Health & Nutrition Health & Nutrition Interventions under Interventions under

IKPIKP

Outline of the presentationOutline of the presentation

► What are we aiming in HN pilot mandals?What are we aiming in HN pilot mandals?► How did we plan to achieve?How did we plan to achieve?► Who are there to implement?Who are there to implement?► Where are we now?Where are we now?► What are the revised strategies proposed? What are the revised strategies proposed? ► Why the coming 6months are critical?Why the coming 6months are critical?► What is expected to do in the year 2006-07?What is expected to do in the year 2006-07?► How can we make it happen?How can we make it happen?

What are we aiming in HN What are we aiming in HN pilots?pilots?

►Empowered CBOs:Empowered CBOs:Demand access and availing health & Demand access and availing health &

nutrition services especially among POP nutrition services especially among POP &Poor&Poor

Improve house hold behaviours that help Improve house hold behaviours that help maternal & child survival and control maternal & child survival and control spread of communicable diseasesspread of communicable diseases

Provide financial support during illnessesProvide financial support during illnessesReduce expenditure on HealthReduce expenditure on Health

How did we plan to achieve?How did we plan to achieve?

Key strategiesKey strategies

►Continuous capacity buildingContinuous capacity building►Convergence with line deptsConvergence with line depts►CIFs (need based)CIFs (need based)►Community health resource Community health resource

persons involvement for behavior persons involvement for behavior changechange

1. Demand access and availing

health& nutrition services

Convergence with line depts

Institutionalization of

Fixed NHD

1. Improved coverage of pregnant ,lactating mothers and children especially among POP &Poor families2. Improved coverage of beneficiaries in the community

Objective Strategy Intervention

1. Reduction of morbidity & mortality (MMR,IMR,NMR)

2. Reduction of disability

Outputs

Outcomes

2. Improved Household

Behaviours for maternal &child survival

and control of communicable

diseases

Capacity building &

Behaviour change communication

(BCC)

Regular trainings,Exposure visits,Demonstrations,

Kalajathas,Rallies,

campaigns

1. Improved knowledge about ANC,PNC, neonatal care, 2. Improved knowledge about control of TB, Malaria and HIV/AIDS3. Change in household behaviours in terms of infant care, pregnancy, post natal care4. Reduction in episodes of TB, Malaria and HIV/AIDS

ObjectiveStrategy Intervention

1. Reduction of MMR2. Reduction of IMR3. Reduction of NMR4. Reduction of morbidity5. Reduction in health expenditure

Outputs

Outcomes

3.Provide financial support during illnesses

Social health fund(CIF)

Health savings -Health Risk Fund

1. Improved access to finance in case of emergencies.2. Improved health seeking behavior among women3. Early detection and treatment4. Referrals only in case of acute and chronic cases

Objective Strategy Intervention

1. Reduction of family expenditure on health2. Increased with increase in number of working days

Outputs

Outcomes

4. Reduction of expenditure

on health

Community managed

health insurance, Social health capital,

Establishment of Referral systems

& CIFs

1. Health activists2. Case managers3. Screening camps4. HRF5. Food security6. Nutrition centers7. Health insurance

• Management of illnesses with home remedies• Early detection of diseases and treatment among women• Referrals only in case of acute and chronic cases• Reduction of childhood illnesses• No delay in seeking treatment

ObjectiveStrategy Intervention

1. Reduction of family expenditure on health2. Reduction of incidences of HIV/AIDS among women

Outputs

Outcomes

What we accomplished?What we accomplished?

► 2003-04: Identification of pilot mandals2003-04: Identification of pilot mandals Recruitment of functionariesRecruitment of functionaries Induction training &exposure to Induction training &exposure to

CRHP, CRHP, Jamkhed staff Jamkhed staff ► 2004-05: Base line data using PRA exercises.2004-05: Base line data using PRA exercises.

Prepared Health action plans & health Prepared Health action plans & health expenditure analysis in all the VOsexpenditure analysis in all the VOs

Positioning of HAsPositioning of HAs Induction training &exposure to CRHP, Induction training &exposure to CRHP,

Jamkhed for HAs.Jamkhed for HAs.

2005-062005-06

► Implementation of AWFPs Implementation of AWFPs ►Trainings to HAs by Jamkhed mobile Trainings to HAs by Jamkhed mobile

teams in their respective villages.teams in their respective villages.

Expenditure incurred: 268.41lakhsExpenditure incurred: 268.41lakhs

2006-till the date2006-till the date

► Position of Master trainers with ANM qualification & Position of Master trainers with ANM qualification & certified by Dr. Arole.certified by Dr. Arole.

► Position of regional/Area H&N coordinators in the fieldPosition of regional/Area H&N coordinators in the field► Exclusive HN-AWFP exercisesExclusive HN-AWFP exercises► Bimonthly regional review meetingsBimonthly regional review meetings► Identification of health CRPs who are best Identification of health CRPs who are best

practitioners.practitioners.► Monthly MIS for HAsMonthly MIS for HAs► Masa Nivedika for health subcommittees at VO,MMS Masa Nivedika for health subcommittees at VO,MMS

&ZS&ZSBudget allocated: 526 lakhs under IHCBBudget allocated: 526 lakhs under IHCB

13.20 crores under CIF13.20 crores under CIF

Who are there to implement?Who are there to implement?In all 44 mandals identified in 22 districts:In all 44 mandals identified in 22 districts:► 1363 Health activists in 1329 VOs to train SHGs1363 Health activists in 1329 VOs to train SHGs► 1184 Health subcommittees to ensure services 1184 Health subcommittees to ensure services

to reach POP and Poor.to reach POP and Poor.► 60 Master trainers to train HAs 60 Master trainers to train HAs ► 31HN CCs to train Health sub committees and 31HN CCs to train Health sub committees and

ground the need based CIFs.ground the need based CIFs.► 7 AC/DPM(HND) to coordinate at district level.7 AC/DPM(HND) to coordinate at district level.► 7 Regional/Area H&N coordinators to provide 7 Regional/Area H&N coordinators to provide

supportive supervision &guidance in the districtssupportive supervision &guidance in the districts

Project Directors to ensure intensive focus in implementationSPMU team to provide technical support & guidance

40 Health CRPs to ensure health as an agenda in SGH/VO/MMS/ZS

Where are we now?Where are we now?► HAs undergone intensive regular training HAs undergone intensive regular training

at mandal level (8-89 days)at mandal level (8-89 days)89 days:89 days: Vizag, Chittoor, Guntur, Ananthapur,Kurnool Vizag, Chittoor, Guntur, Ananthapur,Kurnool8 days:8 days: Nellore, Srikakulam, Khammam, Vizianagaram Nellore, Srikakulam, Khammam, Vizianagaram

► 213 HAs and 208 Health sub committee 213 HAs and 208 Health sub committee members had exposure visits.members had exposure visits.

► Institutionalization of Fixed NHD(769VOs)Institutionalization of Fixed NHD(769VOs) Vizag Vizag (77),(77), Guntur Guntur (46) ((46) (Drawn VO wise schedules Drawn VO wise schedules

& issued proceedings from the collector)& issued proceedings from the collector) Khammam, Medak, Adilabad, Nellore (No NHD)Khammam, Medak, Adilabad, Nellore (No NHD)

Contd..Contd..

► Regular health savings (Rs21250 – 303000)Regular health savings (Rs21250 – 303000) Chittoor (Rs 303000)Chittoor (Rs 303000) Nizamabad (Rs 21,250)Nizamabad (Rs 21,250)

► HRF grounding (Model VOs)HRF grounding (Model VOs) Vizag, Ananthapur, Kurnool, ChittoorVizag, Ananthapur, Kurnool, Chittoor Vizianagaram (all VOs) by diverting funds Vizianagaram (all VOs) by diverting funds

released for training of HAs)released for training of HAs)► Implementation of other CIFsImplementation of other CIFs

Kitchen gardens (Chittoor)Kitchen gardens (Chittoor) Nutrition centers (Vizag, Guntur, Krishna)Nutrition centers (Vizag, Guntur, Krishna)

What made to show good What made to show good progress?progress?

►PDs conviction and involvementPDs conviction and involvement►Committed facilitators (HN CCs)Committed facilitators (HN CCs)► Intensive focus and no deviation on Intensive focus and no deviation on

implementation of proposed implementation of proposed interventions.interventions.

►Exposure visits to CRHP, Jamkhed.Exposure visits to CRHP, Jamkhed.

(seeing is believing)(seeing is believing)►Special review with the field staffSpecial review with the field staff

Why disparities?Why disparities?MTA results revealedMTA results revealed

► No anchor persons positioned.No anchor persons positioned.► If positioned, used their services for non If positioned, used their services for non

HN activities (general work).HN activities (general work).► So, no focus on training of HAs and SHGs So, no focus on training of HAs and SHGs

with a fixed schedule.with a fixed schedule.► Non release and delay in release of budget Non release and delay in release of budget

from DPMU to MMSfrom DPMU to MMS► Diversion of funds at district level from Diversion of funds at district level from

trainings to HRFtrainings to HRF► No clarity among the members of MMS No clarity among the members of MMS

&DPMU regarding HN budget allocations &DPMU regarding HN budget allocations made in 2005-06 AWFP.made in 2005-06 AWFP.

Contd…Contd…

► No orientation to ACs & APMs on HN strategiesNo orientation to ACs & APMs on HN strategies► No monitoring on quality of trainingsNo monitoring on quality of trainings► Not able to link/integrate the related activities Not able to link/integrate the related activities

(IB & Food Security) with HN. Seeing as stand (IB & Food Security) with HN. Seeing as stand alone interventions.alone interventions.

► Never been the agenda in any district level Never been the agenda in any district level review meetings.review meetings.

► No intensive supportive supervision & No intensive supportive supervision & guidance from SPMU.guidance from SPMU.

► No adequate clarity for operationlisation of No adequate clarity for operationlisation of CIFs such as HRF, Nutrition centers, other CIFs such as HRF, Nutrition centers, other need based CIFs generated, introduction of need based CIFs generated, introduction of health as an agenda.health as an agenda.

What are the revised strategies What are the revised strategies proposed in 2006-07?proposed in 2006-07?

► Exclusive Master trainers with ANM qualificationExclusive Master trainers with ANM qualification► Regional/Area H&N coordinators to do intensive Regional/Area H&N coordinators to do intensive

supportive supervision &guidance in the field.supportive supervision &guidance in the field.► Exclusive AWFP exercise with MMS &ZS and Exclusive AWFP exercise with MMS &ZS and

immediate release of budget based on the immediate release of budget based on the performance during the year 2005-06.performance during the year 2005-06.

► Allocation of budget for HRF under social CIF Allocation of budget for HRF under social CIF (@1lakh per VO) with detailed operational (@1lakh per VO) with detailed operational guidelinesguidelines

► Bimonthly regional review meetings ( for 3 Bimonthly regional review meetings ( for 3 districts)districts)

► Identification of Health CRPs from the best Identification of Health CRPs from the best practitionerspractitioners

Contd..Contd..

►Constitution of 10member Mandal Constitution of 10member Mandal cultural teams by MMS (SHG cultural teams by MMS (SHG members+local cultural teams)members+local cultural teams)

►Net working with Pvt/Trust hospitals for Net working with Pvt/Trust hospitals for health insurance & screening campshealth insurance & screening camps

►Fixed days for training of HAs(48 days) & Fixed days for training of HAs(48 days) & Health subcommittees (8days).Health subcommittees (8days).

►Performance based incentives for HAs (10 Performance based incentives for HAs (10 indicators).indicators).

► Introduction of Masa nivediaka on health Introduction of Masa nivediaka on health agenda by health subcommittees.agenda by health subcommittees.

What is expected to do in What is expected to do in districts?districts?(2006-07)(2006-07)1.1. Immediate release of budget to MMS.Immediate release of budget to MMS.

2.2. Positioning of human resources (HAs, CVs, Positioning of human resources (HAs, CVs, Master trainers)Master trainers)

3.3. Exposure visit to CRHP, Jamkhed for all the Exposure visit to CRHP, Jamkhed for all the health subcommittees &HAs.health subcommittees &HAs.

4.4. Fixed schedule for training of HAs @2 Fixed schedule for training of HAs @2 days/fortnight.( 7&8days/fortnight.( 7&8thth and 29 and 29thth&30&30thth day of day of the month).the month).

5.5. Fixed schedule for training of health Fixed schedule for training of health subcommittees @2 days per quarter.(18subcommittees @2 days per quarter.(18thth &19&19thth day of the month). day of the month).

So, fixed training calendar at MVTC.So, fixed training calendar at MVTC.

Contd..Contd..6.6. Convene district/mandal level convergence Convene district/mandal level convergence

meeting to draw schedules for meeting to draw schedules for institutionalization of Fixed NHD in all the institutionalization of Fixed NHD in all the VOs.VOs.

7.7. Regular support by MMS & ZS health Regular support by MMS & ZS health subcommittees in villages.( Try to cover all subcommittees in villages.( Try to cover all the VOs in a period of 6monthsthe VOs in a period of 6months

8.8. Implementation of comprehensive food Implementation of comprehensive food security in all the VOs followed by Nutrition security in all the VOs followed by Nutrition centers wherever necessary based on the centers wherever necessary based on the need on a sustainable model. (Vizag model).need on a sustainable model. (Vizag model).

9.9. Organise screening camps by net working Organise screening camps by net working with trust or other private hospitals.with trust or other private hospitals.

10.10. Release of HRF to VOs who are having Release of HRF to VOs who are having regular savings for health.regular savings for health.

Contd..Contd..

11.11.Initiate the process for introducing health Initiate the process for introducing health as an agenda thru the health CRPs.as an agenda thru the health CRPs.

12.12.Have a base line from the data already Have a base line from the data already collected in the year 2004 and also collected in the year 2004 and also ensure to submit monthly MIS ensure to submit monthly MIS (Quantitative & qualitative data).(Quantitative & qualitative data).

13.13.Introduce the practice of preparing HN Introduce the practice of preparing HN Masa nivedika by Health sub committee Masa nivedika by Health sub committee and VO president.and VO president.

14.14.Organization of Kalajathas in every VO Organization of Kalajathas in every VO once in every quarter by the mandal level once in every quarter by the mandal level cultural teams constituted by MMS and cultural teams constituted by MMS and trained.trained.

Why are the coming 6months Why are the coming 6months critical?critical?

►Need to demonstrate the impact of the Need to demonstrate the impact of the interventions to scale it up in another 55 interventions to scale it up in another 55 mandals with the support from DFID mandals with the support from DFID under health sector reform strategy.under health sector reform strategy.

►We can extend the benefits to POP &Poor We can extend the benefits to POP &Poor in at least in10% of the mandals in the in at least in10% of the mandals in the state.state.

So, Let us not loose the So, Let us not loose the opportunity!opportunity!

What is required to make it What is required to make it happen?happen?

►PDs conviction & involvementPDs conviction & involvement►Positioning of anchor persons (CVs) & Positioning of anchor persons (CVs) &

Master trainersMaster trainers►Focused approach to implement Focused approach to implement

planned interventionsplanned interventions►Clear guidelines for Clear guidelines for

operationlaisation of interventions.operationlaisation of interventions.►Fixed schedules for training of HAs Fixed schedules for training of HAs

and Health sub committees.and Health sub committees.►Organise exposure visits to CRHP, Organise exposure visits to CRHP,

JamkhedJamkhed

Contd..Contd..

► Institutionalization of NHDs in all the VOsInstitutionalization of NHDs in all the VOs► Review of activities as per AWFP based on the Review of activities as per AWFP based on the

output/outcome (Process/ impact indicators).output/outcome (Process/ impact indicators).► Intensive supportive supervision and Intensive supportive supervision and

guidance from SPMUguidance from SPMU► Introducing health as an agenda at SHG level Introducing health as an agenda at SHG level ► Integration with IB& Food security. Integration with IB& Food security. ► Not to consider it as a stand alone Not to consider it as a stand alone

intervention. intervention. ► Use it as an entry point activity to Use it as an entry point activity to

strengthen IB.strengthen IB.

Knowing is not enough,Knowing is not enough,We must applyWe must apply

Willing is not enough,Willing is not enough,We must doWe must do

-Goethe-Goethe