Report - Jharkhandjrhms.jharkhand.gov.in/FileUploaded By User/5. Gumla_District_RMN… · RMNCH+A intensification efforts in the State and HPDs have been divided among the partner

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

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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