Health & Nutrition Interventions under IKP

Outline of the presentation

• Goal

• Objectives

• Strategies

• Tasks accomplished

• Action plan for the year 2007-08

• Conclusion

Goal

Improved health & nutritional status in 45 IKP pilot mandals with 1400 VOs of Andhra Pradesh by 2008.

Objectives

• Empowered CBOs:− Demand access and avail health & nutrition

services − Improve house hold behaviours that help

maternal & child survival and control spread of communicable diseases.

− Provide financial support during illnesses.− Reduce expenditure on Health.

Strategies

• Continuous capacity building

• Convergence with line depts

• Communication for behaviour change through Health CRPs and IEC

• Community Investment fund for need based health and nutrition projects.

Tasks accomplished so far

Human Resources

VO,MMS and ZS level – 1Health activist (HA) in every VO– 5 member health subcommittee at VO,MMS and ZS

levelMandal level:

– 1 HN CC per mandal – 2 Master trainers with ANM qualification per mandal – 3 DPM(HND)

State level:– 2 Regional & 6 district field coordinators– 1 Project Manager

Capacity building• Institutionalized fixed days of training for Health Activists with

a fixed training calendar. (ie.,7th ,8th & 29th &30th) • Capacity building of 5 member Health sub committee (once in

a quarter) by the SPMU team.

• fixed training calendar for regular training of SHG members focusing on Sukhajeevana Suthralu (Neonatal care, maternal care & general health care practices to maintain good health.)

• Organized training cum exposure visit to Jamkhed for :– 478 health sub committee members and health CRPs.(6

days)– 90 Master trainers (15 days of training)– 35 HN CCs ( 10 days refresher training)

Fixed Nutrition &Health Days (NHDs)

Against 1400 VOs, the Fixed NHDs once in 15 days are institutionalized in 859 VOs in 38 mandals.

Health savings-Health Risk fund

• Against 45 mandals,38 mandals have initiated regular and exclusive health savings.(Rs10-30 per month).

• 1,03,771 of women in the SHGs (39%) have regular and exclusive health savings to a total amount of Rs 45,89,629.

• Agianst Rs 13.20 crores (Rs 1 lakh/VO) sanctioned for 1400VOs, 808 VOs were released with Rs 5,84,80,070.

• 6149 SHG members availed loans for health purposes to an amount of Rs. 1,08,85,009. (i.e., 42.2% of POP; 46.7% of poor and 10.7% of APL members of the groups).

Nutrition cum day care centers• 38 centers in 8 districts.

– 8 with project support (Krishna & Guntur)- Rs 13/1meal– 8 with CFSL implementation (Vizag)- Rs 16/2 meals– 22 with loan taken towards diet and support from VO

profits and dovetailing the sources from ICDS and JSY ( Vizianagaram, Vizag, E.G, W.G, Krishna, Guntur, Chittoor and Karimnagar)-Rs 24/2 meals.

• Training module for the members at nutrition center and make them as change agents.

• Regular ANC and PNC at the center.• Counseling of mothers and mother-in-laws on harmful

myths that effect the mother and child during and after delivery.

• Community Kitchen gardens to encourage the practice of use of green leafy vegetables and other vegetables.

Impact on health outcomes• Improved weight of the mother during pregnancy.• Normal deliveries.• Safe deliveries (Institutional/by trained personnel).• No complications during delivery• Birth weight of the baby is >3Kgs.• Practice of neonatal health care measures (2/3rd of

infants deaths are during the neonatal period) – Feeding colostrum– Early and exclusive breast feeding.– Delay in bathing the baby– Kangaroo care for Low Birth Weight babies

• Decreased family expenditure on health of the mother and the child.

(Towards reaching MDG 4,5 &6)

Community managed Health Insurance scheme – KNR & Nalgonda

• ZS Partnership with Pvt medical college• 3-5 years of coverage period• 60,000-120,000 coverage cap• 448-550 premium to all the SHG members and

their families• Discount on tests and medicines• Free In-patient treatment

Vizag model with 17 network hospitals is Ready to launch!

Health CRP strategy for BCC• Constitution of 5 member team identified from 5

different districts with best practitioners in:1. Introducing health agenda in SHG/VO/MMS/ZS meetings2. Training of SHG members on preventive and Promotive health care

measures.3. Promotion of health savings and HRF4. Promotion of Comprehensive Food security and establishment of

Nutrition cum day care centers5. Social mobilization for convergence activities

• Fixed NHDs with ICDS and Health dept• Environmental sanitation and water safety through Panchayat• Screening camps for women• Weaning foods for infants

• 26 days stay in 3 phases (12+12+2) to develop internal CRPs to take it forward.

• External CRPs work for 15 days outside the VO and 15 days for their own VO.

Achievements in 4 months (Jan-April 07)

• 110 external health CRPs were trained to work in 8 districts and covered 52VOs (8+22+22).

• Health agenda is being introduced in all the SHG & VO meetings.

• 100% members have regular health savings.• 90% of members enrolled under CFSL.• 24 Nutrition cum day care centers providing diet

for 280 pregnant and lactating women from POP and Poor.

• 3 Community kitchen gardens under IGA.• Fixed NHDs are institutionalized.

Achievements in 4 months (Jan-April 07)

• Convergence at VO level is improved in conducting health educations sessions by the HA &AWW and ANM.

• Organized screening camps for women and referrals & follow up arrangements.

• Formation of youth and adolescent groups to focus on bringing awareness on environmental sanitation and personal hygiene in the community and the families.

• Regular monitoring and review by the health sub committees at VO,MMS and ZS meetings.

Budget - Expenditure

• Total budget available : 984.39 lakhs

• Expenditure incurred: 2005-06 : 268.41lakhs 2006-07

• IHCB : 320.10 lakhs

• Total expenditure : 588.51lakhs

• Budget proposed for 2007-08 : 533lakhs

Plans for 2006-07

• Continuation of the over arching activities planned such as capacity building.

• Roll out of the Health CRPs strategy and with the involvement of youth and with the support of local Panchayats.

• Establishment of community managed Nutrition cum day care centers ( Pregnant, Lactating, Children upto 2 yrs ) by dovetailing funds from ICDS and Janani Suraksha Yojana Funds.

• Establishment of Drug depots managed at MMS and Village diagnostic centers managed at VO level.

Plans for 2006-07• Establishment of need based CIFs such as sanitary

napkin units to encourage adolescent girls and women to maintain menstrual hygiene and protect themselves form RTIs and communicable diseases such as HIV/AIDS.

• Adoption of tools for community based monitoring and evaluation and make midcourse actions at all levels.

• Replication of HN interventions in 55 mandals supported by DFID under health sector reform strategy. List of 55 mandals proposed is annexed. Still clearance need to be obtained from the dept of Medical health and Family welfare.

Health and Nutrition

Budget estimates for the year 2007-08

S.No Particulars Amount to be released

Responsible for implementation

1 Capacity building of vo, MMS & ZS 27942200 VO,MMS &ZS

2 Health CRP strategy 25361000 SPMU & MMS

Total 53303200

3 CIFs 203940000 VO,MMS &ZS

Grand Total 257243200

Thank you

Schedule to cover in 45 pilot mandals by External & Internal health CRPs

Phase Districts Period of External Health CRP stay

Period of internal Health CRP stay

I 1. Vizag 2. Guntur 3. Chittoor 4. Kareemnagar

Jan –Aug07 Sept 07-Feb 08

5. Vizianagaram 6. E.Godavari 7. W.Godavari 8. Krishna

March –Oct 07 Nov 07- April 08

II 1. Ananthapur 2. Warangal 3. Nizamabad 4. Kurnool

Sept 07-March 08

April 08- Sept 08

5. Prakasam 6. Nalgonda 7. Srikakulam

Nov 07-June 08 July 08-Dec 08

III 1. Adilabad 2. Mahabubnagar 3. R.Reddy 4. Medak

April 08 – Oct 08

Nov 08-Apri 09

5. Kadapa 6. Nellore 7. Khammam

July 08 –Feb 09 March –Aug 09

Giripragathi 1. Adilabad 2. Warangal 3. Khammam

May 07-Dec 07 Jan – June 08

Period Internal teams developed from the Vos

Number of teams emerge from a VO (@ 2 teams from VO)

No.of VOs can be covered in the same mandal

No.of Mandals to cover

Period by which the Internal Health CRP teams will be developed from the Vos

Period of reaching the 30th VO in a mandal

Jan-Feb 07 Vo1,VO2July 07'

March-April 07 VO3,VO4 Aug-07

May-June07 VO5,VO6 Sep-07

July -Aug 07 VO7,VO8 Oct-07

Sept-Oct 07 VO1 & VO2 (2+2) =4V9,VO10, VO11,VO12

April-May 0808-Apr

Nov-Dec 07 VO1 & VO2, Vo3 & VO4 (4+2+2)=8

VO13,Vo14,VO15,VO16,VO17,VO18,VO19,V20

June-July 08

08-Jun

Jan-Feb 08VO1 & VO2, Vo3 & VO4,VO5 (8+2)=10

Vo21,VO22,VO23,VO24,VO25,VO26,VO27,Vo28,VO29,VO30,

Aug-Sept 08 08-Aug

Period Internal teams from the Vos

Number of teams emerge from a VO (@ 2 teams from VO)

No.of VOs can be covered in the other mandal

No.of Mandals to cover

Period by which the Internal Health CRP teams will be developed from the Vos

Period of reaching the VO9-VO30 by the Internal Health CRP teams in same mandal/theother mandals

April-May 08Vo1,VO2,VO3,VO4,VO5,VO6,VO7&VO8 16

As done in Mandal 1 &2 8 March 08-Oct o8 09-Apr

June-July 08 VO9,VO 10,VO11,VO12 8As done in Mandal 1 &2 4 May 08 to Dec 08 09-Jun

Aug-Sept 08VO13,Vo14,VO15,VO16,VO17,VO18,VO19,V20 16

As done in Mandal 1 &2 8 July 08 to Feb 09 09-Aug

08-Sep

Vo21,VO22,VO23,VO24,VO25,VO26,VO27,Vo28,VO29,VO30 20

As done in Mandal 1 &2 10 Sept 08 to April 09 09-Oct

60 30

3. 20 Health CRP teams developed by Internal Health CRP teams will be able to cover 10 mandals @2 teams /mandal.(March 08-Oct 09)

Draft plan for coverage of entire district with health CRP strategy

*The Internal teams developed by External teams (VO1 to VO8) will be used to cover 8VOs in 3 disability and 5 DFID support mandals from March 08 to Dec 08 and the internal CRPs developed will cover VO9-VO30 from Jan-June 09.

*120 teams will be developed in 2 HN pilot mandals simultaneously to cover additional 50mandals in a district from March 08-Oct 09 with the 4 External health CRP teams alloted (@ 2 teams per mandal) to the district for 8months to cover 8VOs in each of the HN pilot mandal.

4. 12 newly emerged External CRPs teams developed from 6VOs will cover 6 mandals .(March 08-Apri 09)

Total no.of mandals can be covered with the 60 internal teams developed in 30VOs developed by 2 teams of exteranl CRPs in one mandal:

Note 1:

* 60 teams will be developed by Sept 08 in Mandal 1 and to use them in 30 additional mandals of the same district (@ 2 teams /mandal) and reach 30thVO in all 30 mandals by October 09.

March 08- Oct 09

*14 months are required to cover 30 Vos in a mandal by External Health CRPs for 8 months (8VOs) and Internal Health CRPs for 6months(22 Vos).

1. 2 teams of External Health CRP teams (5 members) will cover 8VOs in 8 months (Jan 07-Aug 07).

2. 12 Internal health CRP teams developed from 6VOs will cover 24 Vos of the same mandal in 6 months (Sept 07-Feb 08)

Coverage of 8 Vos by External Health CRP teams

08-Feb

No.of health CRPs teams developed in 1 mandal to cover other mandals (50)of the district

No internal teams yet formed. 2 teams of External teams will work in 8 Vos and the internal teams will be developed after 6 months of work in their own VO.

Coverage of 22 Vos by Internal Health CRPs developed in the 8VOs

Mandal 1

Mandal 1