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[DATE][SPEAKERS NAMES]

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 Chavalakshmidurgac@gmail.com

Director (CMH&N)Society for Elimination of Rural Poverty(SERP), Hyderabad, India

,

Presentation outline

• Relevance

• Background

• Rationale

• Paradigm shift

• Implementation

• Mobile tracking

• Results

• Challenges

• Replicable

• Way forward

2

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

3

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 people’s institutions (women SHGs) at

grassroots level

• Works in coordination with the govt. line depts.

4

22 Zilla Samakhyas

1,098 Mandal Samakhyas

45,046 Village Organizations

10,72,627 Self Help Groups

1,17,62,814 Members

ZS

MS

VO

SHG

Women Members

Institutions of Rural Poor in 16 years

5

Poverty Reduction Strategy

6

SHG Bank Linkage – Started in 2000, so far, they have availed bank loans of Rs. 52,950 Crs.

0

2000

4000

6000

8000

10000

12000

173 262 477 898 12382001

3064

588366376501

70938076

11110

0.00

0.50

1.00

1.50

2.00

2.50

0.17 0.22 0.29 0.360.42

0.69

0.831.36

1.391.57

1.82

2.302.44

Year wise SHG wise 7

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 BMI<18.5Kg/m2

• 58.2% of women are anemic

Source: NFHS-38

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 9

Preventive & Promotive Health

CareCurative Care

Financing and Service Delivery

Human/Social Capital• Health activist/ASHA• Community Resource

Person (CRP)

Fixed Nutrition & Health Day (NHD)

Water & Sanitation

Nutrition cum Day Care Centers

Case Managers

Making Services Work for the Poor – Accessing PHCs & Area Hospitals – 108,104 and Aarogyasree services

Community-owned Pharmacy

Community-owned Hospitals

Microfinance Product for NUTRITION

Health Risk Fund/ Health Savings

Health Insurance

SERP model - Health Value Chain towards reaching MDGs

10

730 days270 days

Low Birth Weight

Imaginary line

It is important to note that 50% growth failure accrued by Age 2, occurs in womb & 39% babies are low birth weight

Proportion of children stunted as per NFHS-3 (%)

Peak foetal weight velocity occurs at around 30 wks

Peak foetal length velocity occurs at around 20 wks

Foetal stunting evident by 8 wks

P&PE Suppl. 2013, UNICEF 2013, Gillespie 1997

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• 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 <2 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 time12

Nutrition cum Day Care Center(NDCC) – (1mt film)

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

Wight gain – Birth weight

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Utilization of public health facility

92 % 84 %

66 %54 %

68 %51 %

HN + NDCC (N=234) Control (N=242)

Perc

enta

ge

Study Group

Deliveries at PHF

Three ANC check-ups at PHFRegn. Of pregnancy at PHF

14

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.

15

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

16

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

Counter 1

ASHA (Name)Health education

Counter 2AWW (Name)

Growth monitoring

Counter 3ANM (Name)

ANC-Immunization& supply of drugs

Counter 4AW Helper (Name)

Supplementary food

Surpanch:

Mother Child

17

Players Role : Before-During-After ( 2mt film)

Counter 1

ASHA (Name)Health education

Counter 2AWW (Name)

Growth monitoring

Counter 3ANM (Name)

ANC-Immunization& supply of drugs

Counter 4AW Helper (Name)

Supplementary food

Surpanch:

Mother Child

18

Preloaded SHG member wise database maintained by BF in a different server

Encrypted data sent in string format

Application program decrypts data which is stored in table format

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

Tracking- mNDCC- DSS

Alert sent to provide due list etc.

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Global Innovation - IWG award 2012

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%

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Results – Improved service delivery

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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

22

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)

23

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

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Thank you

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