Norway India Partnership Initiative 2007-2012: Gains and Gaps · 2017. 2. 18. · 2007-2012: Gains...
Transcript of Norway India Partnership Initiative 2007-2012: Gains and Gaps · 2017. 2. 18. · 2007-2012: Gains...
Norway India Partnership Initiative
2007-2012: Gains and Gaps
UNICEF India Country Office,
New Delhi
Norway India Partnership Vision
Scaling-up of quality child health services
• Community based newborn and childcare: Integrated Management of Newborn and Childhood illnesses (IMNCI) – ANMs – ASHAs - AWWs
• Facility based services: Facility based newborn care
• Outreach services: Immunization
Scaling up of community based newborn and child health
0
10000
20000
30000
40000
50000
60000
2005 2006 2007 2008 2009 2010 2011
Numbers of workers trained in IMNCI in NIPI States: 2005-2011
Bihar MP Orissa Rajasthan UP
Scaling up of community based newborn and childcare
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10
20
30
40
50
60
70
80
2006 2007 2008 2009 2010 2011
Co
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ge in
%
3 PNC visits in first 10 days
Non NIPI states
NIPI states
Lessons learnt in community based newborn and childcare (1): Implementation Research
(Bhandari et al, 2012, BMJ)
14% reduction in neonatal and 15% reduction in infant
mortality
Greater reductions in neonatal mortality in the sub-group
of births within the village of residence (20%)
Mortality impact supported by a substantial effect on:
- infant care practices
- prevalence of morbidity
- timely & appropriate care seeking for illness
Lessons learnt in community based newborn and child health (3): Supervision is critical, weak
S
No State
Madhya
Pradesh Chattisgarh Jharkhand Orissa Assam Rajasthan Gujarat
1 TRAINING
1.1 Coverage 2 1 2 2 2 2 2
1.2 Training norms 2 1 2 2 2 2 2
1.3 Recall on training 2 2 1 1 1 1 2
1.4 Knowledge & skills 2 2 1 2 2 2 2
1.5 Coordination of training center &
administration 2 2 0 2 2 2 1
TOTAL FOR TRAINING 10 8 6 9 9 9 9
2 SUPERVISION
2.1 Joint Supervision 2 0 0 0 0 0 0
2.2 Supportive Supervision 2 0 2 1 0 1 0
2.3 Monitoring 0 0 0 0 0 1 0
2.4 Quarterly reviews 2 0 0 1 1 0 0
2.5 District Coordination committee function 0 0 1 0 1 1 1
TOTAL FOR SUPERVISION 6 0 3 2 2 3 1
Lessons Learnt in community based newborn and childcare: Improving supervision is possible!
For achieving improved CCSP skills in trained personnel, there is minimal incremental gain after 3-4 supervisory visits
Optimum IMNCI Program IMNCI
Improve skills of workers - Training in IMNCI – AWW, ASHA, ANMs, - Private providers in formal and informal
sector, government physicians
Community promotion activities - Advertisements of available services - Group meetings - Promotional IMNCI messages - Production of communication material -On the job training by supervisors in conducting group meetings
Health systems strengthening - Supervision visits – ensuring 2 supervisors available per PHC
- Establishing a drugs depot in the village under village level committees, replenish every 3 months
-Performance linked incentives
Lessons learnt in community based newborn and childcare (2): Health System & community promotion missing
Improve skills of workers - Training in IMNCI – AWW, ASHA, ANMs - Private providers in formal and informal
sector, government physicians
Community promotion activities - Advertisements of available services - Group meetings - Promotional IMNCI messages - Production of communication material -On the job training by supervisors in conducting group meetings
Health systems strengthening - Supervision visits – ensuring 2 supervisors available per PHC
- Establishing a drugs depot in the village under village level committees, replenish every 3 months
Opportunities for strengthening community based newborn and childcare
• Large numbers of trained workers
• IMNCI “Plus”:
– Incentives
– Supervisors
• Challenges:
– Numbers
– Quality assurance
– Supportive Supervision
Scaling-up Facility Based Newborn & Childcare
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5
10
15
20
25
30
35
40
Bihar Madhya Pradesh Orissa Rajasthan Uttar Pradesh
Cumulative numbers of SNCUs in five NIPI states, 2008-2012
2007-08
2008-09
2009-10
2010-11
2011-12
Contribution
• Standards and norms – Toolkit
– Operational guidelines
– Developmental follow-up (in progress)
– Accreditation
• Support structures – Collaborative Centers
– National Neonatology Forum
• Evaluation, mid-course corrections, informing policies
• Regional Dissemination
UNICEF
Key learnings (1): mortality declines except form asphyxia
UNICEF
Key learnings (2): Rapidly increasing needs!
Existing number of beds Required Number of Beds
Tonk 12 20
Dibrugarh 17 23
Mayurbhanj 12 25
Purulia 14 32
Lalitpur 12 25
Vaishali 13 32
Guna 20 32
Port Blair 14 10
UNICEF
Key learnings (3): Maintenance of Equipment
Name of the unit Reported time for repair of essential equipment (warners, phototherapy units)
Tonk 6 months
Dibrugarh 1.5 months
Mayurbhanj 6 months
Purulia 1.5 months
Lalitpur 3 months
Vaishali 1.5 months
Guna 0.5 month
Port Blair 6 months
UNICEF
Key learnings (4): Nurses are central to improving outcomes
Key learnings (5): Follow-up care is critical
Facility Follow-up of SNCU discharge
Community Follow-up of SNCU discharge
SCNUs Innovations to address problems
• Equipment: power audit, training of refrigerator mechanics, untied funds
• Human resources (MP): higher remuneration, improved working conditions
• Collaborative Institutions • Survival and Developmental follow-up • One stop shop • Data capturing, management and use for
planning M&E and supportive supervision • Accreditation
Opportunities for Expanding and Consolidating Facility Based Newborn Care
• Large numbers of SCNUs already in place – Large unmet need – Disparities – Quality assurance & Accreditation
• Norms & Standards exist • High political commitment
– Commitment in XII plan – JSY + JSSK – RSBY
• Collaborative Institutions • Expertise and early Experience in Developmental follow-up
– Draft Guidelines
Scaling up immunization (1): Strengthening Cold Chain
• SHTO Pune re-started in 2007 as national cold chain training institute for repair and maintenance of: – ILRs/DFs, – WICs/WIFs, – voltage stabilizers – solar refrigerators
• Almost all refrigerator mechanics in the country trained • More than 14000 (43%) cold chain handlers trained • First National Cold Chain Assessment (with costing) carried out in
2008 (VMAT) and 9 States have followed with VMAT or EVM • Guidance for expansion of cold chain and introduction of new
vaccines in the country • Development of National Cold chain MIS (www.nccvmtc.org) for
real time monitoring
• Vaccine Wastage Assessment carried out in 5 states:
Vaccine wastage range 34% (DPT) to 63% (BCG) at session site
Campaign results: Reported coverage vs. RCA monitoring
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10
20
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100
Aru
nachal
Pra
desh
Assa
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Bih
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Guja
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Jhar
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Man
ipur
Meg
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Nagal
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Tripura U
P
% Reported coverage % area with >90% chidren vaccinated
Activity ongoing in AP, Assam, Gujarat, Rajasthan & Tripura
RCA areas checked < 100 in AP, Manipur and Tripura
68 of 137 districts achieved
>= 90% administrative coverage (50%)
Data as of 14 March 2012:
Number of areas visited for RCA monitoring = 33,212
Number of children verified = 638,660
Reasons for partial or no immunization (source: CES 2009)
• Demand side issues far outweigh supply
• Lack of Knowledge and felt need contributes to majority of left out and drop outs
• Allaying fear of adverse reactions is also important (8%)
1. Communication guidelines for immunization developed
2. IEC prototypes prepared for print, mid and mass media
3. Routine Immunization Guide with FAQs for capacity building of ANM/ AWW/ ASHAs
4. IPC training videos for frontline health workers
5. Media sensitization (national/ state)
Scaling up Immunization (3): Improve Demand
Scaling up enabling mechanisms
• National, State and district:
– “Enabling “ Child Health Division
– Child Survival Cells in Orissa, MP, Bihar and Rajasthan
– Divisional MCH Coordinators in Rajasthan, UP
– District MCH coordinator in Orissa, Bihar
• Hand over: Progressively these cells/structures are jointly supported and owned by partners and state government:
– Bihar
– Rajasthan
– Orissa
• Capacity building programs (techno-managerial) for mid-level managers developed:
– Short course (WHO, UNICEF, PHFI, PGIMER): more than 100 MLMs from NIPI states trained so far
– One year diploma (PHFI, in progress)
Scaling up enabling mechanisms Key learnings
• Fragmentation at state: – NRHM versus RCH
– Line staff versus consultants
• No clear lines of responsibility for RCH at state and district – DIO for immunization, DLO for Leprosy, DTO for
TB, DPMU for “NRHM”, who for RCH?
• Suggest a District RCH Unit, headed by DRCHO, supported by District RCH Consultants
Catalytic and/or Strategic?
• Progress in NIPI states vis-à-vis others
• Progressively models have been implemented and scaled up
• Assessments
• Corrective actions
• Guidelines and standards
• Partnerships developed, their capacity enhanced
• Enabling mechanisms identified and built
• Innovations ongoing