Public Private Partnerships formed by SNEHA City Initiative for Newborn Health ASK partnership Arogya Sarita

3 super-specialty teaching hospitals 14 general hospitals 24 maternity hospitals 167 health posts Intervention facilities Multi-tiered public health system

Issues from formative research 50% of women and children from slums access public health facilities Health posts provide limited antenatal and postnatal services Maternity homes and peripheral hospitals find it difficult to provide designated level of care Tertiary level services are overburdened Referral system not formalised Health care providers need support and skill development to deliver quality care

City Initiative for Maternal and Newborn Health Society for Nutrition, Education and Health Action Municipal Corporation of Greater Mumbai ICICI Centre for Child Health and Nutrition Centre for International Health & Development

Goal To establish a continuous quality improvement (CQI) cycle factoring in clinical and behavioural aspects of service delivery to enable facilities to provide designated level of quality care Arrived at through participatory consultations

MCGM Public health services SNEHA NGO ICICI SIG Corporate bank UCL CIHD Research partner Community

SNEHA NGO founded 1999 Focus on maternal and child health in urban slums Activities in nine city wards Neonatologists, Social workers, Social scientists, Health management specialists, Behavioral scientist

MCGM Public Health services Extensive health infrastructure covering a large section of urban poor Primary health and tertiary care Proactive leadership Participation in designing the project Co-implementation Monitoring

Community Services Infrastructure Monitoring Funding Design input Networking Dissemination Design input Evaluation Networking Dissemination Binding partner Implementation Monitoring Problem identification Mobilisation Monitoring

Strategy for change in health facilities ANC, PNC, Neonatal clinics Community outreach Health Post Clinical & Referral protocols Partograph use Telephone connectivity Maternity home Referral protocols Partograph use Training of Maternity home staff Telephone connectivity Tertiary hospital Appreciative Inquiry and Action Groups Peripheral hospital Regional referral links

Achievements Health posts 8 fully-functioning antenatal clinics with staff trained on antenatal, postnatal, and neonatal care Clinically trained staff across 14 health posts Improvements in motivation and attitude through Communication trainings 700 antenatal clients, 20% make two or more visits More than 1600 neonates brought in for neonatal care

Achievements Maternity homes Standardized evidence-based clinical protocols Clinical training: 20 modules in obstetrics and neonatology Maintenance of partograph by 60% of maternity homes Dedicated hotline connectivity from maternity homes to peripheral and tertiary hospitals Appreciative Inquiry training and communication trainings extended by MCGM across all maternity homes in the city

Achievements Peripheral hospitals Regional referral link with maternity homes has been established in three Hotline connectivity established and functional Initiation and maintenance of transfer in and out records

ASK partnership Society for Nutrition, Education and Health Action Municipal Corporation of Greater Mumbai ASK Foundation

ASK partnership Within the City Initiative for Newborn Health Aimed to upgrade public health facilities ‘Vital’ level of equipment provided for: –3 maternity homes –1 peripheral hospital No user fees Utilization monitored

Society for Nutrition, Education and Health Action Municipal Corporation of Greater Mumbai Mahindra & Mahindra Arogya Sarita

Integrated model of primary health care Kandivili To improve quality of health care and health seeking behaviour in the defined population To build an integrated model of comprehensive primary health care To bring together partners from corporate, government and civil society to deliver improved quality of health care

Partners

Partnership issues Despite equal status of partners, one partner tends to drive the initiative SNEHA at times took a lead role in implementation, monitoring and evaluation This may occasionally have reduced the effectiveness of the initiative –Staff buy-in for partograph introduction –Re-institution of antenatal clinics at health posts MCGM officials are to be commended for their active engagement in the process of change –regular clinical training across the city –partography at maternity hospitals –sanctioning establishment of more clinics at health post

Partnership sustainability Beginning with action groups is useful Partnerships and partner roles take time to mature –over 2 years until ground-level activities established Sustained partnerships lead to further partnerships and new activities –experience in urban health partnership helped leverage funding for further work in Ghatkopar under the Sure Start program There is a difference between contracting out and the sort of partnership we have developed, which involves facilitatory roles for multiple partners