Presentation on theme: "A Presentation by Mr. Sudarsan Das, Secretary,HDF"— Presentation transcript:
1A Presentation by Mr. Sudarsan Das, Secretary,HDF Technical Consultation on the Role of Community Based Providers in Improving MNHMaking MNH & FP Access Reality: Role of Community & Community Based Providers – A case of Odisha, IndiaSupported byIndiaA Presentation by Mr. Sudarsan Das, Secretary,HDFWednesday 30 May 2012
2MDG and MNHAt the turn of the millennium, India, along with the rest of the world, committed itself to a common vision for the future - the Millennium Development Goals (MDGs).The MDGs provide the world time-bound targets for several development goals,The two of these goalposts were for child health (MDG 4) and maternal health (MDG 5).
3Realizing the Goals…The realization of goals requires active engagement and ownership of the community which remains passive recipient of services for long with emphasis on Gender and rights based concerns.
4Status of Maternal, Newborn Health & Fertility Level – Current Scenario GoalsIndicatorTargets by 2015Current levelRangeIndiaOdishaImprove maternal health –MDG- 5Maternal Mortality Ratio (MMR)109212*25881 in Kerala and 390 in AssamReduce infant mortality – MDG-4Infant Mortality Rate (IMR)2850*6112 in Kerala and 67 in Madhya PradeshNPP-2000Total Fertility Rate2.1**2.6*2.43.9 in Bihar and 1.7 in Tamilnadu*Sample Registration System (SRS) , 2011** Target by 2010
5Policy DirectionsThe National Population Policy 2000 reiterates government’s commitment to safe motherhood programmes within the wider context of reproductive health programmes by setting the 2010 targets as high as 80 percent of all deliveries at institutions and all deliveries to be attended by trained professionals. The National Rural Health Mission, which brought in an architectural correction in public health, targets reduction of Infant Mortality Rate to 30/1000 live births and of Maternal Mortality Ratio to 100/ 100,000 live births by –Mission Document-NRHM
6Major challenge is how to bring health services closer to community? The RealityWe are yet to achieve the targets and far behind our commitments. There is large rural and urban gap. Access to health services by rural people and the urban poor is limitedMajor challenge is how to bring health services closer to community?
7The answer lies with… Community Health Providers Auxiliary Nurse Midwife (ANM)Accredited Social Health Activist (ASHA)Anganwadi Workers (AWW)Traditional Birth Attendant (TBA)*Community level institutionsVillage Health & Sanitation Committees (VHSC)Self-Help Groups (SHG)Community Based Organisation (CBOs)*TBAs are now out of the system the ASHA has replaced the TBAs
8Community Based Providers: Positioning in Indian Health System A three-tiered system- primary, secondary and tertiary health care.In 1977 first official announcement of the Indian Government to introduce a CHW Scheme across the country envisaging "provision of health services at the doorsteps of villager”. –Which did not work well.In 2005 with the advent of National Rural Health Mission (NRHM) systemic changes were made by design to induct CHWs in the name of Accredited Social Health Activist (ASHA).
9Purpose-ASHA (CBW)ASHA acting as the interface between the community and the public health system.To play a central role in achieving national health and population policy goals.Not a civil servant but a community based volunteer receiving performance based incentives.
10Roles of ASHAs (CBW) A women from the village… Community mobilization & Village health planBehaviour change communication for health & well beingCoordination with AWW, ANM, MPW (M) and connecting to health systemEscort the patient/pregnant women to hospitalDepot holderFirst aidKnowing people in the villageFacilitate Record and registration of vital events
11Progress so far Village with 1000 population have a female ASHA There are 6,38,000 villages in India (0.63 million).Total 8,55,168 (0.85 millions i.e presence is >100%) ASHAs up to 30th September (there are ASHAs even for 300 population in hilly and difficult areas).70% of ASHAs are active.Monthly earning ($30 to $40) per ASHAs based on incentives for:JSY (MNH-Institutional delivery),FP,Morbidity,Monthly meeting
12Cultural & Social Challenges Myths & MisconceptionsDifferent Social Taboos & PracticesPovertyLow level of EducationMobilityCapacity issuesMotivational and other issuesCapacity building and incentive to ASHA is necessary but not enough to ensure their performances
13Community Perspectives People are not informedThose informed do not have access to health servicesThose who have access need better health services
14Improving MNH through community based volunteers – Intervention through CBD in Ganjam, Odisha Increasing access to Information and services for non clinical contraceptives – A Community Based Distribution(CBD)October 2010 to December-2012A joint Initiative of Dept. of Health and Family Welfare,Govt.of Odisha, UNFPA & HDF
15OBJECTIVE S OF CBD COVERAGE To Promote health of mothers and children by addressing unmet need for spacing between births.To Promote Accredited Social Health Activists (ASHAs) and her spouses as community based volunteers for increasing information and access to non-clinical contraceptives.To Promote & Protect couples and families from HIV through community based approaches by providing condomsCOVERAGEAll 22 blocks of the Ganjam district covering Population 3.53 million ( census), 3171 villages, 82 PHC (N), 460 Sub Centers, and 2792 ASHAs.
16Rationale behind CBD project To address high unmet need for FPTo create a continuum of care covering MNH & FPTo engage male partnersTo promote reproductive rightsTo provide information and services of spacing methods at door steps.
17ApproachesFor achieving the objective of the project a two axis approach has been pursued.Community based ASHA and her Spouse for reaching out to couples with unmet need for information and appropriate servicesStrengthening of logistics and supply system towards ensuring improved availability of contraceptives
18Strategic Intervention Addressing the missing links of the existing systemDevelopment of resource and communication material and critical mass of Resource Persons andEnvironment buildingTraining of CBDV - ASHA and her spouse from the community and the ANM as MentorRegular supplies of oral contraceptive pills and condoms through the Health Systems ensuredMamta Diwas for promoting family planning services - Information, Counseling and Administration of checklistsELCO Survey jointly by ASHA and ANMMIS developed and reporting through AMAR by ASHADocumentation and Advocacy______________In the continuum of services____________
19Project achievement MIS - ASHA Monthly Activity Report (AMAR) Methods Oct 11Mar 12Sterilized147593161479CC User1096314015OCP User2940231755IUCD user27263088CC dist.5135979448OCP dist.1470817068
21No more MTPs for Rama Rama Gauda -village Sirikoi ,Belleguntha Block Married in in the year 2003.1st child 3 years after the marriage -male child who is 6 years now.Rama wasn’t keen on increasing the size of the family. But she also not aware of temporary methods of contraception as a result she conceived frequently and had to undergo MTP (Medical Termination of Pregnancy) each time. Rama was feeling very weak because of these repeated MTPs. She discussed with her husband to adapt to alternatives to avoid frequent pregnancy. Being illiterate, ignorant and guided by the age old conception of the reproductive responsibility of women, Ramesh did not shoulder his share of responsibility.One day Rama consulted Rajalaxmi Nayak -ASHA of the village. Rajalaxmi informed Rama that she used oral contraceptive pills (OCP) and her husband used Nirodh .She also explained Rama in detail about different temporary methods of contraception and their benefits clarifying all doubts of Rama regarding the use of contraceptives. Rajalaxmi also told Rama that she could take Nirodh and OCP from her at any time absolutely free of cost.Since then Rama has been using Mala N contraceptive pills from Rajalaxmi and avoids pregnancy. Initially she did not inform her husband of this. Now her husband also understands the benefits of temporary contraceptives and they are happy.
22OutcomeCBD Project has been successful in promoting spirit of voluntarism among ASHAs in Ganjam.Overcome socio-cultural barriers for mother and child care.Availability, accessibility and acceptance of nonclinical contraceptives has increased.Enabling Environment at every level by the project has been built, resulting scope of sustainability of the project.CBD Project has been promising in bridging gap between User and the service providers under Health & Family Welfare to promote rights based programming.
23Change in ASHA Knowledge, Attitude Practices after CBD Results from the independent studyKnowledge on family planning services, advantages and side effects among ASHAs is more in the CBD implemented districts (mean score 36.7) than non-CBD district (mean score 32.9 significant at p=0.028)Information on sex selective abortion is higher in CBD district (51% in CBD; 13% in non-CBD)ASHA as a major source of Condom and OCP users in CBD districtsThe misconception about FP in the intervention area are about 1/3rd less than the non-intervention areas.Regular supply of OCP/Condom is reported by ASHA for their distribution in CBD district (78%) than in non CBD district (22%)ASHA actively perform Eligible Couple Survey by themselves (81%) in CBD districtStudy byDr. Nishitha Ranjan Dash,Ravenshaw University, Odisha, April 2012
24Way forward: Communitisation- the Key for promoting MNH One of the most important and vital component of NRHM is that it provides mechanisms for what we call “Communitisation” i.e.Community participationCommunity involvementCommunity based planningCommunity managementCommunity monitoringIn short Community action and Community ownershipNeeds attention for intervention
25Way forward Bringing the Public back into Public Health by allowing community members and their representatives to directly give feedback about the functioning of public health services, including giving inputs for improved planning of the same which will in turn bring in transparency, accountability and effectiveness of the system.
26Communitization Framework Health system(health care providers & managers)Community(community-based organizations & NGOs)Communitization ProcessLocal self government institutions
27Can we direct our efforts towards this…….????? EpilogueNo major change is possible without organized involvement of people; If people are organized and mobilized, no change is impossibleCan we direct our efforts towards this…….?????