DR. BHUPUTRA PANDA MATERNAL & CHILD HEALTH: SCENARIO AND LESSONS LEARNED FROM BOLANGIR, ODISHA
Maternal & child health bolangir
Jun 14, 2015
Status of maternal and child health programmes in Bolangir, Odisha
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D R. B H U P U T RA PA N DA
MATERNAL & CHILD HEALTH: SCENARIO AND LESSONS LEARNED FROM
BOLANGIR, ODISHA
BOLANGIR
ABOUT BOLANGIR
• Geographical Area: 6575 sq. kms.
• Population: 1,648,997
• Child Population (0 to 6 yrs.): 216,320
• About 88% of population live in rural area
MATERNAL HEALTH STATUS
• Mothers who received 3 or more ANC: 83.8%
• Mothers who have received at least one TT injection: 99.2%
• Mothers who have consumed IFA for 100 days or more: 23.8%
• Institutional Delivery: 80.1%
• Mothers who have received PNC after 48 hrs of delivery: 86.5%
• Maternal Mortality Ratio: 234
CHILD HEALH STATUS
• Full Immunization: 79.5%
• Neonatal Mortality Rate: 71
• Infant Mortality Rate: 97
• Under Five Mortality Rate: 111
PREVIOUS AND ONGOING INTERVENTIONS BY PHFI-UNICEF
• Assessment of Supportive Supervision strategy of Routine Immunization in Odisha-A randomized post-test study, 2011-12
• ToT to about 175 master trainers across the state on IMNCI basic health worker and follow up supervision, 2012-13
• Evidence based IMNCI, RI, and VHND service delivery through health system strengthening-an external monitoring demonstration project, PHFI, Ongoing project
• 8 of 14 blocks in the district were identified as sample blocks based on WHO 30 cluster sampling
• Baseline survey was completed in July and August 2013 to assess the existing practices in RI, VHND and IMNCI
• Standard RI, VHND and IMNCI supervision checklists were used for data collection
• Data analysis was done using SPSS statistical software to analyze the data of baseline and every quarter
ABOUT ONGOING INTERVENTION
INTERVENTION PACKAGE
• Extensive field visits to RI, VHND and IMNCI sessions accompanied by internal monitors
• Hand-holding support provided to supervisors provided on site on supportive supervision
• Capacity building of front line health workers and supervisors
• Techno-managerial support for quality improvement of the programmes
• Advocacy at district and sub district levels for convergence and health systems strengthening
PROGRESSIVE OUTPUT OF INTERVENTION
• One year of intervention has been planned, of which we are currently in the last quarter
• Data from the field is analyzed every quarter
• Trend from the analysis is reflected in the following slides
FROM ROUTINE IMMUNIZATION
Basel
ine
(N=32
)
1st Q
uarte
r (N=
8)
2nd
Quarte
r (N=
8)
3rd
Quarte
r (N=
9)88
92
96
10098
96
92
100
Vaccine Availability
In %
Basel
ine
(N=32
)
1st Q
uarte
r (N=
8)
2nd
Quarte
r (N=
8)
3rd
Quarte
r (N=
9)0
40
80 99 100
100 100Availability of Syringes
In %
Basel
ine
(N=32
)
1st Q
uarte
r (N=
8)
2nd
Quarte
r (N=
8)
3rd
Quarte
r (N=
9)0
40
8063 63
82 78
Availability of MCP Cards
In %
Basel
ine
(N=32
)
1st Q
uarte
r (N=
8)
2nd
Quarte
r (N=
8)
3rd
Quarte
r (N=
9)0
40
8098 100
6389
Availability of Drugs
In %
Baseline (N=32)
1st Quarter (N=8)
2nd Quarter (N=8)
3rd Quarter (N=9)
0
20
40
60
80
100
72
25 25
67
Availability of Counterfoils
In %
04080 81
63 5088
Availability of functional hub cutter
In %
Baseline (N=32)
1st Quarter (N=8)
2nd Quarter (N=8)
3rd Quarter (N=9)
0
20
40
60
80
100
47
100
50
78
Use of Tally Sheet
In %
Baselin
e (N
=32)
1st Q
uarte
r (N=
8)
2nd Quar
ter (
N=8)
3rd Q
uarte
r (N=
9)0
40
80100
63 5078
Cutting syringe after use
In %
FROM ROUTINE IMMUNIZATION
FROM ROUTINE IMMUNIZATION
Baseline (N=32)
1st Quarter (N=8)
2nd Quarter (N=8)
3rd Quarter (N=9)
0
20
40
60
80
100
50 5063
78
AVD Implementation
In %
Baselin
e (N
=32)
1st Q
uarte
r (N=
8)
2nd Quar
ter (
N=8)
3rd Q
uarte
r (N=
9)0
40
80 81 75 88 89
Segregation at Source
In %
Baseline (N=32)
1st Quarter (N=8)
2nd Quarter (N=8)
3rd Quarter (N=9)
0
20
40
60
80
10081
1338
78
Delivery of 4 key messages
In %
04080
3125 50
89
Asking beneficiaries to wait 30 mins
In %
FROM VHND
0
40
80 75 8161
82
Presence of Health Supervisor
In % 0
4080
11
52 6282
Session Site (Anganwadi Centre)
In %
Baselin
e (N
=32)
1st Q
uarte
r (N=
21)
2nd Quar
ter (
N=13)
3rd Q
uarte
r (N=
17)0
4080 66 47 62 70
Availability of Examination Table
In %
04080
31 22 31 35
Availability of screens for Privacy
In %
FROM VHND
Baselin
e (N
=32)
1st Q
uarte
r (N=
21)
2nd Quar
ter (
N=13)
3rd Q
uarte
r (N=
17)0
40
80 73 5683 78
Availability of Diagnostic Equipment
In %
Baseline (N=32)
1st Quarter (N=21)
2nd Quarter (N=13)
3rd Quarter (N=17)
020406080
100
71
45
7963
Availability of Drugs
In %
Baseline (N=32)
1st Quarter (N=21)
2nd Quarter (N=13)
3rd Quarter (N=17)
0
20
40
60
80
100
37
63 64 65
Relevant History Taken
In %
Baseline (N=32)
1st Quarter (N=21)
2nd Quarter (N=13)
3rd Quarter (N=17)
020406080
100
72
38
6276
Abdominal Palpation Done and Recorded
In %
FROM VHND
04080
1247 54
71
Urine Examination Done and Recorded
In %
04080
37 38 50 53
Privacy Ensured During Exam-ination
In %
Baselin
e (N
=32)
1st Q
uarte
r (N=
21)
2nd Quar
ter (
N=13)
3rd Q
uarte
r (N=
17)0
40
8065 54
77 66
Counseling
In %
Baseline (N=32)
1st Quarter (N=21)
2nd Quarter (N=13)
3rd Quarter (N=17)
020406080
10081
5369
53
Group meeting conducted with Women
In %
FROM VHND
Baseline (N=32)
1st Quarter (N=21)
2nd Quarter (N=13)
3rd Quarter (N=17)
0102030405060708090
100
56 5261 57
Availability of Contraceptives
In %
Baseline (N=32)
1st Quarter (N=21)
2nd Quarter (N=13)
3rd Quarter (N=17)
0102030405060708090
100
78
28
9282
Family Planning Counseling
In %
FROM IMNCI
Baseline (N=64)
1st Quarter (N=29)
2nd Quarter (N=18)
3rd Quarter (N=24)
0
20
40
60
80
100
12
28 3954
Home visits as per IMNCI guidelines
In %
Baseline (N=64)
1st Quarter (N=29)
2nd Quarter (N=18)
3rd Quarter (N=24)
0
20
40
60
80
100
25
3439
50
IMNCI assessment sheets filled up
In %
Baseline (N=64)
1st Quarter (N=29)
2nd Quarter (N=18)
3rd Quarter (N=24)
0
20
40
60
80
100
2731
28
46
IMNCI monthly reporting done
In %
Baseline (N=64)
1st Quarter (N=29)
2nd Quarter (N=18)
3rd Quarter (N=24)
020406080
100
35
4747
56
Skill of worker for 0 to 2 months children
In %
FROM IMNCI
Baseline (N=64)
1st Quarter (N=29)
2nd Quarter (N=18)
3rd Quarter (N=24)
020406080
100
28
3540
56
Skill of worker for 2 months – 5 year children
In %
Baseline (N=64)
1st Quarter (N=29)
2nd Quarter (N=18)
3rd Quarter (N=24)
0
20
40
60
80
100
53
6 8
Availability of IMNCI Board
In %
Baseline (N=64)
1st Quarter (N=29)
2nd Quarter (N=18)
3rd Quarter (N=24)
0
20
40
60
80
100
5458
61
34
Availability of Drugs
In %
Baseline (N=64)
1st Quarter (N=29)
2nd Quarter (N=18)
3rd Quarter (N=24)
75
80
85
90
95
100
85
96
9492
Availability of Forms and Formats
In %
SUMMARY OF INDICATORS Continuously Improving Fluctuating Not Improving
RI
• Vaccine availability at session site • Availability of MCP Cards • AVD Implementation
• Availability of syringes and drugs • Use of counterfoil
• Delivery of 4 key messages • Waste Disposal • Asking beneficiaries to wait for 30
mins after vaccination
• Availability of hub cutter • Visit of health supervisor • Use of Tally Sheet
VHND
• Visit of health supervisor• Availability of VHND
drugs• Group meeting with men
• Availability of examination table and screens
• Ensuring privacy • Visit of ICDS supervisors
• Availability of other essential logistics
• Counseling of beneficiaries
• Participation of PRI Members
• Implementation of VHND Duelist• Group meeting with
women
• Relevant history taking prior to 1st ANC
• Recording fetal heart sound • Abdominal palpation
IMNCI
• Home visits• Availability of IMNCI
drugs • Availability of IMNCI Board
• Filling up of assessment sheets• Availability of other
support logistics
• Monthly reporting • Skills of workers
WAY FORWARD
• To conduct an end line survey in the month of October and evaluate the output of the project intervention
• Scale up the best practices and replicate the model across the state for health systems strengthening
THANK YOU
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