ANNUAL PROJECT REPORT

VRIDDHI: Scaling up RMNCH+A Interventions

Annual Project report VRIDDHI: Scaling up RMNCH+A Interventions

ANNUAL PROJECT REPORT October 01, 2015 - September 30, 2016

Scaling Up Interventions in Reproductive, Maternal, Neonatal, Child, and Adolescent Health (RMNCH+A)

USAID Cooperative Agreement No. AID-386-A-14-00001

Submitted by:

IPE Global Limited IPE Global House, B-84, Defence Colony, New Delhi - 110 024 www.ipeglobal.com

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Annual Project report VRIDDHI: Scaling up RMNCH+A Interventions

Table Contents

EXECUTIVE SUMMARY ...... 4 ROLL OUT OF CARE AROUND BIRTH STRATEGY ...... 6 THEMATIC INTERVENTIONS ...... 8 REPRODUCTIVE HEALTH ...... 8 MATERNAL HEALTH ...... 9 NEWBORN HEALTH ...... 10 ADOLESCENT HEALTH ...... 12 KNOWLEDGE MANAGEMENT ...... 13 MONITORING AND EVALUATION ...... 14 STATE ACHIVEMENTS ...... 16 ANNUAL ACTIVITY HIGHLIGHTS: DELHI ...... 16 ANNUAL ACTIVITY HIGHLIGHTS: HARYANA ...... 17 ANNUAL ACTIVITY HIGHLIGHTS: HIMACHAL PRADESH ...... 18 ANNUAL ACTIVITY HIGHLIGHTS: JHARKHAND ...... 19 ANNUAL ACTIVITY HIGHLIGHTS: PUNJAB ...... 20

ANNUAL ACTIVITY HIGHLIGHTS: UTTARAKHAND ...... 21 NATIONAL RMNCH+A UNIT (NRU) ...... 22 JOHN SNOW INC. (JSI) ...... 24 PLANNED ACTIVITIES VS. ACCOMPLISHMENTS -YEAR 2 ...... 27 PROJECT CONTACTS ...... 40

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Annual Project report VRIDDHI: Scaling up RMNCH+A Interventions

EXECUTIVE SUMMARY

VRIDDHI: Scaling up RMNCH+A Interventions project has witnessed a deepening of partnerships with governments and key stakeholders (at national and state levels). The project has designed a comprehensive Care around Birth (CaB) approach to improve the quality of care at and around the time of birth. The primary focus of the CaB approach is to ensure a continuum of care from labor to immediate post-partum period and address the major drivers of mortality during the intrapartum and immediate postpartum periods. The project also promotes and advocates for evidence- based decision with the government by regularly sharing data from Supportive Supervision interventions.

Highlights of Year 2 activities:

National level: There is an increasing engagement of the project with the Ministry of Health and Family Welfare (MoHFW) and VRIDDHI is being included in various technical groups and Figure 1: Project brochures committees. It has contributed to the development of operational guidelines on Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA), Sentinel Stillbirth Surveillance System, Maternal Death Review and revision of Facility Based Newborn Health guidelines.

The project has been supporting National programs and drives in various ways including participation of national and state teams in the monitoring of - Mission Indradhanush (MI), Pulse Polio Campaigns, National Deworming Day, Integrated Diarrhea Control Fortnight (IDCF), PMSMA, Week lron Folic Acid Supplementation Scheme (WIFS) and Adolescent Menstrual Hygiene Scheme. Project also participates in the MoHFW led Common Review Missions.

VRIDDHI hosted a National learning and sharing workshop on ‘Plugging the gaps – optimizing intrapartum MNH services’. The meeting was chaired by Joint Secretary (RCH), GOI and attended by technical officers from the ministry. Besides them, representatives of USAID, Bill and Melinda Gates Foundation, UNDP, UNFPA, WHO, AIIMS, NHSRC, World Bank, ASSIST, Save the Children, Jhpiego, Abt Associates, Digital Green, Population Council. Deloitte, NIPI, Laerdal, Tata Trusts, CARE, PATH, PHFI and Project HOPE participated in the workshop. The workshop provided a platform to discuss and deliberate upon two critical systemic issues of skills and competencies of service providers and quality of MNH care. Supportive Supervision (SS): RMNCH+A SS initiated in year one has matured, and a total of 15,118 visits have been made to 6,580 facilities across 182 districts in the country by the end of year two. The process was reviewed for the progress and needs for any revision. The checklist has been modified to incorporate emerging needs. A new checklist for the community processes has also been developed. By the end of Year-2, 268 district level monitors from 15 states had been trained on the revised and new checklists. Care around Birth (CaB) Strategy: The project has prioritized 141 high case load facilities across 26 High Priority Districts (HPDs) in the six states for concerted actions and to roll out interventions at scale. The CaB strategy was designed and rolled out in this year in the prioritized facilities. Key inputs included training, mentoring and the introduction of quality improvement processes. A total of 1230 participants (nurses, doctors, and

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Annual Project report VRIDDHI: Scaling up RMNCH+A Interventions concerned staff) were trained through district level and onsite trainings, and this was followed up with structured onsite mentoring. In the CaB supported facilities 141 Quality Improvement teams have been formed, and 217 meetings have been held to discuss and resolve local issues and bottlenecks. Reproductive and Adolescent Health: A total of 518 counselors at 141 delivery points have been trained to strengthen Postpartum Family Planning (PPFP) services in the project focus states. In the six focus states, the adolescent health activities have focused on developing improvement plans to strengthen 76 Adolescent Friendly Health Clinics (AFHCs), which will cater to an adolescent population of 5,999,931. Community based Distribution of Misoprostol: In Himachal Pradesh, an implementation model of Community- based Distribution of Misoprostol has been rolled out. A total of 123 frontline workers and service providers have been trained and equipped to deliver the intervention. In five months of intervention, 375 pregnant women have been given tablets, 83% home delivered mothers were covered with misoprostol and not a single case of postpartum hemorrhage was reported among mothers who had received the tablet. This intervention has also been introduced in two districts of Jharkhand - Dumka and Simdega and a total of 97 master trainers have been trained. Strengthening outreach activities- Urban Health and Nutrition Days (UHND): The Delhi state initiative to strengthen outreach services through UHND in a slum area with 600,000 population is underway. A state policy and intervention framework for UHND have been developed, and 383 service providers have been trained. There is a dramatic increase in the number of outreach sessions in the area - 580 UHND days as compared with 15 outreach sessions in the last three years. Block Level Implementation Strengthening Support (BLISS): In Uttarakhand, BLISS has helped to improve delivery of Antenatal Care (ANC) services through 25 community-based health sub-centres. An initial training of 55 health service providers, has been followed up by mentoring and peer learning in smaller groups. A combined approach of training, mentoring, addressing supply gaps and Supportive Supervision has been initiated. RMNCH+A reviews: The project teams in the six states facilitated 65 RMNCH+A reviews at the state and district level. These are emerging as experience sharing platforms for wider dissemination of project learnings and strategies. The launch of Rotavirus Vaccine: State team supported the launch of Rotavirus Vaccine in Haryana. The project supported training of 40 state level master trainers and 296 district and sub-district trainers. The project team in Himachal Pradesh similarly supported the roll out and implementation of Rotavirus Vaccine in the state. Strengthen Maternal and Child Death Reviews: State teams of Delhi, Himachal Pradesh, Punjab and Uttarakhand provided technical assistance to strengthen Maternal and Child Death Reviews. Kangaroo Mother Care (KMC) and Home Based Newborn Care (HBNC) : Activities to promote KMC and HBNC include preparatory work to set up demonstration models in one HPD each in Uttarakhand (Haridwar) and Jharkhand (Gumla) and initiation of training activities for both interventions. Sites have been finalized to establish KMC units and to strengthen HBNC in Haridwar and Gumla districts of Uttarakhand and Jharkhand states respectively. The Haryana State RMNCH+A Unit (SRU) assisted the establishment of model KMC at the district hospital in Panchkula, Haryana. Private Sector Engagement: Landscape analysis for private sector involvement in the provision of RMNCH+A services has been initiated in seven HPDs across the six project states.

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Annual Project report VRIDDHI: Scaling up RMNCH+A Interventions

Advocacy and Communication Materials: The Project has developed advocacy and communication material. This includes a set of three brochures on Project VRIDDHI, CaB strategy and training; a training kit consisting of one trainer’s manual, a set of eight modular training guides and service provider’s reference kits; a set of five job aids for health facility staff for the 141 CaB facilities. A total of eight posters have been developed to promote respectful maternity care in health facilities.

ROLL OUT OF CARE AROUND BIRTH STRATEGY

The project has designed a strategy to strengthen the quality of care, by scaling up evidence-based interventions for mothers and newborns. The strategy is being implemented in 26 HPDs of six project focus states. A total of 141 high case load facilities (delivery points) including various levels of care (L1, L2, L3), and accounting for 70% of institutional deliveries in public health facilities in the HPDs have been prioritized for the intervention. The CaB package has three core steps namely — identifying the gaps, addressing the gaps identified, and continuous monitoring of progress/changes. A systematic approach of baseline assessment, experiential - participatory training, mentoring and low- dose, high-frequency capacity building and activation of facility based quality improvement teams are the core features of the strategy. A comprehensive baseline assessment carried out in the prioritized facilities helped to identify gaps in infrastructure, knowledge/skill of Figure 2: Care around Birth Brochure service providers and service delivery status. The baseline findings from each of the six states were disseminated in state level advocacy workshops under the chairmanship of Principal Secretaries of the respective states. The workshops also served to sensitize and orient state and district officials on project interventions. Following this, a strategy for training and mentoring was also launched in the form of ‘Technical Intervention Package 1 (TIP-1)’ which targeted the most critical and immediate gaps in services and skills related to essential care during the intrapartum and immediate postpartum period for every mother and newborn.

The training itself was designed as a participant-centered –experiential training based on adult learning principles. The delivery of training at each level from national master trainers to frontline workers focused not only on transferring technical knowledge and skills, but also to inculcate mentoring skills. In the course of the training national, state and district project teams and facility leadership learnt to facilitate the transfer of technical content as well as to assume a mentoring role. Till date 679 service providers have been skilled through district level training and 551 additional service providers have been trained through 235 on-site mentoring sessions.

Further deepening of learning takes place through continued advocacy and mentoring, and engagement of local teams to tackle other gaps impeding service delivery. These efforts have translated in the formation of Quality Improvement (QI) teams to strengthen local level analysis and decision making, improve ownership and ensure sustainability of practices.

Formation of Quality Improvement (QI) Teams: QI teams are mandated to monitor service provision and quality at delivery points on a periodic basis and guide improvements. QI teams address both technical and programmatic aspects of interventions. During this year, 141 QI teams have been formed and notified. QI 6

Annual Project report VRIDDHI: Scaling up RMNCH+A Interventions meetings have been initiated across the HPDs since June. A total 217 QI meetings have been completed from June to September in all six project states.

Figure 3: Quality Improvement Activities Update

CAB State QI Meetings Facilities Jun’16 July’16 Aug’16 Sept’16 Total Delhi 8 1 7 7 2 17 Haryana 31 8 7 5 10 30 Punjab 25 3 4 8 12 27 Himachal 17 0 3 6 6 15 Uttarakhand 18 5 5 7 8 25 Jharkhand 42 23 26 30 24 103

Management Information System (MIS): A robust MIS has been put in place to capture critical data elements on a monthly basis to monitor the trends and ascertain the outcome of the strategy. A simple excel based tool has been prepared and introduced to collect and transmit data from all intervention sites. This data is shared regularly to inform facility, district and state level decision makers on the progress of the interventions which helps to overcome local barriers and guides evidence-based decision making.

HIGHLIGHTS

 Baseline assessment on 748 data entry points completed across 141 high case load health facilities for more than 70% deliveries in the public health facilities in the project HPDs • Six state-level advocacy workshops completed between February-May 2016 • 25 district level training completed on TIP-1 till June 2016. 679 service providers trained during district level training • Additional 551 service providers trained on TIP-1 through 235 onsite mentoring sessions • 141 QI teams notified in the intervention facilities • National Skill Labs networked for capacity enhancement of district level providers Figure 4: Training Brochure

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Annual Project report VRIDDHI: Scaling up RMNCH+A Interventions

Figure 5: Roll out of Care around Birth strategy

THEMATIC INTERVENTIONS

REPRODUCTIVE HEALTH

VRIDDHI aims to strengthen delivery points with a focus on PPFP within the framework of Family Planning 2020. The project builds capacities of counselors on the PPFP component by ensuring knowledge and understanding of the GoI guidelines with an emphasis on soft skills, interpersonal communication, and client- friendly approaches. After a centralized training, these counselors are mentored at their facilities to enhance their counseling and communication skills to motivate clients to access quality FP services.

ACHIEVEMENTS IN REPRODUCTIVE HEALTH IN YEAR 2

Strengthening Post-Partum Family Planning (PPFP) services in 141 CaB facilities: The project worked to increase the number of facilities with information, counseling, services, and supplies. This initiative is expected to enhance access, exposure, utilization of services and supplies at delivery points.

Since contraceptive use has a proven association with improved maternal and infant survival and post-partum mothers are particularly vulnerable, the role of counselors is critical at this stage. They can boost adoption of post-partum family planning methods, increase Postpartum Intrauterine Figure 6: Roll play by ANMs during PPFP training Contraceptive Device (PPIUCD) continuation, and decrease

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Annual Project report VRIDDHI: Scaling up RMNCH+A Interventions

PPIUCD removals. A total of 518 Staff Nurses have been trained on PPFP during this year where counseling is a major component.

Discussion on operational aspects of Family Planning supply chain system in the country and possible mechanisms to address existing gaps: A short meeting was held with USAID representatives from Washington and India offices to discuss the FP supply chain system in the country. The points of discussion included forecasting and procurement of FP commodities, findings of Supportive Supervision on the availability of contraceptives across the country, home-based distribution of contraceptives and ensuring the quality of services, and contraceptive social marketing.

Family Planning Compliance Activities: Orientation sessions were conducted on compliance to USG Abortion and FP requirements for all project staff. All staff members including NTSU, NRU, SRU and DTOs and partner organization- JSI India, successfully completed the US Abortion and FP Requirements certification course through Global Health eLearning Centre. All six USAID focus states and national level completed an analysis of the applicability of legislative and policy requirements and Voluntary Family Planning Compliance Risk Assessment. Additionally, compliance monitoring was done in all 141 facilities of six USAID supported states using standard checklists

MATERNAL HEALTH

Health outcomes for mothers and their newborns are inextricably linked; maternal deaths and morbidities impact newborn survival, growth, and development. Recognizing this, VRIDDHI under its CaB strategy has aligned maternal and newborn care interventions to reap maximum benefits in terms of survival and wellbeing of mothers and newborns. The CaB strategy builds upon the GoI guidelines regarding management of major drivers of maternal and newborn mortality. Under CaB strategy, for TIP -1 the major interventions covered under maternal care are — monitoring labor using simplified partograph, Active Management of Third Stage of Labor (AMSTL), care in the immediate postpartum period and counseling at the time of discharge. The strategy is being rolled-out in 141 high case load facilities of 26 districts across the six states.

Achievements in Maternal Health in Year 2

Maternal Death Review (MDR): VRIDDHI supported MoHFW for revision of MDR guidelines, specifically for the revision of the facility based MDR tool, the concept of obstetric transition and National Task Force for Maternal Death Surveillance and Review (MDSR). A concept note was developed, and the budgetary implications of the MDSR were also drafted and the modalities of project support for the activity discussed.

Research Study and pilot test of a technology-based tool for scaling up the use of partograph: Technical support was provided to two studies to analyze the challenges in use of partograph and explore the possibility of using technology to improve compliance. The first study, conducted in the HPD of Hisar, created a comprehensive narrative of partograph use in sub-district facilities (CHCs and PHCs). The study further explored the possibility of an innovative tool to improve partograph compliance to strengthen intrapartum care in sub- district facilities.

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Annual Project report VRIDDHI: Scaling up RMNCH+A Interventions

Respectful Maternity Care (RMC): The concept of RMC was introduced in TIP-1 as a core cross-cutting intervention across the package. VRIDDHI conceptualized and designed posters to sensitize care providers and beneficiaries on the various aspects of RMC. These will be displayed at all intervention sites. MoHFW initiated stakeholder discussions on RMC and had expressed the need to incorporate RMC in all training sessions.

The second study was a demonstration model of m- labour application developed by Dimagi: The study was conducted at Lal Bahadur Shastri Hospital in Delhi. The Figure 7: Respectful Maternity Care Poster intervention involved training of the staff on the use of paper partograph and the practice of using it to monitor labor. The Dimagi m-labour tool was then introduced to evaluate the possibility of an innovative device to improve partograph compliance and in turn, intrapartum care. Regular feedback and monitoring were done to understand and address key issues related to the use of technology.

Position paper on Partograph: Based on the learning from project CaB intervention and studies on partograph use (focusing on challenges and issues in implementing this evidence-based practice), a project position paper bringing out the key enablers and barriers found at the level of the tool utilization, individual provider use and the organization and recommendations to address them has been drafted. This will be finalized and disseminated in the next year.

Framework for ANC: A draft framework is being developed for interventions under ANC aligning with the various related project interventions. The framework brings out the priorities of the project on ANC across various platforms such as outreach services, Village Health and Nutrition Days (VHNDs), sub-district facilities and district-level facilities. The priorities include addressing maternal anemia, detection, and tracking of High Risk Pregnancies (HRPs) and referral management

Anemia Action Plan: States were supported for the review of the anemia guidelines with an emphasis on incorporating a clear protocol for injectable iron sucrose for the management of moderate to severe anemia. Discussions and consultations for developing an operational framework for Maternal Anemia management were initiated in response to the Punjab government’s request for a comprehensive Anemia Action Plan.

Support for National Programs: VRIDDHI supported MoHFW in the development of operational guidelines for PMSMA and monitoring of PMSMA day across the six states. Under the campaign, a minimum package of antenatal care services will be provided to the beneficiaries on the 9th day of every month at the PMSMA Clinics to ensure that every pregnant woman receives at least one check-up in the 2nd or 3rd trimester of pregnancy by a specialist.

NEWBORN HEALTH

Newborn Health has been given renewed emphasis in India and other countries across the globe in recent years. Consonant with international developments, a number of evidence-based interventions aimed at 10

Annual Project report VRIDDHI: Scaling up RMNCH+A Interventions reducing mortality and improving the wellbeing of newborns have been initiated as part of the CaB strategy, for TIP – 1. Major interventions for newborns include Essential Newborn Care and Resuscitation. The strategy is being rolled-out in 141 high case load facilities of 26 districts across six states.

Achievements in Newborn Health in Year 2

Support to ‘Helping 100K Babies Survive and Thrive’ (HBS) project: The Helping 100,000 Babies Survive and Thrive Initiative seeks to save at least 100,000 newborn lives and to facilitate the future in-country ability to continue protecting neonates by scaling up the HBS training and QI initiative. Beginning in 2015, HBS has been working in five districts of India. Two of the districts (namely Palwal in Haryana and Haridwar in Uttarakhand) overlap with VRIDDHI supported districts.

In view of VRIDDHI’s result-oriented CaB strategy, overlapping geographies between both the partners and VRIDDHI’s field presence and technical capacity strengthened over the past two years — HBS approached VRIDDHI for collaboration on techno-programmatic aspects pertaining to their project.

VRIDDHI has provided continuous technical support and shared related data and information with the HBS team. VRIDDHI has supported HBS in the development of baseline assessment tools and checklists based on tools developed and used by VRIDDHI. VRIDDHI team has also provided training support to the HBS team for conducting a baseline survey. Both the partners found it mutually beneficial to have a formal understanding of the cooperation since it would facilitate collaborative work. This joint effort would customize technical interventions to meet the eventual goal of saving newborn lives.

Guidelines for Establishing Sentinel Stillbirth Surveillance System: As part of Technical Advisory Group on newborn health, the project provided inputs on operational guidelines for stillbirth surveillance. The process was initiated by MoHFW in which various organizations, technical bodies, and academic institutions participated. Following the release of these guidelines, sentinel surveillance sites will be established in selected Figure 8: Job aid of Newborn head to toe Examination facilities in various states.

Support to the development of operational guidelines for Facility-Based Newborn Care (FBNC): The project has been actively engaged with the MoHFW in the formulation of revised FBNC operational guidelines. The initiative led by Kalawati Saran Children’s Hospital is expected to be finalized and released in 2017.

Position paper on Vitamin K prophylaxis: A position paper on vitamin K was drafted, based on the major learnings from the project intervention districts. The document details the achievements, challenges and future support that the project proposes to extend for strengthening vitamin K prophylaxis.

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Annual Project report VRIDDHI: Scaling up RMNCH+A Interventions

Figure 9: Percent of Newborns administered Vitamin K1

% of newborns administered Vitamin K1

Avg.

DELHI HARYANA HIMACHAL PRADESH JHARKHAND PUNJAB UTTARAKHAND

ADOLESCENT HEALTH

Project VRIDDHI endeavors to strengthen the adolescent health component of the RMNCH+A strategy. The project has adopted strategies that strengthen service delivery and improves utilization of adolescent health services. Although certain sections of youth seek care through the formal health system, stigma deters many others from accessing healthcare. Negative attitudes of health workers are also a deterrent for many youths, particularly when seeking care and advice on issues related to sexuality. The project has been effective in its efforts to reach out and address specific adolescent needs through AFHC. The scope of AFHCs includes nutrition, sexual and reproductive health, injuries and violence (including gender-based violence), non- communicable diseases, mental health and substance misuse. The project supports the strengthening of 76 AFHCs across 26 high priority districts, in six states of India, by enhancing the capacity of providers to offer adolescent health care. The ultimate goal is to increase the quality of healthcare services provided to adolescents by improving the capacity of primary healthcare providers — namely the doctors, counselors, and Auxiliary Nurse Midwives (ANMs).

Achievements in Adolescent Health in Year 2

Finalization and dissemination of a Rashtriya Kishor Swasthya Karyakram (RKSK) IEC Repository: Based on requests from state governments and lack of RKSK IEC material at one place, the project extensively mapped IEC materials on adolescent health’ available at the national level as well as in the six USAID focus states (Delhi,

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Annual Project report VRIDDHI: Scaling up RMNCH+A Interventions

Haryana, Himachal Pradesh, Jharkhand, Punjab and Uttarakhand). Desk research, as well as visits by the Project team to Ministries, was conducted in some of the focus states. This repository includes most of the IEC materials developed by governments, non-governmental organizations and International Development Partners (such as UNICEF and UNFPA) that are available in the public domain. Posters, banners, handouts, radio and television spots, and hoardings have been arranged according to thematic areas. The compilation displays an image of the IEC materials along with additional information on the agency/organization which has developed it, the language used and the type of the document collated. The repository was widely shared with MoHFW, State AH divisions from the project as well as non-project states. Figure 10: RKSK IEC Repository

KNOWLEDGE MANAGEMENT

The project has undertaken several initiatives to document learnings and disseminate these among a wider group of stakeholders. The aim being to bring greater visibility to the project, explore and advocate opportunities for further implementation in other geographies. The major initiatives till date are a revival of the website, setting up project social media platforms and development of communication materials. Some achievements in this area include:

The revival of project website: VRIDDHI team is currently working on redesigning and development of the website (www.rmncha.in). The website will serve as a forum to share project activities through stories, best practices and repository of all the materials produced. In addition to the social media accounts, the website will serve as an external link in the public domain for sharing project work and experiences. The design phase is completed, and the dynamic website has been developed. The website will be officially launched subsequent to completion of back-end activities.

Set up and maintenance of Social Media Platforms: The team set up social media platforms on Twitter and Facebook and facilitated discussions about project’s focus areas and achievements. The highlight was Global Twitter Chat relay on International Maternal Health and Rights Day (IDMHR) on April 11, 2016, in which the project moderated a 30 minutes technical session on the topic Comprehensive and Respectful Maternal care at the time of Childbirth’. Apart from this, the project has been actively involved in discussions of Maternal Monday, Women Deliver Conference 2016 and other important days and events

A WhatsApp group for the project was set up. This group has members from all districts, states, and the national office. The projects staff uses this group to update the entire project team on live activities and events that occur at all levels; the group also uses the forum to carry out technical discussions (technical queries, sharing technical guidelines and documents, etc.) and also enables team members to showcase their work and innovative ideas for the benefit of the entire team

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Annual Project report VRIDDHI: Scaling up RMNCH+A Interventions

• Development of Communication Materials and Program Collaterals: Developed communication materials such as project brochure, CaB strategy brochure, training flyer, profiles of six focus states • Training package for CaB: Trainers guide for CaB and job aids (Postnatal Counseling, Postnatal Care for Mother and Newborn, Starting Shift Duty in Labour Room

Figure 11: Trainers' Manual on Care around Birth (TIP-1)

• Posters on Respectful Maternity Care for project intervention sites • Job aid for Misoprostol initiative in Himachal Pradesh and Jharkhand a flipbook in local language • Produced eight RMNCH+A bulletins, two technical updates and 34 weekly updates (as on September 2016)

MONITORING AND EVALUATION

The project log frame and strategic operations plan were finalized at the beginning of year two. The Performance Monitoring Plan was developed with indicators and targets for life of the project. During this process, annual activity targets for the second year were also finalized, and these were used for quarterly reports.

Prioritizing intervention sites: As the first step towards implementation of project activities, criteria for selection of health facilities in the HPDs were defined. In line with the project objective, it was decided to use the number of deliveries conducted as the criteria for selection of facilities for implementing project activities. Accordingly, 141 high case load facilities were identified using Health Management Information System (HMIS) data based on the annual number of deliveries.

Establishment of Baseline: To facilitate establishing a baseline for the project indicators, baseline assessment tools were developed, and an orientation workshop was conducted for DTOs, state teams and other project staff involved in monitoring the data collection process. Baseline data was tabulated and shared with state and national teams for further dissemination with the state and district level officials to facilitate informed decision making.

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Annual Project report VRIDDHI: Scaling up RMNCH+A Interventions

Data Quality Assurance: As mentioned earlier, a robust MIS has been put in place to capture critical data elements on a monthly basis to monitor the project interventions. As part of data quality assurance, the national M & E team reviewed MIS data shared by the SRUs and provided detailed feedback on data errors and provided need based follow-up support to state teams in revising MIS data.

Managing Supportive Supervision Database: VRIDDHI also has the mandate of coordinating with other development partners for Supportive Supervision data compilation, analysis, and sharing findings with the MoHFW, GoI. To facilitate the process, VRIDDHI has developed a user-friendly excel tool that meets all the above mentioned requirements. During the year the tool was refined and new features added to suit local requirements − including internet connectivity, etc. Need-based support was also provided to users (both from project districts and those supported by other development partners) in using the tool.

State level M&E support provided during the year: Use of HMIS data for improving program performance is critical. In order to strengthen the process in the state, HMIS data from Jharkhand was analyzed to assess key services related to Maternal and Child health for the year 2013-14 and 2014-15. A summary table highlighting variations in services coverage across the districts and deviations in coverage during the reference period for each of the indicators across the districts was shared with the Director, NHM, Jharkhand. The Director NHM issued a letter to all the districts to undertake the development of plans and initiate measures to improve program performance in their respective districts.

Database of HR to rationalize deployment: Availability of trained staff is critical for the provision of quality health services. Hence, the SRU coordinated compilation of HR data (based on SBA / NSSK training) for the rational posting of ANMs and Staff Nurses in Labor Rooms. The analysis highlighted trained ANMs/SNs posted in non-delivery points and ANMs posted in high case load delivery points requiring SBA / NSSK training. Based on the findings the Principal Secretary, NHM, Jharkhand issued a letter to all 24 Districts in this regard.

Using HMIS data: Identification of low performing areas is crucial for follow-up action to improve program performance. Hence, the State M&E Cell (NHM) was supported for identification of poor performing blocks based on 16 indicators included in the HMIS Dashboard. For these blocks, a state level review meeting was conducted to discuss the impediments and follow-up actions to improve program performance in these blocks.

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Annual Project report VRIDDHI: Scaling up RMNCH+A Interventions

STATE ACHIVEMENTS

ANNUAL ACTIVITY HIGHLIGHTS: DELHI

Population (Projection 2016) Supportive Supervision: Facility visit update from Persons 21285000 October 2015 to July 2016 Male 11827000 Tota No. of L3 Female 9458000 Name No. of L1 No. of L2 l HF Visited Infrastructure of HPD Visited Visited Visit

No. of District 11 ed No. of HPDs 2 North- Facilities and position 1 0 20 8 28 East No. of District 41 North- Hospitals# 2 0 14 16 30 West No. of Sub Total 0 34 24 58 Divisional/Referral 7

Hospitals# No. of Community Operationalizing Urban Health and Nutrition Day (UHND) in Health Centers 26 Delhi: A demonstration model to strengthen outreach Functional# services in urban slums (with resettlement populations) was No. of Primary Health Centers 5 operationalized in an urban slum in North West District. The Functional need for the pilot arose because of several factors. Delhi No. of Health Sub state is predominantly urbanized and has a complicated 27 Centers Functional system for delivery of public health services. The outreach Mortality health facilities are managed by three different government SRS (10-12) NA* MMR entities – Delhi government, Central government and SRS (12-13) NA* Municipal Corporation of Delhi. The newer GoI guidelines SRS (2012) 25 for outreach services in urban areas needed to be IMR SRS (2013) 24 SRS (2014) 20 interpreted and translated into implementation models, and it is widely accepted that population in slums are often underserved vis-à-vis health services. There is a very heavy rush at a higher level of facilities and poor understanding of and confidence in primary health care processes.

Demonstration Model Area Description: In view of the implementation challenges, the SRU in Delhi was entrusted with the mandate of strengthening outreach services through UHNDs. A decision was also taken to implement a pilot project as a demonstration model (on a smaller scale) which could be replicated across Delhi as and when required. The area selected was North-West district (which is a High Priority District catering to approximately 6,00,000 underserved resettlement population, with high risk factors and low immunization coverage). The majority of the population belongs to the low socio-economic segment, and only three UHNDs have been conducted in last three financial years. The number of sessions being held were inadequate as compared to the community needs. Since large gaps existed in UHND implementation in Delhi, it was decided to strengthen the processes in a phase wise manner. VRIDDHI supported the state to define the services package for UHNDs, developed a training package, helped outreach facilities to assess the number of UHNDs needed in their catchment areas, prepared microplanning formats to define site and day of UHND and roster

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Annual Project report VRIDDHI: Scaling up RMNCH+A Interventions of frontline workers to conduct the session, developed monitoring formats and facilitated inter-departmental meetings between ICDS and health departments . The key achievements of UHND are:

 State specific guidelines developed to implement UHND in June 2016  Training for UHND was rolled out in December 2015. Subsequently, the 383 trained frontline workers started holding UHND days as per their plans  Development of tool to be used in the field (monitoring formats as well as reporting formats) and UHND service delivery package  Until April 2016, 178 sessions were held, and 12 review meetings conducted at the facility level, 5 meetings in the district and 5 convergence meetings were held with ICDS.

ANNUAL ACTIVITY HIGHLIGHTS: HARYANA

Population (Projection 2016) Supportive Supervision: Facility visit update from Persons 27478000 October 2015 to July 2016 Male 14892000 No. of No. of No. of Total Female 12586000 Name of L3 L1 L2 HF Infrastructure HPD Visited Visited Visited Visited No. of District 21 No. of HPDs 5 1 Hisar 0 36 7 43 No. of Blocks 119 2 Jind 2 46 11 59 Facilities and position 3 Mewat 13 27 6 46 No. of District 20 4 Palwal 0 35 10 45 Hospitals 5 Panipat 6 58 23 87 No. of Sub Total 21 202 57 280 Divisional/Referral 20 Hospitals No. of Community Support to Formative Research for Development of a Health Centers 109 Communication Strategy for Adolescents: VRIDDHI Functional partnered with the Government of Haryana to conduct a No. of Primary school-based student health survey to understand the Health Centers 461 prevalence of ‘protective’ and ‘risk factors’ of lifestyle Functional No. of Health Sub diseases among school-going adolescents. This exercise would 2569 Centers Functional contribute towards a comprehensive communication strategy Mortality that would address their health and development needs. SRS (10-12) 146 MMR VRIDDHI supported conceptualization and design of the study SRS (12-13) 127 IMR SRS (2012) 42 viz. development of the survey plan, sampling frame, and SRS (2013) 41 selection of schools, adaptation, and finalization of the survey

SRS (2014) 36 tool, capacity building of RKSK counselors for data collection, data aggregation/entry/analysis and report writing. The findings have been disseminated to relevant officials from the state government

SRU has already held initial meetings with RKSK and Behavior Change Communication Divisions of National Health Mission in Haryana and shared a preliminary matrix with regard to strategic themes around which the

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Annual Project report VRIDDHI: Scaling up RMNCH+A Interventions strategy will be focused. SRU is also supporting the identification of a suitable expert partner who will use the findings of the study to finalize the communication strategy.

Revision of Block Level Microplanning Tool: Haryana is about to launch three new vaccines in their routine immunization package as per GoI guidelines. SRU Haryana has taken leadership in revising the block level monitoring tool in line with state needs. Meetings were organized with the Child Health Division of NHM Haryana and partner agencies (JSI India), wherein the proposed changes Figure 12: Routine Immunization tool were discussed, and inputs from partners were added in the revised version of the tool. All involved agencies have agreed with the changes made and final formatting is of the tool is currently being implemented. ANNUAL ACTIVITY HIGHLIGHTS: HIMACHAL PRADESH

Population (Projection 2016) Supportive Supervision: Facility visit update from Persons 7095000 October 2015 to July 2016 Male 3635000 No. of No. of No. of Total Female 3460000 Name of L3 L1 L2 HF Infrastructure HPD Visited Visited Visited Visited No. of District 12 No. of HPDs 4 1 Chamba 11 29 7 47 No. of Blocks 77 2 Kinnaur 6 25 10 41 Facilities and position Lahual & 3 0 1 0 1 No. of District Spiti 12 Hospitals 4 Mandi 4 30 26 60 No. of Sub Total 21 85 43 149 Divisional/Referral 45 Hospitals No. of Community Community Based Distribution of Misoprostol Intervention: Health Centers 78 Misoprostol is one of Functional the recommended No. of Primary drugs to be given for Health Centers 489 prevention of Post- Functional Partum Hemorrhage No. of Health Sub 2068 (PPH) under AMSTL Centers Functional Mortality in resource- SRS (10-12) NA* constrained settings. MMR The Ministry of SRS (12-13) NA* Figure 13: Misoprostol tablet procured SRS (2012) 36 Health, GoI has IMR SRS (2013) 35 included advance distribution of Misoprostol to pregnant SRS (2014) 32 women for anticipated home deliveries. In April 2016, Himachal Pradesh initiated ‘Community Based Advance Distribution of Misoprostol tablets to prevent PPH,' with technical partnership from VRIDDHI. The implementation model named ‘Suraksha- Protecting Mothers’ was piloted in one remote and inaccessible block – Jhanjheli of Mandi district in Himachal Pradesh. VRIDDHI 18

Annual Project report VRIDDHI: Scaling up RMNCH+A Interventions provided technical assistance to develop an operational framework for implementation including a robust monitoring system. The three overarching and interconnected areas of support during the implementation were (i) Capacity Building and Advocacy (ii) Health System Strengthening (iii) End User Engagement. The intervention was launched in April 2016 in Jhanjheli block of Mandi District. A total of 123 frontline workers and service providers have been trained and equipped to deliver the intervention. At the five month mark, 375 pregnant women have been given tablets, 83% home delivered mothers were covered with the lifesaving Misoprostol and not a single case of PPH was reported among mothers who received the tablet.

Joint Supportive Supervision visits with State Government officials: In year two, the project team conducted comprehensive Supportive Supervision visits covering all programs and services with state officials which created a base for improvements before CRM visits also. Hamirpur, Sirmaur, Solan and Mandi were visited by SRU and a team of Deputy Mission Director and State Program Officers from NHM. This exercise played a critical role in the comprehensive understanding of the functioning of these districts to states, and a number of actions were initiated after these visits including a decision to reduce augmentation of labor, stopping the transfer of staff nurses, hiring of dedicated staff nurses for Labour rooms through PIP, etc. A continuous review system has been created on the basis of findings of these visits.

ANNUAL ACTIVITY HIGHLIGHTS: JHARKHAND

Population (Projection 2016) Supportive Supervision: Facility visit update from Persons 33652000 October 2015 to July 2016 Male 17303000 No. of No. of No. of Total Female 16349000 Name of L3 L1 L2 HF Infrastructure HPD Visited Visited Visited Visited No. of District 24 No. of HPDs 11 1 Dumka 18 19 8 45 No. of Blocks 259 2 Godda 11 21 15 47 Facilities and position 3 Gumla 21 20 12 53 No. of District 4 Latehar 57 14 6 77 23 Hospitals# 5 Lohardaga 13 18 14 45 No. of Sub 6 Pakur 33 11 11 55 Divisional/Referral 11 7 Palamu 49 29 10 88 Hospitals# 8 Sahibganj 11 21 7 39 No. of Community 9 Saraikella 2 19 9 30 Health Centers 188 10 Simdega 12 13 6 31 Functional Singhbhum 11 35 38 17 90 No. of Primary West Health Centers 330 Total 262 223 115 600 Functional No. of Health Sub 3958 Centers Functional Jharkhand Newborn Action Mortality Plan (JNAP): VRIDDHI SRS (10-12) 219 MMR supported the state SRS (12-13) 208 government in developing the SRS (2012) 38 Jharkhand Newborn Action IMR SRS (2013) 37 Plan which defines priority SRS (2014) 34 actions for the state and the Figure 14: Jharkhand Newborn Action Plan (JNAP) 19

Annual Project report VRIDDHI: Scaling up RMNCH+A Interventions districts. SRU has also actively supported the state-level orientation of service providers and program managers on Newborn and Child Health guidelines

.The SRU team prepared a Facilitator's Guide in the local language to serve as a comprehensive training package on Newborn and Child Health for district functionaries and ANMs. This includes capacity building on GoI guidelines, use of Gentamicin and Amoxicillin, antenatal corticosteroid, Vitamin K1, Vitamin A, ORS, and Zinc. The team also developed a training booklet which serves as a ready reckoner for frontline workers. A total of 5241 ANMs were trained using a cascading approach, on recently released guidelines using the module titled ‘Comprehensive Newborn and Child health training module’ developed by the project team.

Rolling out Community Based Distribution of Misoprostol for prevention of PPH: The project team supported the state in implementation of the ‘Community Based Distribution of Misoprostol’ for prevention of PPH through state level orientation. The team also conducted the first ToT for Simdega and Dumka districts and supported the drafting of the guidelines in Hindi, preparation of a handbook for ANMs and Sahiyas and developed a flip book for the training. A total of 97 master trainers have been trained in both these districts. This intervention will be further rolled out to other districts in the state

ANNUAL ACTIVITY HIGHLIGHTS: PUNJAB

Population (Projection 2016) Supportive Supervision: Facility visit update from Persons 29112000 October 2015 to July 2016 Male 15718000 No. of No. of No. of Total Female 13394000 Name of L3 L1 L2 HF HPD Visited Infrastructure Visited Visited Visited No. of District 20 No. of HPDs 5 1 Barnala 0 41 11 52 No. of Blocks 142 2 Gurdaspur 0 4 15 19 Facilities and position 3 Mansa 0 21 34 55 No. of District 4 Muktsar 0 19 18 37 22 Hospitals 5 Sangrur 0 11 24 35 No. of Sub Total 0 96 102 198 Divisional/Referral 41 Hospitals No. of Community RKSK Strengthening: VRIDDHI provided technical support to Health Centers 150 the state for effective implementation of RKSK interventions, Functional which has been No. of Primary Health acknowledged by the 427 Centers Functional state government No. of Health Sub 2951 during Regional Review Centers Functional Workshop organized by Mortality GoI on August 11 - 12, SRS (10-12) 155 MMR SRS (12-13) 141 2016 at Shimla. The SRS (2012) 28 project supported the IMR SRS (2013) 26 development of a state SRS (2014) 24 action plan for WIFS which includes user-friendly recording and reporting tools and Figure 15: RKSK review meeting 20

Annual Project report VRIDDHI: Scaling up RMNCH+A Interventions strengthening other components of WIFS. The project team co-facilitated nine convergence meetings at the state and district levels and undertook Supportive Supervision visits in 22 schools and 19 AWCs and provided real-time feedback to the district and state authorities. This resulted in the immediate procurement of blue IFA and supply of red IFA as an interim arrangement to overcome the stock-out crisis, printing of recording and reporting tools and communication materials. The project team had undertaken gap assessments in 13 AFHCs and developed an operational plan in consultation with the officials. The project team facilitated branding of the AFHC by changing the name to “UMANG”, which was also notified by the state. The project team also facilitated mapping of PHCs for selection of peer educators in RKSK districts and identified 55 PHCs for the initial implementation phase.

ANNUAL ACTIVITY HIGHLIGHTS: UTTARAKHAND

Population (Projection 2016) Supportive Supervision: Facility visit update from October Persons 10632000 2015 to July 2016 Male 5431000 No. of No. of No. of Total Female 5201000 Name of L3 L1 L2 HF Infrastructure HPD Visited Visited Visited Visited No. of District 13 No. of HPDs 3 1 Garhwal 0 33 21 54 No. of Blocks 95 2 Haridwar 12 15 15 42 Facilities and position No. of District Tehri 19 3 7 32 17 56 Hospitals Garhwal No. of Sub Total 19 80 53 152 Divisional/Referral 17 Hospitals Strengthening Antenatal Care: Block Level Implementation No. of Community Strengthening Support (BLISS) Model: In Uttarakhand, the Health Centers 59 coverage and quality of Antenatal Care (ANC) has remained Functional poor over the years. Focus during ANC in public settings No. of Primary (especially at subcenter and outreach level) has been primarily Health Centers 257 Functional on Tetanus Toxoid Immunization and Iron and Folic Acid No. of Health Sub Tablets distribution. Other basic components of ANC Services 1847 Centers Functional — including proper history taking, examination, investigations, Mortality and counseling — have largely been neglected. Essential 29 SRS (10-12) commodities required for providing ANC services are also not 2 MMR available in 28 SRS (12-13) adequate 5 quantities. SRS (2012) 34 The VRIDDHI IMR SRS (2013) 32 SRS (2014) 33 team worked closely with the state government to develop a solution titled the ‘BLISS’ Model.

Figure 16: Ongoing Cluster learning sessions 21

Annual Project report VRIDDHI: Scaling up RMNCH+A Interventions

The BLISS model aims to improve coverage and quality of ANC services, in a systematic manner, by addressing knowledge and competency gaps among providers, improving supply and logistics to increase the availability of commodities, and encouraging regular monitoring and review of ANC services. In the initial phase, the model is being piloted in Laksar block of Haridwar district, in Uttarakhand state. The intervention began in March 2016 and is expected to impact approximately 3800 pregnant women annually in block Laksar alone. An initial training of 55 health service providers, has been followed up by mentoring and peer learning in smaller groups. Going forward, the State is planning to expand the BLISS Model for improving ANC coverage and quality to all three HPD’s in the next phase.

NATIONAL RMNCH+A UNIT (NRU)

KEY ACHIEVEMENTS OF NRU

Supportive Supervision Visits: The NRU team members visited a total of 32 HPDs in 20 states to conduct RMNCH+A Supportive Supervision. Of the Total 23 best practices total 32 HPDs, 17 HPDs were covered in 9 states for joint visits led by the identified with respect to Deputy Commissioner of the respective RMNCH+A divisions at MoHFW and four HPDs in four states for integrated field monitoring visits. NRU Maternal and Newborn conducted a real-time assessment of RMNCH+A indicators during the visits health through and also interacted with the state/district government officials and Supportive Supervision stakeholders. The data gathered during the assessment has been shared Visits with 30 state Mission Directors. As a result, the Supportive Supervision checklist has been amended according to the Visit details L1 L2 L3 Total Facilities Facilities Facilities revised indicators. 168 new indicators were No. of SS 2995 5126 2186 10307 added to the Facility Checklist and a new visits community checklist with 110 indicators was No. of HFs 2070 2541 609 5220 also introduced. covered

Regional Review Meeting: NRU facilitated two regional training workshops for the revised SS checklist at Kolkata and Thiruvananthapuram. These trainings were supported by UNICEF. SRUs, District level monitors (DLMs) and Govt. Officials from 16 states participated in these trainings. Around 110 participants participated in these two trainings.

PIP Process:

 Desk review of draft PIP for all the states was done by NRU

 Based on the desk review and Supportive Supervision Visits data findings, inputs were provided by NRU team members on RMNCH+A components. The inputs were shared with a clear strategy for approval to ensure that objectives are met

 NRU team advocated for the allocation of funds to 16 states during NPCC meetings held at MoHFW under the chairmanship of Additional Secretary and Mission Director. Subsequently, approximately 10 million USD were leveraged through NRU’s advocacy

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Annual Project report VRIDDHI: Scaling up RMNCH+A Interventions

Advocacy for Identification of State Lead Partner for the State of Madhya Pradesh: After phasing out of DFID (state lead RMNCH+A partner) from MP, liaising was done by NRU among MoHFW, Govt. of MP and Tata Trust. As a result of NRU’s advocacy, a MoU between Tata Trust and Govt. of MP has been signed.

National RMNCH+A Review Meeting: NRU facilitated two National RMNCH+A Review meetings chaired by Joint Secretary, RCH. The attendees were Deputy Commissioners from all divisions (Child Health, Newborn Health, Maternal Health and Adolescent Health) and consultants from MoHFW along with representatives from all the development partner organizations (UNICEF, USAID, BMGF, NIPI, and UNFPA).

Common Review Mission (CRM): The Annual Common Review Mission has been one of the most important monitoring mechanisms under National Health Mission (NHM). Teams comprising of Government Officials, Public Health Experts, representatives of the Development Partners and Civil Society Organizations visited states for a period of five days and conducted extensive field visits followed by detailed state-level debriefings, culminating in a final report. NRU participated in CRM visits to five HPDs of five states (Himachal Pradesh, Rajasthan, West Bengal, Haryana, and Chhattisgarh).

Intensified Diarrhea Control Fortnight (IDCF): NRU team visited two states (Himachal Pradesh and Tamil Nadu) to provide hand-holding support to field workers and ensure distribution of ORS and Zinc. The field visit observations were shared with CMO, District Nodal Officer for IDCF and District Program Officers for taking corrective measures to strengthen implementation.

Key objectives IDCF:

• To improve awareness about the use of ORS and Zinc for childhood diarrhea management • To complement awareness activities for prevention and management of diarrhea among children in under-five age group • To assess the preparedness, trainings, availability of ORS and Zinc, convergence and program monitoring • To visit at least 10% of ORS-Zinc corners and 10% of households provided with ORS and at least one village that has been covered by ASHA and verify coverage report

Thematic Area-wise meetings • Maternal Health: Participated in desk review of five North-Eastern states (Nagaland, Arunachal Pradesh, Assam, Meghalaya, and Mizoram). State-specific SS visits data, analysis of maternal health interventions was shared; state-specific challenges and recommendations were discussed

• Newborn and Child Health: Advocated for reviewing program implementation with state health officials and the State Lead Partner in relation to Sick Newborn Care Units functionality, newborn care practices in labor room, Navjat Shishu Suraksha Karyakram trainings, Rashtriya Bal Swasthya Karyakram and HBNC

• Reproductive Health: Provided inputs to FP division for the preparation of state progress reports based on reported Supportive Supervision Visits data. Report was presented in National Family Planning Summit (April 2016)

• Adolescent Health: NRU participated in five RKSK regional review workshops held at Madhya Pradesh, Assam, Uttarakhand, Telangana and Himachal Pradesh. NRU also shared the adolescent health findings and reports compiled on the basis of the review

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Annual Project report VRIDDHI: Scaling up RMNCH+A Interventions

JOHN SNOW INC. (JSI)

HUMAN RESOURCES

District Technical Advisors (DTA) for Haridwar and Gumla were recruited and joined their duties in the first week of January 2016. The DTAs underwent induction training in the second quarter of the year and subsequently interacted with district and state health societies to establish rapport and inform them about their role in the district. National and International JSI team members supported the DTAs in this task. State visits for providing specialized technical assistance to Gumla (Jharkhand) and Haridwar (Uttarakhand) were undertaken by JSI national team along with international experts: Dr. Mary Carnell and Dr. Penny Dawson.

ACTIVITIES

Support advocacy for the introduction of Non- Pneumatic Anti- Shock Garment (NASG) for PPH management: Delays in recognizing obstetric complications, the decision to seek care, time taken to reach a care facility, and receiving quick access to blood or surgery in the facility can result in preventing maternal deaths. According to the latest WHO-PPH guidelines, the use of NASGs is recommended as a temporary measure until appropriate expert care is available. There is only partial buy-in from a few state governments for NASG intervention for PPH, Figure 17: Technical Consultation on NASG and there is only one NASG supplier in the country.

JSI has facilitated the process of development of a comprehensive PPH strategy for the GoI through consultative and iterative processes with academia and professional bodies. JSI is collating evidence and research papers to prepare a technical brief on NASG. Leveraging the MoU and a formal agreement with FOGSI, JSI plans to advocate with and influence GoI towards including NASG as a part of a Comprehensive PPH Strategy. After finalizing the NASG technical brief, JSI will organize technical consultations with key stakeholders to discuss the way forward about NASG.

Support for introduction of Chlorhexidine (CHX) for umbilical cord care: JSI also participated in the Neonatal Action Group Meeting of MoHFW where introduction of CHX was one of the issues for deliberation along with other recent recommendations of WHO on Newborn health guidelines —including a short course on antibiotic regimen for community-based management of sepsis in young infants.

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Annual Project report VRIDDHI: Scaling up RMNCH+A Interventions

Demonstration sites for developing scalable models for selected RMNCH+A interventions:

Strengthen services for KMC and Feeding of Low Birth Weight Infants: In Haridwar district, the SNCU of Chain Rai Women’s Zilla Hospital (Haridwar) has been selected for setting up a facility based KMC model in consultation with State/ District teams. District Hospital (Gumla district) has been selected for developing a model KMC site in Jharkhand state.

Figure 18: Meeting to strengthen KMC sites KMC units at private facilities: Initially, the Ursuline Missionary Hospital, Gumla which is a 12 bedded facility, had been selected as a site for a KMC unit in the private sector. However, the delivery load of this facility is quite low. Therefore, the Basia unit of the same hospital, which has a higher load, has been selected for a private hospital KMC unit. In Haridwar, St. Joseph (a large missionary hospital catering to 100 deliveries per month) has been identified as the site for KMC in the private sector. A decision was taken in consultation with the district NHM managers and the management of private hospitals that all Nursing staff and Doctors attending to Newborns in these identified facilities would be trained in KMC by JSI. Under the guidance of Dr. Harish Chellani, Professor (Department of Pediatrics), Safdarjung Hospital, New Delhi, a two-day training of trainers for master trainers from Gumla and Haridwar districts was conducted in the month of July. Four Master trainers, two each from Haridwar and Gumla districts were trained as state trainers. Capacity-building included theoretical and practical sessions with special emphasis on hands-on skill learning. Operational aspects of setting up a KMC unit and potential challenges and their mitigation were also discussed. Figure 19: Trainee learns oro-gastric feeding in Nursery, Safdarjung Hospital Subsequent to the TOT, a KMC policy was drafted and shared with the Civil Surgeons of the two hospitals that had adopted KMC. The SNCU Haridwar was restructured to accommodate a small KMC room with two reclining chairs, a bed, and a separate entrance. The idea was to provide mothers access to the KMC room directly from the waiting area, without having to enter the SNCU. The KMC for eligible infants has been initiated in the Haridwar hospital. Six chairs have already been procured by the hospital management and placed within the SNCU premises. In Gumla, the procurement of chairs is still in process and hence the KMC unit is yet to be fully functional.

The training of nurses and doctors of the government facility in Haridwar is complete. This training package is based on the GoI KMC guidelines, and a Handout has been prepared for community workers. More than half the staffs of Gumla district hospital have also been trained on KMC. The staff of private facilities and rest of the government staff will be trained in the forthcoming quarter. JSI has assisted local experts in developing and roll-out of recording formats that are currently in use. At both the government facilities at Gumla and Haridwar, KMC has been initiated for all eligible infants.

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Annual Project report VRIDDHI: Scaling up RMNCH+A Interventions

Strengthening HBNC services and use of Injection Gentamicin through ANM: In consultation with State authorities, the Basia block in Gumla was selected for demonstration of the HBNC and PSBI management models. Block profiles were developed using Health HMIS RMNCH+A key life-cycle approach indicators. District profiles were developed using HMIS as well as survey-based data (NFHS 4, AHS 1012-13). On studying the block profile in Haridwar, Imlikheda (Roorkee) block has been selected - since it has lowest HBNC coverage (65%); 47% deliveries are conducted at the home of which only 7% are attended by a SBA. Block Bhadarabad, selected earlier, was changed since the block is not rural but located in a peri-urban area. Due to its proximity to Haridwar, most people access both government and private health facilities in Haridwar for delivery and Childcare. This is evident from a 12% home delivery rate. Studies indicate that the community-based interventions selected under the project are more successful in areas with at least 20% home deliveries.

Before initiating activity for HBNC or Gentamicin, the JSI team completed an informal, regular appraisal of project implementation in districts (RAPID) assessment of the knowledge levels of field functionaries with regard to recognition of the danger signs in Newborns. Interactions with district teams and ASHA reveal that there is a need to strengthen skills of ASHA and supervisors on identification and community management of PSBI.

JSI has adapted available GoI guidelines to develop a simple Handbook, in the local language, along with a Facilitator’s Guide for training health workers in Identification of Signs of Sickness in Young Infants by ASHA and ANM and Appropriate Management of signs. The Government of Uttarakhand has endorsed these training materials.

Training of state master trainers was organized on August 23 to 24, 2016 at Gumla, Jharkhand. Two Medical Officers and two ANMs based at Basia block were trained as master trainers along with ASHA facilitators and Block training team of Basia block. The training of trainers at Haridwar is scheduled in the 1st week of October. Skills development, interactive sessions on calculating the requirements of drugs and logistics and filling the recording format formed part of the curriculum.

Strengthening linkages with the private sector for increasing coverage of RMNCH+A services: Broader coverage and improvements in RMNCH+A indicators are possible by partnering with the private sector. However, one of the weak links in India’s health care delivery system is the lack of connection between public and private health care; exacerbated by a sub-optimal environment for promoting public-private partnerships. Engagement of private sector is now being seen as an important opportunity to improve access to quality care for the rural and urban poor.

JSI has already entered into a formal agreement with FOGSI and IAP for the next three years. JSI acts as a broker and leverages these formal partnerships with both IAP and FOGSI to convene national and selected state governments and professional associations for design and implementation of state level action plans and create a roadmap for forging effective partnerships with the private sector. Identifying important motivators for private sector participation will be critical to envisioning clear benefits and ensure the survival of the partnership. JSI will provide technical assistance for policy formulation to ensure active engagement of identified private facilities for providing a broader range of free healthcare services — such as management of sick newborns and children, quality ANC, and pregnancy complications.

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Annual Project report VRIDDHI: Scaling up RMNCH+A Interventions

Landscape analysis of private sector in the provision of MNCH services: JSI has conducted a landscape analysis of private sector provision of MNCH services. The purposes of this analysis are: to understand the current trends in MNCH service provision in the private sector and to explore opportunities for further engaging private sector providers in the delivery of MNCH services in six northern states in India. The information from landscape assessment would guide the multi-stakeholder process for developing a roadmap for forging effective partnerships with the private sector. The proposed private sector strategy would also elaborate on the institutionalization of structures and mechanisms to operationalize public-private partnerships including adequately resourced state and district cells. Further, JSI has planned to facilitate a national level dissemination, in collaboration with professional bodies like NNF, IAP, IMA, and FOGSI.

Auriga was identified as the agency which would conduct landscape analysis and develop a private sector engagement strategy for six USAID states.

Other Technical Support to MoHFW: The JSI team is also working closely with the MoHFW to provide technical support for the development of the Prime Minister’s flagship program called, ‘PMSMA.' The program’s objective is to improve the quality and coverage of antenatal care, diagnostics, and counseling services as part of the RMNCH+A Strategy.

Innovation Summit (August 29 to 31, 2016): The JSI team attended a three-day Innovation Summit organized by the GOI in Tirupati, to showcase state innovations. Out of more than 100 innovations, approximately30 were selected by the National Committee. The participants were from State Governments and their partners. JSI was invited to attend, participate and support GoI towards launching of the PMSMA. JSI also set up a demonstration kiosk during the Summit. PMSMA was the focus during Summit deliberations. The Health Minister emphasized the importance of a smooth roll- out of the scheme with private sector participation. A short video recording from the Prime Minister’s ‘Mann Ki Baat’ (where he mentions PMSMA) was played. The Joint Secretary (RCH) presented the purpose and operational plan for the PMSMA.

PLANNED ACTIVITIES VS. ACCOMPLISHMENTS -YEAR 2

S. N ACTIVITY PROJECT INPUTS PROGRESS AGAINST ACTIVITIES O Output 1: Increase off-take of RMNCH+A services in HPDs MATERNAL HEALTH (MH) 1.1 Strengthen In Year 2, the focus of activities Project successfully established a baseline of delivery points was to establish a structured resources and evidence-based MH practices in IP for CaB with approach to strengthening and IPP period in 141 high case load facilities in focus on delivery points for CaB in 26 26 HPDs across six states and disseminated Intrapartum (IP) HPDs of six states. A combined findings and learning at all targeted 26 HPDs. and Immediate approach of training focused Developed the MH content for state and district Postpartum(IPP) handholding, and regular level training care Supportive Supervision was used for the improvement of 27

Annual Project report VRIDDHI: Scaling up RMNCH+A Interventions

high impact IP and IPP Trained SRUs and DTOs of six states on the practices at high case load 'Strengthening CaB TIP-1, interventions that are facilities to impact universally applicable approximately 70% childbirths in each of the 26 HPDs 1.2 Strengthen The state and district teams Trained 664 service providers (91 Delhi, 142 delivery points were responsible for Haryana, 85 Punjab, 68 Himachal Pradesh, 62 for CaB with implementing the strategy of Uttarakhand and 216 Jharkhand) and oriented on focus on strengthening CaB. The the administrative and clinical leadership of the intrapartum and training package included both intervention immediate clinical aspects as well as Mentoring visit started and 141 QI teams formed postpartum care) operational approaches to in intervention facilities - state and district facilitate change in clinical level activities practice and improve the organization of the labor room 1.3 Support JSI advocated use of NASG Organized three meetings with GoI and FOGSI advocacy for the with the GoI and inclusion of for the introduction of NASG for PPH introduction of NASG into the comprehensive management NASG for PPH PPH Strategy management NEWBORN HEALTH 1.4 Strengthen Year 2 activities for newborn Developed two orientation packages on delivery points health focused on defining a newborn health, including training tools for care for CaB with structured approach to scaling around newborn care corners focus on up care for newborns in their Trained SRUs and DTOs as master trainers and newborn care earliest stages. The project participated in selected district level trainings to corners and developed and implemented a mentor state and district teams services for standardized training module newborns for labor room staff, supported (National) in ensuring functional Newborn Care Corners at the facility level, supported establishment of a skill station at the focal facility, training follow-up, and handholding through intensified Supportive Supervision 1.5 Strengthen Implementation of the Care District and facility level trainings held, 1230 delivery points around Birth strategy. This participants trained for Care around activity involved training of Setting up of demo skill stations activity for Birth with focus state and district teams, newborn care will be revised and carried forward on Newborn care organizing workshops and in the next work plan corners and setting up learning cycles in the services for selected facilities including newborns (State) continued learning for staff at the focal as well as other facilities

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Annual Project report VRIDDHI: Scaling up RMNCH+A Interventions

1.6 Strengthen Project inputs include Facilitated state and district level advocacy services for KMC development of a KMC meetings in Gumla (Jharkhand) and Haridwar and Feeding of advocacy plan, help to (Uttarakhand) to encourage the adoption of KMC Low Birth Weight establish KMC demonstration by government facilities and private health Infants sites in two selected states, facilities strengthen advocacy for wider Identified and demonstrated, models of KMC in adoption of KMC and one block each in Gumla (Jharkhand) and document successful Haridwar (Uttarakhand) approaches to operationalize KMC in both public and private health facilities 1.7 Strengthening JSI’s focus was on replicating Conducted two advocacy meetings with state HBNC services promising approaches to government for demonstration of HBNC model in improve the coverage and identified two districts in two states quality of early neonatal home Conducted a ToT, developed and adapted job- visits made by ASHAs and on aids to improve the knowledge and practice of sharing global evidence which ASHAs, to track newborns, and/or to monitor proves the value of proactively HBNC visits and outcomes tracking newborns in their communities and training community-based health workers to assess and refer sick newborns to higher levels of care and to begin pre- referral treatment, particularly in areas where formal health services are hard to reach 1.8 Support for JSI's focus was on national Organized and facilitated a National Policy introduction of advocacy, and assessment of meeting on CHX Chlorhexidine the supply chain options Global evidence has been collated and (CHX) for (production, packaging, and synthesized umbilical cord procurement) for CHX development of National Policy brief through care National Technical Consultation and technical working group meetings is underway 1.9 Promote use of Operationalizing the use of Two days’ workshop in two states for advocacy Gentamicin and oral amoxicillin and injectable with state government for demonstration of use oral Amoxicillin Gentamicin by ANMs and of gentamicin/amoxicillin models in identified promoting and documenting two districts evidence-based practices in To counter this, ANMs are being trained in the case management of estimating requirements of logistics for this pneumonia in the private program and generating demand from PHC sector were JSI's focus As per discussions with Block officers of both activities blocks, Gentamicin, and other logistics will be provided using RKS funds to initiate the program. Once it is integrated into the system, ANMs will be supported to manage stock and generate demand CHILD HEALTH

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Annual Project report VRIDDHI: Scaling up RMNCH+A Interventions

1. Expanding use of JSI's focus was evidence Completed assessment of knowledge and 10 ORS-Zinc in the generation for expanding the practices of ORS- Zinc in private sector in two private sector use of ORS-Zinc in the private states under ‘Private Sector Landscape and public sector sector. Regular engagement assessment’ and the findings are being collected with professional bodies to and analyzed reach out to private practitioners to assess gaps, update knowledge, monitor practices, and Improving supply chain management in the public sector 1. Develop strategic Project’s focus was on working Rotavirus vaccine introduced in Himachal 11 framework for with the GoI to develop a Pradesh new vaccine comprehensive and tailor- introduction made new vaccine introduction strategy for India 1.1 Support Efforts for improving coverage 16 HPDs from 15 states covered all the three 2 increased of routine immunization were phases of MI. Major activities covered under MI coverage of focused on Supportive were visiting and monitoring fixed or outreach Routine Supervision and monitoring sessions, mobile sessions, and house-to-house Immunization during MI visits All the 184 HPDs across 30 states were targeted under MI rounds 1.1 Strengthen The project inputs were to 92 AFHCs (Delhi 06, Himachal 16, Haryana 15, 3 Adolescent develop at least one model Punjab 10, Uttarakhand 09, Jharkhand 36) were Friendly Health AFHC in each HPD, used assessed for functionality and operationalization Clinics (AFHCs) Supportive Supervision Developed facility level plan for AFHCs in all 26 checklist to assess the facility HPDs readiness and the data utilized Facilitated trainings/ orientations of AFHC staff for decision making to address and enabling environment at 76 AFHCs (Delhi 05, gaps to set up systems and Himachal 09, Haryana 13, Punjab 05, processes Uttarakhand 10, Jharkhand 34) 1.1 Strengthen Within the framework of the Conducted baseline of PPFP services at 141 4 delivery points FP2020 the Project supported delivery points for CaB' with a the capacity building of Facilitated orientation of 518 counselors on focus on PPFP counselors, follow-up on-site technical knowledge and soft skills within the overall mentoring and Supportive Facilitation of peer exchange meetings to framework of FP Supervision and periodic address provider bias is in process and will be 2020 experience sharing meetings completed by next quarter to overcome provider bias in the choice of FP methods Output 2 Evidence for scale up of RMNCH+A services strengthened SUPPORTIVE SUPERVISION

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Annual Project report VRIDDHI: Scaling up RMNCH+A Interventions

2.1 Institutionalize Compiled Supportive Developed an MIS excel based software for management and Supervision checklist data management, analysis and report generation of use of nationwide from all the 184 HPDs. Supportive Supervision data. RMNCH+A cloud Supportive National and state level base software is in process and will be completed Supervision data analyses have been done by by next quarter (M&E Plan) NTSU and NRU. The project Relevant staff of (districts) has been trained on thrust was on developing the use Supportive Supervision software and software and introduction of capacity building will be completed by next relevant staff from all 184 quarter HPDs through concerned development partners and ensured monthly national and state reports as well as national level review using Supportive Supervision data 2.2 Ensure regular The state and district teams District technical officers conducted 266 Supportive were trained to analyze and Supportive Supervision visits and submitted data Supervision and present data to district and to disseminate Supportive Supervision findings in feedback in six state authorities at regular districts states and 30 intervals Facilitated 65 (Delhi 09, Haryana 37, Punjab 01, HPDs Himachal 02, Uttarakhand 07, Jharkhand 09) state and district RMNCH+A program reviews MONITORING AND EVALUATION PLAN 2.3 Establish systems Developing monitoring Established systems for monitoring for evaluation systems for focused project strengthening Care around Birth strategy for all and monitoring activities was included six states of Project checklist(s)/ format(s), tools Established systems for monitoring Community strategies/ for data entry and tabulation; based distribution of Misoprostol intervention in activities identification of roles and Himachal Pradesh and Jharkhand responsibilities of concerned staff for project data collection, data management, and use 2.4 Facilitate The HMIS data was used to Trained six SRUs and 26 district teams on the use quarterly analysis inform review meetings at of data analysis and dashboard for presentation of HMIS data and state and districts to help of HMIS data through a standard format for use of public health care managers in analysis and presentation of HMIS data standardized planning and taking corrective dashboards for actions the six focus states and HPDs 2.5 Support state The project focus was on Jharkhand conducted a workshop for experience teams in deepening SRU’s sharing of PIP preparation enhancing their understanding of the PIP Delhi, Punjab, Jharkhand and Uttarakhand SRUs involvement in planning and budgeting analyzed their state PIPs for differential budget state PIP processes and engaging in and spending preparation for budget analysis for previous states to facilitate fiscal year

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Annual Project report VRIDDHI: Scaling up RMNCH+A Interventions

budgeting for RMNCH+A related services LEARNING AND KNOWLEDGE SHARING PLAN 2.6 Update all key VRIDDHI collated all the The project produced eight RMNCH+A Bulletins, stakeholders information and latest updates two technical updates and 34 weekly updates in including project of RMNCH+A sector and the Year 2 of project team on latest shared the reports in different developments formats and knowledge in the RMNCH+A sector including innovations, researches, events, and news, on all areas related to RMNCH+A 2.7 Share learning The project facilitated The project developed communication materials and insights from publishing project’s learning in such as project brochure, Care around Birth processes from peer-reviewed journals and strategy brochure, training flyer, profiles of six the project's important conferences, focus states, job aids for Misoprostol initiative in work produced project Himachal Pradesh and Jharkhand, trainers guide communication material such for Care around Birth and job aids (Postnatal as brochures, leaflets, posters, Counselling, Postnatal Care for Mother and documentaries to establish Newborn, Starting Shift Duty in Labour Room and rigorous documentation of the Respectful Maternity Care posters) for project project’s work and producing interventions. The team also produced a reader-friendly documents for compilation of an RKSK IEC Repository which is increasing project visibility being reviewed by Deputy Commissioner, MoHFW, prior to its dissemination 2.8 Setting up The project organized an The project organized a national consultation on learning and annual colloquium and ‘Plugging the gaps: Optimizing Intrapartum MNH sharing platforms activated the RMNCH+A web care services’ on September 08, 2016. The forum portal (rmncha.in) to provided scope for experience-sharing and contribute to the creation of a exchanges of lessons learnt with other platform for sharing good stakeholders. A total of 107 participants practices/ innovative attended the consultation. Participants included approaches representatives from USAID, JSI, JHPIEGO and various agencies and organizations working in the RMNCH+A spectrum like Care India, HLFPPT, Abt Associate, PHFI, Laerdal, WHO, Save the Children, etc. The project has revived the website ‘rmncha.in’ which will launch by the next quarter NATIONAL RMNCH+ A UNIT’S PLAN

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Annual Project report VRIDDHI: Scaling up RMNCH+A Interventions

2.9 Strengthen and NRU visited HPDs to monitor Total 32 HPDs visited during Supportive Coordinate first-hand the progress at Supervision Visits Supportive facilities, interact with DLMs Data of 10307 Supportive Supervision Visits Supervision and SRUs to address emerging carried out by DTOs in 5220 health facilities of Mechanism in issues, and share field 182 HPDs 184 districts in 30 observations with key officials. states Ensuring submission of data from each of the 184 districts involves coordination and follow-up with DLMs, SRUs, and DPs. The NRU team generates monthly state and national reports, which are shared with government counterparts for action 2.1 Mapping Developing and sharing a 23 best practices identified with respect to 0 RMNCH+A good repository / Compendium of maternal and newborn health practices and Sustainable and scalable facilitating cross – health innovations and learning among practices will complement the states project’s learning goals. NRU team will be working closely with the Knowledge Hub team and develop a plan and process for mapping the best practices in different states in response to local situations. The information gathered will be compiled to form a repository of knowledge and shared widely among national and state governments and SRUs to encourage cross- learning 2.1 Support MOHFW NRU team engaged with NRU has completed desk review for all 30 PIPs 1 for ongoing policy MoHFW to help strengthen the specifically in RMNCH+A components while the decisions based implementation of the team has attended 16 National Planning and on Supportive RMNCH+A strategy. They also Coordination Committee meetings at national Supervision data provided regular feedback level and visit findings from Supportive Supervision findings to individual divisions as well as to the whole team during national level reviews of RMNCH+A that helped the government to take policy decisions and respond to the emerging situation in a timely manner

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Annual Project report VRIDDHI: Scaling up RMNCH+A Interventions

OUTPUT 3 RMNCH+A GOOD PRACTICES INCUBATED FOR SCALE UP DELHI 3.1 Strengthening Evidence from a rapid The orientation of front line workers on UHND, outreach services assessment of VHND / UHND ANC care / PNC care, took place during district in urban slums in indicates that the district does monthly and state quarterly review meeting. 383 North West Delhi not have planned VHND/ FLWs (118 ASHA /231 AWW / 34 ANM/ LHV and UHND services in the slums. six facilities MOIC) trained in this year Project inputs were provided UHND micro-plans have been prepared by ANMs to support the district to and shared at district and PUHC levels. improve outreach services Supportive Supervision of the UHND is being with a focus on ANC to done according to the plan. There is a dramatic improve birth preparedness increase in the number of outreach sessions in and identify high-risk the area - 580 UHND days as compared with 15 pregnancies in advance, outreach sessions in the last three years counseling and informing the women about facilities and guiding them to make the correct choice at critical times. The project also supported the district to plan and monitor UHNDs in the two identified slum areas in the district HARYANA 3.2 Improve access High fertility and low The project mapped providers/ sites for limiting to FP services for contraceptive uptake are a methods of contraception in public and private young couples in cause of major concern. There sector in Mewat and Palwal HPDs. The project Mewat and is a dearth of trained providers also has been supporting ‘Salamati project’ Palwal for providing sterilization (supported by BMGF) initiated in the two districts services in Mewat and Palwal to improve choice of spacing methods by districts. Since there is an introducing injectable through the public health acute shortage of human facilities. SRU support to the Salamati project resources in the public health included advocacy, monitoring of injectable at system, efforts were proposed facilities and co-facilitating district reviews to engage the private sector to This was a proposed subgrant under Year-2, and augment the public sector FP in consultation with USAID the project did not services take this further 3.3 Support for District hospitals have a high The project developed tools for facility visit for improving ANC OPD caseload that results the recording of services. Health facility visit was management of in long waiting times, lack of done, and project team interacted with service ANC OPD at prioritized and quality providers and clients to understand the provision selected health management of HRP. Hence of services to ante-natal cases. Clients were facilities- in the project team planned to shadowed to understand client flow and service Haryana facilitate the change in one provision. A draft action plan has been district hospital and develop a developed. Next steps include facilitation of demonstration model for the changes in the facility in line with action plan, state exposure visit to a model ANC Facility and regular follow-up of the facility to ensure continuous change 34

Annual Project report VRIDDHI: Scaling up RMNCH+A Interventions

3.4 Facilitate delivery The project adopted a two- The project developed a concept note to select of pronged strategy to address an agency to support implementation of comprehensive the health challenges in urban comprehensive maternal, newborn, and child maternal, slums, working to improve health package for urban poor in Panipat newborn, and both facility and outreach This activity has been put on hold. This was a child health services. Project targeted proposed subgrant under Year-2, and in package for pregnant women and Children consultation with USAID the project did not take urban poor in 0-3 years old in two urban this further Panipat slums with a population of 3,00,000. The aim of the intervention was to develop a scale-up model for replication in other underserved pockets in the state. It was proposed through sub-project using STTA HIMACHAL PRADESH 3.5 Improve The state took the decision to SRU Himachal participated and facilitated four monitoring of the introduce the national joint Supportive Supervision Visits with state RMNCH+A Supportive Supervision officials services through checklist as a tool to improve Quarterly compilation and analysis of Supportive institutionalizing the effectiveness of the Supervision Visits findings and five state-level Supportive supervision and monitoring reviews took place this year as part of Supportive Supervision Visits efforts of its officers/ staff. The Supervision activities in Himachal Project has been supporting Pradesh planning for Supportive Supervision Visits, conducting joint Supportive Supervision Visits along with government counterparts and compilation and analysis of data for periodic reviews at state and district levels. Finally, the project will transfer data analysis and reporting skills to state counterparts JHARKHAND 3.6 Support the Jharkhand planned to The project developed and implemented an operationalizatio introduce the community- orientation and training package including n of community- based distribution of guidance and job aids for frontline workers for based misoprostol intervention and the intervention distribution of the learning from this Training of district level master trainers for misoprostol in demonstration will be used for program managers and block medical officers the state of scaling up in other geographies took placed in two districts of Jharkhand – Jharkhand Dumka and Simdega. A total of 97 master trainers were trained in both districts

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Annual Project report VRIDDHI: Scaling up RMNCH+A Interventions

Misoprostol drug was procured in Dumka and in the procurement is in process at Simdega district of Jharkhand 3.7 Provide technical Supportive Supervision in the Jharkhand conducted the state level TOT for roll Support for roll state has highlighted an out of new newborn and child health guidelines out of new uneven understanding of and trained over 5241 service providers newborn and newborn and child health The SRU team prepared a Facilitator's Guide in child health interventions among the local language to serve as a comprehensive guidelines in implementers. The state has training package on newborn and child health for Jharkhand prioritized orientation and district functionaries and ANM. This includes training of all levels of capacity building on GoI guidelines, use of functionaries on critical child Gentamicin and Amoxicillin, antenatal health and newborn care corticosteroid, Vitamin K1, Vitamin A, ORS, and interventions Zinc. The team also developed a training booklet SRU Jharkhand has actively which serves as a ready reckoner for frontline supported the development of workers job aids on Newborn and Child health. At the state level, the Project will support the development of the training module, training of trainers for all the districts and monitor the progress of training across the state 3.8 Provide technical The JNAP is being drafted VRIDDHI supported the state government to support for according to guidelines spelled develop the JNAP which defines priority actions preparation of out in the India Newborn for the state and the districts. The project has JNAP Action Plan (INAP). The Project also prepared JNAP dashboard indicators to has the overall responsibility monitor the progress of Newborn health across for preparing the JNAP the state document. During Year 2, the JNAP was finalized and launched in the state and the monitoring of its progress initiated 3.9 Support RAPID RAPID is a process that aims to The project has successfully completed three rounds in four improve the quality of rapid rounds in Lohardaga, Simdega and Godda HPDs of immunization services in the districts. One more rapid round for a different Jharkhand district. The overall activity HPD is planned for October 2016 in Saraikela includes a one-day training on immunization followed by field visits to cold chain points and session sites on day one and dissemination of results on day three, through an analytical tool. The Project has been providing technical support to the state for quality assurance

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Annual Project report VRIDDHI: Scaling up RMNCH+A Interventions

of its RAPID rounds and improvement quality coverage of immunization 3.1 Establish a teen- The Project planned to support This activity has been put on hold. A decision will 0 line to increase the state to improve the be taken for next year's work plan uptake of uptake of services at AFHCs by services in setting up a 'teen-line'. The Adolescent teen-line has been envisaged Friendly Health as a centralized call center at Clinics (AFHCs) in the State level, using the select HPDs in existing 104 helpline of the Jharkhand state. The activity was planned as a sub-project through a Non-Governmental Organization (NGO) for implementation 3.1 Facilitate The Jharkhand SRU Developed the training package including 1 RMNCH+A emphasized a two-day content, pre/post assessment, handouts, and technical update technical update training for all agenda for medical medical officers and RKSK Planning of technical update trainings in seven officers and Health Mission (NHM) HPDs are underway and will be carried forward program program managers posted in in Year- 3 managers in the seven USAID supported Jharkhand HPDs in Jharkhand. The expected outcome of this exercise is an improved knowledge of RMNCH+A thematic interventions among service providers as a pre- requisite for effective implementation PUNJAB 3.1 Support for The Project focused on Project has prepared two documents (English 2 capacity building identification and care of HRP and Punjabi) to support for capacity building of of FLW for in the early stages as a strategy FLW for Identification and reporting of HRP in Identification and that will help to mobilize FLWs Punjab reporting of HRP for improved ANC practices. 54 master trainers have been trained through in Punjab The project supported the regular state level meetings on identification of development/adaptation of HRPs in all the districts training packages and protocols to help FLWs identify HRP and optimize care and conducted state and district level workshops to roll out the entire package

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Annual Project report VRIDDHI: Scaling up RMNCH+A Interventions

3.1 Institutionalize Punjab has initiated the 43 Monthly district level reports have been 3 Supportive process of setting up prepared to institutionalize the Supportive Supervision Supportive Supervision core Supervision data mechanism at Punjab feedback sharing groups at the state and district The project also facilitated two meetings of mechanism at levels. These groups are Supportive Supervision core group at state to district level in mandated to review review data and take decisions, and it will Punjab Supportive Supervision continue in subsequent years findings and take appropriate actions to address bottlenecks and issues. The project team at state and districts facilitated regular meetings of the respective Supportive Super core groups, presented analysis of data as well as action taken reports, and supported the core group to decide on priority actions 3.1 Develop an The project supported a rapid The report of the WIFS rapid assessment was 4 implementation review of the WIFS program in shared with the state government during the CaB model for WIFS Punjab revealed several advocacy meeting. After discussions with the adapted to state implementation gaps. It was state government and in light of MoHFW revised situation in two planned to share the report directives for WIFS, a state action plan has been states Punjab and with the state and support the prepared for WIFS. In the next year, the HP within the preparation of an implementation model will be supported in one overall implementation action plan for HPD prior to scale up across the state framework of the WIFS to address the identified AFHCs gaps UTTARAKHAND 3.1 Strengthen block Uttarakhand planned an Project has developed an Improvement package 5 level intervention to strengthen that will help to address the gap in commodities, implementation block level implementation of knowledge, and skills of RMNCH+A services at both facility and Three trainings have been conducted to support services with a outreach levels. The Project training of master trainers/supervisors and FLWs focus on supported the initiative with a to improve competencies and skills for ANC. An identification of focus on strengthening initial training of 55 health service providers, has HRP in coverage and quality of ANC been followed up by mentoring and peer Uttarakhand services. Technical support learning in smaller groups from the Project includes the State directive to use untied funds for development of an procurement of ANC supplies and commodities improvement package to has resulted in significant improvement in address challenges and gaps in availability of the full package of ANC services commodity, knowledge, skills, practices and documentation, The identification and tracking of HRPs has also and referral linkages in a time- been introduced through the BLISS model and is bound manner. The project beginning to show results staff also co- facilitated the roll-out of the improvement

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Annual Project report VRIDDHI: Scaling up RMNCH+A Interventions

package, and it’s monitoring in one block of Haridwar district Output 4 Multiple stakeholders (including private sector Professional) involved in RMNCH+A service Delivery 4.1 Design an The Project planned to design This activity has been put on hold. A decision will intervention a model intervention package be taken for next year's work plan model to improve for intervention over limited SRH outcome of geographies, to promote adolescents and gender transformative young people approach through gender transformative approach 4.2 Strengthening JSI worked comprehensively To finalize tools, checklist, questionnaires (both linkages with the with private sector to achieve qualitative & quantitative) JSI conducted a series private sector for the state specific roadmap for of meeting with Auriga team and took support increasing the private sector facility from JSI (HQ) and M&E team to finalize PSES coverage of engagement for providing assessment tools RMNCH+A MNCH services Development of data collection tool for services quantitative research and data collection from all six states has already been completed. Analysis of qualitative information is underway, and topline findings will be shared by November 16 Empanelment of private health facilities and establishment of practitioner forum activities are underway and will be carried forward in Year-3

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Annual Project report VRIDDHI: Scaling up RMNCH+A Interventions

PROJECT CONTACTS

NAME NAME OF DESIGNATION CONTACT DETAILS ADDRESS OF UNIT HEAD UNIT NTSU Dr. Rajeev Project Director 9810703515 IPE Global House Gera [email protected] B-84, Defence Colony, New Delhi-110024 SRU Dr. Rakesh State Technical Team 8890858863 Room No. 108, State Institute Parashar Lead [email protected] of Health & Family Welfare, om Parimahal, Kasumpti, Shimla, Himachal Pradesh - 171009 SRU Dr. Chitra State Technical Team 8750099998 6 Floor , DSHM, Vikas Bhawan Rathi Lead [email protected] , Civil Lines , New Delhi 110054 SRU Dr. Nidhi State Technical Team 7508618482 Bays 59-62, Institute of Town Chaudhary Lead [email protected] Planners Building, Sector 2, Panchkula-134109, Haryana SRU Dr. Anurag State Technical Team 8872343444 Room No. 325, Fifth floor, Joshi Lead [email protected] Directorate of Health Services, Parivar Kalyan Bhawan, Sector 34A, Chandigarh- 160022 SRU Dr. Jaya State Technical Team 9031056672 State RCH Campus Swarup Lead [email protected] G.V.I., Namkum Mohanty Ranchi- 834010 Jharkhand SRU Dr. Nitin State Technical Team 9719513146 2nd Floor, RMNCH+A Unit, Bisht Lead [email protected] Office of the Director General Medical Health and Family Welfare, Shasheradhara Road, Dehradun-248001, Uttarakhand NRU Dr. Pawan Team Leader National 9229221902 IPE Global House Pathak RMNCH+A Unit [email protected] B-84, Defence Colony, New Delhi-110024 JSI Dr. Avinash Project Director, JSI 9650039901 B6-7/19, DDA commercial Ansingkar India [email protected] complex, Safdarjung Enclave, m New Delhi-110029

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Annual Project report VRIDDHI: Scaling up RMNCH+A Interventions

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