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Building Public Sector - NGO Partnerships for Urban RCH

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Building Public Sector - NGO Partnerships for Urban RCH Symposium on Urban RCH 31st Annual National Conference of Indian Association of Preventive & Social Medicine – PowerPoint PPT presentation

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Title: Building Public Sector - NGO Partnerships for Urban RCH


1
Building Public Sector - NGO Partnerships for
Urban RCH
  • Symposium on Urban RCH
  • 31st Annual National Conference of Indian
    Association of Preventive Social Medicine
  • February 29, 2004

Dr Siddharth Country Representative, USAID-EHP
Urban Health Program
2
Presentation Outline
  • Urban Growth and Urban Poverty
  • Reproductive Child Health Scenario among the
    Urban Poor
  • Public Sector Services for the Urban Poor
  • Existing Infrastructure and programs UFWCs,
    Health Posts, IPP VIII etc
  • Issues around present RCH services for urban
    slums
  • Experiences/ Lessons in Government-NGO
    Partnerships in IPP VIII and Other Programs
  • What Value can NGOs Contribute to Urban RCH
    Programs?
  • Suggestions and Recommendations

3
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4
Urban Population Growth
5
Especially in Their Smaller Cities
6
Urban Growth in India
7
Where Should efforts focus?
8
Take Home Messages
  • Virtually all growth will be urban in the future
  • Growth is fastest in concentrations of urban poor
    e.g. slums
  • (2-3-4-5 syndrome)
  • Most growth and population will be in small and
    medium size cities
  • Mega-cities will continue to grow and have
    importance beyond their proportion of the urban
    population
  • Urban growth in India has been exponential over
    the last few decades
  • In India, 43 of urban poor reside in the 8 EAG
    States

9
  • Reproductive and Child Health Conditions among
    the Urban Poor

10
Coverage of Child Health Services in Urban Slums
of 6 Municipal Corporations and Rural Areas of
Gujarat
Coverage
State-wide Multi-Indicator Cluster Surveys
(MICSs), 1996
11
Child, Infant and Neonatal Mortality in M.P.
12
Childhood Under-nutrition in Urban M.P. NFHS 2
Re-analysis, EHP 2003
13
Immunization Coverage by Age 1 among Children
12-23 months Madhya Pradesh NFHS 2
Re-analysis, EHP 2003
14
Contraceptive Prevalence in Urban M.P. NFHS 2
Re-analysis, EHP 2003
15
Delivery Related Services in Urban M.P. NFHS 2
Re-analysis, EHP 2003
16
Take Home Messages
  • Urban averages mask sharp disparities between the
    rich and poor in urban settings
  • By many health indicators, urban poor populations
    are comparable to nearby rural populations or
    worse in many cases

17
  • Issues with Public Sector Urban Health Services

18
Urban Health Infrastructure in the Public Sector
  • UFWCs (1950), Health Posts (under Urban Revamping
    Sceme1983)
  • 1083 UFWCs 871 Health Posts, many run from
    hospitals, not proximal to slums
  • With the total urban population of 290 million,
    (with 1954 UFWCs HPs), this works out to one
    UFWC/HP per 148,413 Urban population
  • PP Centres(1966) 1562 (many closed owing to
    discontinuation of Central funding)
  • IPP VIII (1993 to 2003) covered 7 million slum
    population in 4 mega cities and 94 smaller towns
    in 4 states

19
Scenario 1 Areas Where Some Public Sector
Primary RCH Services Exist
  • Inadequate physical and social access
  • Low demand for services among slum dwellers and
    weak community linkages
  • Poor quality (timing, attitude, atmosphere) of
    services
  • Insufficient reach to the under-served slums
  • Weak monitoring and tracking of coverage
  • Low focus on behavior change
  • Little emphasis focus on sustainability
  • NGOs active in several areas.

20
Scenario 2 Areas where Public Sector RCH
services are Not Existing
  • 2nd tier hospitals are burdened with primary care
  • Large pockets of urban poor left out
  • Private informal providers are the major resource
  • NGOs active in small areas

21
Low Utilization of and Access to Public Sector
Services
Urban Slums
Rural Areas
Gujrat State-wide Multi-Indicator Cluster Surveys
(MICSs), 1996
22
Cross-cutting Issues
  • Weak inter-sectoral linkages with non-health
    sectors e.g. Dept. of Urban Development
  • Insufficient focus on hygiene sanitation
    improvement and on other basic services
  • Limited experience with and capacity for
    effective partnerships in diverse settings
  • Every city/town is different, hence context
    appropriate strategies remain vital

23
  • Experiences in Govt. NGO Partnerships for Urban
    RCH

24
Some Examples of Government- NGO partnership for
Urban Health
  • IPP VIII - A.P./Bangalore
  • Link Volunteers Women's Health Groups promoted
    through NGO
  • Financial incentives to WHGs through revolving
    funds.
  • Emphasis on empowering women (NGO supported)
  • Behaviour counseling (child health, nutrition and
    hygiene)
  • First tier facilities operated by NGOs
  • IPP VIII - Delhi
  • First tier facility and maternity services
    operated by NGOs
  • EC Supported UH Program in Guwahati
  • First and 2nd tier facilities operated by
    Charitable Hospital

25
Learnings
  • Govt.-NGO partnership helped in institutional
    capacity building of NGOs and community groups
    and improving health coverage among slums.
  • Financial contribution from community members
    helped improve sanitation, wells
  • Reach to marginalized groups improved through a)
    WHGs and b) Link Volunteers.
  • Flexible contract (developed through
    participatory planning workshops) and regular
    meetings helped in solving problems ensuring
    better management.
  • Complementary and clearly defined roles of
    partners prevent sense of competition.
  • Effective program strategies were replicated

26
  • What Value Can NGOs Add to Urban RCH Programming?

27
Contribution 1 Identifying, Mapping Underserved
Urban Populations
  • Locating and mapping all slums and vulnerable
    pockets including unlisted slums, hidden and
    marginalized pockets.
  • Providing services/linkage to seasonal urban
    migrants
  • E.g. NGOs helped identify hidden urban clusters
    during Pulse Polio Campaigns, CINI ASHA MUSKAAN
    mapped slums in Uttaranchal and West Bengal

28
Marginalized Social Groups Constitute A Large
Proportion Of Urban Poor Background
Characteristics of Urban Uttar Pradesh - NFHS II
29
Marginalized Social Groups Constitute A Large
Proportion Of Urban Poor Background
Characteristics of Urban Delhi NFHS II
30
Contribution 2 Improve Access to Sanitation
and Other Basic Services
  • NGOs can facilitate sustainable community managed
    sanitation programs utilizing resources from
    National schemes such as Nirmal Bharat Abhiyan
  • Forge linkages with NSDP, SJSRY, DWCUA and other
    Ministry of Urban Development programs
  • Can lend an advocacy voice to the basic needs of
    the underserved slums at the city level
  • E.g. SPARC, Apnalaya other NGOs have
    facilitated sanitation programs in Mumbai, Pune

31
Contribution 3 Enhance Demand Utilization
of Services, Build Community Capacity
  • Context appropriate communication activities
  • Capacity building of community link volunteers
    for counseling, linkage to health services
  • Mobilise slum communities for effective outreach
    activities
  • Promote community institutions e.g. NHG, SHG
  • Quality Assurance of existing primary care
    services and of less qualified providers
  • E.g. In IPP VIII in A.P. and Bangalore, NGOs
    helped improve demand for services, SAATH and
    SEWA in Ahmedabad.

32
Contribution 4 Wholly Manage Primary Level RCH
Facilities
  • Where capacity is available and public sector is
    absent, NGOs/Charitable hospitals can manage
    First tier facilities
  • E.g. Govt. of Uttaranchal has proposed this model
    in Haridwar, FPAI manages one UHC in Bhopal,
    Marwari Charitable Hospital in Guwahati

33
Contribution 5 Effective Partnerships and
Convergence
  • Partnership building and maintenance. Facilitate
    coordination of meetings, help record minutes
  • Community-Provider (ANM) linkage, support and
    encourage ANMs
  • Linkage with other Departments, ULB, Schools,
    Traders Associations, Lions etc.
  • E.g. Counterpart International-AMC partnership,
    EHP Indore Ward Coordination Model, Janagraha -
    Bangalore

34
Contribution 6 Innovate Develop Models for
Replication Scale-up
  • Still a lot to learn about Urban Health
    Programming NGOs can serve as learning centres
  • They can conduct operations research to provide
    evidence for larger buy-in
  • Study tours, learning lessons, building a
    critical mass of essential skills needed to
    create a snowball effect
  • E.g. Apnalaya in Mumbai Arogya Sevikas

35
Contribution 7 Capacity Building,
Institutional Strengthening and Sustainability
  • Serve as trainers on a variety of topics e.g.
    urban vulnerability, behaviour change
    communication and counseling
  • Strengthen community-based organizations and link
    volunteers
  • Train Private informal providers
  • Foster Sustainable Programming
  • Promoting ownership among partners of program
    objective and processes
  • Facilitate Health Funds at various through
    available sources including community
    contribution
  • Encourage the humanistic paradigm in programming
    and minimize exclusion and inequity
  • E.g. VHAI and FPAI have served as trainers in
    many states Slum Networking Project in
    Ahmedabad through SEWA and SAATH focus on
    institutional capacity at slum level

36
Contribution 8 Strengthening/Developing Urban
HMIS
  • Focus on an appropriate unit for monitoring
  • Promote denominator based monitoring
  • Innovations such as Family Chit prior to
    outreach camp
  • Murphys Law One single accurate measurement is
    infinitely superior to 1000 intelligent opinions.

37
Contribution 9 Develop the Field of Urban
Health as a Professional Field
  • Emerge as UH Programming and Resource Centres on
    a Regional basis
  • Support State Govts in Planning and Monitoring
    Urban RCH programs
  • Document Urban Health Program experiences and
    promote cross-learning
  • Compile and Disseminate Urban Health Literature
    including data
  • E.g. All India Institute of Local Self Governance
    for Urban Development issues, SPARC for Urban
    Sanitation issues

38
Looking Forward To
Urban Health Program/Policy
  • Long Lever of
  • Commitment
  • Knowledge
  • Experience
  • Motivation
  • Proximity to problems

NGOs
39
  • Suggestions and Recommendations

40
Capacity Building at State and City Level Required
  • Capacity to select and identify the right
    partners apply appropriate selection criteria
  • Capacity to execute and monitor
    partnerships/agreements
  • Capacity to foster and maintain external networks
  • Enhance orientation to focusing on the
    underprivileged

41
Summary and Key Messages
Innovation Development of Models
EAG States - a priority
Govt.
NGO
Multi-Stakeholder Coordination
Quality Demand
Capacity for Planning, Management Monitoring
Reach the Un-reached
Sustainability Institutional, Programmatic, Finan
cial
42
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