Transcript Health & Nutrition pilots

Health & Nutrition
Interventions under IKP
Outline of the presentation
► What
are we aiming in HN pilot mandals?
► How did we plan to achieve?
► Who are there to implement?
► Where are we now?
► What are the revised strategies proposed?
► Why the coming 6months are critical?
► What is expected to do in the year 2006-07?
► How can we make it happen?
What are we aiming in HN pilots?
► Empowered
CBOs:
Demand access and availing health & nutrition
services especially among POP &Poor
Improve house hold behaviours that help
maternal & child survival and control spread of
communicable diseases
Provide financial support during illnesses
Reduce expenditure on Health
How did we plan to achieve?
Key strategies
►Continuous
capacity building
►Convergence with line depts
►CIFs (need based)
►Community health resource persons
involvement for behavior change
Objective
1. Demand
access and availing
health& nutrition
services
Strategy
Convergence with
line depts
Intervention
Institutionalization
of
Fixed NHD
Outputs
1. Improved coverage of pregnant ,lactating mothers
and children especially among POP &Poor families
2. Improved coverage of beneficiaries in the community
1. Reduction of morbidity
& mortality (MMR,IMR,NMR)
2. Reduction of disability
Outcomes
Objective
Strategy
2. Improved
Household
Behaviours for
maternal &child survival
and control of
communicable
diseases
Capacity building
&
Behaviour change
communication
(BCC)
Intervention
Regular trainings,
Exposure visits,
Demonstrations,
Kalajathas,
Rallies,
campaigns
Outputs
1. Improved knowledge about ANC,PNC, neonatal care,
2. Improved knowledge about control of TB, Malaria and HIV/AIDS
3. Change in household behaviours in terms of infant care,
pregnancy, post natal care
4. Reduction in episodes of TB, Malaria and HIV/AIDS
1.
2.
3.
4.
5.
Reduction of MMR
Reduction of IMR
Reduction of NMR
Reduction of morbidity
Reduction in health expenditure
Outcomes
Objective
Strategy
3.Provide
financial support
during illnesses
Social health fund
(CIF)
Intervention
Health savings Health Risk Fund
Outputs
1.
2.
3.
4.
Improved access to finance in case of emergencies.
Improved health seeking behavior among women
Early detection and treatment
Referrals only in case of acute and chronic cases
1. Reduction of
family expenditure on health
2. Increased with increase
in number of working days
Outcomes
Objective
Strategy
4. Reduction of
expenditure
on health
Community
managed
health insurance,
Social health capital,
Establishment of
Referral systems
& CIFs
Intervention
1.
2.
3.
4.
5.
6.
7.
Health activists
Case managers
Screening camps
HRF
Food security
Nutrition centers
Health insurance
Outputs
•
•
•
•
•
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
1. Reduction of
family expenditure on health
2. Reduction of incidences of HIV/AIDS
among women
Outcomes
What we accomplished?
► 2003-04:
Identification of pilot mandals
Recruitment of functionaries
Induction training &exposure to CRHP,
Jamkhed staff
► 2004-05: Base line data using PRA exercises.
Prepared Health action plans & health
expenditure analysis in all the VOs
Positioning of HAs
Induction training &exposure to CRHP,
Jamkhed for HAs.
2005-06
► Implementation
of AWFPs
► Trainings to HAs by Jamkhed mobile teams
in their respective villages.
Expenditure incurred: 268.41lakhs
2006-till the date
►
►
►
►
►
►
►
Position of Master trainers with ANM qualification &
certified by Dr. Arole.
Position of regional/Area H&N coordinators in the field
Exclusive HN-AWFP exercises
Bimonthly regional review meetings
Identification of health CRPs who are best practitioners.
Monthly MIS for HAs
Masa Nivedika for health subcommittees at VO,MMS &ZS
Budget allocated: 526 lakhs under IHCB
13.20 crores under CIF
Who are there to implement?
In all 44 mandals identified in 22 districts:
► 1363 Health activists in 1329 VOs to train SHGs
► 1184 Health subcommittees to ensure services to
reach POP and Poor.
► 60 Master trainers to train HAs
► 31HN CCs to train Health sub committees and
ground the need based CIFs.
► 7 AC/DPM(HND) to coordinate at district level.
► 7 Regional/Area H&N coordinators to provide
supportive supervision &guidance in the districts
Project Directors to ensure intensive focus in implementation
SPMU team to provide technical support & guidance
40 Health CRPs to ensure health as an agenda in SGH/VO/MMS/ZS
Where are we now?
HAs undergone intensive regular training
at mandal level (8-89 days)
►
89 days: Vizag, Chittoor, Guntur, Ananthapur,Kurnool
8 days: Nellore, Srikakulam, Khammam, Vizianagaram
213 HAs and 208 Health sub committee
members had exposure visits.
► Institutionalization of Fixed
NHD(769VOs)
►


Vizag (77), Guntur (46) (Drawn VO wise schedules
& issued proceedings from the collector)
Khammam, Medak, Adilabad, Nellore (No NHD)
Contd..
►
►
►
Regular health savings (Rs21250 – 303000)
 Chittoor (Rs 303000)

Nizamabad (Rs 21,250)
HRF grounding (Model VOs)
 Vizag, Ananthapur, Kurnool, Chittoor
 Vizianagaram (all VOs) by diverting funds released
for training of HAs)
Implementation of other CIFs
 Kitchen gardens (Chittoor)
 Nutrition centers (Vizag, Guntur, Krishna)
What made to show good progress?
► PDs
conviction and involvement
► Committed facilitators (HN CCs)
► Intensive focus and no deviation on
implementation of proposed interventions.
► Exposure visits to CRHP, Jamkhed.
(seeing is believing)
► Special review with the field staff
Why disparities?
MTA results revealed
► No anchor persons
► If positioned, used
positioned.
their services for non HN
activities (general work).
► So, no focus on training of HAs and SHGs with a
fixed schedule.
► Non release and delay in release of budget from
DPMU to MMS
► Diversion of funds at district level from trainings
to HRF
► No clarity among the members of MMS &DPMU
regarding HN budget allocations made in 200506 AWFP.
Contd…
► No orientation to ACs & APMs on HN
► No monitoring on quality of trainings
► Not able to link/integrate the related
strategies
activities
(IB & Food Security) with HN. Seeing as stand
alone interventions.
► Never been the agenda in any district level
review meetings.
► No intensive supportive supervision & guidance
from SPMU.
► No adequate clarity for operationlisation of CIFs
such as HRF, Nutrition centers, other need based
CIFs generated, introduction of health as an
agenda.
What are the revised strategies
proposed in 2006-07?
► Exclusive Master trainers with ANM
► Regional/Area H&N coordinators to
qualification
do intensive
supportive supervision &guidance in the field.
► Exclusive AWFP exercise with MMS &ZS and
immediate release of budget based on the
performance during the year 2005-06.
► Allocation of budget for HRF under social CIF
(@1lakh per VO) with detailed operational
guidelines
► Bimonthly regional review meetings ( for 3
districts)
► Identification of Health CRPs from the best
practitioners
Contd..
► Constitution
of 10member Mandal cultural
teams by MMS (SHG members+local
cultural teams)
► Net working with Pvt/Trust hospitals for
health insurance & screening camps
► Fixed days for training of HAs(48 days) &
Health subcommittees (8days).
► Performance based incentives for HAs (10
indicators).
► Introduction of Masa nivediaka on health
agenda by health subcommittees.
What is expected to do in districts?
(2006-07)
Immediate release of budget to MMS.
Positioning of human resources (HAs, CVs,
Master trainers)
3. Exposure visit to CRHP, Jamkhed for all the
health subcommittees &HAs.
4. Fixed schedule for training of HAs @2
days/fortnight.( 7&8th and 29th&30th day of the
month).
5. Fixed schedule for training of health
subcommittees @2 days per quarter.(18th &19th
day of the month).
1.
2.
So, fixed training calendar at MVTC.
Contd..
Convene district/mandal level convergence
meeting to draw schedules for
institutionalization of Fixed NHD in all the VOs.
7. Regular support by MMS & ZS health
subcommittees in villages.( Try to cover all the
VOs in a period of 6months
8. Implementation of comprehensive food
security in all the VOs followed by Nutrition
centers wherever necessary based on the need
on a sustainable model. (Vizag model).
9. Organise screening camps by net working with
trust or other private hospitals.
10. Release of HRF to VOs who are having regular
savings for health.
6.
Contd..
11. Initiate
the process for introducing health as an
agenda thru the health CRPs.
12. Have a base line from the data already collected
in the year 2004 and also ensure to submit
monthly MIS (Quantitative & qualitative data).
13. Introduce the practice of preparing HN Masa
nivedika by Health sub committee and VO
president.
14. Organization of Kalajathas in every VO once in
every quarter by the mandal level cultural
teams constituted by MMS and trained.
Why are the coming 6months
critical?
► Need
to demonstrate the impact of the
interventions to scale it up in another 55
mandals with the support from DFID under
health sector reform strategy.
► We can extend the benefits to POP &Poor in
at least in10% of the mandals in the state.
So, Let us not loose the opportunity!
What is required to make it happen?
► PDs
conviction & involvement
► Positioning of anchor persons (CVs) &
Master trainers
► Focused approach to implement planned
interventions
► Clear guidelines for operationlaisation of
interventions.
► Fixed schedules for training of HAs and
Health sub committees.
► Organise exposure visits to CRHP,
Jamkhed
Contd..
► Institutionalization of NHDs in all the VOs
► Review of activities as per AWFP based on
the
output/outcome (Process/ impact indicators).
► Intensive supportive supervision and guidance
from SPMU
► Introducing health as an agenda at SHG level
► Integration with IB& Food security.
► Not to consider it as a stand alone
intervention.
► Use it as an entry point activity to
strengthen IB.
Knowing is not enough,
We must apply
Willing is not enough,
We must do
-Goethe