Quarterly Progress Report for EUHP

July- September, 2009

Submitted to

EMG- MCH-STAR
4-9, Upper Ground Floor, Mohta Building 4, Bhikaji Cama Place, New Delhi- 110 066

Urban Health Resource Center B-7/122A Safdarjung Enclave New Delhi-29

ABBREVIATIONS
ACMO ANM APO BGMS BMC BNS CARE CBO CCT CECOEDECON CLV CMHO CMO CVD CV DGM-MCH-SPMU DIO DPM DS-UH DTHC DUDA EFC EOI FIRE-D Additional Chief Medical Officer Auxiliary Nurse Midwife Assistant Project Officer Bharatiya Grameen Mahila Sangh Bhubaneshwar Municipal Corporation Bal Niketan Sangh Cooperative for Assistance and Relief Everywhere, Inc. Community Based Organisations Cluster Coordination Team Centre for Community Economics Consultants Society Community Link Volunteer Chief Medical Health Officer Chief Medical Officer Cardiovascular Disease Community Volunteer Deputy General Manager-Maternal and Child Health- State Project Management Unit District Immunisation Officer Dstrict Program Manager Deputy Secretary D type heath Centre District Urban Development Authority Empowered Finance Committee Expression of Interest Financial Institutions Reform and Expansion Debt

GM-MCH-SPMU GOI HR ICDS IDSSS IFA IMC JHU JS-UH JSY LHV LMO MAS MCH MDG MNRCH MoHFW MOIC M& E MP NGO NIRPHAD NREGA NUHM NUSP OD ORS

General Manager- Maternal and Child Health-State Project Management Unit Government of India Human Resource Integrated Child Development Services Indore Diocese Social Service Society Iron Folic Acid Indore Municipal Corporation John Hopkins University Joint Secretary- Urban Health Janani Suraksha Yojana Lady Health Volunteer Lady Medical Officer Mahila Arogya Samiti Maternal and Child Health Millennium Development Goals Maternal, Neonatal, Reproductive and Child Health Ministry of Health and Family Welfare Medical Officer In-charge Monitoring and Evaluation Madhya Pradesh Non Government Organization Naujhil Integrated Rural Project for Health and Development National Rural Employment Guarentee Act National Urban Health Mission National Urban Sanitation Program Operations Director Oral Rehydration Solution

PMU PO-DUDA PPP UPHC RCH RFA RFP RMNCH RPC SOW SPMU SUHC TOR UH UHC UHRC UMMU UNICEF UP USA USAID USHA VAT WHO

Program Management Unit Project Officer- District Urban Development Authority Public- Private Partnership Urban Primary Health Center Reproductive and Child Health Request for Application Request for Proposal Reproductive, Maternal, Neonatal and Child Health Regional Program Cordinator Scope of Work State Project Management Unit State Urban Health Consultant Terms of Reference Urban Health Urban Health Centre Urban Health Resource Centre Urban Mobile Medical Unit Uniter Nation Children's Fund Uttar Pradesh United States of America United States Agency for International Development Urban Social Health Activist Value Added Tax World Health Organization

Table of Contents
Background

I. II. III.

Summary of Quarterly Progress Human Resource Management Activities & Sub Activities Progress in the Last QuarterResults Achieved in the Last Quarter

Component 1: Technical Support to NUHM

1.1. Technical Assistance for effective roll out of National Urban Health Mission 1.1.1 Support to the National Urban Health Mission 1.1.2 Technical Assistance to State level Urban Health Programming a) Technical Assistance to Government of Uttar Pradesh b) Technical Assistance to Government of Jharkhand c) Technical Assistance to Government of Madhya Pradesh: d) Technical Assistance to Government of Delhi e) Technical Assistance to Government of Rajasthan 1.2. Strengthen NUHM through program learning

a) Indore Capacity building of community organizations and health workers Monthly Outreach Health Camps in partnership with Govt of MP Technical support to Indore city UH Program Ward Coordination Committee Study Tours / Visit to Indore Program b) Agra Coordination with the government Capacity Building sessions Study Tours / Visit to Agra Program 1.3 Increase capacity and resources in India to support NUHM and programmes to improve the health of the Urban Poor. 1.4. Management and Strategic Dissemination of Urban Health knowledge

a) Website b) Data analysis, preparation and dissemination of urban health information through research reports, working papers and articles c) Advocacy Events / Consultations / Related Activities to promote policy and program development d) Participation in Symposium/ Conference/ Seminars/ Workshop/ Summit e) UHRC in Media

Component 2: Improve Basic Water, Sanitation and Hygiene Services for the Urban Poor Situation Analysis of Bhubaneswar City Component 3: Support for Organizational and Institutional Strengthening of UHRC
3.1. Collaborations

3.2. Resource Mobilization Efforts 3.3. Institutional Strengthening 3.4 Finance 3.4.1 3.4.2 3.4.3 3.4.4 Reporting Audit/ Review Sub-grants Management Close Out of EUHP

3.5. Governance, Management, Review 3.5.1. Board Meeting 3.5.2. Core Team Meetings 3.5.3. Staff Meetings IV. V. VI. Partnerships Establishment and Coordination Government (National and State Level): Challenges Encountered Closure Related Activities

MCH-STAR Initiative Quarterly Progress Report for Project [July- September 2009]

Instructions: All instructions are provided in italics. The goal of this report is to identify the progress on activities; deliverables met; and challenges faced during this quarter for your specific project. Please note that in if you are partnering with another SSI for this project a single report can be prepared jointly but copies should be submitted by both institutions.

Project Title: Project Partners (if applicable): Task Order Number: Report Prepared By:

Expanded Urban Health Programme

Background UHRC was institutionalized in 2005, and has since grown from a USAID funded project initiated in 2002, into an independent organization pursuing its mission of bringing about sustainable improvement in the health conditions of the urban poor by influencing policies and programs and empowering the community. UHRC endeavors to strengthen government policies and programs impacting the urban poor by engaging in operations research, evidence-based advocacy, and provision of technical assistance to central and state-level governments. City demonstration programs have been developed in Indore and Agra to provide evidence-based consultative program planning. UHRC has developed a demandsupply linkage approach and a ward-level inter-sectoral coordination approach in Indore, Madhya Pradesh. In Agra, UHRC is supporting the Government of Uttar Pradesh to operationalize a Public-Private Partnership initiative to expand maternal and child health and referral services to un-served slum communities in the city. As a technical resource to the GOI, UHRC has contributed to focused policy attention on urban health and strengthened urban health programming. UHRC has been designated as nodal agency by the MoHFW, GOI for urban health. UHRC is currently helping the MoHFW prepare the framework of the proposed NUHM. It is also involved in technical assistance at the state and city level in seven states, capacity building of policy makers, programmers and practitioners on urban health issues. Building on its technical expertise and growing evidence base from demonstration programs, UHRC has contributed significantly to bridging the knowledge and information gaps relating to health of the urban poor. Attention to urban health has been enhanced among government, donor agencies, Indian foundations and civil society organizations through media articles, scientific publications, nationallevel workshops and sharing experiences in other national and international forums. These efforts have been able to garner greater policy support for and

focus on urban health at the national and state level. International and national donors have also begun according greater commitment to urban health. VII. Summary of Quarterly Progress Please provide a one paragraph summary of the major achievements during this quarter in this project.

This quarter witnessed an array of activities on diverse fronts. The highlights are summarized below:
Operations Director, HR Officer and Administrative and Procurement Officer Joined in the month of August 2009. Efforts are continued to build partnerships with government. City level demonstration activities in Indore and Agra were continued. Capacity Building programs for CBOs and USHA Volunteers were conducted during this quarter.

Progress continued on the organizational development process. Most of the compliance requirements were met. Closure of EMG MCH STAR Grant was announced and close out related activities were initiated.

VIII. Human Resource Management Please provide the details on any new persons hired, retired, resigned or reassigned for this project. Please be certain to highlight details of key project personnel positions. Operations Director, HR Officer and Administrative and Procurement Officer Joined in the month of August 2009 as per project requirement and guidance of MCH-STAR. Accountant and the Urban Health Partnership Officer, Agra resigned owing to delays in payment of salaries and uncertain situation. Salaries and fees to staff/consultants have not been settled since July 2009.

IX. Activities & Sub Activities Progress in the Last Quarter A. Please explain in depth the progress of each of the activities that you have undertaken for this project over the last quarter. Please use your final Detailed Implementation Plan (DIP) for the specific activities and sub activities. Details on activities and sub activities have been provided in the narrative below. Component 1: Technical Support to NUHM 1.2. Technical Assistance for effective roll out of National Urban Health Mission

1.1.3 Support to the National Urban Health Mission Technical assistance was provided for preparation of presentation, preparing response to questions of Planning Commission to MoHFW for the meeting with

Planning Commission regarding NUHM held on July 23, 2009.. Data & information support was also provided. Facilitating and organizing review visit of Joint Secretary, MoHFW to Agra: As part of the consultation exercise with city health officials and the inhabitants of slums, for better informing the proposed National Urban Health Mission, the Joint Secretary, MoHFW, GOI Shri. Amit Mohan Prasad along with members of Urban Health Resource Centre visited Agra on August 1 st, 2009. Mr Prasad reviewed Urban Health program and planning of Agra with Chief Medical Officer of Agra and other officials. He walked through slums, undertook group discussions with members of Mahila Arogya Samiti, interacted with slum-level health volunteers (USHAs) and visited NGO managed Urban Health Centre. Support to MoHFW, GOI in connection with meeting on IPHS: A meeting of the IPSH sub-committee for standards on urban healthcare was held on September 17, 2009, under the chairmanship of Dr. Shiv Lal, Special DG (Public Health), Directorate General Health Services, MOHFW and convened by Sh. Amit Mohan Prasad, Jt Secretary, MoHFW. The outcome of the meeting were (a) service package at UHC reviewed and finalized (b) service package at Outreach sessions discussed, revised and finalized and (c) recommendations regarding constitution of Working Groups/ Sub-committees for follow-up consultations on specific sub-themes. Technical support was also provided prior to the meeting for finalising outputs of the previous meeting (of June 23, 2009).

1.1.2. Technical Assistance to State level Urban Health Programming f) Technical Assistance to Government of Uttar Pradesh A visit was made to Jhansi for verification of GIS map. A Proposal was developed with Remote Sensing Center, Lucknow for undertaking GIS mapping of 2 cities i.e. Agra and Aligarh. Technical and information support was provided for correction of GIS maps of Bareilly and Saharanpur. Documents for baseline survey and health facility assessment were developed and shared with the government Support was provided to the department in compiling MPRs for all 71 districts of the State, reviewing the progress of Lucknow RCH program and in proposals for releasing funds to NRHM. Coordinated and facilitated the meetings of Dr. Sanjay Pandey with Government officials and other stakeholders and follow up tasks assigned. An excel based monthly reporting format was developed for urban health posts funded by NRHM.

g) Technical Assistance to Government of Jharkhand Meetings were conducted with the Civil Surgeon East Singhbhum, Jamshedpur NAC, Jugsalai NAC, Adityapur NAC, ICDS officials, Industry partners in the district / city to gather information for the preparation of the micro plans for Jamshedpur UH interventions. The effort is in process. Handing Over / Project Closure- Key officers in the departments (Health, Urban Development) and the development partners have been informed about the closure of the project by September end. Regards the work commitment as next steps that have been made by the UHRC - state facilitator the officials were informed that they would be

completed / attended on personal level irrespective of the date of the closure of the project. Some of the priority tasks that need to be worked up are: o o o o Preparation of the UH details / micro plan for Jamshedpur. Facilitation of the UH micro plan preparation for the identified 07 cities. Monitoring Plan of the UMMU (Urban Mobile Medical Units) Route Chart of the Urban Mobile Medical Unit was prepared to expand the outreach service in Ranchi Urban Agglomeration. 20 service delivery points have been identified where the mobile medical unit would be serving and these points were identified in close consultation with Mayor, administrator and elected ward commissioner of Ranchi Municipal Corporation.

All reports, documents, fact sheets, contact points, maps and institutional history have been handed over to the Project Director EUHP, MCH Star during his visit to Ranchi.

h) Technical Assistance to Government of Madhya Pradesh: State level planning and review meeting on urban health program at the State Directorate of Public Health and Family Welfare, Bhopal on September 1, 2009. Matters discussed during the review meeting included: a) progress of urban health program in the eight cities; b) utilization of funds till date and stress on expediting program activities; c) input on process of mapping of slums and facilities in eight cities was provided. A visit to Ratlam was undertaken by two Muskaan staff to provide technical support to the District Health Dept, Ratlam on a) mapping of slums and health facilities in the city; b) initiating new UHC through Public Private Partnership in un-reached areas of the city. Meeting was held with JD NRHM, State Directorate of Public Health and Family Welfare on July 27, to discuss update of urban health programs and technical support provided by Muskaan. Meetings with the State Urban Health Consultant, Mr. Rambeer Sikarwar, were held at the State DoHFW for the urban health program in different cities. Issues discussed in these meetings included honorarium to link workers, difficulties being encountered by PPP managed UHCs, digitizing the maps of all the cities and the need for periodic review of program progress in the cities. Technical support was provided to District Health Department, Jabalpur by designing and facilitating a two-day training of USHA volunteers (link volunteers) deployed by the Department in slums. This training session was conducted on July 16-17 by Muskaan in Jabalpur. Review meeting of Urban Health Program in Bhopal was held at office of the District Health Department on 4th September to discuss progress on various program components: PPP managed UHCs, inter-sectoral coordination through meetings at UHC (Dispensary) level. UHC level coordination meetings were facilitated in 3 UHC areas (Kotra Area Dispensary, Sevaniya Gond Dispensary, Panchseeel Nagar Dispensary) in July and two each in August and September.

A cluster level inter-sectoral coordination meeting involving CBO members, ICDS and Health Dept. workers of 6 slums was held in Navgraha basti to facilitate strengthened coordination at implementation level. Such coordination efforts have helped in regularizing immunization day in slums in coordination with AWCs and health Dept. workers. Capacity building of basti-level health groups and input during monthly meetings of the groups was provided to encourage them towards availing of health services during outreach sessions, at UHCs and hospitals and also avail of Government schemes such as the Janani Suraksha Yojana. A study tour of CBO members to Indore was conducted in September to provide first hand exposure and understanding of activities of stronger CBOs and record keeping. Technical support was provided by Muskaan to the District Health Department, Bhopal through periodic visits and review of program of the PPP managed UHCs. Input was provided on training of link volunteers, record keeping and undertaking other program activities.

i)

Technical Assistance to Government of Delhi A meeting with Dr. Dharmendra Deewan, MCH Officer, Delhi State Health Society was held on July 15th, 2009 regarding UHRCs Maternal and Child Health initiatives in North East district of Delhi in partnership with Government of Delhi. Some of the areas in which enhanced support is required from the State or district health society such as requirement of additional ANMs and outreach coverage in areas which are not being covered at the moment were discussed with him. Dr. Deewan assured of all possible support and to take this up with concerned officials. The Delhi State Health Society is in the process of contracting out a number of health facilities to Non-profit organizations. Dr.M.K.Agarwal, State Program Officer, requested UHRC to provide technical support to help it take forward the process. Along with other support, some of the relevant documents such as sample copies of request for expression of interest, case studies of PPP in health facility management and sample TOR for partner NGOs for management of facility were provided to Dr. Agarwal to help the process. Two meetings were held with Dr. Gurpreet Singh, CMO- Planning, Municipal Corporation of Delhi with regard to his request for information support for planning health initiatives. He was provided with the map of Both Shahdra and Narela Zones as well as the vulnerability assessment indicators.

j)

Technical Assistance to Government of Rajasthan Mr. Neeraj Mishra has joined as the state Urban Health consultant for Rajasthan. No specific activities were carried out in this quarter

1.2.

Strengthen NUHM through program learning

The following activities took place under the City demonstration and learning programmes in Indore and Agra: c) Indore Capacity building of community organizations and health workers A Two day training program on routine immunization was organised for partner NGO partners, CC Team members, ANMs and Health workers from Indore & Ujjain on 1st and 2nd July. This training was facilitated by Dr. Karan Sagar, Country Representative and Dr. Manish Jain, State Representative (UP) from IMMUNIZATION/basics. They visited program field sites to get an insight into the activities and identify gaps and solutions. They discussed about the current reporting and monitoring mechanism of the program and provided required recommendations and tools. Two days workshop was organized on 2nd and 3rd Sep, to document Lesson learnt from Indore Urban Health Program and developing graduation strategy. Two members from each CC Team and Staff of Partner NGOs attended this workshop. The Lesson learned section on 2 nd September was facilitated by Birgitt and Dr. Sanjay Pandey. On 3 rd September, Dr. Sanjay Pandey and UHRC team facilitated the process of developing a graduation strategy, which has been documented. A three day training program was organized for 30 CC Team members from 15th to 17th Sep 09. The objective of this training was to develop a comprehensive understanding of Vision- Mission and formulation of a draft Vision Mission Statement for respective CC teams, which are registered as an NGO. The training also captured issues related to Strategic planning and some aspects of proposal development including budgeting. This training was facilitated by Mr. Satya Prakash Arya, Consultant, and UHRC team. Three days study tour to Panchmari was organized for all the NGO staff and CC Team members. The original plan was to visit Mumbai to understand functioning of Health systems at Governmental and NGO level. However, it was not possible in the present circumstances. Hence all partner NGOs and UHRC team decided to organize study tour to Panchmari. The objective of the study tour was to discuss the draft graduation strategy, finalization of contents of job aid and discussion on proposal writing for CC teams. The Study tour was able to accomplish all of its stated objectives. One day session of interaction between CC Team members and Governing board members was organized by IDSSS on 21st July 2009. 3 Governing board members participated in this session. Study tour was organized for 35 CBOs of IDSSS .They visited Shiv Nagar slum for cross learning. They also visited MY hospital, Collectorate and GPO dispensary. Similar visits were organized by CECOEDECON for 12 CBOs members from each CC Team area. They visited Ahirkhedi, Banganga, Mahadev Nagar and Rushtam K Bagicha for cross learning from other CBOs. After this all of them visited Sanyogita Ganj Dispensary. Exposure visit for CBO members of BNS was organized on 1 st Sep to MY Hospital, Vridavan Dispensary, MTH Hospital and Collectorate. A 3 days training for CC team members was held at IDSSS on 29 th, 30th July and 1st August 2009. The topics covered were finance management like to cover issues of basic accounting like cash book maintenance, ledger file, balance sheet, voucher file, Income and expenditure, proposal writing, and the

linkage with government. All the CC team members participated in this training program. One day capacity building refresher program was organized on immunization for two clusters of CBO members. Total 119 CBO members participated in these trainings.

Monthly Outreach Health Camps in partnership with Govt of MP Monthly outreach health camps are held to leverage additional government resources on urban health.17 health camps were held in this quarter too, in partnership with and partial financial support of District Health and Family Welfare Department, Indore, Govt of Madhya Pradesh. These camps are monitored by District Health Society. Five partner NGOs, CC Teams, slum CBOs as well as ICDS and Indore Municipal Corporation (IMC) officials conducted extensive community mobilization to maximize community participation in these camps. Outreach MCH Clinics dated 5th July, 2009 Area of coverage Beneficiaries

2nd 2009

Aug,

6 slum clusters covering sixty slums (Khajrana Area, Dheeraj Nagar, Jagannath Nagar, Pawanpuri, Mahadev Nagar, Musakhedi)

2128 persons including 857 children (0 to 12 yrs), 358 pregnant women (ANC) and others received services. 1865 persons including 929 children (0 to 12 yrs) and 258 pregnant women (ANC) and others received services. 2351 persons including 984 children (0 to 12 yrs) and 268 pregnant women (ANC) and others received services.

6th 2009

Sep,

Technical support to Indore city UH Program Supported Department of Health, Indore, in making a presentation of the activities conducted in the present financial year during the State Level Review Meeting on 1st September at Bhopal. UHRC team also shared its experience of Ward level convergence activities and its effectiveness. Review meeting with State Health Consultant, Mr. Ramvir Singh, DPM and other Department officials done in the month of 17 th-18th Sept which UHRC made presentation on the progress made under the Indore Urban Health Program and supported the consultant in Review of the Ujjain Program.

Ward Coordination Committee A total of 10 Ward Coordination Committee meetings were organized in various wards in Zonal Office and chaired by the Ward Councillor. The participants in the

meeting were officials from IMC, Officials from Narmada water Project, DUDA, ANM, NGO representatives and UHRC staff. Study Tours / Visit to Indore Program Dr. Sanjay Pandey, Rajneesh and Sameer from EMG visited Indore Urban Health Program for program and financial review of Partners on 14 th and 15 July09. Dr. Sanjay Pandey from EMG, Madhuri Narayan and Nate from Intra Health visited IUHP on 12th and 13th Aug09 to interact with CBOs and NGO Partners. Others IDSSS celebrated Safe motherhood day on 7 th July 2009 at Solanki nagar with 100 women including pregnant and lactating mothers. They took active part in the programme. Dr. Hemant Kansal was the resource person on the occasion. Other Competitions held during the quarter areo 53 healthy baby competitions were organized by all the NGO partners in their slums. Total participants in these competitions were 860. o 65 healthy pregnant women competitions were organized by all the NGO partners in their slums and total participants in these competitions were 818. o 40 nutrition competitions were organized and 580 participants were present in these competitions. o 6 Health fair were organized in Bapu Gandhi Nagar, Mayapuri, Kabitkhedi ,Lodhipura, Malviya nagar and Khajrana. Nutrition competition and demonstration on the same by CCT members was the highlight of these events, which also had a poster exhibition, Video show and street play. Pregnant women were asked to bring nutritious food appropriate for the competition and results were drawn on the basis on ingredients, availability cost, and taste presentation of recipe. d) Agra

Coordination with the government A coordination meeting with PO - DUDA was conducted on 21 st of July 2009 in which discussions were made regarding ongoing programme area in different areas. Certain documents regarding the programme detail were also shared in the meeting. A coordination meeting was organized with CARE, UNICEF and WHO on 19 th of July 2009 in which monitoring aspect of Routine Immunization; Bal Swasthya Poshan Mah was discussed.

Capacity Building sessions Capacity building of community organizers on supportive supervision, reporting and MCH in NGO offices were conducted in this quarter. Training of 100 grass root level workers viz. CLVs were conducted on different topics of interpersonal skills, RCH, updating and record keeping in registers etc in the months of July, August and September 09 during monthly meetings. Special training of 44 CLVs of Trans Yamuna area was organized in UHRC office. These trainings were provided for motivation and guidance to the CLVs.

Sessions on Janani Suraksha Yojana, MAS fund, CLV register updation and care of new born child were taken by NGO staff and UHRC team. Besides all the above training, on job training of all staff ( NGOs) and CLVs were done by UHRC team Agra during field visits and review. Supportive supervision and handholding with workers of the field was carried out. During this quarter, three capacity building sessions were conducted as against three planned. In-house capacity building session for CLVs was conducted after assessing the need. Emphasis was given to build up the capacity on the followingso Role of CLVs in case of strengthening the capacities of MAS. o New Born Care. o Immunization. o Nutrition and child health. o Family Planning. o Maintaining of slum based register.

Visits/Study Tours Visit of Joint Secretary, MOHFW, New DelhiJoint Secretary Ministry of Health and Family Welfare Sh. Amit Mohan Prasad visited UHRCs project area along with CMO Agra to observe an outreach camp which was organized at Azampada. In the camp he interacted with services providers (like CLV, PC, CO and LMO) and the beneficiaries and tried to understand the role of community mobilization specially Link Volunteers/USHA keeping in view of upcoming NUHM programme which has to be launched by Govt. of India. Dr. Gita Pillai , FHI visit. Dr. Gita Pillai from Family Health International visited Transyamuna area. She observed MAS meeting in Hanuman Nagar and also visited UHC Transyamuna. Exposure Visit of Embry HowelIn the month of August 09 an exposure visit of Embray Howell from the Urban Institute, Washington was conducted in Transyamuna area. Her visit was with the purpose of documenting lessons from UHRC since inception in 2005 as part of the USAID Washington planned exchange program between APHRC, Kenya and UHRC. She visited Indra Nagar and Naraich slums of Agra and observed meeting of Mahila Arogya Samiti and Outreach Camp.

Other Activities: On 5th of July 2009 an annual day function of the federation was organized in Telipada area of Shaganj to accolade the federations one year of success. In

the annual day function a cultural programme was organized by the children of the communities. In this quarter distribution of deworming tablet to the children from age two and a half year to 12 years was continued in both the areas through our CLVs, ANMs, CO under the guidance of UHCs in Shankarpuri and Trans Yamuna area. Promotional activities for behavior change regarding health were also organized in identified critical slums. One baby show, one mother show, 5 health awareness camps and 2 health rally were organized by the NGO staff.

1.3 Increase capacity and resources in India to support NUHM and programmes to improve the health of the Urban Poor. Urban health related books and journals were provided to Urban Health Division of MoHFW.

1.4. Management and Strategic Dissemination of Urban Health knowledge a) Website UHRC website received 123427 hits and 8047 visitors in this quarter. The library catalogue was updated.

b)

Data analysis, preparation and dissemination of urban health information through research reports, working papers and articles MP wall chart has been completed and is ready for printing. Draft wall chart of Delhi has been prepared. State of Urban Health reports for Bihar and Jharkhand have been prepared and ready for submission. Two Working papers have been prepared on o Child Under nutrition among urban poor in MP: Status, Efforts and Way Forward Maternal and Child Health in Uttar Pradesh

The scientific article titled Social Determinants of Childrens Health in Urban Areas in India was resubmitted after incorporating revisions suggested by reviewers. The revised paper has been accepted for publication in the Journal of Healthcare for the Poor and Underserved. A few abstracts have been 2009. accepted for oral/poster presentation at ICUH

e)

Advocacy Events / Consultations / Related Activities to promote policy and program development Two interviews of UHRC Colleagues on Health Conditions and available Services for the Urban Poor and Importance of Water and Hygiene for Healthy life were broadcasted by Community Radio of One World South Asia through All India Radio. Participation Summit in Symposium/ Conference/ Seminars/ Workshop/

f)

A presentation entitled From Vision to Action Towards Better Health Service Planning; Difficulties & Prospects, was made in the National Consultation on Geographic Information System (GIS) Mapping of Health Facilities and Services in India organised by MoHFW, GoI in collaboration with WHO & IIHMR, on 31.08.2009 & 01.09.2009 at India Habitat Centre, New Delhi. UHRC colleagues participated in the Urban Health Report dissemination workshop organized by USAID and IIPS on September 11, 2009. UHRC in Media An article titled Off the Map, highlighting the marginalization of urban poor migrants, was published in the Indian Express, New Delhi, on July 30, 2009.

g)

Component 2: Improve Basic Water, Sanitation and Hygiene Services for the Urban Poor Desktop review and secondary data collection have conducted to access all available and required data from Bhubaneswar Municipal Corporation, Government of Orissa websites, Public Health Engineering Organization, Census reports, DLHS reports and NFHS data. Individual meetings and consultations with representatives of public sector departments and NGOs were conducted to get an idea of the situation from the concerned stakeholders. Slum list obtained from Bhubaneswar Municipal Corporation. Slum visits have been made in various locations and city map have been collected to complete the situation analysis Situation analysis of Bhubaneswar city was conducted and the draft situation analysis report has been prepared. Various stakeholders were contacted in order to obtain a comprehensive picture of the Bhubaneswar city.

Component 3: Support for Organizational and Institutional Strengthening of UHRC 3.1. Collaborations No new collaborations were made during the period. 3.2. Resource Mobilization Efforts Efforts were made for generating contributions from small entrepreneurs, business houses and individuals.

3.3. Institutional Strengthening Three key positions were filled. Mr. Arun Talwar, Operations Director, Mr. Surendra Singh, HR Officer and Mr. Johney Reberio, Admin & Procurement Officer joined on 3rd of August 2009 as part of compliance under EUHP project. The authority levels in Tally software were defined in consultation with the EMG officials, as part of compliance under EUHP project. Closure Meeting: A closure meeting attended by UHRC staff, EMG/MCH-STAR officials and Intrahealth Officials with the external consultants (Dalar Consultants) appointed by EMG/MCH-STAR was held on 10 th September at Hotel Vasant Continental, New Delhi. Discussions were held on various actions, achievements, Challenges and lesson learned during the project period. Due to non-payment of salary in time and owing to disruption in funding from time to time, the employees morale went down wiping out some of the benefits of earlier capacity building exercise. Despite the support of EMG/MCH-STAR, UHRC was not able to succeed in winning the RFA issued by USAID for Health of Urban Poor project. This was a big setback for UHRC as well as for MCH-STAR. The project has been awarded to PFI and Dr. Sanjay Pandey who is currently Project Director of EUHP from MCH-STAR is Chief of Party with PFI for the project.

3.5 Finance 3.5.1 Reporting Statutory Reporting to regulatory bodies done in timely manner. Monthly Financial Reports for July and August 2009 submitted to EMG. Quarterly Financial Report for April-June 2009 was submitted in July.

3.4.2 Audit/ Review Statutory Audit for Financial Year ended on 31st March 2009 completed. Review of invoices/vouchers by BHS and Company, EMG-MCH Star appointed auditor and EUHP Project Director completed for June, July and August 2009 as desired by MCH-STAR for release of early payment. Details of payable to sub-grantee up till 30th September 2009 submitted to EMG MCH-STAR. The payment to vendors and staff and statutory payments were delayed due to non-availability of funds with UHRC under the grant.

3.4.3 Sub-grants Management Financial review and Capacity Building Training program for the NGO partners, which was due in the quarter, could not be done owing to scarcity of funds.

3.4.4 Close Out of EUHP Letter for Close-out of EUHP being sent to NGO Partners.

EUHP Staff/consultants serviced notice for termination of services in view of the closure of the project. Service providers are being given notice for termination of services/contracts wherever applicable. In view of the close-out of EUHP and future funds flow of UHRC a termination notice of the current lease deed of UHRCs Delhi office and Agra Office has been served.

3.5. Governance, Management, Review 3.5.1. Board Meeting Dr. H.P.S Sachdev resigned as the Chairman of the Board. A Board meeting was held on August 22, 2009. In the meeting, Dr. Siddharth Agarwal resigned as member of the board. Also, Board members, Prof. Amitabh Kundu and Mr. Amitabh Behar had a meeting with the staff members after the board meeting. In separate discussions, board members discussed about restructuring/strengthening of the board as per grant requirements. However closure of grant resulted in dislocation of efforts temporarily.

3.5.2. Core Team Meetings A core team meeting was held on 3 rd July, 2009 with the agenda to discuss the important issues of common cost allocation, cheque signatory, closure of city office bank account, reporting line for TA team, . A core team meeting was held on August 27th wherein it was decided that in view of the closure of the EMG grant, a notice to all staff and consultants working on the project be issued in light of the terms of the employment contract. In the same meeting, it was also decided that a lower cost office premises may also be identified. Another meeting was held on 17th September, 2009 to discuss the work plan for close-out phase in October.

3.5.3. Staff Meetings A staff meeting was held on 16th July to share team updates and future plans, to share the overview of the RFA submitted, and to discuss the issues relating to the delay in release of salary. Another staff meeting was held on 17 th August with the agenda to discuss critical issues like interruption in fund flow, uncertainties after 30 th September, sustainability of organization, optimizing costs and generating revenue, extension of Current Grants and compliance with current Grant requirements. A board and staff meeting was held on 22 nd August, 2009 to discuss the issues related to compliance and progress thereon. Another staff meeting was held on 28th August, 2009 to inform all staff members regarding the issuing of termination letters.

X. Results Achieved in the Last Quarter Please fill in a table with your expected deliverables/results during the quarter and achievement towards deliverables/ results. Please attach all evidence of results/ deliverables in an annex of your report. Expected Deliverable/Result Target Status/Achievement this quarter

Start up and Implementation UHRC to provide QPR quarter ending June,09 for the Quarterly progress reports submitted to MCH-STAR within 13 days of end of quarter QPR submitted

UHRC to submit final report with deliverables and results to MCHSTAR

Final report submitted within 13 days of end of fiscal year

Final Report with deliverables submitted.

Component 1: Technical Support for Effective Implementation of the National Urban Health Mission (NUHM)/Urban Health Component of NRHM or RCH II Sub-component 1.1: Technical Assistance for effective implementation of NUHM/Urban component of GOIs health program/other UH programs at National, State and City levels Assistance in recruitment & financial Two consultants support to at least 2 consultants to contracted and working work in the UH Division, MOHFW with UH Division Assist the UH Division in reviewing city plans during review visits Trip Reports It has been taken over by EMG-MCH Star JS, Ministry and Health and Family Welfare reviewed the Agra Program. . Partnership has been discontinued.

Identify and enhance capacity of Quarterly review partnered NGO in JMC and conduct conducted including field periodic reviews to assess progress review in coordination with MCD and GNCTD to improve reach of services, and improve planning and implementation of activities.

1.1.2. Technical support at the State and City Levels for atleast two states to prepare State and City Urban Health Plans Provide Financial support for urban One consultant each in health consultants in UP, Jharkhand, UP, Jharkhand, Maharashtra and Rajasthan to assist Rajasthan and in developing State urban health Consultants for UP, Jharkhand and Rajasthan in place.

plans

Maharashtra in place UH Plans for UP and Jharkhand submitted to GoI (This activity was completed in the last quarter itself)

Provide TA to State governments for UH Plan for 2 States the development of operational submitted to guidelines for the implementation of Government of India city level urban health PIPs in at least two states

1.1.3 Develop Monitoring & Evaluation plans for NUHM and city systems (subject to roll-out of NUHM) Draft baseline methodology and tools Methodology and instruments for city level NUHM baseline survey This activity could not be done.

Provide technical support to states for holding a meeting with city and state officials on how to implement the urban health M&E plans

Meetings held in 2 states on M&E

This activity could not be done.

Provide technical support to MOHFW for organizing and conducting of the first national urban health progress review workshop/meeting with state and city officials.

National Urban Health Program Review held

This activity could not be achieved since MOHFW is discussing the matter of NUHM with other GOI agencies such as the Planning Commission.

1.1.4. Capacity building activities for select state & city level govt.& non govt. stakeholders Organize, support and facilitate workshop in at least 2 states for capacity building of key stakeholders to enable them to do the situation analysis, organize consultations and develop the city level PIPs Facilitate and support at least 4 study tours of state and city health officers and select NGO managers to successful urban health programs in Agra, Indore or in states such as Maharashtra/Karnataka/Tamil Workshop conducted in two states with participation of state and city/ district health officials A State Urban Health Consultation was held in Jharkhand. Workshop in UP was planned in Jan but cancelled

Study tours conducted

Planned study completed in quarter.

tours last

Nadu/West Bengal.

Sub-component 1.2: Improve NUHM/urban RCH II through Program learning 8 grants to NGOs in Indore & Agra for demonstration and learning activities Technical and management oversight to grantees Build capacity of NGO grantees to host and conduct study tours at program learning sites in Indore and Agra 5 grant in Indore & 3 in Agra signed grant Task Orders Field visits and meetings with NGO partners Lessons learned demonstrated to study tour participants 5 grants in Indore and 2 in Agra (activity completed in the last quarter itself) Regular meetings with NGO partners are ongoing. Lessons learned were demonstrated to study tour participants.

Monitor and document lessons learned from NGO grantees Develop a graduation strategy for Indore sub-grantees aimed to facilitate continued urban health work in a sustainable manner

Indore and Agra lessons learned documented Graduation strategy

Indore and Agra lessons learned were documented Draft is ready

Design and plan an external evaluation of Indore sub-grantee urban health program

Design and plan for external evaluation

Completed

Conduct quarterly program review, including service delivery data, as part of M&E activities

Quarterly review conducted

Quarterly review was not conducted.

Conduct annual program review, document lessons, and develop Scopes of work and budget for next phase Document lessons learned on Stakeholder Coordination and Demand Generation Model from USAID supported work in Indore

Scopes of work and budget for next phase

This activity was not carried out since funding support was not available for the next phase. Lessons were documented and lessons from NGOs also compiled.

Lessons from Ward coordination cum demand generation model.

Document lessons learned on Stakeholder Coordination and Demand Generation Model from USAID supported work in Indore Document lessons learned from non-USAID supported activities in Pimpri Chinchwad Municipal Corporation in Maharashtra

Lessons from PPP initiatives in Agra documented

Lessons were documented.

Lessons from Pimpri Chinchwad Municipal Corporation documented

This activity could not be achieved.

Sub-component 1.3: Increase capacity and resources in India to provide support to NUHM and improve the health of the urban poor State-Level NGO grantee periodically mentored to improve technical support to GOMP UH literature provided to statelevel NGO to strengthen knowledge State level NGO grantee responding to requests for technical support Literature and documents handed over to NGO Quarterly Report of Muskaan attached. This activity was completed in the last quarter itself.

Sub-component 1.4: Ensure management and strategic dissemination of urban health knowledge Support the maintenance of UH library and Website at UHRC Prepare and disseminate the State of Urban Health Report Maharashtra UHRC website and UH library up-to-date State of Urban Health Report Maharashtra Catalogue updated. Report could not be finalized.

Secondary data analysis on urban health conducted and disseminated Produce and disseminate articles, fact sheets, wall charts, reports and publications State of UH Report of Jharkhand prepared and disseminated Publish and disseminate thematic report on Maternal Child Under nutrition among urban poor in India Increase availability of UH information and attention to UH through working papers

Data Analysis Data disseminated

Delhi wall chart attached. MP wall chart attached.

Report disseminated to stakeholders Report disseminated to stakeholders Working papers on UH themes produced and disseminated

Jharkhand report attached. Final Report attached.

Two working papers completed.

UH issues highlighted through articles in print/electronic media

6 articles to be published over the year.

Four articles were published and one sent for publication. Remaining one is being prepared. Delhi and MP wall chart attached. This activity could not be achieved.

Documentation and secondary data analysis conducted Develop strategic partnership and contract with two journals to increase availability of UH Knowledge/ information

2 wall chart ready Partnership with two journals developed

Sub-component 1.5: Convergence of NUHM with JNNURM or WCD Identify priority program learning issue for convergence of NUHM with JNNURM and ICDS Program learning issues on convergence documented This activity could not be achieved.

Develop a TA plan for supporting convergence with JNNURM at National, State and City levels Organize study tour and cross visits to understand convergence related initiatives Organize workshop at state/national level to address key factors related to convergence Identify priority program learning issues for convergence of NUHM with JNNURM and ICDS

Hard copy of plan

This activity could not be achieved. This activity could not be achieved. This activity could not be achieved. This activity could not be achieved.

Tour reports with letter from State Govt. officials Workshop Organized

Program issues on convergence documented

Component 2 Improve Basic Water, Sanitation and Hygiene Services for the Urban Poor Plan for demonstration and learning activity to address hygiene behaviors in select slums of Bhubaneswar Plan prepared Situation Analysis and Stakeholder Consultation was carried out during this quarter. Plan could not be prepared during this quarter.

Component 3 Program planning and Institution Strengthening of UHRC for implementation of the Expanded Urban Health Program Conduct a board retreat to develop a long term organizational vision and 5 year strategy for UHRC and Organizational vision and strategy approved Board reviewed and approved UHRCs vision

regular board meetings Involve UHRC Technical personnel in MCH-STAR capacity building, leadership, advocacy and other workshops and activities

by Board UHRC invited to CB activities

and strategic plan. This activity was completed in the previous quarter.

Close out Activities: Support close out activities of this one year phase of EUHP as per required procedures (Sept-Oct. 2009)

Close out completed

Close out activities are underway.

XI.

Partnerships Establishment and Coordination Government (National and State Level): Have you had meetings with governments or any other key stake holders for this project? How did the outcomes of these meetings contribute to the achievement of your deliverables? Technical assistance was provided for preparation of presentation, preparing response to questions of Planning Commission to MoHFW for the meeting with Planning Commission regarding NUHM held on July 23, 2009. As part of the consultation exercise with city health officials and the inhabitants of slums, for better informing the proposed National Urban Health Mission, the Joint Secretary, MoHFW, GOI Shri. Amit Mohan Prasad along with members of Urban Health Resource Centre visited Agra. A meeting of the IPHS sub-committee for standards on urban healthcare was held on September 17, 2009. The outcome of the meeting were (a) service package at UHC reviewed and finalized (b) service package at Outreach sessions discussed, revised and finalized and (c) recommendations regarding constitution of Working Groups/ Sub-committees for follow-up consultations on specific sub-themes. Technical support was also provided prior to the meeting for finalizing outputs of the previous meeting (of June 23, 2009). MCH-STAR: Have you participated in any collaboration meetings with MCH-STAR for this project? How did the outcomes of these meetings contribute to the achievement of your deliverables? Meeting with project Director, EUHP held on 9-7-09 to discuss feasibility of deliverables given the prevailing constraint in fund-flow. Monthly review meeting to discuss progress on the project was held on August 6. Meeting on August 30th where Project Director informed about the new modality of reimbursement based payment for the period June 1st onwards, on weekly basis after review of invoices/vouchers by Auditor and approval by PD. A meeting was held on 16th September 2009 with Dr. Sanjay Pandey, Dr. Sainath, Mr. Talwar, Dr. Sanjeev, Dr. Aradhana, Ms. Aastha, Ms. Deeksha to discuss the tasks required to be accomplished by UHRC as part of the close-out

process. During this meeting it was decided that the activities in the extension period must focus exclusively on close-out. There should be an internal mechanism for monitoring the progress of closure related activities on daily basis. Only those deliverables which can be completed should be targeted in the close-out phase. Also, a detailed work plan for the close-out period, along with budget should be submitted as early as possible to enable MCH-STAR to process the extension quickly. Another meeting on 8th September09 was held with Dr. Sanjay Pandey, Dr. Sainath Banerjee, Dr. Sanjeev Kumar and Dr. Aradhana Srivastava, in which Dr. Pandey shared the outline of the EUHP Final Report and requested the KM team to begin drafting the report. It was decided that the final report will be submitted to MCH-STAR after completion, for its branding.

Other Key Stakeholders (i.e. Other Donors, Partner NGOs, district level governance institutions such as Municipal Corporations etc.): Have you developed any partnership with any other organisations for this project? If so which ones and why? Partner NGOs:

UHRC works in partnership with NGOs in its demonstration programmes in Indore and Agra. Regular meetings and interactions with NGOs took place for assistance in programme implementation and to review progress. UHRC also supports one state-level NGO grantee is also assisted in providing technical support to GOMP.

District Health Departments:

The Indore and Agra urban health programs work in partnership with the district health departments of Indore and Agra respectively. Regular meetings and interactions were held with them. Technical assistance to the district health department, Meerut was also provided for development of urban health plan for the district.
XII. Challenges Encountered What challenges have you faced in meeting your deliverables for this project this quarter? How can you overcome those challenges? How can the MCH-STAR team help you overcome those challenges? If you are preparing a joint report, please list the challenges SSI specific challenges. EMG grants end date was 30th September 2009, though there have been indications for a month extension. Employees, consultants have been served termination letter, which has drastically affected their motivation and output. Close-out process of EMG MCH STAR has added to the pressure on already shrunken team of UHRC. Scarcity of funds due to non-release of grant in time resulted in disruption of UHRC activities. Sub-optimal fund-flow has also resulted in non-payment of salaries and consultancy fee since July 2009, payment to sub-grantee and to vendors. Motivation level of staff have been very low owing to these circumstances during this quarter. V. Leveraging of Funds

Please write in any other funds leveraged over the last quarter. Leveraged funds refer to all Non USAID funds raised by your organisation for the project/activity. S. No . 1 2 Key Deliverable Area/ Intervention Agency/ Source of funds Intra Health Mission Convergence/ SSS Sub-Grantees Amount of Funds in USD $34,000 $8,451

Improving the Health of Urban Poor District Resource Centre and Gender Resource Centre Indore and Agra Urban Health Program Activities

$ 4,226

XIII. Closure Related Activities Please highlight any major activities or deliverables planed for the next quarter for this project. Please include any specific assistance that you may require from the MCHSTAR team. UHRC received a letter from MCH STAR/EMG outlining the close-out related requirements on September 7th, 2009. Subsequently the steps for close-out were initiated.. There were several meetings that took place between the UHRC Point Person for EUHP, OD with the PD of EMG along with UHRC staff; especially with the point person of the programme. A plan related to the close out was also handed over to UHRC by Project Director EUHP. The specific requirements of close out were discussed. The closeout was focused at collecting following information /documents Following visits and other activities were made to facilitate the closeout activities at the states and the cities Visits were organized on 1st September to Agra and 2 &3rd September to Indore and the following close-out related activities were undertaken: o Staff discussions were held related to future of grant, closer related priorities and closer related deliverables. o Separate meetings were held with NGO partners in order to intimate them about the closure of EUHP. o Discussions were held to identify lessons learned from this programme. o Discussions were held on options available for way forward. o A full day graduation strategy meet was also organized in Indore.

A Visit was organized to Bhubaneswar on 12 th September in which discussions were held with the point person in order to review the SOW, discussions were held on deliverables (what has been achieved and what is left), and discussions were held to figure out the plan for the remaining activities in the close out period. A close-out budget for October and November was prepared and shared with MCH-STAR This was finally approved. SOW for Audit under A-133 circular was prepared and shared with MCH-STAR.

The finance team is working closely with the auditors (BHS and Company) appointed by MCH-STAR to finalize the amount due under the grant. So far expenses of Rs. 54,50,000(approximately) for June to August 2009 have been reviewed by BHS and Company and the Project Director-EUHP. An amount of Rs. 2,000,000/= received from EMG against the expenses reviewed for June to August 2009.