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Norway India Partnership Initiative

Madhya Pradesh

Annual Report 2009


Table of Contents
I. Background and introduction 1

II. NIPI’s focus Districts 7

III. About NIPI strategy 11

IV. Highlights of Key interventions 13

V. Media Reports 26

Norway India Partnership Initiative – Madhya Pradesh 2


List of Abbreviations
ANC Ante-Natal Care
ANM Auxiliary Nurse Midwife
ANMTC Auxiliary Nurse Midwife Training Center
ASHA Accredited Social Health Activist
AWC Anganwadi Centre
AWW Anganwadi Worker
BCC Behavior Change Communications
BCHM Block Child Health Manager
BEmONC Basic Emergency Obstetric Care
BPM Block Program Manager
CEmONC Comprehensive Emergency Obstetric Care
CHC Community Health Centre
CMHO Chief Medical and Health Officer
DCHM District Child Health Manager
DPM District Program Manager
DTC District Training Center
GOI Government of India
GOMP Government of Madhya Pradesh
Govt. Government
HBPNC Home Based Post Natal Care
HMIS Health Management Information System
IEC Information, Education and Communication
JSY Janani Suraksha Yojna
MCH Maternal & Child Health
MDGs Millennium Development Goals
MIS Management Information System
MMR Maternal Mortality Ration
MP Madhya Pradesh
NCHRC National Child Health Resource Center
NGO Non Government Organization
NIPI Norway India Partnership Initiative
NRHM National Rural Health Mission
PHC Primary Health Centre
OR Operation Research
PIP Program me Implementation Plan
RCH Reproductive and Child Health
RH Reproductive Health
RTI Reproductive Track Infection
SBA Skilled Birth Attendant
SHC Sub Health Centre
SHG Self Help Group
SNCU Sick Newborn Care Unit
TBA Trained Birth Attendant
STI Sexual Track Infection
UNOPS United Nations Office for Project Services
VHSC Village Health and Sanitation Committee

Norway India Partnership Initiative – Madhya Pradesh 3


Background and introduction
Until recently Madhya Pradesh was geographically the
largest state in the country with almost 13.5% of the
total area. In November 2000, the primarily tribal
eastern part was carved out to form Chattisgarh.
Madhya Pradesh has a total population of 60.4 million
(2001 Census), the rural to urban ratio being
approximately 73:27. Scheduled castes and scheduled
tribes account for 15.4 and 19.9% respectively of the
total population. Tribal population has decreased from
23.3% to 19.9% of the total population of the state after
the creation of Chattisgarh. Decennial population
growth rate in the state including Chattisgarh during
1991-2001 was 24.3%, about 3% higher than the
national growth rate.

S/N Item MP India


1 Total population (Census 2001) (in million) 60.35 1028.61

2 Decadal Growth (Census 2001) (%) NA 21.54

3 Crude Birth Rate (SRS 2008) 28.0 22.8

4 Crude Death Rate (SRS 2008) 8.6 7.4

5 Total Fertility Rate (SRS 2007) 3.4 2.7

6 Maternal Mortality Ratio (SRS 2004 - 2006) 335 254

7 Sex Ratio (Census 2001) 919 933

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

Norway India Partnership Initiative – Madhya Pradesh 4


Madhya Pradesh has 50 districts and hence an equal number of elected Zilla Panchayats. There are
almost 52,000 inhabited villages grouped under 21,999 Gram Panchayats and 313 Janpad or Block
Panchayats. Average rural population under the purview of a Zilla, Janpad and Gram Panchayat works
out to 984,000, 142,000 and 2010 respectively. A revenue village could consist of a number of separate
habitations known as tola or falia especially in tribal areas. The total number of such habitations in MP is
estimated to be about 112,000. The urban sector falls under the purview of 334 urban local bodies, out
of which the number of Nagar Panchayats (235), Nagar Palikas (85) and Municipal Corporations (14).

Maternal and Child Health


The current situation of child health in the state shows that only 21.6% (NFHS-3) of children are
exclusively breast fed for 6 months and 13.2% of children suffer from diarrhea. The
immunization in the recent times had shown a downward trend with complete immunization
being 40% (NFHS-3) for children in 12-23 months age group. The drop-out rate from BCG to
measles is as high as 23.72% (BCG coverage as per NFHS-3 is 80.5% while coverage for measles
is 61.4% - NFHS-3)

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.

Key Indicators India Madhya Pradesh MDG 2015

IMR 53 (SRS 2009) 70 (SRS 2009) 27

NMR 39 (NFHS-III) 45 (NFHS-III) <20

U5MR 74 (NFHS-III) 94 (NFHS-III) 41

Trends in IMR of India & MP

Norway India Partnership Initiative – Madhya Pradesh 5


Maternal Health Scenario in the State
The strategic efforts under Reproductive and Child Health Program and NRHM taken by the state
government have been successful in reducing the Maternal Mortality Ration from 498 (1998) to 335 in
2004-06 but the Madhya Pradesh state still remains among the group of states with highest MMR in
India. The percentage of institutional deliveries has sharply improved from 27.5 in 2004-05 to 71% in
2007-08 in the state; however, little efforts have been initiated to address postpartum contraceptive
needs of clients.

Maternal Health Monitoring Indicators Current Status Target


(DLHS-3) (2009-10)

% of ANC registrations in first trimester of pregnancy 33.8% 80%

% of pregnant women receiving full ANC coverage 7.9% 30%

3 ANC checks 34.2% 80%

2 TT injections 60.4% 90%

100 IFA Tablets 16.7% 50%

% of pregnant women age 15-49 who are anaemic 57.7% <20%

% of births assisted by SBA 52.8% 80%

% of institutional births 47.1% 75%

% of mothers who received post partum care from a SBA 37.7% 80%
within 2 weeks of delivery

Norway India Partnership Initiative – Madhya Pradesh 6


NIPI Focus Districts (Hoshangabad, Narsinghpur, Raisen & Betul)

Hoshangabad
Geographical Area (in sq.km) 5408.23

Total Populated Villages 923

Blocks 7

Total Gram Panchayats 428

Total Population 10,84,265

Total Males 5,71,774

Total Females 5,12,491

Total Estimated Population 0


(<1 yr)

(2006) 27748

(2011) 26031

(2016) 26025

Males

(2006) 14894

(2011) 13398

(2016) 13729

Females

(2006) 12853

(2011) 12633

(2016) 12296

CEmONC 04

BEmONC 09

Primary Health Centers 17

Sub Health Centers 150

Norway India Partnership Initiative – Madhya Pradesh 7


Narsinghpur
Geographical Area (in sq.km) 5125.55

Total Populated Villages 1040

Blocks 5

Total Gram Panchayats 5

Total Population 9,57,399

Total Males 5,01,407

Total Females 4,55,992

Total Estimated Population 0


(<1 yr)

(2006) 24460

(2011) 23244

(2016) 23017

Males

(2006) 13275

(2011) 12124

(2016) 12285

Females

(2006) 11185

(2011) 11120

(2016) 10732

CEmONC 02

BEmONC 09

Primary Health Centers 20

Sub Health Centers 144

Norway India Partnership Initiative – Madhya Pradesh 8


Raisen
Geographical Area (in sq.km) 8395

Total Populated Villages 1484

Blocks 7

Total Gram Panchayats 501

Total Population 1120159

Total Males 595730

Total Females 524429

Total Estimated Population 0


(<1 yr)

(2006) 34681

(2011) 34601

(2016) 34710

Males

(2006) 18537

(2011) 17759

(2016) 18202

Females

(2006) 16144

(2011) 16842

(2016) 16508

CEmONC 02

BEmONC 09

Primary Health Centers 19

Sub Health Centers 175

Norway India Partnership Initiative – Madhya Pradesh 9


Betul
Geographical Area (in sq.km) 10043

Total Populated Villages 1328

Blocks 10

Total Gram Panchayats 558

Total Population 13,95,175

Total Males 7,09,956

Total Females 6,85,219

Total Estimated Population 0


(<1 yr)

(2006) 36515

(2011) 32922

(2016) 32644

Males

(2006) 19275

(2011) 16688

(2016) 16953

Females

(2006) 17241

(2011) 16234

(2016) 15691

CEmONC 03

BEmONC 15

Primary Health Centers 33

Sub Health Centers 264

Norway India Partnership Initiative – Madhya Pradesh 10


About Norway India Partnership Initiative (NIPI)

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:

• Subsequently improve the performance of the health system as a whole in India


• The development of best procedures for large scale roll-out of interventions addressing MDG 4
also in other countries.

OVER ARCHING APPROACH

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

Norway India Partnership Initiative – Madhya Pradesh 11


Documents, National Health Policy and the National Plan for Action for Children documents as the
important guiding charters. These will be carried out within the implementation framework the same,
with the full participation of the State Governments and stakeholders.
NIPI would aim to strengthen inter-sectoral linkages, at all levels, especially with the ICDS system, water-
sanitation functionaries and Panchayati Raj institutions. Collaboration and synergistic cooperation with
professional organizations, NGOs, development partners and centers of excellence, among others,
would be actively sought and embraced to have maximum possible positive impact on child health.

The implementation mechanism through the state health society is as follows:

 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.

Institutional Frame work and Organization


Joint Steering Committee: The institutional mechanism of NIPI is led by Joint Steering Committee with
Secretary, Health and Family Welfare, Government of India as Chairperson and the Norway Ambassador
to India as the Co-Chair. Additionally, there are representatives of Government of India, Government of
Norway, WHO, UNIECEF and the NIPI focus States.

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.

Norway India Partnership Initiative – Madhya Pradesh 12


High lights of Key interventions:

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.

While the NRHM efforts are focused on strengthening infrastructure


and manpower which are long term interventions, NIPI’s response to
optimize the benefits of JSY during the stay of the mother and the
newborn is introduction of an innovative volunteer support worker at
the facility with high delivery volumes, named Yashoda (a legendary
foster mother of Indian mythology). She is a voluntary worker
compensated based on performance incentive. She supports and
assists the nurse in the provision of various non clinical activities from the time the pregnant woman
enters the facility till she leaves the hospital with the new born.

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.

Norway India Partnership Initiative – Madhya Pradesh 13


While Yashoda support can contribute to improving the confidence of
the mothers utilizing the services of the government facility and
motivate them to stay for a longer duration, initiate immediate an
exclusive breast feeding, immunization and learn basic newborn care,
she is not a solution to all issues related to quality newborn care and
she is not substitute to the existing nursing or paramedical staff in the
hospital.

NIPI Madhya Pradesh has initiated Yashoda program in three


district hospitals of Narsinghpur, Hoshangabad and Raisen in
October 2008. Currently 54 Yashodas are providing services at
the district hospitals, where as another 17 are engaged at block
CHCs of Hoshangabad namely JSR Itarsi, Pipariya, Seoni Malwa &
Sohagpur. Since the inception of this program the Yashodas have
counseled 15733 mothers and served 15208 newborns at the
district hospitals till February 2010. Yashodas have been exposed
to periodic orientation meetings concerning their regular
responsibilities. A separate space has been allocated exclusively
for Yashodas at the district facilities.

The below graphs display the analysis based on the Yashoda Monthly Report versus HMIS Report of a
neighboring district Harda

Percentage of Newborns weighed at Birth at the District Hospitals

Norway India Partnership Initiative – Madhya Pradesh 14


Percentage of Newborns breast fed within 1 hour

Percentage of Newborns administered with OPV 0 (Birth dose)

Establishing Sick Newborn Care Units (SNCU) and stabilization units.

Even though the big dent in child mortality is likely to be


caused by prevention of illness and local management of
common conditions, it is seen as important to complete the
continuum of care with improving capacity for treating sick
neonates and infants at district level and below. Given that
NRHM has put a lot o f effort into getting mothers to give
birth at facilities rather than home, a service for those
children that are ill at birth makes sense if facility birth is to
have any advantages in the mind of the opinion. Also a lot of
effort is put on teaching grass root workers to recognize

Norway India Partnership Initiative – Madhya Pradesh 15


danger signs in newborns and infants, but the effect of this will be attenuated if no proper curative care
for the same is available.

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.

Home Based Post Natal Care (HBPNC)


As a process to support and contribute to NRHM efforts, NIPI places emphasis on identifying the need
for, testing of, and introducing new ways of strengthening the ASHA service, including their support
needs, and referral requirements and in particular building their skills. This becomes critical in the
current context where, despite a quantum jump in the use of institutional facilities for deliveries, about
half of the women in rural areas still deliver at home. Most of the women delivering in the institutions
also return home with newborn within the first 24 hours. NIPI interventions include a package of home
based new born care by ASHA through home visit for newborn care in the first 48 days. The services will
include: Birth preparedness, Care at birth, Post natal care-for sick new born and referral, Immunization
and Birth registration, Breast feeding & Complementary feeding.

This effort will be strengthened by:

• Involving Panchayat Raj Institutions, Women Self help groups, Village Health and sanitation
committees for development of village level plans and validation of ASHA activities.

Norway India Partnership Initiative – Madhya Pradesh 16


• Development and dissemination of Behavior change communication materials targeted at high
risk practices in the community.
• Provision of seed money to a community managed fund for arranging and managing referral
transport to facilitate the timely transportation of the sick children to facilities and improving
referral linkage with the institutions.

NIPI-Madhya Pradesh has successfully initiated the rollout of HBPNC


program in three focus districts by creating 84 responsible HBPNC-
ASHA trainers at state level & block level. They are basically
responsible for creating a cadre of trained ASHAs at the village level,
who will be imparting the necessary knowledge and skills especially
related to Post Natal Care to the pregnant women, mothers and
others. However, 2462 ASHAs have already been trained till the end
of March 2010.

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.

• Be able to facilitate Immunization of the baby


• Be aware of danger signs in the Neonate and refer
them to the nearest facility
• Record the events properly in the PNC card.
• Record the home deliveries and facilitate birth
registration.

Norway India Partnership Initiative – Madhya Pradesh 17


3. To understand the modalities of validation and payment and other Administrative issues.

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.

Strategic support for Immunization


NIPI state plans include strategic support to immunization for
reaching the un- reached areas. The strategy proposed is to create a
bottom-up planning process in selected districts from the four of the
focus states, where block level managerial support is available
through NIPI support. Support will include:

• Analysis of each outreach site for performance.


• Articulation of logistic and access issues.
• Creation of extra vaccination sites, vaccinators, vaccine and transportation, based on
community’s assessment through involvement of Women’s Self Help Groups and
Panchayat members.
• Local resources and cooperation to handle the additional mobilization of children and
local transport support.

Divisional Logistic Managers (DLM) are strategically positioned at the divisional


offices to monitor and supervise the logistic issues related to child health. They
are primarily responsible for strengthening the system for optimal use of &
maintenance of cold chain stores / vaccine focal points while supporting the
procurement and management information system (ProMIS) along with training
divisional & district level managers on child health logistics. State has
constructed the website for information & communication regarding child

Norway India Partnership Initiative – Madhya Pradesh 18


health logistics http://www.mplogistics.webs.com/ along with a common website for general NIPI-MP
information & communication i.e. http://www.mpnipi.webs.com.

Enabling Child health efforts through Techno Managerial Support


This intervention is a key enabling mechanism aimed at providing support to make NRHM child
health investments efficient, by accelerating expenditure, fast tracking implementation and
tracking the progress effectively. The support includes: Recruitment and placing of child health
managers, financial analysts, logistics managers at the state, District and Block levels within the
respective Program Management Units, and hospital based child health supervisors. All the
recruitments are done through state mechanism and within the state financial rules.

National Child health Resource centre (NCHRC)


The NCHRC is established in the National Institute of Health and Family Welfare (NIHFW) a premier
training institute with branches in several states of India.

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.

Strengthening State Training Node & District Training Centers


NIPI assisted interventions in the State as approved by the State Coordination Committee are part of the
State NRHM. The States need involvement of its Institutions for providing technical support to these
interventions. NIPI will be assisting these State Institutions for enhancing their capacity to deliver
technical assistance (TA) by infusion of skilled manpower, hardware, software and other ancillary
supports. This capacity thus built will also help the States to scale up the program to Statewide in future,
including creating a capacity for future re-training, additional training etc in RCH. The State Training Cell
needs to be constituted to monitor and mentor the process of trainings. The state training node thus
developed in state IEC bureau can enhance the resource utilization of IEC bureau and will anchor the
trainings of new interventions especially in child health. In this, these can take note of Government of
India’s National

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.

Norway India Partnership Initiative – Madhya Pradesh 19


The support needed for the NIPI interventions in the States will include:

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.

2. Platform for Child Health-Public Health Discussions

• 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.

3. Distance Education on RCH

• With NIHFW/IGNOU/State University/Institute, facilitate certificate [and possibly, Diploma]


courses for front line workers including nurses.
• Dissemination of nationally produced educational material both hard and soft copies for onward
distribution to front line workers.
• Continuously help in improving Pediatric/New-born nursing/midwifery education in the State
through new courses through long distance education
• Certificate courses in RCH for non-medico Mangers at all levels.
• One of the important tasks is getting materials translated from English to Hindi and providing
quality check on already translated materials.

4. Research & Evaluation

• 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.

Norway India Partnership Initiative – Madhya Pradesh 20


5. IEC

• Facilitate production of education and communication materials (educational CDs) for


dissemination in the district hospitals (using the LCDs).
• Facilitate state level production & dissemination of educational and communication materials
on newborn and child care for field level workers.

6 Links with National process through NIHFW

• 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.

7 District Health Training & Resource Centre (DHTRC)

• 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:

• Output 1: Training of Trainers- Yashoda, ASHA and, Techno Managerial staff


• Output 2: Adapted & printed State specific Training Modules and Material for
different functionaries and disseminated
• Output 3: Process Documentation of the key interventions and Best Practices
• Output 4: Educational material for Primary Health Care Workers and
Community Workers produced
• Output 5: Development of Audio Visual Health Educational material for LCD
in Maternity Wards
• Output 6: OR Studies with Indo Norwegian Institutions
• Output 7: Coordination with NIHFW for promotion of e-learning courses for
health workers
• Output 8: Facilitate certificate course for Nurses and Managers in
coordination with NIHFW/IGNOU
• Output 9: Build and Maintain Child Health Documentation Center
• Output 10: Development of e-learning courses for health workers
• Output 11: Development of database of all NIPI supported health functionaries
• Output 12: State specific output e.g. Establishment cost for state NIPI team
Norway India Partnership Initiative – Madhya Pradesh 21
In order to strengthen the NRHM process, under Techno Managerial Support, NIPI Madhya Pradesh has
supported with the below listed personnel at state, division, district and block level.

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)

Division Level: Divisional Logistic Managers (at Divisional Offices)

District Level: District Child Health Managers (at focus DPMUs)

Block Level: Block Child Health Managers (at focus BPMUs)

Management Capacity Development Program at IIM-A for NIPI-MP Managers

The NIPI managers participated a five day workshop at IIM


Ahmedabad in 24-28 Nov. 2009, after having six months of working
experiences in the above assigned projects. At the beginning of the
workshop the participants were sensitized about the major
issues and challenges that the country is facing in terms of
child health, and were also briefed about the attempted
programmatic solutions.

The Management Capacity Development Program was designed to accelerate the


implementation of Child Health Strategy under NRHM. IIM Ahmedabad has designed a special
course curriculum for the NIPI managers. The participants were exposed to the course during
the first workshop held at Bhopal on July 30, 2009, where they were assigned the below
mentioned project works:

• Management of Neonatal Health: SNCU


• Management of Neonatal Health: Yashoda Interventions
• Management of Immunization Services
• Convergence of Health and Nutrition Programs: Village Health and Nutrition Day
• Managing Childhood Illnesses

The following are some of the key challenges discussed during the workshop at IIMA:

• Low level of public awareness on health issues


• Accessibility and availability of health facilities to patients / community
• Poor health infrastructures
• Poor information and communication systems and infrastructures
Norway India Partnership Initiative – Madhya Pradesh 22
• Competent and motivated human resources
• Feasible and acceptable mechanism / strategies to address the health needs
• Effective implementation of health programs
• Mitigating capacity building needs of health personnel and
• Promotion of innovative initiatives

• How the methodologies helped in understanding

Based on the projects assigned to the groups, the workshop was


designed in such a way that the participants get deeper
understanding on the subjects. The participants had undergone a
through learning process, being exposed to several methodologies
such as lecture method, field visit, observation, interviews,
presentation, discussion and group work.

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.

Moreover, the participants were mostly involved in group works


and presentations, which not only helped to enhance the team
spirit among the group members and uplifted the level of
understanding on the subjects but also enhanced their leadership
quality and sharpened their presentation skills.

• Managerial practices to be adopted, based on the lessons learned in the training


• Relevant management tools such as Gantt Chart / CPM / PERT will be used during on-going
program planning processes, especially in SNCU and HBPNC program
• Other management tool such as Building Block Methods will be used while analyzing
Yashoda and HBPNC program
• Task analysis will be done while monitoring the on-going programs
• Vigorous home work will be done before rolling our IEC / BCC plan
• It will be minutely planned while planning the logistics, as discussed during the workshop

Norway India Partnership Initiative – Madhya Pradesh 23


Other Initiatives
 Public Private Partnership (PPP): Expanding the resource pool for developing innovative
strategies through Public Private Partnership (PPP) by involving non-government actors at all
levels.
 Research and Innovation: Identifying new opportunities on a continuous basis through
collaboration with technical, professional and academic institutions in and outside India for
undertaking research, innovation and monitoring in child health in the overall context of primary
health.
 Monitoring and Evaluation: Enhancing ownership at community, block, district and state level for
concrete results in child health interventions by identifying filling the gaps in the existing survey
and surveillance tools for monitoring and evaluation.

Health Camp for Mother and Child at Hoshangabad


A grand Health Fair was organized for the mothers (ANC & PNC) and
children (0-5 years), at District Hospital Hoshangabad (MP) on 27th
March 2010. The event was a joint venture of District Health Society
Hoshangabad and NIPI Madhya Pradesh.

It was inaugurated by Mr. Girija Shankar Sharma, MLA who was


accompanied by Mrs. Maya Naroliya, President Municipal Corporation
and Bharat Yadav, Assistant. Collector, while at the end of the event Dr.
Tomas Alme, Dy. Director NIP, Dr. K Pappu, National Coordinator, CHRN, NIPI and Dr. Amita Chand, SPO
NIPI along with Dr. Vinay Dubey and Dr. RK Gangrade gave away the prizes to the winners of the
competitions held during the fair.

The Team:

The district administration along with the hospital administration


formed a team of 5 Pediatricians, 8 Gynecologists and 15 Doctors along
with more than 100 Paramedical staff including Yashodas, Hospital
staff, Anganwadi Workers, ASHAs and personnel from Women and
Child Development department, to make the event a grand success.

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.

Norway India Partnership Initiative – Madhya Pradesh 24


However, 74 patients were tested for Ultra Sonography and other 6
patients had tested X-ray. During the checkups at the fare 15 Malnourished
Children have been Identified and sent to the NRC, moreover, 9 children
have been identified as physically challenged and referred to the
rehabilitation center after being certified by the health authority.

Furthermore, Women & Child Development department had a separate


section at the Health Fair where women were exposed to various
methods of preparing healthy foods with the locally available resources.
Prizes were given to those women who took active participation by
answering correctly to the questions asked during the program.

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.

Awards and Prizes:

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.

Norway India Partnership Initiative – Madhya Pradesh 25


Media Reports

Norway India Partnership Initiative – Madhya Pradesh 26


Norway India Partnership Initiative – Madhya Pradesh 27
Norway India Partnership Initiative
Madhya Pradesh
1st Floor, IEC Bureau
J P Hospital Campus
Bhopal, Madhya Pradesh
India – 462011
Web: www.nipi.org.in

NIPI- A Partnership to Reduce Child Death


Norway India Partnership Initiative – Madhya Pradesh 28

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