1. Health & Nutrition Interventions under IKP

2. Outline of the presentation ► What are we aiming in HN pilot mandals? ► How did we plan to achieve? ► Who are there to implement? ► Where are we now? ► What are the revised strategies proposed? ► Why the coming 6months are critical? ► What is expected to do in the year 2006-07? ► How can we make it happen?

3. What are we aiming in HN pilots? ► Empowered CBOs:  Demand access and availing health & nutrition services especially among POP &Poor  Improve house hold behaviours that help maternal & child survival and control spread of communicable diseases  Provide financial support during illnesses  Reduce expenditure on Health

4. How did we plan to achieve?

5. Key strategies ► Continuous capacity building ► Convergence with line depts ► CIFs (need based) ► Community health resource persons involvement for behavior change

6. 1. Demand access and availing health& nutrition services Convergence with line depts Institutionalization of Fixed NHD 1.Improved coverage of pregnant,lactating mothers and children especially among POP &Poor families 2.Improved coverage of beneficiaries in the community Objective StrategyIntervention 1.Reduction of morbidity & mortality (MMR,IMR,NMR) 2. Reduction of disability Outputs Outcomes

7. 2. Improved Household Behaviours for maternal &child survival and control of communicable diseases Capacity building & Behaviour change communication (BCC) Regular trainings, Exposure visits, Demonstrations, Kalajathas, Rallies, campaigns 1.Improved knowledge about ANC,PNC, neonatal care, 2.Improved knowledge about control of TB, Malaria and HIV/AIDS 3.Change in household behaviours in terms of infant care, pregnancy, post natal care 4. Reduction in episodes of TB, Malaria and HIV/AIDS Objective Strategy Intervention 1.Reduction of MMR 2.Reduction of IMR 3.Reduction of NMR 4.Reduction of morbidity 5.Reduction in health expenditure Outputs Outcomes

8. 3.Provide financial support during illnesses Social health fund (CIF) Health savings - Health Risk Fund 1.Improved access to finance in case of emergencies. 2.Improved health seeking behavior among women 3.Early detection and treatment 4.Referrals only in case of acute and chronic cases Objective Strategy Intervention 1.Reduction of family expenditure on health 2.Increased with increase in number of working days Outputs Outcomes

9. 4. Reduction of expenditure on health Community managed health insurance, Social health capital, Establishment of Referral systems & CIFs 1. Health activists 2.Case managers 3.Screening camps 4.HRF 5.Food security 6.Nutrition centers 7.Health insurance Management of illnesses with home remedies Early detection of diseases and treatment among women Referrals only in case of acute and chronic cases Reduction of childhood illnesses No delay in seeking treatment Objective Strategy Intervention 1.Reduction of family expenditure on health 2. Reduction of incidences of HIV/AIDS among women Outputs Outcomes

10. What we accomplished? ► 2003-04: Identification of pilot mandals Recruitment of functionaries Recruitment of functionaries Induction training &exposure to CRHP, Induction training &exposure to CRHP, Jamkhed staff Jamkhed staff ► 2004-05: Base line data using PRA exercises. Prepared Health action plans & health expenditure analysis in all the VOs expenditure analysis in all the VOs Positioning of HAs Induction training &exposure to CRHP, Induction training &exposure to CRHP, Jamkhed for HAs. Jamkhed for HAs.

11. 2005-06 ► Implementation of AWFPs ► Trainings to HAs by Jamkhed mobile teams in their respective villages. Expenditure incurred: 268.41lakhs

12. 2006-till the date ► Position of Master trainers with ANM qualification & certified by Dr. Arole. ► Position of regional/Area H&N coordinators in the field ► Exclusive HN-AWFP exercises ► Bimonthly regional review meetings ► Identification of health CRPs who are best practitioners. ► Monthly MIS for HAs ► Masa Nivedika for health subcommittees at VO,MMS &ZS Budget allocated: 526 lakhs under IHCB 13.20 crores under CIF 13.20 crores under CIF

13. Who are there to implement? In all 44 mandals identified in 22 districts: ► 1363 Health activists in 1329 VOs to train SHGs ► 1184 Health subcommittees to ensure services to reach POP and Poor. ► 60 Master trainers to train HAs ► 31HN CCs to train Health sub committees and ground the need based CIFs. ► 7 AC/DPM(HND) to coordinate at district level. ► 7 Regional/Area H&N coordinators to provide supportive supervision &guidance in the districts Project Directors to ensure intensive focus in implementation SPMU team to provide technical support & guidance 40 Health CRPs to ensure health as an agenda in SGH/VO/MMS/ZS

14. Where are we now? ► HAs undergone intensive regular training at mandal level (8-89 days) 89 days: Vizag, Chittoor, Guntur, Ananthapur,Kurnool 8 days: Nellore, Srikakulam, Khammam, Vizianagaram ► 213 HAs and 208 Health sub committee members had exposure visits. ► Institutionalization of Fixed NHD(769VOs)  Vizag (77), Guntur (46) (Drawn VO wise schedules & issued proceedings from the collector)  Khammam, Medak, Adilabad, Nellore (No NHD)

15. Contd.. ► Regular health savings (Rs21250 – 303000)  Chittoor (Rs 303000)  Nizamabad (Rs 21,250) ► HRF grounding (Model VOs)  Vizag, Ananthapur, Kurnool, Chittoor  Vizianagaram (all VOs) by diverting funds released for training of HAs) ► Implementation of other CIFs  Kitchen gardens (Chittoor)  Nutrition centers (Vizag, Guntur, Krishna)

16. What made to show good progress? ► PDs conviction and involvement ► Committed facilitators (HN CCs) ► Intensive focus and no deviation on implementation of proposed interventions. ► Exposure visits to CRHP, Jamkhed. (seeing is believing) (seeing is believing) ► Special review with the field staff

17. Why disparities? MTA results revealed ► No anchor persons positioned. ► If positioned, used their services for non HN activities (general work). ► So, no focus on training of HAs and SHGs with a fixed schedule. ► Non release and delay in release of budget from DPMU to MMS ► Diversion of funds at district level from trainings to HRF ► No clarity among the members of MMS &DPMU regarding HN budget allocations made in 2005- 06 AWFP.

18. Contd… ► No orientation to ACs & APMs on HN strategies ► No monitoring on quality of trainings ► Not able to link/integrate the related activities (IB & Food Security) with HN. Seeing as stand alone interventions. ► Never been the agenda in any district level review meetings. ► No intensive supportive supervision & guidance from SPMU. ► No adequate clarity for operationlisation of CIFs such as HRF, Nutrition centers, other need based CIFs generated, introduction of health as an agenda.

19. What are the revised strategies proposed in 2006-07? ► Exclusive Master trainers with ANM qualification ► Regional/Area H&N coordinators to do intensive supportive supervision &guidance in the field. ► Exclusive AWFP exercise with MMS &ZS and immediate release of budget based on the performance during the year 2005-06. ► Allocation of budget for HRF under social CIF (@1lakh per VO) with detailed operational guidelines ► Bimonthly regional review meetings ( for 3 districts) ► Identification of Health CRPs from the best practitioners

20. Contd.. ► Constitution of 10member Mandal cultural teams by MMS (SHG members+local cultural teams) ► Net working with Pvt/Trust hospitals for health insurance & screening camps ► Fixed days for training of HAs(48 days) & Health subcommittees (8days). ► Performance based incentives for HAs (10 indicators). ► Introduction of Masa nivediaka on health agenda by health subcommittees.

21. What is expected to do in districts? (2006-07) 1. Immediate release of budget to MMS. 2. Positioning of human resources (HAs, CVs, Master trainers) 3. Exposure visit to CRHP, Jamkhed for all the health subcommittees &HAs. 4. Fixed schedule for training of HAs @2 days/fortnight.( 7&8 th and 29 th &30 th day of the month). 5. Fixed schedule for training of health subcommittees @2 days per quarter.(18 th &19 th day of the month). So, fixed training calendar at MVTC.

22. Contd.. 6. Convene district/mandal level convergence meeting to draw schedules for institutionalization of Fixed NHD in all the VOs. 7. Regular support by MMS & ZS health subcommittees in villages.( Try to cover all the VOs in a period of 6months 8. Implementation of comprehensive food security in all the VOs followed by Nutrition centers wherever necessary based on the need on a sustainable model. (Vizag model). 9. Organise screening camps by net working with trust or other private hospitals. 10. Release of HRF to VOs who are having regular savings for health.

23. Contd.. 11. Initiate the process for introducing health as an agenda thru the health CRPs. 12. Have a base line from the data already collected in the year 2004 and also ensure to submit monthly MIS (Quantitative & qualitative data). 13. Introduce the practice of preparing HN Masa nivedika by Health sub committee and VO president. 14. Organization of Kalajathas in every VO once in every quarter by the mandal level cultural teams constituted by MMS and trained.

24. Why are the coming 6months critical? ► Need to demonstrate the impact of the interventions to scale it up in another 55 mandals with the support from DFID under health sector reform strategy. ► We can extend the benefits to POP &Poor in at least in10% of the mandals in the state. So, Let us not loose the opportunity! So, Let us not loose the opportunity!

25. What is required to make it happen? ► PDs conviction & involvement ► Positioning of anchor persons (CVs) & Master trainers ► Focused approach to implement planned interventions ► Clear guidelines for operationlaisation of interventions. ► Fixed schedules for training of HAs and Health sub committees. ► Organise exposure visits to CRHP, Jamkhed

26. Contd.. ► Institutionalization of NHDs in all the VOs ► Review of activities as per AWFP based on the output/outcome (Process/ impact indicators). ► Intensive supportive supervision and guidance from SPMU ► Introducing health as an agenda at SHG level ► Integration with IB& Food security. ► Not to consider it as a stand alone intervention. ► Use it as an entry point activity to strengthen IB.

27. Knowing is not enough, We must apply Willing is not enough, We must do -Goethe