Strengthening Village Health and Nutrition Days:

Key strategies and lessons learned from Uttar Pradesh, India

Presenter: Ashok Kumar Singh Senior Technical Advisor

Vistaar Project, IndiaMarch-2010

The Vistaar ProjectBackground:USAID funded five year technical assistance project (2006-2011)

Purpose: To assist the Government of India and the state Governments of Uttar Pradesh and Jharkhand in taking knowledge to practice in order to improve MNCHN status

Coverage:

8 districts; 86 blocks;

24 million population (81% rural)

Saha

ranp

ur

Muzaffarnagar Bijnor

Moradabad

RampurJP Nagar

Meerut

GhaziabadGBNagar

Buland

shah

r

Aligarh

HathrasMathura

AgraFirozabad

Etah

Mainpuri

BudaunBareilly

Pilibhit

Shahjahanpur

L Kheri

Sitapur

Hardoi

Unnao

Lucknow

Rae Bareli

Farrukhabad

KannaujEtawah

Auraiya Kanpur Dehat

Kanpur Nagar

Jalaun

Jhansi

Lalitpur

Hamirpur

MahobaBanda

Chitrakoot

Fatehpur Pratapgarh

KaushambiAllahabad

Barabanki

FaizabadAmbedkar Nagar

Sultanpur

Bahraich

ShrawastiBalrampur

GondaSiddharthnagar

Basti Sant Kabir Nagar

Maharajganj

GorakhpurKushinagar

Deoria

Azamgarh

Mau Ballia

Jaunpur Ghazipur

ChandauliVaranasiSRD Nagar

Mirzapur

Sonbhadra

Baghpat

Uttar Pradesh

Background of Village Health & Nutrition Days (VHNDs)

Priority intervention under the National Rural Health Mission (NRHM) of Government of India (2005-2012):

•Objective: Increase access and coverage of basic health & nutrition services for rural community

•Frequency: Monthly service delivery in each village

•Approach: Multiple services on fixed day, fixed time and fixed place

•Services: Guidelines mandate 15 basic MNCHN services

•Service Providers: Collaboration of three frontline workers from Departments of Health & Family Welfare (HFW) and Women & Child Development (WCD)

Why VHNDs?

Evidence indicates that VHND is an excellent available platform for the community to access a range of MNCHN services on an assured basis

Challenges in VHND Strengthening

• Frontline workers not aware of the guidelines and their roles in VHNDs

• Lack of convergence between WCD & HFW Departments

• Lack of tools & mechanism for structuredobservation and monitoring of VHNDs

• Lack of community awareness

• Lack of necessary equipment and supplies

Technical Assistance Strategies for VHND

• Orientation of frontline workers on VHND guidelines & clarification of roles

• Joint (HFW &WCD) district level micro planning for VHND incorporating unreached villages

Technical Assistance Strategies for VHND (cont'd)

• Enhancing community awareness on VHND

• Institutionalizing mechanisms for regular and structured observation and supervision

• Convergence with other development departments

• Improving allocation and use of funds for VHND

Preliminary Results

IndicatorApril to June 09

Nov to Jan 2010

% sessions in which all three frontline workers were present 59.1 71.1

% sessions where child nutrition related services were provided (supplementary nutrition or weighed and plotted)

47.4 61.9

% sessions where maternal health related services were provided (health check up and TT vaccination)

25.9 40.8

% sessions where maternal nutrition related services were provided (supplementary nutrition+ IFA given and explained)

26.1 44.4

% sessions where IEC material was available and displayed/used 8.6 17.7

% sessions with supervisory visit from either Health or WCD 16.7 18

% respondents from disadvantaged community fully aware of VHND

23.8 27.7

% blocks ( sub-district units) where monthly convergence meetings were held

8.3 86.1

Total N (sessions observed) : 546 3143

Source: independent session observation in 8 districts by Vistaar

Lessons Learned

• Build on Government priorities

• Sensitize district officials and assist them in orienting frontline workers on the guidelines-just having guidelines is not enough

• Develop the Microplan jointly (convergence of HFW and WCD) and share it with frontline workers

Lessons Learned

• Regular review and use of monitoring data is important for timely actions to address identified gaps

• VHND should be a standing agenda item for the District Health Society review meetings

• PRI and Education Department can play role to strengthen community mobilization, coverage and accountability of VHND

VHND can make a difference

For more information visit: www.intrahealth.org

Write to: infovistaar@intrahealth.org