NHM Medak & The EARTH INSTITUTE, Columbia University

1. Welcome to all dignitaries 28th December 2013 NHM Medak & The EARTH INSTITUTE, Columbia University

2. NRHM Launched in April 2005 By Hon’ble PM Sri. Manmohan Singh. It was launched in November 2005 in AP. NRHM Goals & Status as on Prior to 2005 2012-13 NHM Goals 2017 MMR = 190 131 81 IMR = 62 43 17 TFR = 2.2 1.8 1.7 NHM – so far

3. To provide effective health care to • the people of Medak in rural areas & remote villages • the disadvantaged groups • Women and children Decrease MMR & IMR nhm OBJECTIVES

4. Improving access to institutional health care services Enabling community ownership Strengthening public health care systems for efficient service delivery Enhancing equity & accountability Promoting decentralization REACHING OBJECTIVES

5. PHCs - 67 SEX Ratio - 989/1000 SUB CENTERS - 536 LITERACY Rate - 55.3% CRUDE BIRTH RATE - 17.3% CRUDE DEATH RATE - 7.2% CPR - 72.5% TFR - 1.8 IMR - 43 MMR - 131 PP Units - 3 UHCs - 4 CEMONC - 7 CHCs - 09 Area Hospitals 4 District Hospital - 1 No .of Gram Panchayaths - 1066 health status and resources

6. Maternal Health • Institutional Deliveries • ASHAs • CEMONC • 24X7 Maternal Health Centers • JSY- JSSK • Blood Banks – Blood Storage Centers • Child Health NRHM • additionalities • Immunization Sub-center untied funds • RBSK VHSC Funds • SCNU HDS Funds • NRC PC&PNDT • NBSU Construction of Health Facilities. • NBCC RNTCP • NSSK NVBDCP • 108 • 104 - FDHS activities under nrhm – medak

7. Medak District was reported to be one • of the high rated district with regard of • MMR/IMR. • There is commendable reduction in the • MMR/IMR in the last 8 years. • MMR came down to 131 from 190 and • IMR came down to 43 mmr / imr in the district

8. HR Under NRHM NRHM District Program Management Unit

9. Under the guidance & support of the District • Collector there is proper utilization of funds in the Dist. • Continuous review meetings by the District Collector • with line departments, SPHOs and Medical Officers has • resulted in improved MCH services at Sub Center level • Effective convergence is happening at District level and village level but the convergence at Block/Mandal level is not upto the mark. support from administration

10. SCNU = 1 : 20 bedded unit at DH Sangareddy with 14 staff • Nurses and 4 Medical Officers to work round the clock. Started on 31st October 2012 and so far • treated 1643 infants as on 30th Nov 2013 • NRC = 1 : 20 bedded NRC with 2 MOs and 3 Staff nurses • etc. Started on 1st December 2012 and so far • treated 271 children as on 30th Nov 2013 • NBSU = 6 : 4 Bedded NBSUs at Zaheerabad, Medak, Jogipet, Narayankhed, Narsapur and MCH Siddipet . Staff nurses recruited and trained and the units are functional from June 2013 • NBCC = 64 : At all delivery points. • 150 Bedded MCH ward at DH Sangareddy is under construction and expected to be completed by April 2014. ADDITIONAL SUPPORT IN MATERNAL & CHILD HEALTH

11. To remind and create a confidence with human touch Introduced reminder card system by ASHA. Reminder Card launched by Hon.Minister Smt.Sunitha Lakshma Reddy on 15th August 2011 and piloted in Narsapur cluster with help of CARPED, NGO which is working on health issues in the state. Activities – reminder card

12. Introduced reminder through phone (ANM Calling) in Gummadidala PHC area. All the ANMs will maintain record of the Pregnant women heath checkup due dates and they remind through phone and provide health council also. Activities – reminder card

13. Introduced SMS based message In Mirdoddi PHC area. ANMs to remind the pregnant women about the health checkups by sending SMS. These three pilots have increased the confidence among the pregnant and their family members about the health services. Based on the success of the above pilots designed 2 innovative programs called MATRUDEVOBHAVA - AYUSHMANBHAVA for the first time in India. sms based message

14. The voice message of the District Collector will be sent to all the pregnant and lactating mothers who are registered in MCTS( Mother and child tracking system). DG Synogeon a soft ware company designed this concept with support from CARPED The pre recorded call from District Collector created confidence on utilization of public health facilities. A pilot in Dubbak CHNC was launched on 11th April 2012. Deliveries & immunization services improved commendably in the public health facilities such as Bhoompally, Timmapur. Immunization coverage gone upto 98% maatrudevobhava

15. Started “Aayushmaanbhava” health help line( 88854442111), initially it serves 8.00am to 8.00 pm to provide the information about the services available under NRHM such as JSY-JSSK and coordinate with the medical staff, providing the ambulance service. This year it will be clubbed with 1098 helpline service and work round the clock the services will be provided by CARPED NGO, the pilot programme is first of its kind. The call center executives will call the pregnant women who are into their 8 month of pregnancy and inform them about the Govt Hospital near to them and facilities under NRHM Aayushmaanbhava

16. Under Matrudevobhava calls sent to 39,132 pregnant women and 34,840 lactating mothers so far. Reminders were also sent to them. Under Ayushmanbhava 1540 pregnant women got benefitted from the helpline. Call center executives made 36,680 calls to the pregnant women informing them to utilize public health facilities.. On random verification it was found that 61 % of the Pregnant to whom the calls were made, delivered at Govt Hospitals. progress so far

17. MCRS - Status report Efficient method to coordinate care

18. MCRS uses a pragmatic approach that leverages MCTS data ANM 6 1 Patient Doctor 7 ASHA brings Pregnant Women / Infants to PHC or sub center for further services Register MCRS 2 5 ASHA ANM 4 3

19. Phone reminders is the right method to improve awareness on Govt. facilities in rural areas

20. Calls will be made to pregnant beneficiaries once a month and to children once in 3 months

21. Project overall status • Including pilot Total 6,25,781 contacts made with beneficiaries • 54116 pregnant beneficiaries and 44121 child beneficiaries covered under the program • We noticed significant improvement on govt. facility deliveries and reduction in abortion rates • Govt. facility deliveries increased to ~2100/month from ~900/month. • Abortions have been considerably reduced

22. Deliveries at PHC • In 2013 on an average 2300 deliveries /month conducted at Govt facilities compared to 900 in 2011-12. • Beneficiaries saved approx. Rs. 2 crore per month by getting services at Govt hospitals motivated by voice call of District Collector. • Kangti PHC conducted 67deliveries in October 2013 • Jaheerabad CHC conducted 459 deliveries in September 2013 with an average of 380 deliveries/month compared to 200 in 2012 * Calculated as 10,000 Rs. Per delivery

23. Call Schedule • 4 days ( Tuesday, Thursday, Friday and Sunday) in a week as per NHD schedule calls are made • At least 2 attempts are made to reach beneficiaries who do not lift the phone • Pregnant women delivery message is communicated monthly in 3 schedules ( 1st of the month, 12th of the month and 20th of the month) • 50,000 preventive guidelines calls per month

24. Data Synchronization with MCTS • Every week Sunday data is synchronized with MCTS • Data from MCTS is reviewed for accuracy and then reconciled with the MCRS data • If services are delivered to beneficiaries all open reminders related to services are closed

25. MCRS Solution Key Benefits • MCRS is integrated with MCTS; No dual data entry • MCRS messages are personalized and configurable • MCRS provides a website to check the progress • MCRS enables manual patient reminders • MCRS reminders are coordinated with Health camp Schedule

26. We established a website to improve ease of access to timely information • A dedicated website (http://www.vcareconnect.com) to monitor progress of the program • Will provide timely access to due lists for ANM/ASHA to coordinate beneficiary visits to PHC/Health camp • Will deliver timely reminder to Beneficiaries in coordination with NHD schedule to put preventive care right on top of their mind • Will provide flexible solution to remind beneficiaries either on-demand or in automated way • Will provide clear and concise statistics to put focus on the areas lagging behind

27. Data updated weekly from MCTS • Using Scheduled Reports section from MCTS we download data per subcenter in an excel sheet and transform that data to fit Reminder system data model • We generate/update patient preventive care schedule based on latest data obtained

28. Aligned reminders with NHD schedule • Most of rural population plan just in time, hence we align the reminder schedule to match with NHD and delivered the message right one day before the health camp. • Reminders delivered will clearly describe the reason for the call as well as articulate the benefits government program provides

29. Train ASHA/ANMs on importance registrations and due list management • With due list reports that will be made available online as well as distributed physically, ASHA/ANM will be able to focus on their priority beneficiaries • Ability to obtain due list report by village or by ASHA or ANM or Condition provided the flexibility staff will be looking for

30. Clear and concise statistics enable successful tracking of the program

31. Deliveries at a glance

32. Percentage of Deliveries

33. Deliveries at PHCs

34. Secondary level facilities

35. The Process of MCRS

36. Greeting Card

37. Greeting card

38. Call pattern

39. Incentives Call center functions

40. SKYPE

41. Innovative Activities taken up in the District • Installing GPRS units in SPHO, 104 and Program Officers’ vehicles. • At 10 PHCs AVD pilot is implemented (Supervisor delivering vaccine at villages in Auto) • Geo tagging of all public health facilities, high load private facilities, 104,108 parking points etc. • First round of QMS is planned in coordination with Columbia University. • Planning a Website for DHS • Soft copies of monthly reports, daily OP, IP particulars, availability of drugs, financial details will be uploaded in the website.

42. IEC

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