Presentation on theme: "Health and nutrition interventions – Mainstreaming HIV/AIDS prevention"— Presentation transcript:
1 Health and nutrition interventions – Mainstreaming HIV/AIDS prevention Lakshmi Durga ChavaState Project Manager (Health & Nutrition)Society for Elimination of Rural Poverty
2 Outline of the presentation Overview of SERPHealth and nutrition: key processesMainstreaming HIV/AIDS preventionImpact assessment resultsRoll out planConclusion
3 Society for Elimination of Rural Poverty (SERP) Sensitive support organization for the poorAutonomous society set up by Government in 2000State wide mandate:To induce social mobilizationTo provide facilitation support to institutions of poorTo sensitize all line departments to be inclusive of the needs of the poor
4 SERPA.P – poverty eradication through empowerment of rural poor women (Indira Kranthi Patham - IKP)Focus: comprehensive poverty eradication - economic and socialbuilding self sustaining institutions of poorRs.2100 crores Project - financed by State Government, World Bank and communities to cover all rural poor in the state (over 100 lakh families, special focus on 26.0 lakh ultra poor)builds on the decade long, statewide rural women’s self-help movement in A.P
5 C.B.Os implement the project A.P Federation ModelSHGs•Thrift and credit activitiesMonitoring group performanceMicro Credit PlanningHousehold inv plansE.C-2 from each S.H.G, 5 Office bearersStrengthening of SHGsArrange line of credit to the SHGsSocial actionVillage developmentMarketing and food securitySupport activists – 3 -52 from each V.O, 5 Office bearersSupport to VOsSecure linkage with Govt.Depts.fin institutions, marketsAuditing of the groupsMicro Finance functions1015V.O150200MMS40006000Z S200,000400,000C.B.Os implement the projectZilla SamakhyaMandal Samakhyas and V.Os plan and implement the variousproject componentsEach Mandal is divided into three Clusters of habitations.A development professional, called Community Coordinator (CC) is placed in each Cluster. S/he stays in her cluster.SERP selects and trains them. After completion of training, they are contracted by the MS and are accountable to MS.M.S responsible for social mobilisation, institution building and funding the microplans of S.H.Gs/V.Os from C.I.FMicro credit plans are evolved by the S.H.Gs in each village. These plans are funded by their own savings, CIF fund and Bank Linkage.V.Os responsible for appraising the microplans and recommending them to M.S for financing from C.I.FV.Os appraise microplans and also finance them from the recycled C.I.FMandal SamakhyaVillage OrganizationSELF HELP GROUPS
6 SHG network Village Organization-VO (approx. 20 SHGs) 9,646,000 Rural Women in 22 Districts of AP810,000Self Help Groups (10-15 women per group)34,852Village Organization-VO (approx. 20 SHGs)1098 Mandal Samakhya-MS(Includes approx villages)22 Zilla Samakhya-ZS(constitutes 1 district)1 State Office (State Project Monitoring Unit)
7 IKP Interventions Targeting – community based targeting. Focus on the poorest of the poor and vulnerable: women, disabledPower of scale – bringing all the poor in the state into social networksScaling up through community resource personsInstitutional design – SHG – V.O – M.S – Z.SLarge scale mobilization of bank finances for poorLarge scale livelihoods promotionCommunity managed food securitySocial issues as an agenda for collective actionSocial risk managementCommunity managed health interventionsConvergence with all line departmentsS.E.R.P’s dynamic role – changes in tune with the changes in the demands of the C.B.Os
8 IKP health model: Core elements Reducing exclusion and social disparities in healthorganizing health services around people's needs and expectationsIntegrating health into all sectorsPursuing collaborative models of policy dialogueIncreasing stakeholder participation
9 Aims to:Improve partnerships between health facilities and the communities.Increase appropriate and accessible health care and information through training of community health workers.Promote key family practices critical for child health and nutrition by training and supporting peer support groups and conducting outreach education campaigns training community resource personsInvolve other community institutions and champions to engage in health education and planning.
10 Convergence Framework for Improved Access to Services Work in collaboration with the existing line departments responsible for enhancement in QOL of the poorestLook at areas where there are gaps and there is a mismatch between the design of service delivery and the incentives linked to those servicesFill those gaps through ways that can be managed and sustained by the community groups even after the project is overHave a cadre of internal facilitators, from among the communities to facilitate/accelerate in the empowerment processHave a cadre of external facilitators to assist in planning and designing sustainable and workable programmesEnable the communities to have choice and control over the services available for themMake the service providers more accountable to the communitiesSuccessful pilots to be up-scaled by the line departments for state-wide implementationSystemsOutputs/outcomePersonnelImproved access to “effective & available” services
11 GoalImproved health and nutrition status of the communities in 62 pilot mandals of Andhra Pradesh by 2009.
12 Objectives Empowered CBOs: Demand access and availing health & nutrition services especially among POP &PoorImprove house hold behaviours that help maternal & child survival and control spread of communicable diseasesProvide financial support during illnessesReduce expenditure on Health
13 5 Key strategies Continuous capacity building Convergence with line deptsCommunity Investment fund (need based health and nutrition projects)Community health resource persons (CRPs) strategy for behavior change.Case Managers
14 IKP Health Value Chain towards reaching MDG 4,5 and 6 Preventive & Promotive Health CareCurative CareFinancing and Service DeliveryHuman/Social CapitalHealth activistCommunity Resource Person (CRP)Microfinance Product for NUTRITIONCase ManagersHealth Risk Fund/ Health SavingsEmpower the CBOs to:Demand and access services from public health systemInfluence household behaviours for maternal and child care practicesNutrition & Health Day (NHD)Health InsuranceMaking Services Work for the Poor – Accessing PHCs & Area HospitalsWater & SanitationCommunity-owned PharmacyNutrition CentersCommunity-owned Hospitals
16 Implementation plan @ 2-5 mandals per district in all 22 districts @ 1 Health Activist per village/habitationHealth sub Committees of VOs/MMS/ZS@ 2 Master Trainers per mandal with ANM training.1 DPM/APM (HND) per district.Field Coordinators at SPMUExisting Committees of Line departmentsFunctionaries of line departments
18 Key outcomesReduction in maternal and child morbidity and mortality (MDG 4 and 5).Reduction in morbidity and mortality due to communicable diseases (MDG 6).Decreased out of pocket expenditure on health
20 Universal interventions Regular capacity building of health activists, health sub committees and health CRPsInstitutionalization of Fixed Nutrition and Health Days (NHDs) towards complete immunization, ANC and PNC.Community kitchen gardensPromotion of weaning foods with locally available commoditiesRegular health savings and HRFCommunity managed health insurance
21 Community-Managed Nutrition cum Day Care Center GoalTo improve Perinatal and neonatal outcomes and child care practices towards achieving the MDGs in rural Andhra PradeshObjectivesTo provide nutritional and health care for pregnant and lactating mothers.To encourage improved health care practices for safe deliveries and have no low birth weight babies.To empower communities to make pregnancy safer and develop change agents to have sustainable impact.
22 Nutrition cum Day Care Center (NDCC) Physical center i.e., building with Kitchen, Dining and Garden (for growing vegetables)TWO MEALS a day prepared and served to pregnant and lactating mothers and children<5 yearsCook is an SHG member trained in preparation of nutritious, traditional diet (with focus on use of millets & greens)
23 Nutrition cum Day Care Center (NDCC) The center also doubles-up as a health check-up centre for pregnant and lactating mothers and children <5 yearsServes as a venue for health education and behavior change communication
24 NDCC Financing Model The cost of meal Rs 25 per day for TWO MEALS for pregnant and lactating mothersRs 10 per day for TWO MEALS for Children <5 yearBeneficiaries pay Rs 18 per day for TWO MEALS; The balance Rs 7 is subsidized by the Community-Based Organization/ Government of Andhra PradeshThe Beneficiary’s contribution is financed via a MICROFINANCE LOAN taken from the Community-Based Organization which will repaid over 24 – 36 months depending on income status of the beneficiary i.e., CONSUMPTION SMOOTHING VIA a CONSUMPTION LOAN
25 Process Discussion with the mothers-mother-in laws Discussion with beneficiariesGrama sabhaDay care for childrenPreparation of MCPFeeding at NDCC
27 Coverage against survey As per enrolment at 600 NDCCs with 332 day care centers.3,220 BPL pregnant women; 1,967 SC/ST3,148 BPL lactating mothers; 1,991 SC/ST3,440 BPL children 0-3yrs; 2,167 SC/STAs per survey at 600 AWCs5092 pregnant women from all categories6043 lactating mothers from all categories9960 children 0-3yrs from all categories.
28 Perinatal outcomes* Against the 2890 deliveries happened: 100 %of women had safe deliveries. [2559 Institutional(88.5%) /331 trained personnel(11.5%)]2599 had normal deliveries (89.9%)291 had cesarean section (10.1%).87% women had complete ANC99% women had PNC46% of pregnant women gained 10-12Kgs weight; 47% gained 7-10kgs weightNo maternal deaths reported among the women enrolled* Source: Internal MIS
29 Neonatal outcomes* 1497 girls (51.7%) and 1398 are boys (48.29%) 97% of babies born with >2.5Kgs56.5% babies with >3KgsNeonatal care practices97% neonates are fed with Colostrum and no pre-lacteal fluids82% delayed bathing the baby for 7 days.* Source: Internal MIS data
30 FAQs about results Accuracy of the measurements? Technical person for supervision?Authenticity of the data?Empirical evidence ?
32 Mainstreaming HIV/AIDS prevention Complementary roles of the Societies.Development of CRPs as TOTs.Regular capacity building of stakeholders at all levels integrated with HN training plans.Exclusive Health CRPs to focus on SHG trainings and referrals.Scale up plans integrated with HN interventions.Knowledge levels and referrals rates are impressive in intervention areas.
33 Roll out plan : 2009-2012 Expansion of mandals (62 to 458) Entire district saturation with universal interventions (6)Coverage of all tribal mandals and disability mandals piloted under IKP.