Generation of evidence and development of guidelines to strengthen comprehensive maternity management system
Photo by- Sunita Singh/PFI
Foundation for Research in Community Health, Pune
Population and area
May 2012 – March 2014
Demonstration of a comprehensive maternity management system with a focus on development of guidelines
The project in its pilot phase would aim at
- Generation of evidence for development, modification or adaptation of guidelines for a comprehensive maternity management system
- Demonstrate the value of guideline adaptation in achieving good outcomes through case studies, both regional and national
- Explore perspectives of guidelines among multiple health providers in the three implementation states
- Select areas for guideline implementation in the selected states for the next phase of the project
Legal Interventions to address the health needs of women, children and adolescents
Socio-Legal Information Centre (SLIC)
Population and area
May 2012 – April 2014
Recognise and protect the sexual and reproductive rights of women and adolescents
- Increase availability, enhance quality and expand access to reproductive health services for women, ensuring that every family is a planned family.
- Increase the capacity of PFI partners, NGOs, lawyers, paralegals and judges to better utilise a rights-based framework and mechanisms to address reproductive health needs and prevent child marriages.
- Increase legal literacy and public awareness of the human rights and entitlements that guarantee access to reproductive health.
Ensuring Reproductive Rights of Women
Photo by -Sunita Singh/PFI
SUTRA (Social Uplift Through Rural Action)
Population and area
300 gram panchayats in five districts of Himachal Pradesh - Kangra, Mandi, Sirmaur, Solan and Una.
May 1, 2012 – April 30, 2015
Ensure reproductive rights of the people to achieve improved reproductive health and sex ratio at birth, and increased adoption of non-terminal methods of family planning.
- Create ownership of the issue at the community level through organizations like Mahila Mandals, Ekal Nari Shakti Sangthan and Self Help Groups
- Promote change in the health-seeking behaviour in the context of RTI/STIs
- Increase women’s access to information on reproductive and sexual rights, enabling them to choose methods for spacing or limiting family size
- Monitor public institutions like government health facilities, anganwadi centres to ensure necessary support and services
Create larger forums in the form of Mahila Gram Sabha to address gender discrimination and promote gender equality
Approximately two million under-5 children die in India every year (UNICEF’s State of the World’s Children Report, 2007). This represents about one-fourth of the global burden of infant and child deaths. Adding to this, is the poor status of maternal mortality in India (over 100,000 women a year), which also accounts for almost one-fourth of the world’s maternal deaths.
India faces the enormous challenge of reducing infant mortality from 53 per 1000 live births to less than 30 and maternal mortality from 254 per 1,00,000 live births to less than 100 by 2015.
Towards a healthy family
Maternal and child health (MCH) is an integral part of our efforts. We have worked to strongly advocate and place on the national agenda the issue that children have a basic right to live, and live well, and that this right should be recognized by both, the family and the state.We emphasize on the care of the newborn, encouraging the adoption and strengthening of both, home-based (community-based) and facility-based services for maximum outreach.
Learning from national and international experience, we expanded our vision and adopted a lifecycle approach to Reproductive and Child Health (RCH), focusing on adolescents too, in addition to women and children.
At the national and state levels we-
- Play a key advocacy role for MCH, deriving strength from the field
- Undertake and support a large number of action research projects
- Publish key analytical documents, highlighting MCH concerns, emphasizing the need for change based on hard evidence
- Provide technical support to the government for strengthening its MCH initiatives including undertaking evaluations of health programmes run by it. Evaluation of the Maternity Benefit Scheme (Janani Suraksha Yojana) in Jharkhand and Phase II of the nationwide behaviour change communication (BCC) campaign, under the National Rural Health Mission (NRHM) are two recent studies undertaken.
At the district and sub-district levels we-
- Provide technical and financial support to civil society organizations for the implementation of MCH projects
- Focus on strengthening monitoring mechanisms
Support pre-project surveys and post-project evaluations that focus on
- the demographic impact of interventions and
- the impact on the quality of healthcare.
Our field-level interventions are directed towards strengthening the delivery of health services as well as improving awareness and empowering women to adopt safe motherhood and childcare practices, primarily through capacity building and BCC.
We, through our partner organizations, have also been working towards improving male participation in MCH programmes and in empowering self-help groups (SHGs) to take on MCH activities. For we believe economic empowerment makes women effective decision-makers, especially for their own health and that of their children.
Important MCH indicators
Current Status vs. Goals:
|Current 12th Five Year Plan||NPP2010||MDGs2015|
|IMR||49 (SRS 2012)||45||30|
|NMR||29 (SRS 2012)||26||20|
|MMR||212 (SRS 2007-2009)||200||100|
IMR,NMR-per 1000 live births; MMR per 1,00,000 live births
Note: IMR – Infant Mortality Rate; NMR – Neonatal Mortality Rate; MMR – Maternal Mortality Ratio, SRS – Sample Registration Survey; NPP – National Population Policy; MDG – Millennium Development Goals
Scaling Up Pilot Projects in Reproductive Health and Adolescent Health in India
Population Foundation of India
Two years: July 1, 2008 – September 30, 2010. The project received a no-cost extension till January 31, 2011.
- To facilitate the scaling up of successful model interventions for reducing maternal mortality and morbidity and addressing young people’s sexual health and reproductive rights.
- To establish Population Foundation of India (PFI) as a Centre of Excellence for Scaling Up Management in India
- To build sustainable capacities within PFI to function as an independent scaling-up intermediary and carry scaling-up work beyond grant period
- To continue support to some of the NGO models funded by the MacArthur Foundation and PFI in Phase I of the project that showed strong potential to go to scale
- To scan for successful innovations in India on adolescent reproductive and sexual health (ARSH) and facilitate them go to scale
- To scan for successful innovations within public health sector and advocate for scaling up
- To create a conducive environment at national and state levels for scaling-up successful NGO interventions
- Organizational capacity building of PFI and other public health institutions and civil society organisations
- Identification and building up a pool of master trainers in scaling-up management
- Ongoing knowledge and skill enhancement and trainings on documentation, institutional development etc
- Integrating ‘scaling up’ in proposal development and grant making of all projects
- Incorporating capacity building and program development as an integral part of all projects
- Strengthening monitoring and evaluation mechanisms
- Building advocacy and partnership development into programmes
- Supporting organizations in scaling up promising practices or successful pilots projects
- Conducting theme-based scans and identifying scalable models through scalability assessments
- Conducting visioning and strategic planning workshops for scaling up
- Supporting institutional strengthening, capacity building and advocacy for scaling up
- Developing mechanisms for monitoring implementation at scale and evaluation of scaled up programmes
We had worked with the following models:
- Home-based Newborn and Child Care (HBNCC), implemented by SEARCH, Gadchiroli, Maharashtra: The model focuses on reducing neonatal mortality and maternal morbidity by community health workers through home-based neonatal care and management of asphyxia and sepsis. This model has proven success of reducing neonatal mortality by over 70 % and in varied socio-cultural settings (field tested under Gadchiroli, Ankur and ICMR trials).
The model has been included in Government of India’s XI Five Year Plan and is currently being scaled up in a number of states including seven districts in Karnataka and
20 districts in Andhra Pradesh. It has also been included in ASHA training modules 6 & 7 and in the module for training of national trainers from 16 states under NRHM.
- Community-based Health Insurance programme implemented by Vimo-SEWA, Ahmedabad, Gujarat: The model explores a voluntary, integrated insurance product, which includes life insurance, health insurance covering hospital stay, asset protection for hut and contents, and accidental death coverage. In some areas, the insurance includes a cashless tie-up system with health care providers.
The current membership of Vimo-SEWA is 1,20,000 with 52% of the policyholders being women. Vimo-SEWA aimed at expanding to South Gujarat and Rajasthan.
- Public-Private Partnership Model of PHC Managementimplemented by Karuna Trust, Karnataka: The model aims at improving the accessibility and availability of health services by the community through undertaking the management of primary health centres (PHCs) and sub-centres from the state government and adopting effective management and financial practices. It not only upgrades the facility but also ensures round-the-clock primary health care services in the catchment area of the PHC. In addition to the regular deliverables, Karuna Trust also delivers many value added services, which include community health insurance, herbal garden and tele-medicine.
The model aimed at scaling up to five states of the country.
- Community Health Care Management Initiative (CHCMI)implemented by the Department of Panchayat and Rural Development, West Bengal government: The focus of CHCMI is on promoting community involvement in health care management through awareness generation and capacity building of PRIs and SHGs. Both PRIs and SHGs are engaged in a range of public health interventions including social mobilization for demand creation, monitoring ICDS and health functionaries in order to improve service provision and village level planning for health.
Started in six districts in West Bengal, CHCMI has been scaled up to all 19 districts in the state.
- Promoting Rights-based Action to Improve Youth & Adolescent Sexual & Reproductive Health & HIV/AIDS in India (PRAYASH) implemented by Child in Need Institute (CINI), West Bengal and Jharkhand: The PRAYASH pilot is designed as a randomized control trial and is based on CINI’s learning from an earlier project Demonstration of Comprehensive Young People Reproductive Health Programme (DCYPRHP) in West Bengal. The mainstay of the model is the establishment of community-based youth drop-in-centres as a safe space for the youth to meet and for provision of sexual and reproductive health information and services. The key strategies adopted by the model include community-based behaviour change, promotion of youth-friendly service delivery and youth-led advocacy.
Key capacity building and advocacy initiatives
- National Conference on Scaling Up in India: Lessons Learnt and Way Forward
- National dissemination of The Ekjut Trial: Saving Maternal and Newborn Lives
- National Dissemination of IHMP, Pachod’s Safe Adolescent Transition in Health Initiatives (SATHI) Model
- Training of Trainers (ToT) on Scaling Up Management
- Capacity building on Institutional Development
Key knowledge generation initiatives
- Publication of a Monograph on Young People’s Reproductive and Sexual Health (YPRSH) Programmes
- Development of tools for-
- Desk review of pilots/promising practices
- Guidelines for exploratory visits
- Rapid NGO assessment tools
Assessing the Need for Periodic Training of ASHA under National Rural Health Mission
Population Foundation of India
June 7, 2010 – December 6, 2010
Assess the training needs of ASHAs (Accredited Social Health Activists) and provide recommendations for the content of the periodic training module, as requested by the NRHM, Government of Uttar Pradesh (GoUP).
- To assess the knowledge level of ASHAs and identify the deficits in performance of their duties.
- To make recommendations to the GoUP on content of the periodic training module.
The Government of India (GoI) launched the National Rural Health Mission (NRHM) to address the health needs of rural populations. ASHAs are appointed to interface between the community and the public health system in each village. The NRHM has designed an induction-training programme for ASHAs and two-day refresher trainings are proposed to be held every second month.
In order to take stock of what ASHAs have gained and retained in terms of knowledge from the induction training, and to identify any gaps between expected and actual knowledge in post training retention, PFI is conducting an assessment of additional training needs.
The study used a cross-sectional quantitative design. The sample was spread over 10 districts (Lalitpur, Mathura, Saharanpur, Shahjahanpur, Sitapur, Varanasi, Basti, Kausambi, Bahraich and Banda), covering two blocks in each district. This is also representative of the five administrative regions in the state as identified by GoUP. A total of 640 interviews were conducted using structured questionnaires with 300 ASHAs, 20 AWWs, 20 ANMs, and 300 ASHA beneficiaries (pregnant women, lactating mothers, mothers with infants between the ages of 7-12 months).
Regional Resource Centres (RRCs) for Bihar and Chhattisgarh
Population Foundation of India in collaboration with the Ministry of Health and Family Welfare, Government of India
Population and area
Covering the Mother NGO and field NGO networks of the states of Bihar and Chhattisgarh
Five years: Started in April, 2005. Annual extension received from the Government; Chhattisgarh RRC staff is supported through PFI core funds
- Support project development by training staff in technical areas and disseminating relevant training and communication material to stakeholders.
- Create and facilitate access to a database of technical and human resources relevant to family planning and RCH interventions.
- Conduct periodic field visits for technical assistance and training needs assessment and follow-up.
- Provide a platform for advocacy to facilitate GO-NGO networking.
- Provide inputs to GoI to enable policy modification/formulation for NGO programmes.
The Ministry of Health & Family Welfare (MoHFW), Government of India (GoI) had initiated the Mother NGO (MNGO) scheme under the Reproductive and Child Health (RCH) programme in 1999 and established four Regional Resource centres (RRC) for covering the entire country.
The scheme was revamped in 2005, and keeping in view the scope of work the pool of regional resource centres was widened from four to 10. These institutions were given a mandate to provide technical assistance and support to the State NGO Committee, Mother NGOs (MNGOs), Service NGOs (SNGOs), Field NGO (FNGOs) networks and other stakeholders across the country. PFI is the Regional Resource Centre for the states of Bihar and Chhattisgarh.
PFI appointed staff for the project and built the capacities of the team on key issues related to reproductive child health and programme management. The RRC staff was also trained in strategic communication. Workshops were organized in each state on specific themes identified in consultation with the government to build a common understanding among stakeholders on key issues.
RRC brought out publications on the themes like planned parenthood and child health. Training manuals on Fundamental of Accountings, Quality of Care and Community Needs Assessment have been published. It has also prepared a resource directory of NGOs and district level RCH data. These publications have been widely disseminated to all stakeholders.
Periodic reviews of RRC activities are organised by PFI and the government.
PARIVARTAN (A Family Welfare and Population Development Project in Rajasthan)
JK Tyres & Industries Ltd.
Population and area
Covers a population of 40,813 from 60 villages in Rajsamand block, Rajsamand district
Nine years: July 2004 upto September 2013
To bring about improvements in the overall health and Reproductive and Child Health (RCH) status through an integrated approach of awareness creation, service provision and taking up need-based socio-economic development activities.
- To raise awareness and knowledge of the community on RCH issues and general health through IEC and Behavioral Change Communication programmes
- To provide quality RCH services through the mobile health team
- To take up socio-economic development activities to enhance the effectiveness and acceptability of the programme
The five-year project, launched in 2004, covered 32 villages from Rajsamand block of Rajsamand district. In 2007, 28 new villages were added.