scaling up interventions in reproductive, maternal

ANNUAL PROJECT REPORT

In association with

Scaling Up Interventions in Reproductive, Maternal, Neonatal,

Child and Adolescent Health

May 2014 - September 2015

Photo Credit: SRU Punjab

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TABLE OF CONTENTS

EXECUTIVE SUMMARY ....................................................................................................................................... 2

ABBREVIATION ............................................................................................................................................... 3-4

I.MAJOR ACCOMPLISHMENTS ...................................................................................................................... 5-14

1. ORGANIZATION OF CALL TO ACTION SUMMIT

2. INSTITUTIONALIZATION OF SUPPORTIVE SUPERVISION

3. DEVELOPMENT OF CARE AROUND BIRTH STRATEGY

4. SUPPORTING BETI BACHAO BETI PADHAO CAMPAIGN

5. CARRYING FORWARD LEARNING FROM THE ASSIST MODEL

6. DEFINING THE ADOLESCENT HEALTH COMPONENT

7. ESTABLISHMENT OF THE KNOWLEDGE HUB

8. CONTINUOUS SUPPORT TO GOVERNMENT THROUGH NATIONAL RMNCH+A UNIT

9. PARTNERSHIP WITH JOHN SNOW, Inc.

II.PROJECT PROGRESS IN THE PAST ONE YEAR .......................................................................................... 15-22

III.STATE HIGHLIGHTS .................................................................................................................................. 23-31

IV.SELECT CHANGE STORIES FROM THE STATES ........................................................................................ 32-37

V.PROJECT CONTACTS ....................................................................................................................................... 38

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EXECUTIVE SUMMARY

The first year of the Scaling Up RMNCH+A Project has witnessed deepening of partnerships with key

stakeholders, especially with the governments at both the national and state level. A prominent example of this

partnership at the national level is the successful organization of the Call to Action Summit, 2015. The support

provided by the Haryana State RMNCH+A Unit to conduct campaigns such as Beti Bachao Beti Padhao is an

example of strategic partnerships at the state level. This robust partnership with the governments was facilitated

by closer and strategic interaction between the National Technical Support Unit, the State RMNCH+A Units and

the national/state governments along with the relentless support provided by the National RMNCH+A Unit. The

project’s technical team (National Technical Support Unit and State RMNCH+A Unit) has been actively involved

in consultations and policy dialogues at national and state levels. The National Technical Support Unit

coordinates with the senior level officials of the Ministry of Health and Family Welfare to offer any required

strategic support.

The project has also promoted evidence based change through distilling and sharing data from Supportive

Supervision with the government. As the technical leaders for the roll out of the Supportive Supervision process,

the project designed clear Standard Operating Procedures, simple data transfer systems and processes for quick

turnaround of data. As of September 2015, Supportive Supervision visits were made to 172 districts and 4161

facilities in India. National and state level reports of Supportive Supervision have been prepared and shared with

government counterparts. Project team supported use of Supportive Supervision data during state level

RMNCH+A reviews.

The seamless relocation of National RMNCH+A Unit from the Ministry of Health and Family Welfare to IPE Global

headquarters and redefining of roles to improve the effectiveness of the unit was also achieved. The project has

successfully partnered with John Snow, Inc. and ASSIST teams for knowledge sharing and also for developing and

implementing the project’s core strategy of “Care around Birth”. Exercises such as state level Labor Rooms

Assessment and relevant and appropriate products developed by the Knowledge Hub helped the project to be

technically updated and systematic in its action. The State RMNCH+A units were instrumental in suggesting,

initiating and catalyzing a number of specific change ideas and driving innovations both at the facility level and

also at the administrative level in high priority districts and states. The project has successfully deployed District

Technical Officers in 26 districts, and inducted them into the program through an intensive six-days induction

training. The project has accomplished almost all of the planned activities in year- 1.

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ABBREVIATIONS

ASHA Accredited Social Health Activists

AFHC Adolescent Friendly Health Clinics

ANM Auxiliary Nurse Midwife

B3P Beti Bachao Beti Padhao

CHC Community Health Centre

DTO District Technical Officer

FP Family Planning

GoI Government of India

HMIS Health Management Information System

HPD High Priority District

HRP High Risk Pregnancies

IAPPD Integrated Action plan for Prevention of Diarrhea and Pneumonia

ICDS Integrated Child Development Services

IDCF Intensified Diarrhea Control Fortnight

IP Intra-Partum

IPP Immediate Post-partum

JSI John Snow Inc.

KH Knowledge Hub

KMC Kangaroo Mother Care

LHV Lady Health Visitor

MI Mission Indradhanush

MDR Maternal Death Review

MNH Maternal and Newborn Health

MoHFW Ministry of Health and Family Welfare

MTCs Malnutrition Treatment Centers

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NHM National Health Mission

NRU National RMNCH+A Unit

NSSK Navjaat Shishu Suraksha Karyakram

NTSU National Technical Support Unit

PGIMER Postgraduate Institute of Medical Education and Research

PPFP Postpartum Family Planning

PPIUCD Postpartum Intrauterine Contraceptive Device

QI Quality Improvement

RAPID Regular Appraisal of Program Implementation in District

RKSK Rashtriya Kishor Swashthya Karyakram

RBSK Rashtriya Bal Swasthya Karyakram

RMNCH+A Reproductive, Maternal, Newborn , Child Health Plus Adolescents

SOP Standard Operating Procedures

SRU State RMNCH+A Unit

SS Supportive Supervision

ToT Trainings of Trainers

USAID United States Agency for International Development

UHND Urban Health and Nutrition Day

VHND Village Health and Nutrition Day

VHSND Village Health Sanitation and Nutrition Day

WHO World Health Organization

WIFS Weekly Iron and Folic Acid Supplementation

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I.MAJOR ACCOMPLISHMENTS

1. ORGANIZATION OF CALL TO ACTION SUMMIT

One of the most significant developments

during the current program cycle has been, the

increasing confidence of Ministry of Health and

Family Welfare, Government of India (MoHFW,

GoI) in the National Technical Support Unit

(NTSU) and the project. At the behest of the GoI,

the project hosted the Secretariat for the Third

Global Call to Action Summit to support and

coordinate all activities for the summit ― from

preparations to implementation― on behalf of

the hosts (MoHFW, GoI, the Ministry of Health,

Government of Ethiopia), and co-hosts (USAID,

United Nations Children's Fund (UNICEF), Bill and Melinda Gates Foundation (BMGF), and Tata Trusts). The two-

day leadership summit saw a confluence of health ministers from 18 priority countries, SAARC countries and

Myanmar; state health

ministers from India,

international academic

experts, health

practitioners, and

global leaders from the

corporate sector, civil

society, and media.

The summit format

was carefully designed

to engage the

delegates through

inspirational sessions

that highlighted key

interventions, best

practices, multisectoral

approaches, and

partnerships.

Prime Minister of India, Shri Narendra Modi and Ministers of 24

Countries, Promise to Reduce Maternal, Child Mortality: An unique

feature of the Summit was, the Ministerial Conclave that resulted in the DELHI

DECLARATION; a commitment made by all participating nations to work together

towards ensuring women, newborn, children and adolescents their right to

survive, thrive, have universal access to healthcare services, and transform –

enjoy an enabling environment that fosters equal opportunity to reach their full

potential. The Valedictory Session of the Summit witnessed Health Ministers and

heads of country delegations from 24 countries adopting the DELHI

DECLARATION on Ending Preventable Child and Maternal Deaths. While speaking

on the occasion Shri Narendra Modi, said: “I am glad to see 24 nations present

here to join together in their commitment to end preventable maternal and child

death. This is a landmark occasion, as for the first time, the Global Call to Action

Summit is being held outside USA. My Government is honored to host this

Summit. All those delegates who have travelled a long distance to attend this

Summit – I heartily welcome you to India and to New Delhi. I am delighted to be

with you this morning.”

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The Prime Minister of India, Shri Narendra Modi, graced the inaugural session. The Health Ministers of participant

countries addressed the Ministerial Conclave, and various sessions along with heads of donor agencies, UN bodies,

corporate sector, and media. The summit ended with the release of a Joint Statement of Action for preventing

child and maternal deaths.

High level discussions were held during the course of the summit by leaders from 24 nations. These panel

discussions and experience sharing sessions were indicative of strengthened commitment towards building a

more sustainable world by ensuring that women and children everywhere survive, thrive, and transform. The

discussions focused around key interventions, best practices, multi-sectoral approaches, and partnerships. The

plenary sessions were led by the Prime Minister of India, Shri Narendra Modi, Health Minister, Shri J.P. Nadda,

and Dr. Rakesh Kumar, Joint Secretary, RMNCH+A, MoHFW, ably supported by NGO partners. The deliberations

highlighted transformative actions in redressing the harsh realities around Maternal and Child Health (MCH) with

measures such as health financing, corporate partnerships for impact and systems to ensure greater

accountability. The thrust of the presentations and discussions were innovations, and the need for the private

sector to leverage competencies in order to enhance government capabilities.

2. INSTITUTIONALIZATION OF SUPPORTIVE SUPERVISION

The government has made substantial

investment for the strengthening of RMNCH+A

services. Delivery points have a special

significance in the RMNCH+A strategy as it is the

hub of activities for all services. The main

strategy under this approach is strengthening the

“nationwide RMNCH+A Supportive Supervision

(SS) mechanism”. SS as a process, has the

potential to accelerate change by engaging

stakeholders at all levels simultaneously to

address situations and issues. It cuts across

themes, processes, and programs, and enables

actions at multiple levels; starting from an individual facility all the way up to the state and even national level.

The primary objective of the project is to help establish a standardized and homogenous SS mechanism across all

states and health facilities. Project conducted two national and five zonal level workshops on SS checklist and its

execution. Two national level Trainings of Trainers (ToT) on RMNCH+A SS, were organized by the Scaling Up

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RMNCH+A Project on February 10-11, 2015 and March 03-

04, 2015 at the Claridges Hotel, New Delhi. These national

level workshops have been conducted to support the vision

of MoHFW: to train all district level monitors in effectively

evaluating the performance of a health services unit using a

checklist, and using this information for improvement of

services. The first national ToT was chaired by Dr. Rakesh

Kumar, Joint Secretary, RMNCH+A, MoHFW, and attended

by Dr. Nancy Godfrey, Director Health Office, USAID India.

During the second national ToT, Mr. Ashwajit Singh,

Chairman and Managing Director, IPE Global also addressed

the participants on SS checklist. Mr. Xerses Sidhwa, Deputy

Director, Health Office, USAID, in his inaugural address

stated that for better implementation of the RMNCH+A

strategy, there is a need for greater alignment of resources

of various development partners.

Prioritizing Health Facilities for Supportive Supervision and Use of Data for Action: A key component of the work

around the checklist focused on developing a concept for prioritizing health facilities for SS, and using data

generated through the use of the SS checklists, for identifying gaps, and developing action plans. Similarly, for

data management, a simple excel based tool was developed to facilitate data entry, and generation of automated

results, which in turn would help the district monitors to share feedback of the SS visits at all relevant platforms

including the facility, block, and district levels. Major achievements of the project were facilitation of the roll-out

of a standardized checklist based on SS of the RMNCH+A program in the 184 High Priority Districts (HPDs) by

District Technical Officers (DTO) deployed by various development partners. Collaborative approach, clear

standard operating procedures (SOPs), simple data transfer systems, quick turnaround of data, and effective

utilization of the SS platform, have helped to position the project as a national level technical partner to MoHFW.

3. DEVELOPMENT OF CARE AROUND BIRTH STRATEGY

The core intervention for the project has been identified as, “Strengthening care around birth”. Strengthening

institutional care around birth by focusing on intrapartum (IP) and immediate postpartum care (IPP), is an

important component of the Scaling Up RMNCH+A Project. In order to develop an intervention model, high case

load facilities were identified across all HPDs in six USAID supported states and labor room assessment was

conducted in 133 health facilities. These facilities will be targeted for focused intense support, to ensure that high

impact evidence based practices are followed in all facilities during the critical IP & IPP period. High case load

facilities (delivery points) across different levels of services (L3, L2, L1) will be targeted. To strengthen skills on

evidence based practices, mannequins were procured and provided at all states.

Support to the nationwide RMNCH+A SS has

been phenomenal. In just over six months

(October 2014-March 2015). The activity has

been scaled up from the pilot state of

Jharkhand to include all the 184 HPDs of the

country.

SS visits have been initiated and 3724

delivery points visited across 172 HPDs till

August 2015. The activity has been prioritized

in the project districts as well and 918 SS visits

made across 613 delivery points in the 30

project HPDs till August 2015.

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Based on the framework of the Maternal Newborn Health (MNH) Toolkit, the NTSU team developed a structured

assessment tool to capture information regarding the following subheads: Infrastructure, Infection Prevention,

Equipment, Drugs & Consumables, Human Resource and Training Status, Documentation, and Referral System.

The current infrastructure was to be assessed through a structured and suitably designed tool.

A tool to assess the resources and infrastructure in the identified facilities on the framework of the MNH Toolkit

was developed. The tool was piloted in two states and revised based on the learnings. A rapid assessment of

resources and infrastructure for provision of care around birth was done across 133 facilities. Data entry was done

with consistency checks, and district and state level reports developed.

4. SUPPORTING BETI BACHAO BETI PADHAO CAMPAIGN

The Government of Haryana launched a “Call to Action”

initiative under the Beti Bachao Beti Padhao (B3P)

Campaign, on July 21, 2015, with a view to educate and

protect girl children in the state. Specific guidelines were

released in a technical workshop organized in Gurgaon

on that day. During the event, Shri Manohar Lal Khattar,

Chief Minister of Haryana, acknowledged the active

participation of various stakeholders – private sector,

civil society, media, and development partners who had

come forward to promote health, education, nutrition,

and the overall development of girls and women.

In Haryana, 12 districts feature in the list of gender

critical districts. To address this issue, a coordinated, and

multi-sectorial action has been initiated namely the Beti

Bachao, Beti Padhao (B3P) Campaign launched by the

Honorable Prime Minister, Shri Narendra Modi on

January 22, 2015 in Panipat.

Shri Manohar Lal Khattar, Chief Minister of Haryana, has hailed the B3P campaign as a flagship program of

Haryana. The state is committed to achieve the defined goals of B3P through intensified efforts. The project

played an important role in the development of operational guidelines and coordination between different

departments as well as advising and guiding the state by providing inputs during B3P meetings.

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5. CARRYING FORWARD LEARNING FROM THE ASSIST MODEL

The ASSIST Project had worked intensively in selected districts of USAID supported states, to support facility, and

community-based teams of health workers to learn and apply Quality Improvement (QI) methods, to address

priority needs. A national level training was organized on September 22, 2015 to share the learnings of the project

with the Scaling Up RMNCH+A Project team.

During the workshop the participants were given an overview of the quality issues in the current healthcare system; history of QI with various definitions adopted at different times; different principles and approaches to QI; components required to support improvement at patient/provider level. The participants were introduced to seven steps for QI of service/system, and different processes and tools for QI adopted by ASSIST. To further understand the different steps and tools, the participants were given group exercises. At the end of the training the follow-up steps/actions were discussed:

QI state workshops

District orientation workshops

Implementation in nodal facilities

Implementation in sub-nodal facilities

The strategy to implement the QI intervention, and care around birth strategy would have the following

components:

Focused intervention in high case load facilities

SS approach across other facilities

6. DEFINING THE ADOLESCENT HEALTH COMPONENT

The expansion of adolescent health services require a mix of strategies to address the diverse needs of this population. In addition to the routine technical assistance and facilitative role (such as trainings, SS, and review meetings), the adolescents health component explores the relative merits of the strategies to address adolescent health needs, by designing sustainable interventions, aiming to increase the access to the full range of counseling and clinical services― including sexual and reproductive health services. The team has mapped, and thereafter contacted various organizations to learn from their experiences, and also identify few models with demonstrated impact. These organizations included MAMTA Health Institute for Mother and Child (MAMTA), Centre for Catalyzing Change (CCC), Child In Need Institute (CINI), Family Planning Association

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of India (FPAI), DASRA, and Packard Foundation. Priorities and high impact interventions that would significantly improve adolescent health outcomes in six project states and HPDs were identified and included in the work plan for next year. A rapid assessment was also undertaken to evaluate the readiness, operationalization, and quality of services at Adolescent Friendly Health Clinics (AFHCs) to further address gaps in setting up systems and processes that facilitate access to quality services in sync with choices of adolescents. Reliable, and accurate facility-level information was gathered using a standard tool from 92 AFHCs across six states. The tool was aligned to the GoI and WHO checklist. A detailed SOP was developed, and training conducted for DTOs. The information captured identified gaps regarding infrastructure, equipment, commodities, HR and training status, documentation and the referral system.

7. ESTABLISHMENT OF THE KNOWLEDGE HUB

A significant achievement of year-1 is the establishment of the Knowledge Hub (KH) by bringing in a small team of

research, documentation, and communication experts to gather, analyze, and share RMNCH+A programing

knowledge within the project, the program, and in the entire RMNCH+A sector of India. This Hub was set up with

the following long term objectives:

Facilitate learning and capacity building within the project and in the sector

Provide a platform for problem solving to RMNCH+A professionals

Informing policy advocacy of the project

Produce collaterals for project implementation

Increase project visibility and contribute to the body of knowledge

Accordingly, the KH has started delivering its outputs in year-1, though most of which will show substantive results

from year-2 onwards. The KH began facilitating learning and capacity building within the project by creating new

platforms to learn while implementing the project. These learning opportunities were based on documentation

of project’s own work in the course of implementation, based on analysis of monitoring and evaluation (M&E)

data, distilled lessons from SS visits and also from gathering innovative and effective practices from similar

projects within and outside India.

The KH (in association with the M&E team) informed policy making by bringing in latest experiences, and evidence

from the program implementation across geographies of district, national and international levels. Examples

include periodic updates based on analysis of data gathered during SS visits, given to GoI. The Hub helped the

project to increase visibility, and contributed to the body of knowledge by closely tracking project activities

through onsite visits, reviewing field visits reports, and other documents prepared by project team, creating photo

and video commentaries, and building team capacity to identify and report of potential best practices.

The Hub facilitated publishing of project’s own learning in peer reviewed journals, and important conferences and

thereby contributing to the body of knowledge. The Hub also supported in producing collaterals for project

implementation, production of all required advocacy, workshop, training, and technical program materials,

including posters exhibited at Market Places, technical write ups for the Call to Action Summit etc.

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KH has already created and disseminated a number of knowledge products including Technical Updates (which

inform and update on technical areas of RMNCH+A), RMNCH+A bulletin (which chronicles RMNCH+A events,

news, opportunities and provide relevant research summaries), Promising Practice notes (which document

emerging best practices from the project states) and Snapshots (change ideas followed up by project team in

states). For quality assurance and technical vetting of its own products, the hub is in the process of setting up

Technical Advisory Groups. It has already set up a four-member Technical Advisory Group to advice on production

of Technical Update. In addition to this the Hub began providing capacity building support to the teams at state

level through onsite training. It has also invited external experts to deliver capacity building sessions to the NTSU

team.

Example of Knowledge Hub Products from Year-1

Technical Update

Promising Practices

RMNCH+A Bulletin

Snapshot of Changes

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8. CONTINUOUS SUPPORT TO GOVERNMENT THROUGH NATIONAL RMNCH+A UNIT

The National RMNCH+A Unit (NRU) is supported by USAID, through Scaling Up RMNCH+A Project, anchored within

the MoHFW, under leadership of the Joint Secretary (RMNCH+A) and the Deputy Commissioner, Child Health (CH).

The NRU team of eight members, has been supporting the MoHFW in monitoring the progress of RMNCH+A

implementation efforts across the states.

The key role of this unit is to help all 29 states to plan, implement, and monitor RMNCH+A strategies. NRU is also

supporting the states to coordinate activities across the 184 HPDs and provide technical assistance to the State

Program Management Unit (SPMU), particularly for planning, implementing, and monitoring the delivery of

priority interventions.

Specific responsibilities of the NRU include, liaising with departments of health to coordinate, and monitor the

intensification of efforts in the HPDs; coordinating with SRUs /state National Health Mission (NHM)s for facility

assessment, situational analysis, and scorecards; presenting key trends to the Joint Secretary - RMNCH+A; sharing

best practices and cross-learning; and promoting adaptation of innovations. In the year- 1, NRU team members

carried out the following key activities:

Program Implementation Plan Appraisal for HPDs: NRU reviewed the status of budget allocation for

HPDs in State Program Implementation Plan (PIP) and the progress of addressing gaps in HPDs. The

outcome for this activity was, allocation of 30% more budget for HPDs and fulfillment of various gaps in

HPDs.

Supportive Supervision Tools: The team coordinated with DTOs, SRUs for getting monthly reports on

time. Collected, collated, and checked SS data received from states across the country and shared the

feedback on issues emerged from states.

Posters

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RMNCH+A Review Meeting: NRU team members organized and participated in monthly RMNCH+A review meetings under the Chairmanship of Dr. Rakesh Kumar, Joint Secretary, RMNCH+A, MoHFW, to review the implementation of RMNCH+A in HPDs.

Supportive Supervision: NRU conducted SS visits in 31 HPDs of 15 states, to augment the implementation of RMNCH+A interventions and support district level program officers and district monitors.

Apart from RMNCH+A SS visits, NRU team members also participated in Common Review Mission (CRM); visit to

states towards formation of New Health Policy; Mission Indradhanush (MI) monitoring; Intensified Diarrhea

Control Fortnight (IDCF) monitoring; National Deworming Day (NDD) monitoring during this period. The NRU team

members also contributed to the work for Call to Action Secretariat as a member of various sub groups.

9. PARTNERSHIP WITH JOHN SNOW, INC.

As a consortium partner, John Snow Inc. (JSI) provides strategic technical support in key RMNCH+A areas, and

leads the following activities at the national and state levels: (1) technical support to the NTSU, (2) child health

and immunization, and (3) monitoring and evaluation. In year-1, JSI activities included:

Being part of on-going technical assistance to government in relation to child health, immunization,

and monitoring and evaluation; the areas of the project’s work for which JSI provides technical

support

Advocacy with the MoHFW

Series of meetings with IPE Global and USAID to discuss expansion of JSI’s role in providing

Maternal Newborn Child Health (MNCH) technical support to the project

Participation in activities related to the Global Call to Action

JSI activities in detail:

a. Child Health

Diarrhea and Pneumonia: JSI team assisted Child Health Division, MoHFW in drafting the Integrated

Action Plans for Prevention of Pneumonia and Diarrhea (IAPPD) guidelines along with WHO and UNICEF.

Based on the draft guidelines, JSI facilitated four orientation workshops, one each in Delhi, Punjab,

Haryana, and Himachal Pradesh. The orientation workshop focused on updated guidelines and

development of an integrated action plan on diarrhea and pneumonia in the state through involving other

stakeholders.

Immunization: GoI launched MI to accelerate immunization activities in 201 districts across India. The JSI

team supported the MoHFW by providing technical assistance in roll-out, and monitoring support to this

campaign. This is an ongoing activity. Apart from support at national level, JSI team provided technical

inputs to the State RMNCH+A Units (SRU) for facilitating the states to conduct the Regular Appraisal of

Program Implementation in District (RAPID) rounds.

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b. Maternal Health

JSI team assisted Maternal Health Division, MoHFW, for developing/revising the following guidelines:

Maternal Death Review Policy Guideline with other partners like IPE Global

Empaneling Private Sector Facilities for Maternal and Newborn Healthcare Services

Upgrading Labor Room and Designs for Obstetrics Intensive Care Units

c. Monitoring and Evaluation

Data Quality Audit: JSI team assisted Statistics Division, MoHFW in developing a concept note, roll-out

plan including identifying various methodologies that have been adapted by various donor

agencies/government for data quality audits of routine data generated in Health Management

Information System (HMIS) in India.

Health Management Information System Dashboards: JSI team coordinated with respective SRUs for

preparation and submission of quarterly Health Management Information System (HMIS) dashboards

from six USAID priority states.

d. Others

While continuing its leadership of the project’s child health and immunization team, in coordination with NTSU team, the JSI national team was fully engaged in writing the proposal for this expanded role, along with a matrix, explaining JSI’s capacity and proposed contributions, a work plan and a PMP. Throughout the Global Call to Action summit, the JSI team actively participated and supported by executing the tasks assigned to the team. Along with the JSI national team, staff from HQ and other country programs including Nepal, Nigeria and Ethiopia also participated in the Summit. JSI team participated in the working groups to develop a presentation on respective thematic areas for District Technical Officers training on SS. The team also attended two ToTs, took part in zonal trainings, and facilitated assigned sessions on child health and immunization. JSI team also facilitated sessions on RMNCH+A during the induction training held in Udaipur from May 9 to 14, 2015.

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II.PROJECT PROGRESS IN THE PAST ONE YEAR

(PLANNED ACTIVITIES VS. ACCOMPLISHMENTS)

Sl. No.

OBJECTIVE PLANNED ACTIVITIES PROGRESS TILL SEPTEMBER 2015

1.

National level technical support to MoHFW for scaling up RMNCH+ A interventions

1.1.1 Establish NTSU to support MoHFW

Project has successfully established NTSU to support MoHFW, states and HPDs

1.1.2 Continue to support members of NRU

Project is continuously supporting the eight member NRU team for further supporting the MoHFW in monitoring the progress of RMNCH+A implementation and intensification efforts across the states

1.1.3 Support to MoHFW in policy design, review and monitoring for scaling up RMNCH+A intervention

The NTSU, NRU and SRUs have been supporting MoHFW and states in various need based policy design, review and monitoring for scaling up RMNCH+A intervention

2.

Continue support to SRUs in six USAID states to support scale up of RMNCH+A interventions

1.2.1 Establish SRUs in six priority states

The project has established SRUs in all six priority states i.e. Delhi, Punjab, Haryana, Uttarakhand, Himachal Pradesh and Jharkhand

1.2.2 Place one District Technical Officer in remaining HPD

Successfully placed a DTO in almost all the HPDs, except Jharkhand, as four districts has UNICEF supported staff for RMNCH+A (Delhi -2, Punjab- 5, Haryana- 5, Uttarakhand- 2, Himachal Pradesh-3 and Jharkhand-7)

1.2.3 Orientation and training of SRU and DCs

Completed a five days induction-cum-orientation training for all project staff

1.2.4 Continuous support and supervision of SRU and district teams to support state governments and HPDs in scale up of RMNCH+A interventions

To support state governments and HPDs in scale Up RMNCH+A interventions; NTSU team conducted several visits and facilitated a number of meetings for regular support and supervision of SRUs and district teams

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1.2.5 Three strategic consultation meetings to identify project priority activities and its implementations with responsibility

Three consultations and two annual work plan meetings were organized with state teams and partners for development of Year-2 work plan (this activity was added in supplementary plan of year-1)

1.2.6 Annual Work Plan Meeting

3.

Provide state and district level support for scaling up RMNCH+A activities ( six priority states and 30 HPDs)

1.3.1 Support state governments in planning, implementing and monitoring of scale up of RMNCH+A in HPDs and other districts

SRUs have been supporting state governments in planning, implementation and monitoring of scale up of RMNCH+A in HPDs and other districts

1.3.2 Support HPDs in planning, implementing and monitoring in scaling up RMNCH+A interventions

SRUs and DTOs have been supporting HPDs in planning, implementing and monitoring in scaling up RMNCH+A interventions

1.3.3 State workshop on SS in Himachal Pradesh and Punjab

Punjab and Himachal Pradesh have organized five workshops on SS (This activity was added in supplementary plan of year-1) (Punjab-2 and Himachal Pradesh-3)

4.

Develop plans to strengthen delivery of family planning services at community level through Accredited Social Health Activists (ASHAs)/ front line workers

1.4.1 Conducted district level review workshops with program managers to review and understand commodity and competency gaps in home delivery of contraceptives by ASHAs/front line workers

Five states i.e. Delhi, Haryana, Uttarakhand, Punjab and Jharkhand, have conducted workshops to review and understand commodity and competency gaps in home delivery of contraceptives by ASHAs/front line workers. SRUs have developed and shared the improvement and monitoring plan with HPDs and states

1.4.2 Develop and share the improvement and monitoring plan with HPDs and states

5.

To strengthen delivery of family planning (FP) services at facility levels

1.5.1 Improve the access to quality Postpartum Family Planning (PPFP) services in the high delivery load facilities in the HPDs of all six states

SRUs have been providing regular support to improve access to quality PPFP services in the high delivery load facilities in the HPDs of all six states

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1.5.2 Strengthen the quality of FP services with a focus on ensuring availability of a range of contraceptive methods

SRUs have been providing regular support to strengthen the quality of FP services with a focus on ensuring availability of a range of contraceptive methods

1.5.3 Support to implement district FP 2020 plans including follow-up of counselors for increase in RMNCH+A service uptake

SRUs have been supporting states to implement district FP 2020 plans including follow-up of counselors for increase in RMNCH+A service uptake

Percentage of targeted facilities with two trained providers on PPFP/ Postpartum Intrauterine Contraceptive Device (PPIUCD) (1.5)

211 providers were trained on PPFP/PPIUCD in targeted facilities (Delhi-30, Himachal Pradesh-12, Haryana-105, Punjab-18, Jharkhand-31, Uttrakhand-15)

Percentage of counselors trained on RMNCH+A package with focus on a range of contraceptive methods

201 counselors were trained on RMNCH+A package with focus on range of contraceptive methods (Delhi-93, Himachal Pradesh-26, Haryana-16, Jharkhand-7, Uttarakhand-59)

6. Improve quality of antenatal care

1.6.1 Orientation workshop for state and district program managers on new GoI guidelines for antenatal care in Jharkhand, Haryana, Punjab, and Himachal Pradesh

Orientation workshops have taken place in Delhi, Punjab and Jharkhand, and in Himachal Pradesh it is planned to be held in year-2 (Delhi- 1, Punjab-1, Jharkhand-1)

7.

Develop plans to strengthen the service delivery, and its quality in labor rooms - L2 and L3 facilities in HPDs

1.8.1 Baseline assessment of resources for maternal and newborn care services/ processes in the labor rooms in identified facilities across HPDs of six states

Baseline assessment of resources for maternal and newborn care services/ processes in the labor rooms completed in all 24 HPDs of six states (Delhi-2, Himachal Pradesh-3, Punjab-5, Haryana-5, Uttarakhand-2, Jharkhand-7)

1.8.2 Competency assessment and development of skill upgradation module for upgradation of labor room staff in targeted facilities

8.

Strengthen competency and skills for essential newborn care

1.9.1 Assessment of delivery points for readiness to provide essential newborn care and resuscitation

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and resuscitation services in HPDs

1.9.2 Assessment of Home Base Newborn Care implementation in Haryana to support strengthening Home Based Newborn Care services

9.

Operationalize guidelines for Integrated Management for Diarrhea and Pneumonia in Children

1.10.1 State workshops for dissemination of guidelines for diarrhea management, and support for developing district level integrated action plans in HPDs in Himachal Pradesh and Punjab

Completed two workshops in Himachal Pradesh and Haryana

1.10.2 State workshops for re-orientation on guidelines for pneumonia management, and support for developing district level integrated action plans in HPDs in Haryana, Punjab and Himachal Pradesh

Conducted three workshops in Haryana, Punjab and Himachal Pradesh

10.

Strengthen Immunization under RMNCH+A interventions

1.11.1 Coordination with Immunization Technical Support Unit/MoHFW –NTSU

NTSU regularly coordinates with Immunization Technical Support Unit/MoHFW

1.11.2 Participation at state and district immunization task force meetings

All six SRUs participated at state and district immunization task force and review meetings (Delhi-3, Haryana-5, Himachal Pradesh-1 , Punjab-1, Uttarakhand- 2, Jharkhand-2)

1.11.3 In HPDs participation at state, district planning and review meetings

1.11.4 Support for introduction of new vaccines; Pentavalent first year.

All six SRUs supported states for introduction of new vaccines, and are planning to continue support in year -2

1.11.5 Planning and monitoring for MI

NTSU, NRU and all six SRUs supported states for planning and monitoring for MI and continue to support in year- 2 (This activity was added in supplementary plan of year-1)

11.

Facilitate operationalization of Adolescent Friendly Health Clinics (AFHCs) in

1.12.1 Facilitate state level workshops for service providers in organizing AFHCs in District Hospitals in Delhi and Himachal Pradesh

Himachal Pradesh has conducted a state level workshops for service providers in organizing AFHCs in District Hospitals and Delhi is planning to conduct in year- 2

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District Hospitals under Rashtriya Kishor Swashthya Karyakram (RKSK)

Percentage of District Hospitals AFHCs in Haryana and Punjab (1.12)

18 District Hospitals organized AFHCs across six states including Punjab -5 and Haryana - 4

1.12.2 Facilitate district level workshops for RKSK in Himachal Pradesh and Delhi

Himachal Pradesh has already initiated a district level workshop and Delhi is planning to conduct it in year 2

1.12.3 Quality Assurance Assessment of AFHCs in four districts of Haryana

Haryana has completed the assessment (This activity was added in supplementary plan of year-1)

12.

Strengthen the delivery of services under Village Health Sanitation and Nutrition Day (VHSND) in HPDs

1.13.1 Review VHSND services in field as well as from secondary sources to identify gaps in one HPD per state

Data collection is over for six states and report writing is under process

A consolidated improvement and monitoring plan for addressing the barriers and gaps identified in the delivery of VHSND package of services (1.13)

1.13.2 Support for follow-up actions for areas that need strengthening

Will be carried forward in Year-2

13.

Provide state level support for generating awareness on GoI schemes for out of pocket expenditure reduction such as Janani-Shishu Suraksha Karyakram (JSSK) / Rashtriya Swasthya Bima Yojana (RSBY) /

1.14.1 Conduct state level orientation for increasing awareness about relevant schemes of GoI in Himachal Pradesh

Himachal Pradesh has conducted two state level workshops

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Janani Suraksha Yojana

14.

Engage with professional associations/ institutions such as but not limited to Indian Academy of Pediatrics, Federation of Obstetric and Gynecological Societies of India (FOGSI) National Neonatology Forum for continued technical inputs for RMNCH+A activities.

2.1.1 Facilitate engagement of professional associations with USAID for involvement in scale-up of RMNCH+A interventions.


2.1.2 Establishment of Technical Advisory Group to work on private sector engagement for RMNCH+A scale up


2.2.3 Document the work that has been done by NHM Haryana in engaging medical institutes - PGIMER Chandigarh and PPGIMS Rohtak

SRU Haryana has documented the work done by NHM Haryana in engaging medical institutes – Post Graduate Institute of Medical Education and Research Chandigarh and Post Graduate Institute of Medical Sciences Rohtak. (This activity was added in supplementary plan of year-1)

15.

Assess interventions/ strategies to identify bottlenecks in RMNCH+A scale-up

3.1.2 Baseline assessment of Malnutrition Treatment Centers (MTCs) / Nutrition Rehabilitation Centers at district level

Both the studies are underway

3.1.3 Assessment of Weekly Iron and Folic Acid Supplementation (WIFS) program in one state

3.1.4 Conduct one round of RAPID survey in one HPD of Uttarakhand, Jharkhand and Himachal Pradesh

Uttarakhand and Jharkhand has conducted one round of RAPID survey in three HPDs

16.

Facilitate and support NHM monitoring activities

3.2.1 Coordinate and facilitate the quarterly state review meetings

Project coordinated and facilitated 17 quarterly state review meetings (Delhi-3, Haryana- 2, Himachal Pradesh- 2, Punjab-2 , Uttarakhand-5, Jharkhand- 3)

3.2.2 Coordinate and facilitate the monthly district meetings

Project coordinated and facilitated 96 monthly district meetings (Delhi-11, Haryana- 13, Himachal Pradesh- 12, Punjab-17 , Uttarakhand-11 , Jharkhand- 32)

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3.2.3 Block monitoring visits with follow-up and discussion on actionable points in district RMNCH+A meetings

All six states have been conducted block monitoring visits with follow-up and discussion on actionable points in district RMNCH+A meetings

3.2.4 Coordinate / facilitate SS visits/activities

Completed in all HPDs except in one HPD of Himachal Pradesh-Lahaul & Spiti

3.2.5 Support in developing the performance and quarterly dashboard and survey based score cards

All six states have been continuously supported in developing performance, quarterly dashboard and survey based score cards

3.2.6 Strengthen the Maternal and Infant Death reviews

All six SRU coordinated to strengthen the Maternal and Infant Death reviews

17.

Support roll out of newer guidelines of RMNCH+A interventions

4.1.2 National & state level training workshops on Kangaroo Mother Care (KMC) and other newborn care guidelines

Haryana and Punjab have organized the state level workshops, and the others will conduct in year-2 (Haryana -9, Punjab- 1 )

Percent of districts prepare and submit plan for dissemination of new guidelines on KMC, newborn care

17 HPDs have prepared and submitted plans for dissemination of new guidelines on KMC, newborn care

4.1.3 Orientation for newer GoI guidelines e.g. Antenatal Corticosteroids, Misoprostol, Injection, Gentamicin etc.

Jharkhand, Delhi and Himachal Pradesh have organized workshops and Punjab and Haryana states clubbed this with other workshops on orientation for newer GoI guidelines e.g. Antenatal Corticosteroids, Misoprostol, Injection Gentamicin etc. (Jharkhand-4, Delhi-1, Himachal Pradesh-2)

Number of workshops held to disseminate new guidelines for thematic and cross cutting components of RMNCH+A (4.1)

4.1.4 Training for SRU on dashboards, score cards based on HMIS and survey data (District Level Household Survey 4/ Annual Health Survey)

Conducted a session during five days Induction Program

18.

Strengthen PSE for nursing cadre in three states

Percentage of Auxiliary Nurse Midwife (ANM) & General Nurse Midwife (GNM) schools with at least two faculty members trained (six week package) (Jharkhand & Uttarakhand) (4.2.1)

This activity will be revised and carried forward in next work plan

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Percentage of institutions achieving / sustaining 70% of performance standards (4.2.3) (Jharkhand & Uttarakhand)

19.

Gender sensitization of service providers and program managers at L1, L2 & L3 facilities in the HPDs

4.3.1 NTSU will design a training module for gender sensitization of health service providers

4.3.2 Master trainers trained on gender sensitization of health service providers

20.

Identify promising innovative interventions for scaling up RMNCH+A interventions

5.1.3 Assessment of Anemia Tracking Module as a Haryana state innovation in Haryana

Haryana has completed the assessment of Anemia Tracking Module as a state innovation (This activity was added in supplementary plan of year-1)

21. Cross Cutting

5.3.1Technical support to a grievance redressal mechanism in Jharkhand

Jharkhand has provided technical support to a grievance redressal mechanism (This activity was added in supplementary plan of year-1)

5.3.2 Organizational development study for strengthening SPMUs and State Program Management (DPMU)s in collaboration with Health Financing and Governance Project in Jharkhand

The activity will be revised and carried forward in next work plan (This activity was added in supplementary plan of year-1)

5.3.3 Initiating the process for software development for SS checklist module and project data base structure

The activity is underway (This activity was added in supplementary plan of year-1)

5.3.4 Technical support to establish model health facilities in Jharkhand

Jharkhand has provided technical support to establish model health facilities (This activity was added in supplementary plan of year-1)

22. Global Call to Action

5.4 Global Call to Action (C2A) Completed in year-1 (This activity was added in supplementary plan of year-1)

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III.STATE HIGHLIGHTS

KEY ANNUAL ACTIVITY HIGHLIGHTS: DELHI

Reproductive Health: State workshop on Family Planning 2020 was organized and facilitated. Another meeting was facilitated for state convergence meeting with AYUSH for family planning. A training of ANM/ Public Health Nurse as RMNCH+A counselors was conducted by Government of Delhi, based on a suggestion made by the SRU team. A district workshop on home delivery of contraceptives was also conducted on issues related to distribution and procurement logistics. The SRU team also supported monitoring of World Population Day Fortnight.

Child Health and Newborn Health: The SRU disseminated new guidelines on child health. They also facilitated MI planning and review meeting at the HPDs. The SRU was also involved in the Nutrition Rehabilitation Centre (NRC) meeting at state level for strengthening NRC activities in the state. In addition

IDCF monitoring and feedback-sharing meetings were facilitated and was chaired by Secretary Health. They also conducted Home Based Newborn Care Assessment in HPDs.

Population

Persons 16787941

Male 8987326

Female 7800615

Infrastructure

No. of District 11

No. of HPDs 2

Facilities and position

No. of District Hospitals

34

No. of Sub Divisional/Referral Hospitals

13

No. of Community Health Centers Functional

0

No. of Primary Health Centers Functional

5

No. of Health Sub Centers Functional

27

Mortality

MMR SRS (10-12) NA*

SRS (12-13) NA*

IMR SRS (10-12) 25

SRS (12-13) 24

Data Source: Census 11, National health profile 15 and NA* data is not

available is SRS

Photo Credit: Maternalstory/Swapna Majumdar

24 | P a g e

Maternal Health: The SRU facilitated state Maternal Health Review meeting. The SRU also facilitated a meeting to review the maternal death review data at state level along with advocacy to formalize the Maternal Death Review (MDR) Committee at the state level. State workshop on Dissemination of Newer Guidelines on Maternal Health was organized. SRU was also instrumental in initiating a facility based MDR in few facilities. Labor room assessments were also planned, and completed in select facilities.

Adolescent Health: RKSK review meetings with DC Adolescent Health was held with participation from all state technical team leads. State inter-convergence meeting for RKSK was conducted with active participation from departments of Integrated Child Development Services (ICDS), education, and various hospitals. SRU also facilitated the SS visits in 22 identified AFHC clinics.

Cross Cutting Activities: Laparoscope sterilization and no-scalpel vasectomy started in District Hospital; PPIUCD services initiated at maternity homes; ultra-sonography services started in North-West district. Logistics and supply improved in the distribution of Vitamin K injections, and various kits. Some Adolescents Reproductive and Sexual Health clinics started functioning in North-East and North-West districts; structural correction at Maternity Home Seelampur for lab services, and Integrated Counselling and Testing Clinics (ICTC), initiated the recruitment of ASHA in Non-ASHA slum and underserved areas of HPDs along with advocacy at state level for non HPD too, and the Urban Health and Nutrition Day (UHND) Assessment was organized in Delhi.

KEY ANNUAL ACTIVITY HIGHLIGHTS: HARYANA

Reproductive Health: Trainings were conducted by RMNCH+A counselors, Performance Based Indicators (PBI) and Terms of Reference for new counselor profiles were created. Qualitative assessment of Home Delivery of Contraceptives (HDC) was done followed by an orientation workshop, and dissemination on HDC. Logistic and technical support provided to Government of Punjab for the national standards in Family Planning Services workshop. Child Health and Newborn Health: Expert group meeting and state level Newborn Health and Child Health workshops were conducted, district level plans were formulated in all HPDs. Actionable points based on recommendations from HNAP workshops were drafted for onward sharing with districts for implementation support. MI was monitored and state level workshops for programmatic orientation of IDCF 2014 rounds, involving stakeholders from health, education, and IDCF were organized.

Supportive Supervision: Facility visit update till August 2015

Sl. No

Name of

HPD

No. of L1

Visited

No. of L2

Visited

No. of L3

Visited

Total HF

Visited

1 North-East

0 3 2 5

2 North-West

1 4 4 9

Total 1 7 6 14

Photo Credit: SRU Haryana

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Maternal Health: Documentation of Anemia Tracking Module was done and a state led innovation has been completed. Field level assessment in districts, monitoring of Antenatal Care Week, and labor room assessment conducted in 30 high delivery load health facilities of five HPDs. Adolescent Health: Qualitative and quantitative assessments of AFHCs were conducted and the National Deworming Days were monitored. Formative research design support to develop the state communication strategy was provided. A school based student health survey was designed (based on WHO Global School Health survey) to assess the behaviors of adolescents. Cross Cutting Activities: Review of SS checklist; technical support provided to state in drafting and finalization of 75*25 strategy; supported the state in organizing regional and district level Data Usage Workshop and conducted VHND Assessment; facilitated district level review meeting; drafted guidelines for B3P Program and attended perspective sharing B3P event.

Population

Persons 25351462

Male 13494734

Female 11856728

Infrastructure

No. of District 21

No. of HPDs 5

No. of Blocks 119



20


20


109


454


2542

Mortality

MMR SRS (10-12) 146

SRS (12-13) 127

IMR SRS (10-12) 42

SRS (12-13) 41


Sl. No

Name of HPD

No. of L1

Visited

No. of L2

Visited

No. of L3

Visited

Total HF

Visited

1 Hisar 2 21 2 25

2 Jind 7 15 2 24

3 Mewat 5 6 0 11

4 Palwal 2 10 1 13

5 Panipat 7 10 3 20

Total 23 62 8 93

Data Source: Census 11, National health profile 15

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KEY ANNUAL ACTIVITY HIGHLIGHTS: HIMACHAL PRADESH

Reproductive Health: A state level orientation workshop on family planning (FP 2020) was conducted. Child Health and Newborn Health: A state level workshop for newer guidelines under child health with child death review was conducted. These guidelines have been disseminated to sub-district levels, and support was provided in HPDs to develop and implement dissemination plans in high priority districts. Sensitization workshop for developing IAPPD, and orientation on the intensified diarrhea control fortnight IDCF was conducted. State level workshop on Introduction of Inactivated Poliovirus Vaccine Pentavalent Vaccine was organized by the project team.

Population

Persons 6864602

Male 3481873

Female 3382729

Infrastructure

No. of District 12

No. of HPDs 4

No. of Blocks 75



12


45


78


489


2068

Mortality

MMR SRS (10-12) NA*

SRS (12-13) NA*

IMR SRS (10-12) 36

SRS (12-13) 35

Photo Credit: wfsnews.org

Data Source: Census 11, National health profile 15 and NA*- data is not

available is SRS

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Maternal Health: A state planning meeting for Maternal Death Review was facilitated by the SRU and also a one day workshop for orientation of state and district level officers on QI in Family Planning Services was conducted. Labor room assessment was conducted in 17 high load delivery points in three high priority districts. Adolescent Health: The SRU facilitated state and district level orientation workshop on RKSK. Cross Cutting Activities: SS orientation was provided to district and block level officers for all 12 districts; based on the SS checklist recommended by the GoI; three regional orientation workshops conducted and designated RMNCH+A counselors were trained across all districts.

KEY ANNUAL ACTIVITY HIGHLIGHTS: JHARKHAND

Reproductive Health: SRU facilitated the training of 336 health functionaries and co-facilitated the state RMNCH+A counselors training and facilitated state level family planning workshop.

Child Health and Newborn Health: Technical support was provided towards drafting of Jharkhand Newborn Action Plan (JNAP) and Integrated Newborn and Child Health Training Module. RAPID for routine immunization was conducted in HPDs.

Maternal Health: SRU supported two state level meetings – one on Community Based distribution of Misoprostol; and an orientation on New Maternal Health Guidelines. Adolescent Health: SRU has been instrumental in facilitating the operationalization of RKSK in Jharkhand. SRU facilitated and coordinated the formation of State Committee for Adolescent Health (SCAH), they have also supported developing guiding tools for constitution of District Committee for Adolescent Health (DCAH) at the district level. Cross Cutting Activities: SS visits have been intensified in the state and the GoI-SS checklist piloted and institutionalized into the State Review Missions in the HPDs; participation and co-facilitation of three divisional review meetings. Co-facilitation of state level review meetings ― quarterly maternal health cell, family planning cell, child health cell, routine immunization cell reviews, and video conferences, state task force


Sl. No

Name of HPD

No. of L1

Visited

No. of L2

Visited

No. of L3

Visited

Total HF

Visited

1 Chamba 3 6 1 10

2 Kinnaur 8 5 1 14

3 Lahul & Spiti 0 3 0 3

4 Mandi 0 12 2 14

Total 11 26 4 41

Photo Credit: milaap.exposure.co

28 | P a g e

meetings during the entire year. The SRU also provided technical support in preparation, and review of PIP 2014-15 and 2015-16. SRU also supported in facilitation of review meetings on Jharkhand Matri- Shishu Swasthya and Poshan Maah (JMSSPM) and Intensified Diarrhea Control Fortnight.

Population

Persons 32988134

Male 16930315

Female 16057819

Infrastructure

No. of District 24

No. of HPDs 11

No. of Blocks 211



24


10


188


330


3958

Mortality

MMR SRS (10-12) 219

SRS (12-13) 208

IMR SRS (10-12) 38

SRS (12-13) 37


Sl. No

Name of HPD

No. of L1

Visited

No. of L2

Visited

No. of L3

Visited

Total HF

Visited

1 Dumka 29 7 1 37

2 Godda 31 5 3 39

3 Gumla 11 4 2 17

4 Latehar 44 6 1 51

5 Lohardaga 29 3 1 33

6 Pakur 11 5 2 18

7 Palamu 27 11 1 39

8 Sahibganj 20 12 2 34

9 Saraikella 10 7 2 19

10 Simdega 19 2 2 23

11 Singhbhum West 12 17 3 32

Total 243 79 20 342 Data Source: Census 11, National health profile 15

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KEY ANNUAL ACTIVITY HIGHLIGHTS: PUNJAB

Reproductive Health: The SRU team facilitated Home Delivery of Contraceptive Scheme (HDCS), assessment was conducted in one HPD, and a ToT was conducted for increasing uptake of PPIUCD. Child Health and Newborn Health: Under this component new guidelines related to newborn and child health were disseminated, the SRU supported communication monitoring for MI in four HPDS.

Maternal Health: A state level maternal health

review was organized to disseminate newer

guidelines of maternal health and discuss issues

like high risk pregnancy, labor room

strengthening and maternal death review.

Adolescent Health: The SRU team facilitated interviews with officials of health, education and ICDS as part of WIFS rapid assessment and also organized district convergence meeting for WIFS with health, education and ICDS in one HPD.

Cross Cutting Activities: A state review meeting for child health, newborn health, RKSK and Rashtriya Bal Swasthya Karyakram (RBSK) with

Population

Persons 27743338

Male 14639465

Female 13103873

Infrastructure

No. of District 20

No. of HPDs 5

No. of Blocks 141



22


41


150


427


2951

Mortality

MMR SRS (10-12) 155

SRS (12-13) 141

IMR SRS (10-12) 28

SRS (12-13) 26


Sl. No

Name of HPD

No. of L1

Visited

No. of L2

Visited

No. of L3

Visited

Total HF

Visited

1 Barnala 29 7 1 37

2 Gurdaspur 31 5 3 39

3 Mansa 11 4 2 17

4 Muktsar 44 6 1 51

5 Sangrur 29 3 1 33

Total 1 51 28 80

Photo Credit: SRU Punjab


30 | P a g e

technical support from USAID/RMNCH+A was organized and a district level VHND assessment was conducted. A state level Comprehensive Abortion Care workshop was conducted to strengthen services and orient participants on various components of CAC. The SRU also supported in preparation of HMIS based score card for all quarters for state as well as five high priority districts.

KEY ANNUAL ACTIVITY HIGHLIGHTS: UTTARAKHAND

Reproductive Health: The SRU team members have organized / facilitated / participated in 26 training sessions at different levels from the national to state, district and sub district level. Key trainings organized by the project staff included, PPIUCD training for medical officers and staff nurses posted in high case load facilities in HPD’s. SRU also organized a workshop on (HDCS). The SRU also facilitated contraceptive training; update for ANM’s and RMNCH+A counselors training.

Child Health and Newborn Health: The SRU conducted supervisory visits during MI, IDCF and RAPID activity for immunization, joint SS visits with USAID health staff, MoHFW - GoI & state teams. Poor Alternate Vaccine Delivery (AVD) mechanism was identified as one of the major

challenges during RAPID activity at Haridwar. Over a period of time this challenge has been largely addressed with regular monitoring and handholding from district and state teams. Workshop for roll out of Pentavalent Vaccine in the state was also facilitated by the SRU. The SRU also facilitated district Task Force Meetings for Immunization and IDCF.

Population

Persons 10086292

Male 5137773

Female 4948519

Infrastructure

No. of District 13

No. of HPDs 3

No. of Blocks 95



19


17


59


257


1847

Mortality

MMR SRS (10-12) 292

SRS (12-13) 285

IMR SRS (10-12) 34

SRS (12-13) 32

Photo Credit: thehindu/V Ganesan


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Maternal Health: The SRU organized a workshop on Early Detection of High Risk Pregnancy at district level. They also facilitated a training on Clinical Skills Standardization for Strengthening of Pre-service Education of Nursing & Midwifery Cadre. They also conducted baseline assessment of resources for maternal and newborn care services/ processes in the labor rooms in 12 high case load facilities.

Adolescent Health: RKSK Training for medical officers and ANMs was conducted.

Cross Cutting Activities: A stakeholder’s workshop on Free Essential Drug Scheme at Health Directorate and training program for ANM tutors were also conducted by the SRU.


Sl. No

Name of HPD

No. of L1

Visited

No. of L2

Visited

No. of L3

Visited

Total HF

Visited

1 Garhwal 0 10 2 12

2 Haridwar 8 7 3 18

3 Tehri Garwal 3 7 3 13

Total 11 24 8 43

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IV.SELECT CHANGE STORIES FROM THE STATES

HARYANA

1. Expansion of Labor Room in Community Health Centre Hodal, Palwal

Need Identification During the SS it was observed that the labor room at the Community Health Centre (CHC) was very small with only one labor table. The average deliveries in the CHC per month was 120. As per the NHM guidelines/toolkit the CHC should have had four labor tables. Lack of resource was identified as an issue to be addressed. Challenges Faced When efforts were made to bring a change in the facility there was inadequate response from Senior Medical

Officer (SMO) at facility/ Chief Medical Officer (CMO) at district level. No one seemed to be accountable for

the quality of the labor room.

Current Status

An advocacy meetings at state level with Medical Director (MD) and Executive Director (ED) State Health

Resource Centre was conducted to discuss the issue. A plan for expansion was developed and shared at district

and state level with the government officials. Advocacy was also done with the new Civil Surgeon (CS) at the

district level. After CS agreed, the DTO facilitated orders to JE for estimation of proposed renovation and the

budget was shared with Deputy Commissioner of the district along with CS.

Next Steps

The DTO will facilitate a meeting of District Health Society for approval of budget and contracting Public Works

Department (PWD) to do the renovation and complete the work.

2. Start Functional Kangaroo Mother Care Corner at Four New Facilities in Jind

Need Identification During SS visits it was observed that KMC was not being given to newborn with weight less than 2500 gms.

Challenges Faced

Awareness of staff nurses about guidelines on KMC was poor, and logistics for implementation were not

available.

Current Status

The feedback was shared with district authorities. KMC corners were established in three high case load

facilities other than District Hospital. Beds in post-partum ward have been identified and demarcated with

provision of screen. Gowns for nursing have been made available from the operation theatre. The staff in

33 | P a g e

these facilities have been oriented on KMC guidelines, and KMC services have been initiated in all the three

identified facilities.

Next Steps

Continue efforts to implement KMC guidelines in the fourth facility and establish dedicated KMC corners. Also

improve and sustain quality of KMC established in these four facilities.

3. Strengthening Procurement and Storage of Essential Commodities (Injection Oxytocin, Injection Labetalol,

Injection Vitamin K1) in 5*5 Matrix

Need Identification During SS visits it was observed that three drugs namely injection Oxytocin, injection Labetalol, and injection

Vitamin K1 had procurement and storage issues. Injection Vitamin K1 and injection Labetalol were frequently

out of stock, as the state was purchasing injection Vitamin K3 in place of vitamin K1, and injection Labetalol

was not in the rate contract list of Haryana Government. Injection Oxytocin was not being stored at the

recommended temperature of less than 25 degrees in the ware house, and during transport which was leading

to decreased potency of the injection.

Challenges Faced

Lack of availability of cold chain space at the warehouse for Oxytocin storage was a challenge.

Current Status

The status of intervention for each drug is as follows:

Injection vitamin K1: SRU suggested a short term plan of procuring this by local purchase and in the meantime

state was advised to put a separate tender which specifies Vitamin K1, this was to ensure that in future Vitamin

K1 is available.

Injection Labetalol: SRU advocated at the state level and got the drug included in the drug list of state.

Injection Oxytocin: SRU discussed the issue at state level and got the state government to ensure that Oxytocin

is stored in cold house at warehouse and transported under cold chain.

These changes have been accepted by Executive Director of Haryana Medical Supplies Corporation Limited

and files for corrective action have been initiated.

Next Steps

The SRU will follow up on the purchase and transportation process and will be reviewing the availability of

stock of these drugs at facilities.

34 | P a g e

DELHI

4. Train ANM on Postpartum Intrauterine Contraceptive Device and Intrauterine Contraceptive Device (IUCD)

Insertion at Maternity Homes

Need Identification During SS it was observed that there was no/ low Postpartum Intrauterine Contraceptive Device (PPIUCD)

uptake by clients at maternity homes.

Current Status

The idea was discussed at the state level with the State Program Officer (SPO). Following this the ANMs are

being trained on insertion of PPIUCD and Intrauterine Contraceptive Device (IUCD) both.

Next Steps

The initiative will be monitored and followed up during the SS visits.

5. Strengthen the Role of ANM as RMNCH+A Counselor

Need Identification During the review of state PIP it was revealed, that there was no provision for a dedicated RMNCH+A counselor in the annual proposed budget, which is a key position in promoting and implementing the RMNCH+A strategy at each facility. Hence it was proposed by the SRU Delhi that the existing ANMs can be trained and their roles can be strengthened as the RMNCH+A counselor. Challenges Faced Due to the additional responsibility of being an RMNCH+A counselor, there was a fear that regular

immunization activities might get effected as the ANM may not get time to deliver her core activities.

Current Status

Currently the trained ANMs are giving the RMNCH+A counseling also they are maintaining the database in the

given formats/registers. During the SS visits they are being followed up and being supported as per the need.

Next Steps

The initial results have been encouraging and the SRU Delhi team has been requested to train them further

on adolescent health component. Additionally during district review meeting the status of their work is being

discussed with Medical Officer in charge.

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HIMACHAL PRADESH

6. Institutionalize the Process of Supportive Supervision, Use of the Data Generated by Increased and

Continued Participation of Government Officials at Every Level (Block/District And State) for Better Uptake

and Improvement of RMNCH+A Services

Need Identification During discussions with government officers at various levels it was identified that very little number of field visits are being done by district and state health officials across the state, coupled with a lack of periodic review process for RMNCH+A programs at state and district levels. Challenges Faced Initially state had less acceptance, and district health officials were poorly oriented about the concept of SS in

RMNCH+A despite the orientation meetings being held at state and HPDs. The idea of doing a structured,

measurable SS has not yet been fully accepted and looks abstract to the officials. Further, these officers not

being data friendly, makes it a challenging job to establish a regular system of SS visits followed by analysis

and use of the data generated thereby.

Current Status

Initial data and feedback of SS visits by the Scaling Up RMNCH+A team was shared and discussed not only at

district level but also at state level. This has motivated higher authorities at state level to organize SS

workshops at regional levels, involving block level health officials in all the district to improve the quality of

RMNCH+A services across all the districts in the state.

This was followed by two regional workshops where eight districts were oriented on SS and block level SS

plans were made for respective districts. As a result of that six, 34 and 64 visits have been made by the health

officials of state, district and development partners respectively.

The findings of all supportive supervision visits were shared with the government and action points were

suggested. The process and efforts were appreciated by the Mission Director (MD)-NHM. On the reinforced

proposal to make this process an integral part of the system, the MD requested for suggestions from all

Program Officers.

Eventually, it was decided that using the central theme of the SS visits with the SS checklist along with the 5 X

5 matrix of RMNCH+A, a comprehensive SS visits plan should be made for the two districts Sirmaur and

Hamirpur (which have been selected for the CRM). This visit shall have a joint participation from the NHM

team, medical college faculty, and SRU so that the SS process can be understood better and refined further.

On the basis of the learnings, this process shall be replicated and followed for other districts on a periodic

basis, intertwined with state level reviews of the visited districts for the follow-up actions.

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Next Steps

The SRU will support state in planning of this process by providing a comprehensive proposal for SS visits

based on the SS checklist, 5X5 matrix of RMNCH+A and checklists/ tools for other programmatic areas of NHM.

They will also plan, schedule, and co-facilitate the visits of state level team in districts of Himachal Pradesh

according to plan, and support the state in further planning and identifying gaps at district and sub district

levels. Additionally they will share observations based on SS visits from all districts on periodic basis with state

and district officials regularly for further decision making to improve the RMNCH+A services. There is also a

plan for developing the capacity of the NHM and district level government officials to use the checklist, to

enter and analyze the data and to interpret the data for decision making.

PUNJAB

7. Ensure Joint Home Based Newborn Care Visits by ASHA and ANMs on Selected Days to Strengthen Post-

Natal Care Services for Mothers and Timely Identification and Referral of Sick Newborns at Fatehgarh

Churiyan Block of Gurdaspur District

Need Identification During SS visits and through interactions with the frontline workers it was found that the ASHA and ANMs were not conducting joint HBNC visits, which have been mandated by the GoI in their guidelines. Challenges Faced The data showed that the referral of sick newborns was very poor (less than one percent) and ANM was not

doing Post Natal Care (PNC) services as per PNC guidelines.

Current Status

The DTO at the district level facilitated a meeting with the CS and ensured that these joint visits were made.

Home visit data from all blocks is being compiled, a directive from CS regarding role of ASHA as facilitator in

HBNC monitoring is being developed.

Next Steps

The initial results have been encouraging and the SRU Delhi team has been requested to train them further

on adolescent health component. Additionally during district review meeting the status of their work is being

discussed with Medical Officer In charge.

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8. Capacity Building of ANMs In-Line Listing and Tracking of High Risk Pregnancies

Need Identification During SS visits and review of records at the sub-centers showed that there was poor reporting of High Risk Pregnancies (HRP). Challenges Faced There were multiple challenges that were identified. There was a gap in the knowledge of Local Medical Officers (LMO), ANMs, Staff nurses, and ASHAs in identification of high risk ANCs. It was also observed that records of HRP was poorly maintained and not updated regularly. There was also poor Mother and Child Tracking Systems data entry and tracking due to poor linkage. In addition there was a lack of initiative by SMOs and poor monitoring and supervision

Current Status

The District has conducted high risk case identification orientation of ANMs and ASHAs in their monthly

meetings. HRP posters of Government of Punjab have also been given to them, HRP identification, listing and

tracking issues were raised in SMO meeting in CS office and they have been instructed to get updated line

listing of HRP in their blocks.

The DTO also discussed HRP identification and listing with MOs and they are urged to mark in their outpatient

department (OPD) register and make their own line lists and coordinate with ANMs and Lady Health Visitors

( LHV) for updating and linkage.

Next Steps

The following activities have been planned by the DTO at the district:

1. Orientation of LHVs and ANMs in HRP identification, line listing, follow-up and record keeping 2. SS by LHVs, Block Extension Educator and district level supervisors for complete and updated HRP

tracking. Using their feedback to inform and further strengthening of HRP tracking. 3. Analysis and use of MCTS data and to improve its completeness and quality.

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V.PROJECT CONTACTS

NAME OF

UNIT

NAME OF UNIT HEAD

DESIGNATION CONTACT DETAILS ADDRESS

NTSU Dr. Rajeev Gera

Project Director, Scaling Up RMNCH+A Project

9810703515 [email protected]

IPE Global House B-84, Defence Colony, New Delhi-110024

SRU Dr. Rakesh Parashar

State Technical Team Lead

8890858863 rakeshparashar@ipeglobal.

com

Room No. 108, State Institute of Health & Family Welfare, Parimahal, Kasumpti, Shimla, Himachal Pradesh - 171009

SRU Dr. Chitra Rathi



6 Floor , DSHM, Vikas Bhawan , Civil Lines , New Delhi 110054

SRU Dr. Nidhi Chaudhary



m

Bays 59-62, Institute of Town Planners Building, Sector 2, Panchkula-134109, Haryana

SRU Dr. Anurag Joshi



Room No. 502, Fourth floor, Directorate of Health Services, Parivar kalyan Bhawan, Sector 34A, Chandigarh- 160022

SRU Dr. Jaya Swarup Mohanty



State RCH Campus G.V.I., Namkum Ranchi- 834010 Jharkhand

SRU Dr. Nitin Bisht



2nd Floor, RMNCH+A Unit, Office of the Director General Medical Health and Family Welfare, Shasheradhara Road, Dehradun-248001, Uttarakhand

NRU Dr. Pawan Pathak

Team Leader National RMNCH+A Unit

[email protected] IPE Global House B-84, Defence Colony, New Delhi-110024

JSI Dr. Sanjay Kapur

Managing Director , JSI India

[email protected]

B6-7/19, DDA commercial complex, Safdarjung Enclave, New Delhi-110029

mailto:[email protected]











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IPE Global Limited

IPE Global House, B-84, Defence Colony, New Delhi - 110 024

Tel +91.11.4075 5900 Fax +91.11.2433 9534

www.ipeglobal.com

DISCLAIMER

This report is made possible by the generous support of the American People through the United States Agency

for International Development (USAID). The contents are the responsibility of IPE Global Limited and do not

necessarily reflect the views of USAID or the United States Government.

scaling up interventions in reproductive, maternal

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