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Madhya Pradesh
V. Media Reports 26
The state is relatively sparsely populated with an average population density of 196 per square km as
against the country average of 274 per square kilometer. Population density in rural areas is about 116
per square kilometer; the corresponding figure in urban areas is 1939 per square kilometer.
Madhya Pradesh has made impressive advances in literacy in the last decade. The literacy rate increased
sharply from 44% in 1991 to 64% in 2001 against a national average of 65%. Nevertheless, MP’s literacy
rate is well below Kerala’s 90.9% and ranks 16th amongst 35 states and union territories. The female
literacy rate is only 50.3%, somewhat lower than the national average of 54.3%.
Population below poverty line (BPL) in MP including Chattisgarh has been estimated to be 43% (as per a
survey conducted in 1987-88) while the Planning Commission arrived at a figure of 42.5% in 1995.
However, the Madhya Pradesh Human Development Report, 1998 indicates a much lower figure of 31%
(vis-à-vis national average of 33.5%).This still means that about 18.8 million people are classified as poor
The Infant Mortality Rate for the Madhya Pradesh has been estimated by SRS at 70 in 2009. The
national IMR at the same time is 53. Madhya Pradesh falls amongst the lowest in IMR
compared with other states. Although, biologically, the girl child is stronger than the male child,
the female infant mortality rates were higher than male infant mortality rates.
% of mothers who received post partum care from a SBA 37.7% 80%
within 2 weeks of delivery
Hoshangabad
Geographical Area (in sq.km) 5408.23
Blocks 7
(2006) 27748
(2011) 26031
(2016) 26025
Males
(2006) 14894
(2011) 13398
(2016) 13729
Females
(2006) 12853
(2011) 12633
(2016) 12296
CEmONC 04
BEmONC 09
Blocks 5
(2006) 24460
(2011) 23244
(2016) 23017
Males
(2006) 13275
(2011) 12124
(2016) 12285
Females
(2006) 11185
(2011) 11120
(2016) 10732
CEmONC 02
BEmONC 09
Blocks 7
(2006) 34681
(2011) 34601
(2016) 34710
Males
(2006) 18537
(2011) 17759
(2016) 18202
Females
(2006) 16144
(2011) 16842
(2016) 16508
CEmONC 02
BEmONC 09
Blocks 10
(2006) 36515
(2011) 32922
(2016) 32644
Males
(2006) 19275
(2011) 16688
(2016) 16953
Females
(2006) 17241
(2011) 16234
(2016) 15691
CEmONC 03
BEmONC 15
The Norway-India Partnership Initiative provides technical cooperation which is co funded through
Government of Norway & Government of India the contribution of the Government of Norway is around
USD 80 million for 5 years (2006-2011). Even though this would form a relatively a modest supplement
to the budget for NRHM/RCH II, it would add a great value because of the way in which this resource is
proposed to be utilized.
The Partnership inputs would complement the national efforts and stimulate acceleration of NRHM
implementation for MDG 4 by providing flexible support to enable implementation and innovation, and
to resolve bottlenecks. In addition, the Partnership will provide access and feed-back to international
experiences and expertise.
The Partnership is being used to attain and sustain a rapid scaling-up of implementation to achieve
MDG-4. Efficiency comes with speed and maintaining the momentum of action is crucial for a mission
approach. Any delay in responding to the program needs with urgency, quality and flexibility has a price
in the form of lost opportunity to save lives. The additional support will provide a strategic and focused
complement to the national efforts.
The value addition to the national effort to reduce child mortality would be achieved by focusing the
partnership on four areas:
1. Strengthen a new government initiative, an independently managed enabling network, to
facilitate the delivery of MDG 4 related services.
2. Test and introduce new ways for scaling up quality services by primary health workers (ASHA
including their support needs and referral requirements (‘ASHA chain’).
3. Recruitment of private sector into the delivery of MDG 4 related services.
4. As the implementation of the NRHM-MDG 4 related activities unfold, there will be a continued
need to explore new opportunities as they arise. The partnership will operate on flexible basis
providing up front catalytic financial support, and facilitate engagement of international and
national expertise as deemed necessary.
Outcomes
• Sustaining routine immunization coverage rate in the country at 80% or more from 2007
onwards.
• Saving an additional half a million under-5 children each year from 2009 onwards.
By virtue of the innovative nature of this initiative and by demonstrating its successful
implementation, the Partnership would contribute to:
All activities undertaken under NIPI shall be directed towards fulfilling the goals and objectives of NRHM,
and in consonance with other program documents including RCH II program implementation plans (PIPs)
of the Centre and States, the Multi-year plan (MYP) for Universal Immunization Program and the State
Immunization PIPs. The Partnership recognizes the National Population Policy, Five Year Plan
Funds are placed with the state Health society for identified child health activities under the State
Action plan, within the state financial and audit rules framework. The objective is to leverage the
NRHM funds for child health by providing funds for catalytic activities.
Activities are identified by the SHS and reflected as part of the district/state plans.
Implemented in selected districts in each state to demonstrate innovations. Flexible to expand state
wide or as required by the state.
States will take up all successful experiments in a cycle of about 18-24 months.
The funds are channeled through an agreement between United Nations Office for Project Services
(UNOPS) through NIPI Secretariat and State health Society.
The Secretary, Heath and Family Welfare of the respective States, as the chair person of the State
Coordination Committee finalizes /modifies the state action plan as per the requirement of the
state, through bottom up planning.
At the state level, activities under NIPI will be implemented by the State Health & Family Welfare
Society, chaired by Secretary, Health & Family Welfare, of respective state government.
Program Management Group (PMG) is a forum for dialogue to form a platform for coordination
between NIPI, NRHM leadership and other stakeholders, and for integration of activities with the NRHM
operational framework. Under the chairmanship of Mission Director, NRHM, MoHFW, the PMG
discusses key technical issues, reviews progress, makes proposals and recommendations to the JSC for
decision making.
A Secretariat under the leadership of Director is established to execute decisions made by the JSC and
function as a secretariat to the JSC and PMG.
In addition to the above, an International Strategy Group (ISG) has been established. The ISG
will advise NIPI, its Secretariat, and Agencies on global best practices towards reaching the
MDG4. At the same time the ISG will help disseminate lessons of the NIPI and the NRHM to the
international community.
YASHODA
Safe motherhood program, Janani Suraksha
Yojana (JSY) in India under its NRHM has
increased institutional delivery from 10.85
million in 2005-06 (NRHM was operationalized in
2005) to 13.59 million in 2007-08. The scheme
focused on expectant mothers belonging to the
poor and disadvantaged families in high-
mortality, low-infrastructure and low-performing
States
This sudden influx of beneficiaries in the public health institutions is a definite opportunity in the history
of public health in India; but also it has emerged as a challenge to provide quality health service. The
public health facilities are challenged with lack of infrastructure, manpower and other facilities to
coordinate and ensure quality service delivery.
First 24 – 48 hrs after delivery is the most crucial phase for the newborn
baby and mother. During this period, Yashoda will support mother for
immediate and exclusive breast feeding; orient the mother about basic
newborn care and immunization and assist the nurse in various post natal
care activities for making the newborn and the mother comfortable.
Apart from helping the mother to de-stress, Yashoda will use this time to
counsel the mother on family planning options and fertility choices. She
will counsel the mother and her family on the various steps in newborn
care after leaving the facility including, nutrition for mother and the new
born, feeding practices, complementary feeding, immunization including
service delivery points, days, use of referral and other relevant
information.
The below graphs display the analysis based on the Yashoda Monthly Report versus HMIS Report of a
neighboring district Harda
NIPI support is given through State Health Society in establishing Sick Newborn Care Units (SNCUs) level
-II at the district hospitals, which caters to a population of roughly 1,000,000 people. The establishment
of these units is guided by the Institute of Post graduate Education and Research (IPGMR) West Bengal,
a pioneer in the establishment of cost effective user-friendly SNCUs in Purulia, known as the Purulia
Model.
Based on the Purulia model, under NIPI state plan, a cost effective
model of SNCU level II units in district and level I /stabilization units at
block hospitals with large number of deliveries are initiated in four
states. NIPI will engage technical agency to facilitate the establishment
and operationalization of the SNCUs. This will initially be in three focus
districts. NIPI will leverage utilization of the NRHM funds for
developing these units and its components.
The additional fund requirement will be met from NIPI state plans. These SNCUs will be linked to medical
colleges for technical assistance, training of medical officers and nursing staff and monitoring of quality
of services. NIPI will build state technical expertise for scaling up this effort to other parts of state.
NIPI Madhy Pradesh has planned to establish Sick Newborn Care Units (SNCU level-II) in all its focus
districts. District Hoshangabad has completed its civil work and set up of the planned equipments are in
the process while district Raisen has also reached its final stage of civil work. However, district
Narsinghpur has got its final civil plan done and the necessary process for establishment of the unit is in
progress. Moreover, process for establishing stabilization units at Hoshangabad blocks (SNCU level-I) has
begun and will be functional soon.
• Involving Panchayat Raj Institutions, Women Self help groups, Village Health and sanitation
committees for development of village level plans and validation of ASHA activities.
The HBPNC-ASHA Block level trainers were trained on the following themes:
1. To revise the key elements in Birth Preparedness, Essential New Born Care, Awareness of Danger
Signals.
• ASHAs will be able to convey comfortably key messages to Mothers and Family Members on
o
o Early initiation of Breast feeding
o Positive effects of feeding colostrums
o Exclusive breast feeding (NOTHING per mouth
except Mother’s milk) and its positive effects
o Keeping the baby warm
o Postpone bathing
2. To familiarize them with the PNC card, appropriate recording on it and Understanding the
Referral Mechanism as well as reporting to the relevant authorities.
The facilitators from NIPI Secretariat and state ensured that the
workshop proceedings were highly participatory and interactive.
Thus, along with the class room technique the resources
persons presented the topics thru practical demonstration by
using models which were then followed by participative
discussions (group work), then role play and questions and
answers. At the end of every presentation, the participants
were challenged by questions, which they worked on during
group discussions. The participants were also given exposures to
the real-time situation as visiting to the maternity ward of
district hospital.
Almost all the eligible ASHAs of Hoshangabad, Narsinghpur & Raisen districts have been trained on
HBPNC training (2days) and they will also experience another 5-days illustrative training on HBPNC soon.
The Child Health Resource Centre at the NIHFW functions as the nodal point for
mainstreaming the child health agenda in public health. The NCHRC is fully
staffed and functional. A technical advisory group comprising of eminent child
health and public health professionals will guide the activities of the NCHRC. The
focus will be on demystifying child health and collection and dissemination of all
the available reports, training materials, policies, program, case studies and
other relevant information on Child Health and related maternal health aspects
to all the workers at the primary level, located at the districts and below.
Institute of Health & Family Welfare [NIHFW] initiated National Child Health Resource Centre (NCHRC)
and put in processes to get the State Child Health Resource Centre proposed in this node aligned to the
national effort. Later, the development and staffing of RHFWTC at Bhopal will fill this gap on long term
basis.
1. Training Capacity
• Adaptation, translation and creating State Ownership of Training Modules for Yashoda, ASHA
and Techno Managerial Interventions. Capacity for other training relevant to NRHM in future
years can also be gradually added.
• Training of Trainers for YASHODA’s, ASHA for PNC and Techno Managerial Staff at different
levels
• Collaborate with IIM-A to deliver the Management Development Program for the Techno
Managerial Staff funded by NIPI at State and District level.
• In addition the State Node will follow up the training for the next six months and help IIM A to
evaluate the learning.
• Regularly attend a random sample of field level training sessions for Yashoda & ASHA for PNC to
ensure quality of training.
• To translate the high level technical child health pedagogy into simple lessons and communiqué
for the use of front line workers at the district and block level.
Publication/adaptation/translation of basic educational and communication materials for front
line workers and nursing staff.
• E-Newsletter on RCH for the State
• Hold two State level Workshops each year among stakeholders of
• Child Health in the State
• Help in dissemination of learning’s within the State by collecting and disseminating best
practices on child health interventions for improving state child health programs.
• Assist in the dissemination of Base line survey in the State and help NRHM to monitor progress
of select indicators in field Collaborate on Operational research studies related to ongoing
interventions, gender studies as determined by State from time to time.
• Providing concurrent evaluation support for specific interventions.
• The write-up on National Child Health Resource Centre may please be referred to. Each STATE
TRAINING NODE is requested to place all this capacity building as suggested above in the
framework of a State Child Health Resource Centre and promote a pilot District
• Health Resource Center in one NIPI-focus district for developing similar capacity in each district
in future.
• Madhya Pradesh has 22 functioning ANMTC and it plans to strengthen them through giving
funds for infrastructure improvement.
• NIPI would like join hands in its three focus districts and will start by doing a swot analysis of
these Training Schools to assess how/why they can be converted into District Health Training
Centers and assist them with some small inputs to improve training capacity in terms of
providing some additional funds that can be used for LCD projector and some good chairs or
buying AC for the Hall Etc.
• These ANMTC’s could be developed later- subject to approval of Sate Government- as District
Health Training Centers. The additional costs required for this will be planned in successive years
of NIPI State plan.
STATE TRAINING NODE- State Child Health Resource Centre [SCHRC] - will be guided by the Outputs
based on the activities detailed above. An indicative list is as below:
State Level: State Logistic Manager, State Finance Analyst, State Data Analyst (at state
NRHM office)
State Training Node: Technical cum Training Officer, documentation Officer with HR specialty, Field
Research Coordinator, IT Officer, Data Assistant cum Accountant, Nursing
Consultant, ANM Consultant, Document Center Officer. (at State Training Unit)
The following are some of the key challenges discussed during the workshop at IIMA:
The field visits to the nearby facilities provided the participants a good deal of exposure to the
functioning systems practiced by Government of Gujrat. Some practices are really appreciable
thus motivated the participants to replicate similar approach at their respective work areas
such as: the role of ASHA during & before the VHND and reinforcement through well-managed
AVDS, the temperament of AWC in taping resources from the community, the nature of IEC
displayed through the wall painting at AWC, Mechanism to record & monitor growth and
immunization of the target children and infants and so on.
The Team:
Activities:
The Total number of 1110 mothers along with expected mothers and
children under 0-5 years have benefited the free medical checkups and
received free medicines during the day-long event. They have received
counseling from Yashodas and other counselors as well.
All who made a visit to the Health Fair had a good exposure about the
various health schemes / programs because of the immeasurable display of
related IEC materials. Moreover, attractive pamphlets containing important
pictorial display of information about mother and child care were
distributed to all the visitors.
Special prizes were awarded for best ANC, best PNC, best fully immunized child, best
healthy baby and best child who has recovered well from the malnourished status. The
competitions were conducted among every 50 registrations. Importantly, the
audiences were also benefited by the experiences shared by the winners after receiving
their prizes.
Among the other dignitaries VHSC members including Sarpanch, ASHAs and AWWs were also invited as
guests to witness the event. Special motivational awards were given away to AWW & AWC for their
remarkable performances at their respective fields. The event was possible due to the special efforts
made by the following contributors: The District Collector Mr. Nishant Varbade, CEO Zila Panchayat Mr.
Sanjeev, Assistant Collector Mr. Bharat Yadav, Dr. N Dubey, Dr. Gangrade, Dr. Damley and Mrs.
Swarnima Shukla, DPO WCD.