improving linkages between primary healthcare services and the … · 2019-04-15 · microsoft...
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© Bill & Melinda Gates Foundation | 1
Improving linkages between primary
healthcare services and the
community:
Overcoming the last mile delivery
challenges in Indian context
Dr. Mrunal Shetye
Country Lead, Maternal, Newborn and Child Health
India Country Office
Bill & Melinda Gates Foundation
© Bill & Melinda Gates Foundation | 3
1.36 billion 1.25 billion 340 million 316 million
CHINA INDIA UP + BIHAR USA
© Bill & Melinda Gates Foundation | 4
Maternal deaths Neonatal deaths Under five deaths
20,000 2,32,000 4,26,000
India burden
Global burden
44% 33% 36%
7% 9% 7%
© Bill & Melinda Gates Foundation | 5
50% children not immunized*
30%currently married women use
modern contraceptives
5% mothers receive full ante natal care
40% children exclusively breastfed*
*For Bihar the full immunization rates are 60% and children exclusively breastfed are 53%
© Bill & Melinda Gates Foundation | 6
Poor health infrastructure
plagues these two states
40% Shortage of Doctors at primary health
care centers
80% Shortage of Specialists at secondary
health care centers
50%Shortage of nursing staff at primary and
secondary health centers
© Bill & Melinda Gates Foundation | 7
In this scenario, is it possible to bring the basic preventive
services closer to the community?
© Bill & Melinda Gates Foundation | 8
ASHAs
Eligible
couple
Child
years<5Adolescent
girl
DeliveryPregnant
woman
ANMsVillage health &
nutrition day
Tertiary
Healthcare
CenterSecondary
Healthcare
Center
Sub-CenterAWWs
Primary
Healthcare
Center
VHND acts as a link between the community and facility
to provide easily accessible health services
© Bill & Melinda Gates Foundation | 9
WHAT HAPPENS AT A VHND?
Pre PostDuring
FLWs match due
lists, prepare micro-
plans
© Bill & Melinda Gates Foundation | 9
11
© Bill & Melinda Gates Foundation | 12
WHAT HAPPENS AT A VHND?
Pre PostDuring
FLWs match due
lists, prepare micro-
plans
© Bill & Melinda Gates Foundation | 12
11
© Bill & Melinda Gates Foundation | 13
WHAT HAPPENS AT A VHND?
Pre PostDuring
FLWs match due
lists, prepare micro-
plans
© Bill & Melinda Gates Foundation | 13
Block level officials
ensure supply and
availability of
essential drugs and
equipment
11
22
© Bill & Melinda Gates Foundation | 14
WHAT HAPPENS AT A VHND?
Pre PostDuring
FLWs match due
lists, prepare micro-
plans
© Bill & Melinda Gates Foundation | 14
Block level officials
ensure supply and
availability of
essential drugs and
equipment
11
22
ASHAs, AWWs
responsible for
beneficiary
mobilization
33
© Bill & Melinda Gates Foundation | 16
WHAT HAPPENS AT A VHND?
Pre PostDuring
FLWs match due
lists, prepare micro-
plans
© Bill & Melinda Gates Foundation | 16
Block level officials
ensure supply and
availability of
essential drugs and
equipment
11
22
ASHAs, AWWs
responsible for
beneficiary
mobilization
33
ANMs responsible for
service delivery
VHND
44
© Bill & Melinda Gates Foundation | 23
WHAT HAPPENS AT A VHND?
Pre PostDuring
FLWs match due
lists, prepare micro-
plans
© Bill & Melinda Gates Foundation | 23
Block level officials
ensure supply and
availability of
essential drugs and
equipment
11
22
ASHAs, AWWs
responsible for
beneficiary
mobilization
33
ANMs responsible for
service delivery
VHND
44
© Bill & Melinda Gates Foundation | 24
WHAT HAPPENS AT A VHND?
Pre PostDuring
FLWs match due
lists, prepare micro-
plans
© Bill & Melinda Gates Foundation | 24
Block level officials
ensure supply and
availability of
essential drugs and
equipment
11
22
ASHAs, AWWs
responsible for
beneficiary
mobilization
33
ANMs responsible for
service delivery
VHND
44
FLWs fill in monitoring
checklists
55
Filled-in checklists
reviewed by block and
district level officials
66
© Bill & Melinda Gates Foundation | 26
WHAT HAPPENS AT A VHND?
Pre PostDuring
FLWs match due
lists, prepare micro-
plans
© Bill & Melinda Gates Foundation | 26
Block level officials
ensure supply and
availability of
essential drugs and
equipment
11
22
ASHAs, AWWs
responsible for
beneficiary
mobilization
33
ANMs responsible for
service delivery
VHND
44
FLWs fill in monitoring
checklists
55
Filled-in checklists
reviewed by block and
district level officials
66
© Bill & Melinda Gates Foundation | 29
2008
Predominantly
RI
New guidelines &
Government
Orders rolled out
VHND
strengthening
campaign
Training of
300,000 FLWs
initiated
VHND
launched in
UP
2008-2014
2015
Q1 2015
Q4 2015
UP example
© Bill & Melinda Gates Foundation | 30
INPUT TO IMPACT PATHWAY
INPUT OUTPUT OUTCOME IMPACT
Improved outcomes in terms of reduction in
maternal and infant mortality
Identification and
management of high
risk cases
Provision of quality health and
nutrition servicesVHNDs organized
every month at village
level
IMPROVED AVAILABILITY AND SERVICE DELIVERY OF ANC SERVICES
48
90
38
81
0
50
100
Q1'15 (58) Q4'16 (47)
Weight Measurement
Equipment Available Service Delivered
14
94
10
88
0
50
100
Q1'15 (58) Q4'16 (47)
BP Measurement
Equipment Available Service Delivered
36
92
24
83
0
50
100
Q1'15 (58) Q4'16 (47)
Blood test to measure Hb
Equipment Available Service Delivered
14
88
3
58
0
50
100
Q1'15 (58) Q4'16 (47)
Urine test to measure glucose & albumin
Equipment Available Service Delivered
UP example
Source: External evaluation survey conducted by Sambodhi
© Bill & Melinda Gates Foundation | 32
IMPROVED FP, NUTRITION AND RI SERVICES
2934
12
56
63
52
0
50
100
Condoms available OCPs available ECPs available
Family Planning Services at VHNDs
Q1'15 (58) Q4'16 (47)
60
48
81
52
0
50
100
IFA distributed Supplymentary nutritionto pregnant woman
Maternal Nutrition Services
Q1'15 (58) Q4'16 (47)
95100
0
50
100
Immunization ofchildren
RI at VHNDs
Q1'15 (58) Q4'16 (40)
UP example
Source: External evaluation survey conducted by Sambodhi
© Bill & Melinda Gates Foundation | 33
GOING FORWARD
Further capacity building of state and district level staff for better monitoring and
FLWs for improved service delivery
Further capacity building of state and district level staff for better monitoring and
FLWs for improved service delivery
Digital tracking of services through
VHND app
Digital tracking of services through
VHND app
Potential to use this platform to roll out
NCD screening and injectables for
family planning
Potential to use this platform to roll out
NCD screening and injectables for
family planning