Navajyoti - Odisha · Navajyoti, the new strategy document captures all the key elements that can ... Eradication Programme (NMEP) report of 1998, 28.6% of all malaria cases and 62.4%

Navajyoti

A strategy to improve Maternal and Child carewith focus on prevention of morbidity and

mortality among new borns

GOVERNMENT OF ORISSADepartment of Health and Family Welfare

22nd December, 2004

Message from the Chief Minister

I am very happy to know that the Department of Health and Family Welfare,Government of Orissa with active cooperation of UNICEF is bringing out Navajyoti; thenew strategy document for the reduction of Infant Mortality Rate (IMR) in the state ofOrissa.

IMR is the single most important social development indicator of any country. It isextremely reassuring that the relentless efforts of our government has had significantimpact on the reduction of IMR from 98/1000 live births in 1998 to 87/1000 livebirths in 2002. What continues to be disturbing, however, is the fact that Orissa stillremains the state with the highest IMR in India.

Navajyoti literally meaning new light therefore comes at an opportune moment. In awell thought out manner, the document articulates the strategies to address IMR bymeans of providing meaningful insights into the weak links of our earlier interventionsalong with a holistic approach to reach all our critical partners, especially thecommunity; co-crusaders in our endeavor to reduce IMR.

With Navajyoti comes a new ray hope for all our children!

I extend my best wishes for the successful implementation of the new strategy.

(Naveen Patnaik)

Naveen PatnaikChief Minister

Government of Orissa

BhubaneswarDate : 20.12.2004

Message from the Chief Secretary

It gives me immense pleasure to know that the Department of Health and FamilyWelfare, Government of Orissa is launching the new strategy document Navajyoti toaddress the issues of IMR in the state of Orissa.

Concerted governmental efforts with support from other partners in Orissa has helpedin reducing IMR from 98/1000 live births to 87/1000 live births in 2002. Thisindicates that committed and concerted efforts from all the stake holders can lead toextraordinary results to achieve low levels of infant deaths in our state. That Orissacontinues to have the highest IMR rate in the country, is an indication enough tointensify our efforts at different levels starting with the household through thecommunity to service provision.

Navajyoti provides us with a unique opportunity, to build upon our learningexperiences and strengthening the weak links.

I am confident that intensifying our awareness creation efforts together with the activeparticipation of our partners will yield positive results in addressing the issue of IMR.

I congratulate the efforts of all who have put together this carefully thought outdocument.

(Subash Pani)

Subash Pani. IASChief Secretary



Message from the Minister for Health,Health and Family Welfare

Infant Mortality Rate, the most critical of all social development indicators poses thegreatest challenge to all functionaries associated with the health system in Orissa.Despite our efforts, Orissa tops the list in India with regard to IMR at 87/1000 livebirths. Each year nearly 80,000 children die in Orissa even before they reach theirfirst birthday. This cautions each one of us about our duties and responsibilitiestowards our infants, our children.

The challenge of IMR in Orissa can be only met by saving the lives of infants in largenumbers. This requires a strategy that is well thought through and impeccably drawnout that looks at each level of intervention with considerable detail and caution.Navajyoti is indeed a timely initiative.

The approach aims to strengthen the efforts through community based awarenesscreation; especially through their active participation; strengthening interventions athousehold level with community care practices and service provision levels andcapacity building of grass root functionaries to maximize impact.

Navajyoti, the new strategy document captures all the key elements that canmeaningfully contribute to the reduction in IMR in Orissa. The success of the strategyheavily depends on inter-sectoral convergent efforts from partners in the Departmentsof Women and Child Development, Rural Development and Panchayati Raj.

While wishing Navajyoti all success, I call upon all our partners from within thegovernment, civil society and UNICEF to provide total support to our endeavor.

(Bijayashree Routroy)

Bijayashree RoutroyMinister for Health



Forward.

Orissa is one of the states in India with high rate of infant mortality withapproximately 80,000 infant deaths every year as reported by SRS 2002. Asnoted, the high levels of mortality in young children are mainly due to illnessesthat can easily be prevented or can be treated with known interventions.These illnesses include malaria, diarrhoeal diseases, acute respiratory tractinfections (ARI) and various vaccine preventable diseases. Over 90 percent ofmorbidity and 80 percent of mortality in young children come from four majorcauses in Orissa: Malaria, vaccine preventable diseases (VPD), diarrhoealdiseases and ARI, all of which can easily be prevented or appropriatelymanaged.Our IMR mission document of 2001 has provided very useful learningexperiences for launching the new strategy for a more ambitious and focusednew born care strategy. We hope to extend the new born care strategy throughthe Navajyoti strategy to every new born at the community level throughempowering the Dhaimas with skills of community based care of maternal topost natal interventions and simultaneously strengthening the facility levelservices at PHC/CHC/FRU levels in districts where IMR is fairly highcompared to other districts.

Our Government will be expanding the partnership by working closely with allthe development partners and like minded NGOs to make the health and wellbeing of mothers and children major priority of our government. Thesignificant reduction in infant mortality and morbidity is on the agenda settingof the government which will be addressed with all available resources at ourdisposal. Concerted efforts will be geared up towards realizing our objectivewhile good monitoring system to track and review the progress made will beput in place.

I am confident that all those working towards changing the lives of women andchildren in Orissa will join hands in tour Government s endeavor in bringingdown the IMR of state on par with other states.

(R. N. Senapati)

R. N. Senapati, IASPrincipal Secretary

Health and Family welfareGovernment of Orissa


CONTENTS

Page

Situational analysis 1

Quality routine reporting system 3

Evidence based interventions 5

Navajyoti strategy for community based care 6

Activities proposed 8

Sources of funding 11

Reporting formats 12-16

Demographic profile 17

LFA Matrix / Indicators 18-23

ABBREVIATIONS AND ACRONYMS USED IN THE DOCUMENT

ANC - Antenatal careANM - Auxiliary Nurse MidwifeARI - Acute Respiratory InfectionsAWW - Anganwadi WorkerBCC - Behaviour change communicationBP - Blood pressureCQ - ChloroquineCHC - community health centreFRU - First Referral UnitGP - Gram PanchayatICDS - Integrated Child Development ServicesIEC - Information, Education and CommunicationIFA - Iron and folic acidIMR - Infant Mortality RateGDP - Gross Domestic ProduceGOI - Government of IndiaGoO - Government of OrissaLBW - Low Birth WeightLHV - Lady Health VisitorMIS - Management Information SystemMDG - Millennium development goalsMO - Medical OfficerNBC - New Born CareNFHS – 2 - Second National Family Health SurveyPHC - Primary Health CentrePRI - Panchayati Raj InstitutionsRCH - Reproductive and Child Health ProgrammeSC - Sub-centreSHG - Self Help GroupS/ME - School and Mass EducationSRS - Sample Registration SystemTBA - Traditional Birth AttendantUNICEF - United Nations’ Children’s FundWASH - Water sanitation and hygiene

1

Situational analysis:Despite several programmes already in place for women and children, our state continues to beplagued by high levels of infant mortality. According to the SRS 2002 approximately 80,000infants die in the state each year, putting our Infant Mortality Rate (IMR) at 87 per 1,000 livebirths -- the highest in the country. This is higher than the national average of 64 per 1,000 livebirths, In our state, over 60% of infant deaths occur in the first 28 days of life – the neonatalstage – This underlines the need to focus attention on the care to the new born.

The main causes of infant death are

• Birth asphyxia.

• Infections and diseases such as ARI, Diarrhoea, measles, malnutrition andmalaria.

• Poor maternal health leading to Low birth weight

IMR -States (India ) 2002 -SRS Provisional87

85

80

7873

7063

62

6261

6055

52

51

5149

45

41

4417

10

0 10 20 30 40 50 60 70 80 90 100

Kerala

Goa

TN

Uttaranchal

Maharashtra

WB

Punjab

Jharkhand

HP

Karnataka

Gujurat

Bihar

Haryana

AP

INDIA

Assam

Chatisgarh

Rajastan

UP

MP

Orissa

STA

TE

S

INFANT DEATHS/1000 LIVE BIRTHS

2

Just eight states contribute to 72% of the total infant deaths in India; Orissa, as a smaller state,contributes 5% to this total despite the relatively high IMR. Institutional delivery plays animportant part in reducing neonatal deaths, reducing the risk of infection, providing skilledinterventions in the event of a problem, and advising on early newborn care practices.

Kerala, which has the lowest IMR (14 per 1,000 live births) in India, conducts nearly alldeliveries in hospitals and private clinics. By comparison, only 22.6% of births in Orissa areinstitutional and 77% are home deliveries, out of which 14% are attended by healthprofessionals (ANMs, LHVs, midwives, nurses or doctors), 29% deliveries are attended by atrained birth attendant (TBA), the remainder (66.5%) are attended by relatives or otheruntrained persons (NFHS2). After delivery, just 19% of women have been seen by a healthcareprovider within two months of delivery. In the interior tribal districts of Koraput, Nabrangpur,Malkangiri and Mayurbhanj, most deliveries are self-deliveries. During delivery, women areforced to undergo unsafe labour either due to the lack of health facilities or certain culturalbarriers that prohibit women from delivering in the presence of doctors and auxiliary nursemidwives (ANMs).

According to NFHS 2 data, only 47% of women had three or more ante-natal check-ups; andonly 34% had a check-up during the first trimester. Only 21.4% of women receive all therecommended services of antenatal care. (Three ANC check-ups, registration in first trimester,two TT injections / booster, 100 IFA tablets and BP /Weight check).

Endemic malaria is a major contributor to the IMR in Orissa. According to the National MalariaEradication Programme (NMEP) report of 1998, 28.6% of all malaria cases and 62.4% of allmalaria deaths reported in India are from Orissa.

Contribution of the 21 larger states to national infant deaths, 2000979693

8983

76

67

43

57

25

6 5 5 5 4 4 3 3 3 2 2 2 1 0 0 0 09 89

0

10

20

30

40

50

60

70

80

90

100

Utta

r Pra

desh

Mad

hya

Prad

esh

Biha

r

Raj

asth

an

And

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Prad

esh

Mah

aras

htra

Oris

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t Ben

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arat

Kar

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il N

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Ass

am

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d

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atis

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ir

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hi

Utta

ranc

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acha

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ala

Cum

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ive

cont

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ion

(%)

Cumulative share in total number of infant deaths nationally

Share in total number of infant deaths nationally

21%51%

3

Malaria chemoprophylaxis during pregnancy, as a strategy for reducing our IMR, wasintroduced in 2002 as part of our IMR Mission However with poorly performing antenatal care,the benefits of malaria treatment and prevention for pregnant women is likely to be modest.

While data about the IMR is available periodically, regular review of infant deaths on a monthlybasis at every level, considering the time of death and cause of death is another issue thatshould be addressed by us. Infant mortality is a development indicator; hence strategies forreducing IMR necessarily involve interventions of various departments. There are wide inter-district variations in Infant Mortality, with the southern and western tribal districts having asignificantly higher IMR. Since causes of infant deaths are likely to be different in differentregions of our state, it is necessary to make district-specific action plans to prioritize theeffective interventions in each location.

RCH 2002 survey very clearly reveals the inter-district variation of IMR.

Quality routine reporting by the system:

One of our districts Rayagada has been monitoring IMR on a monthly basis through theirregular network of Health and ICDS functionaries. The data is being analysed by the districteach month examining the block wise reported IMR and inter block variation. Even within thedistrict, variations can be extreme as Rayagada shows us, varying from a low of 65 in Gunpurblock to a high of 132 in K. Singhpur block. This also strengthens the argument that if routinereporting is streamlined at every level in the district and the data is analyzed as is being done inRayagada, there will be better understanding of the problem and plan our priorities accordingly.

IMR for 15 districts- RCH 2002

RANK DISTRICT 2002

1 Bhadrak 51.5 2 Mayurbhunj 59.2 3 Sambalpur 59.6 3 Sonapur 59.6 4 Bargah 60.1 5 Khordha 61.5 6 Jajpur 63.4 7 Angul 67.2 8 Nuapada 69.4 9 Ganjam 73.6 10 Sundergarh 73.9 11 Kandhamal 79.1 12 Kendujhar 84.1 13 Rayagada 92.6 14 Malkangiri 103.8

Source: RCH survey 2002

4

Infant Mortality Rate – Rayagada District - 2003

Live Births Infant DeathsBlock Boys Girls Total Boys Girls Total

StillBirth IMR

Rayagada 1106 1042 2148 138 111 249 55 116Kashipur 1121 1044 2165 135 100 235 31 109Kolnara 769 583 1352 85 48 133 32 98K. Singhpur 690 698 1388 92 91 183 51 132Gunupur 752 686 1438 55 38 93 46 65Padmapur 503 506 1009 44 35 79 23 78Gudari 506 447 953 64 60 124 32 130Ramanguda 409 365 774 44 31 75 10 97B. Cuttack 702 615 1317 64 43 107 21 81Muniguda 912 801 1713 101 64 165 35 96Chandrapur 393 354 747 53 37 90 27 120District Total 7863 7141 15004 875 658 1533 363 102

MAJOR GOALS OF OUR STATE

• Reduce infant mortality rate (IMR) in Orissa to 60/1000 live births by 2005(IMR Mission -2001)

• Reduce the IMR in Orissa to 50/1000 live births by 2010 (Orissa Vision 2010)

• Reduce incidence of LBW babies by half the current level by 2010(Orissa Vision 2010)

and subsequently to 10% by 2010

Infant Mortality Rate 2003(Deaths per 1000 live births)

116

109

98

132

65

78

130

97

81

96

120

102

020406080

100120140

Ray

agad

a

Kash

ipur

Koln

ara

K. S

ingh

pur

Gun

upur

Padm

apur

Gud

ari

Ram

angu

da

B. C

utta

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Mun

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a

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pur

Ray

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5

The strategies for IMR reduction include programs already existing in our Government for childand maternal care

a. Primary health care services network

b. ICDS program interventions.

We were focusing on three major strategies in the last three years under the IMR mission:• Chemoprophylaxis for malaria with chloroquine to all the pregnant women across the

state• Referral transport to pregnant women in rural areas to promoting institutional deliveries -

Rs 150/- for distance under 10km and 200/- for distance over 10 km• Focussed health care inputs in urban slums in five cities

Evidence based interventions:

The Lancet child survival series of July 2003 states that 63% of child deaths globally couldhave been prevented through full coverage with established simple and effective healthinterventions. The review covers interventions including simple household based interventionslike exclusive breast-feeding and oral rehydration as well as health service interventions likeantenatal care, institutional deliveries and treatment of common illnesses. The MDG goal forchild survival can be achieved only if strategies for delivery interventions are improved andscaled up.

To facilitate development of an evidence based RCH II design, UNICEF, Orissa recentlysupported 8 districts regionally balanced to assess their baseline on these evidence basedinterventions using three survey methodologies; 1) Household survey in 1400 households ineach of the districts 2) Monitoring and validation in 30 subcentres and 3) Facility survey in 10institutions of each district

Some of the highlights of the study are1. Less than 5% of home deliveries attended by TBAs (trained and untrained) are clean2. 77% of all newborns are given a bath within the first 48 hours raising the risk of

hypothermia3. Weekly chemoprophylaxis with Chloroquine is taken only by 50% of pregnant women4. Less than half of infants are exclusive breastfed for the first 6 months5. Less than 4% of children under five benefit from safe water sanitation and hygiene

practices ( WASH)6. Less than 2% of children under five sleep under a treated bed net every night7. Less than one-third of children with diarrhea received more fluids and some form of oral

rehydration8. Less than 10% of pregnant women receive an antenatal check in the 1st trimester9. While 44% of infants receive some post-natal care, less than 10% receive full postnatal

care (3 checks by a health worker) including 1 within the 48 hours

The above data substantiates the need to strengthen the BCC for better care practices at familyand community level.

6

Bargarh

Jharsuguda

SambalpurDebagarh

Sundargarh

Kendujhar

Mayurbhanj

Baleshwar

Bhadrak

Kendrapara

JagatsinghapurCuttack

JajapurDhenkanalAnugul

NayagarhKhordha

Puri

Ganjam

Gajapati

Kandhamal

Baudh

Sonapur

BalangirNuapada

Kalahandi

RayagadaNabarangapur

Malkangiri

Koraput KBKEC/SIPIPD

Orissa Map showing 14 districts for Navajyoti scheme

Bargarh

Jharsuguda

SambalpurDebagarh

Sundargarh

Kendujhar

Mayurbhanj

Baleshwar

Bhadrak

Kendrapara

JagatsinghapurCuttack

JajapurDhenkanalAnugul

NayagarhKhordha

Puri

Ganjam

Gajapati

Kandhamal

Baudh

Sonapur

BalangirNuapada

Kalahandi

RayagadaNabarangapur

Malkangiri

Koraput KBKEC/SIPIPD

KBKEC/SIPIPD

Orissa Map showing 14 districts for Navajyoti scheme

Navajyoti: Strategy for community based care

Out of the thirty districts of the state, fourteen districts have reported IMR above the stateaverage. The following fourteen districts will be taken up in the first phase:

RayagadaMalkangiriNabrangpurKoraput

KalahandiNuapadaSonepur

PhulbaniBoudhBolangir

SundergarhDeogarhKeonjharGajapati

Though Mayurbhanj districthas IMR above the stateaverage it is excluded fromthe scheme since IMNCI hasbeen launched in this districtwith the same objective. Allthe districts listed above aremostly tribal andunderdeveloped with difficultterrain and inaccessiblepockets.

The tribals have pooraccess to the healthservices and they prefer todeliver at home with thehelp of the local dais. TheTBAs have been living closeto the communities and haveestablished credibility andrapport with the communities

than the system functionaries. But not many of them conduct deliveries with all the five cleansand skilled birth attendance is still lacking during deliveries. Our objective under RCH is toensure that every woman delivering receives skilled birth attendance but till such time weensure this happens the public system needs to network with the dais to bring them into ourfold for quality ANC and safe delivery practices during the transition period. Simultaneously theWomen’s Self Help Groups (SHGs) from the respective community needs to be facilitated andnurtured to work closely with the health system to improve skilled attendance as short term goaland improving institutional deliveries as long term goal.

Government of Orissa strongly feels that dais will attend to the new borns through home visitson the assigned days when they will be able to convey simple messages onClean home deliveriesCare of the umbilical cordKeeping the newborn warm (No bath for 7 days)Early initiation of breastfeeding, exclusive breastfeeding and continued feedingCleanliness of mother and babyInitiation of immunizationMaternal nutrition

7

The trained birth attendant, hereafter called asDhaima, will also have the skills to identify theobstetric emergencies / high-risk and sick newborns, advise the family to immediately seek carein health facilities and also will facilitate theirtravel to the appropriate institution.The goal of the revised strategy will be to focuson these fourteen districts where the IMRsituation is worse compared to the state averagewithin two years of implementation of thestrategy.

Objectives:1) Improve Home Based management of new born care in all the remote villages2) Ensure early detection of sick new borns and facilitate their prompt referral to health facilities

The strategies under Navajyoti are:

• Creating awareness of mother and other family members on neonatal & maternal care• Home based essential new born care• Identification of high risk babies• Improvement of service delivery system for maternal and neonatal care at Block Primary

Health Center / Community Health Center / First Referral Units and District headquartershospital

• Ensure 100% quality three Ante Natal Care checkups / early registration within 12 weeks /TT immunization as per schedule/identify and refer complications of pregnancy

• Improved use of Insecticide treated Bed net by pregnant women and newborns andimproved coverage of malaria chemoprophylaxis

• Prevention and management of infections - with immunization, early diagnosis andtreatment of diseases using standard case definition

• Community awareness for birth preparedness / complication readiness with full involvementin pregnancy and new born care.

• Capacity building of functionaries on quality care service delivery

The above stated strategies will strengthen and reinforce the existing strategies of IMR mission(2001) document stated in Table II &III.

8

The Dhaimas will be encouraged to perform the following:• Attend the monthly Fixed Health & Nutrition day in Anganwadi Center• Home visits for all newborn babies on Day 1, 3, 7, 14 and 28 to teach the mother ways to

prevent illness through exclusive breast feeding, essential newborn care and earlyrecognition of illness of the newborn

• Establish good rapport with Health workers (Female) and Anganwadi workers, MissionShakti Self Help Groups, Mahila Swasthya Sangha, Panchayat Raj Institutions

There are 7375 trained dais available in the above fourteen districts and another 10975available but yet to be trained. A total of 18350 Dhaimas will be involved in the new scheme.The untrained dais will be given ten day training in the respective Block PHC and the trainedDhaimas will be given a briefing on their role. The Dhaimas will receive the following incentives

Rs. 25/- for attending to delivery Rs. 25/- for neonatal visits to the houses on the assigned days Rs. 50/- for accompanying the obstetric emergencies/ sick newborn of the family below

poverty line to the institutions Rs 1000/- for the best identified Dhaima for each block of these 14 districts annually.

Activities:

A. Creating awareness of mother and family members on Neonatal & MaternalCare

B. Conduct home visits to educate the mother ways to prevent illness through keepingthe baby warm and exclusive breast feeding. The mothers will also be taught how torecognize early signs of illness of the baby and should advise the mother and herfamily to contact the Anganwadi worker/ Health worker (Female) and Medicalofficers for further management.

C. Attend the Fixed Health and Nutrition Day in Anganwadi center once in a month andcommunicate with Anganwadi worker and Health worker (Female) and the mothersof the village.

D. Dhaima has to establish good rapport relations with Anganwadi worker of the villageand Health worker (Female) working in Sub-center

E. Create awareness on early registration of pregnancy, adequate rest duringpregnancy, malaria chemoprophylaxis and IFA supplementation, nutritional needsof mother and personal hygiene/cleanliness and family preparedness forcomplication

F. Promoting positive behaviour at household/community through Behaviour changecommunication approach.

9

B. Home based Essential Newborn Care• Keeping the baby warm• Initiation of early and exclusive breast

feeding• Maintain cleanliness of mother and

newborn• Initiation of immunization• Identification of danger signs of newborn by

mother• Timely referral of the sick newborn

C. Institutional strengthening for improving service delivery for maternal andneonatal care at Block Primary Health Center, Community Health Center/ FirstReferral Unit & District HQ Hospital.

• Capacity building of the functionaries including IMNCI protocols• Essential supplies for emergency newborn care

• Round the clock services 24 X 7• Availability of specialist• Related logistics- setting up of newborn care corners etc.in all block PHCs and CHCs• Health services for the urban poor and migrant populations – these are the most vulnerable

people,

D. Development and establishment of monitoring, review and reporting guidelines.• Identification of process indicators and implementation guidelines• Development of reporting formats for various levels• Establish integrated monitoring system and structures and feedback system from village

to district level.• Regular review of the activities by CDMOs and reporting to Director, IMR Mission at

state• Audit of maternal and infant deaths monthly at all levels from Sector PHC upwards with

feedback• Monitoring and validation of service delivery by system functionaries themselves to

assess the bottlenecks for corrective action

10

E. Expand and strengthen public private partnerships with Civil SocietyOrganization, Private hospitals and Corporate through an agreement

• Identify and involve credible NGOsworking in the health sector in 14districts

• Identify and involvement of willingprivate and corporate hospitals asReferral centers for Basic EmergencyObstetrics care and Basic EmergencyNewborn care

• Strong inter-sectoral co-ordination forbetter impact

F. Review of the revised strategies at appropriate levels and provide feedback

• Functionalize Block / Subdivision /District level existing Health advisorycommittees / State and Districtsocieties (Zilla Swasthya Samity) toassess the progress of the stated IMRmission objectives

• District level monthly review ofNavajyoti scheme for 14 districts byCDMOs and quarterly review of IMRmission objectives at state level byDirector, IMR mission

• External evaluation every six monthspreferably after implementation

Sustainability:

The Navajyoti scheme envisages provision of incentives to Dhaimas linked to service deliveryfor improved community based care of new borns and timely referral and it is a pilot strategytowards acceleration of institutional deliveries and skilled birth attendance at home level. Thisprogram will be managed through support from various agencies. It is envisaged that onceRCH II is launched, this program can be implemented in all the districts including these districts.

11

Suggested Sources of Funding and districts

IPD KBK EC/ SIPRayagadaMalkangiriNabarangpurKoraput

KalahandhiSonepurNuapada

PhulbaniKeonjharGajapatiSundergarhBoudhDeogarhBolangir

For referral transport charges of obstetric emergencies / sick newborns (up to one month ofage) belonging to below poverty line families, the funds are available in the districts. (Referraltransport funds of IMR Mission).

For training of Dhaima (literate) who are not yet trained in the identified districts will be trainedquickly following the guidelines of Govt. of India (RCH Project) and "Dhai Sahayak Pustika" ofthe scheme Funds will be provided from Dhaimas training component of RCH Project.The Dhaima of the identified districts, who are already trained, briefing for the scheme will bedone at PHC. Funds will be provided from RCH Project (Dai training component).

Financial support partner wise for Navajyoti Scheme (In Rupees)1. Project Support

i. KBK support districtsii. IPD support districtsiii. EC support districts

Total

328095049369407786535

160044252. RCH support

i Dai Training in 14 district

Total

18657500

186575003. UNICEF Support for 14 districts / state wide

Material Support Management Supportdisposable mucus suckers(75000)

1568700 Launching of NavajyotiNavojoyti in state level and at 14districts

89640

Radiant warmers andresuscitation kits (180)

3585600 Development and disseminationof implementation guidelines

89640

colour coded weighing scaleswith a kit bag - 18,000

2913300 Support to monitoring formatsand quarterly review process

44820

Supply of chloroquine tabletsfor malaria chemoprophylaxisto entire state (314 blocks)

14207940 Facilitate reporting of infantdeaths from each district by PRImonthly using a structured formatfor state level review andsensitisation of PRI bodies

134460

Total - Rs. 22,634,100

12

13

Sector PHC reporting format for NavajyotiName of the Sector PHC ___________________________________ Reporting month__________________

Total No. of deliveries_____ No. of Live births_________ No. of Infant deaths _______ IMR of PHC__________

Details of Neonatal visits made No of OBS emergencies/sick neonates

Amount paid towards remunerationSl.No.

Name &Address

ofDhaima

No. ofdeliveriesconducted

No. ofneonataldeaths

reported

Day

1

Day

3

Day

7

Day

14

Day

28

Tota

lVi

sits

Detected Accompanied

Conductingdeliveries

Neonatalvisits

No of OBSemergencies/sick neonates

Total

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Total

Total amount received for Navajyoti scheme during the year __________________Balance at the beginning of the month _____________________Expenditure during the month _________________________Balance at the end of the month _________________________

Signature of the M.O. I/C

14

15

Block PHC reporting format for Navajyoti

Name of the BPHC ___________________________________ Reporting month__________________

Total No. of deliveries_____ No. of Live births_________ No. of Infant deaths _______ IMR of BPHC_______

Details of Neonatal visits made No of OBS emergencies/ sickneonates

Amount paid towards remunerationSl.No.

Nameand

addressof

Dhaima

No. ofdeliveriesconducted

No. ofneonataldeaths

reported

Day

1

Day

3

Day

7

Day

14

Day

28

Tota

lVi

sits

Detected Accompanied Conductingdeliveries

Neonatalvisits

No of OBSemergencies/sick neonates

Total

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Total

Total amount received for Navajyoti scheme during the year __________________Balance at the beginning of the month _____________________Expenditure during the month _________________________Balance at the end of the month _________________________

Signature of the M.O. I/C

16

District Report format for Navajyoti

Name of the District __________________ Reporting month_______________

Total No. of deliveries_____ No. of Live birth______ No. of Infant deaths _______ IMR of the District_________

No of Deaths Remuneration paid to DhaimaSl.No.

Nameof theBlockPHC/CHC

TotalNo. ofLive

birthsInfants Neonates

No. ofdeliveriesconductedby Dhaima

No. ofneonatesvisited byDhaima

No of OBSemergencies/

sickneonatesdetected

No ofOBS

emergencies/ sickneonatesaccompa

nied

Forconductingdeliveries

Forneonatal

visits

Foraccompanyi

ng OBSemergencies

/ sickneonates

Total

Balanceat the end

of themonth

IMRBlockwise

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Total

Signature of the C.D.M.O.

17

18

LOGICAL FRAMEWORK ANALYSIS MATRIXINFANT MORTALITY RATE REDUCTION (IMR) MISSION

GOVERNMENT OF ORISSA

DESCRIPTION OBJECTIVELY VERIFIABLE INDICATOR MEANS OF VERIFICATION LINKAGES WITH OTHERPROJECTS

IMPACT / FINAL GOALBy December 2005

Reduction of IMR in state

Reduction of Neonatalmortality rate in state

Reduction of LBWincidence and prevalence instate

By December 2005

Progressive reduction of IMR from current level of 87 (SRS2002) to below 60 (SRS 2006)

Progressive reduction of neonatal mortality rate to below 40%of the IMR from current level of 60%

Progressive reduction of LBW incidence and prevalence instate from current level of 19.6% (MICS 2001) to 17%

SRS report 2004-2006

SRS report

NFHS/ RCH survey report

RCH PROJECTICDS PROGRAM



KEY RESULTS / OUTCOMESImprovement in access andquality of ANC services

Improvement in quality andaccess of delivery services

Improvement in quality andaccess of post natal careservices

Improved coverage ofMalaria chemoprophylaxis

80% of pregnant women received 3 ANC visits30% of pregnant women had early registration by 12 weeks,received 3 ANC visits with Blood Pressure check up andweight monitoring

30 % of pregnant women who had been delivered atinstitutions by MOs/ Nurses with active management of 3rd

stage of labour50 % of pregnant women who had been delivered at home/SCs by ANMs / ASHA / TBAs following 5 cleans.

50 % of post natal mothers have received at least three visitswithin ten days

30 % of pregnant women received full course of CQ duringANC

RCH Form VI/ VII/VIII

RCH Form VI/ VII/VIIISC validation exercise

RCH Form VI/ VII/VIIISC validation exercise


RCH II project ongoing activity



RCH II project ongoing activityICDS program ongoing activity

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and IFA for pregnantwomen

Improved new born carepractices at household level

Improved effectivecoverage of routineimmunization

Improved coverage ofGrowth monitoring andpromotion services

Improved household levelpractices related toexclusive breast feedingand complementary feedingup to 1 year of age

Improved community levelcase management of sickchildren

90 % of pregnant women received full course of IFA duringANC

80 % of post natal women having initiated early breast feedingand are practicing EBF40% of newborns not given bath within first 7 days80% of newborns with clean cord50% of newborns regularly sleeping under insecticide treatedbed nets95% of infants received complete immunization by the age of1 year

50% of infants identified for growth faltering and referred

80% of infants exclusively breast fed for 6 months50% of infants started semi solid food and given 5 pluscomplementary feeding from 6 months onwards

80% of infants suffering from Diarrhoea received ORS30% of infants suffering from Pneumonia received full courseof Cotrimoxazole80% of infants suffering from severe pneumonia / dehydrationreferred

Rapid Household surveysSC validation reports


MMR of ICDS project blocksDistrict level ICDS project

Rapid Household surveysSC validation reports




ICDS project ongoing activity


RCH II project ongoing activityIMNCI project activity

OUTPUTSFixed Health and NutritionDays planned and held

Early registration ofpregnancies within 12 weeks

Pregnant women receive at

100% of Fixed Health and Nutrition days planned vs. held

50 % of pregnant women registered for ANC in first trimester

80 % of pregnant women receive at least 3 ANC visits and

RCH Form VI/ VII /VIII






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least 3 quality ANCs andreceive 1 DDK during ANC 3ANMs/AWWs check BP & wtrespectively at least 3 timesduring 3 ANCs

All pregnant women receiveeligible services including 64CQ tablets and 100 plus IFAtablets

All villages have at least 1SHG / Mission Shakti groupinvolved in the referraltransport implementation andfamily level birth planning

All pregnant women get thereferral transportation fundbefore discharge frominstitutions / or within 7 daysfrom Anganwadi worker afterdelivery at institution.

All BPHC/CHC have skilledMOs / nurses on newbornresuscitation techniques andBEmOC with functionalnewborn care corners inLabour rooms

All villages/AWCs have atleast 1 NBC & EsOC trainedASHA / TBA in the villageconducting clean deliveries.

DDK during third ANC visit

30 % of PW had at least got their BP and weight checkedthrice during 3 ANC visits and managed accordingly60 % of total pregnant women with complications wereidentified and appropriately referred

80 % of Pregnant women received full course of Iron and FolicAcid30% of pregnant women receive full course of Chloroquinetablets towards malaria chemoprophylaxis

30 % of Anganwadi Centres/ villages have SHGs / MissionShakti groups involved in disbursement of referraltransportation funds30 % of AWCs/ villages have SHGs / Mission Shakti groupsinvolved in development of family level birth preparedness

30 % of post natal women received referral transportation fundwithin 7 days

50 % of BPHC/CHC have skilled staff on EmNBC & EmOC80% of BPHC/CHC have functional newborn care corners inLabour rooms100% of BPHC/CHC following appropriate case managementtechniques on EmNBC & EmOC

90 % of villages / AWCs with trained ASHA/ TBA in the villageconducting clean deliveries

MMR of ICDS projects


RCH Form VI/ VII/VIIIMMR of ICDS blocks

MMR of ICDS blocks

MMR of ICDS blocks

Facility assessment report

SC validation reportVillage level resource map

ICDS program ongoing activity



ICDS program activity

ICDS program activity



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ANM residing at SCs andconducting delivery haveskills on New born care &Essential Obstetrics Careand practice them

All post natal women receive3 Post natal visit within 10days by AWW/ ANM /TBAs

Fixed Immunization Dayplanned and held

All immunization sessionsprovide vaccination for allantigens & Vitamin A dose

All difficult to reach / in-accessible areas areidentified in the block levelmicro-plans throughspecialized camp sessions

All newborns delivered atinstitutions received zerodose polio vaccination andBCG at birth

All eligible children under 1received 1 dose of Vitamin Aand 2 doses of IPPIimmunization

All newborns have their birthweight taken within 48 hrs

50 % of resident Health workers conducting at least 1 cleandelivery per month at SC/ home

50 % of postnatal women received 3 PNC visits within 10days.

90 % of Fixed Immunization Day planned vs. held

80 % of sessions offering all vaccines and Vitamin A in theimmunization sessions

60 % of special immunization camps planned and held

80 % of newborns at birth received BCG and zero dose polioat birth for institutional deliveries50 % of newborns received BCG and zero dose polio within 1month for home deliveries

80 % of children under 1 received 1 dose of Vitamin A95 % of children under 1 covered through Pulse polio

50 % of newborns that are weighed

SC validation reportVillage level ressource map




RCH Form VI/ VII / VIII

RCH Form VI/ VII / VIIIVitamin A reportsIPPI coverage reports

MMR of ICDS blocks

MMR of ICDS blocks









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All families are aware ofhousehold level practicesrelated to exclusive breastfeeding and complementaryfeeding up to 1 year of age

All families are aware aboutthe danger signs of newbornand take the newborn toinstitutions when sick

All sick newborns andchildren receive improvedcommunity level casemanagement for illnesses likemeasles, pneumonia, malariaand Diarrhoea

50 % of families aware of correct household level infantfeeding practices in selected districts.

40 % of families aware about danger signs during neonatalperiod50 % of families contact AWW / ANM or institutions wheninfant is sick

40 % of sick infants suffering from malaria, measles,Diarrhoea and pneumonia managed at Anganwadicentre/Subcentre

IMNCI monitoring reports

IMNCI monitoring reports

Drug distribution register

ICDS project ongoing activity

IMNCI project ongoing activity

IMNCI project ongoing activityIMNCI project ongoing activity

INPUTS

SuppliesDisposable Mucus suckersDDKGlovesAD syringesRadiant warmersAmbu bagsMonitoring formatsNew born care cornerinstrumentsConsumablesInjectablesFluids

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Capacity building sessionsQuality ANCNBC including resuscitationPNCIMNCIEmOC/ENBCFollow up trainingCapacity building ofDhaimas on Navajyotischemes

Human resource placementTBA / ANM / ASHA

Monitoring & reviewsMonitoring systemestablishment for interventionMonitoring visitsSupervisory visitsPeriodic reviewsFacility assessments

Evaluation designAgency for surveySecondary data assessmentMonitoring visits

Modules designed or reprintedTraining sessions designed & TOT identified# of staff trained and sessions held against plan# of staff demonstrating and practicing the skills six monthsafter the training

Training load1) 11000 Dhaimas to be trained for ten days2) Briefing for already trained: 7500 Dhaimas for 1 dayTrainers availableTraining institutions identifiedMonitoring teamsFunds to reach 14 CDMOs by end January 2005Period of training February - April 20052 batches per month in each Block PHC / CHC20 Dhaimas per batchOn day 10, the trained Dhaimas will join the training programin the respective blocks where briefing on Navajyoti will bedone

Navajyoti - Odisha · Navajyoti, the new strategy document captures all the key elements that can ... Eradication Programme (NMEP) report of 1998, 28.6% of all malaria cases and 62.4%

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