Health and Nutrition Interventions

1. Health and Nutrition Interventions Society for Elimination of Rural Poverty Hyderabad

2. Outline of the presentation • Universal approaches • Intensive approaches • outcomes • Model village plan • Scale up plan

3. Universal approaches • Regular schedule for capacity building of Health activists (4 days/month), health sub committees (2 days once in 2 months) and SHG members (2 days in a month) with a fixed calendar & module. • Institutionalization of fixed Nutrition and health days (NHDs)& screening camps. • Regular health savings and health Risk Fund operationalisation in all the VOs. • Introducing health agenda and review of activities at SHG,VO,MMS and ZS levels. • Positioning of case managers for effective referrals. • Establishing Community kitchen gardens. • Preparation of weaning foods for children in 6-12 months age. Currently being implemented in 53 pilot mandals (45+8giripragathi mandals).

4. Intensive approaches • Health CRP strategy:5 member team with best practitioners from different districts spend 30days in a village in 2 phases to focus on: • Introduction of health Agenda at SHG &VO meetings • Promotion of Health savings & HRF • Promotion of Comprehensive Food security line • Establishment of Nutrition cum day care centre • Institutionalize schedule for SHG member trainings • social mobilization and convergence activities. Covered 105 VOs from 20 mandals in 6 rounds since Jan 07.

5. Progress of universal interventions • Health savings : Against 1500 VOs, 1220 VOs have opened exclusive accounts for health savings. (Rs 68,15,022) • Utilization of HRF released @1lakh/VO to all the mandals: • 24% for surgeries • 60% for deliveries • 5% for Gynec problems (improved women’s health seeking behavior with access to credit and services thru' screening camps) • 11% for other medical admissions and OP treatment

6. Institutionalization of Fixed NHDs: (1254 Vos against 1400 VOs). • Organized cluster level screening camps in 40 mandals. • Fixed schedule of trainings for SHGs to focus on preventive and Promotive health care messages through Health Activists/ASHA. • Position of case managers at District/Area/PHCs Health dept in principle agreed to scale up these interventions and to fund under health sector reform strategy program/NRHM for the year 2007-08 & 2008-09.

7. Intensive approach- Health CRP strategy • Identified the best practitioners as external Health CRPs from 45 pilot mandals. • Imparted 15days training(10+5) for all the external health CRPs at Orvakal by SPMU team. (Case studies & Field practice). • Constituted external Health CRP teams with 5-6 specialists from different districts to work 15 days outside the district and 15 days in their respective VOs in a month. • Positioned the teams @ 2-3 teams per mandal. • Phase 1:15 days ( Focus on survey and reaching all the SHG members with the concepts on 6 topics- Communication) • Phase 2: 15 days ( Focus on enrollment of SHG members – Action) • Phase 3: 5 days ( Internal CRPs exposure to CRHP, Jamkhed. • Phase 4: 2 days ( visit by external CRP teams after 2months to assess the functioning of internal CRPs (Varasulu) in discharging the responsibilities taken up) • Phase 5: Identification of Internal health CRP teams after 6 months from the VOs covered by external health CRP teams.

8. External health CRP teams to cover 1/3 of VOs and 2/3 rd to be covered by internal health CRP teams in phases . • Grama sabha involving the VO, Panachyat and the entire community after the survey and before leaving the Village (at the end of 2 months). • Debriefing sessions at DPMU to hand over the responsibilities to internal CRPs identified at every VO level. • Debriefing sessions at SPMU and interactions with Dr.Arole once in 2 months. After 6months: • The internal CRPs from the villages covered by external teams will come to state level to undergo training and will be attached to external teams to have hands on experience in 2rounds.Subsequently, they will also be constituted into teams to go to other districts/in the same mandal.

9. Strength of health CRPs • Dec 06 : 40 • Feb 07 : 80 • Sept 07 : 150 (For every 2 months 100-150 health CRPs developed from the villages covered by external teams) • Nov 07 : 250 • Jan 08 : 350 • March 08 : 500

10. Outputs of health CRP strategy adopted in 105 VOs from 20 mandals in 6 rounds (Jan-Nov 07) • Strengthening of IB: • >10% of new SHGs are formed. • Health agenda: • 91% of SHGs are introducinghealth agenda in their regular meetings by the women identified and trained @ 2 per SHG. • Health savings: • 100% VOs with 91% SHG members initiated exclusive savings for health.

11. Comprehensive Food security: • 72% of the SHG members have enrolled under CFSL. • SHGs Training • 84% of SHG women trained by HA with a seasonal training calendar prepared to train SHGs separately. • Convergence activities • 6 % of the cases attended screening camps referred to Area/district hospitals/net work hospitals for surgeries.

12. Social mobilization • 2050 youth organized into 156 youth groups and opened accounts with the savings of Rs 134000. • 100% VOs are continuing with special drivesonce in15 days for water safety and sanitation measures with the support of youth groups and Panchayat. • Involvement ofPanchayat and support to release the funds available under RCH-II.

13. 2400 adolescent girls organized into 205 Balika sanghalu opened accounts with the savings of Rs 32642. • 1568 girls against 2400 are continuing their education. • MCP for education was done for Rs 493004 towards, fee, transportation and special coaching etc., • Regular trainings on menstrual hygiene are being imparted by the TOTs of ICDS as per the fixed day (Sunday) and fixed training calendar prepared.

14. 96% Vos established Nutrition centers(100). 40% of centers extended with facilities for day care for children(42). 68% VOs developed community Kitchen gardens. 87% of lactating mothers are using weaning foods for their children in the age group of 6-12months Nutrition cum day care centers

15. Outcomes of enrollment at Nutrition center

16. Infant feeding practices

17. Neonatal care practices

18. Sequence of activities in Gunjedu (15 SHGs with 212 members) • Survey to list the beneficiaries and compare with the list available with AWC • Counseling with the beneficiaries; husbands & mothers, mothers-in-laws. • Prepared MCPs; identified SHG member as cook, procured commodities • Prepared training calendar for health education sessions. • Fixed a day for NHD • Prepared weaning foods by the mothers themselves for children between 6-12mths age. • Opened the center in the first phase of CRP strategy ( Oct 07). • Repayments are made as per the installments agreed. All POP and Poor are enrolled at the center

19. Dovetailing funds from ICDS and JSY • Initial 6months to be born by the VO and then the funds will be supplemented by ICDS. • In principle agreed to release JSY funds to VO with nutrition centers. • This will reduce burden on VOs to reduce their contribution (Rs 6 to 7)

20. Plan up to March 2009 • Continuing the activities under universal approach in 45 pilot mandals +8 Giri Pragathi mandals ( Regular Training & exposure visits to Health sub committee members and Health Activists, Fixed NHDs, CIFs for community Kitchen gardens, weaning foods, Sanitary napkins, ISLs, CFSL, Screening camps etc.,) • Roll out of intensive health CRP approach ( focus on 6 components) in: • Saturation of entire Vizag district • 8 Giripragathi mandals in 3 districts. • Addl mandals in 3 Tribal districts (7), 4 Chenchu districts • 15 HN mandals in 8 districts ( VZM,, E.G, W.G. Krishna, Guntur, Chittoor, Kareemnagar+ R.Reddy)

21. Partnerships • Support in development of 20 community managed pre-schools ( Shodhana) • Support in making 100 villages free from open defecation (CRHP, Jamkhed and Gram Vikas, Orissa) • Support to bring health, nutrition and education issues in the agenda of 100 Panchayats (MVF) • Support to bring awareness among 10,000 members about dietary diversification to improve nutritional status of rural communities (Home Science college, Agricultural University) • Internship of 60 students of Home science in HN mandals for 45 days in every year.

22. Impact evaluation studies on health and nutrition interventions under IKP (NIN& CRHP) • Support to build the capacity of SHG members on community health with special focus on HIV/AID (Lepra India) • ZS as MNGo and MMS as field Ngo under NRHM in 11 districts. • Video documentation of implementation processes in health CRP interventions and use them as training films to train the internal CRPs. • Establishment of 5 drug depots (Vizag, Chittoor and Vizianagaram)

23. Road Map

24. Budget estimates (Rs in lakhs)

25. Thank you

26. Expected outcomes in intensive health CRP strategy

27. Health agenda: • SHGs with facilitators to introduce health agenda in regular meetings. • Priority to the MCPs related to health, nutrition and education. • Trainings on preventive and Promotive health care • SHG members have knowledge and practice on Sukhajeevana Suthralu for maternal and Child survival and control of communicable diseases. • SHG members reduce their expenditure on childhood illnesses (Diarrhea & ARI) with the use of home remedies. • Practice in use of green leafy vegetables regularly and reduce the incidence of anemia through promotion of community Kitchen gardens.

28. Nutrition cum day care centres • All Pregnant and lactating mothers and children ( with focus on POP & Poor) get enrolled and avail services provided at Nutrition cum day care centre. • All the eligible women and children avail services on the fixed NHD. • All the mothers have safe and normal deliveries. • All the mothers give birth to the children with >3Kgs birth weight. • All the children have complete immunization by the age 1 year. • All the children have normal growth corresponding to the age.

29. Health savings –HRF: • All the SHG members have regular monthly savings for health (@ Rs20-30/month). • All the SHG members have access to credit for any health emergencies and do not go to money lenders. • Reduction of household expenditure on health. • Involvement of Panchayat • Measures to supply safe drinking water and environmental sanitation on regular basis with the support of youth and VOs. • Resolutions of Panchayat to include issues around health, nutrition and education in due consultation with VO health sub committee members.