TH PROGRAM MANAGEMENT GROUP - UNDP...Floor Conference Room, Ministry of Health & Family Welfare,...

Program Management Group November 3, 2010

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10TH PROGRAM MANAGEMENT GROUP

Venue: 4th Floor Conference Room, Ministry of Health & Family Welfare, Nirman Bhawan, New Delhi,

India

Date: November 3, 2010

Time: 1500 hrs to 1900 hrs

The Norway India Partnership Initiative (NIPI) Program Management Group (PMG) acts as technical

advisory board for the Joint Steering Committee of the NIPI. The role of PMG is to review technical

proposals and to give recommendations to the Joint Steering Committee.

The 10th PMG met in Nirman Bhawan at 3 pm on November 3, 2010 under the Chairmanship of

Additional Secretary and Mission Director National Rural Health Mission (NRHM), Mr P. K. Pradhan.

The Chair opened the meeting and welcomed the participants. Director UNOPS-LFA introduced Mr.

Anthony Cameron, the new Director of NIPI Secretariat, to the participants. This was followed by a

round of introductions of the participants.

Program updates were given by NIPI Focus States, WHO, UNICEF, UNOPS LFA, NIPI Secretariat and

National Child Health Resource Centre (NCHRC).

New proposals

The following proposals were submitted for consideration by the Program Management Group:

1. Strengthening Measles Control Activities in NIPI focus States 2. Accelerating Child Health Interventions:

Capacity building of district level Program Managers in Child Health Program review and management

Strengthening management of Childhood Malnutrition 3. Accelerating Maternal Health interventions:

Strengthening Quality Assurance (QA) of Reproductive and Child Health (RCH) trainings under National Rural Health Mission (NRHM)

Developing implementation model for strengthening maternal and new born health services

Strengthening accreditation of RCH service providers

Capacity building of Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy (AYUSH) practitioners in SBA / IMNCI skills


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4. Strengthening of Nursing and Midwifery Pre-Service Education in Bihar (State Health Society Bihar, NIPI Child Health Resource Network, UNOPS)

WHO: Proposal # 1 Strengthening Measles Control Activities in NIPI focus States (Proposed Budget: US$ 1,824,000)

WHO plans to continue and expand measles surveillance in the NIPI focus States (Bihar, Madhya

Pradesh, Orissa, Rajasthan and Uttar Pradesh). Focus shall be on technical assistance related to training

workshops (State and District Level), operational support related to outbreak and case investigations,

printing and dissemination of guidelines, laboratory support to measles surveillance activities through a

network of WHO accredited national laboratories in mentioned States.

WHO proposes to continue technical support to Measles immunization catch up campaigns in Bihar,

Madhya Pradesh, Rajasthan and Uttar Pradesh (UP). This includes developing training material,

conducting training of trainers and other trainings, supporting and evaluating district level preparedness

for the catch-up campaigns, supporting injection safety and Adverse Events Following Immunization

(AEFI) surveillance and management as well as monitoring the quality of the catch-up campaigns.

Routine Immunization (RI) strengthening is being proposed focusing on technical support to monitor

routine immunization training of medical officers, expansion of RI monitoring through training of

medical officers and institutionalization of the process for feedback.

In response to queries on the budget, WHO clarified that NPSP maintains a network of field offices with

technical and support staff. This network is primarily maintained for supporting Govt. of India and State

Governments in polio eradication activities. Costs for supporting other program outputs are apportioned

to the operational costs for the units. In the proposed budget, 15% of the operational costs of the units

likely to be involved in measles control activities have been apportioned.

The Chair pointed out that of the total budget of 1.8 million, over 75 % is allocated for measles

surveillance and the rest being distributed for the remaining activities. Measles related activities should

be confined to the NIPI focus States. However, UP does not require NIPI funds to take up measles

surveillance in 75 districts. Furthermore, since UP and Bihar also have strong National Polio Surveillance

Project (NPSP) set up, they do not require NIPI funds.

RNE expressed that it is aware that Measles control is beyond any doubt a top priority for child survival

in India and of great importance for global MDG4 efforts. However, RNE raised concerns that funding for

Measles support in Measles surveillance and control activities, particularly in UP and Bihar, need to be

delinked from the Polio related activities. This has been noted by the PMG and will be included as part

of the note that will go to the JSC.


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RNE is also of the opinion that size of the budget in ‘Technical support through NPSP Field Offices’ is significant (and far larger than other activities). Before making a decision, the PMG would therefore require more information on the breakdown as well as an indication of how this will be sustained with the GoI plans of Health Systems strengthening.

DECISION:

PMG takes note of Government of India (GoI) and Royal Norwegian Embassy (RNE) concerns. The PMG

requires WHO to reflect these concerns and respond to the 10th Joint Steering Committee (JSC) with a

revised proposal including more information about Terms Of Reference (TORs), clarities on timelines

and staff time allocation of the Field Officers of Surveillance Medical Officer (SMO) Units. The funding to

WHO would be contingent on GoI endorsement.

WHO: Proposal # 2 Accelerating Child Health Interventions (Proposed Budget: US$ 450,000)

WHO proposed accelerating child health interventions by focusing on ongoing activities such as capacity

building of district level Program Managers in Child Health program review and management,

community monitoring of MCH activities at village level and strengthening Essential Newborn Care

(ENBC).

Under strengthening management of Child Malnutrition an update on ongoing activities like

strengthening Infant and Young Child Feeding, training of MOs/Nurses in facility based management of

SAM children and operational research activities of development of a community based model to

address social determinants of under-nutrition in children (with INCLEN) and study on impact of energy

dense local diets on physiological recovery of children with Severe Acute Malnutrition – a multi-centric

study. (along with DBT/ICMR – NIN) were also discussed. The study on energy dense local foods will be

approved DBT and NIPI ORC before initiation.

DECISION:

PMG recommends that capacity building of Programme Managers in Child Health is an important

activity and scaled up NIPI states as early as possible.

Concerning strengthening management of child hood malnutrition it was recommended that the focus

should be on strengthening community level management of Severe Acute Malnutrition (SAM) among

children. This may be piloted in the State of Madhya Pradesh (MP) and later scaled up to all NIPI focused

districts.

PMG recommends this proposal be submitted to the JSC for approval incorporating the observations

above.


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WHO: Proposal # 3 Accelerating Maternal Health interventions (Proposed Budget: US$ 330,000) WHO presented an update of ongoing activities of strengthening quality assurance of RCH

(EmOC/LSAS/SBA) trainings, development of an implementation model for Maternal and Newborn

Health services and strengthening accreditation of RCH Service providers. A few new proposals like

strengthening maternal managerial capacity of Program Managers, assessment of AYUSH practitioners

for providing SBA and IMNCI service and the planned Iron Sucrose study were also discussed.

DECISION:

PMG also stated that quality assurance of RCH trainings should be instituted in the context of various

levels of MCH care being promoted in the country.

PMG recommends this proposal be submitted to the JSC for approval incorporating the observations

above.

Responding to ‘Capacity building of Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy

(AYUSH) practitioners in SBA / IMNCI skills’ the Chair and Director NHSRC informed that similar studies

have already been undertaken by PHFI in the State of Chhattisgarh.

Furthermore with respect to ‘Developing Implementation Model for Strengthening Maternal and

Newborn health services’ and ‘Strengthening Accreditation of RCH Service providers,’ PMG

recommended WHO to submit detailed proposals with budgets.

Concerning the iron sucrose study it was recommended that the proposal be submitted to the

Operations Research Committee for review and approval.

UNOPS LFA: Proposal # 4 Strengthening of Nursing and Midwifery Pre-Service Education in Bihar (Proposed Budget: US$ 780, 836)

Proposal from JHPIEGO through UNOPS LFA aims to provide technical assistance to Bihar Health

Department in identifying an existing General Nursing and Midwifery (GNM) school as State nodal

centre and to strengthen it using the Indian Nursing Council (INC) programmatic approach. The Nodal

centre in turn will facilitate strengthening of the Auxiliary Nurse Midwife Training Centres (ANMTCs)

through Capacity building of the ANMTC tutors, strengthening of Pre Service Education (PSE) by using

Standards Based Management and Recognition(SBMR) techniques and Network ANMTCs to compare

progress and collectively solve implementation challenges.


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DECISION:

PMG recommends the proposal for approval by Joint Steering Committee (JSC).


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Discusssion points

Bihar

The Principal Secretary, Department of Health & Family Welfare, Government of Bihar presented an

update on NIPI activities in the State of Bihar. Key highlights from the presentation included:

Positive contributions of Mamtas at health facilities. Comparison of data from the three NIPI

focus districts, brought out the fact that retention period of the mothers depends on the

availability of beds and quality of health services.

Analysis of the Post Natal Cards (PNC) filled up by Accredited Social Health Activists (ASHAs) for

Home Based Post Natal Care reveal a number of gaps in the process.

Referral in Home Based Post Natal Care (HBPNC) intervention is emerging as a weak link,

requiring further strengthening. However, it was noted that ASHAs need to undergo 5 days of

skills training which will improve their ability to identify danger signs and therefore, referral

would be strengthened.

Mobile payments to ASHAs for Home Based Post Natal Care are in progress and likely to be

operational in the following month.

State of Bihar has given a turnkey assignment to an agency for 24 SNCUs including in the 3 NIPI

focus districts.

Data on deliveries conducted at home and at facility levels highlighted the fact that about 50%

are home deliveries and therefore, home based post natal care needs to be strengthened.

The Chair suggested that there needs to be more capacity building of the ASHAs especially in regards to

identification of danger signs, referral as well recording of maternal and neonatal deaths. Quality of data

collected by ASHAs on the PNC cards need improvement for better monitoring through validation,

supportive supervision and data analysis.


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Madhya Pradesh

Strengthening the SIHFW by placing the State Child Health Resource Centre (SCHRC) was appreciated by

the Chair. Following which, it was pointed out that, building capacity of the State level institutions is

essential for managing scaling up of interventions.

Regarding accelerating child health immunization, based on the priorities and specifications of the

States, Village Health and Sanitation Committees (VHSCs) should be trained appropriately. It was

suggested that a module may be prepared with inputs from National Health System Resource Centre

(NHSRC).

With regards to standardization in processes, when several agencies (for example, UNICEF, UNOPS-LFA,

Bill & Melinda Gates Foundation) are implementing interventions in various districts, the Principal

Secretary informed that a coordination mechanism has been established at the State level.

The Mission Director NRHM, Government of Madhya Pradesh (MP) made the presentation. Key

highlights from the presentation included:

Process has been adopted for building capacity of ASHAs for postnatal home visits through

training of State level trainers on modules 6 &7 at Gadchiroli, Maharashtra.

Certain suggestions have been made by the State Government to NHSRC on modules 6 &7. The

Director NHSRC clarified that a National training team is in place which is monitoring the roll out

and will respond in couple of weeks.

There are issues pertaining to filling up of managerial positions due to the presence of a strong

reservation policy. This is resulting in severe shortage of nursing cadre which is affecting the

functioning of SNCUs.

Different strategies are adopted each level for coordination of staff, equipment, infrastructure,

supplies across all three levels of SNCUs. This includes involvement of private sector, delegation

to the Districts to use the available manpower suitably, requesting District Managers to

prioritize activities with clear process indicators, setting up of the SNCU cell with Managers to

follow up on logistics and implementation and use of prefabricated structure for speeding up

the process of establishment of infrastructure.

Development of MCH plans is progressing well with UNOPS LFA support in the preparation of

the same in the NIPI focus Districts. Efforts have been considerably appreciated.


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The Chair requested that a formal communication regarding the suggested modifications on modules 6

and 7 be sent to GoI. Regarding capacity building for management of malnourishment, both at facility

and community levels, the Chair suggested that it may be taken up initially at Betul District.

Orissa

The Mission Director NRHM, Government of Orissa made a presentation updating the participants on

NIPI activities. Key highlights from the presentation included:

Mention has been made of the operations research study ongoing which has been undertaken

by an external research agency across intervention and control Districts in Orissa. The positive

role of Yashodas in the maternity wards of the 14 health facilities across intervention Districts

has been highlighted.

Regarding HBPNC, data recorded in the PNC cards show high level of success in few key

indicators such as initiation of early breast feeding. However, low referrals have been indicated

from the data which need to be considered in the light of ASHAs still requiring to undergo 5 days

skills training.

Incentives have increased number of referrals of Grade 3 and 4 malnourished children which

was appreciated. However, in this regard, the Chair pointed out that although incentives are

useful, yet a process of strong checks and balances is required to ensure that services are

provided in accordance to certain standards.

There was a reference to the fact that service data has its limitations and therefore, there is a

need for strong supportive supervision at different levels viz., ASHAs, data entry and data

analysis. In this regard, the Mission Director pointed out that an external agency is already in

place.

MCH plans that are in progress are for the all the Districts and training of cold chain handlers for

ensuring functional cold chains is a significant part of the plans.

In regards to the process of recruitment for the State SNCU Cell, the Chair suggested that in principle,

Orissa should go ahead and conduct the interviews on their own. However, the current interview

process should be completed with the support of NHSRC. The progress of State Child Health Resource

Centre (SCHRC) located in the State Institute Health & Family Welfare (SIHFW) was appreciated as

strengthening such State institutions is critical for sustainability.


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Rajasthan

The Mission Director NRHM, Government of Rajasthan, presented key highlights on update of NIPI

activities in the State of Rajasthan. These included:

Data analysis for tracking morbidity and mortality beyond admissions into SNCUs is important

and needs to be included in HBPNC.

SIHFW has been identified as the third party for providing supportive supervision and data

validation for HBPNC intervention.

Focusing on SNCUs, it was noted that there has been an increased number of referrals of out

born neonates. However, monitoring of the SNCU admission criteria and collection of sex

segregated data are critical. Post discharge monitoring of the neonates from the SNCU to track

survivors at the community level is also important.

SIHFW will be the central agency for all trainings across the entire State.

The Chair pointed out that ANM should ensure early referrals under HBPNC as well as follow up on the

referral cases. The admission criteria in the SNCUs should be monitored to ensure that criteria for

admissions are followed to optimize the use of available limited bed capacity.

WHO

WHO made a presentation focusing on the 3 proposals viz., “Strengthening Measles Control Activities in

NIPI focus States”, “Accelerating Child Health Interventions”, and “Accelerating Maternal Health

interventions”. Summaries of proposals and associated PMG decisions have been stated in the section

on ‘new proposals’.

WHO presented an update on the ongoing activities of strengthening Pre-service IMNCI training,

capacity building of district level Programme Managers in Child Health, strengthening Essential Newborn

Care (Webinars), capacity building of Medical Officers and Community monitoring of MCH activities.

They also presented updates on ongoing activities of strengthening quality assurance of RCH

(EmOC/LSAS/SBA) trainings, development of an implementation model for Maternal and Newborn

Health services and strengthening accreditation of RCH Service providers.


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UNICEF

UNICEF made a presentation with the following highlights:

• Comprehensive Child Survival Program (CSSP) is being supported by UNICEF through NIPI. In the

year 2007, a decision had been taken to implement CCSP in 17 districts (Phase 1) after piloting in

Integrated District Lalitpur. In the year 2009-10, it has been scaled up to 19 additional districts

(Phase 2).

• Supportive supervision has been implemented in 6 blocks of Aligarh District, Uttar Pradesh in

partnership with Department of Sociology and Social Work, Aligarh Muslim University.

• IMNCI has been implemented in 15 districts of Bihar. A program assessment was conducted in

IMNCI districts to identify bottlenecks. Following this, a joint workshop by Department of

Women and Child Development and Department of Health and Family Welfare, has been

organized to share the findings, and way forward.

• 3 National Resource Centres have been established at Delhi for Facility based-IMNCI (Maulana

Azad Medical College, Safdarjang Hospital and KSC Hospital). 20 Master Trainers have been

trained at Delhi from the States of Bihar, Uttar Pradesh, Rajasthan and Orissa.

• Collaborative centres for Facility Based Newborn Care have been set up to support states in

scaling up with quality, capacity building, telemedicine consultations, observer-ships, mentoring

visits and operational research.

• The process for setting up SNCU collaborative centers have been initiated with proposals

finalized with KEM Hospital, Mumbai and Institute of Child Health, Chennai. Proposals under

submission include those from Kalawati Saran Children’s Hospital, New Delhi and Post Graduate

Institute of Medical Research, Chandigarh.

• In regard to One Stop Shop for Perinatal Care Units , the Terms of Reference (TORs) have been

expanded to include entire perinatal care. This includes Perinatal care units, (PCU), labour

rooms, pre and post natal wards, operation theater, allied services. Pre-bid meeting with

prospective vendors has been undertaken resulting in short listing of 10 Vendors and invitations

being sent for these vendors.

• In regards to ‘Operationalization of First Referral Units (FRUS), contract with Deloitte-Touche

has been entered into. Following this, Letter of Support for UNICEF-Deloitte partnership from


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MOHFW to State Mission Directors (Bihar, MP, Rajasthan) have been sent. Initial visit to Bihar

has been done.

• Effective Vaccine Management has been conducted in the State of Madhya Pradesh in the

month of October.

• Plans for 2011-12 include Strengthened District Health Management in 44 districts, supportive

supervision, planning, Quality assurance, Monitoring and Evaluation, roll-out of F-IMNCI and

strengthening of MCH facilities for newborn and child health in 44 districts, Peri-natal care Units

in 4 sites, documentation, cost-effectiveness of IMNCI-Plus intervention, strengthening of

Collaborative centers .

UNOPS LFA

As guided by the 9th JSC, UNOPS-LFA presented a detailed proposal on ‘Strengthening of Nursing and

Midwifery Pre-Service Education in Bihar’ to be implemented by JHPIGEO in Bihar. This has been

recommended by the Chair for funding and RNE concurred with the recommendation.

Some of the key activities highlighted included:

• Mapping of facilities and identification of those with requisite inputs and utilisation for

notification as “MCH Centres” for a catchment area completed in all 13 NIPI focus Districts.

• To expedite preparation of RCH Sub Plans, LFA has reallocated responsibility of one District each

to two of its State Officers and is in the process of hiring one District Consultant in remaining

District hence between existing and new staff all the 12 focus Districts will be covered.

• Supportive Supervision is in place with 12 District Managers and more than 80 Block Child

Health Managers and Training Managers (at district) to strengthen existing

management/supervision structures in District and Blocks.

• Post planning support will include dissemination of the plan, preparation of micro plan for each

identified facility, develop checklist for the managers to follow up on implementation of the

plan, fast track District level training of functionaries (SBA etc) and facilitate accreditation of

MCH centres.

• Supportive supervision is being provided for HBPNC. Currently, 13000 ASHAs are systematically

visiting Homes to provide PNC to Mothers and Neonates and filling PNC cards. Approximately,

190,000 plus Mother Neonates visited.


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• Assessment of Immunization program management and demand for services in three NIPI focus

districts of Rajasthan along with Govt. of Rajasthan and IIHMR is ongoing. An exercise on

supportive supervision for Immunization and Village health and nutrition days in Narsinghpur,

Madhya Pradesh was undertaken.

• In regards to Yashodas, two independent studies have shown good promise. One was

commissioned by Rajasthan Government and the other by PHFI. The PHFI study has just

completed the qualitative aspect of the study and the next phase will focus on quantitative

aspect.

• Seven SNCUs functional in the three states of Rajasthan, Orissa and Madhya Pradesh with a bed

strength of 143; two units are ready and will be functional within a month; three units (Bihar)

will become functional by mid 2011

Director Emeritus, UNOPS LFA emphasized the point that NIPI funding can be for a period of 18 to 24

months at best, by the end of which the States should be able to assess the merits and demerits of the

interventions and absorb the same into State Program Implementation Plan (PIP) or give the same away

if these interventions are found not to be viable. Specific mention was made to the national level activity

of funding the National Child Health Resource Centre (NCHRC) in National Institute of Health and Family

Welfare and New Born Care Resource centre (NCRC) located at Institute of Post Graduate Medical

Education & Research (IPGMER), Kolkata, West Bengal.

NIPI Secretariat

The new Director, NIPI Secretariat, made a presentation on an update of NIPI Secretariat. Key highlights

included:

Sharing of roles and responsibilities of the Secretariat on a National level with equal support to

the 3 partners of NIPI (WHO, UNICEF and UNOPS-LFA) specifically in the areas of Monitoring and

Evaluation, Gender Mainstreaming, coordination of Operational Research, Secretarial support to

JSC, PMG and Finance/ Operations.

Regarding progress on Monitoring & Evaluation, it has been shared that an M&E Strategy for

NIPI has been developed in consultation with the 3 partners and RNE. The strategy focuses on

tracking progress of the program at 3 levels viz., NIPI Partnership, Partners’ interventions and

program management.

Common reporting format across all partners has been finalized. Indicators at output and

outcome levels have also been finalized. However, development of financial reporting formats is

still in progress.


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As guided by the JSC and MTR, NIPI Secretariat has taken specific steps for Gender

Mainstreaming since September 2010. As a follow up of a 2 days Gender Mainstreaming

Training for all the NIPI stakeholders, all the partners have begun the process of developing

specific Gender Action Plans. The Chair pointed out that there is very little attention to the

gender issues of adolescent girls.

In regards to ‘Operations Research’, the PMG was informed that based on the decision by the 9th

JSC, held in June 2010, all administrative responsibilities of Operations Research (OR) have been

transferred to the NIPI Secretariat and the Operations Research Committee (ORC) has been

reconstituted. 2 meetings of the ORC have been held since July 2010.

A decision was taken in the 1st ORC to have a subcommittee with Indian Council of Medical

Research as the Chair. The main objective has been to finalize the research agenda and review

of research proposals prior to submission to ORC for final approval.

On the ongoing research studies being conducted by PHFI and ANSWERS/FAFO, PMG was

informed that while RNE will continue to manage the financial responsibilities related to these,

NIPI Secretariat shall be responsible for oversight and coordination of these studies. Henceforth,

all the administrative and financial management aspects of the new proposals will be the

responsibility of the NIPI Secretariat.

A new proposal submitted by Breast Feeding Promotion Network of India (BPNI) has been

reviewed and comments have been sent to the Principal Investigator(s). A national level

workshop will be held in the third week of November 2010 for finalization of research agenda.

NCHRC

The presentation highlighted the progress on the National Child health Repository and Documentation

Centre and potential for all the partners to access easily.

It was highlighted that that the repository has been a great success with more than 70,000 hits

within the last 6 months from approximately 60 countries. This has been a pioneering step in

promoting the child health agenda in the National and International fora.

Role of the State Child Health Resource Centres (SCHRCs) established at the respective SIHFWs

of Orissa, Rajasthan and Bihar and in the Information, Education and Communication (IEC)

Bureaus in the State of Madhya Pradesh was explained. SCHRCs provide technical oversight and


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facilitate capacity building in NIPI focus districts. This helps in institutionalization of experiences

of various NIPI and NRHM interventions with the aim to support the State when these initiatives

are scaled up.

The Chair appreciated the process of setting up of SCHRCs and suggested that NCHRC should

think of expanding the activity by establishing SCHRCs in the States other than the NIPI Focus

States.

NCHRC is assisting in the HBPNC data analysis and will be supporting printing of output formats,

to enable the managers to improve their performance at various levels.


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List of Participants

MOHFW Mr. P.K. Pradhan (Chair) Dr. Sila Deb ROYAL NORWEGIAN EMBASSY Dr. Ashfaq Ahmed STATE GOVT. Dr. Manohar Agnani Mr. Preetam Yashwant Dr.Pramod Meherda Mr. C.K. Mishra NHSRC Dr. T. Sundararaman UNICEF Dr. Henri v d Hombergh Dr. Pavitra Mohan WHO Dr. Paul Francis Dr. Sunanda Gupta Dr. Archana Chowdhury Dr. Subodh Gupta Dr. Stephen Sossler UNOPS LFA Dr. Kaliprasad Pappu Mr. Prasanna Hota Dr. Karanveer Singh Ms. Kristine Brusletto Ms. Deepa Adhikari UNOPS LFA STATE STAFF Dr. Usha Patnaik Dr.Sudhansu Parida


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Dr. Satya Pal Yadav Dr. Rajan Dubey NIHFW Dr. Vivek Adhish Dr. Rajesh Khanna NIPI Secretariat Mr. Anthony Cameron Ms. Lalitha Iyer Dr. Urvashi Chandra Ms. Shanti Moktan Ms. Prasanna Narayanan

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