1. Health and nutrition interventions – Mainstreaming HIV/AIDS prevention
Lakshmi Durga Chava
State Project Manager (Health & Nutrition)
Society for Elimination of Rural Poverty

2. Outline of the presentation
Overview of SERP
Health and nutrition: key processes
Mainstreaming HIV/AIDS prevention
Impact assessment results
Roll out plan
Conclusion

3. Society for Elimination of Rural Poverty (SERP)
Sensitive support organization for the poor
Autonomous society set up by Government in 2000
State wide mandate:
To induce social mobilization
To provide facilitation support to institutions of poor
To sensitize all line departments to be inclusive of the needs of the poor

4. SERP
A.P – poverty eradication through empowerment of rural poor women (Indira Kranthi Patham - IKP)
Focus: comprehensive poverty eradication - economic and social
building self sustaining institutions of poor
Rs.2100 crores Project - financed by State Government, World Bank and communities to cover all rural poor in the state (over 100 lakh families, special focus on 26.0 lakh ultra poor)
builds on the decade long, statewide rural women’s self-help movement in A.P

5. C.B.Os implement the project
A.P Federation Model
SHGs •
Thrift and credit activities
Monitoring group performance
Micro Credit Planning
Household inv plans
E.C -
2 from each S.H.G, 5 Office bearers
Strengthening of SHGs
Arrange line of credit to the SHGs
Social action
Village development
Marketing and food security
Support activists – 3 -5
2 from each V.O, 5 Office bearers
Support to VOs
Secure linkage with Govt.
Depts.
fin institutions, markets
Auditing of the groups
Micro Finance functions 10 15
V.O
150
200
MMS
4000
6000
Z S
200,000
400,000
C.B.Os implement the project
Zilla Samakhya
Mandal Samakhyas and V.Os plan and implement the various
project components
Each Mandal is divided into three Clusters of habitations.
A development professional, called Community Coordinator (CC) is placed in each Cluster. S/he stays in her cluster.
SERP selects and trains them. After completion of training, they are contracted by the MS and are accountable to MS.
M.S responsible for social mobilisation, institution building and funding the microplans of S.H.Gs/V.Os from C.I.F
Micro credit plans are evolved by the S.H.Gs in each village. These plans are funded by their own savings, CIF fund and Bank Linkage.
V.Os responsible for appraising the microplans and recommending them to M.S for financing from C.I.F
V.Os appraise microplans and also finance them from the recycled C.I.F
Mandal Samakhya
Village Organization
SELF HELP GROUPS

6. SHG network Village Organization-VO (approx. 20 SHGs) 9,646,000
Rural Women in 22 Districts of AP
810,000
Self Help Groups (10-15 women per group)
34,852
Village Organization-VO (approx. 20 SHGs)
1098 Mandal Samakhya-MS
(Includes approx villages)
22 Zilla Samakhya-ZS
(constitutes 1 district)
1 State Office (State Project Monitoring Unit)

7. IKP Interventions Targeting – community based targeting.
Focus on the poorest of the poor and vulnerable: women, disabled
Power of scale – bringing all the poor in the state into social networks
Scaling up through community resource persons
Institutional design – SHG – V.O – M.S – Z.S
Large scale mobilization of bank finances for poor
Large scale livelihoods promotion
Community managed food security
Social issues as an agenda for collective action
Social risk management
Community managed health interventions
Convergence with all line departments
S.E.R.P’s dynamic role – changes in tune with the changes in the demands of the C.B.Os

8. IKP health model: Core elements
Reducing exclusion and social disparities in health
organizing health services around people's needs and expectations
Integrating health into all sectors
Pursuing collaborative models of policy dialogue
Increasing stakeholder participation

9. Aims to:
Improve partnerships between health facilities and the communities.
Increase appropriate and accessible health care and information through training of community health workers.
Promote key family practices critical for child health and nutrition by training and supporting peer support groups and conducting outreach education campaigns training community resource persons
Involve other community institutions and champions to engage in health education and planning.

10. Convergence Framework for Improved Access to Services
Work in collaboration with the existing line departments responsible for enhancement in QOL of the poorest
Look at areas where there are gaps and there is a mismatch between the design of service delivery and the incentives linked to those services
Fill those gaps through ways that can be managed and sustained by the community groups even after the project is over
Have a cadre of internal facilitators, from among the communities to facilitate/accelerate in the empowerment process
Have a cadre of external facilitators to assist in planning and designing sustainable and workable programmes
Enable the communities to have choice and control over the services available for them
Make the service providers more accountable to the communities
Successful pilots to be up-scaled by the line departments for state-wide implementation
Systems
Outputs/outcome
Personnel
Improved access to “effective & available” services

11. Goal
Improved health and nutrition status of the communities in 62 pilot mandals of Andhra Pradesh by 2009.

12. Objectives Empowered CBOs:
Demand access and availing health & nutrition services especially among POP &Poor
Improve house hold behaviours that help maternal & child survival and control spread of communicable diseases
Provide financial support during illnesses
Reduce expenditure on Health

13. 5 Key strategies Continuous capacity building
Convergence with line depts
Community Investment fund (need based health and nutrition projects)
Community health resource persons (CRPs) strategy for behavior change.
Case Managers

14. IKP Health Value Chain towards reaching MDG 4,5 and 6
Preventive & Promotive Health Care
Curative Care
Financing and Service Delivery
Human/Social Capital
Health activist
Community Resource Person (CRP)
Microfinance Product for NUTRITION
Case Managers
Health Risk Fund/ Health Savings
Empower the CBOs to:
Demand and access services from public health system
Influence household behaviours for maternal and child care practices
Nutrition & Health Day (NHD)
Health Insurance
Making Services Work for the Poor – Accessing PHCs & Area Hospitals
Water & Sanitation
Community-owned Pharmacy
Nutrition Centers
Community-owned Hospitals

15. Key players Village Organisations Mandal Mandals Samakhyas
Zilla Samakyas
HN CC
Health Activist
AWW
ANM

16. Implementation plan @ 2-5 mandals per district in all 22 districts
@ 1 Health Activist per village/habitation
Health sub Committees of VOs/MMS/ZS
@ 2 Master Trainers per mandal with ANM training.
1 DPM/APM (HND) per district.
Field Coordinators at SPMU
Existing Committees of Line departments
Functionaries of line departments

17. Organgram
Community Facilitators
Project Facilitators

18. Key outcomes
Reduction in maternal and child morbidity and mortality (MDG 4 and 5).
Reduction in morbidity and mortality due to communicable diseases (MDG 6).
Decreased out of pocket expenditure on health

19. Universal and intensive Interventions

20. Universal interventions
Regular capacity building of health activists, health sub committees and health CRPs
Institutionalization of Fixed Nutrition and Health Days (NHDs) towards complete immunization, ANC and PNC.
Community kitchen gardens
Promotion of weaning foods with locally available commodities
Regular health savings and HRF
Community managed health insurance

21. Community-Managed Nutrition cum Day Care Center
Goal
To improve Perinatal and neonatal outcomes and child care practices towards achieving the MDGs in rural Andhra Pradesh
Objectives
To provide nutritional and health care for pregnant and lactating mothers.
To encourage improved health care practices for safe deliveries and have no low birth weight babies.
To empower communities to make pregnancy safer and develop change agents to have sustainable impact.

22. Nutrition cum Day Care Center (NDCC)
Physical center i.e., building with Kitchen, Dining and Garden (for growing vegetables)
TWO MEALS a day prepared and served to pregnant and lactating mothers and children
<5 years
Cook is an SHG member trained in preparation of nutritious, traditional diet (with focus on use of millets & greens)

23. Nutrition cum Day Care Center (NDCC)
The center also doubles-up as a health check-up centre for pregnant and lactating mothers and children <5 years
Serves as a venue for health education and behavior change communication

24. NDCC Financing Model The cost of meal
Rs 25 per day for TWO MEALS for pregnant and lactating mothers
Rs 10 per day for TWO MEALS for Children <5 year
Beneficiaries pay Rs 18 per day for TWO MEALS; The balance Rs 7 is subsidized by the Community-Based Organization/ Government of Andhra Pradesh
The Beneficiary’s contribution is financed via a MICROFINANCE LOAN taken from the Community-Based Organization which will repaid over 24 – 36 months depending on income status of the beneficiary i.e., CONSUMPTION SMOOTHING VIA a CONSUMPTION LOAN

25. Process Discussion with the mothers-mother-in laws
Discussion with beneficiaries
Grama sabha
Day care for children
Preparation of MCP
Feeding at NDCC

26. NDCC Coverage 2007-08 : 200 centers 2008-09 : 400 centers

27. Coverage against survey
As per enrolment at 600 NDCCs with 332 day care centers.
3,220 BPL pregnant women; 1,967 SC/ST
3,148 BPL lactating mothers; 1,991 SC/ST
3,440 BPL children 0-3yrs; 2,167 SC/ST
As per survey at 600 AWCs
5092 pregnant women from all categories
6043 lactating mothers from all categories
9960 children 0-3yrs from all categories.

28. Perinatal outcomes* Against the 2890 deliveries happened:
100 %of women had safe deliveries. [2559 Institutional(88.5%) /331 trained personnel(11.5%)]
2599 had normal deliveries (89.9%)
291 had cesarean section (10.1%).
87% women had complete ANC
99% women had PNC
46% of pregnant women gained 10-12Kgs weight; 47% gained 7-10kgs weight
No maternal deaths reported among the women enrolled
* Source: Internal MIS

29. Neonatal outcomes* 1497 girls (51.7%) and 1398 are boys (48.29%)
97% of babies born with >2.5Kgs
56.5% babies with >3Kgs
Neonatal care practices
97% neonates are fed with Colostrum and no pre-lacteal fluids
82% delayed bathing the baby for 7 days.
* Source: Internal MIS data

30. FAQs about results Accuracy of the measurements?
Technical person for supervision?
Authenticity of the data?
Empirical evidence ?

31. Early outcomes

32. Mainstreaming HIV/AIDS prevention
Complementary roles of the Societies.
Development of CRPs as TOTs.
Regular capacity building of stakeholders at all levels integrated with HN training plans.
Exclusive Health CRPs to focus on SHG trainings and referrals.
Scale up plans integrated with HN interventions.
Knowledge levels and referrals rates are impressive in intervention areas.

33. Roll out plan : 2009-2012 Expansion of mandals (62 to 458)
Entire district saturation with universal interventions (6)
Coverage of all tribal mandals and disability mandals piloted under IKP.

35. Please visit www.serp.ap.gov.in/HN for more details
Thank You