3 rd Common Review Mission NRHM

1. 3rd Common Review MissionNRHM Madhya Pradesh Response 22.12.2009 NRHM, M.P.

2. SIHMC - Revitalization strategy • A post of CEO - being created. • Training management professional identified. • Discussions initiated with PHFI Delhi and SOCHRA Bangalore for strengthening SIHMC. • UNICEF & UNFPA have agreed to extend their technical and financial support. NRHM, M.P.

3. SIHMC - Revitalization strategy MP TAST is fine-tuning training policy. SIHMC would take the lead to develop & implement Comprehensive Training Plans. Support of NHSRC desired for filling up vacancies. NRHM, M.P.

4. Nursing Training – Initiatives • Up gradation of 6 GNM training schools to BSc Nursing College planned. • Two new BSc Nursing Colleges at Jabalpur & Ujjain are ready (INC support needed). • 10 new GNM training school in district hospitals with > 300 Beds planned. • All district Hospitals to have ANMTCs. NRHM, M.P.

5. Nursing Training – Initiatives Training schools in a district to be brought under one roof for optimum utilization of training faculty. Positioning of in-service MSc & BSc trained nursing staff as faculty in nursing schools. Public - Public Partnership being tried with Puduchery for running nursing colleges on turnkey basis. NRHM, M.P.

6. ANM skills enhancement • Monitoring of SBA training sessions and post training follow up by consultants with UNFPA support (proposed). • Refresher training for poor performing ANMs in PIP 2010-11. • Training kit & Quality monitoring tool developed by JICA under implementation in Sagar Division. • Implementation planned state wide following authentication by GoI. NRHM, M.P.

7. Continual Family Planning services - delinking seasonal phenomenon • Fixed day facility based strategy would be strictly enforced & monitored. • Post Partum Sterilization (PTT) targets will be set. • Number of PTT & IUD insertion would be important work appraisal criterion for Family Planning Counselors. • In addition to training on Zoe model, ANMs are given hands on exposure under integrated SBA training. • “Prerna” and “Santushti” schemes of JSK are being promoted. NRHM, M.P.

8. Decentralized Drug Procurement System • Drug policy revised and implemented. • MoU with TNMSC for centralized rate contract. • Need based procurement by districts. • Directives issued for providing free drugs to all patients. • ProMIS will be implemented in entire State. • Plans for customization of ProMIS for State supplied drugs also. • Display and monitoring of all essential drugs in each health facility will be ensured. NRHM, M.P.

9. Emergency service management • Plan developed for all District Hospitals- • Casualty wing including trauma unit for managing medical & surgical emergencies • Maternity wing which includes model labour room & fully equipped OT, extension of maternity ward to address the case load • Obstetric ICU in identified District Hospitals for obstetric emergencies • Paediatric ICUs. • Fund for all above interventions assured by 13th Finance Commission. NRHM, M.P.

10. RKS Reforms/Strengthening • Re-organising the objectives with core patient – welfare focus i.e. essential drugs, quality of care, basic amenities (toilet, potable water, waiting spaces, signage, stewards), ambulatory services. • Emphasizing on citizens’ engagement by increasing their membership, capacity building and prioritizing regular meetings 10 • Fund utilization, generation and reportage being standardized. NRHM, M.P.

11. RKS Reforms/Strengthening • Health administration is being provided stewardship role at sub-district level with Executive Committee’s Chair positions. • A cap of a quarterly re-imbursement of RKS expenditures from the State corpus is also being introduced for core operations and maintenance function to meet the challenges of acute resource strain on RKS funds. NRHM, M.P.

12. RKS Reforms/Strengthening State agrees to the recommendations- putting RKS funds utilization under public domain and monitoring through a process of social audit and untied funds & annual maintenance grants to be put under the purview of the RKS. NRHM, M.P.

13. IEC strengthening • Knowledge Resource Center (e-library) established in IEC Bureau with UNICEF support. • MADHYAM identified as Professional agency for designing IEC material for ASHA & ANMs. • IPC skills training strategy developed and training of master trainers is in process. • High Voltage IEC Campaign planned with DFID support, ToRs developed. NRHM, M.P.

14. ASHA programme – Bridging Gaps • Selection of ASHA in accordance to the number of AWW is in progress. • Backlog of ASHA trainings will be completed by the end of current financial year. • Instructions issued for monthly meetings of ASHA at the block level for performance monitoring, refilling of drug kit & payment of incentives through e-transfer as envisaged by GoI. NRHM, M.P.

15. ASHA support system • LHVs and BPMs assigned supervisory and monitoring responsibilities for ASHAs. • Vacant positions of state resource center being filled. • Field visits of ASHA Mentoring Group is being planned. NRHM, M.P.

16. Revamping community monitoring programme • Community monitoring programme piloted in 5 districts. • Monitoring Committees constituted in PHC & CHC of identified blocks. • Jansunwai conducted by MCs and need based services provided. • As suggested by CRM revamping of AGC (Action Group for Communitization) & up scaling of community monitoring programme will be done. NRHM, M.P.

17. Inter-Sectoral convergence approach • “Swasth Gram Samiti” with mandate on determinants of health is being constituted in each village. • Integration of WATSAN Committees of TSC, Matra Sahyogini Samiti of ICDS & VHSC of NRHM. • VHND and SGS platform for inter-sectoral convergence. NRHM, M.P.

18. Community action for Nutrition • Recommendation of CRM regarding ICDS focus on only 3-6 years and ASHA from Birth to 2 years needs to be re looked. • State specific module for ASHA & AWW on nutrition will be developed with inputs from ASHA module 2. • All ASHAs will be trained on New Born Care by developing a State specific module with inputs from ASHA module 2, HBNC and IMNCI modules. NRHM, M.P.

19. State strategy for management of SAM Joint UN Statement: Severe Acute Malnutrition remains a major killer under 5 years. Until recently treatment is restricted to Facility based approach. New evidence suggest large number of SAM cases can be treated in the communities without being admitted to health facility. NRHM, M.P.

20. Monthly Growth monitoring by AWW into Normal, Moderate and Severe underweight categories Children in Moderate Underweight category Children in Severe Underweight category MUAC to be done by ANM on VHND and examined for medical complication Enrolled in SNP by AWW Children with Bilateral Oedema and/or Medical complication MUAC >11.5 cm MUAC <11.5cm – Appetite test to be done by ANM on VHND Admitted in NRC, WHO Protocol, Transferred to OTPon stabilization NRHM, M.P.

21. INTEGRATED MANAGEMENT OF SEVERE ACUTE MALNUTRITION MUAC <11.5cm – Appetite test to be done by ANM on VHND Appetite test Pass without Medical Complication Appetite test Pass Appetite test Fail • Medical Complication • Anorexia, • Lower respiratory tract infection, • Severe palmar pallor, • High fever, • Severe dehydration, • Not alert Bilateral Oedema Admitted to Out-Patient Therapeutic Feeding Program (OTP) for 2 months RUTF ration by AWW Admitted in NRC, WHO Protocol, Transferred to OTPon stabilization After 2 months enrolled in SNPby AWW NRHM, M.P.

22. Thank You NRHM, M.P.