Innovations in NE for Backward Districts

1. Innovations in NE for Backward Districts Dr A C Baishya Director - RRC NES

2. High Focus Districts in the North East*out of 264 high focus districts, 28 are in the NE (>10%)

3. Initiatives for High Focus Districts

4. Planning Process During October 2009, 1st Workshop was conducted by RRC-NE in collaboration with NHSRC for capacity building towards preparation of PIPs with special emphasis on High Focus Districts Focus was on creating a database and analysis of the following components at the district & block levels • Infrastructure Status • Human Resources Availability and Gap • Service Delivery • Facility Output • ASHA Component Preparation of “Block Plan” was also highlighted

5. Follow-up Consultative Workshops for preparation of DHAP/ SPIP were held in the States by RRC-NE • Special focus was on analysis of available information on Facilities, HR, Outputs etc. • Preparation of Block and District Plans (Draft Plans) DHAP Appraisal for all NE States at the Regional Level in Dec 2009 in the presence of JS, GoI (NE) and ED (NHSRC) where plans for the High Focus Districts were presented by the District Officials • Focus was mainly on Gap Analysis of Infrastructure and HR in the High Focus Districts • Special initiatives on planning for maternal & child health, Malaria, Tuberculosis in these districts

6. Special visits to high focus districts and inclusion of specific data on infrastructure, HR and Facility Outputs as annexure in the PIPs • HMIS Analysis of High Focus Districts shared with the States and verified • Differential Planning for the High Focus Districts finalized and incorporated in the Draft State PIP which was appraised at the Sub Group Meeting held at Guwahati during Jan 2010.

7. HMIS - Planning A comparative data analysis have been done and shared with the districts on different health indicators for 28 High Focus Districts for 08-09 & 09-10 based HMIS data from the NRHM HMIS Web Portal Data analysis have been also done on different health indicators for these districts based DLHS II & DLHS III Facility wise comparative data analysis have been done on output indicators for all High Focus Districts of NE States for 2009-10.

8. Facilitated the states in doing the situation analysis by triangulation of data (HMIS, DLHS and NFHS / SRS data) for preparation of BHAP/ DHAP / SPIP. Facilitated in conducting Cluster Survey for Block / District of NE states for identifying different determinants of Child Health & Maternal Health so as to prepare need based Block / District action plan. Preparation of Facility based Sub-Plan has been initiated by analyzing the HMIS data at the facility level. Disease Component of HMIS / Training Need of facilities were analyzed

9. Planning of Supportive Supervision • Visit by Ministry Team to High Focus Districts of Assam (Dhubri and Goalpara) during May 2010 Emphasis on • Coverage of all Pregnant Women and Children with adequate care • Disease Control Components e.g. Malaria & Tuberculosis • Facility mapping and up gradation • Ministry Team visited 2 Districts in Meghalaya (Jaintia & West Khasi Hills) during April 2010 • Apart from this, RRC-NE Team has visited Meghalaya, Tripura and Arunachal Pradesh and covered 4 High Focus Districts during June 2010 (West Khasi Hills, East Garo Hills, Dhalai, South Tripura)

10. Preparation of implementable need-based Sub Plan in consultation with the State and District Officials Detailed District Visits with a focus on: • Gap Analysis of Infrastructure & Equipments; Manpower & Training; Service Delivery, ASHA component , Community involvement etc. • Maternal Health: • Converting ANC Registration to Full ANC Coverage • Increase Institutional Deliveries • Increase SBA attended Home Deliveries • Network of FRU/Comprehensive Obstetric Care in remote areas • Referral Mechanism in difficult areas (Doli Services, Boat Clinic and Boat Ambulances) • Sub Centers with ANMs as Institutional Delivery Point

11. Child Health • Converting more PHCs with New Born Care • Gaps in Immunization • Dropouts from BCG to Measles - Tracking of Dropouts • Priority on IMNCI & NSSK Trainings Family Planning • Training of ANMs on method mix counseling • JSY beneficiaries to be motivated • Mandate PPS at DH & FRUs Malaria • Review of program components including surveillance, laboratory, RD Kits, Bed Net distribution, IRS, Manpower & Training, adequacy of drugs & diagnostics, IEC etc. • Gap Analysis & Suggestive Interventions Tuberculosis • Detailed Peripheral Health Institution Analysis • Sub-Plans to improve case detection and case holding

12. Community Process • In NE States, total 54261 ASHAs are engaged out of which 20340 are in the 28 HF Districts; • 18597 ASHAs are trained up to module IV in HF Districts • 18839 trained ASHAs are with drug kit in 28 HF Districts • Malaria RD Kits distributed to ASHAs • ASHA Facilitators / Block ASHA Coordinators are engaged in Assam / Meghalaya • ASHA Evaluation done in 2 districts (1 HF District) of Assam • ASHA evaluation for 2 districts each in Meghalaya & Tripura is planned • Home based New Born Care ToT completed at Gardchiroli

13. To understand the functioning of ASHA in the field, visits are made along with state and district officials: • Role in transporting mother to facility • Incentive received and problem in getting incentives • Status of drug kit receipt and refilling • ASHA’s involvement in ensuring immunization • Holding VH & ND at anganwadicentres • Home visits are made to the houses where deliveries have taken place recently to understand the role of ASHA

14. Examples in the NE States

15. Assam Visit to the high focus districts and preparation of sub-plan with specific interventions such as: • To provide IDs in riverinechar services • To Prefabricated structures for creating infrastructure in the difficult to access areas • Posting of Rural Practitioners in Sub Centers to facilitate institutional deliveries • Extend the network of boat clinics and setting up of Boat Ambulance to reach the unreached (char areas) • Strengthening of PPP with Tea Estate Hospitals • Proper implementation of majoni scheme for the girl child and mamoni scheme for the pregnant women and linking it with the tracking of pregnant women • Encourage 48 hr Post Natal stay in hospital with mamta kit

16. Tripura DOLI SERVICES (Referral Mechanism) • Porter Service to carry patients to hospital from remote / inaccessible areas • Implemented in Dhalai District (especially in Chawamanu & Dumburnagar block) • Porters are identified by Gaon Panchayat and Rs. 500/- is given to the team for each case

17. Arunachal Pradesh Public Private Partnership (PPP) • PPP is introduced to manage remote PHCs / CHCs including those in the High Focus Districts • 1 CHC has also been given to VHAI • The Centers are managed by the NGOs and Staff recruited and posted by them • Financial support is provided under NRHM

18. Arunachal Pradesh & Meghalaya Public Private Partnership (PPP) • PPP is introduced to manage remote PHCs / CHCs including those in the High Focus Districts • A total of 16 PHCs in Arunachal Pradesh (3 in High Focus Districts) and 18 PHCs in Meghalaya (13 in High Focus Districts) are being managed by NGOs • The Centers are managed by the NGOs and Staff recruited and posted by them • Financial support is provided under NRHM and state Govt.

19. Reaching the unreached in Dhubri, AssamBoat Clinic and Service Delivery in the Community

20. Tripura Ambulance under Bidhayak Area Unnayan Project (BAUP) RSBY in Gandacherra

21. MeghalayaInstitutional Delivery at SC (Damalgre)

22. Thank You