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Building Public Sector - NGO Partnerships for Urban RCH

Building Public Sector - NGO Partnerships for Urban RCH . Symposium on Urban RCH 31 st Annual National Conference of Indian Association of Preventive & Social Medicine February 29, 2004. Dr Siddharth Country Representative, USAID-EHP Urban Health Program. Presentation Outline .

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Building Public Sector - NGO Partnerships for Urban RCH

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  1. Building Public Sector - NGO Partnerships for UrbanRCH Symposium on Urban RCH 31st Annual National Conference of Indian Association of Preventive & Social Medicine February 29, 2004 Dr Siddharth Country Representative, USAID-EHP Urban Health Program

  2. Presentation Outline • Urban Growth and Urban Poverty • Reproductive Child Health Scenario among the Urban Poor • Public Sector Services for the Urban Poor • Existing Infrastructure and programs: UFWCs, Health Posts, IPP VIII etc • Issues around present RCH services for urban slums • Experiences/ Lessons in Government-NGO Partnerships in IPP VIII and Other Programs • What Value can NGOs Contribute to Urban RCH Programs? • Suggestions and Recommendations

  3. Urban Population Growth

  4. Especially in Their Smaller Cities

  5. Urban Growth in India

  6. Where Should efforts focus?

  7. Take Home Messages • Virtually all growth will be urban in the future • Growth is fastest in concentrations of urban poor – e.g. slums • (2-3-4-5 syndrome) • Most growth and population will be in small and medium size cities • Mega-cities will continue to grow – and have importance beyond their proportion of the urban population • Urban growth in India has been exponential over the last few decades • In India, 43% of urban poor reside in the 8 EAG States

  8. Reproductive and Child Health Conditions among the Urban Poor

  9. Coverage of Child Health Services in Urban Slums of 6 Municipal Corporations and Rural Areas of Gujarat Coverage State-wide Multi-Indicator Cluster Surveys (MICSs), 1996

  10. Child, Infant and Neonatal Mortality in M.P.

  11. Childhood Under-nutrition in Urban M.P. NFHS 2 Re-analysis, EHP 2003

  12. Immunization Coverage by Age 1 among Children 12-23 monthsMadhya Pradesh – NFHS 2 Re-analysis, EHP 2003

  13. Contraceptive Prevalence in Urban M.P. NFHS 2 Re-analysis, EHP 2003

  14. Delivery Related Services in Urban M.P. NFHS 2 Re-analysis, EHP 2003

  15. Take Home Messages • Urban averages mask sharp disparities between the rich and poor in urban settings • By many health indicators, urban poor populations are comparable to nearby rural populations – or worse in many cases

  16. Issues with Public Sector Urban Health Services

  17. Urban Health Infrastructure in the Public Sector • UFWCs (1950), Health Posts (under Urban Revamping Sceme1983) : • 1083 UFWCs & 871 Health Posts, many run from hospitals, not proximal to slums • With the total urban population of 290 million, (with 1954 UFWCs & HPs), this works out to one UFWC/HP per 148,413 Urban population • PP Centres(1966): 1562 (many closed owing to discontinuation of Central funding) • IPP VIII (1993 to 2003) covered 7 million slum population in 4 mega cities and 94 smaller towns in 4 states

  18. Scenario 1: Areas Where Some Public Sector Primary RCH Services Exist • Inadequate physical and social access • Low demand for services among slum dwellers and weak community linkages • Poor quality (timing, attitude, atmosphere) of services • Insufficient reach to the under-served slums • Weak monitoring and tracking of coverage • Low focus on behavior change • Little emphasis focus on sustainability • NGOs active in several areas.

  19. Scenario 2: Areas where Public Sector RCH services are Not Existing • 2nd tier hospitals are burdened with primary care • Large pockets of urban poor left out • Private informal providers are the major resource • NGOs active in small areas

  20. Low Utilization of and Access to Public Sector Services Urban Slums Rural Areas Gujrat State-wide Multi-Indicator Cluster Surveys (MICSs), 1996

  21. Cross-cutting Issues • Weak inter-sectoral linkages with non-health sectors e.g. Dept. of Urban Development • Insufficient focus on hygiene & sanitation improvement and on other basic services • Limited experience with and capacity for effective partnerships in diverse settings • Every city/town is different, hence context appropriate strategies remain vital

  22. Experiences in Govt. –NGO Partnerships for Urban RCH

  23. Some Examples of Government- NGO partnership for Urban Health • IPP VIII - A.P./Bangalore: • Link Volunteers & Women's Health Groups promoted through NGO • Financial incentives to WHGs through revolving funds. • Emphasis on empowering women (NGO supported) • Behaviour counseling (child health, nutrition and hygiene) • First tier facilities operated by NGOs • IPP VIII - Delhi • First tier facility and maternity services operated by NGOs • EC Supported UH Program in Guwahati • First and 2nd tier facilities operated by Charitable Hospital

  24. Learnings • Govt.-NGO partnership helped in institutional capacity building of NGOs and community groups and improving health coverage among slums. • Financial contribution from community members helped improve sanitation, wells • Reach to marginalized groups improved through a) WHGs and b) Link Volunteers. • Flexible contract (developed through participatory planning workshops) and regular meetings helped in solving problems ensuring better management. • Complementary and clearly defined roles of partners prevent sense of competition. • Effective program strategies were replicated

  25. What Value Can NGOs Add to Urban RCH Programming?

  26. Contribution # 1Identifying, Mapping Underserved Urban Populations • Locating and mapping all slums and vulnerable pockets including unlisted slums, hidden and marginalized pockets. • Providing services/linkage to seasonal urban migrants • E.g. NGOs helped identify hidden urban clusters during Pulse Polio Campaigns, CINI ASHA & MUSKAAN mapped slums in Uttaranchal and West Bengal

  27. Marginalized Social Groups Constitute A Large Proportion Of Urban PoorBackground Characteristics of Urban Uttar Pradesh - NFHS II

  28. Marginalized Social Groups Constitute A Large Proportion Of Urban PoorBackground Characteristics of Urban Delhi – NFHS II

  29. Contribution # 2Improve Access to Sanitation and Other Basic Services • NGOs can facilitate sustainable community managed sanitation programs utilizing resources from National schemes such as Nirmal Bharat Abhiyan • Forge linkages with NSDP, SJSRY, DWCUA and other Ministry of Urban Development programs • Can lend an advocacy voice to the basic needs of the underserved slums at the city level • E.g. SPARC, Apnalaya & other NGOs have facilitated sanitation programs in Mumbai, Pune

  30. Contribution # 3 Enhance Demand & Utilization of Services, Build Community Capacity • Context appropriate communication activities • Capacity building of community link volunteers for counseling, linkage to health services • Mobilise slum communities for effective outreach activities • Promote community institutions e.g. NHG, SHG • Quality Assurance of existing primary care services and of less qualified providers • E.g. In IPP VIII in A.P. and Bangalore, NGOs helped improve demand for services, SAATH and SEWA in Ahmedabad.

  31. Contribution # 4Wholly Manage Primary Level RCH Facilities • Where capacity is available and public sector is absent, NGOs/Charitable hospitals can manage First tier facilities • E.g. Govt. of Uttaranchal has proposed this model in Haridwar, FPAI manages one UHC in Bhopal, Marwari Charitable Hospital in Guwahati

  32. Contribution # 5 Effective Partnerships and Convergence • Partnership building and maintenance. Facilitate coordination of meetings, help record minutes • Community-Provider (ANM) linkage, support and encourage ANMs • Linkage with other Departments, ULB, Schools, Traders Associations, Lions etc. • E.g. Counterpart International-AMC partnership, EHP Indore Ward Coordination Model, Janagraha - Bangalore

  33. Contribution #6 Innovate & Develop Models for Replication & Scale-up • Still a lot to learn about Urban Health Programming: NGOs can serve as learning centres • They can conduct operations research to provide evidence for larger buy-in • Study tours, learning lessons, building a critical mass of essential skills needed to create a snowball effect • E.g.: Apnalaya in Mumbai: Arogya Sevikas

  34. Contribution # 7 Capacity Building, Institutional Strengthening and Sustainability • Serve as trainers on a variety of topics e.g. urban vulnerability, behaviour change communication and counseling • Strengthen community-based organizations and link volunteers • Train Private informal providers • Foster Sustainable Programming • Promoting ownership among partners of program objective and processes • Facilitate Health Funds at various through available sources including community contribution • Encourage the humanistic paradigm in programming and minimize exclusion and inequity • E.g. VHAI and FPAI have served as trainers in many states; Slum Networking Project in Ahmedabad through SEWA and SAATH focus on institutional capacity at slum level

  35. Contribution # 8 Strengthening/Developing Urban HMIS • Focus on an appropriate unit for monitoring • Promote denominator based monitoring • Innovations such as “Family Chit” prior to outreach camp • Murphy’s Law: “One single accurate measurement is infinitely superior to 1000 intelligent opinions”.

  36. Contribution # 9 Develop the Field of Urban Health as a Professional Field • Emerge as UH Programming and Resource Centres on a Regional basis • Support State Govts in Planning and Monitoring Urban RCH programs • Document Urban Health Program experiences and promote cross-learning • Compile and Disseminate Urban Health Literature including data • E.g. All India Institute of Local Self Governance for Urban Development issues, SPARC for Urban Sanitation issues

  37. Looking Forward To Urban Health Program/Policy • Long Lever of : • Commitment • Knowledge • Experience • Motivation • Proximity to problems NGOs

  38. Suggestions and Recommendations

  39. Capacity Building at State and City Level Required • Capacity to select and identify the right partners: apply appropriate selection criteria • Capacity to execute and monitor partnerships/agreements • Capacity to foster and maintain external networks • Enhance orientation to focusing on the underprivileged

  40. Summary and Key Messages Innovation & Development of Models EAG States - a priority Govt. NGO Multi-Stakeholder Coordination Quality & Demand Capacity for Planning, Management & Monitoring Reach the Un-reached Sustainability: Institutional, Programmatic, Financial

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