USAID NATIONAL INTEGRATED CHILD SURVIVAL AND MATERNAL HEALTH PROGRAMNIP

1
USAID NATIONAL INTEGRATED CHILD SURVIVAL AND
MATERNAL HEALTH PROGRAM-NIP

• Dr. Rajiv Tandon
• MCHUH/PHN/USAID India
• 27TH JAN. 2006
• NEW DELHI

2
Presentation Outline

• Background Situation in India
• Operational/Program Framework
• GoI programs and challenges
• NIP details
• NIP interventions

3
MNCHN Scenario in India

• High rates of maternal, newborn, infant, and
  child mortality
• Substantial share of global mortality and
  malnutrition burden need progress in India to
  achieve MDGs
• Slow or no progress in recent years (90s)
• Major inequities economic (quintiles), social,
  gender, geographic (EAG)

4
Indias child survival challenge

• Birth rate 25 (2002)
• 2.7 crore neonates to take care
• U5MR 95 (1998-99)
• 25 lakh die before completing 5 years
• IMR 60 (2003)
• 16 lakh die before completing 1 year
• NMR 40 (2002)
• 11 lakh die before 4 weeks of age

 
Greatest burden in the world!
5
Why do children die
6
Direct Causes of Maternal Death (MDG 5) India,
1998
Magnesium sulfate
Other
Active mgt. of 3rd stage of labor
Toxemia
Hemorrhage
Caesarean section
Obstructed labor
Abortion
Family planning, post-abortion care
IFA, malaria control, deworming
Anemia
Sepsis
Clean delivery, antibiotics
Food, IFA, workload reduction, deworming
Malnutrition
SRS 1998
7

• Comprehensive obstetric care
• Treatment of severe newborn child illness

Referral Level Care
Outside Health Service Interventions

• Basic preventive services (ANC, immunization,
  etc.)
• Primary treatment of MNCH illness (IMNCI, basic
  essential and emergency obstetric care)
• Counseling

1st level - Private Services
1st level - Public Services
Operational Framework
Barriers, constraints, facilitating factors

• Transport of complicated deliveries and sick
  children
• Organization for ANC immunization
• Community oversight and monitoring
• etc.

• ANC
• Immunization
• AWW, ASHA, supervision supply
• Health information
• Private provider training
• etc.

gt60 of Deaths
Community Health Interventions
Community linkages to health services
Public
Private
Care delivered in the community

• Breastfeeding
• Feeding
• ORT
• Birth planning
• Newborn care
• Care seeking
• etc.

• Safe/clean delivery
• Active mgt. 3rd stage of labor
• IFA
• LBW special care
• ORT
• Vitamin A, zinc
• Abx. for pneumonia
• etc.

Family practices
8
Family Planning is key to Mother and Child
Survival
Reduced lifetime risk of maternal death
Fertility Reduction
Family Planning
Improved maternal health nutrition
Birth Spacing
Increased infant birth weight and survival
9
National goals MDG context
Estimated
10
GoI programsRCH I (1997-2005) interventions

• Immunization
• Diarrheal disease control
• ARI control
• Essential newborn care (at limited facilities)
• Vitamin A

11
RCH II how different?

• From project to program mode
• State ownership, states in drivers seat
• Decentralized planning
• Institutional strengthening
• Some states to have link volunteers
• Pooling of external funding
• Improved financial flows
• Equity-based monitoring
• Performance-based funding

12

• National
• Rural Health
• Mission
• (NRHM)
• Goal IMR, MMR reduction
• 18 high burden states
• gt300,000 new community health workers (ASHAs) in
  10 states more to follow

Launched in April 2005
13
Backdrop to 11th Plan

• High level of political commitment to health, in
  particular IMR reduction
• Increased health outlay
• Health system reform environment
• RCH II, an improvement over RCH I
• High economic growth
• Launch of NRHM

14
The Challenge of NRHM

• The challenge of human resources for reaching
  quality health services to the poorest households
  in the remotest rural areas
• Making the public health system accountable,
  affordable and accessible by improved management
  and community action.
• Developing pro-people partnerships with the
  non-governmental sector to provide quality health
  care services to the poor.
• Making health professionals and para medics
  deliver quality health services in remote rural
  areas through improved human resource
  management.
• Forging alliances with wider determinants of
  health under the PRI umbrella like water,
  sanitation, social and gender equality.

15
Strategies to meet the challenge

• Communitization PRIs, User Groups, Rogi Kalyan
  Samitis, managing health institutions at village,
  Gram Panchyat, Block and District levels with
  large untied funds, flexibility and functions to
  manage budgets
• Flexible contractual systems for engaging local,
  resident health workers improved motivation and
  regulation of doctor/paramedics
• Improved fund flow, timely procurement of goods
  and services, better cadre management, planning
  and monitoring through infusion of managerial
  skills
• Contd...

16
Strategies to meet the challenge contd.

• Planning as per peoples needs, mapping household
  needs, tracking facility performance, co-opting
  non-governmental providers
• Autonomy to Health Institutions (SHC/PHC/CHC)
  through untied funds (responsibility to spend
  budget under community ownership / scrutiny

17
NIP (how)

• Focus on MNCHN/RH results at scale
• Leverage resources to influence larger programs
• Build on RCH II and the Rural Health Mission
• Work with both public and private sector
• Build on Indian competencies and build capacity
• Link with other CH/MH/RH health programs
• geographically
• programmatically

18
NIP (who and where)

• Focus on vulnerable populations
• Promote equity
• Concentrate geographically
• Build on USAID investments and successful
  platforms
• Work where there is political commitment and
  opportunity for successful partnerships
• Support appropriate approaches for urban and
  rural populations

19
NIP (what)

• Evidence-based programming
• Focus on major causes of mortality and proximate
  determinants
• Address critical gaps and constraints
• Work in areas of USAIDs comparative advantage
• Five year timeframe

20
USAID National Integrated Program/NIP2006 to
2011

• About 25 million over 5 years
• In states of U.P Jharkhand
• Community action for maternal, neonatal, child
  and reproductive health interventions
• Focus on district level activities to help scale
  up through NRHM platforms
• Ensure governmental (MOHFW DWCD)
  ownership/partnership sustainability/exit

21
NIP

• Complement and support GoIs commitment to
  improving maternal, childhood and newborn health
  and nutrition
• Focus on NRHM state-level policies, resource
  allocations and programs through effective
  introduction of best practices derived from and
  introduced through technical assistance at
  district and block level
• Consider proposals that include innovative
  financing such as sub grants and loans to NGOs
  for furthering service delivery
• Quick start, be flexible and innovative in its
  approaches
• Refine previous learning bring together some
  best practices from previous programs

22
NIP

• Cost-effective operational models that are
  community-focused on maternal and newborn care
  and are adopted by NRHM
• Effective approaches to improve selected Maternal
  Neonatal Child Health and Nutrition outcomes in
  entire districts (rural and urban areas of less
  than 100,000) and incorporated into NRHM
• Cost effective models for increasing Reproductive
  and Child Health service delivery to vulnerable
  families and groups incorporated into NRHM
• Effective approaches which incorporates private
  provision of key Maternal Neonatal Child Health
  and Nutrition services incorporated into NRHM
  (Public Private partnerships)
• Assist effective operationalisation and scale up
  of NRHM by government

23
NIP

• complement other efforts that focus on health
  system strengthening and clinical care by USAID
  and others by supporting key sets of
  evidence-based and prioritized interventions
• Community ownership/participation through
  mobilization of communities to create demand for
  improved services using community organizers at
  the local level e.g. (ASHA/SHG/PRI/MM)
• Household skills building in essential maternal,
  childhood and newborn care and care-seeking
  through Behavior change of beneficiaries and
  service delivery personnel at district and block
  level
• Facilitating access to skilled attendance at
  birth at the community and FRU levels and
  effective management of pneumonia with
  antibiotics in the community and
• Strengthening linkages between communities and
  the public and private health care systems.

24
NIP

• Collect, analyze and manage a knowledge base to
  determine what works, and identify best or
  promising practices.
• Monitoring, by establishing base lines, support
  to routine monitoring, and effective information
  management.

25
Results Framework
Improved maternal, newborn and child health
nutrition at scale in India
Effective implementation of RHM

• Improved
• Policies
• Program approaches
• Resource allocation

Effective RHM program implemented in key
states
26
This is a call to action not a call to
rhetoric - Secretary of HFW, Mr. P. K. Hota
27
Thank you