Health and Nutrition Interventions

1
Health and Nutrition Interventions

• Society for Elimination of Rural Poverty
• Hyderabad

2
Outline of the presentation

• Universal approaches
• Intensive approaches
• outcomes
• Model village plan
• Scale up plan

3
Universal approaches

• Regular schedule for capacity building of Health
  activists (4 days/month), health sub committees
  (2 days once in 2 months) and SHG members (2 days
  in a month) with a fixed calendar module.
• Institutionalization of fixed Nutrition and
  health days (NHDs) screening camps.
• Regular health savings and health Risk Fund
  operationalisation in all the VOs.
• Introducing health agenda and review of
  activities at SHG,VO,MMS and ZS levels.
• Positioning of case managers for effective
  referrals.
• Establishing Community kitchen gardens.
• Preparation of weaning foods for children in 6-12
  months age.
• Currently being implemented in 53 pilot
  mandals (458giripragathi mandals).

4
Intensive approaches

• Health CRP strategy 5 member team with best
  practitioners from different districts spend
  30days in a village in 2 phases to focus on
• Introduction of health Agenda at SHG VO meetings
• Promotion of Health savings HRF
• Promotion of Comprehensive Food security line
• Establishment of Nutrition cum day care centre
• Institutionalize schedule for SHG member
  trainings
• social mobilization and convergence activities.
• Covered 105 VOs from 20 mandals in 6 rounds
  since Jan 07.

5
Progress of universal interventions

• Health savings Against 1500 VOs, 1220 VOs have
  opened exclusive accounts for health savings. (Rs
  68,15,022)
• Utilization of HRF released _at_1lakh/VO to all the
  mandals
• 24 for surgeries
• 60 for deliveries
• 5 for Gynec problems (improved womens health
  seeking behavior with access to credit and
  services thru' screening camps)
• 11 for other medical admissions and OP treatment

6

• Institutionalization of Fixed NHDs
• (1254 Vos against 1400 VOs).
• Organized cluster level screening camps in 40
  mandals.
• Fixed schedule of trainings for SHGs to focus on
  preventive and Promotive health care messages
  through Health Activists/ASHA.
• Position of case managers at District/Area/PHCs
• Health dept in principle agreed to scale up these
  interventions and to fund under health sector
  reform strategy program/NRHM for the year 2007-08
  2008-09.

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Intensive approach- Health CRP strategy

• Identified the best practitioners as external
  Health CRPs from 45 pilot mandals.
• Imparted 15days training(105) for all the
  external health CRPs at Orvakal by SPMU team.
  (Case studies Field practice).
• Constituted external Health CRP teams with 5-6
  specialists from different districts to work 15
  days outside the district and 15 days in their
  respective VOs in a month.
• Positioned the teams _at_ 2-3 teams per mandal.
• Phase 115 days ( Focus on survey and reaching
  all the SHG members with the concepts on 6
  topics- Communication)
• Phase 2 15 days ( Focus on enrollment of SHG
  members Action)
• Phase 3 5 days ( Internal CRPs exposure to CRHP,
  Jamkhed.
• Phase 4 2 days ( visit by external CRP teams
  after 2months to assess the functioning of
  internal CRPs (Varasulu) in discharging the
  responsibilities taken up)
• Phase 5 Identification of Internal health CRP
  teams after 6 months from the VOs covered by
  external health CRP teams.

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• External health CRP teams to cover 1/3 of VOs and
  2/3 rd to be covered by internal health CRP teams
  in phases .
• Grama sabha involving the VO, Panachyat and the
  entire community after the survey and before
  leaving the Village (at the end of 2 months).
• Debriefing sessions at DPMU to hand over the
  responsibilities to internal CRPs identified at
  every VO level.
• Debriefing sessions at SPMU and interactions with
  Dr.Arole once in 2 months.
• After 6months
• The internal CRPs from the villages covered by
  external teams will come to state level to
  undergo training and will be attached to external
  teams to have hands on experience in
  2rounds.Subsequently, they will also be
  constituted into teams to go to other
  districts/in the same mandal.

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Strength of health CRPs

• Dec 06 40
• Feb 07 80
• Sept 07 150
• (For every 2 months 100-150 health CRPs developed
  from the villages covered by external teams)
• Nov 07 250
• Jan 08 350
• March 08 500

10
Outputs of health CRP strategy adopted in 105
VOs from 20 mandals in 6 rounds (Jan-Nov 07)

• Strengthening of IB
• gt10 of new SHGs are formed.
• Health agenda
• 91 of SHGs are introducing health agenda in
  their regular meetings by the women identified
  and trained _at_ 2 per SHG.
• Health savings
• 100 VOs with 91 SHG members initiated exclusive
  savings for health.

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• Comprehensive Food security
• 72 of the SHG members have enrolled under CFSL.
• SHGs Training
• 84 of SHG women trained by HA with a seasonal
  training calendar prepared to train SHGs
  separately.
• Convergence activities
• 6 of the cases attended screening camps
  referred to Area/district hospitals/net work
  hospitals for surgeries.

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• Social mobilization
• 2050 youth organized into 156 youth groups and
  opened accounts with the savings of Rs 134000.
• 100 VOs are continuing with special drives once
  in15 days for water safety and sanitation
  measures with the support of youth groups and
  Panchayat.
• Involvement of Panchayat and support to release
  the funds available under RCH-II.

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• 2400 adolescent girls organized into 205 Balika
  sanghalu opened accounts with the savings of Rs
  32642.
• 1568 girls against 2400 are continuing their
  education.
• MCP for education was done for Rs 493004 towards,
  fee, transportation and special coaching etc.,
• Regular trainings on menstrual hygiene are being
  imparted by the TOTs of ICDS as per the fixed day
  (Sunday) and fixed training calendar prepared.

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Nutrition cum day care centers

• 96 Vos established Nutrition centers(100).
• 40 of centers extended with facilities for day
  care for children(42).
• 68 VOs developed community Kitchen gardens.
• 87 of lactating mothers are using weaning foods
  for their children in the age group of 6-12months

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Outcomes of enrollment at Nutrition center
16
Infant feeding practices
17
Neonatal care practices
18
Sequence of activities in Gunjedu (15
SHGs with 212 members)

• Survey to list the beneficiaries and compare with
  the list available with AWC
• Counseling with the beneficiaries husbands
  mothers, mothers-in-laws.
• Prepared MCPs identified SHG member as cook,
  procured commodities
• Prepared training calendar for health education
  sessions.
• Fixed a day for NHD
• Prepared weaning foods by the mothers themselves
  for children between 6-12mths age.
• Opened the center in the first phase of CRP
  strategy ( Oct 07).
• Repayments are made as per the installments
  agreed.

All POP and Poor are enrolled at the center
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Dovetailing funds from ICDS and JSY

• Initial 6months to be born by the VO and then the
  funds will be supplemented by ICDS.
• In principle agreed to release JSY funds to VO
  with nutrition centers.
• This will reduce burden on VOs to reduce their
  contribution (Rs 6 to 7)

20
Plan up to March 2009

• Continuing the activities under universal
  approach in 45 pilot mandals 8 Giri Pragathi
  mandals
• ( Regular Training exposure visits to Health
  sub committee members and Health Activists, Fixed
  NHDs, CIFs for community Kitchen gardens, weaning
  foods, Sanitary napkins, ISLs, CFSL, Screening
  camps etc.,)
• Roll out of intensive health CRP approach
• ( focus on 6 components) in
• Saturation of entire Vizag district
• 8 Giripragathi mandals in 3 districts.
• Addl mandals in 3 Tribal districts (7), 4 Chenchu
  districts
• 15 HN mandals in 8 districts ( VZM,, E.G, W.G.
  Krishna, Guntur, Chittoor, Kareemnagar R.Reddy)

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Partnerships

• Support in development of 20 community managed
  pre-schools ( Shodhana)
• Support in making 100 villages free from open
  defecation (CRHP, Jamkhed and Gram Vikas, Orissa)
• Support to bring health, nutrition and education
  issues in the agenda of 100 Panchayats (MVF)
• Support to bring awareness among 10,000 members
  about dietary diversification to improve
  nutritional status of rural communities (Home
  Science college, Agricultural University)
• Internship of 60 students of Home science in HN
  mandals for 45 days in every year.

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• Impact evaluation studies on health and nutrition
  interventions under IKP (NIN CRHP)
• Support to build the capacity of SHG members on
  community health with special focus on HIV/AID
  (Lepra India)
• ZS as MNGo and MMS as field Ngo under NRHM in 11
  districts.
• Video documentation of implementation processes
  in health CRP interventions and use them as
  training films to train the internal CRPs.
• Establishment of 5 drug depots (Vizag, Chittoor
  and Vizianagaram)

23
Road Map
24
Budget estimates (Rs in lakhs)
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Thank you
26
Expected outcomes in intensive health CRP strategy
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• Health agenda
• SHGs with facilitators to introduce health agenda
  in regular meetings.
• Priority to the MCPs related to health, nutrition
  and education.
• Trainings on preventive and Promotive health care
• SHG members have knowledge and practice on
  Sukhajeevana Suthralu for maternal and Child
  survival and control of communicable diseases.
• SHG members reduce their expenditure on childhood
  illnesses (Diarrhea ARI) with the use of home
  remedies.
• Practice in use of green leafy vegetables
  regularly and reduce the incidence of anemia
  through promotion of community Kitchen gardens.

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• Nutrition cum day care centres
• All Pregnant and lactating mothers and children (
  with focus on POP Poor) get enrolled and avail
  services provided at Nutrition cum day care
  centre.
• All the eligible women and children avail
  services on the fixed NHD.
• All the mothers have safe and normal deliveries.
• All the mothers give birth to the children with
  gt3Kgs birth weight.
• All the children have complete immunization by
  the age 1 year.
• All the children have normal growth corresponding
  to the age.

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• Health savings HRF
• All the SHG members have regular monthly savings
  for health (_at_ Rs20-30/month).
• All the SHG members have access to credit for any
  health emergencies and do not go to money
  lenders.
• Reduction of household expenditure on health.
• Involvement of Panchayat
• Measures to supply safe drinking water and
  environmental sanitation on regular basis with
  the support of youth and VOs.
• Resolutions of Panchayat to include issues around
  health, nutrition and education in due
  consultation with VO health sub committee members.