SYSTEMCHALLENGE: Uniform Service Delivery …€œPait nahi bharenge toh swaasth ka kya karenge..”...
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THEORY OF IMPACT I INNOVATION DIRECTION Building A Self Aware Delivery System Making the system capable of self diagnosis, self governance, self correction aided through evidence based decision making and creative problem solving tools HEALTH ! PUBLIC Socio-Temporal phenomenon APR JUN AUG Reduced/no access to healthcare facilities. Reduced/ no interaction with health care servicep roviders Higher number of home deliveries Higher number of deliveries in transit '…nadi ka bahav itna hota hain ki kitne baar to logon ko nadi par karnein main 4-5 ghante lag jatein hain. Aap hi bataon aise main kaunjayenga aspatal.’ Advent of the 1000 days period Migratory workers return home for festivities (Chaat, Dusshera, Diwali), invariably making it the highest conception period. Absence of any focused or dedicated Family planning drive Lack of any communication targeted at the father who is mostly home only during this time. JULY - AUGUST - SEPTEMBER OCTOBER - NOVEMVER - DECEMBER JUL SEPT OCT NOV JA N FEB MAR DEC MAY R e t u r n o f t h e M i g r a n t s JUNE - JULY - AUGUST MARCH - APRIL SYSTEM CHALLENGE: Uniform Service Delivery Across Diverse Socio-Behavioural-Geographic Contexts UNACCOUNTED SOCIAL, BEHAVIOURAL, CONTEXTUAL VARIATIONS: H a r v e s t S e a s o n P e k a a M r a r i g e S e a s o n Certain communities consume a diet that largely consists of rice (carbohydrates) and salt which leads to malnourishment in mothers – yet there is no focused communication around this issue. Most villages in Kishanganj prac- tice the concept of maternal houses gifting palnas to new par- ents - As a result there is no con- cept of skin to skin care, since the new-born is kept in the palna from day 1. In Saharsa many mothers return to working in fields soon after de- livery and this acts as a hindrance to the routine breastfeeding of the infant, yet there is no coun- selling by the system to the pri- mary caretaker, in terms of the kind of infant care to be given, feeding pattern, etc. In muslim communities, there is massive resistance to family plan- ning interventions, since it is per- ceived as being against their reli- gion “Agar hum nirodh ka ista- maal karenge toh hamein jannat nahi milegi”. Yet there is not cul- turally sensitive behavior strategy as a systemic response. Deliveries spike from 3-4 to as high as 20-30 deliveries a day. Absence of response in terms of additional medical staff leading non-medical staff assisting in deliveries. Lack of adequate number of female medical doctors increase the load on ANM .ANm is required to flit between multiple deliveries and demand for attention occuring deliveries. Decreased interactions between the healthcare system and the beneficiaries High drop-out rates at RI/VHSND as harvesting takes higher importance. “Pait nahi bharenge toh swaasth ka kya karenge..” Kishanganj Araria Purnia Katihar Asha 150 ANM 45 + Asha 85 ANM 20 + Asha 100 ANM 30 + Asha 130 ANM 35 + Araria + Purnia + Katihar + Kishanganj + 7 Days DEPLOY ANM 8 - A Grade 2 - Permanent 8 - Contract SITUATION AVAILABILITY 195 DATA LAYERING: Health Vulnerabilities Outcomes Resistance Awareness to Family Planning is at the minimum. Idea of Birth spacing poor. High in Anemia. Highly Mal-nutritioned. MUZZAFFARPUR Muslim Area 3 lakh PURNIA Hindu Area 5.23 lakh NALANDA Hindu Area 2.75 lakh + + + + HR Trained to give care in flood effected area. Been successful in muslim areas. Experience of 5 Yrs. 7 Yrs Nalanda A Grade 8 ANM’s HR HR Anemia Tanzania + Anemia Canada + Anemia The Gambia + Anemia BEST PRACTICES Dr Lindsay Barnes says : We give Shitavari con- coction to increase the breast milk in woman who have no milk or low. Dr. Subhash Sharma says : Chirayata sticks and black gram in water helps increase haemoglobin drastically, without side effects. Dr Agembe: We put forth a campaign to make sure that women dont drink coffee at the time of preganancy, as caffine is a Iron blocker . We started giving lemons + pulses “nimbu aur dal, machai kamal” Putting Iron piece in the cooking vessel increases iron by 75% in your daily diet. GH Nutrition / Experts + Practioners Global Health SOCIO-TEMPORAL-HEALTH PHENOMENA APR JUN AUG JUL SEPT OCT NOV JA N FEB MAR DEC MAY Setting community health camps and capacity in villages cut-off due to floods Increase Campaigns and Supplements for water borne diseases Intensive Family Planning campaigns with increased Focus on benefits of delayed first child bearing targetting mother-in-laws and husbands. Increased Marriage & New Brides Registrations Increased Mobilisation Drives for Ante-natal care and Immunization Deploying a contigency response healthcare cadre band band including Dais-in-Training, Medical College Student Internships, Mid-wives without Borders Modular and Mobile Birthing Infrastructure Intensive Focus on Family Planning campaigns Increased Registrations R e t u r n i n g M i g r a n t s I n cr e a s e i n M a r r i a g e s H a r v e s t H e a v y R a i ns a n d F l o o d H i g h B i r t h i n g An interactive dynamically updated dashboard that allows health practioners, from different schools of medicine, from around the world to upload emerging learnings, success stories and impact case studies in maternal and child health. The dashboard allows for quick access to a variety of solutions, techniques, tips, strategies to some prevelant local health issues. These can be rapidly piloted and tested by block health managers andhealth-workers to see what works. The dashboard allows users to search for solutions using a hashtag logic #ways to tackle anemia, # ways to diagnose or prevent eclempsia, ways to improve nutritional profile etc. A tool for or block health managers that visualizes the specific nature of problems prevelant and makes sense qualitative data for villages undes their coverage areas. The dashboard maps health outcomes, local health vulnerabilities, cultural or attitudinal factors of resistance, local health practices, seasonal phenomena, health infrastructure etc. Anemia Tanzania + Anemia Canada + Anemia The Gambia + Low lactation GH Nutrition / Experts + Practioners Global Health + Low Lactation What works Tanzania Dr Lindsay Barnes says : We give Shitavari concoction to increase the breast milk in woman who have no milk or low. GROW SHITAVARI ‘WHAT WORKS?’ : A DASHBOARD FOR EMERGING MATERNAL AND CHILD HEALTHBEST PRACTICES VILLAGE QUALITATIVE PROFILING TOOL | CONTEXT RESPONSIVE BLOCK LEVEL PLANNING A workshopping space that enables a knowledge sharing and enriching conversation amongst the fronline health workers based on their prati- cal experience. FLWs discuss and note down their learn- ings, coping mechanisms and micro-innovations they have experimented with. HUMAN RESOURCE RATIONALIZATION SEASONAL SYSTEM STRENGTHENING AND PROGRAM STRATEGY CREATION REFLECTIVE WORKSHOPS FOR HEALTHWORKERS A framework that qualitatively maps skill and experience of frontline health cadres and aligns them with the right context that can make best usage of their talent. A description of the area of need could allow the system to understand the appropreate re- source that needs to be deployed for it. A broad service delivery strategy based on an understanding of Socio-Temporal phenomena and its impact on health and access, to healthcare services. doh saal se bacho mai chamki bhoot bar gaya hai. Arre ye toh maine bhi dekha tha. doh saal pehle he toh oxycitocia labour mein dena shooru kiya tha. MICRO - INNOVATIONS BANK FAILURES, LEARNINGS BOARD "Mahilayein bolti hain din ki dihaari nahi milti teekakaran pe aane ki wajah se. Maine kaha bachcha beemar ho gaya toh zindagi bhar ghar baithogi, koi paisa nahi kama paogi" "Main garbhvati mahilaaon ke ghar bina bataye jaa ke unki iron ki goli ke pattey ko check karti hoon. Phir mujhe pata chalta hai kisko baar baar bolna hai" Wo kehe rahe the ki ab copper t kya hain bache toh allah ki den hain. Maine Unse kaha ki quran mai he lekha hai ki ek bache ke baad kam se kam doh saal ki doori rakhni cha- hiye. MUZZAFFARPUR Muslim Area 3 lakh PURNIA Hindu Area 5.23 lakh NALANDA Hindu Area 2.75 lakh + + + HR HR HR High Risk Pregnancies: 19 Local Health Vulnerabilities: Extremely high number of Anemia Cases as opposed to other villages High number of Pre-Eclampsia Cases as opposed to neighboring villages High number of Diarrhea Cases as opposed to neighboring villages Observed Factors of Resistance: Socio-Cultural: Families ‘bache allah ki kheti hain, hum rokenge toh allah ko jawab denge, jannat nahi milegi’. This popu- lar perception impacts the uptake of family planning services in the village. Attitude: There is overall poor demand for immunization, leave aside Ante-natal check-ups or any other service. Also any information on nutrition is met with the response that ‘it is the luxury of the rich.’ Popular Local Health and Nutrition Practices | Health Seeking Behaviour: There is a custom of maternal households gifting Palnas (Cots) to new mothers and from day 1 new-borns are kept in these cots. There is a complete absence of a culture of holding the baby for extended time periods or providing skin to skin care. Healthcare Infrastructure: Distance from Sadar Hospital: 2 hours, 45 kilometers Distance from Bahadurganj PHC: 45 mins, 20 kilometers Any Emerging Contextual Information The hamlets are sparsely inhabited which makes it difficult for ASHA to mobilise people and for people to turn up for RI. During monsoons some hamlets gets completely cut from the mainland making RI inaccessible for beneficiaries and vice versa. MOHAMADNAGAR VILLAGE + BAHADURGANJ BLOCK KISHANGANJ DISTRICT
Transcript of SYSTEMCHALLENGE: Uniform Service Delivery …€œPait nahi bharenge toh swaasth ka kya karenge..”...
THEORY OF IMPACT I INNOVATION DIRECTION
Building A Self Aware Delivery SystemMaking the system capable of self diagnosis, self governance, self correction aided through evidence based decision making and creative problem solving tools
HEALTH!PUBLIC
Socio-Temporalphenomenon
APR
JUNA
UG
Reduced/no access to healthcarefacilities.
Reduced/ no interaction with healthcare servicep roviders
Higher number of home deliveries
Higher number of deliveries intransit
'…nadi ka bahav itna hotahain ki kitne baar to logon ko nadipar karnein main 4-5 ghante lagjatein hain. Aap hi bataon aise mainkaun jayenga aspatal.’
Advent of the 1000 days periodMigratory workers return home forfestivities (Chaat, Dusshera, Diwali),invariably making it the highestconception period.
Absence of any focused or dedicatedFamily planning drive
Lack of any communication targeted atthe father who is mostly home onlyduring this time.
JULY - AUGUST - SEPTEMBER
OCTOBER - NOVEMVER - DECEMBER
JU
L
SEPT
OCT
NOV
JAN
FEB
MAR
DEC
MAY
Retu
rnofth
eM
igra
nts
JUNE - JULY - AUGUST
MARCH - APRIL
SYSTEM CHALLENGE:
Uniform Service Delivery Across Diverse Socio-Behavioural-Geographic Contexts
UNACCOUNTED SOCIAL, BEHAVIOURAL, CONTEXTUAL VARIATIONS:
Harvest S
eason
Pe
kaa
Mr
ari geS
eason
Certain communities consume a diet that largely consists of rice (carbohydrates) and salt which leads to malnourishment in
mothers – yet there is no focused communication around this issue. Most villages in Kishanganj prac-tice the concept of maternal houses gifting palnas to new par-ents - As a result there is no con-cept of skin to skin care, since the new-born is kept in the palna from day 1. In Saharsa many mothers return to working in fields soon after de-livery and this acts as a hindrance to the routine breastfeeding of the infant, yet there is no coun-selling by the system to the pri-mary caretaker, in terms of the kind of infant care to be given, feeding pattern, etc. In muslim communities, there is massive resistance to family plan-ning interventions, since it is per-ceived as being against their reli-gion “Agar hum nirodh ka ista-maal karenge toh hamein jannat nahi milegi”. Yet there is not cul-turally sensitive behavior strategy as a systemic response.
Deliveries spike from 3-4 to as high as 20-30 deliveries a day.
Absence of response in terms of additional medical staff leading non-medical staff assisting in deliveries.
Lack of adequate number of female medical doctors increase the load on ANM
.ANm is required to flit between multiple deliveries and demand for attention occuring deliveries.
Decreased interactions between the healthcare system and the beneficiaries
High drop-out rates at RI/VHSND as harvesting takes higher importance. “Pait nahi bharenge toh swaasth ka kya karenge..”
KishanganjAraria
Purnia
Katihar
Asha 150ANM 45
+
Asha 85ANM 20
+
Asha 100ANM 30
+
Asha 130ANM 35
+
Araria+
Purnia+
Katihar+
Kishanganj+
7 Days
DE
PLO
Y ANM8 - A Grade2 - Permanent8 - Contract
SIT
UA
TIO
N
AVAILABILITY195
DATA LAYERING:
Health VulnerabilitiesOutcomes Resistance
Awareness to Family
Planning is at the minimum.
Idea of Birth spacing poor.
High in Anemia.
Highly Mal-nutritioned.
MUZZ AFFARPURMuslim Area
3 lakh
PURNIAHindu Area
5.23 lakh
NALANDAHindu Area
2.75lakh
+
+
+
+HR
Trained to give care in flood effected area.Been successful in muslimareas. Experience of 5 Yrs.
7 YrsNalanda
A Grade8 ANM’s
HR
HR
AnemiaTanzania+
AnemiaCanada+
AnemiaThe Gambia+
Anemia BEST PRACTICES
Dr Lindsay Barnes says : We give Shitavari con-coction to increase the breast milk in woman who have no milk or low.
Dr. Subhash Sharma says : Chirayata sticks and black gram in water helps increase haemoglobin drastically, without side effects.
Dr Agembe: We put forth a campaign to make sure that women dont drink coffee at the time of preganancy, as caffine is a Iron blocker.
We started giving lemons + pulses “nimbu aur dal, machai kamal”
Putting Iron piece in the cooking vessel increases iron by 75% in your daily diet.
GHNutrition /
Experts + Practioners
Global Health
SOCIO-TEMPORAL-HEALTHPHENOMENA
APR
JUNA
UG
JU
L
SEPT
OCT
NOV
JAN
FEB
MAR
DEC
MAY
Setting community health camps and capacity in villages cut-off due to floods
Increase Campaigns and Supplements for water borne diseases
Intensive Family Planning campaigns with increased Focus on benefits of delayed first child bearing targetting mother-in-laws and husbands. Increased Marriage &New Brides Registrations
Increased MobilisationDrives for Ante-natal care and Immunization
Deploying a contigencyresponse healthcare cadre band band including Dais-in-Training, Medical College Student Internships, Mid-wives without Borders
Modular and Mobile Birthing Infrastructure
Intensive Focus on FamilyPlanning campaigns
Increased Registrations
Retu
rnin
g M
igra
nt
s
Incre
ase in
Marria
ge
s H
arvest
Heavy Rains and Flood
High BirthingAn interactive dynamically updated dashboard that allows health practioners, from different schools of medicine, from around the world to upload emerging learnings, success stories and impact case studies in maternal and child health. The dashboard allows for quick access to a variety of solutions, techniques, tips, strategies to some prevelant local health issues. These can be rapidly piloted and tested by block health managers andhealth-workers to see what works.
The dashboard allows users to search for solutions using a hashtag logic #ways to tackle anemia, # ways to diagnose or prevent eclempsia, ways to improve nutritional profile etc.
A tool for or block health managers that visualizes the specific nature of problems prevelant and makes sense qualitative data for villages undes their coverage areas. The dashboard maps health outcomes, local health vulnerabilities, cultural or attitudinal factors of resistance, local health practices, seasonal phenomena, health infrastructure etc.
AnemiaTanzania+
AnemiaCanada+
AnemiaThe Gambia+
Low lactation
GHNutrition /
Experts + Practioners
Global Health
+Low Lactation What works
Tanzania
Dr Lindsay Barnes says : We give Shitavari concoction to increase the breast milk in woman who have no milk or low.
GROW SHITAVARI
‘WHAT WORKS?’ : A DASHBOARD FOR EMERGING MATERNAL AND CHILD HEALTHBEST PRACTICES
VILLAGE QUALITATIVE PROFILING TOOL | CONTEXT RESPONSIVE BLOCK LEVEL PLANNING
A workshopping space that enables a knowledge sharing and enriching conversation amongst the fronline health workers based on their prati-cal experience. FLWs discuss and note down their learn-ings, coping mechanisms and micro-innovations they have experimented with.
HUMANRESOURCERATIONALIZATION
SEASONAL SYSTEM STRENGTHENING AND PROGRAM STRATEGY CREATION
REFLECTIVE WORKSHOPS FOR HEALTHWORKERS
A framework that qualitatively maps skill and experience of frontline health cadres and aligns them with the right context that can make best usage of their talent. A description of the area of need could allow the system to understand the appropreate re-source that needs to be deployed for it.
A broad service delivery strategy based on an understanding of Socio-Temporal phenomena and its impact on health and access, to healthcare services.
doh saal se bacho mai chamki bhoot bar gaya hai.
doh saal se bacho mai chamki bhoot bar gaya hai.
Arre ye toh maine bhi dekha tha.
doh saal pehle he toh oxycitocia labour mein dena shooru kiya tha.
MICRO - INNOVATIONS BANK
FAILURES, LEARNINGS BOARD
"Mahilayein bolti hain din ki dihaari nahi milti teekakaran pe aane ki wajah se. Maine kaha bachcha beemar ho gaya toh zindagi bhar ghar baithogi, koi paisa nahi kama paogi""Main garbhvati mahilaaon ke ghar bina bataye jaa ke unki iron ki goli ke pattey ko check karti hoon. Phir mujhe pata chalta hai kisko baar baar bolna hai"
Wo kehe rahe the ki ab copper t kya hain bache toh allah ki den hain.Maine Unse kaha ki quran mai he lekha hai ki ek bache ke baad kam se kam doh saal ki doori rakhni cha-hiye.
MUZZ AFFARPURMuslim Area
3 lakh
PURNIAHindu Area
5.23 lakh
NALANDAHindu Area
2.75lakh
+
+
+HR
HR
HR
High Risk Pregnancies: 19
Local Health Vulnerabilities: Extremely high number of Anemia Cases as opposed to other villagesHigh number of Pre-Eclampsia Cases as opposed to neighboring villagesHigh number of Diarrhea Cases as opposed to neighboring villages
Observed Factors of Resistance:Socio-Cultural: Families ‘bache allah ki kheti hain, hum rokenge toh allah ko jawab denge, jannat nahi milegi’. This popu-lar perception impacts the uptake of family planning services in the village.Attitude: There is overall poor demand for immunization, leave aside Ante-natal check-ups or any other service. Also any information on nutrition is met with the response that ‘it is the luxury of the rich.’
Popular Local Health and Nutrition Practices | Health Seeking Behaviour:There is a custom of maternal households gifting Palnas (Cots) to new mothers and from day 1 new-borns are kept in these cots. There is a complete absence of a culture of holding the baby for extended time periods or providing skin to skin care.
Healthcare Infrastructure:Distance from Sadar Hospital: 2 hours, 45 kilometersDistance from Bahadurganj PHC: 45 mins, 20 kilometers Any Emerging Contextual InformationThe hamlets are sparsely inhabited which makes it difficult for ASHA to mobilise people and for people to turn up for RI.During monsoons some hamlets gets completely cut from the mainland making RI inaccessible for beneficiaries and vice versa.
MOHAMADNAGAR VILLAGE
+
BAHADURGANJ BLOCKKISHANGANJ DISTRICT
