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  1. CLICK TO ADD TITLE The 6th Global Health Supply Chain Summit November 18 -20, 2013Addis Ababa, Ethiopia One stop shop for improved access, Quality health care and service delivery for rural poor through community managed Nutrition Centers in Andhra Pradesh, India Lakshmi Durga Chava lakshmidurgac@gmail.com Director (CMH&N) Society for Elimination of Rural Poverty(SERP), Hyderabad, India , [SPEAKERS NAMES] [DATE]

  2. Presentation outline Relevance Background Rationale Paradigm shift Implementation Mobile tracking Results Challenges Replicable Way forward

  3. Relevance • Share the experiences in establishing • demand chain – the other side of the health supply chain • mobile tracking system in reaching the unreached • Explore potential networks for partnerships

  4. Society for Elimination of Rural Poverty (SERP) • Autonomous organization established by GoAP in 2000 • Responsible for implementing poverty reduction projects supported by State and Central Govt.; WB and other national and international donors • Works with people’s institutions (women SHGs) at grassroots level • Works in coordination with the govt. line depts.

  5. Institutions of Rural Poor in 16 years 22 ZillaSamakhyas ZS 1,098 MandalSamakhyas MS 45,046 Village Organizations VO 10,72,627 Self Help Groups SHG 1,17,62,814 Members Women Members

  6. Poverty Reduction Strategy

  7. SHG Bank Linkage – Started in 2000, so far, they have availed bank loans of Rs. 52,950 Crs. Year wise SHG wise

  8. Magnitude of the malnutrition 40.4% of children with under weight 37.3% of children are stunted 12.5% of children are wasted 82.7% of children are anemic 37.5% women with BMI<18.5Kg/m2 58.2% of women are anemic Source: NFHS-3

  9. Much concern among poorer sections Source : NFHS-3 Figures are presented as percent of children who are below 2 standard deviations from the median growth indicator value calculated from the WHO reference population

  10. SERP model - Health Value Chain towards reaching MDGs Preventive & Promotive Health Care Curative Care Financing and Service Delivery Microfinance Product for NUTRITION Human/Social Capital • Health activist/ASHA • Community Resource Person (CRP) Case Managers Health Risk Fund/ Health Savings Fixed Nutrition & Health Day (NHD) Health Insurance Making Services Work for the Poor – Accessing PHCs & Area Hospitals – 108,104 and Aarogyasree services Community-owned Pharmacy Water & Sanitation Nutrition cum Day Care Centers Community-owned Hospitals

  11. It is important to note that 50% growth failure accrued by Age 2, occurs in womb & 39% babies are low birth weight 270 days 730 days Imaginary line Proportion of children stunted as per NFHS-3 (%) Low Birth Weight Peak foetal length velocity occurs at around 20 wks Peak foetal weight velocity occurs at around 30 wks Foetal stunting evident by 8 wks P&PE Suppl. 2013, UNICEF 2013, Gillespie 1997

  12. Nutrition cum Day Care Center(NDCC) – (1mt film) Physical center i.e., building with Kitchen, Dining and Garden (for growing vegetables) THREE MEALS a day prepared and served to pregnant and lactating mothers and children <2 years Cook (Para nutritionist) is an SHG member trained in preparation of nutritious, traditional diet (with focus on use of millets & green leafy Vegetables) Health activist (Community nutritionist) provides NHED duirng lunch time

  13. Wight gain – Birth weight • 90% had normal deliveries • 10% had cesarean section. • 52% of pregnant women gained 9 -10Kgs weight Note: study conducted in 8 districts inclusive of mandals in 3 ITDAs. Source : External evaluation study by SOCHURSOD

  14. Utilization of public health facility

  15. Rationale – low uptake • Failure to reach 100% coverage with basic health services is two fold : • no accessibility • lack of quality services • Very little interaction between the departments for • Social mobilization • Service delivery • Fixation of day and time by the service providers often conflict with the work schedules of users. • Users have not had any say in the scheduling process.

  16. Paradigm shift • Fix the mis-match between supply and demand • Community to have stake in quality service delivery • Fix a day to deliver the services on a common platform • Complementary roles by service providers and the user groups

  17. Fixed Nutrition and Health Day (NHD)- The 5 counters platform Mother Child Counter-5 IKP Health sub committee Names: Counter 4 AW Helper (Name) Supplementary food Counter 3 ANM (Name) ANC-Immunization & supply of drugs Counter 2 AWW (Name) Growth monitoring Counter 1 ASHA (Name) Health education Surpanch:

  18. Players Role : Before-During-After ( 2mt film) Mother Child Counter-5 IKP Health sub committee Names: Counter 4 AW Helper (Name) Supplementary food Counter 3 ANM (Name) ANC-Immunization & supply of drugs Counter 2 AWW (Name) Growth monitoring Counter 1 ASHA (Name) Health education Surpanch:

  19. Tracking- mNDCC- DSS Individual JARs for each mobile/VO has to be downloaded. New enrollments or editing existing member information possible Various reports generated as per program design Encrypted data sent in string format Application program decrypts data which is stored in table format Alert sent to provide due list etc. Global Innovation - IWG award 2012 Preloaded SHG member wise database maintained by BF in a different server

  20. Impact of mNDCC • Exceptional reports generation as review tools and take action for • reaching the unreached • escalating the issues if not resolved • Regular review using the exceptional reports showed improved coverage among POP • Enrollment from 58% to 72% • ANC from 10% to 31% • PNC from 5% to 29% • Immunization from 16% to 24% • Growth monitoring from 12% to 39% • Health Education from 14% to 48%

  21. Results – Improved service delivery

  22. Challenges Sensitization and coordination among the line depts Internalization of the concept among stakeholders Fix a day to every habitation based on ANM Tour schedule Accountability to CBOs Bring into the district administration agenda Consolidation and track the outcomes at member level

  23. Way forward – Village level institutions in the driving seat • Recognition of Village Organisation as the nodal institution to monitor health , nutrition and sanitation outcomes (Community) • Institutionalization of VSHNDs under NRHM (Panchayat) • Issue of Government Order – ‘Maapru’ (The Change) to bring all the stakeholders to a common platform (Service providers)

  24. Is it replicable ? • Yes, it is. • Pre-requisites • Availability of community based network • Partnership between the CBOs and the line departments • Sensitization & regular capacity building of the stakeholders • Exposure visits • Trainings • Tracking the member based outcomes • Maintenance of supply chain as per the demand • Political commitment to mainstream

  25. Thank you