1. Country Team Action Plan Bihar, INDIA

2. Tracks 1 & 2 2 Where are we now? Current levels of accomplishment/Progress and challenges since Bangkok 2007 Health Indicato r India (Present) Bihar (Present) Goal 2011 CPR47% total,28% total, 24% limiting, 4% spacing 31% total 26% limiting, 5% spacing

3. Tracks 1 & 2 3 Where do we want to be? GOAL Increase CPR from 28% to 31% by 2011 Increase birth limiting from 24% to 26% by 2011 Increase birth spacing method use from 4% to 5% by 2011 Total case load expected: Approx. 2 million new clients

4. Track 1 4 What are the gaps (1)? Current Situation –Space constraints prohibit retaining women after delivery –Shortage of trained Human resources –Supervisory limitations –Govt. service providers not trained in PPIUD –Provider prefer to deliver permanent methods

5. Track 1 5 What are the gaps (2)? Current Situation –Low level of rapport and trust in client-provider interaction –Lack of male/family involvement –Non involvement of RMPs –Inadequate monitoring and supervision –Less use of data for feedback in monitoring –Prevalent superstitions and doubts about modern methods

6. Track 1 6 What are the gaps (3)? Current Situation –Misconceptions about “delay” of first pregnancy versus “spacing” and “limiting” births –Breaks in service delivery due to floods every year –Limited involvement of private sector providers –Issues in supply chain management –Client attrition due to migration –Competing health priorities (polio/JSY) with limited health resources

7. Track 1 7 What interventions can we use to close the gap? Task shifting/Task sharing Increased involvement of private sector in service delivery

8. Track 1 8 Task shifting/Task sharing

9. Track 1 9 Action steps for Task shifting/Task sharing In service training on Contraceptive Updated counseling to ANM/ASHA (Volunteers)/AWW Review and revise job description for ASHA/AWW/ANM Provide supportive supervision Post-Partum Home visit to be mandatory by AWW/ASHA and monitored by ANM

10. Track 1 10 Action steps for Task shifting/Task sharing (continued..) Incentivise post partum home visits by ASHA and AWW Include and prioritize FP in VHND agenda Training of ANM on post partum IUCD insertion Utilize opportunity for counseling for IUCD/other modern methods in institutional deliveries.

11. Track 1 11 What are the possible challenges to the intervention? ChallengesSolution Government approval for job revision Advocacy, Sharing of evidence Resistance from govt. providers on task sharing /shifting Reward, Award & Recognition to providers Exposure Visits Ensuring supplies and distributionLogistics Planning and Supply chain management Quality maintenance at scaleIP training and supply. Operationalize QAC

12. Track 1 12 Who are the possible partners, allies, and stakeholders? Sl # AreasPartners 1Policy and Funding MOHFW, MOWCD (Center & State), UNFPA,DFID, BMGF, PACKARD, WHO, Unicef 2Technical Assistance Development Partners( JSK, UNFPA,Path finder, PFI, PACKARD,BMGF,DFID, B TAST,CARE, PSI) 3ServicesCARE, Janani, PSI, Path finder, other NGOs, MOHFW,MOWCD 4AdvocacyElected Representatives, SHGs and CBOs.

13. Track 1 13 Involvement of Private Sector

14. Track 1 14 Action steps for Increasing involvement of private sector Advertisement in local and national news papers and media during June (State Directorate). Stake holders consultation( IMA/FOGSI) DGFW – State IMA/FOGSI President. Provision of Funds in PIP. Approval from GOI for resource fee for Pvt. Service providers Competency Assessment of providers/training Empanelment of selected providers (DGFW).

15. Track 1 15 Action steps for Increasing involvement of private sector, cont’d Contact government in other states (state PS) to facilitate empanelment of service providers. TOR (Government and FOGSI). Target 38 district/534 blocks (CMO). Operational Plans (# of clients, support staff, equipments, supplies) Design mobile teams for FDFS (fixed day fixed site) service

16. Track 1 16 What are the possible challenges to the intervention? ChallengesSolution Existing GOVT doctors might complain about involvement of outsiders Sensitization of government doctors Physical verification and paymentsThird party verification/ on spot verification Adequate number of clientsStrengthen BCC Compliance with Government norms regarding standards and practice Training programs Private providers’ expectationsCounseling

17. Track 1 17 Additional points for involving pvt. sector Pvt. Sector involvement for birth spacing methods –Injectible contraceptives –IUCD –Oral Pills –Condoms –SDM/LAM Action plan to be determined

18. Track 1 18 Thanks