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Programme Design for the RCH 2 PIP Review

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Programme Design for the RCH 2 PIP Review NATIONAL RURAL HEALTH MISSION REPRODUCTIVE & CHILD HEALTH PROGRAMME PHASE II 8TH JOINT REVIEW MISSION July – September, 2011 MOIRE DONOR COORDINATION DIVISION MINISTRY OF HEALTH & FAMILY WELFARE GOVERNMENT OF INDIA CONTENTS PAGE NO. 1. INTRODUCTION 1 2. EXECUTIVE SUMMARY 1 Progress 1 Areas requiring attention 5 Key recommendations 6 3. PROGRESS TOWARDS PROGRAM OBJECTIVES 8 RCH II Goals 8 RCH II Outcomes 8 4. PROGRAMME MANAGEMENT AND SUPERVISORY STRUCTURES 9 5. HR DEVELOPMENT 12 6. HMIS AND DATA MANAGEMENT 14 7. QUALITY ASSURANCE SYSTEMS 16 8. GENDER AND SOCIAL EQUITY 18 9. MATERNAL HEALTH 21 10. CHILD HEALTH 24 11. FAMILY PLANNING 25 12. ADOLESCENT HEALTH 27 13. PRIVATE SECTOR INVOLVEMENT/PPPs 28 14. BEHAVIOR CHANGE COMMUNICATION 29 15. PROCUREMENT 32 16. FINANCIAL MANAGEMENT 33 ANNEXES ATTACHED TO THIS AIDE MEMOIRE ANNEX NO A RESULTS MATRIX FOR ASSESSING PERFORMANCE OF RCH – II, INDIA 2005-2009 B STATE VISIT REPORTS - Jammu & Kashmir - Madhya Pradesh - Meghalaya - Maharashtra - Paschim Banga The cover is a reproduction of a Jamini Roy painting titled “Mother and Child”. Courtesy - National Gallery of Modern Art, New Delhi -i- LIST OF ABBREVIATIONS AHS : Annual Health Survey ANC : Antenatal Check ANM : Auxiliary Nurse Midwife ARI : Acute Respiratory Infection ARSH : Adolescent Reproductive and Sexual Health ASHA : Accredited Social Health Activist AWC : Anganwaadi Centre AWW : Anganwadi Worker AYUSH : Ayurveda, Yoga, Unani, Siddha and Homeopathy BCC : Behaviour Change Communication BEmOC : Basic Emergency Obstetric Care BPL : Below Poverty Line CEmOC : Comprehensive Emergency Obstetric Care CES : Coverage Evaluation Survey CH : Child Health CHC : Community Health Centre CNAA : Community Needs Assessment Approach CRM : Common Review Mission (for NRHM) CTP : Comprehensive Training Plan DCGI : Drug Controller General of India DH : District Hospital DHAP : District Health Action Plan DHFW : Department of Health and Family Welfare DLHS : District Level Household Survey DP : Development Partner DPM : District Programme Manager DPMU : District Programme Management Unit DQAC : District Quality Assurance Committee DRCHO : District Reproductive and Child Health Officer DWCD : Department of Women and Child Development EAG : Empowered Action Group EC : Emergency Contraception ECR : Eligible Couple Register ELA : Expected Level of Achievement EmOC : Emergency Obstetric Care EPW : Empowered Procurement Wing F-IMNCI : Facility Based Integrated Management of Neonatal and Childhood Illness FMG : Finance Management Group FMR : Financial Management Report FP : Family Planning FRU : First Referral Unit GM : Gender Mainstreaming GMP : Good Manufacturing Practices GMSD : Government Medical Supplies Department GoI : Government of India HMIS : Health Management Information System HP : Himachal Pradesh HR : Human Resources HRD : Human Resource Development ii LIST OF ABBREVIATIONS (CONT …) ICDS : Integrated Child Development Services IEC : Information, Education and Communication IMEP : Infection Management and Environment Plan IMNCI : Integrated Management of Neonatal and Childhood Illness IMR : Infant Mortality Rate IPAI : Institute of Public Auditors of India IPC : Interpersonal Communication IPHS : Indian Public Health Standards IUD : Intra Uterine Device J&K : Jammu & Kashmir JE : Janani Express JRM : Joint Review Mission JSK : Jansankhya Sthirta Kosh JSSK : Janani Shishu Suraksha Karyakram JSY : Janani Suraksha Yojana LSAS : Life Saving Anaesthesia Skills M&E : Monitoring and Evaluation MCH : Maternal & Child Health MCTS : Mother and Child Tracking System (for pregnant women & children) MDG : Millennium Development Goal MDR : Maternal Death Review MH : Maternal Health MMR : Maternal Mortality Ratio MNGO : Mother NGO MO : Medical Officer MoHFW : Ministry of Health and Family Welfare MTP : Medical Termination of Pregnancy MTR : Mid-term Review NABH : National Accreditation Board for Hospitals NACO : National AIDS Control Organisation NHSRC : National Health Systems Resource Centre NIHFW : National Institute of Health and Family Welfare NMR : Neonatal Mortality Rate NRHM : National Rural Health Mission NSSK : Navjaat Shishu Suraksha Karyakram PCPNDT : Pre-conception and Pre-natal Diagnostic Techniques PHC : Primary Health Centre PHFI : Public Health Foundation of India PIP : Programme Implementation Plan PMU : Programme Management Unit PP : Post Partum PPIUCD : Post Partum Intra Uterine Contraceptive Device PPP : Public Private Partnership QA : Quality Assurance RBF : Results Based Financing RCH : Reproductive and Child Health RKS : Rogi Kalyan Samiti RTI : Reproductive Tract Infection SAA : State Appropriate Authority iii LIST OF ABBREVIATIONS (CONT …) SAC : State Advisory Committee SBA : Skilled Birth Attendant SBCC : Social and Behaviour Change Communication SC & ST : Schedule Caste and Scheduled Tribe SFT : State Facilitation Team SHC : Sub Health centre SHSRC : State Health Systems Resource Centre SIHFW : State Institute of Health and Family Welfare SN : Staff Nurse SNCU : Sick Newborn Care Unit SOP : Standard Operating Protocol SPMU : State Programme Management Unit SRS : Sample Registration System SSB : State Supervisory Board STI : Sexually Transmitted Infection TA : Technical Assistance TFR : Total Fertility Rate TMSA : Technical & Management Support Agency TNMSC : Tamil Nadu Medical Services Corporation TOT : Training of Trainers TRG : Technical Resource Group U5MR : Under 5 Mortality Rate UNFPA : United Nations Population Fund UNOPS : United Nations Office for Project Services UT : Union Territory VHND : Village Health & Nutrition Day VHSC : Village Health and Sanitation Committee iv REPRODUCTIVE & CHILD HEALTH PROGRAMME, PHASE II 8th JOINT REVIEW MISSION O 1. INTRODUCTION The Eighth Joint Review Mission (JRM-8) of Reproductive and Child Health Programme Phase II (RCH II) primarily assessed progress on programme management and supervisory structures, quality, HMIS and data management and gender and social equity. Agreements on the way forward were reached within the core principles of RCH II that include a strong pro-poor focus to reduce disparities in health, gender mainstreaming, state ownership through bottom-up planning, promoting evidence based interventions to ensure quality of care and strengthening results measurement. The JRM-8 held during July 19 – September 16, 2011 was led by the Ministry of Health and Family Welfare (MoHFW) and included state representatives and all development partners suppor ng the RC programme. ield isits ere made to e states i.e. Jammu ashmir Maharashtra Madhya radesh Meghalaya and est engal. his ide Memoir summari es the ndings o the JRM and recommendations on actions to be taken. 2. EXECUTIVE SUMMARY Progress ndia’s MMR at 212 SRS 2007-09) has improved significantly from 254 (SRS 2004-06), IMR at 47 (SRS 2010) has improved from 50 (SRS2009), while TFR at 2.6 (SRS 2009) has improved from 3.0 (SRS 2003). The number of states /UTs achieving the RCH II /NRHM goal1 for MMR, IMR and TFR are 2, 12 and 14 respectively. Two states i.e Kerala and Tamil Nadu have achieved all the three RCH/ NRHM goals. These figures do not reflect the full impact of RCH. Off take of selected services amongst SC, ST, lowest wealth quintile and EAG states has been better than the national average: 12-23 months children fully immunized, overall increase (CES- 2009 over DLHS-2) is 15.2 percentage points where as for SC it is 17 percentage points, for lowest wealth quintile 16 percentage points and for EAG states 18.2 percentage points. Similarly % of eligible couples using modern contraceptive methods the overall increase (DLHS-3 over DLHS-2) is 1.4 percentage points, whereas for SC and ST it is 6 and 3 percentage points respectively. At the national level Programme management Management o RC at the central le el has become much more “hands-on” resulting in a continous search for innovative solutions and improvement. MH, CH and FP have had one 1 By 2012 : MMR : <100; IMR : <30; TFR : < 2,1 - 1 - workshop each with state level counterparts, while ARSH has had two (workshops); a system of periodic, thematic in-depth reviews of groups of states has been initiated; dedicated teams for visits to states / high focus districts have been set up and 34 high focus districts have been visited. Monthly review Meetings with the State Program officers of MH, CH, Immunisation and FP are also being undertaken by National Program Officers particularly for high focus states. 2 state level workshops on Comprehensive Abortion Care have been organised in the states of MP and Chhattisgarh in November and December 2011. Janani Shishu Suraksha Karyakram (JSSK): In an effort to eliminate out of pocket expenses incurred by pregnant women and parents of sick new- born, MoHFW launched Janani Shishu Suraksha Karyakram (JSSK) on 1st June, 2011. Field visits noted satisfactory progress in rolling out of JSSK. JSSK seeks to finance facilities based on a standard costing of agreed inputs to ensure free and cashless deliveries; and hence is a mo e to ards “results based inancing” R and also rights based entitlement . The system of allocating flexi funds to states, preparation and appraisal of state PIPs and preparation of quarterly variance analysis reports for major states has shown further improvement. Efforts have been made to reduce overlaps between RCH and Mission Flexi pools. The quarterly variance analysis report for each state , now also provides an assessment of performance of high focus districts. The Operating Manual for preparation and monitoring
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