MCSP India Program Year 5 Quarter 1 Report
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MCSP India Program Year 5 Quarter 1 Report OCTOBER – DECEMBER 2018 Submitted on: 1 March 2019 Submitted to: United States Agency for International Development Cooperative Agreement #AID-OAA-A-14-00028 Submitted by: Maternal and Child Survival Program INTRODUCTION The Maternal and Child Survival Program (MCSP) is a global U.S. Agency for International Development (USAID) cooperative agreement to introduce and support high-impact health interventions in 27 priority countries with the ultimate goal of preventing child and maternal deaths. MCSP engages governments, policymakers, private sector leaders, health care providers, civil society, faith-based organizations and communities in adopting and accelerating proven approaches to address the major causes of maternal, newborn and child mortality such as postpartum hemorrhage, birth asphyxia and diarrhea, respectively, and improve the quality of health services from household to hospital. MCSP’s predecessor, The Maternal Child Health Integrated Program (MCHIP) worked in India for its entirety (2009- 2014), supporting the Ministry of Health and Family Welfare (MoHFW) and the National Health Mission (NHM). The program worked with a variety of partners and states to expand access to family planning, improve the quality of midwifery and nursing pre-service education, improve the quality of newborn health care and expand routine immunization coverage. Current MCSP Program Areas in India: Family Planning program (FP) Technical Support Unit-Adolescent Health (TSU-AH) Human Resources for Health- Health & Wellness Centres (HRH-HWC) Family Planning: In India, the Family Planning (FP) program under the MCSP (MCSP-FP) is working to expand access to high-quality family planning services and contribute to India’s FP2020 commitments. The program has successfully advocated for introduction of newer contraceptives in Government of India’s FP basket. The program is also undertaking strategic demonstration at 52 selected health facilities for the introduction of new contraceptives through public health system. Built on the tenets of informed choice, respectful care, gender- sensitivity and community participation in family planning services, MCSP is advocating for the adoption of evidence-based approaches, strategies, interventions and solutions to strengthen the delivery of quality contraceptive services. MCSP is strengthening the ecosystem for delivering quality services by setting up quality counseling services and counseling corners, expanding providers’ as well as trainers’ pool, streamlining facility level management processes, strengthening facility, district and state quality assurance mechanisms, strengthening community linkages and addressing the system level gaps. Technical Support Unit-Adolescent Health (TSU-AH): Technical Support Unit- Adolescent Health (TSU-AH) under the MCSP provides catalytic support to the National and State Governments in effective implementation of the National Adolescent Health Programme (Rashtriya Kishor Swasthya Karyakram) as well as the School Health Program under ‘Ayushman Bharat’. The TSU-AH is also involved in strengthening inter-sectoral co-ordination and convergence between ministries and other agencies working on adolescent health issues, for better synergies. 2 Human Resources for Health- Health & Wellness Centres (HRH-HWC) In India, MCSP is providing technical assistance for strengthening delivery of RMNCH+A and Comprehensive Primary Health Care (CPHC) services and creation of sustainable training ecosystems in five high focus states (Assam, Chhattisgarh, Jharkhand, Madhya Pradesh and Odisha) and seven north- eastern states (Arunachal Pradesh, Manipur, Meghalaya, Mizoram, Nagaland, Sikkim and Tripura). The project includes developing of roadmaps, operational plans and financial proposals for setting up of HWCs in intervention states. Additionally, the project will also build the institutional capacity of the intervention states to train Mid-level Health Providers (MLHPs) in six-month certificate course on community health by establishing the required number of training sites (Program Study Centers) and creation of a pool of trainers. About this report This report is a narration of MCSP activity updates for PY5Q1 and covers the progress on the following program components: Family Planning Technical Support Unit- Adolescent Health Human Resources for Health - Health & Wellness Centers 3 1.0 FAMILY PLANNING GOAL: CONTRIBUTE TO UNIVERSAL ACCESS TO QUALITY CONTRACEPTIVE SERVICES IN INDIA; THUS CONTRIBUTING TO THE FP 2020 COMMITMENTS Objective 1: National level, 5 States: Odisha, Chhattisgarh, Maharashtra, Telangana, and Assam, 5 Districts, 52 facilities Objective 2: National level, 5 States: Odisha, Chhattisgarh, Maharashtra, Telangana, and Assam, 19 Districts, 186 facilities 1.1 OBJECTIVE 1: TO PROMOTE THE EXPANSION OF THE CURRENT BASKET OF CONTRACEPTIVES AVAILABLE IN INDIA BY ADVOCATING FOR (AND DEMONSTRATING) THE INCLUSION OF MORE PROVEN MODERN CONTRACEPTIVE OPTIONS I.E. PROGESTERONE-ONLY PILL (POP) AND CENTCHROMAN. MCSP continues to maintain POP supplies at the 52 focus facilities beyond the 18-month demonstration period that ended on October 31, 2018. MCSP has initiated advocacy with the respective state governments of the five focus states for procurement of POP through state resources and its’ addition in the contraceptive basket at present public health facilities. Government of Chhattisgarh has included and budgeted for POP in the Essential Drug List using state funds to maintain POP commodities at current facilities so that the gains made so far in POP service provision are not wasted. The program is working closely with India Mission in this regard and looks forward to further guidance. Image 1: POP has been included and budgeted in the Chhattisgarh state’s Essential Drug List. (Mubeen Siddiqui/ In PY5Q1, MCSP focused on the strengthening the MCSP India) service provision further for the two new methods (POP and Centchroman) at 52 focus facilities (FF) across five states: Assam, Chhattisgarh, Maharashtra, Odisha and Telangana, increasing the number of women choosing a postpartum family planning (PPFP) method to 21%, as compared to 10% at the beginning of the demonstration (baseline). 4 120% 100% 10% 17% 21% 80% 60% 90% 40% 83% 79% 20% 0% Apr - Dec'16 (Deliveries Apr - Dec'17 (Deliveries Apr - Dec'18 (Deliveries = 69,177) = 74,627) = 74,725) No Method accepted PPFP Method accepted Graph 1: PPFP Shift (Immediate postpartum) The introduction of two newer contraceptives in the public sector contraceptive basket created additional PPFP users, rather than erode the acceptance of other FP methods, as an increase in uptake of methods like PPIUCD and PPS was also witnessed. (Graph 2) 0.… 2.0% 2.3% Apr'18 to Dec'18 (N=25,752) 26.7% 5.2% 33.2% 6.7%4.2% 16.1% 3.4% 1.5% 3.0% 2.1% Apr'17 to Dec'17 (N=20,471) 32.4% 27.2% 8.9% 14.2% 10.0% 0.0% 0.6% 1.9% Apr'16 to Dec'16 (N=16,818) 36.4% 5.8%3.5%6.4% 33.4% 12.5% 0.1% 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% 100.0% Sterilization NSV COC ECP Condom PPIUCD IUCD POP Centchroman Inj. DMPA Graph 2: Comparing the Method Mix across 52 focus facilities Since the roll out of POP and Centchroman services in April 2017 at 52 focus facilities (FF), 4,369 and 7,479 women have accepted POP and Centchroman, respectively, as of December 2018. In the reporting quarter, 375 women accepted POP while 1,119 women accepted Centchroman. Overall, 4.2% of total postpartum women delivering at focus facilities between October to December 2018, accepted either POP (1.4%) or Centchroman (2.8%). 5 Table 1- POP and Centchroman Acceptors by State POP Centchroman Other POP Other State Deliveries Post- than Post- Centchroman Post- than Post- partum Post- partum Post-partum partum partum partum Assam 5667 31 2 0.5% 128 83 2.3% Chhattisgarh 4472 131 2 2.9% 414 150 9.3% Maharashtra 3711 49 2 1.3% 58 79 1.6% Odisha 5633 96 0 1.7% 102 25 1.8% Telangana 7323 60 2 0.8% 54 26 0.7% Total 26806 367 8 1.4% 756 363 2.8% Source: Monthly Progress Reports (MPRs) received from October 2018 – December 2018 The program followed up with both POP and Centchroman acceptors at prescribed intervals of one, three and six months, to see how many among them were continuing with the chosen method. For POP acceptors at completion of 6 months: (Graph 4) o 3,511 acceptors were due for follow-up o 2,598 (74%) were followed-up o 2,374 (91%) were continuing the method All POP acceptors are informed and counselled to switchover to a more effective method at six months and 56% (1,336) of the 2,374 POP acceptors had made a decision to do so. 75% (1,000) of the 1,336 acceptors chose a spacing method, with more than half of them, choosing the Combined Oral Contraceptive (COC) pill (533). Other popular spacing methods included Centchroman (208) and condoms (179). The remaining opted to undergo sterilization (a limiting family planning method). (Graph 3 and Table 2) Most POP discontinuers reported that they discontinued the method due to family reasons (12%). Other reasons for discontinuation included bleeding/menstrual related issues (6%) and the acceptor deciding to become pregnant (6%). Graph 3: Transition of POP Acceptors after Six months (Combined result for all five states) 6 Table 2-Transition of POP acceptors after six months State Continuation Mala-N Centchroman Condom Injectable IUCD Sterilization No Method Assam 297 166 76 34 0 21 0 0 Chhattisgarh 761 33 73 4 3 16 11 621 Maharashtra 273 49 22 36 0 9 10 147 Odisha 869 276 20 89 14 15 309 146 Telangana 174 9 17 16 0 2 6 124 Total 2374 533 208 179 17 63 336 1038 Source: Monthly Progress Reports (MPRs) received from April 2017 – December 2018 Similarly, for Centchroman, the third follow-up was due 6 months after acceptance. (Graph 4) o 4,073 acceptors were due for follow-up.