NRHM CRM-Sub group meeting on finalization of PIP - 2010-11 MCR-HRD Institute 22.01.10

1. NRHMCRM-Sub group meeting on finalization of PIP - 2010-11MCR-HRD Institute22.01.10

2. Proposal for integrated health and nutrition package in remote and interior villages Society for Elimination of Rural Poverty Dept. of Rural Development Govt. of A.P 22.01.10

3. Outline of the presentation • Overview of IKP interventions • Rationale for an integrated model • IKP health and nutrition model • Critical NDCC model • Convergence experiences • Health impacts • Budget estimates -2010-11 • IKP investments • Action plan for 2010-11

4. Society for Elimination of Rural Poverty (SERP) • Sensitive support organization for the poor • Autonomous society set up by Government in 2000 • State wide mandate: • To induce social mobilization • To provide facilitation support to institutions of poor • To sensitize all line departments to be inclusive of the needs of the poor

5. IndiraKranthiPatham (IKP) : • Comprehensive poverty eradication through empowerment of rural poor women • building self sustaining institutions of poor • Rs.2100 crores Project - financed by State Government, Govt of India, World Bank cover all rural poor in the state • builds on the decade long, statewide rural women’s self-help movement in A.P

6. Institution building • 9.7 million women organised into 850,000 S.H.Gs, • All Villages covered • S.H.G Federations: village – 35,525 V.Os, mandal – 1098 M.M.S, and, district – 22 Z.Ss • Universal coverage of poor - 90% of rural poor households organized

7. A.P Federation Model Z S 200,000 400,000 • E.C - 2 from each V.O, 5 Office bearers • Support to VOs • Secure linkage with Govt. Depts. fin institutions, markets • Auditing of the groups MMS • Micro Finance functions 4000 6000 • E.C - 2 from each S.H.G, 5 Office bearers - • Strengthening of SHGs • Arrange line of credit to the SHGs • Social action • Village development V.O • Marketing and food security 150 200 • Support activists – 3 -5 - • Thrift and credit activities • Monitoring group performance SHGs • Micro Credit Planning SHGs SHGs SHGs SHGs SHGs • Household inv plans 10 - 15 C.B.Os implement the project Zilla Samakhya Mandal Samakhyas and V.Os plan and implement the various project components • Each Mandal is divided into three Clusters of 10-12 habitations. • A development professional, called Community Coordinator (CC) is placed in each Cluster. S/he stays in her cluster. • SERP selects and trains them. After completion of training, they are contracted by the MS and are accountable to MS. • M.S responsible for social mobilisation, institution building and funding the microplans of S.H.Gs/V.Os from C.I.F • Micro credit plans are evolved by the S.H.Gs in each village. These plans are funded by their own savings, CIF fund and Bank Linkage. • V.Os responsible for appraising the microplans and recommending them to M.S for financing from C.I.F • V.Os appraise microplans and also finance them from the recycled C.I.F Mandal Samakhya Village Organization SELF HELP GROUPS

8. Social capital created • 17,00,000 trained grassroots women leaders managing S.H.Gs and federations • 180,000 para professionals at village level – accountable to women’s groups • 20,000 Community resource persons – scaling up and deepening social mobilisation

9. Mandal Samakhya Terms of Partnership (VO – MS) Repayment Period 100 - 120 Months Terms of Partnership (SHG – VO) Banks 40 - 60 months Terms of Partnership (Member – SHG) SHG SHG SHG Prioritization of Needs and Members 12-24 months Members Micro Credit Plan Financing model Village Organization

10. SHG-Bank Linkage in AP Target 2009-10: Rs.9000 crores

11. Key IKP Initiatives • Sustainable agriculture initiative • Collective marketing of agriculture produce • Women dairies: franchisees of A.P State Coop dairy • Social risk management • Food security credit • Health and nutrition initiative • Education • Gender initiative • Persons with disability

12. Women’s network a platform for convergence of all anti-poverty programmes: housing, land access, civil supplies, urban development, forest management • Line departments modified implementation procedures in consultation with S.H.G federations • S.E.R.P’s dynamic role – changes in tune with the changes in the demands of the C.B.Os

13. What is the problem? • 42.5% of children are underweight • 48% of children are stunted • 19.8% of children are wasted • 22% are low birth weight • 34-36% of adults with BMI<18.5 • 79% of children are anemic • 70% of adolescent girls are anemic • 56% of women are anemic • 50% of child deaths are due to malnutrition

14. Why is it S.E.R.P’s concern? • Ill health - strongly correlated with poverty – both cause and effect • Health shocks drag people into poverty and keep them in poverty • Malnutrition prevents poor people from achieving their full potential – physically and mentally • S.H.G loans – bulk of small loans for health

15. What has been done till now? Why it did not work? Major Govt. interventions for nutrition: ICDS Coalition of Sustainable nutrition security in India says.. • ICDS: • Programmatic focus on supplementary nutrition. It is not an optimal nutrition intervention • No ownership of the community in planning, implementation and monitoring . • Weak implementation and monitoring

16. Why Community managed model promoted by S.E.R.P works? • Sustainable solutions emerge when institutions of poor develop solutions, own them and manage them • Solutions developed by women’s groups in collaboration with S.E.R.P, health, women and child welfare and rural development dept s • Holistic model – promotes livelihoods security, and, food and nutrition security

17. Integrated community managed health and nutrition model

18. IKP health &Nutrition model: Aims • Improve partnerships between health facilities and the communities. • Increase appropriate and accessible health care and information through training of community health workers. • Promote key family practices critical for child health and nutrition by training and supporting peer support groups and conducting outreach education campaigns by training community resource persons • Involve other community institutions and champions to engage in health education and planning.

19. IKP Health Value Chain towards reaching MDGs Preventive & Promotive Health Care Curative Care Financing and Service Delivery Microfinance Product for NUTRITION • Human/Social Capital • Health activist/ASHA • Community Resource Person (CRP) Case Managers Health Risk Fund/ Health Savings Fixed Nutrition & Health Day (NHD) Health Insurance Making Services Work for the Poor – Accessing PHCs & Area Hospitals – 108,104 and Aarogyasree services Community-owned Pharmacy Water & Sanitation Nutrition Centers Community-owned Hospitals

20. “Nutrition Cum Day Care Centre (NDCC) – An Enterprise Model in Addressing Nutrition”

21. NDCC Vs AWC

22. POP pregnant woman diet at Home, AWC and NDCC

23. Nutrition Center – The Scale * Nutrition Centers are at the rate of ONE PER VILLAGE • Beneficiary: • Average of 15 pregnant & lactating mothers per center • Average of 15 – 20 children <5 years per center

24. Convergence experiences • ANM • Fixed NHDs • Participation in VO meetings • Referral services/Family planning • Participation in VO meeting. • ASHA • Training of SHGs • Fixed NHD • Participation in VO meeting. • AWW • Fixed NHDs • Participation in VO meetings • Health Education • PRIs • Cleaning up of water tanks, drains, garbage bins in Health CRP strategy • Screening camps • Exposure visits to CRHP, Jamkhed • ODF villages thru’ W&S committees Note : To institutionalize the process at all levels, there is a need to issue a GO jointly by the depts of health, WDCW, RWS and Rural development.

25. Internal MIS results ( 4200 deliveries)

26. External Impact evaluation results • 90% had normal deliveries • 10% had cesarean section. • 52% of pregnant women gained 9 -12Kgs weight • Note: study conducted in 8 districts inclusive of mandals in 3 ITDAs.

27. 2010-11Mapping of pilot mandals with PHCs

28. Model wise cost estimates

29. Support for 1500 NDCCs

30. Health impacts

31. IKP: health and nutrition Interventions

32. Contd..

33. Total budget for 1500 NRHM villages

34. NRHM leveraging IKP livelihood funds in 5 years in a VO Total NRHM funds: Rs 3.00 lakhs Total IKP funds : Rs 204 lakhs

35. Sustainable and replicable • Strong institutional architecture • Trained social capital to scale up • Owned and managed by women’s groups right from the beginning • Livelihoods enhancement – so that good health and nutrition practices are imbibed by the entire family • Continuous support from Government

37. Action plan:2010-11 • Coverage of 110 mandals with special focus on tribal mandals ( mapped with the PHCs selected). • Establishment of 1500 NDCCs from 110 NRHM pilot mandals. • Institutionalization of Fixed NHDs in all 110 mandals • Adoption of HBMNCC model in NRHM villages towards reduction of NMR • Development of social capital (CRPs) at every SHG level (Thailand model) • Decision support system at all levels through computerized member based data management for generation of reports. • Independent external evaluation on the outcomes expected under NRHM in all intervention villages and comparison with non-intervention villages.

38. Thank you