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Popfocus 2010 April June English PFI |
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Volume XXIII; No.2 April–June 2010
THE POPULATION FOUNDATION OF INDIA NEWSLETTER
Regional Conference on Population, Health and Social Development
in the Western States: Maharashtra, Gujarat and Rajasthan
A s part of the 40th year
celebrations of PFI, three
regional conferences (Eastern,
Western and Northern), followed by
a national conference have been
planned with the aim of bringing
out region specific priorities and
recommendations related to
population, health and social
development. The first Regional
Conference on ‘Population, Health
and Social Development in the
Eastern States – Bihar, Jharkhand,
Orissa and West Bengal’ was
organized at Bhubaneshwar on
February 16 – 17, 2010. Various
recommendations emerging from the
conference were culled out and
printed as a report for wider
dissemination.
The second Regional Conference on
‘Population, Health and Social
Development in the Western
States: Maharashtra, Gujarat
and Rajasthan’ was organized at
Dr Narendra Jadhav, Member, Planning Commission (centre) releasing the publications
of PFI. Others are (from left): Mr A R Nanda, Executive Director, PFI; Mr Hari Shankar
Singhania, Chairperson, PFI Governing Board; Mr B G Deshmukh, Vice-Chairman, PFI
Governing Board; and Mr J K Banthia, Principal Secretary & Commissioner (Family
Welfare), Department of Public Health and Family Welfare, Government of Maharashtra
Pune City on May 13-14, 2010.
The Conference was intended to bring
out region-specific priorities and issues
and recommend strategies that would
help in improving the status of
population, health and social
development in the region. In the
Participants at the Regional Conference
Inside
National Conference on
Scaling Up in India: Lessons
Learnt and Way Forward
...4
Youth Efforts Continue in
PFI’s 40th Year Celebrations ...6
Urban Health Challenges
and Efforts to Overcome
Them
...7
CSR Module Released
...9
National Dissemination
Meeting on Community
Monitoring under NRHM
...10
And the Award Goes to .... ...12
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From the Executive Director’s desk...
India has the highest number of maternal deaths in the world.
Over one lakh women are dying due to complications of
pregnancy and child birth each year i.e one woman dies every 8
minutes. For each woman who dies as many as 30 other women
develop chronic and debilitating conditions, which seriously affect
their quality of life. Early marriages and teenage pregnancies
are significant causes of high maternal and infant mortality.
MMR/IMR are also high in states with more women who have
multiple and closely spaced pregnancies. Population stabilization
is still a major and vital challenge in case of all the large north
Indian states - Bihar, UP, MP, and Rajasthan. These four States
have particularly low health indicators: high maternal mortality,
high infant mortality, high child malnutrition as well as high
maternal malnutrition. This is complicated further by low literacy
and high levels of poverty, thereby resulting in low age at marriage
and high fertility rate. These states account for nearly 40% of
country’s population and will contribute well over 50% of growth
in coming decades. The performance and the demographic
outcomes of these states will determine the time and the size of
population at which India will achieve population stabilization in
next six decades or so.
While India’s population growth rate has been declining over
the years, the overall population will continue to grow as over
51% of the female population is in the reproductive age group
(15-49 yrs). Also the number of people entering the reproductive
age group increases by the year due to high birth rate of the
previous years. This phenomenon will continue to add large
numbers to India’s population in the coming decades. The most
important factor that can reduce this population momentum
is raising the age at marriage/ cohabitation and increasing the
interval between marriage and first pregnancy as this stretches
out the time between generations and the strongest impact of
this can come through increasing years of schooling for girls.
Population momentum can also be curtailed by promoting valued
roles for women other than motherhood, increasing young
women’s access to education, income and financial credit,
providing young women and men with information and access to
appropriate services and fostering equality between young
women and men and improving their perceptions of marital
responsibility. The focus should clearly remain on improving
health and family planning services for the poor and marginalized
by addressing issues of Access and Quality and developing
practical indicators for assuring Quality of Care (QoC). We
are on the verge of an opportunity that may never arise again –
to reap the Demographic Dividend – with the largest segment
ever of young population. However, we can do so only by keeping
them healthy and empowering them to make the right
reproductive choices with access to quality of care in services.
While NRHM is an opportunity for systemic reforms and
developing convergence mechanism for achieving the socio-
demographic goals for population stabilization, it is essential to
remind ourselves that the essence is empowerment of people
and community level planning, implementation and surveillances
that it needs to be pursued as a national movement.
A. R. Nanda
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conference, PFI brought together on one platform,
administrators, social scientists and scholars,
national/international institutions and NGOs
concerned with these issues from the Western
Region for discussion on the achievements, gaps
and recommendations for the future. Around 95
participants attended the Conference.
The objectives of the conference were to:
• Attain a clear perspective of the demographic
and health transition process in the states of
Maharashtra, Gujarat and Rajasthan
• Recapitulate initiatives taken by the State
Governments on population and health issues
• Draw out recommendations with policy and
programmatic implications at the state,
regional and national levels
Mr Hari Shankar Singhania, Chairperson,
PFI Governing Board in his welcome speech
pointed out that India is in the midst of
demographic transition. Substantial differences
are visible among the states in the achievement
of basic demographic indices.
Dr Narendra Jadhav, Member, Planning
Commission was the Chief Guest at the
inaugural session of the Conference. In his
inaugural address, he pointed out to the steps
that were being taken to raise the plan
expenditure on health and allied sectors. He also
presented a status report on the specific health
indicators and the direction in which planning
needed to be oriented.
Dr Jadhav released the publications of PFI:
District Profile and Wall Chart on
Population, Health and Social Development:
Gujarat, Maharashtra and Rajasthan
specially brought out for the Conference at the
inaugural session.
Mr J K Banthia, Former Registrar General and
Census Commissioner, India and presently,
Principal Secretary & Commissioner (Family
Welfare), Department of Public Health and Family
Welfare, Government of Maharashtra, in his
keynote address on “Demographic Transition in
Gujarat, Maharashtra and Rajasthan: Issues and
Concerns”, highlighted the various theories related
to population growth and demographic transition
since the late 18th century. Regarding projected
population for 2025, he said, “The annual growth
rate would be very close to 1%. In 2026, India’s
population is likely to be 1.4 billion, crossing
China’s. Life expectancies are going to increase,
and female life expectancy is going to be higher.
Among populations which went through the last
stages of demographic transition, like Sweden,
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Japan, 20-30-40 years ago, life
expectancy is well over 85 now.”
In addition to the inaugural and closing
sessions, the Conference had five
business sessions: (a) Reproductive
Health of Married Adolescents, (b)
Child Nutrition: Issues and Concerns,
(c) Community Action under NRHM,
(d) Safe Motherhood: Issues and
Concerns, and (e) Contraception and
Qualify of Care: Issues and Concerns.
Shri Hari Shankar Singhania,
Chairperson, PFI Governing Board;
Mr. B.G Deshmukh, Vice-Chairman,
PFI Governing Board; and other
distinguished Governing Board
Members of PFI including Justice Leila
Seth; Mr B G Verghese; Prof Ranjit
Roy Chaudhury; Mr. J.C. Pant; and
Dr. Nina Puri; and PFI Advisory
Council members including Dr Usha
R Krishna and Dr Leela Visaria
graced the conference with their
participation.
Each session was chaired by a
member of the PFI Governing Board,
with a subject expert as Discussant.
The panelists for the various sessions
numbered between two and five.
The panelists generally made their
PowerPoint projections, supple-
mented by explanatory remarks.
There were in all 18 presentations in
the business sessions, besides
interventions by the Chairperson and
Discussant.
Each session was followed by an open
house discussion, in which the audience
participated enthusiastically. The
questions-and-answers and comments
became an occasion for fruitful
exchange of views and for eliciting a
multi-dimensional perspective on the
issues being discussed.
The conference as such became a
valuable learning experience for the
participants in terms of what initiatives
the various states (both Government
and civil society) were taking to make
progress on the issues of concern in
their own jurisdiction. It also generated
many points for action-oriented
reflection.
The overall impression conveyed by
the participants representing the
various state governments was that
Youth performing Marathi Cultural Repertory
they were genuinely aware of the
areas of concern, government’s
responsibility as a stakeholder in social
development, and of shortfalls. While
enlightening the conference on the
various measures they had taken or
proposed, they were also earnestly
receptive to learning. For all
stakeholders represented in the
conference, it seemed to have
been a rich earning experience,
encouraging a positive outlook that
they could look forward to more
dedicated outcomes from all
stakeholders.
To aid in planning such events in future
and as a part of learning, the
organizers elicited feedback from
the participants at the end of
the conference with a graded
questionnaire.
The conference was interspersed with
a scintillating cultural programme
highlighting the wealth of Marathi
cultural repertory, presented on the
intervening evening by a troupe
of youngsters from INTACH. The
programme was generally perceived
by the participants to have been an
enriching experience.
The conference received good and
positive coverage from the local
and national media: print, audiovisual
as well as internet. Media personnel
were well represented at various
sessions.
Some recommendations emerging
from the Conference revolved around
the following areas of concern:
• A fully functional civil registration
system is of critical importance to
the country. Issue of registration
certificate is essential for the
success of the registration system.
• The growing adverse sex ratio,
which in this region seems to be
concomitant with growing
affluence, is a matter of serious
concern and requires strong
political will to counter.
• Strong political will is also required
to end the socially damaging
phenomenon of child marriages.
• Convergence among the various
ministries and departments is
crucial in addressing health-related
issues.
• The importance of monitoring and
evaluation of programmes needs
to be constantly emphasized.
• Procuring medicines at wholesale
rates by the government for
distribution in the community would
go far in reducing health-related
costs and in upgrading the health
index of the community.
Various recommendations emerging
from the conference are being printed
as a report for wider dissemination.
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National Conference on
Scaling Up in India: Lessons Learnt and Way Forward
Over the past few years, PFI, with
support from the MacArthur
The inaugural
session high-
Foundation and the Management
Systems International (MSI), has been
facilitating ‘scaling up’ of NGO
led innovations in the area of
lighted the
concept of
scaling up
and built a
Reproductive and Child Health (RCH)
in India. These scaling up efforts have
been guided and based on the
application of a scaling up
common
understanding
on the Scaling
Up Manage-
management framework developed ment Frame-
by MSI. PFI’s emphasis on scaling up,
in large part, has been due to the
recognition that there are many
work which
had been used
to scale up the
promising, or even proven, small reproductive Panelists at the Inaugural Session
scale innovations which can have
substantial impact on health outcomes,
if they are scaled up systematically.
health pilots in
India. Ms. Poonam Muttreja,
Country Director, MacArthur
Foundation shared the Foundation’s
perspectives of the Planning
Commission on scaling up,
Ms. Sudha Pillai, Secretary,
To enable a sharing of scaling up experience and challenges of funding Planning Commission said that the
experience, a National Conference on innovations / pilots with a potential National Conference focused on a
Scaling Up: Lessons Learnt and Way to be scaled up. Mr. A. R. Nanda, subject on which discussion was long
Forward was organized on April 19, Executive Director, PFI, overdue. Her advice to civil society
2010, at the Gulmohar Hall, India Dr. Richar d Kohl, Project was to have inbuilt developmental
Habitat Centre, New Delhi. Director, Scaling Up, MSI and milestones in pilot programmes which
Organized with support from the Dr. Rajani Ved, Senior Associate, would help scale them up. For the
Planning Commission and in MSI spoke on the Scaling Up government, she felt it was important
collaboration with the MacArthur Framework and shared experience of not to launch pilots but embark on
Foundation and MSI, the Conference facilitating scaling up as an large scale projects that factored in
brought together on a common intermediary resource organization specific needs of different regions and
platform, practitioners, administrators and the lessons learnt thereof. Giving imbibed flexibility. Mr. Larry
and academicians from the the Inaugural Address Mr. Arun Cooley, President, MSI presented
national and international arena. Maira, Member, Planning the global perspective on scaling up.
The conference drew on national Commission, Govt. of India He shared seven practical lessons on
and global experience of scaling up emphasized the need to devise scaling up and said that although
and explored the reasons behind solutions which were effective at the scaling up was a small enterprise in
the limited success in scaling up of global and local levels at the same India, it was important to nurture it.
many pilot projects. It aimed at time.The first session focused on Lead Economist Dr. A. K. Shiva
developing a vision and strategy for ‘Scaling up through government Kumar stated that while there was
scaling up social sector programmes systems’, was chaired by Mr. Arun growing interest in the scaling up
in India.
Maira. The panelists for this process it was important to know how
session were: to handle scaling up in the right
Ms. Sudha manner and ensure that the most
P i l l a i , marginalized groups remained the
S e c r e t a r y , focal point of scaling up. Interventions
P l a n n i n g in the social sector were necessarily
Commission, multi-sectoral and the challenge was
Government how to scale up in a very complex
of India; Mr. environment where there were
Larry Cooley, multiple organizations/actors and
President, MSI; multiple issues. For example, while
and Dr. A.K. ensuring access to food one had
Shiva Kumar, to look at a host of other related
Development factors like health, education,
E c o n o m i s t . nutrition and women’s status, among
Session I: Scaling Up through Government Systems
Sharing the others. Mr. Arun Maira, Member,
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Session II: Experience of Scaling Up
Planning Commission concluded
the session by stating that the process
of scaling up was dynamic and that
resource organizations served a useful
role in facilitating scaling up. He also
emphasized the ability to collaborate
as being fundamental to scaling up.
The second session showcased the
selected experience of scaling up.
The Chairperson for the session was
Dr. Syeda Hameed, Member,
Planning Commission and the
panelists included: Dr. Abhay Bang,
SEARCH; Dr. H. Sudarshan, Karuna
Trust; Ms. Mirai Chatterjee, Vimo-
SEWA; and Mr. K. S. Murthy,
Bhavishya Alliance. Dr. Abhay Bang
shared the experience of scaling up
the Home-Based Newborn and Child
Care (HBNCC) model, an inter-
vention pioneered and developed by
SEARCH. Outlining the efforts made
to ensure ‘quality’ implementation of
the model at scale, Dr Bang said that
SEARCH, over the years, developed
a variety of training materials as well
as developed a cascade model of
training which covered four levels of
implementers: managers, trainers,
supervisors and the ASHAs. The
evidence based approach adopted by
the model helped counter a lot of
challenges, and the result was that the
model was being scaled up not only
in different States of India but also in
other countries like Bangladesh and
some countries in Africa. Pointing out
the most recent global policy change
– a joint statement by WHO, UNICEF,
USAID and Save the Children in
2009 which endorsed home visits of
neonates and management of sick
neonates at home by trained workers
if referral was not possible – he
said that it took over 20 years of
advocacy to medium to long-term sustainability of
bring about this community based micro-insurance
change. Dr. H. was possible. Mr. K. S. Murthy,
Sudarshan, Bhavishya Alliance spoke on
Karuna Trust ‘Improving Child Nutrition in India
spoke on the through Multi Sectoral Partnership’.
‘Public-Private- Mr. Murthy stated that the pilots
P a r t n e r s h i p undertaken by Bhavishya Alliance
(PPP) model of were designed to work within
Primary Health government programmes, systems
Care (PHC) and structures and could therefore be
Management’ scaled up with minimal policy
being imple- changes. The Chairperson of the
mented by the session Dr. Syeda Hameed stated
Trust. High- that all the presenters were icons in
lighting the challenges faced in scaling their field and their path breaking
up, Dr. Sudarshan pointed out that work – each in a different area of
while scaling up their PPP model, they social development – was being
faced resistance from a number of replicated with great success. She
stakeholders, fought against declared that their experience
corruption at different levels, faced provided useful pointers about scaling
many organizational challenges such up in India.
as staff turnover and management of
budgets and yet overcame them all.
He said the Trust, today, was not only
providing good quality primary health
care services in 48 PHCs in five States
but was in the process of scaling up
further to three more States by 2011.
It was also expanding to PPPs in
District Health Management and the
Management of FRUs. Ms. Mirai
Chatterjee of the Gujarat based
NGO, Vimo-SEWA spoke on Vimo-
SEWA’s experience of Scaling Up
Community Based Micro Insurance.
The third session looked at the
‘Role of Monitoring and Evaluation
and Evidence Building in Scaling
Up’. The Chairperson for the session
was Dr. Narendra Jadhav, Member,
Planning Commission, Govt. of India
and the panelists were: Dr. Prathap
Tharyan, Director, South Asia
Cochrane Centre and Network;
Dr. Richard Cash, Harvard School
of Public Health; and Dr. T.
Sundararaman, Executive Director,
National Health Systems Resource
She said that the process of scaling Centre (NHSRC).
up began with setting goals such as
ensuring outreach of insurance to
women workers across their life cycle
in a viable manner. It was then
followed by a number of steps such
as developing a business plan
Dr. Prathap Tharyan, Director,
South Asian Cochrane Network
and Centre spoke on ‘Cochrane
Reviews: Evidence Building for
Scaling Up’. He said, “Don’t just do
charting growth targets, geographic
spread, partners and strategies.
Contd. on page 8
Highlighting
the major
lessons learnt
in this process,
she said that
generating
revenues for
sustainability
was a challenge.
However, with
appropriate
products and
distribution
channels and
by scaling up, A Glimpse of the Audience
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Youth Efforts Continue in PFI’s 40th Year Celebrations
A s part of the 40th year
celebrations of PFI, poster,
slogan and skit competitions were
organized among the youth from the
vulnerable sections of the society,
particularly non school going
adolescents/youth of urban slums in
four districts each of Maharashtra,
Rajasthan and Gujarat.
The Foundation has selected six NGO
partners: Community Aid and
Sponsorship Programe (CASP),
Bal Sansar Sanstha (BSS), Society to
Uplift Rural Economy (SURE), Indian
Red Cross Society (IRCS), SAHAJ and
GANATAR for carrying out the works
in these four states. CASP organized
the events in Mawal, Raigad, Pune
and Mumbai districts of Maharashtra.
In Rajasthan, the competitions were
organized in Jaipur and Ajmer districts
by BSS and Barmer and Jaisalmer
districts by SURE. In Gujarat, Indian
Red Cross Society organized the
activities in Bhavnagar and
Gandhinagar districts, whereas
SAHAJ and GANATAR organized
the events in Vadodara and
Surendranagar districts.
The winners of the competitions at the
district and state levels were given
cash prizes, certificates and
mementos. Certificate of participation
was also given to all participants.
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Urban Health Challenges and Efforts to Overcome Them
Rapidly Growing Urban
Population and Poverty
Urban population of India is
increasing rapidly, during the
decade 1991-2001 it grew by 31.2%
while the rural population grew at a
much slower rate of 17.9 per cent.
Census estimates suggest that current
urban population of 350 million will
grow to 534 million by the year 2026
constituting 38.2 percent of the
country’s total population.
Urban poor are the fastest growing
segment of Indian population, and
are expected to increase from 80
million in 2005 to 202 million by the
year 2020 (UN Habitat). Most of the
urban poor reside in slums, many of
which are unlisted in official records.
Even within these slums, there are
pockets of more vulnerable groups
such as rag pickers, construction site
workers and pavement dwellers.
They stay in highly degraded
environment with meagre access to
health and other basic services.
Health of the Urban Poor
Unhealthy conditions of slums and
other urban poor settlements along
with lack of services make the urban
poor vulnerable to the health risk.
Their health status is worse-off than
the urban middle and rich income
groups. These health inequalities are
not reflected in commonly available
health statistics. Most large datasets
provide information for rural and
urban averages and mask the
inequalities which exist within the
various economic groups in urban
areas. As per NFHS 3 (2005-06) data
under five mortality rates (U5MR)
among the urban poor (72.7) are
nearly twice higher than the rates for
the urban high income groups (41.8).
Among the urban poor, 60% children
do not get all recommended vaccines
whereas in urban high income groups
their number is nearly half of them
(35%). The percentage of under-
weight children among the urban
poor is 47% which is considerably
higher (26.2%) than that of urban high
income groups. Despite proximity to
health facilities more than half (56%)
of the deliveries among urban poor
households are conducted at home
under unsafe conditions, which is
nearly three times (21.5%) more than
of urban high income groups. Safe
drinking water and availability of toilets
are considered as important
determinants of health status. Among
the urban poor the facilities of piped
water, which is considered relatively
safer, is available to only one fifth
(18.5%) of the urban poor households
and toilets are accessible to less than
half (47.2%) of the urban poor
population. If proper attention is not
paid to improve these conditions, with
the rapid population growth these are
going to be further worsened.
Factors of Limited Reach of
Services to the Urban Poor
These factors can be categorized into
systemic and community related
factors:
Systemic Factors
Reach of healthcare services in urban
poor settlements is strained by several
challenges. In urban areas, unlike
rural areas there is lack of dedicated
and organized three tier healthcare
system that has resulted into
concentration of curative care
services, neglecting primary care
aspects of the healthcare. The health
facilities in urban areas are not
managed effectively and they function
sub-optimally. An evaluation study of
IIPS (2005) suggests that in 30% of
the sanctioned facilities, the post of
medical officer is vacant and there is
inadequate trained staff and lack of
equipments, medicines and other
related supplies. Weak referral
system further restricts the reach of
services to the urban poor. The
unsuitable timing of the health
facilities to the urban poor and rough
behavior of service providers often
dissuade the poor from availing the
services.
There is inequitable distribution of
available resources for the urban poor
among different cities. While, medium
and small cities have significant urban
population, most urban programs
have focused on mega cities like
Mumbai, Delhi, Kolkata and Chennai.
The neglect of the smaller cities
and towns keeps them under
compromised healthcare service.
In addition, weak municipal capacity
and insufficient health program
management experience in most
middle and small size cities and
towns leads to ineffective service
delivery.
There are multiple urban health
stakeholders including Health and
Family Welfare Department, ICDS,
ULBs, DUDA, NGOs, CBOs, donor
agencies, professional bodies (IMA,
IAP) and formal and informal private
practitioners. These stakeholders
operate in isolation with little
coordination, leading to concentration
of services in some areas leaving
others deprived. They can benefit
greatly by sharing resources,
information, and expertise and
avoiding duplication of efforts.
Community Related Factors
Slums where usually the urban poor
reside are informal settlements with
no land tenure rights. These are
considered for relocation at some
point of time. Therefore, there has
been hesitation for developing
permanent infrastructure for service
delivery. In addition, nearly half of the
total slums are unlisted and many of
the settlements remain hidden, such
as workers’ huts at brick-kilns and
construction sites. Since these are not
in official records, more often than not
they remain outside of the purview of
the health programs.
Issues like illegality, social exclusion,
uncertainty of land tenure, threat of
eviction, and being forced to live in a
disabling environment result in lack
of confidence and a sense of
resignation among slum dwellers
which prevent them from being able
to negotiate with service providers to
ask for their entitlements.
Moreover, the urban poor are mostly
of migratory nature. After a certain
period they return to their native
villages where due to distances to
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health facilities, unavailability of
previous record of services received
and lack of awareness and negotiating
capacity they do not get health
services. All these reasons
cumulatively results in restricted reach
of services and limited access of the
poor to avail them.
Efforts to Address Health
Needs of the Urban Poor
The Government of India is
increasingly recognizing the
disproportionate burden of ill health
on the urban poor and has made
provisions for services under
JNNURM, NRHM and ICDS.
Recently it has proposed to bring out
a comprehensive and dedicated
health program under a National
Urban Health Mission (NUHM) to
improve the health status of the urban
poor particularly the slum dwellers
and other disadvantaged sections by
facilitating equitable access to quality
health care through a revamped
public health system, partnerships
and community risk pooling with the
active involvement of the urban local
bodies.
Health of the Urban Poor
Program (HUP)
In addition to the government
efforts, international and bilateral
development agencies and civil
society organizations are also working
for improving the health status of the
urban poor. Recognizing the growing
health needs of the rapidly growing
urban poor, the Population
Foundation of India (PFI) has initiated
Health of the Urban Poor (HUP)
Program with financial support from
United States Agency of International
Development (USAID). It aims to
support the achievement of improved
delivery of reproductive and child
health and family planning
interventions, including promotion of
nutrition, water supply, sanitation and
hygiene services to the urban poor
communities. By providing technical
assistance to the Government of India
and State governments, establishing
partnerships with the private sector,
promoting convergence among
different urban health and
development efforts and
strengthening the evidence based
rigor through city level demonstration
and learning programs, HUP
envisages to bring sustainable
improvement to the lives of the urban
poor in the country. HUP has chosen
Pune, Jaipur, and Bhubaneswar for
developing city demonstration health
programs for learning, testing and
bringing scientific evidence. Learning
from city demonstration programs,
HUP aims to provide technical
assistance to GOI and the states of
Rajasthan, Uttar Pradesh, Madhya
Pradesh, Jharkhnad, Orissa,
Uttarakhand, Chhattisgarh and Bihar
for strengthening the urban health
strategies and improved planning and
implementation of health programs.
It is hoped that these efforts of HUP
will be able to help government in
achieving the goal of providing
preventive, promotive, affordable and
curative healthcare services to the
urban poor.
Contd. from page 5
it, do it right” and “The devil is in
the detail” were the two mantras that
needed to be followed for scaling up.
Emphasizing the need to gain clarity
before Scaling Up, Dr. Tharyan said
that it was important to evaluate the
evidence and potential tradeoffs in
terms of efficiency, effectiveness, and
scalability. It was also important to
explore what needed to be done to
generate (better) evidence of
efficiency and scalability in pilot
programmes. Dr. Richard Cash,
associated with the Harvard School
of Public Health and the Public
Health Foundation of India
shared BRAC’s Experience in
Scaling Up Health Programmes
(Oral Rehydration Therapy and
Tuberculosis). Dr. Cash said that
evaluation, adaptation and advocacy
were crucial for scaling up. The need
to consider longer, more realistic
scaling up time frames was one of the
key lessons learnt in the process.
Dr. T. Sundararaman, Executive
Director, National Health
Systems Resource Centre
8
(NHSRC) spoke on ‘Evidence
Building for Scaling Up: From Projects
to Missions and Movements’. Sharing
his experience of scaling up the
Community Health Worker (CHW)
programme he said that one of the
key lessons of scaling up was that size
mattered. Changing the size or scale
of the programme meant making
changes in the design of every
component of the programme
to cater to the expanded scale.
He emphasized the relevance of
evaluation for successful scaling up and
stated that given the constraints of the
government system, an internal
evaluation with in-built externality,
where key processes were evaluated
qualitatively offered the best way
forward. Chairperson of the session,
Dr. Narendra Jadhav, Member,
Planning Commission summarized
the discussion and concluded by
emphasizing the importance of data
collection in evidence building and
added light heartedly that “if one
tortured the data long enough, it would
confess anything”.
In the concluding session,
Ms. Poonam Muttreja, Country
Director, MacArthur Foundation
and Dr. Richard Kohl, Project
Director, Scaling Up, MSI
summarized the discussions and said
that one of the biggest challenges that
emerged during the deliberations was
that many NGO pilots were not
designed with scaling up goals in mind
and lacked quantitative evidence of
impact. This highlighted the need for
evidence based implementation
designs. They also pointed out that
the issue of fund management, cost
effectiveness and accountability
required more study for the scaling
up process to be a sustainable one.
Asserting that the challenge today was
‘building commitment towards the
adoption of a pro-active approach
to scaling up’, they concluded the
conference with the hope that further
dialogue with the Planning
Commission would bring forth some
answers.
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CSR Module Released
A meeting in collaboration with
the Mahratta Chamber of
Commerce, Industries and Agriculture
(MCCIA) was held on 14th May, 2010
at MCCIA, Pune for the dissemination
of the CSR Module ‘A Reproductive
Health Package: Corporate
Social Responsibility’. The
meeting was presided over by
Mr B. G. Deshmukh, Vice Chairman,
PFI Governing Board, Mr Anant
Sardeshmukh, Additional Director
General, MCCIA and Mr A.R. Nanda,
Executive Director, PFI. The meeting
drew the participation of corporate
house, civil society organizations and
other dignitaries.
Mr Anant Sardeshmukh welcomed all
the participants to the meeting.
He briefed about the MCCIA and their
functioning and how corporate social
responsibility became an important
agenda in the organization. He lauded
the attempts of PFI for bringing out
this reproductive health package and
said that, in the current environment
the corporate sector is giving greater
attention towards their social
responsibility and is looking forward
to learning from their rich
experience. There is an urgent need
for corporate and civil society to build
and strengthen technical expertise
and knowledge for cross learning and
to collaborate with the government to
maximize their efforts.
In his address, Mr B. G. Deshmukh
highlighted PFI’s long and prolific
association with the corporate sector
since its inception and stated that the
corporate sector and civil society
organization play a catalytic role to
create an enabling environment at the
national, state and local levels for
policy advocacy on issues related to
population stabilization, women and
child welfare through action research
programmes. He mentioned that the
current initiatives of PFI with
corporate sector, both its core and
external funding, spread over in the
states of Uttar Pradesh, Jharkhand,
Rajasthan, Karnataka, Maharashtra
and Tamil Nadu and focus on
communities living in underserved
areas of these states. He further stated
The MCCIA Additional Director General Mr Anant Sardeshmukh releasing the
CSR Module. Others are (from left): Dr Sharmila Ghosh Neogi, Joint Director, PFI;
Mr B G Deshmukh, Vice-Chairman, PFI Governing Board; Mr A R Nanda, Executive
Director, PFI; and Mr Shriniwas Rairekar, Senior Director, MCCIA
that the module has been prepared
based on the requirements of
information to corporate sector on
health, reproductive health, project
management and related issues.
He invited the corporate sector to
invest more on health and assured that
Population Foundation of India would
strengthen its tie-up with corporate
sector through this package.
Mr Nanda, in his presentation, traced
the history of PFI’s engagement with
the corporate sector. He elaborated
that PFI had a corporate origin and
was established in 1970 by socially
committed industrialists led by Mr JRD
Tata has had a mandate of supporting
corporate sector since then for 40
years of its existence. PFI’s journey
with the corporate sector can be
divided into various phases, which
involved fund raising from 350 Indian
industries and corporate trusts. During
the 1990s advocacy on family
planning issues continued and PFI also
started supporting small pilot projects
on issues of Reproductive Health.
PFI continued its collaboration with the
corporate sector during the 21st
century as well. Currently PFI is
supporting corporate sector in the
states of UP, Rajasthan, Jharkhand,
Kar nataka, Tamil Nadu and
Maharashtra on various aspects
related to reproductive health and
HIV/AIDS.
Mr Nanda also shared PFI’s
experience with the corporate sector
documented in a monograph titled
“Engaging with Corporate Sector:
1970-2007” brought out in 2007.
It was followed by a presentation of
Dr Sharmila Ghosh Neogi, Joint
Director (Programmes), PFI on the
background, purpose and the
contents of the CSR module. A needs
assessment survey: discussions,
reviews, interviews, studies and field
visits was done to identify the gaps,
which revealed that there was a need
of comprehensive reproductive health
materials to scale up the programmes
in the corporate sector. An assistance
package on RCH ‘A Reproductive
Health Package: Corporate
Social Responsibility’ was thus
brought out. The assistance package
provides guidelines for various aspects
such as proposal development,
strategy formulation, monitoring
mechanisms as well as issue based
information on RCH and family
planning.
This was followed by vote of thanks
by Mr Shriniwas Rairekar, Senior
Director, MCCIA. Acknowledging the
initiative, Mr Rairekar envisaged that
the module would serve to facilitate
greater involvement of corporate
sector on public health and
reproductive health issues.
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National Dissemination Meeting on
Community Monitoring under NRHM
C ommunity Monitoring and
Planning (Community Action) has
been seen as an important
component of both the
communitization processes and the
monitoring mechanism of National
Rural Health Mission. The Advisory
Group on Community Action (AGCA),
a standing committee constituted by
the Ministry of Health and Family
Welfare (MoHFW), Government of
India, has been involved in developing
the operating methodology for
community monitoring and has
supported and supervised the
implementation of community
monitoring in nine pilot states:
Maharashtra, Orissa, Rajasthan,
Madhya Pradesh, Tamil Nadu,
Jharkhand, Assam, Chhattisgarh and
Karnataka. The first phase covered
35 districts and more than 6920
villages in nine states during 2007-
2009. The entire process was done
in coordination with the government
and the NGO facilitating partners at
all levels.
Nine state level nodal agencies
together with district and block level
NGOs worked in partnership with the
State Mission Directorate, District
Programme Management Units,
medical officers and health workers
on the one hand and empowered the
Village Health and Sanitation
Committees on the other, to conduct
community monitoring exercises,
prepare village and facility level
report cards and share them at Jan
Sanwads (public sharing event) to
identify the gaps and plan for future
action. Changes have been reported
in the functioning of health facilities
and the overall uptake and utilization
of public services through this process.
The process of community monitoring
has been incorporated into the State
Programme Implementation Plans
(PIPs) of nearly all the states in the
year 2010-2011. This necessitated
a sharing of the outcomes and process
of the first phase of community
monitoring among the stakeholders,
mainly those who will be responsible
10
Panelists at the Inaugural Session (from left) : Mr S Ramanathan, TRIOs Development
Support (P) Ltd; Dr Abhijit Das, Member, AGCA; Dr Tarun Seem, Head – Health Support
Unit, PHFI; Mr Puneet Kansal, Director, NRHM; and Mr A R Nanda, Executive Director, PFI
for the expanded roll out in the pilot
states and in the states where this
process has not been implemented.
In view of the above, a one-day
Dissemination Meeting was organized
in collaboration with the Ministry of
Health and Family Welfare,
Government of India at the India
International Centre, New Delhi
on June 16, 2010. The main
objectives of the meeting were to (i)
share the implementation process,
results and outcomes of the first phase
of community monitoring with the
relevant stakeholders, (ii) enable those
who were not part of the first phase,
to learn about the community
monitoring process for imple-
mentation of the programme in their
states, (iii) share the consolidated
report including outcomes,
observations and recommendations of
the external review process, and (iv)
facilitate dialogue and interaction with
the participants/stakeholders from
the states. The meeting saw the
participation of around 100 dignitaries
including senior government officials
from the national and state levels and
civil society representatives from
various states. A project report
summarizing the implementation
process, the results and findings of the
concurrent review process, was
released at the meeting along with a
short film on Community Monitoring.
Mr A R Nanda, Convener, AGCA and
Executive Director, Population
Foundation of India welcomed the
participants for the meeting and
shared about the objectives of the
dissemination meeting along with a
brief mention of the importance of the
communitization process under
NRHM.
The meeting had four sessions: (1)
Introducing Community Monitoring,
(2) How Community Monitoring has
Supported Achievement of NRHM
Goals, (3) Empowering Communities
to Stimulate Demand and
Accountability, and (4) Community
Monitoring: Partnership Challenges –
Government, NGO and Community.
Dr. Tarun Seem, former Director,
NRHM and currently Head – Health
Support Unit, Public Health
Foundation of India (PHFI) chaired the
first session and Mr. Puneet Kansal,
Director, NRHM, represented the
Ministry of Health and Family Welfare.
Ms. Indu Capoor, Member, AGCA,
Dr. Ramesh Chandra Sagar, Mission
Director, NRHM, Maharashtra and
Dr. Thelma Narayan, Member,
AGCA, chaired session 2, 3, and 4
respectively.
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2.1 Page 11 |
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In his presentation on ‘Community
Monitoring Processes’, Dr Abhijit Das,
Member, AGCA briefed about the
process of Community Based
Monitoring (CBS) undertaken in the
nine pilot states under NRHM. He
also shared the role of Advisory Group
on Community Action (AGCA) and the
National Secretariat in providing
technical support at various stages of
the processes in the nine states.
Mr S Ramanathan, who led the
external Review Committee made a
presentation on ‘Review of Pilot
Phase of Community Monitoring
Programme’. He shared about the
objectives and the process undertaken
for the review of the community
monitoring programme in the nine
states. The review also highlighted
some of the significant observations,
achievements and recommendations
for further improvement of the
programme.
There were a total of 12 presentations
from various states sharing their
experience/ achievements/lessons
learned in the implementation of the
first phase of community monitoring
programme in their respective states.
The presenters included VHSC
members, media representatives,
Panchayat representatives and
people from the community, in
addition to the nodal agencies from
each state. Each session was followed
by a question and answer session, in
which audience participated
enthusiastically.
Some of the important outcomes
shared by different states during the
dissemination workshop were:
• Practice of prescribing medicine
from the private shops has largely
stopped, some required medicines
are now getting from Rogi Kalyan
Samities
• Illegal charging and private
practice by certain medical officers
have now stopped
• Utilization of untied funds for
purchasing furniture and fences for
Anganwadis have stopped and
funds are used for other more
relevant health related activities
• Based on accurate recording, now
there is no discrepancy between
Anganwadi records and
independently taken weights of
malnourished children
• Frequency of visits of ANMs and
MPWs in villages has led to
improved village health services in
many villages; there is definite
improvement in immunization
coverage in the villages
• Certain sub-centers and mobile
units which were not working have
now started functioning
• Increase in institutional deliveries
thereby phenomenal increase in
the number of JSY beneficiaries
• Decrease in infant and maternal
deaths
• Boards on Citizen’s health charter
and availability of medicines have
been displayed
• Increase in number of toilets under
Total Sanitation Campaign (TSC)
• Formation/Reorganization of
VHSCs and training of VHSCs
• Regular meeting of VHSCs and
ASHAs & Panchayat Members
• Public dialogues and public
hearings organized at different
places helped in understanding the
health issues and in giving rise to a
sense of empowerment
Excerpts from experience shared by different stakeholders
Maharashtra: Mr. Yogiraj Prabhune, Media and Mr. Shashikant Gaikwad, PRI Member
Mr.Yogiraj Prabhune, Senior Reporter of local newspaper shared some positive outcomes of the community based
monitoring (CBM) process by comparing the pre and post CBM situations. Before CBM initiatives, many VHSCs
were mostly non functional, existing only on paper. Infrastructure was there but, services were not available. CBM
along with the media has helped community to become aware of their health rights. In a span of 2 years, 6 Jan
sunvais were organized which generated awareness amongst community people about their rights and entitlements.
Questions were raised on issues like availability of medicines in the health centers, working of MPWs, ASHAs and
Medical Officers. Information on medicine stock was given. Sonography operator was appointed and Anganwadi
started functioning effectively and quality and regularity of nutrition supplements was ensured, which helped in
improving the health status of children.
Mr. Shashikant Gaikwad informed that before CBM, people preferred to avail services in private hospitals due to
lack of proper services in the government hospitals. The CBM process led to increased awareness in the community
and they started questioning health services providers. All this lead to a change in the behaviour of the service
providers towards the community.
Tamil Nadu: Mr. Vanamiyalan, Community Trainer
Mr.Vanamiyalan shared that initially people’s response towards CBM was lukewarm but slowly people with adverse
experience came forward and started participating in the process. People do not recognize Govenment health
facility as the centre for quality services. Medical officers did not give proper explanation to people about their
conditions, field workers did not visit village regularly, untied funds were also not utilized properly. He also shared
many positive outcomes such as user fee was banned (except X-ray, MRI and USG), number of OPD days increased,
corruption in Maternity Benefit Scheme reduced etc.
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2.2 Page 12 |
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And the Award Goes to ....
The Childrens’ Education Awards were given away by
Mr A R Nanda, Executive Director, at a function organised at
PFI on June 25, 2010 for the academic year 2009-10. These
awards were constituted by the Foundation to encourage
children of PFI staff to excel in their academic performance
and motivate them to do better in the coming years. The awards,
every year, are presented to children, who score a minimum of
eighty percent marks in their final examinations. A three
member “Children Education Award Committee” has been
constituted, which shortlists applications according to the
eligibility criteria and nominates the winners.
In the current academic year, the children who scored 80%
and above, for their performance in class I to V standard,
were: Shruti Paul (97%), daughter of Mr P K Paul; Ahana Mondal
(<95% - A+), daughter of Dr Subroto Kumar Mondal; Janhvi
Joyal (<95% - A+), daughter of Mr Rakesh Joyal; Aakash Rawat
(93%), son of Mr Mohan Singh Rawat; Kanika Sahni (90%),
daughter of Ms Monica Sahni; and Anushka Joyal (83.6%),
daughter of Mr Rakesh Joyal. In this category, Shruti Paul
received a cash award of Rs 1000/-, a meritorious
certificate, a trophy and a gift and the other children received
certificates of merit, trophies and gifts.
In the second category, the children, who scored 80% and
above for their performance in class VI to IX standard were:
Pratyush Ramesh (92.98%), son of Ms Prema Ramesh;
Amruta S Nair (88.33%), daughter of Ms Usha S Nair; Hari
Krishnan P (84%), son of Mr P Narayanan; Nishtha Neogi
(81.2%), daughter of Dr Sharmila G Neogi; and Urvashi Paul
(81%), daughter of Mr P K Paul. In this category, Pratyush
Ramesh received a cash award of Rs 2000/-, a
meritorious certificate, a trophy and a gift and the rest of
the children received certificates of merit, trophies and gifts.
In the third category (class X), Abhishek Sekharan, son of
Mr P J Sekharan received cash award of Rs 3,000,
a meritorious certificate, a trophy and a gift for
his performance in X standard (<95% - A+) and in the
fourth category (class XI-XII), Satyanarayanan, son of
Mr K Venkatachalam, received cash award of Rs 4,000,
a meritorious certificate, a trophy and a gift for his
outstanding performance in XI standard (89.4%).
We wish all the Children the very best in their academics and
hope they continue to make us proud, year after year!
We welcome...
Mr Surendra Singh, who has joined the
Foundation as HR Manager in April 2010. He has
over 12 years of experience in Human Resource
Management function and he has worked with British
High Commission, ActionAid and Handicap
International before joining the Foundation. He is
a graduate from Delhi University and has done MBA
from IMT, Ghaziabad.
Dr Sanjeev Kumar, who has joined the
Foundation as MIS Officer for the project ‘Health of
Urban Poor (HUP)/USAID’. He is Ph.D. in Public
Health and has more than twelve years experience.
Earlier he used to work at Urban Health Resource
Centre as Team Leader, Research, Knowledge
Management and Advocacy unit.
Ms Geeta S. Kumar, who has joined the
Foundation as Secretarial Assistant for the project
‘Health of the Urban Poor (HUP)/USAID’. She is a
Science graduate and pursuing her MBA at present.
She has more than 19 years of experience in
various capacities. She has worked with NPCIL,
Rajasthan, Subros Ltd, Sify, Oxfam, CARE and
UNESCO before joining the Foundation.
Mr S Ramaseshan
retired from PFI
as Secretary &
Treasurer on May
31, 2010 after 34
invaluable years of
service. Mr A R
Nanda, Executive
Director,
PFI
honoured him with
a memento and bouquet at a function organized on
May 31, 2010. In his farewell speech, Mr Nanda
appreciated his long association with PFI for over a period
of three decades in various capacities. The PFI staff wish
him a happy and peaceful retired life.
We bade farewell to Ms Mridu Pandey, who worked
with Programme Division as Programme Associate;
Mr Vijay Kumar, who worked with Global Fund
(HIV/AIDS) project as Senior Grants Manager; Mr Satya
Ranjan Mishra, who worked as Project Manager
(Packard project); and Dr Shrabanti Sen, who worked
with Scaling up Division as Programme Manager.
Editorial Guidance
Mr A.R. Nanda
Ms Sona Sharma
Editor
Ms Chandni Malik
Editorial Assistance
Ms Jolly Jose
12
Editorial Committee
Ms Usha Rai
Dr Almas Ali
Dr Lalitendu Jagatdeb
Dr Sharmila G. Neogi
Published by
Population Foundation of India
B-28, Qutab Institutional Area
New Delhi-110016, India
Tel: 91-11-43894100
Fax: 91-11-43894199
e-mail: popfound@sify.com
website: www.popfound.org
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