USAID | DELIVER PROJECT PowerPoint Presentation template, Task Order 3, June 2007 - PowerPoint PPT Presentation

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USAID | DELIVER PROJECT PowerPoint Presentation template, Task Order 3, June 2007

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CLICK TO ADD TITLE The 6th Global Health Supply Chain Summit November 18 -20, 2013 Addis Ababa, Ethiopia One stop shop for improved access, Quality health care and ... – PowerPoint PPT presentation

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Title: USAID | DELIVER PROJECT PowerPoint Presentation template, Task Order 3, June 2007


1
CLICK TO ADD TITLE
The 6th Global Health Supply Chain
Summit November 18 -20, 2013Addis
Ababa, Ethiopia 
One stop shop for improved access, Quality health
care and service delivery for rural poor through
community managed Nutrition Centers in Andhra
Pradesh, India Lakshmi Durga Chava lakshmidurgac
_at_gmail.com Director (CMHN) Society for
Elimination of Rural Poverty(SERP), Hyderabad,
India ,
DATE
SPEAKERS NAMES
2
Presentation outline
  • Relevance
  • Background
  • Rationale
  • Paradigm shift
  • Implementation
  • Mobile tracking
  • Results
  • Challenges
  • Replicable
  • Way forward

3
Relevance
  • Share the experiences in establishing
  • demand chain the other side of the health
    supply chain
  • mobile tracking system in reaching the unreached
  • Explore potential networks for partnerships

4
Society for Elimination of Rural Poverty (SERP)
  • Autonomous organization established by GoAP in
    2000
  • Responsible for implementing poverty reduction
    projects supported by State and Central Govt. WB
    and other national and international donors
  • Works with peoples institutions (women SHGs) at
    grassroots level
  • Works in coordination with the govt. line depts.

5
Institutions of Rural Poor in 16 years
6
Poverty Reduction Strategy
7
SHG Bank Linkage Started in 2000, so far, they
have availed bank loans of Rs. 52,950 Crs.
Year wise
SHG wise
8
Magnitude of the malnutrition
  • 40.4 of children with under weight
  • 37.3 of children are stunted
  • 12.5 of children are wasted
  • 82.7 of children are anemic
  • 37.5 women with BMIlt18.5Kg/m2
  • 58.2 of women are anemic
  • Source NFHS-3

9
Much concern among poorer sections
Stunted (height-for-age) Wasted (weight-for-height) Underweight (weight-for-age)
Scheduled Caste 53.9 21.0 47.9
Scheduled Tribe 53.9 27.6 54.5
Backward Class 48.8 20.0 43.2
Other 40.7 16.3 33.7
Source NFHS-3 Figures are presented as percent
of children who are below 2 standard deviations
from the median growth indicator value calculated
from the WHO reference population
10
SERP model - Health Value Chain towards reaching
MDGs
Preventive Promotive Health Care
Curative Care
Financing and Service Delivery
  • Human/Social Capital
  • Health activist/ASHA
  • Community Resource Person (CRP)

Microfinance Product for NUTRITION
Case Managers
Health Risk Fund/ Health Savings
Fixed Nutrition Health Day (NHD)
Health Insurance
Making Services Work for the Poor Accessing
PHCs Area Hospitals 108,104 and Aarogyasree
services
Community-owned Pharmacy
Water Sanitation
Nutrition cum Day Care Centers
Community-owned Hospitals
11
730 days
270 days
Imaginary line
Peak foetal length velocity occurs at around 20
wks
Peak foetal weight velocity occurs at around 30
wks
Foetal stunting evident by 8 wks
PPE Suppl. 2013, UNICEF 2013, Gillespie 1997
12
Nutrition cum Day Care Center(NDCC) (1mt film)
  • Physical center i.e., building with Kitchen,
    Dining and Garden (for growing vegetables)
  • THREE MEALS a day prepared and served to pregnant
    and lactating mothers and children lt2 years
  • Cook (Para nutritionist) is an SHG member trained
    in preparation of nutritious, traditional diet
    (with focus on use of millets green leafy
    Vegetables)
  • Health activist (Community nutritionist) provides
    NHED duirng lunch time

13
Wight gain Birth weight
Indicators NDCC Beneficiaries (N 234)
Mean weight gain for pregnant women (kg) 9.01 (SD 0.1557)
Anemia detected during pregnancy () 35
Mean Birth Weight (kg) 2.912 (SD 0.20)
Weight Class (kg)
2.5 - 2.99 28.7
3.0 56.1
  • 90 had normal deliveries
  • 10 had cesarean section.
  • 52 of pregnant women gained 9 -10Kgs weight
  • Note study conducted in 8 districts inclusive of
    mandals in 3 ITDAs.
  • Source External evaluation study by SOCHURSOD

14
Utilization of public health facility
15
Rationale low uptake
  • Failure to reach 100 coverage with basic health
    services is two fold
  • no accessibility
  • lack of quality services
  • Very little interaction between the departments
    for
  • Social mobilization
  • Service delivery
  • Fixation of day and time by the service providers
    often conflict with the work schedules of users.
  • Users have not had any say in the scheduling
    process.

16
Paradigm shift
  • Fix the mis-match between supply and demand
  • Community to have stake in quality service
    delivery
  • Fix a day to deliver the services on a common
    platform
  • Complementary roles by service providers and the
    user groups

17
Fixed Nutrition and Health Day (NHD)- The 5
counters platform

Mother
Child
Counter-5 IKP Health sub committee Names
Counter 4 AW Helper (Name) Supplementary food
Counter 3 ANM (Name) ANC-Immunization supply of
drugs
Counter 2 AWW (Name) Growth monitoring
Counter 1 ASHA (Name) Health education
Surpanch
18
Players Role Before-During-After ( 2mt film)

Mother
Child
Counter-5 IKP Health sub committee Names
Counter 4 AW Helper (Name) Supplementary food
Counter 3 ANM (Name) ANC-Immunization supply of
drugs
Counter 2 AWW (Name) Growth monitoring
Counter 1 ASHA (Name) Health education
Surpanch
19
Tracking- mNDCC- DSS
Individual JARs for each mobile/VO has to be
downloaded. New enrollments or editing existing
member information possible
Various reports generated as per program design
Encrypted data sent in string format
Application program decrypts data which is stored
in table format
Alert sent to provide due list etc.
Global Innovation - IWG award 2012
Preloaded SHG member wise database maintained by
BF in a different server
20
Impact of mNDCC
  • Exceptional reports generation as review tools
    and take action for
  • reaching the unreached
  • escalating the issues if not resolved
  • Regular review using the exceptional reports
    showed improved coverage among POP
  • Enrollment from 58 to 72
  • ANC from 10 to 31
  • PNC from 5 to 29
  • Immunization from 16 to 24
  • Growth monitoring from 12 to 39
  • Health Education from 14 to 48

21
Results Improved service delivery
22
Challenges
  • Sensitization and coordination among the line
    depts
  • Internalization of the concept among
    stakeholders
  • Fix a day to every habitation based on ANM Tour
    schedule
  • Accountability to CBOs
  • Bring into the district administration agenda
  • Consolidation and track the outcomes at member
    level

23
Way forward Village level institutions in the
driving seat
  • Recognition of Village Organisation as the nodal
    institution to monitor health , nutrition and
    sanitation outcomes (Community)
  • Institutionalization of VSHNDs under NRHM
    (Panchayat)
  • Issue of Government Order Maapru (The Change)
    to bring all the stakeholders to a common
    platform (Service providers)

24
Is it replicable ?
  • Yes, it is.
  • Pre-requisites
  • Availability of community based network
  • Partnership between the CBOs and the line
    departments
  • Sensitization regular capacity building of the
    stakeholders
  • Exposure visits
  • Trainings
  • Tracking the member based outcomes
  • Maintenance of supply chain as per the demand
  • Political commitment to mainstream

25
Thank you
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