Scaling Up RMNCH+A Interventions

VRIDDHI

2014–2020

RMNCH+A: Reproductive, Maternal, Newborn, Child and Adolescent Health

Vriddhi is a USAID fl agship program which supports scale up of high impact Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCH+A) interventions with the goal of preventing child and maternal deaths. It partners with governments of six states and the Ministry of Health and Family Welfare (MoHFW), Government of India (GoI) to catalyze change, innovate solutions, build collaborative partnerships, and contribute to policy to expand the reach of RMNCH+A solutions.

Vriddhi – Scaling Up RMNCH+A Interventions

GOAL Reduce preventable maternal, neonatal and child deaths in High

Priority Districts (HPDs) of six states − Delhi, Haryana, Himachal Pradesh, Jharkhand, Punjab and Uttarakhand in India

OBJECTIVE Increase uptake of Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCH+A) services in 26 HPDs in six states

STRATEGIC OUTPUTS

Improved availability and quality of RMNCH+A services in government health facilities

Strengthened evidence for scale up of RMNCH+A services

Incubating RMNCH+A good practices for scale up

Involvement of multiple stakeholders and private sector partners, in delivery of RMNCH+A services

GUIDING PRINCIPLES

Prioritizing interventions to:

Address major drivers of mortality

Optimize resources

Plan for scale

STRATEGIC INTERVENTIONS

Innovating solutions to reach the unreached targeting urban and rural poor populations in remote and inaccessible terrains and tribal pockets

Collaborative partnerships to build consensus and align actions towards a common goal as in nationwide RMNCH+A Supportive Supervision

Contributing to policy and implementation to expand the reach of RMNCH+A services, by active engagement in technical task forces and core groups at national and state levels.

Catalyzing change through ‘Care around Birth’, a timebound approach to improve quality of care in labor rooms in public health facilities

Supported Interventions

State newborn action plans

Engaging private sector Improving PPFP counseling

Expanding coverage of new and underutilized vaccines

Generating evidence for strategic planning – PIP

Strengthening Adolescent Friendly Health Clinics

Planning and monitoring of national health programs

RMNCH+A Supportive Supervision Care around Birth

Demonstration models WIFS, community based advanced distribution of misoprostol, KMC, HBNC

PMSMA strengthening antenatal care

Enhancing ANC outreach

ANC: Antenatal Care; HBNC: Home Based Newborn Care; KMC: Kangaroo Mother Care; PIP: Program Implementation Plan; PMSMA: Pradhan Mantri Surakshit Matritva Abhiyan; PPFP: Postpartum Family Planning

Rolled out across 141 high caseload facilities in 26 Project supported HPDs

Care around Birth Catalyzing Change‘Care around Birth’ (CaB) is an approach that catalyzes change in clinical practices, labor room organization and client interactions. Aiming to improve care of mothers and newborns, it promotes effective implementation of evidence based practices during critical intrapartum and immediate postpartum periods. Using a holistic Health Systems Strengthening (HSS) approach, ‘Care around Birth’, combined innovative capacity building techniques, Quality Improvement (QI) processes and Respectful Maternity Care (RMC) practices to demonstrate visible changes in 141 high caseload delivery points over a short span of time.

77 facilities in 17 non-HPDs in

Punjab

45 additional facilities in 3 HPDs

in Uttarakhand

Capacity Building

Mentoring

Inputs

QualityImprovement

Team Approach

Prioritizing Data for Action

Outputs

Outcomes

Motivated &Competent

Staff

Essential Physical

Resources Available

Leadership &

Ownership

ActionableInformation

Systems

Provision of care High impact technical interventions

Experience of care Respectful Maternity Care

Coverage of key practices

IMPACT

Ending Preventable Maternal and

Newborn Deaths

Health System

s Strengthening

54 facilities and 9 non-HPDs in

Delhi

50 facilities in 7 non-HPDs in

Haryana

SCALED UP to 266 facilities and 41 non-HPDs

25 facilities in 8 non-HPDs in

Himachal Pradesh

15 additional facilities in 6 HPDs

in Jharkhand

463,713 mothers

458,152 newborns

COVERAGE

Achievements

195,577 women monitored using partograph

during delivery

317,020newborns received all three vaccines (BCG, OPV, Hep B)

356,848 newborns

received Vitamin K1 after birth

338,776 women administered oxytocin within one minute of delivery

264,049 women counseled on

Postpartum Family Planning (PPFP)

Key components of CaB

Comprehensive baseline

Experiential training package

Trainings (centralized and onsite)

Onsite mentoring

Quality Improvement teams/circles

Tracking performance

Feedback and improvement

Sustaining the momentum

Learnings from CaB are imbibed into LaQshya: National Labor Room Quality Improvement Initiative.

Vriddhi support includes development of national guidelines and operational plans for LaQshya and setting up a Program Management Unit (PMU) at MoHFW to coordinate LaQshya roll out nationwide. Vriddhi will support LaQshya implementation in the project states.

Jan 2016

Dec 2017

Mothers correctly monitored with partograph

Mothers administered oxytocin within one minute of delivery

CaB practices: Key trends

32% 35% 37% 53% 36% 14%

83% 93% 85% 94% 88% 94%

Women counseled on PPFP methods

Newborns administered Vit. K1 at birth

Delayed cord clamping in newborns

Newborns monitored within one hour of birth

(Jan 2016 – Dec 2017)

Innovating Solutions

Vriddhi demonstrated the feasibility of the national program for community based advanced distribution of misoprostol tablets for preventing postpartum hemorrhage (PPH) in home deliveries. The model was piloted in Janjehli, a remote block in Himachal Pradesh.

Community based intervention to prevent PPH in home deliveries

KMC Demonstration Sites were established at high caseload Special Newborn Care Units (SNCUs) in two districts (Gumla in Jharkhand and Haridwar in Uttarakhand) through JSI India. JSI India also piloted a model in one block each of Jharkhand and Uttarakhand to demonstrate feasibility of using injectable gentamicin by Auxiliary Nurse Midwives (ANMs) for management of sepsis among sick newborns.

Demonstration models for critical newborn care

l 816 home deliveries coveredl 88% pregnant women received misoprostol tabletsl 83% women consumed misoprostol tablets

It has now been scaled up in 12 additional blocks across HPDs in Himachal and in five districts of Jharkhand.

In supported blocks,l 300 frontline workers trained on use of Gentamicinl 143 sick newborns identified l 133 sick newborns started on antibiotics(Jan – Nov 2017)

(March 2016 – April 2017)

The pilot initiative, Block Level Implementation Strengthening Support (BLISS) in Laksar block, Haridwar district of Uttarakhand was designed to improve quality and coverage of ANC services with an emphasis on identification and care of high risk pregnancies and strengthening services at sub centers.

Strengthening outreach in rural areas

SaMMaN - Safe Motherhood and Newborn Health Initiative, a state initiative to improve maternal and newborn health incorporates learnings from BLISS and CaB for scale-up across the state in a phased manner.

Vriddhi supported Delhi state to systematize implementation of ‘Urban Health and Nutrition Days’ (UHND) to improve access to health care for the urban poor. In response to gaps highlighted in a rapid assessment of UHND by the project, the state team supported adaptation of UHND

Improving services for urban poor

guidelines for the state and piloted these in urban slums of North West district. The pilot focused on bottom up planning, detailed microplanning, defining day and duty roster, structured monitoring, regular reviews and inter-departmental convergence meetings.

Key achievements are:

Within one year there was: l 30-fold increase in distribution of IFA tablets to

pregnant womenl 22.5% increase in institutional delivery rates

l About 600,000 people have access to better health care services l 383 frontline workers and medical officers trained (2016) l State is scaling up UHND to remaining 10 districts (2018)

(April 2016 – March 2017)

Vriddhi focused on strengthening AFHCs using Supportive Supervision. Addressing issues related to inadequate manpower, untrained human resources, poorly maintained equipment and frequent stock-out of commodities are helping improve availability and quality of services for adolescents.

(Jan 2016 – Dec 2017)

86,062 adolescent girls

67,521 adolescent boys

Adolescent Friendly Health Clinics

Vriddhi supported the state government of Punjab to develop Operational Guidelines for the Weekly Iron and Folic Acid Supplementation (WIFS) scheme to overcome implementation challenges related to supply, reporting and coverage of WIFS. WIFS implementation model in Barnala district successfully achieved interdepartmental convergence through proactive advocacy efforts. This helped in creating a sense of ownership among Departments of Education and Women and Child Development for implementation of the project in schools and Anganwadi centers (AWCs).

Addressing adolescent anemia

l 100% stock available across all 666 AWCs and 308 schools

l Increased coverage of adolescents who received four or more IFA tablets in a month (42% to 78%)

(Apr – Sep 2017)

The national maternal, newborn and child health guidelines were abridged and essential information for implementation was presented in an easy-to-use format for frontline workers in Jharkhand to use as ready reckoners post training.

l 3,145 ANMs and staff nurses oriented on newborn and child health guidelines (2016)

l 1,592 frontline workers oriented on maternal health guidelines (2017)

In Haryana, Vriddhi supported the government in developing guidelines to implement the Beti Bachao Beti Padhao (Ensuring survival, protection and empowerment of the girl child) campaign to promote gender equity. The Project provided technical assistance for validation of the Civil Registration System (CRS) data for births registered in 2016 to validate the reported sex ratio at birth in all 21 districts. The process has been institutionalized and the state plans to continue data validation with involvement of medical colleges.

Promoting gender equity

Demystifying national guidelines

RMNCH+A Supportive Supervision is a model demonstrating partnerships to achieve impact at scale. Led by GoI, it harmonizes the support of development partners to leverage resources for an efficient and resilient health system in HPDs of India.

Envisaged as a core RMNCH+A strategy for improving health service delivery, RMNCH+A Supportive Supervision was conceptualized as an external concurrent monitoring system. Vriddhi led the technical support to establish the Supportive Supervision process and continues this support through its ‘National RMNCH+A Unit (NRU)’.

Collaborative PartnershipsRMNCH+A SUPPORTIVE SUPERVISION

CALL TO ACTION

Vriddhi aligns with global priorities and contributes to the ‘Acting On the Call (AOTC): Ending preventable child and maternal deaths’ agenda, which aims to save 15 million children and 600,000 women worldwide by 2020. In 2015, the project hosted the secretariat and collaborated with MoHFW, GoI, USAID and other partners to support the 3rd Global Call to Action Summit in New Delhi. Similarly in 2017, Vriddhi again supported MoHFW to showcase its best practices and achievements at the 4th Global AOTC summit.

Between January 2015 and December 2017

20,000 Supportive Supervision visits were made to 7,000 health facilities across HPDs.

ENGAGING PRIVATE SECTORLed by the project partner JSI India, Vriddhi undertook a landscape assessment across the six states to help identify potential areas of engagement with the private sector in the RMNCH+A arena. The Project facilitated the orientation of private providers on national guidelines and operationalized Public-Private Partnership (PPP) cells in Delhi, Jharkhand and Uttarakhand.

The model impacts nearly 8.3 million pregnant women and 7.6 million infants in HPDs, accounting for 25% of the annual cohort in India.

Vriddhi’s Support to Policy and Program Vriddhi provides technical support to GoI and state programs for development of policy documents and guidelines. It participates in taskforces and technical core groups for developing implementation frameworks for various policies. Vriddhi supports roll out of newer national programs and drives like Mission Indradhanush (MI), National Deworming Day (NDD), Integrated Diarrhea Control Fortnight (IDCF), Mother’s Absolute Affection (MAA), Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) etc.

Vriddhi contributes to national guidelines

Disseminating Vriddhi’s learnings

Project works and its learnings are being disseminated at various national and international events.

11th World Congress on Adolescent Health hosted by the International Association for Adolescent Health (IAAH)

Knowledge products developed including state briefs, technical briefs, intervention briefs, Health Atlas and app

DISCLAIMER

This report is made possible by the generous support of the American People through the United States Agency for International Development (USAID). The contents are the responsibility of IPE Global Limited and do not necessarily refl ect the views of USAID or the United States Government

Vriddhi: Scaling Up RMNCH+A Interventions

website: www.rmncha.intwitter: @USAID_RMNCHA

IPE Global Limited

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Published: May 2018Photo Credit: Vriddhi

Punjab

Haryana Delhi

Himachal Pradesh

Uttarakhand

Jharkhand

ChhattisgarhOdisha

Assam

Vriddhi’s Reach

The road ahead (June 2018 – May 2020) The project will support eight states: Assam, Chhattisgarh, Haryana, Himachal Pradesh, Jharkhand, Odisha & Uttarakhand