Transcript Slide 1

Service Delivery Modes in the
MBB
Examples of tracer interventions, and
the determinants of their effective
coverage
MBB follows a horizontal approach
Malaria
HIV
EPI
RH
Child
TB
etc.
Family oriented
community based services
Population oriented
schedulable services
Individual oriented clinical
services
2
Service delivery mode & service package
1.1 Family Preventive/WASH Services
1. FAMILY ORIENTED
SELF CARE
1.2 Family neonatal care
1.3 Infant and child feeding
1.4 Community based illness management
2.1 Preventive care for adolescent girls & women
2. POPULATION ORIENTED
SCHEDULABLE
SERVICES
2.2 Preventive pregnancy care
2.3 HIV/AIDS prevention and care
2.4 Preventive infant & child care
3.1 Clinical primary level maternal & neonatal care
3. INDIVIDUAL ORIENTED
NON SCHEDULABLE
SERVICES
3.2 Clinical primary level child and adult care
3.3 Clinical first referral illness management
3.4 Clinical second referral illness management3
Community Level Tracer Intervention selected: 1.1 Family Preventive/
WASH services (Supply of safe drinking water)
Interventions
Family
Preventive/
WASH
Services
Bottleneck
determinants
Indicators
Likely data
sources
Availability
essential
commodities
% households with availability of soap at the time
of survey%
MICS,
PDHS??
Availability
human
resources
% of population covered by Lady Health Workers
LHW MIS
Accessibility
% of population with at least one home visit by LHW
LHW MIS
Initial
Utilization
% (Population) mothers washing hands at least after
going to toilet
MICS 200708?
Timely
continuous
utilization
% (Population) mothers washing hands after going
to toilet & before eating % of population washing
hands at least twice (before eating and after
attending latrine) yesterday?
MICS 200708?
Effective
coverage
% mothers (Population) washing hands every time
with 5 key actions (after toilet, after disposing child's
faeces, before eating, before preparing food, before
feeding a child)
MICS 200708?
Community Level Tracer Intervention selected: 1.2 Family neonatal care
(early breastfeeding and temperature management (delayed bathing)
Interventions
Family
neonatal care
Bottleneck
determinants
Indicators
Likely data sources
Availability
essential
commodities
% of children (0-2) living with their
mother
PDHS 2006-07
Availability
human
resources
% of Population covered by LHW
LHW MIS
Accessibility
% of newborn visited in first 24 hours by
a trained community health worker
LHW MIS
Initial Utilization
% of newborn breastfed in first hour by
their mother
PDHS 2006-07
Timely
continuous
utilization
% of newborns receiving at least 3 PNC
visits within one month
LHW MIS
Effective
coverage
% of newborns receiving 3 PNC visits
within one month and birth weight taken
CMW Report
Community Level Tracer Intervention selected: 1.3 Infant and child
feeding (Complementary feeding)
Interventions
Family
Preventive/In
fant and
child feeding
Bottleneck
determinants
Indicators
Likely data sources
Availability
essential
commodities
% of household consuming less than
1800 Calories (financial terms) per day?
PPAF and PSLM
Availability
human
resources
% of population covered by Lady Health
Worker
LHW MIS
Accessibility
% of mothers with knowledge of
complementary feeding
National Nutrition
Survey…
Initial
Utilization
% of infants (six to nine months)
receiving solid food between breast
feeding
PDHS 2006-07
Timely
continuous
utilization
% of infants(6 to nine months receiving)
complementary feeding at least twice
in a day
MICS 2007-08
Effective
coverage
% of infants(6-11months ) adequately
fed (breast and complementary feeding)
MICS 2007-08
Community Level Tracer Intervention selected: 1.4 Community Illness
management (ORT))
Interventions
Family
Community
management
illness
Bottleneck
determinants
Indicators
Likely data sources
Availability
essential
commodities
% of Lady Health
Workers without stock
of ORS during last
month
LHW MIS
Availability human
resources
% of population covered
by Lady Health Workers
LHW MIS
Accessibility
% of LHW with
knowledge of ORT
LHW Evaluation Report
Initial Utilization
% of children with
diarrhea attended by
LHW
LHW MIS
Timely continuous
utilization
% of children with
diarrhea receiving ORT
LHW MIS
Effective coverage
% of children receiving
ORS, Zinc and
continued feeding
LHW Evaluation Report
Population Oriented Tracer Intervention selected: 2.1 Preventive care for
adolescents & adults (Family Planning)
Interventions
Population
oriented/
outreach
Family
planning
Bottleneck
determinants
Indicators
Likely data sources
Availability
essential
commodities
% of outreach workers (Lady Health
Workers) without stock out of
contraceptives (oral pills &
contraceptives
LHW MIS
Availability
human resources
% of Population covered by Lady Health
Workers
LHW MIS
Accessibility
% of couples with access to a functional
PHC (family planning services) facility
with in three kilometer distance
MICS 2007-08
Initial Utilization
% of currently married women (15-49
years) ever used any contraception
(current users plus those used
previously)
MICS 2007-08
Timely
continuous
utilization
% of currently married women currently
using any contraception
MICS 2007-2008
Effective
coverage
% of currently married women currently
using modern method of contraception
PDHS 2006-07
MICS 2007-2008
Population Oriented Tracer Intervention selected: 2.2 Preventive
pregnancy care (Antenatal care)
Interventions
Population
oriented/
preventive
pregnancy
care
Bottleneck
determinants
Indicators
Likely data sources
Availability essential
commodities
% of PHC facilities without stock
out of IFA for last six months
DHIS, LHW MIS
Availability human
resources
% of PHC facilities with at least
one female health care provider
HSRP monitoring
reports
Accessibility
% pregnant women with access to
ANC services in a functional PHC
facility with in three kilometers
DHIS
MICS ?
Initial Utilization
% of pregnant women who had at
least one ANC in last pregnancy
DHIS
MICS
Timely continuous
utilization
% of pregnant women who had 4
ANC visits in last pregnancy
DHIS
MICS
Effective coverage
% of pregnant women received
ANC1 in first trimester during their
pregnancy
PDHS
Population Oriented Tracer Intervention selected: 2.3 HIV/AIDS
prevention and care (PMTCT)
Interventions
Bottleneck
determinants
Indicators
Likely data sources
Population
oriented/ HIV
prevention
Availability
essential
commodities
% of PMTCT centers with no stock
outs of HIV tests, ARVs and
cotrimoxazole over last six months
PACP
UNICEF
Availability
human
resources
% of PMTCT centers with at least 2
WMOs ( Gynecologist) offering
PMTCT services
PACP
UNICEF
Accessibility
% of HIV positive spouses of high risk
groups utilizing PPTCT services
HIV AIDS Sero
prevalence HASP
studies
Initial
Utilization
% of at risk pregnant women
counseled and tested for HIV
PACP
UNICEF
Timely
continuous
utilization
% of HIV-infected pregnant women
who received Prenatal, Natal and Post
natal PPMTCT prophylactic measures
& other counseling services
PACP
UNICEF
Effective
coverage
% of newborn of HIV positive mothers
with HIV negative status
PACP
UNICEF
Population Oriented Tracer Intervention selected: 2.4 Preventive infant
& child care (Measles immunization)
Interventions
Population
oriented/pre
ventive
infant and
child care
Bottleneck
determinants
Indicators
Likely data
sources
Availability
essential
commodities
% of EPI centers without stock out of
vaccines and diluents for the last six
months
EPI cell
Availability
human
resources
% UCs with a fixed EPI center
EPI cell
Accessibility
% LHWs trained in Immunization
EPI cell
Initial
Utilization
% of Children (0-23 months) receiving
BCG
EPI cell
Timely
continuous
utilization
% of Children (0-23 months) receiving
DPT 1,2, & 3 / Pentavalent
EPI cell
Effective
coverage
% Children fully immunized (all
vaccines)
EPI cell
Clinical services Tracer Intervention selected: 3.1 Maternal and neonatal
care at primary clinical level (Normal delivery by skilled birth attendant)
Interventions
Bottleneck
determinants
Indicators
Maternal and
neonatal
care at
primary
clinical level
Availability
essential
commodities
% health facilities with out stock out of
oxytocin
Availability
human
resources
% health facilities with a skilled birth
attendant
Accessibility
% ANC with skilled birth attendant
(1 visit)
Initial
Utilization
% Deliveries conducted by a skilled birth
attendant
Timely
continuous
utilization
% mothers receiving at least 1 PNC
from skilled health care provider within
first three days
Effective
coverage
% mothers receiving 3 PNC visits from
skilled health care provider
Likely data sources
PDHS
Clinical Care tracer Intervention selected: 3.2 Management of illnesses at
primary clinical level (Antibiotics for U5 pneumonia)
Interventions
Management of
illnesses at
primary clinical
level
Bottleneck
determinants
Indicators
Likely data sources
Availability
essential
commodities
% of PHC facilities with
stock of essential
medicines available
DHIS
Availability
human
resources
% of PHC facilities with
staff trained in IMCI
DHIS
Accessibility
% of Families with access
to health facilities with in 3
kilometers
MICS
Initial
Utilization
% of suspected cases of
pneumonia taken to
appropriate health care
provider
MICS
Timely
continuous
utilization
% of suspected cases of
pneumonia treated by
Antibiotics (Cotrimoxazole,
Amoxicillin)
DHIS
Effective
coverage
% of suspected pneumonia
cases treated by a skilled
worker (IMCI)
MNCH Programme
Clinical services tracer intervention selected: 3.3 Clinical first referral care
(Basic emergency obstetric care (B-EOC))
Interventions
Bottleneck
determinants
Indicators
Likely data sources
Clinical
services/Clin
ical first
Referral care
Availability
essential
commodities
% of B EmONC health facilities with stock of
oxitocin, magnesium sulfate and Ambu bag
available during last 6 months
HSRP
DHIS
Availability
human
resources
% of B EmONC facilities having skilled birth
attendant to provide services round the clock
HSRP MNCH
monitoring report
Accessibility
% of population having (within 3 km) access to
a B EmONC facility with services round the
clock
Initial
Utilization
Proportion of all expected births in the
population that took place in B EmONC facility
Timely
continuous
utilization
% of women & new borns with complication
treated at the B EmONC facility
Effective
coverage
% of women & newborn with pregnancy
complication timely referred to the C EmONC
facility
Clinical Services tracer intervention selected: 3.4 Clinical second referral
care (Comprehensive emergency obstetric care (C-EOC))
Interventions
Clinical
services/secon
dary referral
care
Bottleneck
determinants
Indicators
Likely data sources
Availability essential
commodities
% of C EmONC facilities without
interruption in stock of essential
supplies and drugs (safe blood,
oxytocics, magnesium sulfate and
antibiotics, oxygen & assisted
ventilation)
DHIS, HRSP
Availability human
resources
% c EmONC facilities with SBAs
trained in EmONC and medical
officers trained in anesthesia
MNCH Project, HSRP
Accessibility
% of Tehsils having at least one
24/7 C EmONC facility
HSRP, MNCH
Initial Utilization
% of expected deliveries
conducted in CEmONC facilities
Timely continuous
utilization
% of C-Sections conducted in
CEmONC facilities
Effective coverage
Case Fatality Rate of mothers and
newborns
HSRP
DHIS