Health & Nutrition Interventions under IKP

Outline of the presentation Goal Objectives Strategies Tasks accomplished Action plan for the year Conclusion

Goal Improved health & nutritional status in 45 IKP pilot mandals with 1400 VOs of Andhra Pradesh by 2008.

Objectives Empowered CBOs: −Demand access and avail health & nutrition services −Improve house hold behaviours that help maternal & child survival and control spread of communicable diseases. −Provide financial support during illnesses. −Reduce expenditure on Health.

Strategies Continuous capacity building Convergence with line depts Communication for behaviour change through Health CRPs and IEC Community Investment fund for need based health and nutrition projects.

Tasks accomplished so far

Human Resources VO,MMS and ZS level –1Health activist (HA) in every VO –5 member health subcommittee at VO,MMS and ZS level Mandal level: –1 HN CC per mandal –2 Master trainers with ANM qualification per mandal –3 DPM(HND) State level: –2 Regional & 6 district field coordinators –1 Project Manager

Capacity building Institutionalized fixed days of training for Health Activists with a fixed training calendar. (ie.,7th,8th & 29th &30 th ) Capacity building of 5 member Health sub committee (once in a quarter) by the SPMU team. fixed training calendar for regular training of SHG members focusing on Sukhajeevana Suthralu (Neonatal care, maternal care & general health care practices to maintain good health.) Organized training cum exposure visit to Jamkhed for : –478 health sub committee members and health CRPs.(6 days) –90 Master trainers (15 days of training) –35 HN CCs ( 10 days refresher training)

Fixed Nutrition &Health Days (NHDs) Against 1400 VOs, the Fixed NHDs once in 15 days are institutionalized in 859 VOs in 38 mandals.

Health savings-Health Risk fund Against 45 mandals,38 mandals have initiated regular and exclusive health savings.(Rs10-30 per month). 1,03,771 of women in the SHGs (39%) have regular and exclusive health savings to a total amount of Rs 45,89,629. Agianst Rs crores (Rs 1 lakh/VO) sanctioned for 1400VOs, 808 VOs were released with Rs 5,84,80, SHG members availed loans for health purposes to an amount of Rs. 1,08,85,009. (i.e., 42.2% of POP; 46.7% of poor and 10.7% of APL members of the groups).

Nutrition cum day care centers 38 centers in 8 districts. –8 with project support (Krishna & Guntur)- Rs 13/1meal –8 with CFSL implementation (Vizag)- Rs 16/2 meals –22 with loan taken towards diet and support from VO profits and dovetailing the sources from ICDS and JSY ( Vizianagaram, Vizag, E.G, W.G, Krishna, Guntur, Chittoor and Karimnagar)- Rs 24/2 meals. Training module for the members at nutrition center and make them as change agents. Regular ANC and PNC at the center. Counseling of mothers and mother-in-laws on harmful myths that effect the mother and child during and after delivery. Community Kitchen gardens to encourage the practice of use of green leafy vegetables and other vegetables.

Impact on health outcomes Improved weight of the mother during pregnancy. Normal deliveries. Safe deliveries (Institutional/by trained personnel). No complications during delivery Birth weight of the baby is >3Kgs. Practice of neonatal health care measures (2/3 rd of infants deaths are during the neonatal period) –Feeding colostrum –Early and exclusive breast feeding. –Delay in bathing the baby –Kangaroo care for Low Birth Weight babies Decreased family expenditure on health of the mother and the child. (Towards reaching MDG 4,5 &6)

Community managed Health Insurance scheme – KNR & Nalgonda ZS Partnership with Pvt medical college 3-5 years of coverage period 60, ,000 coverage cap premium to all the SHG members and their families Discount on tests and medicines Free In-patient treatment Vizag model with 17 network hospitals is Ready to launch!

Health CRP strategy for BCC Constitution of 5 member team identified from 5 different districts with best practitioners in: 1.Introducing health agenda in SHG/VO/MMS/ZS meetings 2.Training of SHG members on preventive and Promotive health care measures. 3.Promotion of health savings and HRF 4.Promotion of Comprehensive Food security and establishment of Nutrition cum day care centers 5.Social mobilization for convergence activities Fixed NHDs with ICDS and Health dept Environmental sanitation and water safety through Panchayat Screening camps for women Weaning foods for infants 26 days stay in 3 phases ( ) to develop internal CRPs to take it forward. External CRPs work for 15 days outside the VO and 15 days for their own VO.

Achievements in 4 months (Jan-April 07) 110 external health CRPs were trained to work in 8 districts and covered 52VOs ( ). Health agenda is being introduced in all the SHG & VO meetings. 100% members have regular health savings. 90% of members enrolled under CFSL. 24 Nutrition cum day care centers providing diet for 280 pregnant and lactating women from POP and Poor. 3 Community kitchen gardens under IGA. Fixed NHDs are institutionalized.

Achievements in 4 months (Jan-April 07) Convergence at VO level is improved in conducting health educations sessions by the HA &AWW and ANM. Organized screening camps for women and referrals & follow up arrangements. Formation of youth and adolescent groups to focus on bringing awareness on environmental sanitation and personal hygiene in the community and the families. Regular monitoring and review by the health sub committees at VO,MMS and ZS meetings.

Budget - Expenditure Total budget available : lakhs Expenditure incurred:  :268.41lakhs  IHCB: lakhs Total expenditure : lakhs Budget proposed for : 533lakhs

Plans for Continuation of the over arching activities planned such as capacity building. Roll out of the Health CRPs strategy and with the involvement of youth and with the support of local Panchayats. Establishment of community managed Nutrition cum day care centers ( Pregnant, Lactating, Children upto 2 yrs ) by dovetailing funds from ICDS and Janani Suraksha Yojana Funds. Establishment of Drug depots managed at MMS and Village diagnostic centers managed at VO level.

Plans for Establishment of need based CIFs such as sanitary napkin units to encourage adolescent girls and women to maintain menstrual hygiene and protect themselves form RTIs and communicable diseases such as HIV/AIDS. Adoption of tools for community based monitoring and evaluation and make midcourse actions at all levels. Replication of HN interventions in 55 mandals supported by DFID under health sector reform strategy. List of 55 mandals proposed is annexed. Still clearance need to be obtained from the dept of Medical health and Family welfare.

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