs available

Family Planning Services at VHNDs

Q1'15 (58) Q4'16 (47)

60

48

81

52

0

50

100

IFA distributed Supplymentary nutritionto pregnant woman

Maternal Nutrition Services

Q1'15 (58) Q4'16 (47)

95100

0

50

100

Immunization ofchildren

RI at VHNDs

Q1'15 (58) Q4'16 (40)

UP example

Source: External evaluation survey conducted by Sambodhi


GOING FORWARD

Further capacity building of state and district level staff for better monitoring and

FLWs for improved service delivery

Further capacity building of state and district level staff for better monitoring and

FLWs for improved service delivery

Digital tracking of services through

VHND app

Digital tracking of services through

VHND app

Potential to use this platform to roll out

NCD screening and injectables for

family planning

Potential to use this platform to roll out

NCD screening and injectables for

family planning


Nurse mentorANMAWWCRPASHA

THANK YOU

improving linkages between primary healthcare services … 3/mrunal shetye... · improving linkages...

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