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Report
“Gumla District Workshop for Intensification and Harmonization of
Efforts in High Priority Districts for Improved Maternal and Child
Health Outcomes”
Conference Hall, Deputy Commissioner Office
District Gumla, Jharkhand
26th October 2013
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Contents
Introduction 4-5
Technical Sessions
An Overview of Reproductive, Maternal, Newborn Child Health +
Adolescent Health (RMNCH+A) Strategy and State Level RMNCH+A
progress update
5-8
Progress and Challenges of RMNCH+A in Gumla district 8
Block Monitoring Visits envisaged under RMNCH+A 9
Jharkhand Dashboard for Child Survival: Progress monitoring of
RMNCH+A implementation in Jharkhand 9-10
New Initiatives under RMNCH+A: Rashtriya Bal Swasthya
Karyakram 10-11
Open Forum 11
Glimpses 12
Annexure 1: Workshop Agenda 13
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Introduction
To accelerate the progress towards attaining Millennium Development Goals 4 and 5, health
based targets enlisted in the 12th Five Year Plan and achieve the goal of reducing Under 5
Mortality Rates (U5MR) to less than 20 by 2035 as envisaged in the Call for Action Initiative;
Government of India (GOI) has prioritized 184 poor performing districts across 29 states in the
country based on a composite set of indicators for focused interventions across the entire
Maternal and Child Health spectrum. GOI has adopted the Reproductive Maternal Newborn
Child Health + Adolescence (RMNCH+A) approach for implementation across these 184
districts referred to as the High Priority Districts (HPDs). Jharkhand is one of the focus states in
the country critical to the implementation and realization of this strategy.
To fast track the implementation of the RMNCH+A approach in Jharkhand; The Department of
Health, Medical Education and Family Welfare, Government of Jharkhand (GOJ) in
collaboration with USAID organized the “State Consultation for Intensification and
Harmonization of efforts in High Priority Districts for improved Maternal and Child Health
outcomes”, at Ranchi, on 19thJuly 2013.
Continuing forward with the intensification of efforts district level RMNCH+A orientation
workshops have been planned in all the 11 HPDs of the State. The fourth in this series of
workshops was organized in District Gumla on 26th October 2013 by the district administration
in collaboration with USAID-MCHIP.
The orientation workshop provided a platform for the formal launch of the RMNCH+A strategy
in the district and brought together 76 district and block level delegates from the Health, Social
Welfare and Education departments to discuss and deliberate on efforts and interventions aimed
at reducing infant and child mortality in the district. Conducted under the chairmanship of the
Deputy Development Commissioner Sri Punai Oraon, the workshop was attended by all the
important district administrators and officials including the Civil Surgeon Dr. L. N. P. Bara,
Additional Chief Medical Officer Dr. J. P. Sanga, District Social Welfare Officer Ms. N.
As a part of this strategy GOI has identified 11 such HPDs namely Dumka, Godda,
Gumla, Latehar, Lohardaga, Pakur, Palamu, Sahibganj, Seraikella-Kharsawan,
Simdega and West Singhbhum in Jharkhand
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S.Kumtia and Deputy Superintendant of Education Mr. Arjun Prasad. The workshop also saw
the participation of technical experts from USAID-MCHIP, WHO-NPSP, UNICEF, IHBP-FHI
360, Save the Children and Vikas Bharti. The workshop started with Dr.L.N.P. Bara welcoming
the participants and briefing them about the RMNCH+A strategy.
Technical Sessions
An Overview of Reproductive, Maternal, Newborn Child Health + Adolescent
Health (RMNCH+A) Strategy and State Level RMNCH+A progress update
The first technical session of the workshop provided an overview of the RMNCH+A strategy and
progress update on activities undertaken in the State till date by Dr. Gunjan Taneja, State
RMNCH+A Team Leader, USAID-MCHIP. He began his talk by updating the participants on
the Global and National Call to Action Summits held at Washington and Chennai respectively
which resolved to bring down Under 5 Mortality to less than 20 by 2035 and laid the foundation
for the roll out of the RMNCH+A strategy in India. Dr. Gunjan stressed upon the fact that the
Call to Action initiative in the country has brought together all key stakeholders be it National
Ministries dealing with social determinants of Health, State Governments, Development
Partners, Academicians and Researches, Private Sector, NGOs and Civil Society Organizations
(CSOs) to work in unison towards
improved and better Maternal and Child
Health Outcomes. He stated that the
immediate and foremost objective of the
RMNCH+A strategy is achieving the
Millennium Development Goals (MDGs)
and health related targets as outlined in the
12th Five Year Plans. Dr. Gunjan then
elaborated on the scope and need of the
RMNCH+A strategy including the key
features of the entire approach. He stated that the strategy links maternal and child survival to
other components (family planning, adolescent health, gender & PC & PNDT) and plus for
adolescent health identifies it as a distinct life stage. He stated that the strategy tries to link up
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various life stages be it pregnancy, newborn period, childhood, adolescence and reproductive
years and in addition also endeavours to provide quality care across all levels of health facilities
and at the community level. He also highlighted the fact that key maternal and child health
indicators cannot be improved while working in vertical components and the need of the hour
remains linking and integrating various dimensions and life stages. The RMNCH+A strategy
tries to achieve this by strengthening health systems, prioritizing intervention areas and
interventions, focussing on integrated monitoring, developing accountability and finally
establishing and building partnerships. He reiterated the fact that through the RMNCH+A
strategy, Government of India is aiming to achieve the 12th five year plan goals through
improved RMNCH+A outcomes, in identified 184 High priority districts (HPDs), by intensifying
efforts adopting standardised approach and harmonized action involving all international partners
and stakeholders (including other line departments like Social Welfare, Education, Tribal
Welfare etc).
Dr. Gunjan spoke about the 3 essential interventions enlisted out under the strategy of involving
Deputy Commissioners as mentors, harmonizing technical assistance of partners and involving
Medical Colleges and other academic and research institutes as guiding and supporting units for
the HPDs. He also briefed the participants about the criteria adopted for selection of HPDs by
Government of India (GOI) and spoke about the 5 key steps proposed in the district
intensification plans which include: assessment for gap identification, health systems
strengthening for gap filling & supply chain management, improving demand for services,
engagement with other Social-Sector departments and concurrent monitoring & Supportive
Supervision. He re-stressed the need to have maximum thrust on the most backward blocks.
Following on Dr. Gunjan stated that Government of India very well recognizes the role of the
Deputy Commissioners in driving forward the strategy in the districts by acting as mentors and
leaders with focus on key programmatic indicators for improved maternal and child health
outcomes. In his talk Dr. Gunjan spoke about the 5x5 Matrix developed for high impact
RMNCH+A interventions. This matrix identifies 5 critical interventions across the 5 RMNCH+A
thematic areas and also talks about the minimum essential commodities absolutely essential to
provide continuous and quality RMNCH+A services. He stated that the 5x5 Matrix should be
religiously adhered to and if implemented with high quality and coverage should produce the
maximum impact on improving maternal and child survival.
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He continued his talk by
stating that Development
Partners need to provide
technical assistance across
the entire RMNCH+A
spectrum and act as catalysts
handholding the State and
District Program
Management Units. He
spoke about the various
support structures which
have been established at the national, state and district levels as the National RMNCH+A Unit
(NRU), the State RMNCH+A Unit (SRU), the State Unified Response Team (SUT) and the
District Level Monitors (DLMs) for monitoring and providing technical assistance to
RMNCH+A intensification efforts in the HPDs.
The second part of the technical session focused on the activities undertaken till date on the
RMNCH+A intensification efforts in Jharkhand. Dr. Gunjan briefed the participants about the
activities completed at the State and District Levels. He said that the strategy was rolled out in
the State on the 19th of July 2013 with the conduction of the State Level RMNCH+A
Consultation which was attended by a high level delegation from GOI lead by Dr. Rakesh
Kumar, Joint Secretary (RCH). He stated that USAID has been identified as the State Lead
Partner (SLP) for coordinating the strategy in Jharkhand. Dr. Gunjan briefed that both the SRU
(established in the State by USAID-MCHIP) and SUT have been notified in the State and the
information shared with GOI. In addition District Profiling of the 11 HPDs has been completed
and list of all the health facilities in the HPDs compiled. The Jharkhand Child Survival Score
Card based on Annual Health Survey (AHS) data has been prepared. Through a ranking system
introduced in the score card it is apparent that the HPDs are clustered in the bottom half and need
focused support. He stated that around 20 partner organizations have come on board to support
RMNCH+A intensification efforts in the State and HPDs have been divided among the partner
agencies for coordinating RMNCH+A efforts with USAID being the coordinating partner for
Gumla district. Support for RMNCH+A efforts in the district would be offered through the
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USAID-MCHIP and USAID-ASSIST projects. He also introduced the HMIS based quarterly
score cards and the Block Monitoring Formats to the participants and concluded his talk by
elaborating on the Gap Analysis exercise initiated in the district which would focus on assessing
the delivery points on key service delivery parameters with community assessment to look into
the uptake of services by the community as a whole.
Progress and Challenges of RMNCH+A in Gumla district
The second technical session focused on the progress and challenges of RMNCH+A in Gumla.
District Program Manager Mr. Samresh Kumar spoke about the demographic indicators of the
district which fare poorly as compared to the state figures. In his talk Mr. Samresh highlighted
the major challenges being faced by the district including lack of adequate Human Resource
across all cadre of health workers and functionaries, paucity of adequate infrastructure with only
3 of the 11 designated Community Health Centers (CHCs) functioning with 30 beds, poor
training quality leading to poor implementation at the field level, poor supportive supervisory
practices, weak interdepartmental coordination, poor community ownership and engagement
with public health schemes and interventions, left wing extremism and geographical remoteness
of number of areas in the district. Mr. Samresh also highlighted the fact that high infant and
neonatal mortality in the district was a result of poor implementation of Integrated Management
of Neonatal and Childhood Illness (IMNCI) measures and non functional New Born Care
Corners (NBCCs), New Born Stabilization Units (NBSUs) and Sick New Born Care Units
(SNCUs). Low institutional delivery rates in insurgency hit areas was also a contributing factor.
Mr. Samresh identified skill based training of health staff, appointment of adequate HR including
specialists, construction of health facilities as per Indian Public Health Standard (IPHS) norms
and imcreasing institutional delivery rates in remote areas through improved access to Mamta
Vahan as actionable points to be undertaken on priority basis. Mr. Samresh concluded his talk by
requesting the State and Development Partners for technical support across all thematic areas of
RMNCH+A specially in planning process, providing regular feedback through monitoring visits
and supporting the monthly review meetings at the district.
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Block Monitoring Visits envisaged under RMNCH+A Strategy
The next session focused on the findings from the block monitoring visits undertaken in two
blocks of Gumla district. Mr. Narayan Behera, State RMNCH+A Technical Officer, USAID-
MCHIP started his presentation by stressing upon the objectives of the block monitoring visits
which include making a quick assessment of the infrastructure, human resources, provision of
services (both at facility and community level), assessing service delivery (quality and coverage)
at block level, reviewing progress of community outreach and community / home based
interventions and validating the data reported into HMIS. The visits were undertaken in Bharno
and Sisai blocks of the district. Positive findings from the visits included functional NBCCs in
both the blocks, 98% VHNDs being held against planned, fixed day sites operating for
Intrauterine Contraceptive Devices (IUCDs) with good uptake of services and home visits being
undertaken by Sahiyas as part of Home Based New Born Care (HBNC) services. The visits also
identified gaps at various levels including SBA / NSSK untrained service providers being posted
at delivery points particularly in Sisai block, poor registration of pregnant women in the first
trimester, low drop back rates under Janani Shishu Suraksha Karyakram (JSSK) in Bharno block,
unavailability of reports of Weekly Iron Folic Acid Supplementation (WIFS) program and poor
rates of PPIUCD insertions. Suggestible action points at the district and block level included
monthly coordination meeting with Health, Education and Social Welfare Departments,
designating RMNCH+A nodal person at the block level, distribution of blocks amongst District
Level Program Officers for effective Supportive Supervision, conducting joint block monitoring
visits, institutionalizing fixed day sites for family planning services, line listing of severely
anaemic women and under 5 deaths, initiating infant and child death reviews, validating HMIS
data during block visits, undertaking provider mapping for various RMNCH+A related training
programs and above all incorporating RMNCH+A review at all available forums.
Jharkhand Dashboard for Child Survival: Progress monitoring of
RMNCH+A implementation in Jharkhand
In the next technical session Dr. Jaya Swarup Mohanty, State RMNCH+A Technical Officer,
USAID-MCHIP spoke about the 16 indicator based HMIS scorecard prepared for Q1 (April –
June) 2013-14 which ranks districts as good performing, promising, low performing and very
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low performing. Based on the overall composite
index Gumla district was in the low performing
category. Across individual life cycle stages the
district was in the promising category in
reproductive age group, pregnancy and child care
and was very low performing in post natal mother
and new born care category. Dr. Mohanty also
talked about the block specific score cards for the
district from April – September 2013 which
reflected Palkot, Raidih and Sisai as good performing blocks and Bharno, Dumri and Ghagra as
poor performing. He however cautioned against reading too much into the figures as validity and
accountability of the HMIS data was a big factor as reflected by variations in reports visible on
the HMIS portal and that provided by the blocks and the district and other quality issues
highlighted during review of HMIS data in the district.
New Initiatives under RMNCH+A: Rashtriya Bal Swasthya Karyakram
In the final technical session of the day Dr. Gunjan Taneja briefed the participants about the
Rashtriya Bal Swasthya Karyakram (RBSK). He stated that RBSK is an initiative undertaken by
Government of India to improve child survival & quality of life. The entire programme utilizes a
systemic approach to prioritize early identification of 4Ds: Defects at birth, Diseases,
Deficiencies and Developmental delays including Disabilities in children 0 to 18 years of age.
He stated that the scope of existing School Health Programme under NRHM has been expanded
to include comprehensive screening for all children and the scheme is expected to cover more
than 27 crore children in a phased manner. Primarily the initiative aims to ensure free
management and treatment including surgical interventions at tertiary level through NRHM. Dr.
Gunjan spoke about the magnitude of the 4Ds in the country with an estimated 17 lakh babies
likely to be born with birth defects in the country which account for 9.6% of all newborn deaths.
Dental caries affected 50-60% school children in the country with up to 70% of them suffering
from various deficiencies, moreover 10% children are affected with development delays leading
to disabilities. He stated that 30 conditions would be screened out through RBSK and this
screening would take place through mobile health teams twice in the year at Anganwadi Centers
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(AWCs) for children aged between 0-6 years and once a year in Government and Government
aided schools for children between 6-18 years. Screened children suffering from any listed out
condition would be referred to District Early Intervention Centers (DEIC) for diagnosis and
management and if needed to higher centers from DEICs for specialized care and support. He
stated that within the entire RMNCH+A spectrum RBSK was visualized as a platform to fully
integrate the Health, Education and Social Welfare departments and each of the three
departments would have to equally contribute to realize the objectives of the scheme. Dr. Gunjan
concluded by stating that the prime benefit of RBSK was in ensuring better survival and also
overall cognitive and physical development of children.
Open forum
Leading the discussions Sri Oraon stated that RMNCH+A is a comprehensive strategy adopted
and implemented by GOI and stated that the district administration will definitely undertake the
review of all RMNCH+A components every month. Sri Oraon said that the RMNCH+A strategy
aims at convergence and strong inter linkages across Health, Education and Social Welfare
departments and this would definitely result in improving and further strengthening Intersectoral
coordination in the district. He stated that the need of the hour remains improving institutional
delivery rates by improving access to services even in the remotest parts of the district and also
further strengthening Mamta Vahan services in Gumla. Dr. Pawan Pathak, National Technical
Officer, USAID-MCHIP stated that the RMNCH+A strategy provides a sound platform for states
and the identified High Priority Districts (HPDs) of the country to make the final push for
achieving the MDGs and the 12th Five Year Plan goals. He said that with support from
Development Partners and coordinated efforts the district can very well improve across the
various thematic areas and also stressed upon internalizing the 5x5 matrix for follow up on
priority interventions across the entire district. In the end Dr. Pathak concluded by stating that
through the list of Minimum Essential Commodities the district can ensure adequate and proper
supply chain management.
The workshop concluded with Dr. J.P. Sanga delivering the vote of thanks.
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Glimpses
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Annexure 1 District Workshop for Intensification and Harmonization of Efforts in High Priority
Districts for Improved Maternal and Child Health Outcomes
26 October, 2013
Venue: Conference Hall, DC Office, Gumla, Jharkhand Timing: 10:30 AM – 02:00 PM
Key Objectives-
To orient District Government Officials including District Health Officials, Block Health Officials,
Partner agencies, Mentoring Institutions and other Stakeholders on Reproductive Maternal Newborn
Child Health + Adolescence (RMNCH+A) strategic approach
To orient participants about High Priority Districts (HPDs) and Government of India’s plan to
intensify action for improving maternal and child health outcomes
To discuss modalities and mechanisms for harmonised technical assistance for integrated
programming and monitoring for RMNCH+A interventions
To discuss modalities for development of district level implementation plan for RMNCH+A
activities.
Time Session Facilitators
10.30 – 11.00 Registration
11.00 – 11.10 Welcome Address Dr. L.N.P. Bara, Civil Surgeon,
Gumla
11.10 – 11.20 Key Note Address Sri Punai Oraon, Deputy
Development Commissioner, Gumla
11.20 – 12:00
An Overview of Reproductive, Maternal,
Newborn Child Health + Adolescent Health
(RMNCH+A) Strategy and State Level
RMNCH+A progress update
Dr. Gunjan Taneja,
State RMNCH+A Team Leader,
USAID – MCHIP
12.00 – 12.20 Progress & Challenges of RMNCH+A in Gumla Dr. L.N.P. Bara, Civil Surgeon,
Gumla
12.20 – 12.40 Block Monitoring findings
Mr. Narayan Behera, State
RMNCH+A Technical Officer,
USAID-MCHIP
12.40 – 13.00 RMNCH+A strategic approach, score card and
new initiatives
Dr. J.S. Mohanty, State RMNCH+A
Technical Officer, USAID-MCHIP
13.00 – 13.15 New Initiative – Overview of RBSK
Dr. Gunjan Taneja,
State RMNCH+A Team Leader,
USAID – MCHIP
13.15 – 13.45 Open forum on district specific issues related to
harmonized action
Dr. Pawan Pathak, National Technical
Officer, USAID-MCHIP
13.45– 13.55 Way forward and plan of action with specific
timeline
Smt. Veena Srivastava,
Deputy Commissioner,
Gumla
13.55– 14.00 Vote of thanks Dr. J.P. Sanga, ACMO,
Gumla
Lunch
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With Technical Support from
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