NHM &

The EARTH INSTITUTE, Columbia University

GREETINGS TO ALL DELEGATES

Workshop on Innovative programs in e-governance -CIPS

12-13th December 2013

NHM – so far

NRHM Launched in April 2005 By Hon’ble PM Sri. Manmohan Singh.

It was launched in November 2005 in AP.

NRHM Goals & Status as on

Prior to 2005 2012-13 NHM Goals 2017 MMR = 190 131 81 IMR = 62 43 17 TFR = 2.2 1.8 1.7

NHM - Objectives

To provide effective health care to • the people of Medak in rural areas & remote villages • the disadvantaged groups • Women and children

Decrease MMR & IMR

Reaching Objectives by

Improving access to institutional health care services

Enabling community ownership Strengthening public health care systems for efficient service delivery

Enhancing equity & accountability Promoting decentralization

health status and resources

PHCs - 67 SEX Ratio - 989/1000 SUB CENTERS - 536 LITERACY Rate - 55.3% CRUDE BIRTH RATE - 17.3% CRUDE DEATH RATE - 7.2% CPR - 72.5% TFR - 1.8 IMR - 43 MMR - 131 PP Units - 3 UHCs - 4 CEMONC - 7 CHCs - 10 Area Hospitals - 3 District Hospital - 1 No .of Gram Panchayaths - 1066

activities under nrhm – medak

Maternal Health • Institutional Deliveries • ASHAs • CEMONC • 24X7 Maternal Health Centers • JSY- JSSK • Blood Banks – Blood Storage Centers Child Health NRHM additionalities • Immunization Sub-center untied funds • RBSK VHSC Funds • SCNU HDS Funds • NRC PC&PNDT • NBSU Construction of Health Facilities. • NBCC RNTCP • NSSK NVBDCP

108 104 - FDHS

mmr / imr in the district

• Medak District was reported to be one of the high rated district with regard of MMR/IMR. • There is commendable reduction in the MMR/IMR in the last 8 years. • MMR came down to 131 from 190 and IMR came down to 43

Sl.No Name of the Cadre Sanctioned In positioned Vacant

1 Specialist Doctors 6 1 5

2 Staff Nurses 128 87 41

3 2nd ANMs 502 420 82

4 Theatre Assistants 4 4 0

5 ASHAs 2129 2010 119

Sl.No Name of the Cadre Sanctioned In position Vacant

1 DPMO 1 1 0

2 JBAR Coordinator 1 1 0

3 IMNCI Coordinator 1 0 1

4 District Program Officer 1 1 0

5 Accounts Officer 1 1 0

6 MIS Officer 1 1 0

7 Data Entry Operator 2 1 1

HR Under NRHM

NRHM District Program Management Unit

support from administration

• Under the guidance & support of the District Collector there is proper utilization of funds in the Dist. • Continuous review meetings by the District Collector with line departments, SPHOs and Medical Officers has resulted in improved MCH services at Sub Center level •Effective convergence is happening at District level and village level but the convergence at Block/Mandal level is not upto the mark.

ADDITIONAL SUPPORT IN MATERNAL & CHILD HEALTH

• SCNU = 1 : 20 bedded unit at DH Sangareddy with 14 staff Nurses and 4 Medical Officers to work round the clock. Started on 31st October 2012 and so far treated 1643 infants as on 30th Nov 2013

• NRC = 1 : 20 bedded NRC with 2 MOs and 3 Staff nurses etc. Started on 1st December 2012 and so far treated 271 children as on 30th Nov 2013 • NBSU = 6 : 4 Bedded NBSUs at Zaheerabad, Medak, Jogipet, Narayankhed, Narsapur and MCH Siddipet . Staff nurses recruited and trained and the units are functional from June 2013

• NBCC = 64 : At all delivery points. • 150 Bedded MCH ward at DH Sangareddy is under construction and expected to be completed by April 2014.

Activities – reminder card

To remind and create a confidence with human touch

Introduced reminder card system by ASHA.

Reminder Card launched by Hon.Minister Smt.Sunitha Lakshma Reddy on 15th August 2011 and piloted in Narsapur cluster with help of CARPED, NGO which is working on health issues in the state.

Activities – reminder card

Introduced reminder through phone (ANM Calling) in Gummadidala PHC area. All the ANMs will maintain record of the Pregnant women heath checkup due dates and they remind through phone and provide health council also.

sms based message

Introduced SMS based message In Mirdoddi PHC area. ANMs remind the pregnant women about the health checkups by sending SMS.

These three pilots have increased the confidence among the pregnant and their family members about the health services.

Based on the success of the above pilots designed 2 innovative programs called MATRUDEVOBHAVA - AYUSHMANBHAVA for the first time in India.

maatru devobhava

The voice message of the District Collector will be sent to all the pregnant and lactating mothers who are registered in MCTS( Mother and child tracking system). DG Synogeon a soft ware company designed this concept with support from CARPED

The pre recorded call from District Collector created confidence on utilization of public health facilities. A pilot in Dubbak CHNC was launched on 11th April 2012. Deliveries & immunization services improved commendably in the public health facilities such as Bhoompally, Timmapur. Immunization coverage gone upto 98%

Aayushmaanbhava

Started “Aayushmaanbhava” health help line( 88854442111), initially it serves 8.00am to 8.00 pm to provide the information about the services available under NRHM such as JSY-JSSK and coordinate with the medical staff, providing the ambulance service.

This year it will be clubbed with 1098 helpline service and work round the clock the services will be provided by CARPED NGO, the pilot programme is

first of its kind.

The call center executives will call the pregnant women who are into their 8 month of pregnancy and inform them about the Govt Hospital near to them and facilities under NRHM

progress so far

Under Matrudevobhava calls sent to 39,132 pregnant women and 34,840 lactating mothers so far. Reminders were also sent to them.

Under Ayushmanbhava 1540 pregnant women got benefitted from the helpline. Call center executives made 36,680 calls to the pregnant women informing them

to utilize public health facilities..

On random verification it was found that 61 % of the Pregnant to whom the calls were made, delivered at Govt Hospitals.

MCRS - Status report

Efficient method to coordinate care

MCRS uses a pragmatic approach

that leverages MCTS data

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Pregnant Women / Infants Register with

ANM and receive services through

ANM

ANM communicates to PHC and receives medications for

distribution

PHC enters data into MCTS

MCRS downloads data from MCTS and

calculates the schedule for the Beneficiary

according to the Mother and Child delivery and immunization schedule

MCRS loads data to the

dialer

MCRS system reminds

Benificiary/ ANM/ASHA on schedule due

dates via Phone based on the Health camp

schedule

Register

AN

M

Patien

t

Docto

r

AN

M

ASH

A ASHA brings

Pregnant

Women / Infants

to PHC or sub

center for further

services

MCRS

1

2

3

4

5

6

7

Phone reminders is the right method to

improve awareness on Govt. facilities in

rural areas

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Reminder Mode

Pros Cons

Email Cost efficient for sender Easy to include elaborated content Digitally stored Delivery can be tracked

Most of the Patients do not have email access Accessing internet to read email is expensive

and not affordable Expects population to be literate

Text Easy to reach larger population Instantaneously delivered Delivery can be tracked Digitally stored

Patient will have to bear carrier charges to receive text

To be effective message size is limited to 50 characters

Expects population to be literate

Letters Easy to include elaborated content Physically stored

Expensive for sender Delivery cannot be tracked On-time delivery not guaranteed Expects population to be literate

Phone call Easy to reach larger population Instantaneously delivered Delivery can be tracked No Cost to Patient, as incoming is free Reaches all population irrespective of

literacy status

Relatively expensive for sender

Calls will be made to pregnant beneficiaries

once a month and to children once in 3

months

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Immunization At birth 6 weeks 10 weeks 14 weeks 9-12 months 16-24 months

BCG X

OPV X X X X X

DPT X X X X

Hep-B X X X X

Measles X X

JE X X

VIT A Drops X

VITA 2nd Dose X

Total Reminders 0 1 1 1 1 2

Total 6 Reminders

Pregnancy < 12 weeks 14-26 Weeks 28-34 weeks 34 weeks < 35th weeks 36th week Delivery

(40th week) Post natal

care

Regular pregnancy

X X X X X X X XX

Total Reminders 1 1 1 1 1 1 1 2

Total 9Reminders

Project overall status

• Including pilot Total 6,25,781 contacts made

with beneficiaries

• 54116 pregnant beneficiaries and 44121 child

beneficiaries covered under the program

• We noticed significant improvement on govt.

facility deliveries and reduction in abortion

rates

• Govt. facility deliveries increased to

~2100/month from ~900/month.

• Abortions have been considerably reduced

Deliveries at PHC

In 2013 on an average 2300 deliveries /month

conducted at Govt facilities compared to 900 in

2011-12.

Beneficiaries saved approx. Rs. 2 crore per month

by getting services at Govt hospitals motivated by

voice call of District Collector.

Kangti PHC conducted 67deliveries in October

2013

Jaheerabad CHC conducted 459 deliveries in

September 2013 with an average of 380

deliveries/month compared to 200 in 2012 * Calculated as 10,000 Rs. Per delivery

Call Schedule

• 4 days ( Tuesday, Thursday, Friday and

Sunday) in a week as per NHD schedule

calls are made

• At least 2 attempts are made to reach

beneficiaries who do not lift the phone

• Pregnant women delivery message is

communicated monthly in 3 schedules ( 1st of

the month, 12th of the month and 20th of the

month)

• 50,000 preventive guidelines calls per month

Data Synchronization with

MCTS

• Every week Sunday data is synchronized

with MCTS

• Data from MCTS is reviewed for accuracy

and then reconciled with the MCRS data

• If services are delivered to beneficiaries

all open reminders related to services are

closed

MCRS Solution Key Benefits

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MCRS is integrated with MCTS; No dual data

entry

MCRS messages are personalized and

configurable

MCRS provides a website to check the

progress

MCRS enables manual patient reminders

MCRS reminders are coordinated with Health

camp Schedule

We established a website to

improve ease of access to timely

information • A dedicated website

(http://www.vcareconnect.com) to

monitor progress of the program

• Will provide timely access to due lists

for ANM/ASHA to coordinate

beneficiary visits to PHC/Health camp

• Will deliver timely reminder to

Beneficiaries in coordination with

NHD schedule to put preventive care

right on top of their mind

• Will provide flexible solution to remind

beneficiaries either on-demand or in

automated way

• Will provide clear and concise

statistics to put focus on the areas

lagging behind

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Data updated weekly from

MCTS

• Using Scheduled Reports section

from MCTS we download data per

subcenter in an excel sheet and

transform that data to fit Reminder

system data model

• We generate/update patient

preventive care schedule based on

latest data obtained

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Aligned reminders with NHD

schedule

• Most of rural population plan just in time, hence we align the

reminder schedule to match with NHD and delivered the message

right one day before the health camp.

• Reminders delivered will clearly describe the reason for the call as

well as articulate the benefits government program provides

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Train ASHA/ANMs on importance

registrations and due list

management

• With due list reports that will be made available online as well as

distributed physically, ASHA/ANM will be able to focus on their

priority beneficiaries

• Ability to obtain due list report by village or by ASHA or ANM or

Condition provided the flexibility staff will be looking for

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Clear and concise statistics enable

successful tracking of the program

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Deliveries at a glance

Percentage of Deliveries

Deliveries at PHCs

Secondary level facilities

The Process of MCRS

Greeting Card

Greeting card

Call pattern

Incentives Call center functions

SKYPE

SKYPE

Innovative Activities taken up in the District

• Installing GPRS units in SPHO, 104 and Program Officers’ vehicles.

• At 10 PHCs AVD pilot is implemented (Supervisor delivering vaccine at villages in Auto)

• Geo tagging of all public health facilities, high load private facilities, 104,108 parking points etc.

• First round of QMS is planned in coordination with Columbia University.

• Planning a Website for DHS

• Soft copies of monthly reports, daily OP, IP particulars, availability of drugs, financial details will be uploaded in the website.

IEC

.

Questions/Suggestions please