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PA00TJT1.Pdf Acronym List ANM: Auxiliary nurse midwife ASHA: Accredited social health activists AWW: Anganwadi workers BGMF: The Bill & Melinda Gates Foundation CMO: Chief Medical Officer DHS: District Health Society DMPA: Depot medroxyprogesterone acetate DPMU: District Program Management Unit DWH: District Women’s Hospital EoI: Expression of Interest FDS: Fixed day services FPA: Family Planning Associates FPC: Family Planning Coordinators FP: Family planning FPLMIS: Family Planning Logistics Management Information System GoI: Government of India HIA: High impact approaches HMIS: Health management information system IUCD: Intrauterine contraceptive device MAS: Mahila Arogya Samiti mCPR: Modern contraceptive prevalence rate MNCH: Maternal, newborn, and child health MoU: Memorandum of Understanding MP: Madhya Pradesh NBSU: Newborn Stabilization Unit NHM: National Health Mission NHSRC: National Health Systems Resource Centre's NSV: No-scalpel vasectomy NUHM: National Urban Health Mission ORC: Out Reach Camps PIP: Program Implementation Plan PSI: Population Services International RMNCH: Reproductive, maternal, newborn, and child health RMNCH+A: Reproductive, maternal, newborn, child and adolescent health RoP: Record of Proceedings SIFSPA: State Innovations in Family Planning Services Project Agency SBCC: Social and Behavior Change Communication SPMU: State Programme Management Unit TCI: The Challenge Initiative TCI U: The Challenge Initiative University TCIHC: The Challenge Initiative for Healthy Cities ToR: Terms of Reference ToT: Training of Trainers UHND: Urban Health and Nutrition Day UP: Uttar Pradesh UPHC: Urban Primary Health Center UCHC: Urban Community Health Center 2 Background The Challenge Initiative for Healthy Cities (TCIHC) is a “business unusual” approach for scaling up proven solutions to improve the health of the urban poor. TCIHC is a multi-year intervention supported by USAID/India and the Bill and Melinda Gates Foundation (BMGF) to strengthen city- level systems and improve family planning and maternal health and new born health services for the urban poor in three states of India - Uttar Pradesh (UP), Madhya Pradesh (MP), and Odisha. The interventions are founded upon evidence-based approaches and provide technical guidance to improve overall health systems of cities. Population Services International (PSI) in partnership with Save the Children work with national, state and city officials, civil society and private sector partners to develop proposals for scale up of proven FP and MCH interventions that are both cost-effective and customized to urban needs and circumstances The Initiative builds on existing service delivery mechanisms within the Government of India’s (GoI) National Health Mission to help meet urban health care needs. Through coaching and mentoring at different levels and through community outreach and behavior change campaigns, the Initiative helps to raise awareness and increase demand for FP and MNH services. Finally, through advocacy at the city, state and national levels, the Initiative helps to ensure continuity and sustainability in the funding and functioning of city health systems. In so doing, it assists urban local governments to build their own capacity to manage, implement, and monitor responses to health issues, increase modern contraceptive prevalence rates (mCPR), and improve the coverage and quality of other RMNCH interventions. Major Accomplishments Scale: TCIHC drove the systematic scale up of the program from 12 cities in the previous quarter to 31 cities in three states during the reporting period. TCIHC management team initiated support to these cities through hiring staff, training Accredited Social Health Activists (ASHAs), and ongoing mentoring and coaching support to ASHAs. For state details see sections below. Sustainability: TCIHC ensured that the government was fully on board and in the driving seat for all scale-up activities. Two key developments occurred during the reporting period to this end: NHM Uttar Pradesh signed a tripartite memorandum of understanding (MoU) between PSI, NHM, and the Health directorate which clearly defines the role of government as leader and TCIHC as facilitator. Similarly, the government of Odisha issued a long-awaited letter of support to TCIHC. Both the MoU and the letter of support will be key in supporting program activities and sustainability. Monitoring and Evaluation: TCIHC submitted the required Performance Monitoring Plan (PMP) to USAID and Gates Institute during the report period. The Initiative team developed and piloted 3 a TCIHC management information system (MIS) in UP, with the intent of scaling up the system in MP and Odisha, as well as shifting from a paper-based system to a mobile based real-time/near- time data management system (pls confirm time period for these two efforts within MIS, 2 months 6 months?). The MIS was developed and is being implemented to understand how far, fast, and well TCIHC is operating. TCIHC has received a partial data inflow in this quarter, with the aim of having a full dataset for the next quarterly reporting cycle. Additionally, the output tracking survey (OTS) received the necessary approvals including Indian and JHU IRB approvals and is now set to be rolled out in next quarter in 14 TCIHC cities (April-June). Additionally, PMA Agile initiated data collection in all three TCIHC cities. Launch of referral mechanism: The referral mechanism has been operational in Indore from December 1, 2017 and the mechanism has been rolled out in Gwalior and Berhampur, with formal launches planned for next quarter. The baseline assessment, customization of referral protocols, finalization of the referral loop, translation of protocols and referral slips, and pre- testing of all the tools have been completed in Gwalior and Berhampur cities. The District Program Management Unit (DPMU), Bhopal has also requested TCIHC to initiate this activity in Bhopal and discussions have begun. At present, six city teams (three from each state) and state level delegations from both Odisha and MP have completed exposure visits to Pune to understand the referral mechanism established there by Save the Children’s Saving Newborn Lives program. TCIHC is advocating with government to scale up the model in other cities with NUHM resources. Use of High-Impact Approaches “How To” tools: Codified high-impact approaches were significantly used during this quarter and resulted in many outputs. The fixed day services (FDS) tool helped to scale up FDS services from 53 to 138 facilities across the three TCIHC states. The Program Implementation Plan (PIP) tool helped 22 cities in all three states to navigate the PIP process. All 9 tools have been uploaded to TCI University and can be accessed at the following link: https://tciurbanhealth.org/india-toolkit/ Two key achievements are appended below which show a significant change in the number of intrauterine contraceptive device (IUCD) insertions and facilities conducting FDS, demonstrating increased system readiness: 4 1. 44 facilities where TCIHC supported initiation of FDS reported an 84% increase in IUCD insertions compared to the previous year during the same period (Source government HMIS): 2. The number of facilities activated (started FDS) for FP and MNH services increased from 53 in the last quarter to 138 during this reporting period across the three TCIHC states (source-Project reports): STATE WISE PROGRESS Uttar Pradesh (UP) • Support extended to Government of UP in preparation of program implementation plans (NUHM PIPs, 2018-19): In the current quarter, the TCIHC team supported preparations for the annual budget planning exercise at the state and city level (the 2018-19 Program Implementation Planning [PIP] process) in collaboration with the National Urban Health Mission (NUHM). In the PIP, TCIHC worked with cities to integrate high-impact approaches (HIA) such as FDS into their proposals to increase the uptake of FP services across all urban 5 primary health centers (UPHCs). Further, to strengthen service delivery in UPHCs and urban community health centers (UCHCs), TCIHC helped cities integrate critical procurements for equipment and consumables. Out of 20 cities on board in UP, TCIHC provided this support to 11 cities1. • City consultations in new cities: To bring all urban health stakeholders onto a common platform and identify gaps and possible solutions for demand and service delivery challenges, city consultations were organized in Saharanpur and Ghaziabad cities. As a result, stakeholders operating in the arena of urban health converged and developed a City Plan to improve urban health indicators, with special focus on slum dwellers. Total # # of Total consultations Planned for Remarks of cities sConsultations till date next quarter (this quarter) 20 2 7 13 Gaps identified (for supply, demand and enabling environment). Detailed report is under preparation. • Visit of Dr. Basab Gupta, Deputy Commissioner, NUHM, GoI: Dr. Basab Gupta visited one of the TCIHC cities, Varanasi, to observe the Intensified Mission Indradhanush (IMI) to improve immunization status in cities. He also met with the City Commissioner, Mayor, and Chief Medical Officers (CMOs) of the city to support convergence among various departments. His visit resulted in improved coordination between the District Urban Development Agency (DUDA) and the Health Department (for instance, as a result a City Coordination Committee meeting was organized that brought together government stakeholders from various departments
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