annual report 2009_nipi mp _draft

Norway India Partnership Initiative Madhya Pradesh

Annual ReportAnnual ReportAnnual ReportAnnual Report 2009200920092009

Norway India Partnership Initiative – Madhya Pradesh 2

Table of Contents

I. Background and introduction 1

II. NIPI’s focus Districts 7

III. About NIPI strategy 11

IV. Highlights of Key interventions 13

V. Media Reports 26


List of Abbreviations

ANC Ante-Natal Care

ANM Auxiliary Nurse Midwife

ANMTC Auxiliary Nurse Midwife Training Center

ASHA Accredited Social Health Activist

AWC Anganwadi Centre

AWW Anganwadi Worker

BCC Behavior Change Communications

BCHM Block Child Health Manager

BEmONC Basic Emergency Obstetric Care

BPM Block Program Manager

CEmONC Comprehensive Emergency Obstetric Care

CHC Community Health Centre

CMHO Chief Medical and Health Officer

DCHM District Child Health Manager

DPM District Program Manager

DTC District Training Center

GOI Government of India

GOMP Government of Madhya Pradesh

Govt. Government

HBPNC Home Based Post Natal Care

HMIS Health Management Information System

IEC Information, Education and Communication

JSY Janani Suraksha Yojna

MCH Maternal & Child Health

MDGs Millennium Development Goals

MIS Management Information System

MMR Maternal Mortality Ration

MP Madhya Pradesh

NCHRC National Child Health Resource Center

NGO Non Government Organization

NIPI Norway India Partnership Initiative

NRHM National Rural Health Mission

PHC Primary Health Centre

OR Operation Research

PIP Program me Implementation Plan

RCH Reproductive and Child Health

RH Reproductive Health

RTI Reproductive Track Infection

SBA Skilled Birth Attendant

SHC Sub Health Centre

SHG Self Help Group

SNCU Sick Newborn Care Unit

TBA Trained Birth Attendant

STI Sexual Track Infection

UNOPS United Nations Office for Project Services

VHSC Village Health and Sanitation Committee


Background and introduction

Until recently Madhya Pradesh was geographically the

largest state in the country with almost 13.5% of the

total area. In November 2000, the primarily tribal

eastern part was carved out to form Chattisgarh.

Madhya Pradesh has a total population of 60.4 million

(2001 Census), the rural to urban ratio being

approximately 73:27. Scheduled castes and scheduled

tribes account for 15.4 and 19.9% respectively of the

total population. Tribal population has decreased from

23.3% to 19.9% of the total population of the state after

the creation of Chattisgarh. Decennial population

growth rate in the state including Chattisgarh during

1991-2001 was 24.3%, about 3% higher than the

national growth rate.

S/N Item MP India

1 Total population (Census 2001) (in million) 60.35 1028.61

2 Decadal Growth (Census 2001) (%) NA 21.54

3 Crude Birth Rate (SRS 2008) 28.0 22.8

4 Crude Death Rate (SRS 2008) 8.6 7.4

5 Total Fertility Rate (SRS 2007) 3.4 2.7

6 Maternal Mortality Ratio (SRS 2004 - 2006) 335 254

7 Sex Ratio (Census 2001) 919 933

The state is relatively sparsely populated with an average population density of 196 per square km as

against the country average of 274 per square kilometer. Population density in rural areas is about 116

per square kilometer; the corresponding figure in urban areas is 1939 per square kilometer.

Madhya Pradesh has made impressive advances in literacy in the last decade. The literacy rate increased

sharply from 44% in 1991 to 64% in 2001 against a national average of 65%. Nevertheless, MP’s literacy

rate is well below Kerala’s 90.9% and ranks 16th amongst 35 states and union territories. The female

literacy rate is only 50.3%, somewhat lower than the national average of 54.3%.

Population below poverty line (BPL) in MP including Chattisgarh has been estimated to be 43% (as per a

survey conducted in 1987-88) while the Planning Commission arrived at a figure of 42.5% in 1995.

However, the Madhya Pradesh Human Development Report, 1998 indicates a much lower figure of 31%

(vis-à-vis national average of 33.5%).This still means that about 18.8 million people are classified as poor


Madhya Pradesh has 50 districts and hence an equal number of elected Zilla Panchayats. There are

almost 52,000 inhabited villages grouped under 21,999 Gram Panchayats and 313 Janpad or Block

Panchayats. Average rural population under the purview of a Zilla, Janpad and Gram Panchayat works

out to 984,000, 142,000 and 2010 respectively. A revenue village could consist of a number of separate

habitations known as tola or falia especially in tribal areas. The total number of such habitations in MP is

estimated to be about 112,000. The urban sector falls under the purview of 334 urban local bodies, out

of which the number of Nagar Panchayats (235), Nagar Palikas (85) and Municipal Corporations (14).

Maternal and Child Health

The current situation of child health in the state shows that only 21.6% (NFHS-3) of children are

exclusively breast fed for 6 months and 13.2% of children suffer from diarrhea. The

immunization in the recent times had shown a downward trend with complete immunization

being 40% (NFHS-3) for children in 12-23 months age group. The drop-out rate from BCG to

measles is as high as 23.72% (BCG coverage as per NFHS-3 is 80.5% while coverage for measles

is 61.4% - NFHS-3)

The Infant Mortality Rate for the Madhya Pradesh has been estimated by SRS at 70 in 2009. The

national IMR at the same time is 53. Madhya Pradesh falls amongst the lowest in IMR

compared with other states. Although, biologically, the girl child is stronger than the male child,

the female infant mortality rates were higher than male infant mortality rates.

Key Indicators India Madhya Pradesh MDG 2015

IMR 53 (SRS 2009) 70 (SRS 2009) 27

NMR 39 (NFHS-III) 45 (NFHS-III) <20

U5MR 74 (NFHS-III) 94 (NFHS-III) 41

Trends in IMR of India & MP


Maternal Health Scenario in the State

The strategic efforts under Reproductive and Child Health Program and NRHM taken by the state

government have been successful in reducing the Maternal Mortality Ration from 498 (1998) to 335 in

2004-06 but the Madhya Pradesh state still remains among the group of states with highest MMR in

India. The percentage of institutional deliveries has sharply improved from 27.5 in 2004-05 to 71% in

2007-08 in the state; however, little efforts have been initiated to address postpartum contraceptive

needs of clients.

Maternal Health Monitoring Indicators Current Status

(DLHS-3)

Target

(2009-10)

% of ANC registrations in first trimester of pregnancy 33.8% 80%

% of pregnant women receiving full ANC coverage 7.9% 30%

3 ANC checks 34.2% 80%

2 TT injections 60.4% 90%

100 IFA Tablets 16.7% 50%

% of pregnant women age 15-49 who are anaemic 57.7% <20%

% of births assisted by SBA 52.8% 80%

% of institutional births 47.1% 75%

% of mothers who received post partum care from a SBA

within 2 weeks of delivery

37.7% 80%


NIPI Focus Districts (Hoshangabad, Narsinghpur, Raisen & Betul)

Hoshangabad

Geographical Area (in sq.km) 5408.23

Total Populated Villages 923

Blocks 7

Total Gram Panchayats 428

Total Population 10,84,265

Total Males 5,71,774

Total Females 5,12,491

Total Estimated Population 0

(<1 yr)

(2006)

(2011)

(2016)

27748

26031

26025

Males

(2006)

(2011)

(2016)

14894

13398

13729

Females

(2006)

(2011)

(2016)

12853

12633

12296

CEmONC 04

BEmONC 09

Primary Health Centers 17

Sub Health Centers 150


Narsinghpur

Geographical Area (in sq.km) 5125.55


Blocks 5






(<1 yr)

(2006)

(2011)

(2016)

24460

23244

23017

Males

(2006)

(2011)

(2016)

13275

12124

12285

Females

(2006)

(2011)

(2016)

11185

11120

10732

CEmONC 02

BEmONC 09




Raisen

Geographical Area (in sq.km) 8395


Blocks 7


Total Population 1120159

Total Males 595730

Total Females 524429


(<1 yr)

(2006)

(2011)

(2016)

34681

34601

34710

Males

(2006)

(2011)

(2016)

18537

17759

18202

Females

(2006)

(2011)

(2016)

16144

16842

16508

CEmONC 02

BEmONC 09




Betul

Geographical Area (in sq.km) 10043


Blocks 10






(<1 yr)

(2006)

(2011)

(2016)

36515

32922

32644

Males

(2006)

(2011)

(2016)

19275

16688

16953

Females

(2006)

(2011)

(2016)

17241

16234

15691

CEmONC 03

BEmONC 15




About Norway India Partnership Initiative (NIPI)

The Norway-India Partnership Initiative provides technical cooperation which is co funded through

Government of Norway & Government of India the contribution of the Government of Norway is around

USD 80 million for 5 years (2006-2011). Even though this would form a relatively a modest supplement

to the budget for NRHM/RCH II, it would add a great value because of the way in which this resource is

proposed to be utilized.

The Partnership inputs would complement the national efforts and stimulate acceleration of NRHM

implementation for MDG 4 by providing flexible support to enable implementation and innovation, and

to resolve bottlenecks. In addition, the Partnership will provide access and feed-back to international

experiences and expertise.

The Partnership is being used to attain and sustain a rapid scaling-up of implementation to achieve

MDG-4. Efficiency comes with speed and maintaining the momentum of action is crucial for a mission

approach. Any delay in responding to the program needs with urgency, quality and flexibility has a price

in the form of lost opportunity to save lives. The additional support will provide a strategic and focused

complement to the national efforts.

The value addition to the national effort to reduce child mortality would be achieved by focusing the

partnership on four areas:

1. Strengthen a new government initiative, an independently managed enabling network, to

facilitate the delivery of MDG 4 related services.

2. Test and introduce new ways for scaling up quality services by primary health workers (ASHA

including their support needs and referral requirements (‘ASHA chain’).

3. Recruitment of private sector into the delivery of MDG 4 related services.

4. As the implementation of the NRHM-MDG 4 related activities unfold, there will be a continued

need to explore new opportunities as they arise. The partnership will operate on flexible basis

providing up front catalytic financial support, and facilitate engagement of international and

national expertise as deemed necessary.

Outcomes

• Sustaining routine immunization coverage rate in the country at 80% or more from 2007

onwards.

• Saving an additional half a million under-5 children each year from 2009 onwards.

By virtue of the innovative nature of this initiative and by demonstrating its successful

implementation, the Partnership would contribute to:

• Subsequently improve the performance of the health system as a whole in India

• The development of best procedures for large scale roll-out of interventions addressing MDG 4

also in other countries.

OVER ARCHING APPROACH

All activities undertaken under NIPI shall be directed towards fulfilling the goals and objectives of NRHM,

and in consonance with other program documents including RCH II program implementation plans (PIPs)

of the Centre and States, the Multi-year plan (MYP) for Universal Immunization Program and the State

Immunization PIPs. The Partnership recognizes the National Population Policy, Five Year Plan


Documents, National Health Policy and the National Plan for Action for Children documents as the

important guiding charters. These will be carried out within the implementation framework the same,

with the full participation of the State Governments and stakeholders.

NIPI would aim to strengthen inter-sectoral linkages, at all levels, especially with the ICDS system, water-

sanitation functionaries and Panchayati Raj institutions. Collaboration and synergistic cooperation with

professional organizations, NGOs, development partners and centers of excellence, among others,

would be actively sought and embraced to have maximum possible positive impact on child health.

The implementation mechanism through the state health society is as follows:

� Funds are placed with the state Health society for identified child health activities under the State

Action plan, within the state financial and audit rules framework. The objective is to leverage the

NRHM funds for child health by providing funds for catalytic activities.

� Activities are identified by the SHS and reflected as part of the district/state plans.

� Implemented in selected districts in each state to demonstrate innovations. Flexible to expand state

wide or as required by the state.

� States will take up all successful experiments in a cycle of about 18-24 months.

� The funds are channeled through an agreement between United Nations Office for Project Services

(UNOPS) through NIPI Secretariat and State health Society.

� The Secretary, Heath and Family Welfare of the respective States, as the chair person of the State

Coordination Committee finalizes /modifies the state action plan as per the requirement of the

state, through bottom up planning.

Institutional Frame work and Organization

Joint Steering Committee: The institutional mechanism of NIPI is led by Joint Steering Committee with

Secretary, Health and Family Welfare, Government of India as Chairperson and the Norway Ambassador

to India as the Co-Chair. Additionally, there are representatives of Government of India, Government of

Norway, WHO, UNIECEF and the NIPI focus States.

At the state level, activities under NIPI will be implemented by the State Health & Family Welfare

Society, chaired by Secretary, Health & Family Welfare, of respective state government.

Program Management Group (PMG) is a forum for dialogue to form a platform for coordination

between NIPI, NRHM leadership and other stakeholders, and for integration of activities with the NRHM

operational framework. Under the chairmanship of Mission Director, NRHM, MoHFW, the PMG

discusses key technical issues, reviews progress, makes proposals and recommendations to the JSC for

decision making.

A Secretariat under the leadership of Director is established to execute decisions made by the JSC and

function as a secretariat to the JSC and PMG.

In addition to the above, an International Strategy Group (ISG) has been established. The ISG

will advise NIPI, its Secretariat, and Agencies on global best practices towards reaching the

MDG4. At the same time the ISG will help disseminate lessons of the NIPI and the NRHM to the

international community.


High lights of Key interventions:

YASHODA

Safe motherhood program, Janani Suraksha

Yojana (JSY) in India under its NRHM has

increased institutional delivery from 10.85

million in 2005-06 (NRHM was operationalized in

2005) to 13.59 million in 2007-08. The scheme

focused on expectant mothers belonging to the

poor and disadvantaged families in high-

mortality, low-infrastructure and low-performing

States

This sudden influx of beneficiaries in the public health institutions is a definite opportunity in the history

of public health in India; but also it has emerged as a challenge to provide quality health service. The

public health facilities are challenged with lack of infrastructure, manpower and other facilities to

coordinate and ensure quality service delivery.

While the NRHM efforts are focused on strengthening infrastructure

and manpower which are long term interventions, NIPI’s response to

optimize the benefits of JSY during the stay of the mother and the

newborn is introduction of an innovative volunteer support worker at

the facility with high delivery volumes, named Yashoda (a legendary

foster mother of Indian mythology). She is a voluntary worker

compensated based on performance incentive. She supports and

assists the nurse in the provision of various non clinical activities from the time the pregnant woman

enters the facility till she leaves the hospital with the new born.

First 24 – 48 hrs after delivery is the most crucial phase for the newborn

baby and mother. During this period, Yashoda will support mother for

immediate and exclusive breast feeding; orient the mother about basic

newborn care and immunization and assist the nurse in various post natal

care activities for making the newborn and the mother comfortable.

Apart from helping the mother to de-stress, Yashoda will use this time to

counsel the mother on family planning options and fertility choices. She

will counsel the mother and her family on the various steps in newborn

care after leaving the facility including, nutrition for mother and the new

born, feeding practices, complementary feeding, immunization including

service delivery points, days, use of referral and other relevant

information.


While Yashoda support can contribute to improving the confidence of

the mothers utilizing the services of the government facility and

motivate them to stay for a longer duration, initiate immediate an

exclusive breast feeding, immunization and learn basic newborn care,

she is not a solution to all issues related to quality newborn care and

she is not substitute to the existing nursing or paramedical staff in the

hospital.

NIPI Madhya Pradesh has initiated Yashoda program in three

district hospitals of Narsinghpur, Hoshangabad and Raisen in

October 2008. Currently 54 Yashodas are providing services at

the district hospitals, where as another 17 are engaged at block

CHCs of Hoshangabad namely JSR Itarsi, Pipariya, Seoni Malwa &

Sohagpur. Since the inception of this program the Yashodas have

counseled 15733 mothers and served 15208 newborns at the

district hospitals till February 2010. Yashodas have been exposed

to periodic orientation meetings concerning their regular

responsibilities. A separate space has been allocated exclusively

for Yashodas at the district facilities.

The below graphs display the analysis based on the Yashoda Monthly Report versus HMIS Report of a

neighboring district Harda

Percentage of Newborns weighed at Birth at the District Hospitals


Percentage of Newborns breast fed within 1 hour

Percentage of Newborns administered with OPV 0 (Birth dose)

Establishing Sick Newborn Care Units (SNCU) and stabilization units. Even though the big dent in child mortality is likely to be

caused by prevention of illness and local management of

common conditions, it is seen as important to complete the

continuum of care with improving capacity for treating sick

neonates and infants at district level and below. Given that

NRHM has put a lot o f effort into getting mothers to give

birth at facilities rather than home, a service for those

children that are ill at birth makes sense if facility birth is to

have any advantages in the mind of the opinion. Also a lot of

effort is put on teaching grass root workers to recognize


danger signs in newborns and infants, but the effect of this will be attenuated if no proper curative care

for the same is available.

NIPI support is given through State Health Society in establishing Sick Newborn Care Units (SNCUs) level

-II at the district hospitals, which caters to a population of roughly 1,000,000 people. The establishment

of these units is guided by the Institute of Post graduate Education and Research (IPGMR) West Bengal,

a pioneer in the establishment of cost effective user-friendly SNCUs in Purulia, known as the Purulia

Model.

Based on the Purulia model, under NIPI state plan, a cost effective

model of SNCU level II units in district and level I /stabilization units at

block hospitals with large number of deliveries are initiated in four

states. NIPI will engage technical agency to facilitate the establishment

and operationalization of the SNCUs. This will initially be in three focus

districts. NIPI will leverage utilization of the NRHM funds for

developing these units and its components.

The additional fund requirement will be met from NIPI state plans. These SNCUs will be linked to medical

colleges for technical assistance, training of medical officers and nursing staff and monitoring of quality

of services. NIPI will build state technical expertise for scaling up this effort to other parts of state.

NIPI Madhy Pradesh has planned to establish Sick Newborn Care Units (SNCU level-II) in all its focus

districts. District Hoshangabad has completed its civil work and set up of the planned equipments are in

the process while district Raisen has also reached its final stage of civil work. However, district

Narsinghpur has got its final civil plan done and the necessary process for establishment of the unit is in

progress. Moreover, process for establishing stabilization units at Hoshangabad blocks (SNCU level-I) has

begun and will be functional soon.

Home Based Post Natal Care (HBPNC) As a process to support and contribute to NRHM efforts, NIPI places emphasis on identifying the need

for, testing of, and introducing new ways of strengthening the ASHA service, including their support

needs, and referral requirements and in particular building their skills. This becomes critical in the

current context where, despite a quantum jump in the use of institutional facilities for deliveries, about

half of the women in rural areas still deliver at home. Most of the women delivering in the institutions

also return home with newborn within the first 24 hours. NIPI interventions include a package of home

based new born care by ASHA through home visit for newborn care in the first 48 days. The services will

include: Birth preparedness, Care at birth, Post natal care-for sick new born and referral, Immunization

and Birth registration, Breast feeding & Complementary feeding.

This effort will be strengthened by:

• Involving Panchayat Raj Institutions, Women Self help groups, Village Health and sanitation

committees for development of village level plans and validation of ASHA activities.


• Development and dissemination of Behavior change communication materials targeted at high

risk practices in the community.

• Provision of seed money to a community managed fund for arranging and managing referral

transport to facilitate the timely transportation of the sick children to facilities and improving

referral linkage with the institutions.

NIPI-Madhya Pradesh has successfully initiated the rollout of HBPNC

program in three focus districts by creating 84 responsible HBPNC-

ASHA trainers at state level & block level. They are basically

responsible for creating a cadre of trained ASHAs at the village level,

who will be imparting the necessary knowledge and skills especially

related to Post Natal Care to the pregnant women, mothers and

others. However, 2462 ASHAs have already been trained till the end

of March 2010.

The HBPNC-ASHA Block level trainers were trained on the following themes:

1. To revise the key elements in Birth Preparedness, Essential New Born Care, Awareness of Danger

Signals.

• ASHAs will be able to convey comfortably key messages to Mothers and Family Members on

o

o Early initiation of Breast feeding

o Positive effects of feeding colostrums

o Exclusive breast feeding (NOTHING per mouth

except Mother’s milk) and its positive effects

o Keeping the baby warm

o Postpone bathing

2. To familiarize them with the PNC card, appropriate recording on it and Understanding the

Referral Mechanism as well as reporting to the relevant authorities.

• Be able to facilitate Immunization of the baby

• Be aware of danger signs in the Neonate and refer

them to the nearest facility

• Record the events properly in the PNC card.

• Record the home deliveries and facilitate birth

registration.


3. To understand the modalities of validation and payment and other Administrative issues.

The facilitators from NIPI Secretariat and state ensured that the

workshop proceedings were highly participatory and interactive.

Thus, along with the class room technique the resources

persons presented the topics thru practical demonstration by

using models which were then followed by participative

discussions (group work), then role play and questions and

answers. At the end of every presentation, the participants

were challenged by questions, which they worked on during

group discussions. The participants were also given exposures to

the real-time situation as visiting to the maternity ward of

district hospital.

Almost all the eligible ASHAs of Hoshangabad, Narsinghpur & Raisen districts have been trained on

HBPNC training (2days) and they will also experience another 5-days illustrative training on HBPNC soon.

Strategic support for Immunization

NIPI state plans include strategic support to immunization for

reaching the un- reached areas. The strategy proposed is to create a

bottom-up planning process in selected districts from the four of the

focus states, where block level managerial support is available

through NIPI support. Support will include:

• Analysis of each outreach site for performance.

• Articulation of logistic and access issues.

• Creation of extra vaccination sites, vaccinators, vaccine and transportation, based on

community’s assessment through involvement of Women’s Self Help Groups and

Panchayat members.

• Local resources and cooperation to handle the additional mobilization of children and

local transport support.

Divisional Logistic Managers (DLM) are strategically positioned at the divisional

offices to monitor and supervise the logistic issues related to child health. They

are primarily responsible for strengthening the system for optimal use of &

maintenance of cold chain stores / vaccine focal points while supporting the

procurement and management information system (ProMIS) along with training

divisional & district level managers on child health logistics. State has

constructed the website for information & communication regarding child


health logistics http://www.mplogistics.webs.com/ along with a common website for general NIPI-MP

information & communication i.e. http://www.mpnipi.webs.com.

Enabling Child health efforts through Techno Managerial Support

This intervention is a key enabling mechanism aimed at providing support to make NRHM child

health investments efficient, by accelerating expenditure, fast tracking implementation and

tracking the progress effectively. The support includes: Recruitment and placing of child health

managers, financial analysts, logistics managers at the state, District and Block levels within the

respective Program Management Units, and hospital based child health supervisors. All the

recruitments are done through state mechanism and within the state financial rules.

National Child health Resource centre (NCHRC)

The NCHRC is established in the National Institute of Health and Family Welfare (NIHFW) a premier

training institute with branches in several states of India.

The Child Health Resource Centre at the NIHFW functions as the nodal point for

mainstreaming the child health agenda in public health. The NCHRC is fully

staffed and functional. A technical advisory group comprising of eminent child

health and public health professionals will guide the activities of the NCHRC. The

focus will be on demystifying child health and collection and dissemination of all

the available reports, training materials, policies, program, case studies and

other relevant information on Child Health and related maternal health aspects

to all the workers at the primary level, located at the districts and below.

Strengthening State Training Node & District Training Centers

NIPI assisted interventions in the State as approved by the State Coordination Committee are part of the

State NRHM. The States need involvement of its Institutions for providing technical support to these

interventions. NIPI will be assisting these State Institutions for enhancing their capacity to deliver

technical assistance (TA) by infusion of skilled manpower, hardware, software and other ancillary

supports. This capacity thus built will also help the States to scale up the program to Statewide in future,

including creating a capacity for future re-training, additional training etc in RCH. The State Training Cell

needs to be constituted to monitor and mentor the process of trainings. The state training node thus

developed in state IEC bureau can enhance the resource utilization of IEC bureau and will anchor the

trainings of new interventions especially in child health. In this, these can take note of Government of

India’s National

Institute of Health & Family Welfare [NIHFW] initiated National Child Health Resource Centre (NCHRC)

and put in processes to get the State Child Health Resource Centre proposed in this node aligned to the

national effort. Later, the development and staffing of RHFWTC at Bhopal will fill this gap on long term

basis.


The support needed for the NIPI interventions in the States will include:

1. Training Capacity

• Adaptation, translation and creating State Ownership of Training Modules for Yashoda, ASHA

and Techno Managerial Interventions. Capacity for other training relevant to NRHM in future

years can also be gradually added.

• Training of Trainers for YASHODA’s, ASHA for PNC and Techno Managerial Staff at different

levels

• Collaborate with IIM-A to deliver the Management Development Program for the Techno

Managerial Staff funded by NIPI at State and District level.

• In addition the State Node will follow up the training for the next six months and help IIM A to

evaluate the learning.

• Regularly attend a random sample of field level training sessions for Yashoda & ASHA for PNC to

ensure quality of training.

2. Platform for Child Health-Public Health Discussions

• To translate the high level technical child health pedagogy into simple lessons and communiqué

for the use of front line workers at the district and block level.

Publication/adaptation/translation of basic educational and communication materials for front

line workers and nursing staff.

• E-Newsletter on RCH for the State

• Hold two State level Workshops each year among stakeholders of

• Child Health in the State

• Help in dissemination of learning’s within the State by collecting and disseminating best

practices on child health interventions for improving state child health programs.

3. Distance Education on RCH

• With NIHFW/IGNOU/State University/Institute, facilitate certificate [and possibly, Diploma]

courses for front line workers including nurses.

• Dissemination of nationally produced educational material both hard and soft copies for onward

distribution to front line workers.

• Continuously help in improving Pediatric/New-born nursing/midwifery education in the State

through new courses through long distance education

• Certificate courses in RCH for non-medico Mangers at all levels.

• One of the important tasks is getting materials translated from English to Hindi and providing

quality check on already translated materials.

4. Research & Evaluation

• Assist in the dissemination of Base line survey in the State and help NRHM to monitor progress

of select indicators in field Collaborate on Operational research studies related to ongoing

interventions, gender studies as determined by State from time to time.

• Providing concurrent evaluation support for specific interventions.


5. IEC

• Facilitate production of education and communication materials (educational CDs) for

dissemination in the district hospitals (using the LCDs).

• Facilitate state level production & dissemination of educational and communication materials

on newborn and child care for field level workers.

6 Links with National process through NIHFW

• The write-up on National Child Health Resource Centre may please be referred to. Each STATE

TRAINING NODE is requested to place all this capacity building as suggested above in the

framework of a State Child Health Resource Centre and promote a pilot District

• Health Resource Center in one NIPI-focus district for developing similar capacity in each district

in future.

7 District Health Training & Resource Centre (DHTRC)

• Madhya Pradesh has 22 functioning ANMTC and it plans to strengthen them through giving

funds for infrastructure improvement.

• NIPI would like join hands in its three focus districts and will start by doing a swot analysis of

these Training Schools to assess how/why they can be converted into District Health Training

Centers and assist them with some small inputs to improve training capacity in terms of

providing some additional funds that can be used for LCD projector and some good chairs or

buying AC for the Hall Etc.

• These ANMTC’s could be developed later- subject to approval of Sate Government- as District

Health Training Centers. The additional costs required for this will be planned in successive years

of NIPI State plan.

STATE TRAINING NODE- State Child Health Resource Centre [SCHRC] - will be guided by the Outputs

based on the activities detailed above. An indicative list is as below:

• Output 1: Training of Trainers- Yashoda, ASHA and, Techno Managerial staff

• Output 2: Adapted & printed State specific Training Modules and Material for

different functionaries and disseminated

• Output 3: Process Documentation of the key interventions and Best Practices

• Output 4: Educational material for Primary Health Care Workers and

Community Workers produced

• Output 5: Development of Audio Visual Health Educational material for LCD

in Maternity Wards

• Output 6: OR Studies with Indo Norwegian Institutions

• Output 7: Coordination with NIHFW for promotion of e-learning courses for

health workers

• Output 8: Facilitate certificate course for Nurses and Managers in

coordination with NIHFW/IGNOU

• Output 9: Build and Maintain Child Health Documentation Center

• Output 10: Development of e-learning courses for health workers

• Output 11: Development of database of all NIPI supported health functionaries

• Output 12: State specific output e.g. Establishment cost for state NIPI team


In order to strengthen the NRHM process, under Techno Managerial Support, NIPI Madhya Pradesh has

supported with the below listed personnel at state, division, district and block level.

State Level: State Logistic Manager, State Finance Analyst, State Data Analyst (at state

NRHM office)

State Training Node: Technical cum Training Officer, documentation Officer with HR specialty, Field

Research Coordinator, IT Officer, Data Assistant cum Accountant, Nursing

Consultant, ANM Consultant, Document Center Officer. (at State Training Unit)

Division Level: Divisional Logistic Managers (at Divisional Offices)

District Level: District Child Health Managers (at focus DPMUs)

Block Level: Block Child Health Managers (at focus BPMUs)

Management Capacity Development Program at IIM-A for NIPI-MP Managers

The NIPI managers participated a five day workshop at IIM

Ahmedabad in 24-28 Nov. 2009, after having six months of working

experiences in the above assigned projects. At the beginning of the

workshop the participants were sensitized about the major

issues and challenges that the country is facing in terms of

child health, and were also briefed about the attempted

programmatic solutions.

The Management Capacity Development Program was designed to accelerate the

implementation of Child Health Strategy under NRHM. IIM Ahmedabad has designed a special

course curriculum for the NIPI managers. The participants were exposed to the course during

the first workshop held at Bhopal on July 30, 2009, where they were assigned the below

mentioned project works:

• Management of Neonatal Health: SNCU

• Management of Neonatal Health: Yashoda Interventions

• Management of Immunization Services

• Convergence of Health and Nutrition Programs: Village Health and Nutrition Day

• Managing Childhood Illnesses

The following are some of the key challenges discussed during the workshop at IIMA:

• Low level of public awareness on health issues

• Accessibility and availability of health facilities to patients / community

• Poor health infrastructures

• Poor information and communication systems and infrastructures


• Competent and motivated human resources

• Feasible and acceptable mechanism / strategies to address the health needs

• Effective implementation of health programs

• Mitigating capacity building needs of health personnel and

• Promotion of innovative initiatives

• How the methodologies helped in understanding

Based on the projects assigned to the groups, the workshop was

designed in such a way that the participants get deeper

understanding on the subjects. The participants had undergone a

through learning process, being exposed to several methodologies

such as lecture method, field visit, observation, interviews,

presentation, discussion and group work.

The field visits to the nearby facilities provided the participants a good deal of exposure to the

functioning systems practiced by Government of Gujrat. Some practices are really appreciable

thus motivated the participants to replicate similar approach at their respective work areas

such as: the role of ASHA during & before the VHND and reinforcement through well-managed

AVDS, the temperament of AWC in taping resources from the community, the nature of IEC

displayed through the wall painting at AWC, Mechanism to record & monitor growth and

immunization of the target children and infants and so on.

Moreover, the participants were mostly involved in group works

and presentations, which not only helped to enhance the team

spirit among the group members and uplifted the level of

understanding on the subjects but also enhanced their leadership

quality and sharpened their presentation skills.

• Managerial practices to be adopted, based on the lessons learned in the training

• Relevant management tools such as Gantt Chart / CPM / PERT will be used during on-going

program planning processes, especially in SNCU and HBPNC program

• Other management tool such as Building Block Methods will be used while analyzing

Yashoda and HBPNC program

• Task analysis will be done while monitoring the on-going programs

• Vigorous home work will be done before rolling our IEC / BCC plan

• It will be minutely planned while planning the logistics, as discussed during the workshop


Other Initiatives

� Public Private Partnership (PPP): Expanding the resource pool for developing innovative

strategies through Public Private Partnership (PPP) by involving non-government actors at all

levels.

� Research and Innovation: Identifying new opportunities on a continuous basis through

collaboration with technical, professional and academic institutions in and outside India for

undertaking research, innovation and monitoring in child health in the overall context of primary

health.

� Monitoring and Evaluation: Enhancing ownership at community, block, district and state level for

concrete results in child health interventions by identifying filling the gaps in the existing survey

and surveillance tools for monitoring and evaluation.

Health Camp for Mother and Child at Hoshangabad

A grand Health Fair was organized for the mothers (ANC & PNC) and

children (0-5 years), at District Hospital Hoshangabad (MP) on 27th

March 2010. The event was a joint venture of District Health Society

Hoshangabad and NIPI Madhya Pradesh.

It was inaugurated by Mr. Girija Shankar Sharma, MLA who was

accompanied by Mrs. Maya Naroliya, President Municipal Corporation

and Bharat Yadav, Assistant. Collector, while at the end of the event Dr.

Tomas Alme, Dy. Director NIP, Dr. K Pappu, National Coordinator, CHRN, NIPI and Dr. Amita Chand, SPO

NIPI along with Dr. Vinay Dubey and Dr. RK Gangrade gave away the prizes to the winners of the

competitions held during the fair.

The Team:

The district administration along with the hospital administration

formed a team of 5 Pediatricians, 8 Gynecologists and 15 Doctors along

with more than 100 Paramedical staff including Yashodas, Hospital

staff, Anganwadi Workers, ASHAs and personnel from Women and

Child Development department, to make the event a grand success.

Activities:

The Total number of 1110 mothers along with expected mothers and

children under 0-5 years have benefited the free medical checkups and

received free medicines during the day-long event. They have received

counseling from Yashodas and other counselors as well.


However, 74 patients were tested for Ultra Sonography and other 6

patients had tested X-ray. During the checkups at the fare 15 Malnourished

Children have been Identified and sent to the NRC, moreover, 9 children

have been identified as physically challenged and referred to the

rehabilitation center after being certified by the health authority.

Furthermore, Women & Child Development department had a separate

section at the Health Fair where women were exposed to various

methods of preparing healthy foods with the locally available resources.

Prizes were given to those women who took active participation by

answering correctly to the questions asked during the program.

All who made a visit to the Health Fair had a good exposure about the

various health schemes / programs because of the immeasurable display of

related IEC materials. Moreover, attractive pamphlets containing important

pictorial display of information about mother and child care were

distributed to all the visitors.

Awards and Prizes:

Special prizes were awarded for best ANC, best PNC, best fully immunized child, best

healthy baby and best child who has recovered well from the malnourished status. The

competitions were conducted among every 50 registrations. Importantly, the

audiences were also benefited by the experiences shared by the winners after receiving

their prizes.

Among the other dignitaries VHSC members including Sarpanch, ASHAs and AWWs were also invited as

guests to witness the event. Special motivational awards were given away to AWW & AWC for their

remarkable performances at their respective fields. The event was possible due to the special efforts

made by the following contributors: The District Collector Mr. Nishant Varbade, CEO Zila Panchayat Mr.

Sanjeev, Assistant Collector Mr. Bharat Yadav, Dr. N Dubey, Dr. Gangrade, Dr. Damley and Mrs.

Swarnima Shukla, DPO WCD.


Media Reports


Norway India Partnership Initiative

Madhya Pradesh

1st

Floor, IEC Bureau

J P Hospital Campus

Bhopal, Madhya Pradesh

India – 462011

Web: www.nipi.org.in

NIPI- A Partnership to Reduce Child Death