12TH NIPI PROGRAM MANAGEMENT GROUP

12TH NIPI PROGRAM MANAGEMENT GROUP

MINUTES Venue: Jacaranda II conference hall, First floor, India Habitat Centre, Lodhi Road, Delhi

Date: November 22, 2011

Time: 15.00 hrs to 1800 hrs

The Norway India Partnership Initiative (NIPI) Program Management Group (PMG) acts as technical

advisory board for the Joint Steering Committee of the NIPI. The role of PMG is to review technical

proposals and to give recommendations to the Joint Steering Committee.

The 12th PMG met in Jacaranda II conference hall, First floor, India Habitat Centre, Chaired by the

Acting Mission Director National Rural Health Mission (NRHM), Ms Anuradha Gupta.

Director NIPI Secretariat welcomed all participants and requested the acting Mission Director NRHM

to Chair the meeting.

Presentations by UNICEF were given on 2 proposals for subsequent funding through NIPI, and approval

through the JSC. These were followed by 2012 budget presentations from 3 NIPI implementing

partners and the NIPI Secretariat.

Each Mission Director from 4 NIPI supported States was asked to present an update on progress on

NIPI funded activities in the last reporting period since the JSC in May 2012.

Programme progress updates from implementing partners and NIPI Secretariat were deferred due to

lack of time, but copies of the presentations would be circulated electronically.

Discussion on the future of NCHRC and SCHRCs was led by Dr Pappu, and the PMG Chair arrived at

some specific recommendations to be put forward to JSC.

New proposals in brief

New proposals were submitted by UNICEF for consideration by the Program Management Group.

These included:

1. Social marketing of ORS and Zinc for Diarrhoea Management Program in 44 high focus districts

of India– 2011-2012

PROPOSED BUDGET $3,710,000

2. Conducting a baseline assessment of quality of maternal-newborn care

PROPOSED BUDGET $400,000

(one year)

Coverage of maternal and newborn health interventions increasing, skepticism on quality

Impact of coverage on maternal mortality and infant mortality will depend on quality

o Limited impact of JSY on perinatal mortality (Lim et al)

RCH-II had planned that “..for assessing quality of services an integrated (internal and

independent) system involving M& E cell and medical colleges will be instituted”

However, the QA monitoring plan did not take-off

Program Management Group 22 November, 2011

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UNICEF: Proposal # 1 Social marketing of ORS and Zinc for Diarrhoea

Management Program in 44 high focus districts of India– 2011-2012

Social marketing of ORS and Zinc for Diarrhoea Management Program in 44 high focus districts of

India– 2011-2012

There are two major issues related to management of Diarrhoea among infants and children in the

country: first lack of awareness and use of ORS and Zinc for management of Diarrhoea by health workers

and, second, poor and interrupted supply of ORS and Zinc for Diarrhoea management. When

appropriately addressed, both these problems could lead to avoidable deaths amongst children

suffering from Diarrhoea.

It is against this background that a project is proposed to increase availability, awareness and utilization

of ORS and Zinc for proper management of Diarrhoea in children in 44 high focus districts of 13 states in

India (Details in Annexure-1), especially through a social marketing concept.

Objectives of proposal:

1. Increase regular availability of ORS + Zinc in public and private sector (traditional and non-traditional outlets)

2. Increase awareness and knowledge of the rationale and advantages to prescribe ORS and Zinc for management of childhood Diarrhoea by public and private health workers

3. Change prescribing habits of Frontline and primary care health workers to recommend use of ORS and zinc for management of childhood diarrhoea

4. The proposal seeks to increase the supply and promote the demand and use of ORS & zinc to prevent deaths due to Diarrhoea among children 2 -59 months. The contracted firm will create informed demand for ORS and Zinc through a communication campaign targeting families of children 2-59 months, and ensure wide availability of ORS and Zinc tablets (co-package) at chemists.

5. The specific tasks to be undertaken by the social marketing firm include: a. Training b. Create a network of depot holders – increasing supply c. Linkages and Networking d. Creating awareness e. Monitoring & Reporting

6. Amount budgeted in PBA for the activity USD 3,710,000


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(Detailed Proposal in Annex 1)

DECISION:

PMG takes note of Government of India (GoI) concerns on the need to focus more on supply and

logistics in ORS rather than a social marketing approach. There is a need to strengthen the existing

supply and logistics system. The PMG recommends UNICEF redraft the proposal for a Nation wide

communication strategy on awareness generation regarding ORS and Zinc. There is also a need to focus

on creating awareness regarding the use of home-made solutions for those children not requiring ORS

under Diarrhoea management. It is not recommended for presentation at JSC in its current form. The

revised proposal to be developed in consultation with the National Health System Resource Centre

(NHSRC).

UNICEF: Proposal # 2 Quality Assessment of Maternal and Newborn Care in 5

States

Note on baseline assessment of quality of maternal-newborn care

Monitoring and evaluation mechanisms currently capture only quantitative outputs. The quality of care

is not assessed by current mechanisms. RCH-II has led to significant improvements in coverage of several

maternal and newborn interventions such as institutional deliveries, special care for sick newborns,

home visits to all newborns etc. The coverage is likely to further increase in coming years. However, the

increase in coverage of these interventions will result in impact on mortality outcomes only if the quality

of care is high. It is becoming increasingly clear that further substantial improvements in maternal and

child survival will not be possible unless there are substantial improvements in quality of care.

At the moment, there are no quantitative estimates for quality of maternal, newborn and childcare. For

example, while there is information on what proportion of newborns are visited at home in the first

week of life, there is no information on what proportion of newborns receive quality assured care during

the home visits. Similarly, while the proportion of deliveries by “skilled birth attendants” is known, there

is limited information on what proportion of deliveries receives “skilled birth attendance”. Part of the

reason for not having this information is that it is more difficult to collect information on quality of care.

It is proposed that in the year 2012, UNICEF will work with NIPI partners (WHO and UNOPS) to generate

estimates of key indicators on quality of care across NIPI states. These estimates would serve as

baselines against which subsequent efforts to improve quality by different partners could be measured.


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This would be done by a mix of methods: observation of quality of care, analysis of the secondary

information, estimation of UN indicators etc. A detailed methodology will be prepared and shared on

receiving the in-principle approval. A summary matrix of suggested methodology is placed below:

Purpose Method

Assessment of quality of

newborn care by front-line

workers

Structured observations of Home Visits

Review of case records


essential newborn care

Structured observations of delivery at health facilities

Surveillance of stillbirth rates in health facilities


special newborn care

Structured assessment using quality checklists

Monitoring of case fatality rates

Surveillance of one month and one year survival


maternal care

Structured assessment using checklists

Monitoring of UN Indicators (case fatality rates, perinatal mortality rates, numbers of complications treated)

Proposed Budget in the first year $400,000

Total Cost of Activity $1.5 million

DECISION:

PMG recommends the proposal be put forward to JSC for approval but with the modification that the

proposal goes beyond only the assessment to include capacity development and PHCs where deliveries

are taking place, across all 44 districts.

Discusssion points

NCHRC: Future of the Centre. SCHRCs sustainability. NCHRC has been an intervention unique to NIPI. Since 2008 it has been exclusively funded by UNOPS

NIPI Programme (LFA) and is housed at NIHFW.

Main activities of NCHRC to date have been: Support in Operational Research e.g. coordinated OR

prioritisation workshop, facilitating development of State Child Health Resource Centre, developing


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database on HBPNC, development of ‘Repository On Child Health’ and development of IEC/BCC gallery,

developing CH publications, advocacy and networking e.g. supporting the ‘Child Health Thematic Group.’

The current functions undertaken by NCHRC are a departure from its original mandate. There has also

been a disconnect between NCHRC and SCHRCs which has contributed to the State level centres’

underperformance.

Another concern on SCHRCs establishment is that they may be functioning in parallel to the better

performing SHSRCs.

The exclusive association to UNOPS NIPI Programme has not encouraged other NIPI partners to take

ownership of the centre to date.

Following discussion among the NIPI Partners pre PMG, 3 general options with some SWOT analysis,

have been developed to facilitate an open discussion with government about the NCHRC’s sustainability,

SCHRCs have been dealt with separately and have also been analysed using SWOT.

DECISION:

PMG recommends a return to the original mandate of NCHRC. NIHFW Director agreed to have NCHRC

remain under its auspices, and requested funding from Government of India for this purpose. NCHRC

needs to strengthen its collaborative management with NHSRC with the view of being a technical

resource centre in child health for the States. Functional Autonomy is required for NCHRC but

management structures need strengthening. NIPI may continue to fund NCHRC for an interim period

(which needs to be defined) until which time NIHFW will assume funding responsibility. The timing of

the interim phase to be decided at the JSC.

SCHRCs were recognised as being non functional, with the exception of Orissa.

NCHRC ANNUAL BUDGET (with New Organizational structure)

S.N. Items No. of units Unit cost (Rs.) Annual cost (Rs.)

SALARY

1 Coordinator 1 1,75,000 21,00,000

2 Consultants 2 80,000 19,20,000

3 Associates 4 50,000 24,00,000

4 Library cum IT officer 1 40,000 4,80,000


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5 Data Entry operators 2 20,000 4,80,000

6 Office assistant 1 15,000 1,80,000

7 Total (1-6) 75,60,000

RECURRING EXPENSES

9 Includes Stationary, TA/DA for

monitoring & data collection,

Publications, Conferences,

Meetings, conducting research

Details later 44,40,000

10 TOTAL 1,20,00,000

State Presentations by Mission Directors

BIHAR

The update from the State of Bihar was presented by the Executive Director NRHM Bihar. Key highlights

from the presentation included:

1. MAMTA Initiative

2. HBPNC (Home Based Post Natal New Born Care)

3. Sick New Born Care Unit (SNCU)

4. Techno Managerial support

5. Support to SIHFW

6. Mobile Money Transfer to ASHA

7. Support to JHEPIEGO

NIPI is implementing these interventions through the NRHM using the same public health

mechanisms

Mamta Initiatives

From July 2008 to June 2011, 649 MAMTAs were supported by NIPI in 48 Hospitals ( District

and Sub Divisional Hospitals)

From July 2011 onwards MAMTA activities in all health facilities are supported by State

Government. At present about 4400 MAMTAs are working in 540 PHCs, Sub Divisional

Hospitals and District Hospitals


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However at present NIPI is supporting 51 MAMTAs in 3 District and one Sub Divisional Hospitals

of NIPI Focused Districts pending Government decision.

In a year more than 300 thousand mother and new born were followed by 649 MAMTA across

48 health facilities.

During current year of period Jan-Sept. 2011, over 13291 mother –new born followed by 51

Mamta in 3 district and one sub-division hospital of NIPI focused districts

Average Retention period of Mothers increased initially from 6 hours to more than 40 Hours in

Nalanda and Sekhpura and about 18hours In Jehanabad District

Home Based Post Natal Care (HBPNC)

Since April 2010 after 2 days HBPNC training, 174,000 mother –new born provided 6 PNC visit at

home by 3721 ASHA .

During current year from Jan-Sept. 2011, over 36,965 Mother – New born were provided 6 post

natal home visit

No. of Babies Born in Health Facility : 25,628 (69 % )

No. of Babies Born in Home: 11,268 (31 %)

More than 88 percent of neonates are reported to be on exclusive breast feeding

In the same period , more than 2 percent of sick neonates have been referred to the health

facilities

5 days HBPNC training programme of ASHA will start from December 2011

Techno Managerial Support

At state level 4 Consultants (i.e. HR consultant, Finance Consultant, IT Consultant and MAMTA

coordinator) have been provided by NIPI

75

91 89 80

98 98

0

20

40

60

80

100

120

Jehanabad Nalanda Seikhpura

Breast feeding with 1 hour and vaccination at Birth ( In %)

Percent New born intiated breastfeeding within 1st hour of birth

Percent neonates vaccinated at Birth


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10 Deputy Child Health Managers are working in different districts (i.e. 3 in NIPI Focused

Districts and 7 in those districts where immunization coverage is less than 60 % )

33 Junior Child health managers have recently joined in 33 PHCs of NIPI Focused Districts to give

supportive supervision and monitoring the HBPNC

7 Child Health Supervisors are working in 7 different District Hospitals

A State Child Health Resource Center (SCHRC) has been established at SIHFW. 4 following staff

at present are working.

1. Documentation Consultant

2. Management Consultant

3. ANM Consultant

4. Data Asst. Cum Accountant

Activities include

Field studies on HBPNC , MAMTA activities, MMT Supervision and ANM skill development at

PHC level.

Web Page development ( www. Sihfw.schrcbihar.org)

Supporting activities of SIHFW on Training, skill building and proposal writing etc.

Organizing the Orientation and training to Techno managerial staff (i.e DCHM, JCHM and CHS)

District Health Resources and Training Center at Nalanda District is ready. The staffs for District

health resources training center (i.e. one Coordinator and one Data analyst ) are to be

appointed soon.

To initiate strategy and actions for IEC activities , a committee has been formed under the

chairmanship of Director SIHFW. It has prepared the action plan for IEC during 2011-12 .

An action plan has been developed for SCHRC.

Sick New Born Care Unit (SNCU)

SNCUs in 3 NIPI focus Districts are under construction.

It is expected that the Building construction will be completed by December 2011

SNCU instruments have already been purchased

The main challenges are to recruit and train staff for SNCU

Mobile Money Transfer (MMT)- Pilot in Sheikpura

95% of ASHAs in Sheikupra are getting their incentives through MMT for HBPNC, Family

Planning, Muskan, Asha Day, JBSY, Training etc.

A total of more than 50 Lakh rupees of incentives have been paid to ASHA through this system.

Strong positive response and feedback from the ASHAs for accurate and speed of payments.

MOIC finds it useful to track functional and non functional ASHAs and Activities in the block.


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Madhya Pradesh

Based on the experience in Sheikpura it has been extended to ASHAs in the NIPI district of

Nalanda. Planning will start with the BC for Jehanabad.

Additionally the government is exploring expansion to 4 Non NIPI Districts, where the BC already

has established systems: Rothas, Vaishali, Samastipur and Bagalpur.

MMT will then cover 13 000 ASHAs in more than 70 Blocks.

For the ease of roll out improved processes for account opening and standardized training

material is made available and an Implementation manual for managers has been developed.

Support To JHPIEGO

NIPI has funded to JHPIEGO for giving technical support for establishing 19 ANMTC centers, 6

GNM centers and 1 Nursing College in Bihar.

JHPIEGO will help in developing the Nursing courses as per the guideline of Nursing Council and

support Faculty members for quality Nursing Education.

Finding of Rapid assessment done by JHPIEGO was shared with Technical Advisory Group.

The Base line study by JHPIEGO is in process.

MOU have been signed between State Health Society and JHPIEGO on 20.10. 2011 in presence

of Health Minister of Bihar and Deputy Ambassador of Norway

The challenges of up-scaling MMT were raised by other NIPI implementing partners. The ED Bihar

explained there was an economy of scale in making the MMT a viable payment mechanism.

When questioned on Mamtas uptake by the State the ED reiterated that NIPI was now only providing

funding support in 3 focus districts.

The update from the State of Madhya Pradesh was presented by the Mission Director NRHM MP. Key

highlights from the presentation included:

Home Based Newborn Care (HBNC)

Sick Newborn Care Unit (SNCU)

Yashoda

Immunization


State Child Health Resource Centre (SCHRC) & District Training Centre (DTC)

HBPNC

ASHAs trained (2 days) - 2583


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Six home visits for mothers and newborns - 20963

HBNC to be scaled up after training of ASHA in module 6th & 7th.

Support from NIPI for HBNC included

Weighing scales

For ASHA in four NIPI Districts

For 161 training centres - 483

Funding support for ASHA Sahyogi in four NIPI districts

Sick Newborn Care Unit (SNCU)

Fully functional at Hoshangabad and Raisen

HR as per norms (4 doctors & 12 nurses)

HR capacity includes 8 Doctors and 21 Staff Nurses of SNCU of Hoshangabad, Raisen &

Narsinghpur trained (15 days) in IPGMER (Kolkata)

2838 sick newborns treated (girls-1207 & boys- 1631)

Narsinghpur to start in November-2011 and Betul in February-2012

Protocols followed for infection prevention with the technical guidance from IPGMER, Kolkata

Video Conference Facility functional at SNCU Hoshangabad

SNCU Hoshangabad has started providing trainings to NBSU personnel

District Neonates Admitted Neonates Treated Neonates died

Hoshangabad 1304 1201 103

Narsinghpur 959 849 110

Raisen 575 572 3

Total 2838 2622 216


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Establishment of SNCU TTC at Hoshangabad with provision of dedicated Human Resources,

Training hall, Demonstration room, etc.

Objectives of establishment of SNCU TTC -

Provide Supportive Supervision to the SNCUs, NBSUs and NBCs

Support capacity building efforts and hands on training while function as a training hub

for FBNC trainings

Human Resources:

1 PGMO (MD, Pediatrics having exp. in neonatology / NNF trained)

2 staff nurses (BSc Nursing/ MSc Nursing )

Newborn Stabilization Unit (NBSU) Status

3 NBSUs at Hoshangabad district started, 3 more planned

3 NBSUs at Narsinghpur, 2 at Raisen, & 2 at Betul are planned this year.

Features

Human resource (1 pediatrician & 4 staff nurses)

Referral mechanisms (neonatal transportation system to be piloted in Hoshangabad)

92

8

89

11

99

1

92

8

Neonates Treated Neonates died

SNCU Report Analysis (%)

Hoshangabad Narsinghpur

Raisen Total


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YASHODA

112 Yashodas in place in 4 districts (Hoshangabad, Narsinghpur Raisen & Betul)

Numbers of mother counseled – 57,788

Numbers of newborns cared - 56,291 (27,101 girls & 29,190 boys)

o % of newborns weighed at birth – 98%

o % of newborns breastfed with in the 1 hour of birth – 93%

o % of newborns given zero doses vaccinations

o OPV - 93%

o BCG - 93%

o Hep-B - 84%

Birthing kits being distributed to all newborns (at Hoshangabad, Narsinghpur & Raisen Yashoda

facilities).

Strengthening Immunization Services

Supportive Supervision in Narsinghpur & Hoshangabad

Regular monitoring of VHNDs by District / Block Managers

Renovation of District Cold Chain Store at Hoshangabad


State Finance Analyst – 01

District Child Health Manager – 02

Child Health Supervisor – 02

Block Child Health Manager - 20

SCHRC/ DTC

SCHRC personnel supporting state to rollout HBNC ASHA module 6th & 7th along with other HR

processes of state.

District Training Centres functional at Hoshangabad and Narsinghpur.

Software for district trainings and monitoring process at DTC Hoshangabad is under process.

Neonatal Emergency Transportation System

Proposal for Neonatal Transport (Goa Model) is under consideration.

Rs. 25 lacs for equipments and 1.5 lacs as running cost sanctioned for Hoshangabad in current

year

Model to be replicated in other districts

Other

Establishment of Well Baby Clinic & Samarpan (Early Intervention Clinic) at Hoshangabad District

Hospital.


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District Disability Rehabilitation Centre– machines, equipments and software through NIPI

Funds

o Ortho Prosthetist, Physiotherapist, Consultant Psychologist, Ear Mold Technician, Mobility

Instructor, Psychiatrist, and support staff from DDRC funds.

Finance

FINANCIAL REPORT TILL END OF 31ST MARCH 2011

RS. IN LAKHS

INTERVENTION UTILIZATION

1. YASHODA 116.23

2. HBPNC 47.02

3. TECHONOMANAGERIAL SUPPORT 217.99

4. SNCU 221.48

5. IMMUNIZATION 7.72

6. OTHERS 84.92

Total 695.36

BUDGET FOR APRIL 2011 TO MARCH 2012

RS. IN LAKHS

INTERVENTION AMOUNT

1. YASHODA 108.78

2. HBPNC 137.81

3. TECHONOMANAGERIAL SUPPORT 123.20

4. SNCU 272.08


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5. IMMUNIZATION 72.69

6. OTHERS 191.56

Total 906.12

RAJASTHAN

The update from the State of Rajasthan was presented by the Mission Director NRHM Rajasthan. Key

highlights from the presentation included:

General Profile of NIPI Districts

Yashoda Initiative

HBPNC (Home Based Post Natal New Born Care)

Facility Based New Born Care (SNCU)

Techno Managerial support and enabling activities

NIPI Districts: General Profile

Programme being implemented in three Districts Alwar, Bharatpur and Dausa

North East part of Rajasthan adjoining Haryana & Uttar Pradesh

Population 78 lakhs

Expected Deliveries (CBR 24.7) 1.82 lakhs

Maternal Deaths (MMR 318) 578

Infant Deaths (IMR 59) 10,738

Neonatal Deaths (NMR 40) 7280

Yashoda Intervention

Intervention started in three NIPI districts in August 2008

Intervention upscaled in all the districts in July, 2009

555 Yashodas working in the state at 28 District Hospitals and 42 CHCs

Based on data from three districts visible improvement in:

o Weighing Newborns (100%)

o The Initiation of Breast Feeding (<1hr) which was 41.9% (DLHS 3) is now around 83 percent

where Yashodas are deployed

o BCG and Zero Dose Polio Vaccination which was around 60-65% before deployment of

Yashodas is over 90%


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o 24 hrs stay of mothers (93%)

Yashoda Progress

Particulars APR 2009 to

MAR 2010

APR 2010 to MAR 2011

APR 2011 to

OCT 2011

Total mother child cohort attended 19213 19504 12987

Total live birth weighed 15291

(80%)

19504

(100%)

12987

(100%)

Initiation of BF within 1 hour 11546

(60%)

15748

(80.7%)

10766

(83%)

Immunization BCG and Zero Dose Polio 13723

(71%)

17958

(91.3%)

12359

(95%)

Stay of mother (>24 hrs) 13140

(69%)

16788

(84.5%)

12053

(93%)

Home Based Post Natal Care (HBPNC) Intervention

Initiated in 3 NIPI districts in August 2009

5191 ASHAs given 2 Day Induction Training

Five Day HBPNC Training given to

o 181 Block Trainers

o 151/165 ASHA Supervisors

o 4890/5191 ASHAs (up to 31.10.11)

Out of 69,544 deliveries 55,554 (80%) provided Home Based Post Natal Care services

Including 13,880 Home Deliveries


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HBPNC Progress

Apr 2010 to Mar. 2011 Apr 2011 to Oct. 2011

S.No Indicator Number Percentage Number Percentage

1. Total Deliveries 86015 - 69544

(i) Institutional

(ii) Home

69286

16759

80.55%

19.45%

55664

13880

80.03%

19.97%

2. HBPNC given 70634 82% 55554 80%

3. Babies <2500 gm 27468 39% 18712 34%

4. Breast feeding within 1

hour

62912 89% 53954 97%

5. New born excl BF 57781 82% 44657 84%

6. New born given OPV &

BCG

61473 87% 55106 92%

Apr 10 to Mar 11 Apr 11 to Oct. 11

Number Number

7. New born identified

with danger signs

349 860

8 New borns referred to

institution

343 401

9. Mothers identified with

danger sign

277 85


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10. Mothers referred to

institutions

171 79

11. Neonatal deaths 977 1348

Facility Based Newborn Care

SNCU

o SNCUs functional at District Hospitals in Alwar, Bharatpur & Dausa

o 25 bedded units (15 Beds, Main Unit + 5 Beds, Step Down + 5 Beds Neonate Ward)

o Manpower Support to SNCUs: Additional 2 Pediatricians and 4 Nurses at each unit

o Trainings at IPGMER, Kolkata-Five batches consisting of 12 Doctors and 39 Nurses

trained

o Reorientation training by IPGMER Kolkata scheduled from Dec, 2011.

SNCU Progress

Particulars SEP 2009 to MAR

2010

APR 2010 to

MAR 2011

APR 2011 to OCT 2011

Total Admissions 2805 4991 4010

Extramural admissions 19% 32% 1353 (33.7%)

Babies birth weight <2.5 kg. 54% 61% 56%

Septicemia 13% 16% 19%

Prematurity 18% 14% 23 %

Asphyxia 20% 26% 28.8%

Neonatal deaths 6% 6% 6.8 %


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Death on 1st day 50% 43 %

Death on 2nd -7th day 42% 35 %

Death on 8th -28th day 8% 22 %

Referred to higher Centre 5% 5%

Facility Based Newborn Care

SNSU (Stabilizing Units)

4 Bedded stabilizing units being developed at block CHC’s

Out of 20 units planned 12 are functional Alwar (2) Bharatpur (8), Dausa (2).

Training to one batch of staff (20 doctors and 40 nurses) given by a team from IPGMER Kolkata

led by Dr. Arun Singh.

Equipments procured and supplied to all the units

Remaining 8 units will be functional by December 2011.

Other Enabling activities

Activity Institutions Progress

(A) Well Baby Clinics District Hospital Alwar,

Bharatpurt, Dausa

Children up to 5 years age attend clinic for

growth and development monitoring

(B) LCD TVs in maternity

wards

District Hospitals (28) • 43 installed

• CHCs (37) • 12 installed

(C) Strengthening

District ANM/Gen.

Nursing Training

centre's

• Alwar • Repair renovation of training hall

• Library books

• Teaching aids

• Bharatpur • --do--


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(D) Strengthening

medial college for

programme related

training

JK Lon Hospital • Repair renovation of auditorium

cum training hall.

• Library books

(E) PPIUCD Intervention

through JHPIEGO

Hospitals attached to SMS

Medical College, Jaipur

District Hospital, Alwar,

Bharatpur & Dausa

• 33 Doctors Trained

• 574 PPIUCDs performed

Expenditure Status

S.No Particulars Amount

(Rs in Crores)

1 Fund Received from NIPI Delhi 15.60

2 Total Expenditure 11.59

3 Advances to District and State Agencies 3.34

4 Net Balance 0.77


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ORISSA

State Profile • Total Population : 42 million

• Total Number of districts : 30 districts

• NIPI focus districts : 3 districts

• Population (Census of India 2011) : 2.8 million

MDG 4 and 5 Related Indicators

Indicator % (rate/ratio) in State*

Annual Live born infants CBR 20.0

(Annual Health Survey 2011)

Under 5 Mortality 82


Infant mortality 62


Neonatal Mortality 40


Maternal Mortality 258

(SRS 2009)

ANNUAL HEALTH SURVEY 2010-11

NIPI focused State

and Districts

Infant Mortality

Rate (IMR)

Neo -natal

Mortality Rate

Under five

Mortality Rate Sex Ratio at Birth


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Odisha 62 40 82 905

Angul 50 31 60 834

Jhasuguda 51 41 58 870

Sambalpur 56 35 73 877

NIPI in ODISHA

Home Based Post Natal Check Up by ASHAs in 3 NIPI Focused Districts.

Engaging Yashoda ▫ At 15 district Headquarter Hospitals + Capital Hospital, Bhubaneswar( Proposed) ▫ Special New Born Care Unit (SNCU-II) ▫ At Sambalpur, Angul & VSS Medical College, Burla

Routine Immunization strengthening in 3 NIPI districts.

Support to State Institute of Health & Family Welfare (SIH&FW) ▫ For setting up of State Child Health Resource Centre & District Health Training and

Resource Centre.

Techno-Managerial Support ▫ Maternal and Child Health Coordinators at block level in 3 NIPI districts

Home Based Post Natal Care

Home Based Post Natal Care

2,578 numbers of ASHAs trained in 2 days & 5 days HBPNC Training.

26,512 Numbers of Mother-Baby Cohorts covered through HBPNC during January-September,

2011

More than 2,500 ASHAs have been supported by External Supervisory Agency (Paribartan).

Approx. 30-40 ASHAs are being supervised by 1 Block Supervisor.

3 Block Supervisor for each block & 1 Zonal Coordinator to coordinate for 3 Blocks.


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YASHODA

54,604 no. of deliveries have been followed by 156 YASHODAs in 15 DHQs during Jan-Sept,

2011.

Beside 3 focused district, YASHODAs are also in place at 12 DHQs (Balasore, Dhenkanal, Ganjam,

Jagatsinghpur, Jajpur, Kalahandi, Keonjhar, Koraput, Malkangiri, Mayurbhanj, Puri & Rayagada)

All the YASHODAs have been trained 3 days induction training & 1 day training on post partum

care & family planning.

The State Health Society has also the plan to takeover the YASHODA Intervention

Sick New Born Care Unit

94%

98%

88%

80%

85%

90%

95%

100%

YASHODA Outcome (Jan-Sept, 2011)

% newborn initiating breast feeding in 1 hr

% newborn weighed

4446

2865

1581

711

0

1000

2000

3000

4000

5000

Admissions Inborn Outborn Death

SNCU Report (June, 2010 to September, 2011)


MINUTES

24

State SNCU Cell Deliverables:

Operational Plans for scaling up of implementation of SNCU-I, SNCU-II and NBC developed

Training Plans for MO and Nurses on Neonatal Care

Posting & training of staff in the sites facilitated

Procurement and maintenance of equipments streamlined

Monitoring system established: including

a) Deployment of Regional Monitoring teams

b) Development and adoption of monitoring tools

Monthly Reporting system established; analysed institutions wise disaggregated data available.

District, Regional and State level Review Mechanism established.

HR:

One Management Consultant is in place at state level

Strengthening Immunization

Immunization Training completed for BMCHCs from 21 to 24 October

Walk In Cooler (WIC) Operators have been appointed at 7 District Vaccines & Central Store. for

24 hour monitoring of WIC

Cold chain Tag Monitors to be purchased by DFW. Orders for supply given to SDMU.

Sub centre wise Micro planning completed in 3 NIPI focus districts.

Immunization Status

(HMIS Jan-August, 2011)

Angul Jharsuguda Sambalpur ODISHA

% Immunization Sessions held 98.5 99% 96% 87.53%

Full Immunization coverage rate

(against reported live births)

100% 100% 95% 98%


MINUTES

25

Support to State Institute of Health & Family Welfare (SIH&FW)

Personnel support ( 8 Technical and secretarial)

o Technical-cum-Training Officer, Documentation Officer, Management Consultant,

Nursing Consultant, Management Consultant, Field Research Coordinator, IT Officer

(vacant) & Accountant

Equipment (software and hardware) and other logistics support

Infrastructure development (Facility, SCHRC, Documentation centre)

Workshops and review meetings

Develop District Health Training and Resource Centre, at Angul, Jharsuguda & Sambalpur

State Child Health Resource Centre

State Child Health Resource Centre (SCHRC) is one of the NIPI assisted interventions at State

Institute of Health & Family Welfare (SIH&FW), Orissa.

The Centre aims at providing resource support for facilitating and stimulating technical

discourse on Child Healthcare interventions in the state.

Vision and Mission

Vision: Developing a comprehensive platform by collecting, learning & disseminating

information on child health & related issues using modern cost effective techniques &

technologies

Mission: Establishing a close link between research & action -thereby reducing knowledge

gaps & demystifying child health perceptions.

Activities of SCHRC

Training

Documentation & Reports

Development of Resource Materials for frontline workers. i.e. for S.N, A.N.M, ASHA,

Yashoda

Evaluation & Research

Advocacy (Conclave/Workshop/Campaign/Meeting)

Distance Learning Courses

Strengthening of DHTRC

Major Activities of SCHRC- Completed

A seminar on SCHRC on 19.05.2010


MINUTES

26

A state level workshop on “Child Rearing Practices in Orissa” on 04.09. 2010

JSY Evaluation Study Phase-II

A state Child Health Conclave on 26. 10. 2010

Sensitization workshop for GKS members on childhood malaria on 23.12.2010 at Banapur

CHC

Workshop on “Under nutrition among under 5 children on 17.01.2011 at Kuchinda SDH

Training on “Gender Sensitization for District level Managers” on 20th & 21st Jan. 2011

Training programme on “Interpersonal Communication for Child Health Coordinators &

District Training Coordinators” on 29th & 30th April 2011

Workshop on “SCHRC Intervention for Child and Maternal Health Issues for LHVs of Angul

district” on 5th June 2001

A for day training organized on “Immunization for Block level Managers” from 21st to 24th

September 2011.

Developed a website (www.schrcodisha.org)

Published Documents

A Training Module on “Management of Diarrhoea in Children”

A Quarterly News Letter focusing child health issues and state’s intervention

A Report on “State Level Workshop on Child Rearing Practices in Orissa”

A Booklet In Oriya on “Role of Yashoda in Child & Maternal Health Care”

A Report on “Training Programme of JYS Evaluation Study, Phase-II”

A Process Document on ASHA-PNC Programme in three NIPI Focused Districts of Orissa”

VHND appraisal in Sambalpur, Nayagarh, Kandhamal

SCHRC library—more than 150 books both in the form of soft and hard copies.

In Process

Two certificate courses through IGNOU for nursing personnel

Strengthening District Health Training Resource Centre (DHTRC)


Sl No Position titles* Sanctioned In position

1 District Training Coordinator

(Angul, Jharsuguda & Sambalpur)

3 1

2 Data Assistant 3 3

http://www.schrcodisha.org/


MINUTES

27

3 Child Health Supervisor (District Level) 17 14

4 Block Maternal & Child Health Coordinator (Block

Level)

22 16

5 Accounts Executive (State level) 1 1

Positions Taken over by NRHM in course of time

S, No Positions titles* Status

1 District Maternal & Child Health Coordinator (District level) 14

2 Financial Analyst (State level) 1

3 Documentation & Media Consultant (State level) 1

4 HR Consultant (State Level) 1

Presentations by NIPI Implementing Partners

WHO

WHO activities – update (April 2011 – till date) Accelerating Child Health interventions:

Strengthening Pre-service IMNCI training:

Expanding Pre-service training in IMNCI for Medical students in the NIPI states:

Review of operationalization of pre-service IMNCI training in the NIPI states conducted - May

2011 in collaboration with UNICEF and NIPI-UNOPS


MINUTES

28

o National Nodal Centre now updating curriculum as per 2009 revised IMNCI guidelines

and

o Addition of F-IMNCI in the curriculum being considered

Expanding Pre-service training in IMNCI for Nursing students in the NIPI states:

Focus on Pre-service IMNCI for nursing and ANM students enhanced

o promoted as part of SBA curriculum – a pilot has been initiated in states of Madhya

Pradesh and Orissa

o Also to be initiated in the remaining states of Rajasthan and Uttar Pradesh by WCO

Accelerating Child Health interventions:

Capacity building of District level Program Managers in Child Health Program Review and

Management:

Integrated RCH Short Program Review Package

A consultation meeting - August, 2011 with representatives of Child Health division of MOH,

UNICEF, UNOPS and PHFI

Consensus on developing a single SPR RCH package with focus on simplicity for use by the

programme managers at various (state and district) levels

Module due for completion in November end 2011

Integrated RCH training package for District level Program Managers

Meeting with stakeholders and partners including GoI, UNICEF, UNFPA, NIPI – UNOPS and

various academia held on September 2011 to finalize modalities.

Development of module ongoing: first draft by second week of December 2011

Strengthening Community based management of Childhood Malnutrition:

Determination of appropriate value of MUAC (Mid-Upper Arm Circumference) to identify SAM (Sub-

Acute malnutrition) children with Weight for Height as reference in Indian population.

Protocol revised as per recommendations of the XIth JSC & ORC

Protocol, research methodology and survey tools finalized in consultation with the participating

centres

IRB/ERC clearances obtained for all the participating centres

Sampling frame: 250,000 (approx. 900 SAM children)

Project Advisory Group with representatives from Child Health division, MOH, academia and

partners established for study oversight & monitoring


MINUTES

29

Awaiting JSC go-ahead

Documentation of models of community based management of SAM children in the country and

develop a compendium of the same.

Concept note submitted, under consideration

Community monitoring of MCH activities at village level

Initial discussions with stakeholders held

Proposal being developed

Accelerating Maternal health Interventions:

Strengthening Accreditation of RCH Service providers – Mapping of Private Nursing Home (PNH)

facilities in the states of Madhya Pradesh and Orissa

o Mapping of service providers completed (May 2011)

o NIPI districts each of MP and Orissa included in the study

o Total of 121 PNH’s were identified of which 83 finally analyzed

o In terms of provision of services and the availability of the necessary equipment and the

facility, Orissa and MP were comparable

o None of PNHs were aware of GoI accreditation guidelines.

o Most had 5 beds (92%), availability of 24 hours MBBS doctors & OBGYN was in 1/3rd

o Majority offered ANC services (80-85%), EmOC services – few, PNC services – almost all,

Neonatal care: varied (30-70%), most unable to manage LBW <1800 gms, half unable to

provide MVA, most were not equipped for sterilization procedures (M/F)

PNH meeting majority of the criteria’s were keen to be part of the RCH initiatives for providing

services, however they were not keen to participate in the SBA training initiative

Discussions on with Maternal Health division for next steps

Strengthening Quality Assurance (QA) of EmOC and LSAS trainings under NRHM –RCH trainings

under NRHM:

Achievements:

State Quality Monitoring Units have been activated in states of Bihar, Madhya Pradesh & Orissa.

Assessors in the NIPI states have been trained and field activities have started in Orissa,

Rajasthan, MP, UP and Bihar


MINUTES

30

State Quality Monitoring has now become part of PIP in Madhya Pradesh

Recommendations from the Experts’ group has highlighted the following:

Better Coordination is required between Medical College and District Hospital for training and

monitoring;

Operationalization of FRUs with reference to proper posting of trained doctors, skill practice,

number of caesarean section performed and other obstetrics emergency handled is required;

Contents & duration for LSAS & EmOC training requires relook to keep pace with advancements

Strengthen SBA training under NRHM:

Objective:

Strengthening Nursing and Midwifery Education in two states – Madhya Pradesh and Orissa

A better trained workforce that can function at the primary care level with minimal hand

holding

Activities:

Strengthening National Nodal Centre in LHMC, New Delhi and State Nodal Centres as identified

by the states

Pool of master tutors/ trainers (two weeks training in National Nodal Centre) to be set up -

subsequently provide quality education as per norms in ANM and nursing schools

Update:

Initial visit to Odisha

Baseline Assessment in LHMC Nov 21-24 in collaboration with INC and JHPIEGO

Similar assessments planned for MP and Odisha in December 2011

Implementation Model for Strengthening Reproductive and Child Health Services in District

Bharatpur, Rajasthan using Health Systems Approach under NRHM

Broad Objective:

To improve Coverage and Quality of Reproductive and Child Health services in Bharatpur district in

Rajasthan

Specific Objectives:

Assessment of coverage and quality of (maternal and newborn health) reproductive and child

health care services in the district and document the change over time


MINUTES

31

To identify existing gaps in the district health system and service delivery mechanism and fill in

the identified gaps mainly through opportunities provided under NRHM with minimum external

inputs

To strengthen techno-managerial capacity in the district for planning, implementation and

monitoring/supervision of RCH services in the district

Capacity Development of the district health system:


MINUTES

32

Capacity building of block and district level Program Managers:

Integrated RCH Short Program Review and Program Management modules (Q1 2012)

Healthcare providers’ capacity: RCH components including nutrition

o SBA training: pre-service and in-service (Q1-3, 2012) o Facilitate EmOC training (Q1&2, 2012) o Nutrition (Q1, 2012)

• Management of SAM children in the facility (nurses and doctors) and

community

• Strengthen linkages between community and facility

2. Strengthening Quality Assurance (QA) Mechanism QA mechanism (Q2 end

2012)

Adapt tools for quality assurance of clinical maternal, newborn, child and adolescent health

training and services

Strengthen QA process establishment - post a QA manager at the district level

Strengthen monitoring and supervision by the program managers

Periodic assessment of quality and coverage of services

Build in a system of Communication as envisaged under NRHM (by end of Q3, 2012)

Each VHSNC ensures VHNDs are conducted and monitors them

Accelerating Maternal health Interventions:

Pilot an intervention model to delay first pregnancy and spacing of second child among married

adolescents and young adults.

Objectives:

To provide adolescent friendly services in context to adolescent pregnancy.

To document the process and effect of these interventions in reaching out to married

adolescents.

To recommend a model intervention package for married adolescents based on experiences

and operational feasibility in the project.

Methodology:

Phase I - Baseline to be carried out in two states


MINUTES

33

o Intervention (2) and control (2) districts o In-depth interviews of adolescents and field level functionaries o knowledge, perceptions and practices related to sexual and reproductive health

including adolescent pregnancy amongst married adolescents. o assess in context to adolescent pregnancy the knowledge, perceptions and readiness to

provide services of field level functionaries like ASHAs • Quality of pre-service training for nurses in reproductive and child health improved:

o Pre-service SBA training for Nurses and ANMs in Madhya Pradesh, Orissa and Rajasthan (Bharatpur district).

• Reproductive, child and adolescent health services Programme Management capacity at different levels strengthened

o Programme Managers Course and Short Programme Review developed and promoted in all NIPI states

• Strategies to address childhood malnutrition and early childhood development defined and promoted

o strengthening community based management of childhood malnutrition documenting of models of community based management of SAM in the country

• Quality assurance in maternal, newborn, child and adolescent health services promoted • Developing am implementation model for strengthening MNCAH services (including Quality of

Care) • Evidence-based advice for policies and strategies for influencing the scaling up of maternal,

newborn, child and adolescent health interventions increased • Determination of appropriate value for MUAC to identify SAM in Indian children • Pilot an intervention model for delaying first pregnancy and spacing of second child

Budget Summary of WHO Activities

Activities Proposed Budget (USD)

1. Accelerating Child health Interventions 390,000

2. Accelerating Maternal Health Interventions 480,000

Amount available with WHO 875,004

Additional funds requested Nil


MINUTES

34

NIPI LFA UNOPS PROGRAMME

Elements of the Comprehensive NewBorn Care Package at District Level

Institution Strengthening

NCHRC at NIHFW

NCRC at IPGMER

IGIMS and ANM/GNM Training Centres in Bihar

Janana Hospital, Jaipur for PPIUCD

DTCs at Districts

Third Part Supportive Supervision systems for HBPNC

Training Package /Guidelines/Job Aids etc (about 58 products)

Operational Guidelines for HBPNC and Yashoda

Training packages for Yashoda, Yashoda Supervisors, HBPNC, ASHA Supervisors,

SNCU and Managers, Immunization modules for managers.

Job aids - Counseling Cards, referral Booklets

Newborn kits, HBPNC kits, FAQ on RI for ASHAs

Checklists & reporting systems – Checklists for monitoring of Trainings, PNC Card, Supervisors and

Managers checklists and Customized HBPNC Software

HBPNC Yashoda SNCU Strengthening RI MMT


MINUTES

35

HBPNC- Learning So far

Tracking Coverage, Referral and neonatal mortality in the NIPI Districts

Home Based Post Natal Care – Ensuring Quality Training

Process Examples of Prompt Corrective actions

Using checklists for pre training

assessment of sites

Grading trainers

Of 33 Blocks of Bihar, only 13 Blocks chosen as sites

Trainers graded during TOT and only suitable recommended.

Ensuring 50% time spent on Skill

development during training

Ensuring provision of vehicles at peripheral training sites for

community and ward visits.

Involving Medical Officers in wards to identify cases for

practical training.

Checklist used by external monitors to

check quality of each batch

CHCs with low delivery load attached to District Hospitals for

better skills development.

Facilitator Trainee ratio maintained (8 trainers pool in each

training site).

84 79 72


MINUTES

36

Home Based Post Natal Care – Task shifting in Supportive Supervision

ANM, LHV and MO time optimized for technical support in the supervisory system.

While managerial and administrative (Operations) support can be undertaken by non

technical managers.

Third party supervision useful in the initial stages

With NRHM pool of managers /supervisors (BPM, BCM, ASHA Supervisors) , at different

levels, effective task shifting can be undertaken.

Home Based Post Natal Care - Challenges

Institutional arrangement for quality training, program assurance and Supportive Supervision

District and State Health officials to track coverage, referrals, neonatal mortality- geographical

distribution

Along Continuum of care –Yashoda In a year, 4,00,000 mother- newborns have been served by 1454 Yashodas in 148 facilities across the

several districts in the NIPI focus states

Yashoda – Key recommendations from PHFI- ASNI study Sept 2011

There is need for Yashodas role as a mother’s aide to be made specific and keep her identity

distinct from that of nurse’s aide.

Role of Yashoda as sympathetic friend and mother’s aide needs to be strengthened in her

training.

Weak supervision of Yashodas has serious implications of discharge of duties by them, and

therefore needs to be strengthened, especially at the CHC level.

The presence of ASHAs at registration provides an excellent opportunity for Yashodas to

interact with them and take over the mother’s care from ASHA to themselves.

Scope of improvement in postnatal care- counselling on danger signs, facilitation of PNC

checks.

Yashoda – PHFI recommendation and NIPI’s immediate Response

1. Refinement and updating of Yashoda 's skills through a series of Thematic trainings on o Identification of signs of illness o Family planning counseling and o Counseling for Breast feeding

The latter two exercises will be done in coordination with UNFPA and BPNI respectively. 2. Strengthening Yashoda as Mother’s aide – Training to orient Yashoda in Human Rights, Dignity, Gender, Community support proposed.


MINUTES

37

Value addition to SNCU system

Sick Newborn Care Unit Customizing Design and Value-additions

Patient Care Area Ancillary Area

Designed for 25 Beds to cater to District Needs

SNCU-Training and Treatment centre Hoshangabad-Operationalized

Objectives :

o Guidance to the newer units in implementing clinical SOP

o supportive supervision for problem solving

o capacity building for newer recruited staffs.

o hands on training for the staff trained at NCRC at IPGMER

Value additions

o Post training hands-on skill building of SNSU and NBC staff.

o Video Conference facility.

o Supportive supervision tools

o MOs and Nurses training to be taken up when sufficient experience and maturity is acquired

o HR Support- For Training additional Doctor and Nurse will be placed

Triage area

Main SNCU

Neonatal ward

Step down area

Isolation room

Triage area

Main SNCU

Neonatal ward

Step down area

Isolation room


MINUTES

38

o Similar model in Alwar in pipeline

Support through NCRC Kolkata

Role Support provided

Establishment of the knowledge

center for newborn care

Automated Treatment protocols developed with support from IIT

Standardization and guiding in

setting up infrastructure,

equipment procurement and

maintenance, training s

Intense Hand Holding Support Being Provided in Rajasthan and MP

Setting up of a reporting system Web based data entry and reporting system developed

Quality assurance system Through periodic assessment as per checklist

Innovations Design: Concept of Triage and Neonatal ward

Training and handholding of ANM protocols being finalized

Strengthening Routine Immunization Immunization Strengthening and Quality at implementation level


MINUTES

39

Management support wanes towards the periphery.

Lessons learnt to achieve improved quality of immunization.

Program Resources

are largely

available

Need for program management support:

Block and below.

Roles are more managerial than technical- supervision, logistics, data management and social mobilization.


MINUTES

40

Efforts of Child health managers in RI quality improvement – Narsinghpur

RI Strengthening - Capacity development Modules for Child Health Managers

Based on gaps identified, modules developed for capacity development of non-clinical

managers

On-line version of modules for managers recommended in National consultative meet

chaired by DC Immunization.

Based on gaps identified, modules developed for capacity development of non-clinical

managers

On-line version of modules for managers recommended in National consultative meet

chaired by DC Immunization.

• From 16% to 94% at cold chain store in last 1 month.

• From 50% to 100% of HSC areas in last 3 months

Improvement in supervision

visits

• Stock maintenance above buffer levels in 80% of stores

• All vaccines at immunization site from 94% to 100%

Improvement in logistics

management

• Known pregnancy and births added to ANM register 56% to 93%

• Active tracking for drop-outs using due-lists from 44% to 86%

Improvement in data

management Improvement

in social mobilization


MINUTES

41

Mobile Money transfer Mobile Money Transfer –Post Sheikpura Pilot

Good feedback from ASHAs and district and block staff

o Efficiency and reliability of transparent payment processes

o Monitoring activity levels of ASHAs

o Female empowerment – respect for technology and keeping savings.

SHS Bihar agreed for expansion to 5 districts: Nalanda, Rothas, Vaishali, Samastipur and

Baghalpur.

Approx. 13000 ASHAs will be empowered with MMT.

MMT Implementation Manual for managers developed.

Video documentation for communication and advocacy is being finalised.

National Child Health Resource Centre (NCHRC) at NIHFW Objectives

Provide a nationwide common knowledge platform for prof. in child health, related

maternal health and public health.

Collation and dissemination of information on best practices to various stakeholders

through a Repository of information on MCH, useful/accessible for States and different level

personnel.

Build capacities of health functionaries at the district, block and grass root level in MCH

through publications, trainings and long distance courses

Engage in operations research in keeping with the focus areas and objectives of the resource

centre.

Build partnerships with Institutions at the national/ state level to strengthen the focus and discussion on

MCH.

Achievements

CH Repository

Comprehensive online collection of 850 resource materials including 90 Government

Guidelines and 96 Government Training modules.

HBPNC Implementation support:

Development of software and web-based application for data transfer from block. Technical report

submitted to NIPI-UNOPS with suggestions for improvement in data management

SCHRC - Facilitating development of centers in 4 states


MINUTES

42

Conducted capacity building workshop

Follow-up and support

Operations Research:

Conducted National Workshop jointly with ICMR for prioritization of MCH topics for OR and helped in

developing priority agenda for OR relevant for the NIPI program.

Recent Activities

Monitoring and assessment of FBNC (esp. SNCU) in coordination with Child Health division,

MoHFW

Orientation training workshop for RCH/NRHM Consultants working in NIHFW/CTIs on

monitoring of Newborn Health (focus on FBNC)

Strengthening PSE for Nursing Midwifery Cadre in Bihar

Mandate:

o Strengthening the quality of PSE in 6 GNM Schools and 19 ANMTCs of the state

o Setting up a state nodal center of excellence for PSE in Bihar at the College of Nursing in

Bihar

Programme Components

Improved Quality of PSE

Improved Educational Processes (at the institutions)

Improved Clinical Practices (at the clinical practice sites)

Strengthened Capacity of the Faculty (both teaching and clinical skills)

Strengthened training infrastructure (Class rooms, skill labs, IT)

Introduction of internship for ANMs


MINUTES

43


MINUTES

44

Programmatic approach: Strengthening the capacity of the faculty

Facilitate the updating of faculty in targeted knowledge & clinical skills

Conduct pedagogic courses for tutors and support the application of modern teaching principles

o A six week-curriculum focusing on teaching skills, clinical skills, IT skills and Management

skills has been developed and approved by the INC for this training

o Initial training for the faculty in this 6 week course is being conducted at NRSMC,

Kolkata- to be subsequently followed by trainings at the IGIMS

Build the capacity of schools to follow a competency and clinic-based training

Strengthening the Training infrastructure at the institutions

Strengthening of educational infrastructure by establishing clinical skills labs equipped with

anatomic models and AV aids etc.

Strengthening of the IT infrastructure


MINUTES

45

Developing quality libraries

All of this will be done concurrently with the state’s initiative for strengthening of the basic

school infrastructure-including classrooms, hostels etc.

Network schools to compare progress and collectively solve implementation challenges

All of these will be done by using a Standards Based Management approach (SBM-R) .

Budgetary support for infrastructure strengthening by the SHS/GoB

Activities so far

Activities GNM schools ANMTC IGIMS

Rapid assessment √ √

SBMR workshop √ √

TAG formed √

Baseline assessment √ √

Addressing gaps in educational processes √ √

Training of tutors in clinical and

educational skills

√ √

Jhpiego and Govt. of Rajasthan Funded by NIPI

Strategic Approach: PPIUCD in Rajasthan


MINUTES

46

Achievements: PPIUCD in Rajasthan

Highest number of trainers in Country among all states

o ( Total 19 Trainers including 14 Associated Professors, 1 Principal medical officer, 2

Assistant Professors and 2 MO)

PPIUCD services being provided

o at the three district hospitals

Improvement in the Follow Up of clients

Government is planning for scaling up the program based on the experiences of the pilot phase

Program Update: PPIUCD in Rajasthan

Development of State Nodal Training Sites for PPFP/PPIUCD:

o SMS Medical College, Jaipur

Demand Generation:

o BCC material-print and AV- have developed and being used

o Training Material and job-aides (for ASHA and YASHODA) being prepared in

collaboration with IIHMR

Services initiated in the three focus districts

o Following completion of training of all service providers

ASHAs and Yashodas of 3 NIPI districts have been trained

o for awareness generation and counseling

o this material has been adopted by state

Introduce PPFP/PPIUCD services in key state level

institutions in Jaipur

Develop these institutions as the central training sites

Introduce PPFP PPIUCD services the three designated district hospitals of NIPI focus

districts


MINUTES

47

Uptake by state governments Uptake of NIPI interventions by State Governments

Intervention Bihar Madhya Pradesh Orissa Rajasthan

HBPNC Contributed to GOI HBNC Guidelines for the country

Yashoda

SNCU

Recurring Costs

Taken up by GoB

in the entire State.

(Final decision to

be communicated

from CM Office)

GoMP in 5th SCC

meeting

undertakes to

write to GOI for

inclusion of

Yashoda in 12th

Plan

Taken up

MD on advice from

Health Secretary

and Family Welfare

Commissioner

written to MD GOI

Taken Up

PHS approved on

file to facilitate

funds

mobilization for

the intervention.

Taken up with

some

supplementary

funds being

provided

Uptake of NIPI interventions by State Governments - Techno Managerial Staff

Intervention Bihar Madhya Pradesh Orissa Rajasthan

Program

Managers

State LM, 8

Divisional LM

DMCH, State FA,

HR Consul,

Documentation

Consultant

PPP for infant health services

Health access international with NIPI funds in Bihar and Orissa Nipi districts

Health Access International Project Core-Phase 3

Purpose: to align the strengths of Government, private, for-profit and not-for profit institutions as well

as practitioners to catalyze achievement of Millennium Development Goal Four

Desired outcomes:


MINUTES

48

Scalable partnership models of demand-side financing for reducing Infant Mortality Rate for

the selected districts of Bihar & odissa

Knowledge that can be used to expand government contracting and monitoring mechanisms

to all main primary health care services

Geography: Jehanabad, Nalanda and Sheikhpura districts of Bihar and Angul, Jharsuguda

and Sambalpur districts of Orissa,

Timeframe

18 months from date of contracting; 6 months for design and 12 for piloting

3 months for post project documentation

ACCESS Study Infant Health Status in NIPI Districts in Bihar

Health Access International. The Pilot Aims to:

Challenge 1: Sick infants gathering at the highest levels of care

ACTION: Triaging and referral network

Challenge 2: Families of sick infants having to pay out of pocket for care

ACTION: In-patient secondary care linked to RSBY, contracting for tertiary care

Challenge3: Quality of care received-


MINUTES

49

ACTION: Establish and monitor adherence to quality protocols for outpatient and in-patient

infant health care

Budget Proposal 2012

PARTICULARS AMOUNT (In USD)

Grants to State Health Societies (Madhya Pradesh, Orissa,

Bihar and Rajasthan) 3,984,678.89

National Level Expenses 1,091,503.31

Grants to Partner Agencies, Contracts and Travel of State

Officers 1,588,484.80

Four State Office Expenses 576,382.30

TOTAL 7,241,049.30

Proposed Budget from SHS for the Year 2012

States

Total Amount

Released/expected

to released by

Nov. 2011, to the

States

Total

Expected

Fund

Utilization by

end of Dec

2011

Expected

unspent

Fund at state

level by end

of Dec 2011

Budget for

the Year

2012

(Jan-Dec)

Additional

Budget for

2013 Jan-

Mar (buffer

for 3

months)

Total Budget

for

15 months

Fund

Required for

the period of

Jan 2012 -

Mar 2013

Fund

Required

for the

period of

Jan 2012 -

Mar 2013

(USD)

Rajasthan

176,000,000

116,896,123

59,103,877

103,090,000

25,772,500

128,862,500 69,758,623

1,550,192

M.P.

156,500,000

110,669,440

45,830,560

77,702,178

19,425,545

97,127,723

51,297,163

1,139,937

Orissa

148,500,000

97,809,389

50,690,611

55,760,600

13,940,150

69,700,750

19,010,139

422,448

Bihar


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230,015,536 205,015,536 25,000,000 51,395,700 12,848,925 64,244,625 39,244,625 872,103

Total 711,015,536

530,390,488

180,625,048

287,948,478

71,987,120

359,935,598

179,310,549

3,984,679

UNICEF

NIPI-UNICEF: Progress 2011 and Plan 2012 Key Outputs in reporting period

Four Regional Collaborative centers set up and functional for supporting scale-up of Facility

Based Newborn Care in India

o Train more than 50 staff (doctors and nurses) from SCNUS of the NIPI states

Operational Guidelines for Facility Based Newborn Care finalized, disseminated

Cost-effectiveness assessment of IMNCI completed

IMNCI Self-learning Multi-media package developed

“One-stop-shop” model for setting up Perinatal Care Units in progress, 2 agencies contracted

Key Outputs

Communication strategy developed for

o Routine Immunization

o Measles second dose

o Introduction of pentavalent

Inventory and guidelines for use of BCC material on newborn and child health developed

Program on capacity development of mid-level mangers on planning and management of child

health programs finalized, with WHO

o Training of Trainers conducted to engage six more institutions

National MIS for Cold Chain developed

100 combo solar freezers installed and functional in inaccessible sites of 15 districts

EVM / VMAT conducted in Assam and West Bengal

Key Outputs: Publications

Introduction strategy for second dose measles in India. Indian Pediatrics, 48 (5): 379-382

Scaling up facility based newborn care in India. Journal of Health, Population and Nutrition

(JHPN)


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Community Based Newborn Care: A Systematic Review and Meta-analysis of Evidence: UNICEF-

PHFI Series on Newborn and Child Health, India. Indian pediatrics, 48 (7): 537-546

Acute Respiratory Infection and Pneumonia in India: A Systematic Review of Literature for

Advocacy and Action: UNICEF-PHFI Series on Newborn and Child Health, India: Indian Pediatrics,

48 (3): 191-218

Financial report

Opening Balance as of 1 Jan 2011 : $ 3,489,319

Additional funds received in August 2011 : $ 1,225,407

Unallocated balance in 2011 : $ 730,243


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Social Marketing of ORS and Zinc in 44 districts Promote demand: communication campaign

o Interpersonal (ASHAs, AWWs, private providers)

o Mid-media

o Mass-media

o Mobile

Ensure supply:

o Enhance skills of providers (private and public)

o Supplies of ORS and Zinc (multiple channels, formal and informal)

Baseline assessment of quality of maternal and newborn care Coverage of maternal and newborn health interventions increasing, skepticism on quality

Impact of coverage on maternal mortality and infant mortality will depend on quality

o Limited impact of JSY on perinatal mortality (Lim et al)

RCH-II had planned that “..for assessing quality of services an integrated (internal and

independent) system involving M& E cell and medical colleges will be instituted”


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However, the QA monitoring plan did not take-off

Baseline assessment of quality of care in five NIPI focus states

Purpose Method


newborn care by front-line

workers

Structured observations of Home Visits

Review of case records


essential newborn care

Structured observations of delivery at health facilities

Surveillance of stillbirth rates in health facilities

Assessment of quality of special

newborn care

Structured assessment using quality checklists

Monitoring of case fatality rates

Surveillance of one month and one year survival


maternal care

Structured assessment using checklists

Monitoring of UN Indicators (case fatality rates, perinatal

mortality rates, numbers of complications treated)

Estimates of Required Funds (activities in red are new proposed activities) Community based newborn and childcare (IMNCI Plus): 2 million USD

o Monitoring & supervision

o Quality assurance

o Social Marketing of ORS and Zinc

Facility based maternal, newborn and child health (essential care, special care, F IMNCI,

operationalization of FRUs): 1.5 million USD

o Collaborative centers

o States Perinatal Resource Centers

o Operationalization of FRUs

o Essential newborn care in focus districts

o Baseline assessment of quality of newborn care

Community and facility (essential and special)


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Estimates of required funds Immunization: 1 million USD

o Technical assistance to measles, routine immunization

o Cold chain assessment and strengthening

Strengthened Management: 1.5 million USD

o Capacity Building of State and District Program Managers

o Collaborative centers for District Program Management Course

o PG Diploma in MCH Management

TOTAL: 6 million USD; balance 0.7 million

NIPI SECRETARIAT

Budget request 2012

Year 2012 Budget Requirement (in USD)

NIPI Secretariat budget for the year 2011 (JSC approved) 2,092,056

Funds received for Operational Research on 20 Dec 2010 318,391

Cash Balance remaining from Dec 2010 (incl OR) 1,208,758

2,092,056 - 1,208,758 =

TOTAL Required 2011 883,298

Budget 2012 projected 2,122,000

Programme Assurance

Standardised reporting formats for NIPI Programme established, with regular reporting.

Alignment of NIPI outcome/output indicators with that of GoI e.g. HMIS, AHS, DLHS, CES

Operational Research formalised and functional

Secretariat fully staffed and supported technically

Documentation of NIPI Programme managed by Secretariat.


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Support to Government

Technical Assistance with 2 PCPNDT consultants to MoHFW.

SCNU coordinator recruitment.

Government of India Child health video production.

Print media, 2 Radio jingles, 2 video spots for declining child sex ratio.

Operational / Applied Research

Facilitate Still birth workshop NIPH, @ NHSRC

Connect Indian research agencies for OR to Norwegian partners

WHO MUAC study to ORC for approval

Contracting for OR proposals Phase I, Phase II RFPs

Cost analysis of NIPI Programme interventions undertaken

ASNI and Optimal breastfeeding practice study results dissemination

Promoting Innovation

Assessment of how the NIPI Programme might address declining child sex ratio. STBG JSC

approved in principle.

Management of NIPI programme data systematised, regularised, analysed and integrated in

existing government health information systems (DMIS).

Promoting Gender Equity

Working with a) Partners b) Government c) other UN Agencies

Assistance to G.O. Rajasthan gender primer for the grassroots level workers publication

Represented in Core group to develop minimum standards for Mother and Baby Friendly

Services and Perinatal Care during Transport

Gender mainstreaming efforts through NIPI semi-annual reports

Contributing to all UN forum on declining sex ratio lead by UNFPA


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Annexure 1

UNICEF SOCIAL MARKETING OF ORS AND

ZINC FOR DIARRHOEA MANAGEMENT

PROGRAM IN 44 HIGH FOCUS DISTRICTS IF

INDIA– 2011-2012

1. Background

Diarrhoea remains one of the major causes of childhood mortality in the country. It is estimated

that each child in India suffers an average of 1.6 episodes of diarrhoea per year for first five

years1. Most deaths due to diarrhoea can be avoided by appropriate and adequate use of

combined ORS and Zinc (Zn) supplementation2. Even though ORT has reduced child mortality

in India from 1.9% to 0.6%, more needs to be done to reduce this further. Estimations of the

burden of diarrhoeal diseases in India by the National Institute of Cholera and Enteric Diseases

(NICED) indicate that diarrhoeal diseases contribute to about 9.1% of deaths in the age group of

0– 6 years. If this is extrapolated, an estimated 158,209 children die each year in India due to

diarrhoea3 . SRS report on causes of death: 2001-2003 by RGI, reported diarrhoeal diseases to

account for 14% of deaths among children aged 0-4 years. Government of India has included

Low osmolar ORS and Zinc in the Revised National Guidelines on Management of Childhood

Diarrhoea, 2007. The utilization of ORS remains very low and that of Zn almost inexistent.

1 (Viswanathan H. Rohde J. Diarrhoea in rural India. A nationwide study of mothers and Practitioners, All India Summary, Vision Books). 2 Effect of zinc supplementation started during diarrhoea on morbidity and mortality in Bangladeshi children:

community randomised trial: Baqui AH, Black RE, El Arifeen S, Yunus M, Chakraborty J, Ahmed S, Vaughan

JP.BMJ. 2002 Nov 9;325(7372):1059.

3 NCMH Background Papers·Burden of Disease in India

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Baqui%20AH%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Black%20RE%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22El%20Arifeen%20S%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Yunus%20M%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Chakraborty%20J%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Ahmed%20S%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Vaughan%20JP%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Vaughan%20JP%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus

http://www.ncbi.nlm.nih.gov/pubmed/12424163?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus


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In the DLHS-III survey conducted in 2007-8, the percentage of children with diarrhoea (in the

two weeks preceding the survey) who received ORS was only 17.3%. This is despite the fact

that 75% of the community members received some treatment or the other for diarrhoea

management. This indicates that health care providers are likely prescribing other treatments,

such as antibiotics, rather than recommending ORS and Zn. CES 2009 reveals ORS use rate of

42.8% among children 0-2 years suffering from diarrhoea.

There are two major issues related to management of diarrhoea among infants and children in

the country: first lack of awareness and use of ORS and Zn for management of diarrhoea by

health workers and, second, poor and interrupted supply of ORS and Zinc for diarrhoea

management. When appropriately addressed, both these problems could lead to avoidable

deaths amongst children suffering from diarrhoea.

It is against this background that a project is proposed to increase availability, awareness and

utilization of ORS and Zn for proper management of diarrhoea in children in the 44 high focus

districts of 13 states in India (Details in Annexure-1), especially through a social marketing

concept.

Geographic Area: Delhi and 44 high focus districts in 13 selected states

2. Purpose and rationale

Objectives:

7. Increase regular availability of ORS + Zinc in public and private sector (traditional and non-

traditional outlets)

Indicators:

i. % of retail outlets and health facilities reporting stock out of ORS and Zinc at provider

level in each district

ii. % of ASHA workers stocked with ORS and Zinc for distribution at community level

8. Increase awareness and knowledge of the rationale and advantages to prescribe ORS and

Zinc for management of childhood diarrhoea by public and private health workers

Indicators:


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i. % of physicians surveyed able to describe the advantages of prescribing ORS and Zinc

for childhood diarrhoea

ii. % of ASHA/AWW/ANM workers having correct knowledge of preparing ORS and use of

zinc tablets

9. Change prescribing habits of Frontline and primary care health workers to recommend use

of ORS and zinc for management of childhood diarrhoea

Indicators:

i. % of physicians surveyed prescribing ORS and Zinc for childhood diarrhoea

ii. % of ASHA/AWW/ANM workers having correct knowledge of preparing ORS and use of

zinc tablets

iii. % of children 2-59 months with diarrhoea received ORS and zinc

Low- osmolar ORS and Zinc are the two key interventions for management of childhood

diarrhoea. Two major issues linked to the low use rates are – insufficient availability of ORS and

Zn at the levels of health system, community and household and secondly the limited

awareness about the importance of use of ORS and Zn at the community level.

There is enough evidence to suggest that use of zinc during acute diarrhoea reduces the

duration and severity of diarrhoea and risk of acute respiratory infections subsequently. Based

on this evidence, GOI has issued new guidelines, allowing for use of zinc for acute diarrhoea,

for a total duration of 14 days. Zinc not only reduces the duration and severity of the treated

episode of acute diarrhoea but also reduces subsequent episodes. But the awareness regarding

the availability and use of Zn in the community is very low.

The UNICEF 2008, 10 districts survey revealed only two percent of the mothers whose child

had diarrhoea in the last two weeks prior to the survey reported to have heard of zinc and 70%

had knowledge about ORS. Of these mothers who sought care only 47% and 1% were

prescribed ORS and Zinc respectively.

Research on appropriate treatment for acute diarrhoea has also found that continuous feeding

(breast feeding and complementary feeding) reduces stool output and duration of diarrhoea

episodes. In fact, cessation of normal feeding has been found to prolong diarrhoea episodes.

Continuous feeding in conjunction with ORS/zinc has the potential to significantly reduce the

duration and severity of acute diarrhoea in children. But, the UNICEF 2008 survey reports that

only 9 percent of the mothers, who took their child to some health provider for treatment of

diarrhoea, were advised to continue or increase frequency of breast feeding or complementary

feeding to their child during diarrhoea, while only 15 percent were advised to give more fluids

than usual to the child during diarrhoea.


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There is a felt need to increase the awareness and availability of ORS and Zn and educate the

healthcare providers and influence their prescription practices.

This initiative, we hope, would also serve as an example for the states to scale up in other

districts, to increase the use of ORS and Zn. Since the states are receiving ORS and Zinc as

part of Kit A from the centre and are also procuring Zn and ORS at local level, this initiative – if

scaled up – would serve as a complement to the initiative taken by the state government

towards effectively managing diarrhoea in the state.

Strategy for promoting appropriate management of diarrhoea through Social Marketing

Traditionally, governments have sought to ensure availability of the above products through its

own supply system: products are procured by the state or district administration, and then are

supplied to the health centres. However, several evaluations (including CRM, JRM and

validation exercise in border and other districts) have suggested that there are frequent stock-

outs of these products at the health centres due to several reasons. Besides, even when they

are available the health staff is not aware of the use of Zinc in childhood diarrhoea.

Social marketing is the process of using different marketing strategies for promoting use of

products that are socially relevant, in order to improve health or well-being of the community.

Using the market principles, the strategies also aim towards developing self-sustainable

demand-supply equations in the community. Thus, through this intervention, it is possible to

develop an alternate channel of delivery of ORS and Zn and also increase awareness regarding

the use of these by the community i.e. addressing both the demand and supply issues

simultaneously. Thus, introducing Zn and ORS through the social marketing channels would not

only increase the availability and utilization of these services, it would also ensure sustainability

of the initiative subsequent to the conclusion of UNICEF’s direct support.

3. Details of work:

The contract seeks to increase the supply and promote the demand and use of ORS & zinc to

prevent deaths due to diarrhoea among children 2 -59 months. The SM firm will create informed

demand for ORS and Zn through a communication campaign targeting families of children 2-59

months, and ensure wide availability of ORS and zinc tablets (co-package) at chemists.

PDS/NGO/CBO/other shopkeepers than local chemist shops should be trained and incentivized

for supplying ORS and zinc tablets (co-package) with other health products as non-traditional

retail outlets in these 44 districts.

The ORS would be Low-osmolarity WHO Formula procured from GMP certified manufacturers.

Zn dispersible tablets (20 mg Zinc Sulphate) would be procured by the SM firm through GMP

certified manufacturers. The intent is that the SM firm procures good-quality supplies

themselves or motivates the private entrepreneurs to procure such supplies and sell them at

acceptable profit through the additional outlets/ depot-holders. This will ensure that even if there


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are no government supplies available, the community still gets ORS/Zn at affordable prices, at a

depot near their home.

The specific tasks to be undertaken by the social marketing firm include:

A. Training:

Task 1: Collect available training and IEC material including the latest Government of

India guidelines on Diarrhoea management and amalgamate in a set for the purpose of

training:

Public and private healthcare providers

Depot holders (ASHA/AWW/Local chemist/SHG members/NGO etc.) Task 2: Orient cum train

All Health-care providers (Public and Private Sector)

Depot holders

B. Create a network of depot holders – increasing supply

Frequent stock outs of ORS and Zinc occur in health facilities due to weak functioning of health

system. To address this issue a networking approach needs to be evolved so that community or

localized depot holders are part of the supply chain management to avoid shortage of the

product. A networking of the depot holders at multiple levels is important to create a linkage with

the main stockiest and supplier.

Task 1: Develop the network of depot holders

Identify & engage Field Agents/ Depot holders4

Engage the retail points, in rural and in urban areas of districts5

Task 2: Increase the availability of ORS and Zn through the network

Build linkages between chemists/ private manufacturers of ORS and Zn tablets and the depot holders for stocking adequate supplies of ORS and Zinc

Arrange for procurement of ORS and Zinc to maintain stocks

Monitor of sales in private outlets

Monitor availability in government outlets- Subcenters, PHCs, CHCs ,District hospital and with frontline health workers

Ensure regular contact with the outlets and suppliers

4 The intent is to involve a locally active member of the community as depot holder, which may include ASHA, local chemist, AWW, SHG members etc - who is keen to take forward the activity 5 The supplies would have to be stocked/ procured out of private chemists/ pharmaceutical companies (only GMP certified manufacturers) by the SM firm.


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C. Linkages and Networking

Task 1: Strengthen networking and advocate

Strengthen networking with the CBOs, NGOs and PRIs to increase their involvement

Include diarrhoea management as one of the agenda in VHNDs and VHSCC

meetings

Advocate with NRHM officials to include ORS and Zinc supplies and use rates in the

monthly reporting system Task 2: Demonstrate use of ORs & zinc

Model in some blocks household demonstration on use of ORS and zinc by

ASHA/AWW workers

D. Creating awareness

Task 1: Adapt available IEC materials for local use:

Fliers, posters, prototypes of wall-paintings Task 2: Information-Education-Communication Campaign:

Interpersonal: Families, Group meetings through frontline workers and the depot holders

Coloured wall-paintings: at all prominent places (at least one per village, 6’X3’ size)

Distribution of fliers, pamphlets to families

Other channels: SMS messages, community radio, local television, street shows, rural melas etc.

E. Monitoring & Reporting

Task 1: Evaluate the project

Baseline and End-line evaluation report by an independent agency

Task 2: Document progress of implementation

Develop MIS and monthly progress reports

Implementation Plan in Phase Manner:

1. Preparatory Phase: 0-2 months

The major tasks will be to do rapid baseline assessment by an independent agency chosen in consultation and approval from UNICEF, setting project infrastructure and personnel in place, development of training materials, development of point of purchase, linkages with traditional, non- traditional outlets and health , ICDS and education departments ,health training of health service providers and depot holders, development of an extensive distribution channel, pre-


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testing of IEC materials and printing, identification of agencies for local media implementation, streamlining process of reporting and data compliance by developing MIS software

2. Implementation Phase: 2- 9 months

The project activities will reach their peak during this period. Distribution system will be in place, promotion and IEC campaign fully operational and MIS system fully functional

3. Sustainability Phase: 9 to 12 months

The project will focus on consolidation and recording of data. An end term evaluation by an

independent agency will be done. The learning and cost of the intervention will be shared with

stakeholders on building strategies for sustainability of the intervention. State governments will

be assisted in introducing the concept in their plans for other districts.

5. Deliverables

The broad objective of the program would be to increase the ORS and Zinc use rate by 30%(

baseline DLHS-3) in around 16 million household covering 8 million population in 44 high

focused districts.

As a result of the activities undertaken under this contract, the following deliverables are

expected:

a. In terms of training: 100% training of healthcare service providers in public and private

sector and depot holders for appropriate management of diarrhoea and use of ORS, and use of zinc tablets

b. In terms of creating network of depot holders: At-least one in each village retail

depots and outlets stocked with ORS and Zinc tablets in the district6 c. In terms of distribution of ORS and zinc: At-least 10% of ORS sachets meeting GMP

certification and courses of zinc tablets of expected demand procured and distributed by the Social Marketing firm using its own funds.

d. In terms of awareness generation: The depot holders would be mandated to create awareness and thereby increase demand for use of ORS and Zn in the community. The locally-adapted IEC material would be developed and at-least 150,000 distributed to households having children under-five.

e. In terms of IEC materials produced: IEC materials (posters, pamphlets, skits)

developed by UNICEF will be adapted and translated in local language for promoting use of ORS and Zn, to be developed within 2 months of the project initiation.

f. In terms of monitoring and evaluation: The consultancy firm will develop an

integrated management information system (MIS). They will submit comprehensive progress reports documenting implementing processes; a monthly progress report on availability of ORS and Zinc in public and private sector, and; a final report at the end of

6 While a minimum of one new depots are proposed, the SM firm would have the freedom to develop and maintain more depots/ outlets out of its own resources, if they wish.


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the project period including unit costing of the intervention. Baseline and Endline (at the end of the project) evaluation (quantitative and qualitative) on use of ORS and Zn in the community to document the success of the project by an independent agency chosen and approved by UNICEF.

7. Amount budgeted in PBA for the activity

USD 3,710,000

______________________________________________________________________

8. Qualifications/specialized knowledge/experience required Qualifications and experience

Qualifying submissions MUST have direct experience from India in planning and implementation of social marketing projects. This aspect should be supported by letter of recommendations from the client / government.

Qualifying submissions should have presence of office/technical staff in all regions of India.

Financial performance of business entity MUST show profitability in each of the last 5 years of operation and must not show accumulated losses.

Firm should be qualified to enter into MOU with UNICEF and State governments and should have all permissions from government authorities (central/state/local) to carry out this business or activities

Name of the State Focussed districts

Uttar Pradesh Balrampur

Sonbhadra

Agra

Aligarh

Lalitpur

Bihar Bhagalpur

Darbhanga

Purnia

Gaya

Vaishali

JHARKHAND Deogarh


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Gumla

Hazaribagh

Pakaur

Palamu

Chattisgarh Bilaspur

Kanker

Dantewada

Rajnandgaon

Madhya Pradesh Katni

Mandla

Guna

Ratlam

Shivpuri

Rajasthan Barmer

Dungarpur

Swai Madhopur

Baran

Orissa Mayurbhanj

Kandhamal

Koraput

Malkangiri

Nabarangpur

Andhra Pradesh Warangal

Assam Gwalpara

Nalbari

Gujarat Dangs

Valsad


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Karnataka Raichur

Maharashtra Nandurbar

Gondiya

Gadchiroli

West Bengal Dakshin Dinajpur

Purulia

TOTAL : 44


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List of Participants:

Participants List

12th Programme Management Group (PMG) on 22nd November 2011

S.No. Name of Participant Department

1 Ms. Anuradha Gupta MOHFW

2 Dr. Ajay Khera MOHFW

3 Dr. Sila Deb MOHFW

4 Mr. Sharad Kumar Singh MOHFW

5 Dr. T. Sunderaraman NHSRC

6 Dr. Madhulekha Bhattacharya NIHFW

7 Dr. Henri Hombergh UNICEF

8 Dr. Pavitra Mohan UNICEF

9 Dr. Satish Gupta UNICEF

10 Dr.M. Jagadeesan UNICEF

11 Ms. Inger Sangnes RNE

12 Dr. Ashfaq Bhat Ahmed RNE

13 Dr. Pramod Meherda Bhubaneswar

14 Dr. Gayatri Rathore Rajasthan

15 Mr. Sanjay Kumar Patna

16 Dr. Manohar Agnani Madhya Pradesh

17 Dr. Paul Francis WHO

18 Dr. Archana Choudhury WHO

19 Dr. Kaliprasad Pappu LFA NIPI

20 Dr. Usha Patnaik LFA NIPI- Bhubaneswar

21 Dr. Satyapal Yadav LFA NIPI - Rajasthan

22 Dr. Harish Kumar LFA NIPI

23 Dr. Narottam Pradhan LFA NIPI

24 Dr. Amrita Misra LFA NIPI

25 Mr. Tony Cameron NIPI Secretaritat

26 Ms. Lalitha Iyer NIPI Secretaritat

27 Dr. Urvashi Chandra NIPI Secretaritat

28 Ms. Shanti Moktan NIPI Secretaritat

29 Ms. Prasanna Narayanan NIPI Secretaritat

30 Mr. Aditya Mishra NIPI Secretaritat

31 Dr. Rajesh Khanna NCHSRC/ NIHFW

12TH NIPI PROGRAM MANAGEMENT GROUP

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