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PFI Annual Report 2007-2008 |
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Annual Report
2007-2008
Population Foundation of India
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ANNUAL REPORT
2007-08
Population Foundation of India
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Designed and Printed by :
Impression Communications
9811116841, 65749684
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CONTENTS
annual report
2007-2008
PFI Governing Board and Advisory Council
vi
Governing Board Chairperson’s Address
ix
From the Executive Director’s Desk
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Programmes during the year:
(A) Reproductive and Child Health Intervention/ Action-Research Projects:-
(i) RCH Projects with Corporate Sector
3
- Swastha Aangan – Promoting healthy families in Uttar Pradesh
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- Naya Savera - An Integrated family welfare programme in Rajasthan 5
- PARIVARTAN - A family welfare and population development
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project in Rajasthan
- Improving reproductive and child health status of the tribals in
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Noamundi Block, in West Singhbhum District of Jharkhand
(ii) RCH Projects with NGOs
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- Total Management of Essential RCH and Primary Health Care
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through Public-Private Partnership: A Model and Innovative
Project in Karnataka
- Promotion of maternal and neonatal survival among tribals in
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Rayagada District of Orissa
- Promotion of family initiatives to address family planning and
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reproductive and child health needs , through increased male
participation in Uttar Pradesh
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- Intervention Study among adolescents, pregnant and lactating
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mothers to reduce prevalence of anaemia in Haryana
- Improvement of maternal and child health through Life cycle
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approach in Jharkhand
- Safe Motherhood through RCH interventions in Rajasthan
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- Reproductive and Child Health programme for Malto Tribes
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in Jharkhand
- Instituting Rational Use of Drugs ( RUD) in Reproductive and
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Child Health Care in FPAI clinics in India
- Swabhiman: Urban Reproductive and Child Health Program with an 26
Empowerment approach in Delhi
- Evidence based advocacy for maternal and child health amongst the 29
urban poor of Vadodara city of Gujarat
- Enhancement of health status of women, children and adolescents
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through RCH Life cycle approach in Uttar Pradesh
- Reducing reproductive Morbidity among Married Young Women
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in Rural Maharashtra
(iii) New Initiatives in the Current Year
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- A Model Initiative to Ensure Quality Family Planning Services in
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Uttarakhand
- Reduction of Iron Deficiency Anemia and Awareness on
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Reproductive and Sexual Health among Adolescent Girls in
Ganjam District of Orissa
- Maternal and Child Health Sustainable Technical Assistance
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and Research: A new approach
(B) Advocacy and Communication Projects
- Advocacy and Communication Projects under UNFPA Country
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Programme 6 in Punjab, Haryana, Himachal Pradesh and Bihar
- Advocacy for building supportive policy and program environment on
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rights based population and family planning /reproductive health
issues in India
- Regional Resource Centres (RRCs) for Bihar and Chhatisgarh
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- Scaling up Pilots and Innovations in Reproductive and Child health in
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India: PFI’s role as an Advocacy Organization
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- Community Monitoring of Health Services under NRHM
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- 4th Asia Pacific Conference on Reproductive and Sexual Health and Rights 60
(C) HIV/AIDS Program
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- The Global Fund Round 4 and Round 6 HIV/AIDS Program
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Publications during the year:
78
Accounts
81
PFI Addresses
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Our Team
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annual report
2007-2008
PFI GOVERNING BOARD AND
ADVISORY COUNCIL
annual report
2007-2008
Governing Board
Mr Hari Shankar Singhania, who succeeded Dr Bharat Ram as Board Chairman in September
2007, heads the Governing Board. The Board, with the advice of an Advisory Council,
determines the policies and programme strategies of the Foundation and sets priorities. The
distinguished members of the Governing Board as on March 31, 2008 are:
Chairman
Mr Hari Shankar Singhania
Vice-Chairman
Mr. B G Deshmukh
Members
Prof. Ranjit Roy Chaudhury
Mr. K L Chugh
Dr. Abid Hussain
Mr. R V Kanoria
Mr. Kiran Karnik
Begum Bilkees Latif
Mr. J C Pant
Mrs. Nina Puri
Ms. Justice Leila Seth
Mr. Ratan N Tata
Mr. B G Verghese
Dr Vinay Bharat-Ram
Dr. M S Swaminathan (Permanent Invitee)
Secretary, Ministry of Health and Family Welfare, GOI (ex-officio)
Mr. A R Nanda, Executive Director, PFI
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Advisory Council
The Advisory Council, consisting of experts in related fields, such as Sociology, Demography,
Communications, Health Services, Environment, Education, Management, Women’s
Development etc. contributes to the formulation of the Foundation’s policies and programmes.
The distinguished members of the Advisory Council as on March 31, 2008 are:
Chairman
Dr. M S Swaminathan
Members
Mr. T V Antony
Mrs. Rami Chhabra
Dr. S D Gupta
Dr. B K Joshi
Dr. Usha R Krishna
Mr. Ajay S Mehta
Dr. Saroj Pachauri
Dr. Yash Pal
Dr. Ragini Prem
Dr. Gita Sen
Dr. K Srinivasan
Dr. Leela Visaria
Dr. Bobby John
Ms. Mirai Chatterjee
Prof. G P Talwar
Mr. Yashodhan Ghorpade – representing the young people
Representative of the Ministry of Health & Family Welfare
Mr. A R Nanda, Executive Director, PFI
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GOVERNING BOARD CHAIRPERSON S ADDRESS
annuaual report
2007-2008
It is my pleasure to invite you to the Annual General Body Meeting of the Foundation.
Over the decades, there has been a substantial increase in contraceptive use in India. The
direction, emphasis and strategies of the Family Welfare Programme have changed over time
to achieve the desired outcomes. However, meeting the contraceptive needs of considerable
proportions of women and men and improving the quality of family planning services continue
to be a challenge. The 1990s witnessed a growing recognition of this, and several innovative
policy and programme initiatives were launched to address these issues. It was a time of
dramatic changes in the family welfare policy and programme in the country. The passing of
the 72nd and 73rd Constitutional Amendments and the Panchayati Raj and Nagar Palika Acts
in 1992 set in motion the process of democratic decentralization, and brought the Family
Welfare Programme, legally, in the domain of Panchayati Raj Institutions. In addition, several
factors like the organized pressure from multiple constituencies to bring issues of quality and
choice into the programme, and the recognition of inherent constraints in the programme
contributed to changes in policy and program approach.
The International Conference on Population and Development in 1994 and the Beijing Women’s
Conference in 1995 further catalyzed the process of policy change. In 1996, the government
took the radical decision of abolishing method-specific contraceptive targets that had been
used to guide, monitor and evaluate the programme for decades, replacing it with what was
initially called the Target-free Approach, where health workers’ case loads would be determined
by needs identified at the community level, rather than centrally-assigned.
In 1997, the Reproductive and Child Health (RCH) programme was launched, which espouses
the principles of client satisfaction in delivering comprehensive and integrated high quality
health and family planning services. A few years later, in the year 2000 the National Population
Policy advocated a holistic, multisectoral approach towards population stabilization, with no
targets for specific contraceptive methods except for achieving a national average Total Fertility
Rate (TFR) of 2.1 by the year 2010. This resulted in a shift in implementation from centrally
fixed targets to target-free dispensation through a decentralized, participatory approach. The
target-free approach was recast as the community needs assessment approach.
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The National Population Policy provided a framework for achieving the twin objectives of
population stabilization and promoting reproductive health within the wider context of
sustainable development. The Tenth Five Year Plan outlined efforts in three broad areas:
1. Meeting the unmet need for contraception;
2. Reducing infant and maternal mortality; and
3. Enabling families to achieve their reproductive goals.
With regard to addressing the unmet need for contraception, the government is focusing
particularly in areas where fertility declines have been lagging. Issues such as improved
adolescent reproductive health, preventing unintended pregnancy and increasing access to
safe abortion are addressed. Counselling, access to and provision of good quality services and
follow-up care are emphasized. And hence the programme focus has shifted away from vertical
family planning services towards the provision of comprehensive integrated reproductive health
care at all levels of the health sector.
The Eleventh Five year plan puts greater emphasis on active involvement of the Panchayati Raj
Institutions in the implementation of public sector programmes. Sarva Swasthya Abhiyan will
be introduced that includes National Urban Health Mission along with National rural Health
Mission. The Plan focuses on voluntary fertility reduction and highlights the need to increase
the role of civil society organizations in areas where the public sector is weak.
The Foundation is recognized by the Government of India for its rights based and community
empowerment approach to programme. Therefore it serves as the Secretariat for The Advisory
Group on Community Action for the National Rural Health Mission ( NRHM) programme of
the Government of India.
PFI has consistently strived to carry out its core mandate of capacity building, service provision,
advocacy and communication as well as intervention research in reproductive and child health
and family planning through a number of programs in the country. There is renewed emphasis
on family planning, which, in view of the changing face of policy, is repositioned with a larger
focus on Quality of Care with client satisfaction at the heart of it, and with the realization that
it has to go hand in hand with the other needs with respect to health issues in general and
reproductive health in particular.
The renewed emphasis on client- centered and rights- based reproductive health care both in
India and globally, has guided PFI in aligning its vision, mission and strategy with the same.
“Promoting, Fostering and Inspiring sustained and balanced human development with a focus
on population stabilization through an enabling environment for an ascending quality of life
with equity and justice”, is the vision that PFI strives to realize, by promoting and formulating
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2007-2008
gender sensitive and rights based population and development policies, strategies and
programmes. PFI will continue to focus on un-served, underserved areas and vulnerable sections
of society, collaborate with central, state and local government institutions for effective policy
planning, formulation and facilitation of programme implementation. Socio demographically
backward and high fertility states of Uttar Pradesh, Bihar, Madhya Pradesh and Rajasthan,
which represent 40% of the country’s population, will continue to be the focus states, while
implementing innovations with a focus on reproductive health and family planning in various
states that could be scaled up.
Advocacy and communication are a central feature of PFI’s agenda. Therefore the issues of
national and state level significance are identified and taken up with relevant stakeholders
such as parliamentarians, state legislators, corporates, media, NGOs and other civil society
organizations through initiatives like conferences on population, health and social development
through networks, alliances and coalitions, thus creating an enabling environment for policy
formulation and policy change and advocacy for scaling up of successful pilot interventions.
Behaviour change communication continues to be an integral component of all PFI supported
projects.
The changing scenario in population and social development provides a challenge as well as
an opportunity for PFI to play a key role in achieving the national agenda with full commitment
and renewed enthusiasm.
Acknowledgements
The Foundation is grateful to the members of the Governing Board, Advisory Council,
consultative panels, expert groups, social workers, health professionals and NGO partners
who have readily responded to our call for advice and assistance in the true spirit of service for
a cause of national importance.
We are grateful to the various departments of government, particularly the Ministry of Health
and Family Welfare, Ministry of Youth Affairs, Ministry of Panchayati Raj, Ministry of Information
and Broadcasting, Prasar Bharati, Press Information Bureau, NACO, office of the Registrar
General of India and Planning Commission for their sustained interest and co-operation in
furthering the aims of the Foundation. We are also grateful to the media- both print and electronic,
who in the recent times, have displayed enhanced sensitivity to population, development and
gender issues, and helped build public opinion in favour of determined action.
I wish to thank the partner donor organizations, particularly The Global Fund, The David and
Lucile Packard Foundation, UNDP, UNFPA, UNICEF, CEDPA, The John D and Catherine T
Mac Arthur Foundation, Sir Dorabji Tata Trust and Population Reference Bureau.
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I thank the various team members; the NGOs, the CBOs, Government and Corporate partners,
who are working towards realizing the vision of India and humanity at large.
I take this opportunity to express the Governing Board’s and my own appreciation of the
excellent work put in by Mr. A.R. Nanda, Executive Director of Population Foundation of
India. I also appreciate the staff of the Foundation, who continue to discharge their duties with
enthusiasm and efficiency. I look forward to their new initiatives towards the future of the
Foundation.
Hari Shankar Singhania
Chairperson
November, 2008
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FROM THE EXECUTIVE DIRECTOR S DESK
annauual report
2007-2008
Greetings from the Population Foundation of India!
The year 2007-2008 has been both challenging and exciting at the Foundation.
PFI has been growing and expanding considerably, both in terms of human resources as well
as by way of opening new offices across the country. With emphasis on capacity building and
services, the underlying theme in all PFI programmes is “Quality Of Care”. Keeping in view
this renewed commitment to quality, client-centered and rights-based approach to programming,
the Foundation undertook a systematic strategic planning exercise, to revisit its Mission, Vision
and Goals for the future. The Vision was developed keeping in view the Foundation’s mandate
of working towards sustainable human development and focusing on population stabilization
with a holistic approach in enhancing the quality of life for the population.
Through the year, PFI continued to implement its core programmes across 11 States in the
country. 5 innovative pilots have also been launched, that focus on various pertinent issues
requiring continued attention, like ensuring quality family planning services and reducing iron
deficiency anemia to ensure good health among adolescent girls.
Under the David and Lucile Packard Foundation funded advocacy project on young people,
the Foundation tasted success in Jharkhand, in its effort at providing technical assistance to
Government in formulating the Youth Policy of Jharkhand. The policy has been approved by
the Jharkhand Government this year. This was a three year bottom up, process oriented approach
that PFI adopted in policy advocacy. PFI is continuing its assistance to help ensure that the
policy is implemented in its true spirit for the youth of Jharkhand and with involvement of
various stakeholders.
The Foundation also brought out a critical document focusing on Bihar State, titled ‘State of
Health in Bihar’. As part of the programme PFI continues its advocacy with large youth based
organizations like NCC in Jharkhand and NYK in Bihar to institutionalize Life Skills Education
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training in their curriculum. The Foundation through NYK has already trained 360 youth club
members in Gaya district.
With the funding support from the John D and Catherine T Mac Arthur Foundation, PFI has
been strengthening its capacity to establish itself and function as a center for scaling up of
successful pilot innovations. As an intermediary organization between the originating and the
adopting organizations, this year has been full of opportunities as well as challenges. The
Foundation has been conducting visioning workshops with NGOs to assess scalability of
models in the areas of maternal mortality reduction and young peoples’ reproductive and
sexual health.
Another initiative with tremendous potential for the Foundation to grow, is being part of the
Maternal and Child Health Sustainable Technical Assistance and Research (MCH-STAR) project
which will focus on improving policies, programs and resources in the areas of maternal,
neonatal, child health and nutrition (MNCHN) in India. It aims at strengthening the capacity
of Indian institutions to conduct meaningful research, policy analysis and advocacy and provide
technical assistance in MNCHN matters in the long run. Apart from the focus at the national
level, Jharkhand and Uttar Pradesh will be the focus states. The Population Foundation of
India is one of the three selected Indian institutions represented in the project as Star Supported
Institutions (SSIs) along with Public Health Foundation of India (PHFI) and India Clinical
Epidemiology Network (India CLEN).
I wish to thank our Governing Board as well as the Advisory Council, for their continuous
support that guides the Foundation in fulfilling its commitment to the nation.
A.R. Nanda
Executive Director
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Reproductive and Child Health Intervention/Action
Research Projects
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2007-2008
RCH PROJECTS WITH
CORPORATE SECTOR
Joint Initiatives of PFI with Corporates
Swastha Aangan Promoting Healthy Families in Uttar Pradesh
The current project, ‘SWASTHA ANGAN’ is a sequel to the Intensive Family Welfare Programme
(IFWP) implemented by PFI through Tata Chemicals Society for Rural Development, from
December 2001 to April 2007 in 96 villages of Babrala Block in District Badaun of Uttar
Pradesh.
The rationale for the project was that Badaun district had extremely poor indicators
of Reproductive and Child Health and overall social and demographic
development .
The end-line evaluation of the IFWP project brought to the fore several successes
and promising practices from the project. Compared to the baseline, early
registration (i.e. before 12 weeks) of pregnancy increased from 32.5 percent to
56.1 percent. The percentage of women receiving the recommended three ante-
natal checkups increased significantly from just 20.9 to 60.7 percent. Though there was little
increase in proportion of institutional deliveries as the existing government health infrastructure
was inadequate, the proportion of home deliveries conducted by Traditional Birth Attendants
trained under the project rose significantly from just 6.9 to 59.2 percent. There was also a six-
fold increase in proportion of women getting postnatal visit and counseling. The number of
fully immunized children increased from just 7.1 percent to 44.1 percent. The most significant
achievement was in the Contraceptive Prevalence Rate, which increased from just 9.1 percent
in the beginning of the project to 23.7 at the end.
The current project ‘Swastha Angan’, covering a population of 70000 in 50 villages of Babrala
block, is aimed at consolidating these gains and sustaining the benefits of the IFWP programme
with active participation at family and community levels and enhanced linkages and integration
with the government health care and development agencies. Thus, there is a distinct shift in
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approach from individual to family and from a mobile van based provision of RCH services to
linkages with and supplementation to the government health care system. The specific objectives
of this phase of the project are:
1) To create community based mechanisms and linkages for increasing access to quality
RH/FP services.
2) To bring about desired behaviour changes among eligible couples (women in the
age group of 15-49 years of age) through integrated IEC package and increasing
involvement of different stakeholders at the family level on Family Planning/
Reproductive and Child Health.
3) To promote use of modern contraceptives among eligible couples by providing a
basket of choices through strengthening Parivar Kalyan Kendras and appropriate
referrals.
4) To document learning, processes and good practices for replication and scale up.
The project was formally inaugurated in November 2007 in presence of senior
government health officials and officials from the TCSRD and Tata Chemicals.
The Project Manager, 10 Field Coordinators, 65 Village Level Motivators (most
of whom are ASHA workers) have been appointed and oriented.
A team of 3 Field Coordinators from the project attended the 5-day training
program on formation and facilitation of Village Health Committees at CINI
Ranchi, Jharkhand. This training focussed on issues related to family planning,
maternal health, child health and HIV-AIDS, preparing village health plans and
formation of village health committees. Experts from Sutra, Himachal Pradesh
and CINI, Jharkhand facilitated the training. A seven-day training program for project staff on
“Creating Awareness through Puppetry” by renowned “Thar Gavaniyar Lok Kalakar Samiti”
from Rajasthan was organized and a three day training program on Health & Sanitation was
also held.
A Community Needs Assessment Approach based planning and service delivery has been
initiated. Objectively verifiable indicators (along the logical framework of activities under the
project), for monitoring the progress of the project have been set up. Based on the same, a
detailed Management Information System has been set up with technical support from PFI to
help collect, collate and analyse the data and generate desired reports at different levels.
50 Parivar Kalyan Kendras (PKK) were set up in project villages during the earlier phase. PKKs
are operated by ‘Swasthya Mitra’ who are male volunteers from the community, mostly husbands
of the local VLM. The project envisages their evolution as effective channels for social marketing
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by linking them with existing social marketing initiatives as a measure to expand the basket of
supplies at PKKs by including Iron and calcium supplements, some over the counter drugs,
sanitary pads etc and thus make it lucrative and sustainable.
AIDS Awareness Week was celebrated to mark the World AIDS Day 2007. A Jan-Chetna Rath
moved across the project villages to spread awareness about transmission modes of HIV.
International Women’s Day (8th March) was celebrated across the project villages to raise
awareness among rural women on gender and RCH issues.
The mobile health van continued its services where no government facility was available.
Efforts are going on to vitalize the Village Health and Sanitation Committees to monitor and
advocate for provision of quality RCH services by the government system.
Naya Savera: An Integrated Family Welfare Programme in Rajasthan
Naya Savera, a four year project launched in August 2004, is an integrated Family Welfare
project being implemented by PFI in collaboration with JK Lakshmi Cement Ltd, Sirohi,
Rajasthan. The project covers 10 revenue villages with a population of approximately 27000
in Pindwara tehsil of Sirohi district in Rajasthan. The project villages are characterized by large
population with some scattered around the main villages in habitats locally known as ‘Phali,’.
Some of the ‘Phalis’ are separated by distances as long as 13 kilometres making regular service
provision a challenging task. Moreover, the main village mainly consists of non- tribals (General,
Scheduled Castes and Other Backward Castes) while the ‘Phalis’ are predominantly tribals.
Huge differences are observed in health and other socio-economic indicators between the
main villages and Phalis.
The aim is to improve the maternal and child health in the area by increasing
access to health services through an outreach programme in partnership with
the local people. The specific objectives of the project are to build capacity of
community level volunteers; to raise awareness and knowledge of the target
groups from the community and different community stakeholders; and to provide
basic quality RCH services in the target areas through a mobile van.
Significant progress had already been made by the end of the third year as reflected
in the mid- term assessment carried out last year. During the next phase, efforts
will be made to build upon the successes and to fill gaps in capacity building
and service provision activities.
Refresher trainings were organized separately for all the 14 Village Level Motivators and 31
Traditional Birth Attendants trained under the project. The refresher trainings focused on RCH
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issues, government schemes especially the Janani Suraksha Yojana, National Rural Health
Mission, role of stakeholders in management of emergencies related to mother and child and
the importance of liaisoning with the government. Two training programs were held for
stakeholders of the project and representatives of Mahila Mandal active in the project area. In
an effort to raise awareness and mobilize the community further, health melas and mass meetings
were organized.
House to house contacts and Mahila Mandal meetings were held regularly. A documentary
film was produced to document the project activities and highlight achievements of the project.
A dissemination meeting with the district authorities was held in February 2008 attended by
the District Collector and other district and block level officials, PRIs and JK Lakshmi Cement
Managing Director, Mrs. Vinita Singhania. The dissemination included release of the
documentary film, presentation on the project and sharing of experiences by the village level
workers.
Provision of reproductive and other health services through the mobile health van continued
to be the fulcrum of all project activities. Till March 31, 2008, 1828 camps have been held
benefiting more than 20000 people which included 1908 ANC visits, 712 RTI/STI cases
treated, and more than 2000 post natal consultations. Under the project, the proportion of
institutional deliveries has increased significantly from just 27 percent (Baseline 2004) to about
66 percent in 2007-08. During the year 2007-8, 323 deliveries out of 489 deliveries that took
place in the project area were conducted at institutions. Also, a majority of the home deliveries
were attended by traditional birth attendants trained under the project. All the women delivering
in the project area received a post natal visit from either the VLM or the ANM within a week of
delivery. 479 new couples were added to the list of contraceptive users during the year, most
of them adopting a spacing method. So far more than 2000 non users have adopted a modern
method of contraception under the project. An intensive campaign promoting Non Scalpel
vasectomy was undertaken during the quarter. “Kinara”, the educative documentary on NSV
produced by PFI was screened in the villages. Acceptance of NSV has been very low and it is
expected that with BCC efforts it will gain more popularity and the numbers will go up.
To further strengthen the project functioning, a review meeting was held at PFI in September’07
where the Managing Director of JKLC Mrs Vinita Singhania and the Director Mr S.K. Wali
were present alongwith PFI and JKLC project staff. It was shared that ANMs are making home
visits to cover unreached women and children. It was also stated that rates of safe delivery and
child survival have improved, pregnancy rate in eligible couples has gone down and so have
the infant deaths. It was discussed that strengthening of VLMs-ASHA, use of innovative media
such as magic shows could be instituted. Additional villages could be taken up to further
consolidate the efforts in the next phase.
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The project added one more feather in its cap this year. Naya Savera was awarded the “Golden
Peacock” award (established by Institute of Directors in 1991) for Corporate Social Responsibility
(CSR) by Justice P.N. Bhagwati, former Chief Justice of India. The project was selected from
among 100 entries.
PARIVARTAN - A Family Welfare and Population Development Project
in Rajasthan
Parivartan is a five year project launched in July 2004 being implemented in
partnership with a prominent corporate group, JK Tyres Limited, around their
manufacturing premises in district Rajsamand in Rajasthan. The project, initially
launched in 32 villages, was expanded last year to 28 additional villages post
mid term evaluation taking the total number of villages to 60, and population
covered to approximately 100000. The objectives of the project continued to be
(a) building the capacity of community level volunteers on issues related to general
health & hygiene as well as RCH; (b) raising awareness and knowledge of the
community stakeholders, through IEC and behavioural change communication
programmes; (c) providing quality RCH services in the target areas through
mobile van and (d) organizing socio-economic development activities in the
target villages to enhance the effectiveness and acceptability of the programme. The mid term
assessment conducted last year through an independent agency indicated significant
improvements in reproductive and child health indicators, specifically antenatal and postnatal
coverage, family planning acceptance and proportion of institutional deliveries.
This was the fourth year of implementation and several capacity building, awareness creation,
and BCC activities were taken up. Under capacity building, a three-day orientation programme,
a one-day refresher training program, and a four-day refresher training on RCH issues was
organized for all the project staff. ARTH, Udaipur, an agency specializing in providing training
to ANMs and VLMs and other paramedical staff provided technical support.
Under the awareness generation component several rounds of awareness camps were organized
for eligible women, adolescents and children under 15 years of age in each of the project
villages. Nukkad Nataks (street plays) were staged in 10 project villages through an external
agency (Bhartiya Lok Kala Mandal) on select RCH themes. House to house contact with target
women remained an integral component of the over all BCC strategy. The advocacy team from
PFI assisted them in preparing an IEC strategy. An intensive drive was launched to promote
Non Scalpel Vasectomy (NSV) as well. While PFI and Parivartan team at JK Tyres, focused on
behavior change communication, government institutions having facilities for NSV were
identified and linkages were established for provision of services.
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Under the head of “socio-economic activity”, one wall was constructed around
a public well and four public toilets were constructed in tandem with technical
specifications of UNICEF under the District Water and Sanitation Program.
All these efforts had an impact on the off- take of services and the resulting
impact on RCH indicators. Of the total 1021 deliveries taking place in the project
area during the year, 768 (almost 75 percent) were institutional. All the women
going for institutional delivery also received post natal check up within 24 hours
of birth. About 11000 couples have adopted family planning methods, all
indicators of significant improvement in the RCH status of the project villages.
Improving Reproductive and Child Health Status of the Tribals in
Noamundi Block, West Singhbhum District of Jharkhand
This project commenced in May 2007 for a period of 5 years in collaboration with Krishi
Gram Vikas Kendra (KGVK). KGVK is the Corporate Social Responsibility wing of USHA
Martin Ltd that was set up to address the overall growth and development needs of the
communities in 1972. KGVK started work in health since 1985 and has been undertaking a
range of health activities including managing a secondary care hospital.
The goal of this project implemented in collaboration with PFI is to improve the status of
reproductive health in underserved areas with support from the community and the government
service delivery system. It is being implemented in 34 villages of Noamundi Block of West-
Singhbhum district covering a population of 30,000.
The main objectives of the project are:
(i) Generating awareness among eligible couples (women in the age group 15-49 years
of age) on use of modern contraceptives for family planning and child spacing and
issues related to maternal and child health.
(ii) Increasing use of modern contraceptives by eligible couples by providing basket of
choices through social marketing and improving access to both male and female
sterilization.
(iii) Creating community based mechanisms and linkages for improved health services
and referrals for maternal and child care.
(iv) Building capacities of adolescents in contraception and neonatal care for sustaining
positive health seeking behaviour.
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The baseline survey conducted in the initial phase of the project showed that about 80 percent
women were illiterate. 44 percent of women registered for ANC but full ANC was given to
only 3 percent. 90 percent women delivered at home and only 15 percent had a safe delivery.
About 25 percent had experienced complications after delivery but only one third of them
sought treatment. Among children, complete immunization was found to be only 25 percent.
The awareness level regarding knowledge of at least one modern family planning method was
52 percent. Vasectomy was the most common method that the respondents were aware of (37
percent). The Contraceptive Prevalence Rate (CPR) was very low. CPR for any method was
10.5 percent and CPR for modern method was 4.6 percent. Awareness on RTI/STI and HIV/
AIDS was 30 percent and 15 percent respectively.
The project area has been divided in to 6 clusters of 5-6 villages in each cluster. During the
year 2007-8, Village Health Committees (VHC) were formed in every village (total 34 VHCs)
and Sahhiyas (community based health workers) were selected by the VHC members under
this project. Sahhiyas are women from the community engaged in spreading awareness on
RCH issues, mobilizing communities and providing a link with the service providers. To sensitize
the male members of the community Male Health Workers (MHWs) were selected and trained
at the village level.
The Sahhiyas and VHC members were oriented on the programme. A cohort register for tracking
of pregnant women and children was developed and the Sahhiyas were trained to collect and
enter data in the same. House visits were made by project staff, MHW and Sahhiyas to identify
the reproductive health needs and spread awareness on reproductive and child health and
family planning. Reporting formats were also developed for the project and are currently in
use.
Health check up camps were organized through mobile clinics and simultaneously six sub
centers were identified for refurbishment. The Baraiburu subcenter has already been renovated
and re- inaugurated by the Deputy District collector and the health services at this subcenter
have become regular.
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COMPREHENSIVE RCH MODULE FOR
CORPORATE SOCIAL RESPONSIBILITY
One of the mandates of PFI is to support Corporates for partnerships in reproductive and child
health and family planning. PFI has been playing the role of a grant making organization and also
partnering with corporate houses in implementing programmes on reproductive and child health.
The experience of working with the corporate houses shows that there is an increasing need for
technical support on reproductive and child health and also for other related factors that have an
impact on the status of reproductive and child health. In view of this, the Foundation has taken an
initiative towards developing a comprehensive RCH module which would help corporates to build
and implement effective RCH interventions as part of their Corporate Social Responsibility (CSR).
Overall, this module would foster corporate participation in integrated health and development
with special focus on family planning/RCH. The process of developing this package involved review
of existing RCH modules for CSR, identifying the key cross-cutting needs of the corporate sector to
implementing effective RCH/FP programmes and developing a comprehensive package containing
guidelines on reproductive and child health .
The existing documents and modules developed by Confederation of Indian Industries (CII), TATA
Energy Research Institute (TERI), Harvard Business School, International Centre for Corporate Social
Responsibility and University of Cambridge were reviewed and discussions regarding the need and
content of the proposed module were held with CII, FICCI, IFFCO, Tata Steel Family Initiative
Foundation and Usha Martin Ltd. Based on the review of materials available and the subsequent
discussions, issues to be addressed in the module were finalized.
The draft RCH module for CSR has been developed. In addition to the core RCH topics this module
also contains issues of quality of care, gender and gender based violence, reproductive rights, project
management tools and techniques, community needs assessment approach, advocacy and effective
communication methodologies, planning for scaling up successful interventions and perspectives
on population stabilization.
Each chapter covers an introduction to the issue with definitions and actionable steps that could be
adopted by the corporate houses for making CSR effective in the Indian context. This document
seeks to provide valuable insights and pragmatic solutions to the corporate managers. The draft of
the document has been shared with various corporates for their feedback. The module will be
finalized based on the feedback and made available for use in 2008-09.
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RCH PROJECTS WITH
NGOs
annauual report
2007-2008
Total Management of Essential RCH and Primary Health Care through
Public-Private Partnership: A Model and Innovative Project in Karnataka
Karuna Trust is a voluntary organization established in 1987 with the
objective of facilitating integrated development among poor and marginalized
people through health, education, vocational training and socio-economic
programs. The organization has been a pioneer in implementing models of
Public Private Partnership in India by taking over the total management of a
Primary Health Centre, Gumbali in Yalandur district of south Karnataka in
1995. Since then, the Trust has moved paces and currently manages 25
PHCs in Karnataka and 9 PHCs in Arunachal Pradesh and is in the process
of taking over PHCs from the governments of Orissa and other north and
northern eastern states. The Karuna Trust approach is to demonstrate that
‘not for profit’ organizations can not only successfully deliver the total package
of standard primary health care but also add value to the existing programs
by incorporating innovations and pilots. The recently launched National Rural Health Mission,
lists “promotion of Public Private Partnership (PPP) for achieving public health goals” as one of
its supplementary strategies.
PFI joined this initiative of Karuna Trust and the Government of Karnataka
in implementing the program to facilitate effective management of PHCs
and piloting value additions aimed at enhancing quality of delivery of
Reproductive Health Care. The five year project, initiated in May 2006,
aims to demonstrate models of Primary Health Centers which effectively
deliver the essential RCH and primary health care services. PFI support is
given to seven PHCs situated in the backward districts of northern Karnataka
along with their 39 sub-centres catering to a population of approximately
2,00,000. The specific objectives of PFI support to the project are:
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• Supporting enhancement in quality of management for routine functions in seven
select government Primary Health Centers and strengthen them into model PHCs
• Enhancing the quality and utilization of RCH services at the sub-centers of the select
model PHCs.
• Influencing and facilitating change for improved health seeking behaviour among
the population.
PFI has been extending financial, technical and implementation support
primarily to pilot the value additions. The aim is to facilitate development
of adequate capacity of managers, service providers at all levels and
communities and to strengthen community governance mechanisms for
effective functioning of the primary health care systems and community
involvement.
2007-8 was the second year of implementation of the project and during
the year, capacities of the staff were further built in Manual Vacuum
Aspiration, a safe abortion technique, use of partograph during delivery,
identification and management of postpartum hemorrhage, essential new
born care including kangaroo care and screening for cervical cancer.
Laboratory technicians have been trained in conducting basic diagnostic tests including tests
for RTI/STI.
To enhance community involvement and quality of PHC planning, staff has been oriented on
Community Needs Assessment Approach and Arogya Raksha Samitis have been formed to
increase community participation in management of the PHCs.
To enhance management competencies of supervisory staff and coordinators, a series of trainings
on PHC management including managing PHC accounts have been conducted. A new
supervisory format has been developed in consultation with PFI for supervisory staff visiting
the primary health centres. A computerized Health Management Information System has been
developed with technical support from IIM Bangalore.
Now, all the seven PHCs are operational 24 X 7 with the core staff staying
at the campus, with women friendly arrangements, institutionalized rational
use of drugs and bin card system of managing drug inventory, scientific
waste management with segregation at source and proper disposal/treatment.
All PHCs are linked with ISRO supported satellite based Village Resource
Centres and the Citizens’ Charter is at display for the community at all
times.
Service utilization from PHCs and Sub-Centres has improved significantly.
During the year, the PFI supported PHCs served 1,11,549 outpatients and
4019 in-patients. Including the sub centers, 1635 deliveries were conducted
and family planning services were provided to 2241 couples. In addition,
the ANMs have conducted 2615 deliveries at home.
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Promotion of Maternal and Neonatal Survival among tribals in Rayagada
district of Orissa
The Population Foundation of India, New Delhi in collaboration with UNFPA and Government
of Orissa had implemented an advocacy programme in the districts of undivided Koraput on
maternal mortality. Increasing access to essential health services emerged as one of the key
strategies to address maternal morbidity and mortality. This led to a collaboration between PFI
and Orissa Voluntary Health Association (OVHA), Bhubaneshwar for implementing an
innovative initiative to promote maternal and neonatal survival in a tribal and remote block
(Bissamcuttack block) in Rayagada district of Orissa which was initiated in October 2006.
OVHA is a state level federation of 154 NGOs working at the grassroots level on health issues
in the state. The project covers 60 remote tribal villages in 12 Gram Panchayats of the block
and caters to a population of approximately 33000.
The objectives of the project are to (i) facilitate the process of ensuring essential antenatal care,
intra natal, post natal care and impart education to young women and expectant mothers on
all aspects of pregnancy, hygiene and newborn care, (ii) ensure effective links for referral
system and encourage institutional delivery of high-risk pregnancies and obstetrical emergencies,
(iii) elicit active community participation and ownership through involvement of community
stakeholders, (iv) promote modern family planning practices through information sharing on
various contraceptive choices to eligible couples and (v) documentation and dissemination of
lessons learned at the state level.
A baseline survey conducted in 60 villages showed that over 94 percent of currently married
people were 19 years or less at the age of marriage. The neo-natal mortality was 81, infant
mortality rate was 115, child mortality rate (below 2 years) was 127 and the under five mortality
rate was 145 per 1000 live births. The maternal mortality ratio was 483 per 1,00,000 live
births. Knowledge about the danger signs during pregnancy was quite poor amongst the
pregnant women. Nearly 87 percent of women reported that their last delivery was at home.
Full immunization coverage of the children in the age-group of 12-23 months was only 28
percent. The fertility rate of women in the reproductive age was estimated at 4.67.
The current initiative is aimed at addressing the three critical delays responsible for maternal
and neo natal deaths - delay in decision making, delay in transportation and delay in getting
services at the health centre. Under the project, 60 Community Health Volunteers (CHVs)
were selected and the trained. CHVs are village level community women engaged in spreading
awareness on RCH issues and linking communities with the service providers. Trainings were
also provided on making micro-plans based on the Community Needs Assessment Approach.
During the year 2007-08, detailed village-wise registers were prepared for tracking pregnant
women and children and were filled up in the villages by the community health workers. An
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ambulance was provided to cater to transport requirements of the poor and the needy. At the
same time, attempts were made to sensitize the community to make their own transport
arrangements at the village level. 482 pregnant women were identified as high risk pregnancies
out of which 121 were referred through project ambulance. 285 children in the age group of 0-
2 years had complete immunization. 852 eligible couples were motivated for family planning
in which 22 accepted CuT, 28 cases were referred for tubectomies and 6 cases were referred
for vasectomies in addition to distribution of contraceptive pills and condoms. The organization
has joined hands with government departments, PRIs, ICDS officials and referral centres to
make easy access to RCH services a reality.
Promotion of Family Initiatives to Address Family Planning and
Reproductive & Child Health Needs, Through Increased Male
Participation in Uttar Pradesh
This project commenced in October 2006 for a period of three years to be
implemented by PFI in association with Center for Rural Entrepreneurship and
Technical Education (CREATE), Uttar Pradesh. With support from Population
Foundation of India, CREATE had already acted as regional training and resource
development center (RTRDC) for RCH activities in the eastern region of Uttar
Pradesh.
The current project is an action research demonstration project towards
enhancing male participation in family planning and other reproductive health
issues. The overall goal of this project is to promote health seeking behavior of
families through increased male involvement for family planning, safe motherhood, and child
health services. It is being implemented in 60 villages in Rajgarh block of Mirzapur district
covering a population of approximately 70,000.
The main objectives of the project are:
1. Enhancing the knowledge, attitude and practices on family planning, safe motherhood
and child health practices among eligible couples and especially men in the family.
2. Addressing the unmet need for contraception by increasing access and choices of
modern family planning methods among the eligible couples, including more of
male methods.
3. Facilitating provision of services for safe motherhood and primary immunization.
4. Documenting and disseminating the lessons learnt.
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Baseline survey conducted in 2007 showed that the rate for 3 ANC
check-ups was 22 percent, institutional delivery was as low as 13.2
percent, complete routine immunization in the area was 47.3 percent.
Only 17.2 percent women had knowledge about all methods of
contraception. The acceptance of NSV was as low as 1 percent.
Under the project 60 Lady Link Workers (LLWs) and 20 Male Link
workers (MLWs) were selected, oriented and trained. These link workers
are the main outreach workers as well as the change agents at the
community level. They are from within the community and are literate.
The management information system (MIS) was developed in line with the community needs
assessment and the reporting system was established.
During the year 2007-08, the project has reached out to 9308 eligible couples along with
other stakeholders in the project area. Awareness generation activities were carried out on
family planning and child heath issues. Existing community based institutions such as women’s
groups and SHGs were strengthened and included in the project. The focus was given to
increasing utilization of government health services through information dissemination of
government schemes at local level and demand generation activities. Extensive IEC and BCC
activities were carried out in which 118 wall paintings, (approximately 2 paintings per village)
were done. The messages mostly comprised information on family planning, immunization,
antenatal care, postnatal care, safe delivery etc. Street plays were organized in 30 villages.
Each play was divided in to 4 parts for addressing 4 key messages in a day. Themes of these
plays dealt with issues such as family planning, child immunization, maternity care, HIV/
AIDS. Film shows were also organized in 66 villages on different issues. The project has
developed 6-page calendars addressing male participation in family planning and health issues.
3000 calendars were printed and distributed to key stakeholders.
PFI provided technical support to CREATE for designing and developing 10 kinds of posters
(3 ft X 2 ft ) in Hindi. Each type of poster was displayed in strategic locations in all villages.
Social marketing of condoms, pills and disposable delivery kits was initiated. LLWs, MLWs
and some of the local shops were made depot holders for social
marketing. A total of 85 depot holders were established in the project
area and products were distributed under this project. Special attention
was given to outreach with male members of the community wherein
regular meetings with husbands of eligible couples were conducted.
During the year 2007-08, the project has successfully reached out to
9308 new eligible couples. 2600 couples were supplied with condoms,
2285 women were given contraceptives pills, 150 CuTs were inserted,
445 women were sterilized and 23 Non-Scalpel Vasectomies were
conducted. Complete routine immunizations were done for 1055
children in the age group of 0-23 months.
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2007-2008
Intervention Study Among Adolescents, Pregnant and Lactating Mothers
to Reduce Prevalence of Anaemia in Haryana
Sukarya, a charitable trust set
up in 1999, has been taking
up charitable and
humanitarian activities like
holding free medical camps
and distribution of medicines
along with clothes, utensils
etc for the poor in various
slums of Delhi and Gurgaon.
Sukarya’s mission is to
harness people’s energy and
potential for a better and
healthier society.
An action research project
was launched by PFI with
Sukarya Charitable Trust,
Gurgaon, Haryana on May
1, 2007 which focuses on
reducing prevalence of Iron Deficiency Anaemia (IDA) among the girls in the age group of 13-
18 years and pregnant and lactating mothers in 10 villages of Gurgaon district in Haryana.
According to NFHS-1, NFHS-2 & DLHS 2002 more than half of pregnant and lactating women
suffer from anemia in Haryana. Similarly, the prevalence of anemia in adolescent girls too is
very high. The main reasons identified for IDA have been inadequate intake of iron, low
bioavailability (1-6 percent) of dietary iron from plant foods due to inhibitory factors, low
levels of absorption enhancers in the diet, repeated pregnancies, increased needs during growth
and development among children and adolescents, parasitic infestations and chronic blood
loss.
The high prevalence of IDA among adolescent girls, pregnant women and lactating women
along with poor dietary and culinary habits provided justification to the project. The project
strategy aims at addressing these issues.
Specific objectives of the project are:
• To measure the prevalence of anaemia in the target group.
• To understand the knowledge, attitude and practices regarding consuming iron rich
food and the health seeking behaviour.
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• To create awareness on anaemia and its adverse effects and methods of prevention
and treatment.
• To prevent and treat anaemia among the target group.
The project strategy involves capacity building of project staff and developing village level
resources, undertaking intensive communication (one to one and in groups) and BCC activities
through Community Health Volunteers (CHVs) with target groups to bring about desired
behavioural changes; holding health camps to assess anemia level, networking with health
and Integrated Child Development Scheme (ICDS) for better accessibility to Iron Folic Acid
(IFA) Tablets and holding nutrition demonstrations for healthy culinary practices.
The baseline survey showed that 58.9 percent (almost 2/3rd) of pregnant women, 51.2 percent
of lactating women and 35 percent of the unmarried adolescent girls were found to be anaemic.
A majority of the women identified lacked knowledge of nutritional food as the root cause of
anemia.
Social mapping of the 10 project villages was done using Participatory Research Approach to
capture information of health facilities, schools, water & sanitation facilities and roads etc.
This process also led to increased awareness on the issue and garnering community support to
the project activities.
All the project staff have been given intensive training on nutrition, family planning, and
communication skills and an MIS that was developed to monitor the progress of the project
activities. Exposure visits have been taken up to promote cross learning. So far, 15 intensive
training programs have been conducted for the project staff.
Major IEC activities implemented included wall paintings in 49 locations, distribution of more
than 5000 leaflets and putting up more than 750 posters along with frequent shows of a
special film on anemia made under the project. Stakeholders’ meetings are a regular feature
and have greatly enabled people to access services from the government system.
Till March 31, 2008 the project had organized 70 health camps benefiting 3186 adolescent
girls, pregnant and lactating women and has cumulatively identified and treated 1196 person
from target groups for Iron Deficiency Anemia. The project is doing social marketing of iron
fortified health salt and iron utensils. Sukarya has procured 1000 kgs of health salt and 350
iron utensils. As result of constant promotion, more than 260 households have taken to use of
iron fortified salt and use of iron pans for cooking.
The project has been able to raise considerable awareness and bring about significant changes
in health seeking and culinary behaviour. The same has resulted in decreasing proportions of
anemic cases and especially severely anemic cases seen during the health camps.
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Improvement of Maternal and Child Health through Life Cycle Approach
in Jharkhand
PFI started implementing this five year project in April 2004 in association with Child in Need
Institute (CINI), Jharkhand and Nav Bharat Jagriti Kendra (NBJK) in Churchu Block of
Hazaribagh district in Jharkhand. The project renders services to a population of 85,000. Sir
Dorabji Tata Trust joined this collaboration and is providing part of the financial support to
this initiative.
The main objectives of the project are to strengthen the capacities of one
NGO each from four divisions of Jharkhand to provide integrated RCH
services using the life cycle based community level intervention to improve
safe motherhood and child survival and growth. Attainment of fertility goals,
male participation, informed choices on health and health service delivery,
documentation and dissemination of the lessons learned are also integral
to the project.
The project is being implemented in three phases over a period of five
years. In the initial six months (1st phase), the focus was on capacity building
of NBJK, designing since the intervention package and conducting a baseline
survey. The baseline results showed that the complete ANC coverage was only 24.9 percent,
90 percent home deliveries were conducted by untrained persons, CPR was 40 percent,
childhood immunization was as low as 24 percent and mean age at marriage was 15 years.
Awareness was good on ANC, TT, IFA, sterilization and childhood immunization, but awareness
on danger signs of pregnancy and child birth, five cleans, importance of institutional deliveries,
new born care, HIV/RTI/STI and condom use was low.
In the implementation phase of 48 months (IInd phase),
the project concentrated on strengthening capacities of
NGOs for programme implementation with a desired level
of quality of care. During the period, community based
institutions were formed such as Village Health
Committees (VHC), youth groups and SHGs. In this
phase, Village Health Volunteers locally called Sahhiyas
were selected and trained. The State Government has
also provided an ambulance to NBJK to provide services
in remote areas including 24 hour referral services.
A mid-term review was conducted with a quantitative
sample survey of women in the age group of 15-49 years,
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who gave birth after June 2004. The report revealed that 3 ANC coverage was 64 percent, 2 TT
coverage was 95 percent, 50 percent received IFA and its consumption was 54 percent. Of the
596 women surveyed, 125 women were using modern contraceptive methods. It was also
found through the survey that the Sahhiyas had good knowledge on RH issues.
In the 4th year, the project focused on the capacity building of 5 NGOs on Life Cycle approach.
Advocacy efforts with government were strengthened with regular meetings with key
government officials. Recommendations from mid term evaluation were incorporated. Some
of the efforts put in included strengthening monitoring systems of the project by putting extra
fulltime personnel in the field, strengthening the federations of the Village Health Committees
(VHC), and increased advocacy with the state government on the model. A state level Sahiya
Sammelan was organized by CINI along with different partner organizations, Sahhiyas of
different areas, government representatives, intellectuals, policy makers and representatives of
NGOs participated in the one day meeting. Mr. Bhanupratap Sahi, Minister of Health, Jharkhand
presided over the meeting and interacted with Sahhiyas. During the meet many Sahhiyas
informed about their process of working and shared success stories from the community. The
Sahhiya model has gained lot of recognition in the area and is being scaled up under NRHM
scheme in the state.
Training of VHC members was conducted for the second time in the project period and focus
was given to enhancing the knowledge level of VHC members. The members of VHC
federations were re-elected and a road map for the strengthening of federation was prepared.
Efforts were made to link VHCs with the State NRHM to receive untied fund of Rs 10000/- per
year for various health related activities. VHCs and Sahhiyas are now contributing responsibly
towards proper implementation of Janani Suraksha Yojana of state government.
Service delivery components were strengthened during the year 2007-08, in which 1087
pregnant women were identified and registered before 12 weeks of pregnancy. Number of
deliveries with complete ANC rose to 1159. Complete immunization of 2580 children was
done. 5404 new eligible couples were supplied with condoms.
OCPs were given to 1257 new eligible women. As many as
521 women were referred to government hospitals for
sterilization.
The model is now well recognized in the state and has received
appreciation from the state government. PFI has assessed the
scalability of the project with the help of scalability assessment
tools developed by Management System International, USA.
The focus of the project is now on documenting promising
practices within the model. Some of the components of the
project have already been incorporated in the state NRHM
program.
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Safe Motherhood through RCH Interventions in Rajasthan
The state of Rajasthan has been plagued by very high maternal mortality and continues to be
one of the poor performing states with regard to reproductive and child health indicators. The
National Family Health Surveys have shown a very slow progress on reproductive health
indicators in the state. The maternal mortality ratio (MMR) in the state is 430 per 100000 live
births (NFHS- 3) as against 300 for the country. The factors responsible for this high MMR
have been identified as very low institutional deliveries (32 percent), low access and coverage
under ante and post natal care and poor quality of and access to reproductive and child health
services.
Action Research Training and Health (ARTH), Udaipur, a technical support
agency in the field of mother and child health has developed a ‘Community
based 24 hour centre model for maternal health services’ operated by Nurse-
Midwives to provide quality RCH services to the rural community. This was
piloted by ARTH in two areas in Rajasthan .
The three year project “Safe Motherhood through RCH interventions in
Rajasthan”, was almost a replication of the ARTH model .The project was
launched in August 2004 in three districts of the state in collaboration with
three NGOs viz. Shikshit Rojgar Kendra Prabandhak Samity (SRKPS), Jhunjhunu,
Shiv Shiksha Samiti (SSS), Tonk and Social Work and Environment for Rural Advancement
(SWERA), Ajmer, with technical and monitoring support from ARTH and PFI. It aimed at
providing affordable, accessible, quality health services specially in ante, intra and post natal
health care. The main objective of the project was to deliver quality safe motherhood and RCH
services by establishing health centers accessible to identified villages through trained nurse
midwives. The project also aims to raise awareness of the community and important stakeholders
like PRIs and Aanganwadi workers on the issue of safe motherhood and RCH
The strategy involved setting up a health centre in consultation with the community, operated
by two Nurse-Midwives providing 24 hour service along with organizing field visits, identifying
and training of village health workers, carrying out IEC and BCC activities, undertaking field
clinics and providing follow up services to the community.
Over the past three years, the project has been able to make a mark in provision of quality
maternal services. Of late, the Janani Suraksha Yojana had diverted a substantial load to
Government health facilities despite the fact that infrastructure and manpower were not
adequately geared up to cater to the increased caseload.
With the frequent turnover of ANMs, their recruitment and skill-building has been a significant
issue, where ARTH continued to provide training to new replacements in 2007-08 as well.
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ARTH trained 3 ANMs at their training centre for two weeks using the training module developed
for the purpose. A 3-day workshop was organized for developing materials to be used in the
training of the village level health workers planned later in the quarter. All the VLMs were
provided a three day refresher training and some of them were identified as Master Trainers. A
“Facilitator guide for the Skilled Birth Attendants (SBA) training” was printed by ARTH for
training of ANMs and doctors on skilled birth attendance. A two-day orientation of the doctors
visiting the respective centers was done in the month of September ’07 to orient them on
adherence to standard treatment guidelines.
Supervision and quality assessment of the services in the field and in health centres through
checklists developed by PFI and ARTH was an important activity. All the partners were visited
at least once a quarter and provided with technical and administrative guidance. Every quarter
a review meeting was held, attended by all partners, to discuss areas of improvement, especially
issues like financial monitoring.
On service provision front, the three centres provided health services to 8601 clients: 5017 at
centre and 3584 during field clinics. ANC services were provided to 2092 women and 90
deliveries were conducted at health centres.192 patients were treated for Reproductive Tract
and Sexually Transmitted infections and 1803 laboratory tests conducted. All the three partners
also took up tally based accounting and started the practice of daily reporting of services
delivered both at the health centres and during field clinics.
IEC materials developed at ARTH were shared with the partners and adapted for dissemination
at local level. Safe motherhood day and International breast feeding week in the month of
August ’07 were observed by all the three partners. House to house contacts with target groups
by VLMs and ANMs continued and nukkad nataks were organized among other BCC activities
in the each of the three project areas. Advocacy efforts
have been initiated at district, state and national levels
for securing accreditation of the health centres under
Janani Suraksha Yojana from the government of
Rajasthan. Alternative guidelines for accrediting private
facilities for normal delivery services were developed
and submitted to the state government on request. In
order to help scale-up of the model, a process
documentation of the project has been commissioned
through an external consultant.
SRKPS shifted the health center to a more accessible
village (Dhandhoori) in the month of December 2007.
During the last quarter of the year , a no cost extension
was given to two of the partners(SRKPS and SSS) till
31st March 2008.
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Reproductive and Child Health Programme for Malto Tribes in Jharkhand
Maltos are a primitive tribal group living in Raj Mahal Hills which
is spread over Sahibganj, Pakur and Godda districts of Jharkhand.
This tribe lives in extreme poverty, very low levels of literacy,
primitive style of agriculture and forest based economy.
Geographically, they are scattered, hamlets constituting 30-40
households and living in small huts. The Malto population is
characterized by the first phase of demographic transition i.e
very high death rate and fertility rates.
PFI in association with Prem Jyoti Community Health and
Development Project (CHDP), a unit of the Emmanuel Hospital
Association had taken up an initiative to enhance the RCH status of Malto and other tribes in
the area. The project was taken up for a period of three years starting in April 2005. Under the
project, outreach services were rendered in 140 Malto villages with a population of 16,000 .
The goal was to provide comprehensive Reproductive and Child Health services to improve
the health status. This was supported by a 15-bedded referral hospital with surgical facilities
managed by Prem Jyoti.
The main objectives of the project were to (i) build the capacity of the communities to take care
of their own health at the village and cluster levels and to improve the reproductive and child
health of the target community, (ii) improve awareness of the community on major health
problems that affect women and children related to vaccine-preventable diseases, Malaria,
Diarrhoea and Tuberculosis, and (iii) provide RH services to target community.
The entire project area was divided into 13 clusters of 10-12 villages each. Volunteers were
selected at the village level and Cluster Health Guides were identified. Under the project 118
Community Health Volunteers (CHVs) and 13 Community Health Guides (CHGs) were trained.
Though the CHVs were mostly women, a small percentage of men were also selected as
volunteers in some villages. They were trained on general health,
aspects of maternal and child health, family planning, simple
record keeping and IEC /BCC approaches. One CHG per cluster
was identified, generally an educated Malto woman from the
community. They were given extensive theoretical and practical
training in the secondary health care referral hospital on safe
delivery, new born care, integrated management of childhood
illnesses, immunization, malaria, kala azar and other minor
ailments. In addition, CHGs were given an 11 day training on
simple oral medicines, collection of vital statistics, growth
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monitoring etc. CHGs were then qualified to dispense all basic drugs after passing an exam.
They were given equipments like a bag for carrying drugs, umbrellas, torches etc. They were
provided with a treatment kit including essential equipment to diagnose and treat patients. The
project made efforts to develop an Area Health Committee (AHC) in each cluster. The AHC
meets once a month to discuss health related issues and also supervise the work of CHGs and
CHVs.
Outreach RCH services were provided through peripheral clinics and cluster level static Mini
Health Centers. Liaison with the government was done to take preventive measures on malaria
and kala azar. Essential drugs and 4400 impregnated mosquito nets were procured for
distribution from the government. Prem Jyoti Hospital has been recognized as one of the 15
centres in special Kala Azar elimination programme in four districts of Santhal Paraganas by
the Government of Jharkhand.
The project was evaluated to assess the changes in health and reproductive health status. A
multistage random sampling design was followed both for base line as well as the end line
evaluations. Apart from this, qualitative techniques such as Focus Group Discussions (FGDs)
and in-depth interviews were done with key stakeholders to gather necessary qualitative
information especially during the end line survey. Comparative evaluation shows a positive
change in indicators related to health and reproductive health status of women and children,
as displayed below:
Indicator
Women accessing services from Prem Jyoti
Women covered by full ANC
Women receiving TT from the project
Safe deliveries
Women giving supplementary feeding from birth
Children in 12-23 months with Full Immunisation
Increase in awareness of RTI/STI
Increase in awareness of HIV/AIDS
Women reporting incidence of Malaria in last 3 months.
Family Planning
Increase in awareness of condoms
Increase in awareness of pills
Increase in awareness of IUD
Baseline
36%
31%
30%
9%
23.3%
24%
28%
9%
48%
27%
64%
78%
Endline
86%
57%
83%
18%
4.9%
51%
49%
18%
40 %
57%
84%
87%
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This project has successfully reached out to remote un-served and underserved areas and
contributed meaningfully towards empowering communities through primary and secondary
health care services.
Mariam’s Achievement
A 2 year old Malto boy was hospitalized for the treatment of complicated tuberculosis.
His sister, Mariam Malto took care of him at the hospital. During this period Mariam had
regular interaction with the nurses of the ward and developed an interest in their work.
Having completed her Matriculation, she expressed a keen desire to work as a nurse. She
began working as a volunteer at the hospital in full earnest. Prem Jyoti project staff
noticed her capabilities and encouraged her to continue. Ms Shashi Bala, a senior nurse
at the hospital, took her under her wing and began tutoring her with the aim of preparing
her to take the entrance examination for nursing. Mariam familiarized herself with medical
terminologies and the English language.
Auxiliary Nurse Midwife (ANM) courses are conducted at some of the hospitals linked
with the Emmanuel Hospital Association. The efforts paid off, and after six months, she
was selected for training at the Navjivan Hospital at Satbarwa. Knowledge is power and
this was a milestone for Prem Jyoti, bringing about empowerment in the Malto community
to take care of their health in a better way.
Instituting Rational Use of Drugs (RUD) in Reproductive and Child Health
Care in FPAI clinics in India
Institutionalization of RUD is critical in the Indian scenario where more than 70 percent
expenditure on health is “out of pocket” and still about one third of the population is living
below poverty line. With the increasing costs of health care, this project becomes all the more
relevant.
Population Foundation of India is implementing the project “Instituting Rational Use of Drugs
in Reproductive and Child Health” in partnership with FPAI. The project aims at rationalizing
the drug/ medicine use in 26 clinics of FPAI branches. The project period was initially from
October 2006 to March 2008, which has been extended to December 31, 2008. The specific
objectives of the project are:
1. To assess the existing prescribing practices and drug store management along with
the availability of drugs.
2. To train Medical Officers (MOs), Branch Managers, Storekeepers and Paramedics
on RUD in RCH.
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3. To assess the impact of training and guidelines on prescribing practices and drug
costs.
The project started with a Baseline Survey which revealed that none of the 26 FPAI clinics was
referring to any Standard Treatment Guidelines (STGs) and no specific Standard Treatment
Guidelines existed for Reproductive and Sexual Health services through the clinics. On an
average 5-6 drugs were prescribed as against the national standard of 2-3, Essential Drug List
was not available and adhered to and there were no specific drug storage guidelines. Bin
Cards were not in use and drug procurement system was ad-hoc as well.
During the year 07-08, Standard Treatment Guidelines (STGs) which comprehensively covered
all SRH services and recommended drug use under each of these services were developed. All
MOs from the 26 clinics were oriented on STGs through workshops. Similarly, the branch
managers, store keepers and other stores persons were oriented in procurement (right quantity
at right time), storage, indenting, issue and bin card system of inventory management. These
workshops were followed by briefing meetings and preparation of action plans at the respective
branches. An essential drug list was prepared with respect to Sexual and Reproductive Health
services and procedures. The most important intervention to ensure observance of Essential
Drug List and Inventory management policies by MOs and other branch personnel was setting
up of a Task Force comprising volunteers, staff and members of medical sub-committee keeping
record of all prescriptions by branch doctors.
An impact assessment was carried out in 5 branches (Lucknow, Madurai, Mumbai, Bangalore,
and New Delhi) during January to March 2008 by a team of six investigators picked up from
different clinics and trained by Delhi Society for Promotion of Rational Use of Drug (DSPRUD).
Formats developed by DSPRUD were used for the assessment. The impact assessment was
done on the basis of objectively verifiable indicators like average number of drugs prescribed
per patient, percentage of generic brands in total prescriptions, number and instances of
prescription of antibiotics and injections, physical presence of EDL and STGs with MO,
percentage of patients where STGs were followed, percentage drugs prescribed from Essential
drug List, average number of days for stock out of essential drugs, existence of procurement
policy and maintenance of bin cards and stock register This exercise helped in building the in-
house capacity of FPAI as well as helped to create the base for future sustainability of the
project.
The assessment found that there is an overall improvement in the average number of drugs
prescribed. A large variation has been observed among the branches in prescription of generic
drugs, use of essential drug list and development of procurement and disbursement policies.
However, BIN Card system was being regularly followed and the Medical Officers were well
apprised with the Standard Treatment Guidelines.
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It is important to note that the project has been able to bring about significant improvements in
drug prescription, procurement, storage and dispensation practices. A visioning exercise for
further scale up of the project activities is planned to be organized in September 2008 with
technical and financial support to be provided by PFI.
SWABHIMAN: Urban Reproductive and Child Health Program with
An Empowerment Approach in Delhi
The three year Swabhiman project was initiated in May 2007, by PFI in collaboration with
Smile Foundation and four local partners viz. Navshristi, Association for Development of
Human Actions and Rehabilitation (ADHAAR) Society, Sahyogita Samaj Vikas Sanstha (SSVS)
and Health and Care Society.
Smile Foundation, is a registered Indian Trust funding a host of grassroots level
initiatives undertaken by partner NGOs across 15 States of India. The Foundation
is managed by a group of Indian Corporate Executives, as Trustees and a team
of professionals; reaching out to more than a lakh under-privileged children. Its
mission is to consciously advocate and work for empowerment of the masses
through education and awareness generation.
The project focuses on adolescent girls in the age group of 10-19 years in the
rural/peri-urban areas of Delhi. The overall objective of the project is
empowering adolescent girls from low socio-economic strata of the society
residing in the rural/peri-urban areas and empowering them towards a dignified
adulthood and responsible motherhood. The project aims to benefit a population of about
80000 from four rural/peri-urban areas of Delhi.
Specific Objectives are:
• To generate awareness on issues of reproductive and sexual health covering safe
motherhood, child health, family planning, RTI/STI/HIV-AIDS among adolescent
girls.
• To sensitise adolescent girls on gender issues and imparting Life Skill Education
(LSE) including communication and negotiation skills.
• Providing reproductive and child health services through mobile health clinic for
currently married women, adolescents and children.
• Documentation of processes, case studies and success stories for dissemination.
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The strategy involves generating awareness among adolescents on issues
of reproductive health, women’s reproductive rights, violence against
women, and establishing linkages with different institutions for referral
through a cadre of trained Community Health Educators (CHEs) assisted
by Swabhiman Health Volunteers (SHVs). There are 10 CHEs and each
is supported by four SHVs. The project has 40 SHVs. The CHEs were
imparted extensive training/orientation for a duration of 1 month to help
them emerge as Master Trainers. CHEs also provide crucial linkages
between the service providers and recipients and supplement it with
provision of services through a mobile health van.
The project started with identification and exact demarcation of the target population, followed
by a house listing and baseline survey to establish benchmarks for comparison. The baseline
survey showed awareness on all ‘five cleans’ of delivering a child to be only 4 percent. It
showed that 53 percent of adolescents were aware of legal age of marriage for girls. Awareness
on anaemia, birth control and HIV/AIDS was found to be 24 percent, 46 percent and 59
percent respectively among adolescents. Though 90 percent pregnancies were registered, full
ANC was received by only 29 percent women and only 37 percent had availed institutional
deliveries. The full childhood immunization coverage was found to be 85 percent. Contraceptive
Prevalence Rate for modern contraceptive methods was 51percent. 62 percent of the women
had taken treatment for RTI/STI’s while 72 percent were aware of HIV/AIDS. 23 percent of
women were victims of violence in past 6 months.
The 10 Community Health Educators (CHEs) and 40 Swabhiman Health Volunteers (SHVs)
have been selected and given an intensive training for 15 days, covering issues including
gender, health and nutrition, adolescence and the growing up processes, sex and sexuality,
early marriage, safe motherhood and family planning and life skills. The training module for
this purpose was developed by Prerana, with technical inputs from PFI.
The mobile health clinic visits each NGO on fixed days. Smile team helps the partner NGOs
in planning activities and monitoring progress. The general health cards, ANC and immunization
cards have been printed and are being used. Management Information System has been
developed to generate information related to indicators established as per the Logical Frame
Work (LF). The Community Needs Assessment Approach (CNAA) is being used for tracking of
pregnant ladies, adolescents, and children between 0-5 and for planning project activities as
well.
More than 30 groups of women and adolescent girls have been formed with a total of about
600 active members. The groups have been actively meeting every month and discussing
issues related to their reproductive health.
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A Swabhiman logo has been developed jointly by PFI and SMILE
to give the project a unique identity. An E-News letter has been
launched to raise awareness on RCH issues. The news letter is
published every six months. The first issue was released in
March 2008 and the next issue is due in September 2008. A
dedicated website- www.swabhimanindia.org has been
launched. The website is being frequented by a large number of
people.
National and international days and events are being observed
actively to allow adolescents opportunities for self expression
and display of skills and potential. International Women’s Day,
World Health Day, International Girl Child Week and
International Breast Feeding Promotion Week were celebrated
with role models of women’s empowerment like Ms. Kiran Bedi
participating and providing encouragement, direction and confidence among young enterprising
adolescent girls.
Street plays are being used as an effective media for communicating messages regarding
adolescent health and reproductive health issues. Theatre groups Aradhya, Nav Umang Yuva
Sansthan and Mehak have developed innovative scripts around adolescent reproductive and
sexual health issues and have become quite popular among the target community. So far 16
street plays, four in each quarter, have been staged.
Stakeholders’ meetings are being held by all partners every month. Principals of Municipal
Council of Delhi schools, Councillors, Pradhans, AWWs, ANMs, Medical Officers from local
PHCs etc. are actively participating in and contributing to these meetings. The meetings are
used to devolve information and benefits from government schemes like Janani Suraksha Yojana,
Ladli Scheme and help sort out local civic problems.
In order to ensure coordinated efforts from all the four partners, a Project Implementation
Committee has been formed with representation of all the partners, SMILE Foundation and PFI.
The Committee meets every six months and discusses strategic and operational issues related
to the project.
During the first year of implementation itself, the project has been able to achieve significant
progress with more than 4000 women using mobile health services, 1280 couples adopting a
modern family planning method, more than 50 percent women going for institutional delivery
and bringing about behavioural changes like early initiation of breast feeding and improved
coverage under Ante and Post natal care.
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Evidence Based Advocacy for Maternal and Child Health
Amongst the Urban Poor of Vadodara City of Gujarat
According to the United Nations’ ‘State of the World Population 2007’, the urbanization of
India is taking place at a faster rate than the rest of the world and by 2030, 40.76 per cent of
India’s population will be living in urban areas compared to about 28.4 per cent currently.
Slums have come to form an integral part of the urbanization phenomenon in India providing
shelter to millions of urban poor in India. It has been demonstrated by various studies that the
indicators of health status among urban poor are worse than rural poor. The predominant
attention to rural population in formulation of health and development policies and schemes
in India has left the voice of the urban poor unheard and unanswered precipitating an urban
health crisis.
This project aims at collecting evidence on health and RCH indicators
for urban poor to advocate for higher attention and consideration
towards their health needs at different forums. The 18 month project,
‘evidence-based advocacy’, is being implemented by PFI in partnership
with Sahaj-Shishu Milap, a community based organization from
Vadodara, Gujarat in 15 urban slums of the Vadodara city from May
1, 2007. Sahaj has over 20 years of engagement in Baroda slums in
the form of non-formal education centres, programmes and projects
on gender, rights, sexuality and health with adolescent boys and girls
through community development approach. Sahaj is an active member
of several networks and coalitions: Jan Swaasthya Abhiyan, Medico
Friend Circle, Coalition for Maternal- Neonatal Health and Safe
Abortion, WOHTRAC in WSRC, MS University etc. Its secretary,
Ms. Renu Khanna is an internationally known health activist.
The project, based on a Right to Health and Health Care framework, a strong gender perspective
and a community mobilization strategy, aims at improving maternal and child health indicators
for the urban poor of Vadodara city. The specific objectives of the project are to:
i. determine the maternal (ANC, safe delivery and PNC) and children’s (up to three
years old) health status in the slums of Vadodara city.
ii. Examine the quality of health services being used by urban poor for the above
purposes and ascertain the approximate cost incurred in using these services.
iii. Use this data for advocacy at the city as well as the state level in order to strengthen
the related public health programmes and schemes, and improve the quality and
accessibility of the health services, with specific focus on Reproductive and Child
Health.
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iv. Identify and train community health workers to provide basic health education,
provision of primary services for common illnesses, and link community with the
public health system in the city.
v. Increase community’s access to quality health services through the Municipal
Corporations’ health care service delivery system.
The strategy involves collection and analysis of data using Participatory Action Research (PAR)
approach involving interactions with the community, house hold surveys, cost analysis,
interviews with key stakeholders, facility surveys; review and analysis of plans and policy
documents related to reproductive health; participation at relevant fora; and giving feed back
and information to the community, policy makers, administrators and other stakeholders. Effective
networking with like minded NGOs and CBOs along with awareness generation among the
community on Reproductive and Child Health is another plank in the over all strategy. Thus,
the project adopts an integrated approach of both advocacy and direct implementation for a
community-based programme.
The community-based programme involves identifying and training a health worker in each of
the 15 bastis, formation of community development committees (CDCs), counseling and
following up with eligible couples for their reproductive health needs and making community
aware of their reproductive health status, rights and of various government health schemes.
The capacity building also includes taking CDC members on exposure visits to help them
understand the working of government departments including health and others, and making
presentations on specific health issues and problems to the Government.
The baseline conducted under the project revealed that 36 percent women had home deliveries,
21 percent by untrained providers, only 33 percent women used government health facilities,
45 percent women reported problems during delivery, 23 percent women did not have any
ANC and only 19 percent initiated breastfeeding in first hour,
35 percent received PNC, only 15 percent received 3 PNCs. It
also revealed that a normal delivery costs Rs. 150 to Rs. 2,000
in a government facility whereas it cost Rs. 500 to Rs. 20000
in private facilities. Similarly, delivery through a Caesarian
section would cost Rs. Rs. 1500 to Rs. 10,000 while in private
facility it would cost between Rs. 5000 to Rs. 17,000. The
survey clearly indicated poor health status and high and
unaffordable costs of reproductive health care for urban poor.
Despite challenges of constant demolition of slums and a
floating population, the project has been able to achieve
significant progress. 16 Community Health Workers (CHWs)
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have been identified and oriented in RCH and cost estimation. They were oriented to government
schemes like Janani Suraksha Yojana and Chiranjivi Yojana. Government functionaries
themselves facilitated the orientation programs as resource persons. 14 Community
Development Committees have been formed who meet every month and discuss health issues
plaguing them. The baseline findings have been shared with the Community Development
Committees. The CHWs and members from the committees were taken for an exposure visit
to government hospitals. They were also taken to Kashiba Govardhandas Children’s Hospital
to see facilities like ultrasound, blood, breast milk and eye bank, artificial and dental care units
etc. Workshops on issues like Early Marriage and Early Pregnancy (EMEP) were organized for
the young people from the slums. Sahaj is advocating with the public health system for Janani
Surakhsa Yojana and Chiranjivi Yojana as many genuine beneficiaries are being denied the
benefits of the scheme by service providers on flimsy grounds.
Sahaj has also come out with a quarterly newsletter ‘Jagrat Yuva Sarjan’ which focuses on
Reproductive & Child Health issues. Sahaj has also effectively aligned itself with the Jan
Swasthya Abhiyan, e- networks like ‘Coalition on Maternal and Child Health’, Dai Association
of Gujrat, Arogya Trust and SRIJAK of Chetna, Ahmedabad. Sahaj has actively represented the
case of health of urban poor at several state and national level meetings with government and
non government agencies/departments, NRHM forums, state and national workshops and
events.
Overall, the results of this integrated approach and advocacy are trickling in, in the form of
increased proportion of utilization of government services and improved quality of services at
government health facilities.
Enhancement of Health Status of Women, Children and Adolescents
through RCH Life Cycle Approach in Uttar Pradesh
This project was implemented by PFI in association with an NGO Manav Seva Sansthan
(SEVA), Gorakhpur from October 2004 to September 07 in 53 villages of Jungle Kaudia block
in Gorakhpur district of Uttar Pradesh.
The objectives of this three year project were to (i) sensitize, train and build capacities of the
project key stakeholders for improving the quality of RCH services and ensuring its sustainability,
(ii) raise awareness and sensitize the target community on RCH issues, increase health seeking
behaviour through IEC/BCC activities, and (iii) deliver quality RCH services by adopting a life
cycle approach.
A baseline survey was conducted at the begining of the project. The survey revealed that
contraceptive prevalence and complete immunization rate was low, prevalence rate of RTI/STI
was high and deliveries assisted by skill birth attendants were low.
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The project area was divided in to 13 clusters and Health Information and Service Centers
(HISC) were set up in each cluster. These centers were equipped with necessary instruments
and manpower for primary level health care and counseling. The space for these centres was
provided by the Panchayats which were mostly Panchayat Bhavans. Doctors and nurses
periodically provided services at these centres. A user fee of Rs.10/- was charged for the clinical
services provided. HISCs were also used for meetings with CBOs developed in the project and
counseling of pregnant and lactating women and adolescents of the area. A Management
Committee comprising Gram Pradhan, other members of Panchayat, Community Health
Educator (CHE) and an influential member of the community was formed to manage the HISCs.
Efforts were made to establish community
based institutions and women’s groups. A
total of 53 adolescents groups and 159 SHGs
were formed in the project area. The
adolescent groups took initiative in
addressing local issues pertaining to maternal
and neonatal health issues. The groups are
expected to help sustain the benefits of the
project in the future.
IEC/BCC activities were carried out through
wall paintings, awareness rallies and
hoardingss in strategic locations as well as
group meetings etc. Special efforts were
made under the project for prevention and
treatment of seasonal outbreak of Japanese encephalitis in the area.
Social marketing was an important strategy adopted by the project, which helped increase
access to common health and contraceptive products at affordable prices. Women are now
purchasing oral contraceptive pills and condoms from depot holders as well as from the
CHEs. As part of the future strategy, SEVA plans to include female condoms and sanitary pads
under this activity.
To assess the impact of the project, an endline evaluation was conducted by an independent
organization known as Midstream Marketing Research Private Ltd. A quantitative and qualitative
survey was carried out in which 573 currently married women within the age group of 15-49
years from 15 villages were interviewed. Focus group discussions with eligible women, and
adolescents were carried out for assessing the qualitative aspects of the survey. Apart from
this, in-depth interviews with key stakeholders were carried out. The key findings are given in
the following table:
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Table below highlights the improvement in Reproductive Health Status:
Indicators
Baseline (%) End line (%)
Full immunization
31.7
43.3
ANC Registration
22
87
Any ANC checkup
36.4
85.6
Home delivery attended by trained birth attendant (TBA)
11.6
25.5
Breast feeding initiated within an hour of birth
20.2
60.3
Colostrum Feeding
19.8
92.2
Contraceptive Prevalence Rate (CPR)
16.4
45.2
Willingness to use FP method in future
9
52.2
IFA tablet received
24
69.2
Treatment seeking for RH problem
22.5
61.2
Awareness on HIV/AIDS
32.0
84.3
A document highlighting the strategies and promising practices of the project has been
developed.
Reducing Reproductive Morbidity among Married Young Women in Rural
Maharashtra
Maharashtra is the second most populated state in India (Census, 2001). The Contraceptive
Prevalence Rate in the state is relatively high (60.9%), however the Total Fertility Rate (TFR) of
2.7 is still above the replacement level of 2.1 children per women. Contribution of married
young women in 15 to 19 years of age, to the TFR in the state is 26 percent suggesting that
most women here get married quite early, attain the desired family size by the age of 24 and
that contraception is adopted usually after achieving the desired family size and composition.
Low age at marriage and non-use of contraception by young married adolescents are two
critical factors which need to be addressed to attain replacement level TFR.
Young married adolescents constitute about 22 percent of the total population of Maharashtra.
In Maharashtra, median age at marriage, for women age 20-24 years, was 17.1 for rural areas.
The proportion of girls getting married before 18 years ( the legal age for marriage), is 62
percent in rural areas. The issue of adolescent sexual and reproductive health has received a
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special focus in the government of India’s RCH-2 policy document.
Maharashtra has been selected as one of the states for the
implementation of this programme during the RCH-2 project
period. Yet very few interventions are planned to address adolescent
health needs and there are very few successful programmatic
models on how adolescent health services can be operationalized
though the existing public health system.
An IHMP study (1999) conducted in project districts indicated that
90 percent of currently married women were mothers even before they were 19 years old. It is
well documented that married adolescents are at a high risk for adverse reproductive health
outcomes. Burdened with the negative consequences of early childbearing, limited educational
opportunities and compromised social status married adolescents are one of the most vulnerable
groups in terms of health and social risk.
The Population Foundation of India (PFI) and the Institute of Health Management Pachod
(IHMP) have joined hands to implement a three year integrated, multi-site action research
project in Maharashtra, which will demonstrate the implementation of an Adolescent
Reproductive and Sexual Health programme for married adolescents in 5 very backward
districts of Maharashtra. Sir Dorabji Tata Trust is providing financial support to the project.
The proposed action research project is being implemented in 5 of the most vulnerable districts,
in terms of the RCH index, of Marathwada and Vidharba regions of Maharashtra viz. Nanded,
Beed, Amaravati, Buldana and Betawad. The project covering a rural population of 1,00,000
is implemented through 5 local NGOs viz. Sanskruti Samvardhan Mandal, Nanded; Gram
Vikas Mandal, Beed; Apeksha Homoeo Society, Amaravati; Youth Welfare Association of
India, Buldana and Late Shriram Ahirrao Memorial Trust, Dhule.
The three year multi-site action- research project which started from January 2008, aims to
demonstrate how an integrated package of services for young married women and their spouses
can help them achieve better Reproductive and Sexual Health status. Specific objectives of the
project are:
1. Increasing median age at first conception,
2. Increasing contraceptive use among married adolescents,
3. Reducing prevalence of anaemia among young married women,
4. Improving treatment seeking behaviour for RTI, post abortion complications and
post natal complications among married young women,
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5. Increasing utilization of antenatal, delivery and post natal services by young married
women, and
6. Increasing utilization of Voluntary Counseling and Testing Centres for early detection
and prevention of HIV.
The major components of the project are:
1. Primary level health-care, nutrition education, detection and treatment of anemia,
ante-natal care and advice regarding child birth, easy and confidential access to
family planning, MTP, RTI / STI detection and treatment, HIV/AIDS awareness and
counseling,
2. Organising women’s groups and involvement of PRIs,
3. Behaviour Change communication (BCC),
4. Community Based Surveillance and referral and
5. Capacity building of implementing agencies in development of systems and
mechanisms to plan, monitor and evaluate the programme and build capacities for
action research and advocacy.
The project was formally launched on January 4, 2008 at a workshop on Research on Adolescent
Sexual and Reproductive Health at Pune, in presence of senior state government officials, state
and national level NGOs engaged in adolescent research and programming. In the first quarter
of its operation i.e. till March 31, 2008, preparatory activities like recruitment of all the project
staff and putting in place the required infrastructure viz. setting up of offices, procuring furniture,
computers and vehicles for mobility of the project staff has been completed. The capacity
building, baseline and service delivery activities have been planned in the forthcoming months
in 2008-09.
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New Initiatives in the
Current Year
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A Model Initiative to Ensure Quality Family Planning Services in
Uttarakhand
A new programme with a focus on ensuring Quality Family Planning Services in Uttarakhand
was designed during 2007-08 for implemention in collaboration with Himalayan Institute
Hospital Trust, Dehradun. The project would aim to identify the unmet needs for family planning
among the eligible couples and increase awareness on family planning. It would also endeavor
to complement and supplement the government programme by reinforcing the skills of service
providers (ANMs/Nurses, ASHAs) and delivering quality services for family planning.
Reduction of Iron Deficiency Anemia and Awareness on Reproductive
and Sexual Health among Adolescent Girls in Ganjam District of Orissa
The project ‘Reduction of Iron Deficiency Anemia and Awareness on Reproductive and Sexual
Health among Adolescent Girls’ in Ganjam District of Orissa was designed in 2007-08 to be
initiated in the next financial year 2008-9 in collaboration with Multi-Applied System, an
NGO based in Orissa. This project aims to address a group of adolescent girls aged between
12-19 years and reduce the prevalence of anemia through control of hookworm infestation.
The project also focuses on a larger objective of reducing maternal and infant mortality in the
state by empowering adolescent girls with knowledge on reproductive and sexual health issues
including family planning.
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Maternal and Child Health Sustainable Technical Assistance and
Research: A new approach
The Maternal and Child Health Sustainable Technical Assistance
and Research (MCH-STAR) is an approach to improve policies,
programs and resources in the areas of maternal, neonatal, child
health and nutrition (MNCHN) in India, particularly in Jharkhand
and Uttar Pradesh. It aims to strengthen the capacity of Indian
institutions to conduct meaningful research, implement programs
and advocacy efforts that will provide technical leadership in
MNCHN matters in the long run. The ultimate objective is to leave
a legacy of Indian institutions with sustained capacity to respond
to the demand of providing technical assistance and leadership in
the field of MNCHN.
The Population Foundation of India is one of the three selected Indian institutions represented
in the project as Star Supported Institutions (SSIs) along with Public Health Foundation of India
(PHFI) and India Clinical Epidemiology Network (India CLEN). The initiative is facilitated by
the MCH-STAR Consortium (Emerging Markets Group, Boston University and CEDPA). MCH-
STAR partners aim to support the goals of the National Rural Health Mission (NRHM), the
Integrated Child Development Services (ICDS) and Reproductive and Child Health (RCH II) in
the country. It is supported by United States Agency for International Development (USAID).
The focus of the programme is on:
• Improving policies, program approaches and resource allocations for MNCHN
through Indian Institutions by building capacity and institution strengthening in
MNCHN technical leadership and technical assistance services, policy analysis and
advocacy.
• Helping the government to fill the gaps in data and knowledge to improve policies
and program approaches namely NRHM, RCH-II and ICDS.
Key strategies include:
• Focus on major causes of maternal, neonatal, and childhood morbidity and mortality
and malnutrition, and their proximate determinants;
• Promotion of evidence-based programs and policies to address MNCHN needs
thus addressing critical gaps and constraints. This will be done through consultative
processes, state-level technical advisory group priorities, consensus among key
stakeholders, and reviews of evidence;
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• Focus on poor, vulnerable and marginalized populations and prioritize programs
and policies that benefit populations with the worst MNCHN indicators;
• Building the capacity of Indian institutions that can provide sustainable technical
leadership in MNCHN.
The project was initiated in September 2007 when the MCH-STAR consortium partners were
awarded the project by USAID. The three SSIs were identified and a planning meeting was
held in December 2007 where the scope of work of the project was clarified. Subsequently,
fortnightly meetings were held where further discussion on the operationalization of the project
was done between the partners. Meetings were held with government representatives at the
Center as well as in the States of Uttar Pradesh and Jharkhand along with civil society members
to identify and prioritise the government needs for MNCHN. Through this process, a number
of focus areas and gaps in the field of MNCHN were identified.
Based on the prioritized issues in both states SSIs are focussing their proposals on the identified
gaps or priorities in the MNCHN area. A consultative workshop was held to draw up a detailed
implementation plan for the project in March 08. The three SSIs were supported by MCH
STAR in drawing up their plans keeping the deliverables of MCH STAR project and the
government priorities in view.
Capacity building at every stage of implementation is an important aspect of the project. In this
context capacity assessment of PFI was done by MCH-STAR which highlighted the need for
building capacity on operations research, policy research and advocacy, writing of white papers,
costing and widening of technical resource base. These have been adequately addressed in the
detailed implementation plan of the MCH-STAR initiative.
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Advocacy and Communication Projects under UNFPA Country
Program-6 in Punjab, Haryana, Himachal Pradesh and Bihar
With an objective to transform “Advocacy in to Action”, the Foundation undertook this project
from UNFPA/GOI in continuation of the Phase II activities of the project implemented in
Punjab (Fatehgarh Sahib and Patiala districts), Haryana (Kurukshetra and Ambala), and Himachal
Pradesh (Solan and Sirmour) on Missing Girls and in two districts of Bihar (Gaya and Vaishali)
on quality of care.
In the third phase, PFI continued its interventions in the selected districts of the three states and
also expanded to 10 new adjoining villages in each district and 26 new Gram Panchayats,
thereby increasing the total number of villages from 40 to 80 and Gram Panchayats from 24 to
55. In addition, the intervention on quality of care on RCH issues in Gaya and Vaishali districts
of Bihar continued in the same 70 villages. The activities of the third phase started in December
07, and continued till March 08. Further extension has been approved up to September 08).
Missing Girls
As per the action plan, forty new villages were identified in the 4 districts in Punjab
and Haryana on the basis of a pre-determined criteria which included: lowest
child sex ratio, population of over 500 and close proximity to the existing project
villages to facilitate better monitoring and evaluation.
Four advocacy workshops were organized with stakeholders in all the four project
districts of Haryana and Punjab. These workshops were attended by CMOs, ICDS
workers, AWW, ANMs, PRI members, village heads, members of Sakshar Mahila
Samuh (SMS) of Haryana, civil societies and media. The objective of the workshops
was to discuss the project intervention with the concerned stakeholders, explore
possibilities of integrating the efforts undertaken by the state governments and other organizations
in the region to avoid duplication of efforts and get government support. One of the major
objectives of the workshop was to sensitize the PRI members and village heads to form support
groups at the village level and train them to undertake advocacy and act as change agents. The
workshop came up with innovative ideas on the formation of village level support groups
named “Beti Sneh Samuh”. Consequently they were formed by community participation in all
the 40 new villages in Punjab and Haryana
In Himachal Pradesh, 26 new Gram Panchayats were identified in addition to the 24 Gram
Panchayats selected in the previous phase. The GPs were identified on the basis of having the
lowest child sex ratio. One-to-one and group sensitization exercises were taken up with the
PRI members to encourage them to discuss the issue and declare their respective villages
‘Kanya Bhroon Hatya Nishedh Gaon’. Community support groups were established in all new
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Gram Panchayats, and training of PRIs was done covering government schemes, PCPNDT Act
and related issues in both districts.
Activites planned for the next year 2008-09 include youth melas, an advocacy workshop with
District Magistrates as well as engaging with the media on a continuous basis.
Quality of Care
Under the advocacy and communication initiatives to strengthen NRHM activities in selected
blocks of Gaya and Vaishali districts in Bihar, planning meetings with the networking NGO
partners in all the seven blocks were organized.. The objective of the meetings was to review
the previous year’s interventions, discuss the initiatives planned for the current phase and
formulate an action plan. The planning meetings were followed by a two-day training programme
of the networking NGO partners on advocacy and communication with special emphasis on
taking up advocacy with concerned stakeholders and facilitating the formation and activation
of VHSCs. The motive of training also aimed to equip partners to facilitate village health plans
and ensure quality health care services. Liaison with government officials was taken up vigorously
in both the districts. The officials were briefed about the project interventions to garner their
support. Advocacy exercises with PRI/community/frontline health workers were done to
sensitize them and facilitate the formation of VHSCs, following which 25 VHSCs were formed
and ratified by the Village Panchayats. Under the project, activities planned for the coming
year 2008-09 include street plays for raising awareness and material production and distribution.
Advocacy for Building Supportive Policy and Program Environment on
Rights based Population and Family Planning /Reproductive Health
Issues in India
PFI is implementing a three year advocacy initiative (January 2007-December
2009) with support from the David and Lucile Packard Foundation, USA. The
goal is to facilitate formulation and implementation of rights based polices and
programs on population and family planning/reproductive health, with a focus
on young people.
The key objectives are:
1. To support and sustain advocacy at the national and state level (in
Bihar and Jharkhand) by building capacity of institutional partners.
2. To ensure better delivery of FP/RH services in underserved areas like Bihar and
Jharkhand through monitoring of the National Rural Health Mission (NRHM) and
Reproductive and Child Health (RCH-Phase II) program.
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3. To strengthen regional advocacy for supportive policy
and programs on sexual and reproductive health through
technical assistance.
The strategies adopted are:
1. Training and orientation of government officials,
judiciary, panchayati raj institutions, media and NGOs.
2. Building state level alliances for monitoring NRHM,
RCH-2
3. Creating a resource pool of individuals and NGOs for
advocacy.
4. Providing technical support to the state governments to effectively implement sexual
and reproductive health programs.
Some of the key interventions in 2007-08 were the following:
Orientation of PRI members
CENCORED has been working for the past couple of decades in various districts of Bihar on
the issue of building capacities of Panchayati Raj Institution members. Alongside they have
also implemented programmes on reproductive health and family planning at district level in
order to delay age at marriage in the region with a focus on adolescents. PFI’s six month
support to CENCORED was to pilot training of 974 PRI members (Block/Panchayat Samiti
members and Mukhiyas) in Muzaffarpur district of Bihar in order to ensure effective
implementation of NRHM and RCH-II program in the state.
The strategy is to build capacities of the participants on reproductive
health, family planning and role of PRI in the National Rural Health
Mission (NRHM) issues through a two-day non-residential training
program. Special emphasis was given towards ensuring
participation of elected women leaders in the district who overall
constitute 60 percent of elected local self government leaders in
the panchayat elections of 2007 in Bihar. A trainer’s handbook
was developed for the purpose in Hindi along with poster on
maternal health and leaflet on roles and responsibility of PRIs.
Emphasis was given on easy to read documents with visuals. A
total of 921 members (535 from panchayat samitis and 386
mukhiyas) were trained.
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The women PRI members who were working with some NGO or were members of SHG
are more confident and eager to learn. Some women who got elected on reserved seats,
because male members could not contest, had to negotiate with their family members for
attending the training. In Paru block, the son of Pramukh attended on behalf of his
mother.
In Bandara block, the daughter-in-law of Mukhiya is Pramukh. She participated in the
training on the first day, but she was not permitted by her father-in-law to attend on the
second day.
In most of the blocks, Mukhiyas and Pramukhs suggested to the resource persons that
such orientation should be organized for ward members, Sarpanches and Panches. They
are more close to community and have less work to do in comparison to Mukhiya. Mukhiya
remains busy either in preparation of BPL list or in relief work.
Panch, Sarpanch and Ward members always attend meetings of Gram Sabha and make
difference with their precious vote in Gram Sabha. By getting training in NRHM, they
will be more responsible and accountable to community on reproductive health issues.
“This is the first time that I have come out of the house to attend such a training. It
helped increased my confidence to go back and talk about health issues in my panchayat
meetings.” – A PRI member
It was good that you gave us the information about NRHM, I did not know about the
health services in the village earlier. – A PRI member
Interventions for Youth:
In Jharkhand, the Foundation provided technical assistance to the State Government for
formulating the Youth Policy of Jharkhand. The policy has been approved by the Jharkhand
Government in July 2008. This was a three year bottom up approach that PFI adopted in policy
advocacy. PFI is continuing its assistance to the state government to ensure that the policy is
implemented in its true spirit for the youth of Jharkhand and with involvement of various
departments, civil societies, NGOs and youth based organizations.
In Bihar, the Foundation organized regional consultations in collaboration with the Department
of Youth, Art and Culture, Government of Bihar, NGOs, youth and youth based organizations
to collate inputs for the draft Youth Policy of Bihar. The recommendations from all the
consultations were compiled and submitted to the state government for further action.
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PFI in collaboration with Naandi Foundation, Hyderabad undertook two
feasibility studies on School Health Programme and Livelihood Opportunities
for Youth in Jharakhand. The study on school health programme was conducted
in all the Government aided schools in urban Ranchi whereas the livelihood
study covered five towns of Jharkhand viz Ranchi, Jamshedpur, Dhanbad,
Garhwa and Dumka. The livelihood study recommended formation of vocational
education training (VET) centers which would aid in generating employment in
the service sector. Recommendations in the school health study included
partnerships with the private sector to improve access to health care, designing
local specific communication strategies and strengthening community networks
such as parents’ groups, self help groups, teachers groups and their linkage with health providers.
Ms. Poonam of Kharati Village who is the sister in law of Priyatama, one of the participants
in NYK training, said, “This is a fruitful effort by NYK and PFI. I can now see the change
in Priyatama which I had not seen since my marriage in 2004. I am a teacher in Panchayat
School. Here I teach students upto 5th standard. I was unaware of life skills information
when I got married. This is essential for all to know during adolescence, to help them
lead a safe life. I have also learned from Priyatama and can now share this knowledge in
the Panchayat School where the trainees from Jawanbigha and Kharati villages gather
once in a month to discuss and exchange their experience and views.”
Ms. Sangam Kumari of Hatiyar in Bodh Gaya said, “I have been nursing the ambition to
become an air hostess whenever I saw airplanes flying over our village. When I was a
teenager I remember that, I hardly spoke to people. I was shy even with my mother and
friends. This was perhaps due to the physical changes I was experiencing, which I could
not understand. Sometimes I could not concentrate on my studies and any other work I
used to do. Then the Youth Club Member and NYK volunteer of our village, Mr. Rakesh
informed me and my parents about the Life Skill Training. With the consent of my parents
I became the part of the 8 day long process. Now, six months after the training my
parents and my friends can see how I have changed. I am now out-spoken and open to
discussions and views from others. I am now self confident and concentrating better on
my studies. I am working towards making my dream of becoming an air hostess a reality.”
In collaboration with Nehru Yuva Kendra (NYK), Gaya, Bihar, PFI has imparted
life skill training programme for the young adolescents of Gaya district of Bihar.
Before the commencement of the training a ToT was organized by NYK (as
contribution to the effort). 20 persons were trained out of which 6 were identified
as master trainers for the entire programme. There were eight batches of training
programme and 360 youth club members (belonging to the age group of 13 to
19) were trained. Following the training an impact assessment was undertaken
by an external researcher to find the positive changes among the trainees and
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their contribution in bringing changes in their family and community. The
assessment targeted the trainees, their peers, family members, and school teachers.
The overall impact of the efforts was reflected in remarkable change in the life of
the trainees.
In collaboration with CINI, two batches of training on Life Skill Education were
organized in Jharkhand for the ANOs (Associated NCC Officers). The National
Cadet Corp (NCC) ANOs from school and colleges participated in the training.
A pool of master trainers from the ANOs was created and a training module
was developed. The ANOs expressed the need to expand the effort to a larger area and train
the NCC in a residential course during the annual camp with training assistance from PFI and
CINI.
Building Coalitions for advocacy
PFI facilitated the formation of a national level coalition against the coercive
two-child norm with Centre for Health and Social Justice (CHSJ) as the Secretariat
in view of the possible inclusion of the two-child norm in Panchayat elections
in Bihar and other states of India. A network of NGOs, “Jan Adhikar Manch” in
Bihar was formed to mobilize and undertake initiatives for intensive advocacy
campaign on the issue. As a result of these efforts, the Chief Minister of Bihar
Mr. Nitish Kumar on the eve of a national seminar of PRI members on 24th April
2008 at New Delhi submitted a charter to the Prime Minister of India that the
state was not in favour of introducing the Two Child Norm in PRI elections.
Evaluation studies on reproductive health
Two evaluation studies on Maternal Health in Bihar and NRHM in Jharkhand were undertaken
in collaboration with Centre for Health and Social Justice (CHSJ). These studies have been
printed and shared at the NRHM stakeholders’ consultation facilitated by CHSJ. A report on
the stakeholders’ consultation has also been published and disseminated.
Capacity building of NGOs on strategic communication:
With the support of Spitfire Strategies USA, a series of capacity building training on Strategic
communication for advocacy was undertaken in building the capacity of PFI and the NGOs
working in Bihar and Jharkhand. PFI being the lead country organization for the purpose a
pool of master trainers has been created taking the NGO representatives from these states and
also from the organizations working on RH and FP issues at the national level to take the effort
forward. This effort helped the NGOs in Bihar and Jharkhand in developing communication
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plans for advocacy on reproductive health and family planning using a tool called “Smart
Chart”. The activities undertaken under the effort were:
1. One day training for PFI staff.
2. Two day training for Bihar and Jharkhand NGOs.
3. Incorporating Spitfire modules in IPAS communications workshop.
4. Regional training for NGOs in Bihar and Jharkhand.
PFI initiated a community radio programme in collaboration with “Manthan
Yuva Sansthan”, Ranchi, Jharkhand. This is a two year effort to build the capacity
of community on FP and Reproductive Health issues in Jharkhand and Bihar
using media. As part of the effort, Manthan is undertaking media scanning, training
of journalists in Bihar and Jharkhand on health reporting, community radio in
Lohardaga district of Jharkhand in collaboration with All India Radio and wall
newspapers on the issue.
A comprehensive and user friendly document, ‘State of Health in Bihar’ has
been published under this project. This publication brings out the realities of the
health and population scenario of the state of Bihar based on latest data. It
reflects the current context of the health status and the gaps and priorities, which need to be
addressed in a development-oriented approach. The publication is meant to be a comprehensive
reference for policy makers, the state government, district administration, planners, programme
managers and NGOs for the State of Bihar.
Regional Resource Centres (RRCs) for Bihar and Chhattisgarh
The Government of India sanctioned this project in February 2005 for a period of five years to
PFI, and after a preparatory phase of two months, the RRC was fully functional from April
2005. The Apex Resource Centre (ARC), a technical body was created by the Government of
India to orient the RRCs. PFI is the Regional Resource Centre for the states of Bihar and
Chhattisgarh. The RRC for Bihar is supported financially by Government of India and the RRC,
Chhattisgarh is funded by PFI.
The objectives of the RRC are (i) to support for project development, training in programme
and technical areas, dissemination of relevant training and communication material, (ii) to
create and facilitate access to database of technical and human resources relevant to family
planning and RCH interventions, (iii) to conduct periodic field visits for technical assistance
and training needs assessment and follow up of effectiveness of inputs, (iv) to provide a platform
for advocacy to facilitate GO-NGO networking, and (v) to provide inputs to GOI to enable
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policy modification/formulation for NGO programmes. RRCs provide assistance and support
to the state NGO committee, Mother NGOs (MNGOs), Service NGOs (SNGOs), Field NGOs
(FNGOs) and other stakeholders in programme management and the RCH technical
interventions. The expected outcomes from the RRC are:
• A network of institutions across the country capable of providing high quality
technical assistance to a range of NGOs working to improve RCH as per the goals
of the National Population Policy, 2000
• Closer linkage between the State Governments and the MNGOs/SNGO at the state
and district levels.
• Increased access of NGOs to district level data, training and communication material,
and information on policies and programmes.
• Development of NGO resource directory for RCH issues at the state level
• State government and Government of India receive inputs for mid course correction
and policy modification
Bihar RRC
During the year 2007-08, six regional thematic workshops on ‘Quality of Care in Reproductive
and Child Health Services’ were held at Aurangababd, Bhagalpur, Begusarai, Araria, Vaishali
and West Champaran districts of Bihar. These workshops were focused on perspective building
of State Health functionaries, State Ministers, MNGOs/FNGOs, NGOs and other stakeholders’
on quality of care in reproductive and child health services. One state level thematic workshop
on ‘Quality of Care in RCH Services’ was held at Patna . A one-day orientation of MNGOs on
outputs / measurable indicators of the MNGO scheme was held at Patna on June 30, 2007 to
enhance understanding of the MNGOs on various outputs and their measurable indicators.
An exposure visit of RRC staff to SUTRA, Himachal Pradesh was arranged to build capacity of
staff on advocacy strategies, training and gender. A two days’ workshop on Financial
Management for MNGOs was also organized at Patna. Field appraisals
were conducted in 40 clinics / hospitals in Bihar with key government
functionaries such as District Accounts Manager, Civil Surgeon and
Medical Officer in project areas. The RRC also participated in the review
meeting held by Government of India on 24th August 2007 in New
Delhi in which concerns over delay in fund disbursement to MNGOs
were communicated. The RRC published workshop reports on ‘Bihar
Population in the New Millennium’ and ‘Reducing Infant Mortality in
Bihar.
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Chhattisgarh RRC
In Chhattisgarh, two regional thematic workshops on ‘Immunization’ were held at Rajnandgaon,
and Kawardha districts. One state level workshop on ‘Immunization’ was conducted at Raipur
and discussions were facilitated on ensuring injection safety methods. In addition 4 regional
thematic workshops on Malaria were held at Bastar, Kanker, Ambikapur, and Korba. A three
days residential training programme on financial management was held at Ambikapur for
MNGOs. Another five days residential training programme on Puppetry – a tool for BCC was
organized for MNGOs at Raipur basically to enhance quality in the IEC activities. Further one
day re-orientation programme was conducted for MNGOs on record keeping, data entry for
baseline survey through the prescribed computerized package, understanding on RCH indicators,
advocacy and communication need assessment at Chhattisgarh by PFI.
The MNGOs were asked to conduct base line surveys to assess the RCH status of un-served
and underserved areas. RRC facilitated the MOUs between state Health Society and MNGOs
as well as MOUs between MNGOs and FNGOs. MIS and formats on tracking of pregnant
women, eligible couples and children below 23 months were developed. All the formats are
being used by FNGOs in the state. Case studies on delivery hut were contributed by the
community at Dongargaon and Bemeterara Block in Chattisgarh.
Other materials published for MNGOs include a Resource Directory on Population Health
and Development, Prevention and Management of Infertility in PHC setting, Fundamentals of
Accounting, Status of Heath in Bihar and Socio Economic Development Index. The 3rd edition
of the newsletter, “Nayi Kiran” was brought out on the issue of Quality of Care in both English
and Hindi and disseminated to all stakeholders.
Scaling-Up Pilots and Innovations in Reproductive and Child Health in
India: PFI s role as an advocacy organization
Global and national experience has shown several models or innovations that have potential
to impact at a larger scale – both geographically and to larger populations. That this has not
happened is largely the result of a lack of understanding of the processes required to scale up
the models into larger health systems, public, NGO or private. In 2006, Mac Arthur Foundation
in India awarded a two year grant to the Population Foundation of India (PFI) to establish a
center for scaling up. The grant included technical support to PFI from Management Systems
International, USA, a MacArthur grantee, who have developed a Scaling-Up Management
Framework. This Three-Step-Ten-Task framework, which is a set of tools and techniques to
facilitate scaling up, was tested in Nigeria and Mexico. The objective of the India initiative was
to support and build capacity of PFI to facilitate scaling up of models in the areas of maternal
mortality reduction and Young People’s Sexual and Reproductive Health. PFI, on its part, was
expected to facilitate documentation, advocacy, networking and constituency building around
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the promising models at the state and national levels. As part of a two years plan, PFI is being
developed as a centre for scaling up pilot initiatives in India.
The project objectives were:
1. To facilitate the scaling up of successful model interventions for reducing maternal
mortality and morbidity and addressing young people’s sexual health and reproductive
rights.
2. Create and convene a multi-stakeholders’ working group composed of government,
NGOs, donors and the private sector that fosters the scaling up of pilot projects. It
would serve as a community of practice and learning for scaling up by sharing
experience of projects in various stages of scaling up, facilitating documentation,
dissemination, networking and advocacy.
PFI has worked with MSI to facilitate scaling-up of selected models, like the Home Based
Newborn Care (HBNC), implemented by SEARCH, Gadchiroli, and to assess scalability and
facilitate scale-up visioning and planning of models like Safe Adolescent Transition in Health
Initiative (SATHI), implemented by Institute of Health Management, Pachod (IHMP), Improving
Routine Immunization through Complementing Nutrition Services and Enhanced Monitoring,
implemented by Seva Mandir, Udaipur, Community Based Health Insurance program
implemented by Self Employed Women’s Association (SEWA), Ahmedabad, Training Medical
Officers of Primary Healthcare Centers in Emergency Obstetric Care (EmOC), implemented by
Federation of Obstetricians and Gynaecologists Society of India (FOGSI), Mumbai, Quality
and Safe Delivery Services through Nurse Midwives, implemented by Action Research and
Training in Health (ARTH), Udaipur, Intensive Family Welfare Program by Tata Chemicals
Society for Rural Development (TCSRD), Uttar Pradesh, The Public Private Partnership Model,
implemented by Karuna Trust, Karnataka, Community Health Care Management Initiative
(CHCMI) initiated by Department of Panchayat and Rural
Development, Government of West Bengal to help Panchayati Raj
Institution (PRIs) analyze and monitor key public health indicators.
In addition to identifying and facilitating scaling up of successful models
on reproductive health in India, PFI has started the process of
mainstreaming scaling up components in its grant making and project
management. A team of technical experts was identified, nurtured
and developed for the purpose through series of training programs as
well as hands on mentoring by MSI team. The team is being trained in
applying scalability assessment tools and works on strengthening
scalability components of the projects being funded by PFI.
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Experiences of Working with Originating Organizations
Home Based Newborn Care implemented by SEARCH Gadchiroli
The HBNCC model pioneered by SEARCH has now been accepted as the key
intervention to improve neonatal, infant and child health indicators in the country.
The HBNCC model, delivered through a community level health worker is a
composite of community participation, high quality training, intensive
supervision, well functioning procurement and logistic structures, and efficient
monitoring and evaluation systems. The scaling up is envisaged through the public
sector health service system. ASHA is expected to be the worker to deliver
HBNCC. Scaling up HBNCC offers a valuable opportunity to completely revamp
ASHA training structure, training systems, monitoring and evaluation methods.
The series of planning and consultative workshops and meetings with key policy
makers and influencers in India resulted in including home based newborn care
to reduce neonatal mortality through HBNC in the Eleventh Five Year Plan. The future challenge
is to implement the policy in the states for which a national level strategic planning workshop
with key stakeholders has been planned in April/May 2008 in New Delhi for getting adoption
and implementation of the HBNCC model widely. PFI along with MSI has been working very
closely towards developing the strategies and other details of the planning workshop.
Various states expressed keen interest to implement in part or entire component of the HBNCC
model. PFI/MSI along with SERACH has visited some of these states to explore, discuss and
identify the next steps for implementation of HBNCC in these states. During the second year
of the grant the team from PFI/MSI and SEARCH visited West Bengal, Andhra Pradesh and
Chhattisgarh. As part of the coalition building and advocacy work, PFI /MSI participated in
several meetings with key stakeholders such as Planning Commission, Government of India
and NIPI.
Safe Adolescent Transition in Health Initiative (SATHI), implemented by Institute of Health
Management (IHMP), Pachod
The Safe Adolescence Transitions in Health Initiatives (SATHI) program for married adolescent
girls, aimed to demonstrate a set of interventions that will increase age of first conception,
improve access to and use of spacing methods among young women, reduce anemia and,
consequently, reduce high risk pregnancies and child deliveries. Strong surveillance (a key
component of NRHM) and community audit through village health committees (another key
component of NRHM) were the key processes. As a result of MSI-PFI strategic planning exercises
and as part of a comprehensive national and state level plan, IHMP undertook initiatives to
demonstrate results of the model in other tribal districts. The Government of Maharashtra is
scaling up the SATHI model in the form of a Randomised Control Trial in 10 of the most
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backward districts of the State through the government health system in collaboration with the
IHMP. Simultaneously, five leading NGOs in Maharashtra are conducting multi-centric research
on the SATHI intervention employing a quasi-experimental research design being supported
by PFI and Sir Dorabjee Tata Trust (SDTT).
A state level advocacy workshop on Adolescent Reproductive and Sexual Health (ARSH) and
related issues was organized which was a unique opportunity to bring together evidence from
Formative and Intervention Research studies that have been conducted on ARSH during the
last decade in Maharashtra. The ownership of the state has been further strengthened during
the state level advocacy workshop where various other models were presented and discussed.
Formulating recommendations for future intervention and research initiatives on ARSH in
Maharashtra was one of the major outcomes of this workshop. The PFI-SDTT supported program
for ARSH research on married adolescents in five districts of Maharashtra was also launched
at the same time. Continuous advocacy efforts are going on with the state and central government
to scale up the promising practices of SATHI. PFI and MSI worked closely with IHMP and
various strategic planning and one-on-one advocacy meetings were carried out to create
supporters and sensitize different stakeholders.
Improving Immunization Uptake in Tribal Population by Seva Mandir, Udaipur
Seva Mandir has piloted a model to universalize immunization amongst tribal population,
wherein General Nurse Midwives (GNMs) provide immunization at a fixed date and fixed
place in every intervention hamlet. Incentives, in form of nutritional supplementation (like
lentils) and utensils have resulted in 17 fold increase in complete immunization.
PFI facilitated a one –day meeting between MacArthur Foundation, Seva Mandir, Jameel Poverty
Action Lab, MSI and PFI to discuss the Seva Mandir interventions and build a common
understanding on taking the model to scale. In line with one of the felt needs during the
meeting, Dr. Vikram Gupta of PFI was assigned to Seva Mandir as a Principal Investigator to
provide technical assistance to its health unit in various areas such as research, training,
documentation and scaling up. Based on the internal review meetings along with the emerging
results from recently conducted action research studies, and changes in the policy environment,
the need to modify maternal health strategy was strongly felt within Seva Mandir.
In order to facilitate this process of strategy development, Seva Mandir requested
a team from PFI and MSI to review its maternal health strategy. PFI/MSI has
reviewed all the maternal health programs run by Seva Mandir and drafted a
maternal health strategy for them. PFI and MSI have worked closely with Seva
Mandir, aiding them in strategizing the scaling-up, developing linkages with
stakeholders at national and state levels. One of the major challenges that this
model faced is the moral stand that many stakeholders have on incentives and
conditional transfer of resources.
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Community Based Health Insurance by Vimo SEWA, Ahmedabad
This model explores a voluntary, integrated insurance product, which is the most
challenging type of micro-insurance. It includes insurance for hospitalization,
including maternal health care. In some areas, this is combined with a cashless
tie-up system with health care providers, which means that funds are transferred
directly to the health-care provider, so that clients don’t have to advance funds
themselves.
PFI and MSI undertook several planning workshops with VimoSEWA where
VimoSEWA expressed interest in scaling up its community based health insurance
model for the poor, working women. PFI helped SEWA in collecting and collating
information on competing Community Based Health Insurance designs, facilitated
building of training manuals for its staff and assisted in documenting the health and insurance
linkage under VimoSEWA. SEWA also explored opportunities to expand its VimoSEWA client
base, with SEWA Bharat (esp. Madhya Pradesh unit) and NGO partnerships emerging as the
two most potential options for sustainability and scale. PFI hired consultants to finalize the
training modules of the health insurance model of VimoSEWA. SEWA has expressed interest
for a similar exercise for its health programme model – ArogyaSEWA. In 2008-09 PFI will help
SEWA in finalizing the training manuals for the health model as well and would look into the
scope for convergence between the two.
Providing low-cost, sustainable services for Maternal and Child Health Care through Skilled
Birth Attendants by ARTH, Udaipur
This is a model to increase access of rural and tribal population to quality safe delivery and
other MNH services and provided by Nurse Midwives in areas where quality medical facilities
are not available. They have referral link to tertiary health care facilities. Services are priced.
ARTH’s model on ANM runs clinics for round the clock access for maternal health services in
the remote areas is also being looked at for scalability. PFI helped ARTH in identifying the gaps
before taking this model to scale. As part of the process, PFI has helped ARTH in doing the cost
analysis and develop strategies for scaling up. With the developments at state and national
level policy arena, strategic planning exercises are in the pipeline.
Tata Chemicals’ Society for Rural Development (TCSRD) Badayun
PFI’s scaling up team along with the Program Development division undertook a 2-day visioning
exercise for TCSRD. TCSRD’s intervention was moving to second phase. PFI facilitated
discussions on the critical processes that were implemented in the first and those which must
be taken into second phase, decisions on the geographical and target population focus, and as
process of scaling-up, inclusion of documentation and costing as critical tasks in the second
phase.
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The Public Private Partnership Model, implemented by Karuna Trust, Bangalore
Karuna Trust has been working towards improving the accessibility
and availability of health services by undertaking the management
of primary health care centers (PHCs) and its sub centers from the
state government. The state government provides Karuna Trust with
three fourth of the regular budget for running a PHC in the state and
expects Karuna Trust to generate funds from other sources, if needed.
Karuna Trust not only upgrades the facility but also ensures round
the clock primary health care services in the catchments area of the
PHC.
PFI and MSI team visited Karuna Trust in Bangalore where the model
was presented by team members of the Karuna Trust. Karuna Trust has shown interest to scale
up its model using a systematic approach with the help of PFI/MSI. State level dissemination
workshop of the model along with the visioning exercise is in the pipeline. An external
assessment of the PPP model was necessary. The study was assigned to Institute of Health
Management Research Bangalore (IHMR Bangalore). The findings form the assessment study
are expected to support evidence based advocacy for scaling up this model.
Community Health Care Management Initiative (CHCMI), Kolkata
Over last four years CHCMI being complemented by the deep rooted panchayat system in
West Bengal has been able to involve Self Help Groups (SHGs) as a key partner. CHCMI has
a committed financial resource from The Department of Health and Family Welfare under
National Rural Health Mission (NRHM) for the formation of Village Health and Sanitation
Committees (VHSC) and it plans for the SHGs to play not only a key role in monitoring but
also delivering primary health care to reach the poorest of the poor.
On invitation from CHCMI, a team from PFI and MSI visited West Bengal in January 2008 for
initial discussions. Subsequent to this the West Bengal team comprising Mr. Dilip Ghosh,
Special Secretary, Department of Panchayat and Rural Development, Government of West
Bengal and Ms. Chaitali Chatterjee, Program Manager, CHCMI, visited PFI in March 2008 and
presented their model and the expected support from PFI/MSI in its scaling up. Later the PFI/
MSI team joined them during their visit to ‘Mitanin’ program in Chattisgarh to look into the
Mitanin model and explore the possible synergy between CHCMI, HBNCC and Mitanin. The
team towards the end of the visit brainstormed and reflected on the possible strategies and
operational challenges with respect to HBNCC in West Bengal.
PFI’s Strategic Planning
A two-day strategic planning workshop was conducted where all the staff of PFI participated
actively. Under the guidance of the Additional Director, the scaling up unit participated actively
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in preparing the background document as well as facilitating the complete process within the
organization. Management Systems International (MSI) facilitated the strategic planning
workshop which was held in PFI. The minutes of the meeting were circulated to all the concerned
staff and suggestions for possible actions are being regularly followed up. The Additional
Director, PFI, involved the scaling-up team in preparing presentations for the Governing Board
and in follow-up discussions on defining future directions for PFI.
Training of trainers
A team of professionals were identified from various divisions of PFI and their capacity was
built over a period of time on scaling up and related issues. These trainers participated in a
series of training and capacity building workshops on scaling up management and went through
a review of their capacity building process facilitated by MSI. MSI has built the capacities of
these identified trainers and mentored them through a series of scaling up exercises. The trainers
have selected projects being funded by PFI to apply the scalability assessment tools and also
work on strengthening scalability components of these projects.
Scan for Successful Innovations in India on Adolescent/Young People’s Reproductive and
Sexual Health (YPRSH): The first two years of scaling up were primarily focused on Maternal
and Child health innovations. However, PFI will expand focus to
Adolescent Reproductive and Sexual Health (ARSH) in the 3rd year.
Towards this, PFI has decided to do a scan of promising practices on
ARSH. As part of the ARSH scan, 55 promising practices were identified
from across the states. These will be further shortlisted based on a
predetermined criteria assessed for scalability.
PFI Core projects: The scaling up team participated in Internal Review
Committee meetings and has provided input to key interventions/ new
proposals submitted by various NGOs.
The extension of the project to the second phase (2008-2010), has been
designed which give PFI the scope to
• Study PFI supported interventions to identify promising practices that have potential
for scaling-up.
• Expand scaling-up capacity to other divisions of PFI, and also institutional capacity
building, especially in documentation and facilitating planning for scaling-up in a
larger way.
• Scanning of ARSH promising practices and to select a few to facilitate scaling up.
• To form thematic multi-stakeholder forums and make it more objective and result
oriented.
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• Document lessons learned while doing scaling-up in India
• Widely disseminate the knowledge and methodology of scaling up
As a scaling-up intermediary, PFI has attempted to strengthen its position internally with a
team of trainers and externally with new alliances at the state and national level. From creating
the trust among the originating organizations for itself as an intermediary to their scaling-up
efforts, to encouraging documentation among the NGOs, to managing the scaling-up in fast
changing political and policy landscape, every action that PFI took was replete with lessons.
Some of the key avenues for further work in PFI include those in evidence-gathering and analysis
of competing evidence, documentation of interventions and processes, and harmonizing the
attributes of the pilot interventions with the existing systems of adopting organizations. Though
intensive work on scaling up by PFI continues, there is still more potential to expand the work
as the interests from different organizations are overwhelming.
Community Monitoring of Health Services under NRHM
The Government of India’s flagship initiative - the “National Rural Health Mission
(NRHM)”, launched on April 12, 2005, focuses on enhancing the access of
rural population to safe, rational, effective, affordable and quality health services
including reproductive health and family planning services in the eight EAG
states, the eight north eastern states, Himachal Pradesh and Jammu & Kashmir.
The guiding principles as laid down in the implementation framework of the
Mission are to promote equity, access, efficiency, quality and accountability,
decentralize and involve local bodies, recognize the value of our traditional
knowledge base, promote innovations, methods and process development and
enhance people oriented and community based approach. One of the strategic shifts that the
NRHM wishes to bring about is in the monitoring framework by involving communities in
planning and monitoring programmes.
The Advisory Group on Community Action (AGCA), a standing group under NRHM constituted
by Ministry of Health and Family Welfare, Government of India, is mandated to spearhead the
community related initiatives under NRHM at the national level and at the state level by a joint
State Community Monitoring Mentoring group set up specifically for this purpose. The group
consists of eminent public health professionals associated with major NGOs. The Population
Foundation of India functions as the National Secretariat for the AGCA.
In order to further the objectives of ensuring community monitoring processes as envisaged
under NRHM, the Union Ministry of Health and Family Welfare initiated the first phase of
Community Monitoring of Health Services to be implemented in 9 states of Assam, Chhattisgarh,
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Jharkhand, Karnataka, Madhya Pradesh, Maharashtra, Orissa, Rajasthan and Tamil
Nadu for a period of eleven months from March 07 to January 2008. The
programme has been extended by the Ministry till December 2008. The Population
Foundation of India functions as the National Secretariat for this project, co
supported by the Centre for Health and Social Justice (CHSJ).
In the first phase, Community Monitoring covers a selected number of districts
in each state (depending upon the size of the state). In each of these districts,
three blocks are being covered and within each block 3 PHCs and within each
PHC area, 5 villages are being covered. This leads to a total of 1350 villages,
270 PHCs and 90 blocks being covered for Community Monitoring in the first phase.
Over the past one year, PFI has facilitated operationalization of the programme at the state
level. The emphasis has been on the following:
1. Preparation of operational guidelines and tools for monitoring : PFI in collaboration
with CHSJ has developed a range of guidelines, operating manual, training tools,
community based monitoring tools, posters and pamphlets. These have been adapted,
translated to local languages and modified based on state needs.
2. Advocacy with the state government : The entire programme is taken up in partnership
with the state governments. PFI has helped facilitate the start up of the programme
in the states with interactions with the state government and meetings with civil
society groups who are part of the implementing process.
The highlights of the programme include:
1. Formation and strengthening of the Village Health and Sanitation Committees (VHSC).
2. Formation of Planning and Monitoring Committees at PHC, Block and District level.
3. Capacity building of implementing NGOs, health services providers and VHSC
members on processes of community monitoring and community action.
4. Initiating the process of community monitoring at the village and facility level.
A lead NGO has been identified in each of the nine states to take the project forward. Currently
the lead NGOs in partnership with the state governments and the block level NGO partners,
are in the process of undertaking community monitoring to collect and collate data on the state
of services under NRHM and the services guarantees under the various schemes under NRHM.
These will be in the form of village and facility level report cards reflecting status of maternal
and child health services. These report cards will form the basis for community action to be
undertaken at all levels. Civil society groups, particularly peoples’ organisations in the nine
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states have adopted innovative approaches of the community (through village
health day), the media (through fellowships and interaction) and panchayat
members (orientation sessions) to play an active role in community based
processes of monitoring health services. Many of the governments from the pilot
states have already expressed an interest in incorporating the processes as part
of their state programme implementation plans.
PFI is in the process of consolidating the learnings from the programme in order
to assist Government of India replicate and generalise this process across the
pilot states and in other states of the country. The details of the programme are
also available at the specially created website www.nrhm.communityaction.org.
4th Asia Pacific Conference on Reproductive and Sexual Health and
Rights
The Fourth Asia Pacific Conference on Reproductive and Sexual Health and Rights (APCRSH)
was held on October 29-31, 2007 in Hyderabad, Andhra Pradesh, hosted by the India
Consortium on Sexual and Reproductive Health and Rights. PFI played a key role in organizing
the Conference, with Mr A R Nanda, Executive Director, PFI being the Chairperson of the
India Organizing Committee as well as the International Steering Committee. The overall goal
of the conference was to enhance and accelerate the process of operationalizing the sexual
and reproductive health and rights agenda in the countries of the Asia Pacific Region.
The overarching theme of the 4th conference was, “Exploring New Frontiers in Sexual and
Reproductive Health and Rights”. The conference provided a platform for people with diverse
perspectives, expertise and experience to exchange ideas, discuss and debate issues of concern,
and learn from each other about sexual and reproductive health and rights, with specific reference
to the implementation of the Programme of Action of the International Conference on Population
and Development (ICPD, 1994).
The scientific programme of the conference included parallel sessions, poster presentations,
plenary sessions, symposia, satellite sessions, and skills building and empowerment workshops
etc. Plenary sessions, organized in the morning on all three days of the conference, included
contemporary topics to reflect the conference objectives. Distinguished speakers, primarily
from the Asia Pacific Region, delivered lectures at these sessions. Skills building and
empowerment workshops designed to provide knowledge and skills to participants were
organized focusing on strengthening their capacity in methodologies, strategies and technologies.
Specific sexual and reproductive health and rights-related themes based on the six tracks were
displayed with a daily change in the poster presentations. Presenters provided information and
answered questions on their poster presentations.
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More than 1,250 participants from about 50 countries were present at the
conference to discuss and debate key sexual and reproductive health and rights
issues concerning countries of the Asia Pacific Region. Stakeholders, representing
policy-makers, parliamentarians, donors, researchers, programme managers,
activists, NGOs and others were also present at the conference who reflected
and shared diverse views, perspectives and experiences.
In addition to helping organize the conference, the Population Foundation of
India organized three satellite sessions :
1. From Pilot to Programmes: Scaling up Innovations into Public Sector Systems
Given that Governments and donors alike are increasingly trying to effect large-scale
change with limited resources by funding innovative health pilot projects, which they
then hope will be implemented at scale, this session, comprising speakers, encapsulated
lessons learned from scaling up of NGO and government-led interventions to reduce
maternal and neonatal mortality and morbidity within the public health system. The first
two presentations discussed the challenges in the application of a management framework
for scaling up reproductive health projects in India. The second presentation dealt with
developing and scaling up a community based health care model within a state health
system driven by political and civil society activists. The last presentation focused on
the systematic building up of evidence for a model for newborn care and the processes
involved in scaling up.
2. ‘Empowering People’: A Rights-based Effort for Policy Advocacy in Addressing Sexual
and Reproductive Health in India
This particular session reflected the experiences of ongoing efforts that enable government
and other stakeholders to formulate policies and programmes for reproductive health,
family planning and adolescent sexual health. The main aim of all these efforts is to
involve the community, especially young people, and building their capacity to influence
health programmes at the state and local levels. The objectives are to effect change in
Bihar, Jharkhand, Chhattisgarh and Orissa states where the Government of India is making
special efforts.
The conclusion drawn from the session was that people’s health should be in their own
hands. NRHM has provided that opportunity by involving the community at a very basic
level and also brought back primacy of primary health care. Policy advocacy is a trust
building process that is difficult and time consuming where-in civil society must play a
critical role in shaping policies, as reforms are about people and processes. There is need
to bridge communication gap between adults and young people by directly involving
young people in programme assessment.
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3. Care and Support Programmes for People Living with HIV/AIDS
Since PFI is one of the principal recipients of The Global Fund grants for Round 4 and 6
and is implementing a project to enhance access to care and treatment in six high
prevalence states of India, the Foundation has identified issues needing attention and has
conducted eight special studies for providing possible solutions. These studies were
seen as integral elements of the programme and their results are expected to feed into the
programme to improve its coverage and effectiveness.
Four presentations drawn from the above operations research studies, were made at the
session, on assessing PLHA expectations about quality of care and support services with
a view to strengthen district-level networks of PLHAs, setting up guidelines for providing
care and support services including cost of care and support services: A study of selected
community care centers and understanding support group meetings of PLWAs.
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HIV/AIDS Program
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The Global Fund Round 4 and Round 6 HIV/AIDS Program
The Global Fund Round 4 HIV/AIDS program “Access to Care and Treatment- ACT” is being
implemented in the six high prevalence states- Andhra Pradesh, Karnataka, Maharashtra, Manipur
Nagaland and Tamil Nadu. The sub-recipients involved in implementing the care and support
component of this program are Indian Network for People Living with HIV/ADS (INP+),
Freedom Foundation, Engender Health Society (EHS), and Confederation of Indian Industry
(CII). Population Foundation of India (PFI) as the Principal Recipient (PR) signed the grant
agreement with the Global Fund for Round4 HIV/AIDS Program in March 2005. Phase I of the
program has been completed in March 2007 and Phase II of the program is currently under
implementation. PFI has also signed the grant agreement as PR with the Global Fund for
Round 6 HIV/ADS program “Promoting Access to Care and Treatment-PACT”. Phase I of the
Round 6 program is being implemented in the eight highly vulnerable states – Bihar,
Chhattisgarh, Gujarat, Madhya Pradesh, Orissa, Rajasthan, Uttar Pradesh and West Bengal.
The Sub –recipients of this program are Indian Network for People Living With HIV/AIDS
(INP+), Hindustan Family Planning Promotion Trust (HLFPPT)and Catholic Bishops’ Conference
of India (CBCI). This phase has been in operation since June 2007.
Round 4 Program- “Access to Care and Treatment-ACT”
In Phase I of the Round 4 HIV/AIDS program, care and support services were provided to
114,454 PLHAs through 127 District Level Networks (DLNs)and 40 Treatment Counselling
Centers (TCCs), 6888 PLHAs were provided services through 10 Positive Living Centers
(PLCs)and 5 care and support centers. Training in different areas has been provided to peer
educators, counsellors and doctors in the program. NGOs have been trained in home based
care. Refresher trainings have been conducted for service providers.Three corporate ART centres
have been set-up, providing services to the larger community. MoUs have been signed with 4
more corporate centres for setting-up ART centres.
Care and Support Services
District level Network (DLNs)
127 DLNs have been established and 113,047 PLHAs have been enrolled in these DLNs.
37,832 PLHA on ART have been enrolled out of the total 113,047 PLHAs. The average
enrollment at each DLN has increased from 617 to 890 in the last one year.
DLNs have enabled the PLHAs to come together, participate in Support Group Meetings (SGM)
and have facilitated care and support services like counselling, home based care services,
nutrition support for children, linkages and referrals to other service delivery sites and treatment
education at the taluk level by trained peer educators.
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The information to PLHAs and their families on positive living, nutrition, tests and treatment
options, preventive behaviour, human rights, public speaking, advocacy and networking has
helped PLHAs to overcome isolation and take control of their lives.
PLHAs enrolled at DLNs
Promoting Access to Treatment Campaign
INP+ organized the “Promoting Access to Treatment” Campaign across the six states. This
campaign has helped in increasing awareness and knowledge among the key district level
government functionaries, other stake holders and people living with HIV on care, treatment,
positive prevention and services available.
Interaction Meeting
Interaction meetings with the service providers, care givers and the PLHAs were conducted at
the district level in coordination with the DLNs. These meetings helped Service Delivery
Points in strengthening linkages. It also provided an opportunity to PLHAs to bring out their
problems and seek explanation and support from the service providers. Some of the interaction
meetings were organized inside the government hospitals which helped the DLN to improve
rapport with the ART center and other departments of the hospital.
Exposition
A two day exposition in each of the six states was planned. Around 100 PLHAs from each
state, representing various DLNs participated. It was envisaged that the event would enable a
better understanding of the access to care and treatment, disseminate the learnings and promote
the concept of positive living through various activities.
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The PFI state unit of Maharashtra, along with Maharashtra Network of People living with HIV/
AIDS (MNP+) organized an exposition to celebrate International Women’s Day by involving
Women Living with HIV (WLHA) from DLNs of Maharashtra. The concept was to bring women
together and provide them a platform where they receive information on the issues related to
HIV and treatment. There were sessions on income generation programs and vocational
training, inheritance, rights of women and treatment and adherence. These sessions were
facilitated by Chaitanya and Kasturbha Gandhi College, Lawyers Collective and National AIDS
Research Institute (NARI). The DLNs enacted street plays, displayed handicrafts and participated
in the cultural events. There were rangoli and poster competitions.
Good Practices
• The State Social Welfare Board, Nagaland provided financial support of Rs.1,00,000
(Rupees One Lakhs) to the State Level Network as seed money for preparation and
distribution of nutritious diet to the PLHAs.
• Kolhapur DLN prepared a snake and ladder game for providing life skills education
to adolescent groups.
• Thane DLN started a self help group of 16 women. Each member of the self help
group contributes Rs.50/- a month towards savings. The savings are being used for
Income Generation Programs (IGP) such as preparation of food and dress materials.
• The Inner Wheel Rotary club of Deonar, Mumbai agreed to support the nutritional
needs of 3 Women Living with HIV/AIDS for three months.
Treatment Counseling Center
Treatment Counseling Centers have been set-up in this program in the ART health facilities.
The TCCs have complemented the government ART centers in providing group and individual
counseling on treatment adherence. The TCC staff have coordinated with ART centers in
obtaining the list of defaulter cases. These cases have been followed up through the DLN
outreach.
Positive Living Centre (PLC)
Positive Living Centres have been set-up in the high prevalence districts within the states to
provide (a) Health and medical care services which include health promotion, health monitoring
for PLHAs and their families, treatment for minor opportunistic infections, psychological support,
outreach activities for promotion of preventive behaviour, treatment education and adherence
(b) Nutritional supplement, educational support, life skill education and recreational trips for
children infected and affected, (c) Networking with local stake holders like government hospitals,
Primary Health Centres, Taluk hospital, ART centre and NGOs to access care and support
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services, and (d) Advocacy to sensitize the stake holders for referral. In this program, 10 PLCs
were established and 6888 PLHAs received services from the PLCs.
Children’s Club Activity & Drop in center at Pune PLC
PLC, Pune, Maharashtra formed 10 children clubs in 7 different communities. They
trained children on life skills education using Family Health International module. In
addition, activities like puppet shows, story telling, movie, birthday celebration etc., were
carried out.
A trading company agreed to support 60 children (Rs 250 per child per month) for their
nutritional requirements. Currently PLC is providing nutritional support to 50 children.
PLC obtained support from local advocates and “Mahila Suraksha Samiti” (a committee
of 6 people - 2 police, 2 NGO representatives and 2 lawyers) on legal issues of PLHAs.
Comprehensive Care and Support Centers (CCSCs)
Out-patient and in-patient services to PLHAs were provided from the Comprehensive Care
and Support Centres run by Freedom Foundation at Guntur, Andhra Pradesh and St. Joseph’s
Leprosy Hospital & HIV/AIDS Care center at Tuticorin, Tamil Nadu set-up in Phase I of the
program. Two more CCSCs were setup by Freedom Foundation during the year. The centers
are run from Trichy, Tamil Nadu since December 2007 and Bagalkot, Karnataka since February
2008. PFI has also sub-granted to Development Association of Nagaland to run a 10 bedded
CCC in Dimapur, Nagaland.
Centers at Guntur, Trichy and Bagalkot have a capacity of 50 beds each, the center at Tuticorin
has a capacity of 20 beds and DAN, Nagaland is a ten bedded center. The range of services
available at the center includes clinical management, psychosocial and nutritional support.
The services are provided free of cost from these centers to PLHAs.
Corporate ART Centers
Corporates have played an important role in scaling up interventions for HIV/AIDS prevention,
care and treatment. Through this program, Confederation of Indian Industry (CII) advocated
with corporates to set up corporate ART centers. CII facilitated the setting up of 3 corporate
ART centers through larger advocacy meetings and subsequent follow-up with corporates. CII
has also entered into an MoU with NACO for free ARVs, rapid test kits and OI drugs for the
Corporate ART Centers
Care and support services have been provided from the corporate ART centers set up at Wadi,
Karnataka with the support of Associated Cement Companies Ltd., and at Ballarshah,
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Maharashtra with the support of Ballarpur Industries Ltd., Maharashtra in Phase I of the program.
During Phase II (Year 1) of the program, with the support of Associated Cement Companies
and Christian Medical College, Vellore, Tamil Nadu, one more ART centre has become
operational. These centers provide counselling, opportunistic infections management and
ART services.
Four more corporate ART centers have been identified and MoUs have been signed between
CII and the corporates to run the activities from those centres. However, there have been
certain procedural delays in the formal site assessment and signing of MoUs between the
corporate agencies and NACO.
BILT ART centre at Ballarshah, Dist Chandrapur, Maharashtra
The unit of Ballarpur Industries Ltd (BILT) is located in Ballarshah which is one of the
high prevalence areas for HIV/AIDS in the country. BILT has a hospital, Voluntary
Counselling and Testing Centre (VCTC) and ART centre. The ART centre is situated within
in the hospital premise and is open to the community. The center is equipped with
machines and equipment including CD4/ CD8 cell counting machine. Up to March
2008, 634 individuals have been counselled and 208 PLHAs put on ART. The centre has
referral linkages for specialised services / inpatient admission. The BILT ART centre also
receives blood samples from the Chandrapur government ART centre for CD4 testing –
another milestone in the public private partnership.
Capacity Building
Capacity building has continued to be an important component in this program. EHS through
the training modules developed during Phase I of the program, continues to provide training to
various categories of service providers through the Continuing Education and Training Centres
(CETCs) set up in Chennai, Tamil Nadu; Mysore, Karnataka and Imphal, Manipur. The objective
is to increase the number of NGO sector providers capable of delivering quality care and
support services in accordance with the national guidelines. 112 peer educators, 193
counsellors, 15 health care workers and 7 doctors have been trained from district level
networks, treatment counselling centers, positive living centers and comprehensive care and
support centers. 65 NGOs from six states have also been trained on home based care.
Continuing Education and Training Centers (CETCs)
In Phase – I, Engender Health Society had established two Continuing Education and Training
Centers (CETCs) to train counsellors, social workers, master peer educators and health care
providers (doctors, nurses, paramedics). The CETC, Swami Vivekananda Youth Movement
(SVYM) Mysore, Karnataka covers the states of Karnataka and Maharashtra and DESH in
Chennai, Tamil Nadu covers the states of Andhra Pradesh and Tamil Nadu. In phase II,
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Engender Health Society has identified Diocesan Social Service Society (DSSS), Manipur for
setting up a CETC to cover the states of Nagaland and Manipur.
IEC Material Development
While implementing the program, IEC material was a felt need in peer education. A workshop
and series of meetings on Common Minimum Program (CMP) and IEC was held with national
team and state level networks of INP+. The workshop brought out the key activities associated
with the service delivery points, IEC materials required and the key messages to be produced.
PFI identified New-Concept Information Systems, New Delhi to facilitate and develop the
prototypes of IEC material keeping in view the needs of peer educators and out reach activities
in the service delivery areas.
Monitoring and Evaluation
Training on MIS and CMIS
The Monitoring and Evaluations systems for effective implementation of the program were
further strengthened by conducting various trainings for MIS and CMIS. Two days MIS and
CMIS refresher training was organized by PFI for INP+ and SLN teams of INP+. Refresher
trainings on MIS were conducted for 115 DLNs. Trainings were also conducted for the staff of
the newly established service delivery points in the year.
External Program Evaluation
An external program evaluation to review the program performance for phase I was completed
in April 2007. The team submitted their report providing recommendations and suggesting
corrective measures for the program.
External MIS Audit
The second round of external MIS audit was conducted for assessing the quality of the program
data and assisting sub recipients to improve the quality of reporting. During the second round,
audit was undertaken to determine the improvement in the data quality systems among the
DLNs that were audited in the first round and to assess the quality of data among other DLNs
that had not undergone the first round of audit. The audit covered a total of 24 DLNs which
included 9 DLNs which had undergone first round audit and 15 new DLNs.
Special Studies
Three special studies that were conducted by PFI were disseminated in a satellite session at the
4th Asia Pacific conference of Sexual and Reproductive Health in October 07 at Hyderabad.
The following were the three studies disseminated:
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i) Assessing PLHA expectation regarding care and support services with a view to
strengthening networks of PLHA ;
ii) Understanding support group meetings of People Living with HIV/AIDS ; and
iii) Setting up guidelines for providing care and support services including palliative
care for People Living with HIV/AIDS.
In the year three of the program PFI instituted the following two studies.
• Client satisfaction at Positive Living Centers; and
• Towards an integrated Continuum of Care (CoC) for Injecting Drug Users (IDUs),
including People living With HIV, in Imphal, Manipur: situation assessment of services
and action plan for CoC
Round 6 HIV/AIDS program - “Promoting Access to Care and Treatment (PACT)”
District Level networks
35 District Level Networks were set-up in the states of Uttar Pradesh, Rajasthan and Madhya
Pradesh. These provided care and support services to 1446 PLHAs. DLNs have enabled the
PLHAs to come together, participate in Support Group Meetings (SGM) and facilitated care
and support services like counselling, nutrition support , linkages and referrals to other service
delivery sites, tracing of defaulters , mobilizing general community for testing and linking
People Living with HIV/AIDS with other government schemes.
Community Care Centre
Out-patient and in-patient services to PLHAs are being provided from the Community Care
Centres set up by Catholic Bishops’ Conferences of India and Hindustan Latex Family Planning
Promotion Trust. 30 Community Care Centres have been set-up across the eight states and
have provided care and support services to 3250 PLHAs The services include care and treatment
for minor opportunistic infections (OI), counseling, referral and defaulter tracing.
Joint Appraisal of Organisations to set up CCC-
Joint Appraisal Teams were constituted along with SACSs and sub-recipients in each of the
states for sub granting the NGOs/CBOs to set up Community Care Centers.
Coordination at the District level
Regular meetings have been taking place at the district level among the CCC, ART centre and
DLN in the states of Gujarat, West Bengal and Uttar Pradesh. Meetings have been initiated in
other states as well for smooth coordination among all stakeholders at the district level so that
PLHAs have easy access to treatment and care and receive quality services.
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In these meetings, the structure and system of CCC, DLN and ART were shared with the
participants, and expectations of each structure from the other structures are also explained.
Advocacy Meetings (with PRI, Health and ICDS)
The Global Fund Round-6, proposal aimed to “create an enabling environment for multi sectoral
convergence to mainstream, converge and integrate gender, reproductive health and HIV/
AIDS”.
In line with this, advocacy workshops were organized by Population Foundation of India in
Seoni and Balaghat districts of Madhya Pradesh on 12th and 13th of March 2008 for district and
block level health functionaries, Integrated Child Development Scheme and Panchyati Raj
Institution (PRIs) to mainstream HIV/AIDS and focus on reducing stigma and discrimination.
The objectives of the advocacy meetings included;
• Building an understanding on HIV / AIDS issues among stakeholders.
• Exploring avenues of coordination among stakeholders at the district, block and
community level.
• Developing interest among PRIs to address issues around HIV/AIDS at various tiers
of the Panchayat Raj System.
From the Desk of Collector Balaghat, MP
“ It is good that Population Foundation of India has taken initiatives to mainstream the
HIV/AIDS with other community Development Programs. Indeed it is required for Seoni,
the prevalence rate in the district must be high due to NH-7 and as it borders with
Maharashtra. I also request PFI not to close the issue at this level but also conduct such
workshops at block and cluster level. The District Administration will support in every
way to create awareness on HIV and mainstreaming with other schemes.”
Observation of World AIDS Day on 1st December
PFI regional units observed the “World AIDS Day” on Dec 1, 2007 along with SACS and the
state level networks.
On 1st December 2008, PFI Regional Unit MP joined hands with FPAI and UNFPA to organize
awareness activities. The theme of the day was “Youth Leadership” .
On the occasion of World AIDS Day, Population Foundation of India, New Delhi also organized
a meeting to discuss on issues involving prevention of HIV and care and support services
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among people living with HIV. On this occasion, PFI team arranged a street play where PFI
staff, representatives from key civil society organisations and local stakeholders (taxi / auto
unions, street / local vendors) from the adjoining area participated. PFI state units observed the
“World AIDS Day” on Dec 1, 2007 along with SACSs and state level networks (SLNs).
Red Ribbon Express: - PFI UP Team participated in the Red Ribbon Express. This Red Ribbon
train was in Lucknow for three days and Ms. Mukta Sharma, PFI Regional Coordinator, UP
and the officials of State Level Network facilitated the different trainings organized for
government officials.
Program Management
The PFI Program Management Unit at New Delhi, the PFI State Programme Coordination
Units (SPCUs) and the PFI Regional Programme Coordination Units along with the sub-grantees
have been instrumental in implementing the program and have established systems for managing
and monitoring the program.
National Level Reviews and Consultations
• Project Advisory Board (PAB) constituted by PFI for the program, met at regular
intervals. Experts from the field of HIV/AIDS, sub-recipients and PFI’s Board members
constitute the PAB. They reviewed the program and suggested corrective measures.
• At the national level, NACO and PFI reviewed the program every quarter. In addition,
PFI formed a coordination committee with NACO to review the program. The
quarterly reviews helped in understanding and solving issues related to policies and
procedures at the national and state levels.
• Regular interactions with Sub-recipients (SR) at the national level have been
conducted. These meetings have resulted in improved coordination between PR
and SRs helped in identifying gaps in the program. Possible strategies have been
worked out based on the identified gaps. The meetings with SRs have also enhanced
the coordination.
• A Coordination, Planning and Review meeting for the Global Fund Round 4 Program
‘Access to Care and Treatment –ACT’ with the State Programme Units of Population
Foundation of India (PFI) and Indian Network of People living with HIV/AIDS (INP+),
was held in April 07. The focus of the meeting was to discuss the achievements and
challenges faced in Phase I and plans for Phase II
• A four day joint Review and Planning Meeting for the Global Fund Round 4 ‘Access
to Care and Treatment – ACT’ and Round 6 ‘Promoting Access to Care and Treatment
– PACT’ Programme was conducted at Bangalore in January 2008. The national,
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state and regional program teams of Round 4 and Round 6 participated in the meeting.
The purpose of the meeting was to share the experiences of R-4 and R-6 teams and
the progress made in the respective regions. This also provided ample opportunity
to learn from each region. Sessions on basics of HIV/AIDS, counselling, care and
support and stress management were undertaken in addition to the regular progress
review.
State Level Reviews and Consultations
• State level program coordination committees have been formed with respective State
AIDS Control Societies in the six states for Round 4 and eight states for Round 6
program. The state level committees reviewed the program at state level and sorted
out issues on program implementation. The Project Directors of SACS chaired the
meetings convened by the PFI State and Regional Coordinator.
• Regular visits to the service delivery points by the PFI state team helped in building
capacity in terms of technical, managerial, financial and reporting skills of the staff
at DLNs, TCCs, PLCs and CCCs. The PFI state team facilitated the implementation
of MIS and CMIS at service delivery point level.
Facilitation by the Global Fund
• As part of the monitoring program, the Global Fund’s Local Fund Agent( LFA) team
had visited the states of Tamil Nadu and Nagaland
• The Executive Director, The Global Fund to Fight AIDS, TB and Malaria (GFATM)
Prof. Michel Kazatchkine, and Chairman, The Global Fund Board,, Mr. Rajat Gupta,
along with Team Leader, Mr. Taufiqur Rahman and a team of The Global Fund
visited India during 18-21st December, 2007. The team visited the state of Tamil
Nadu as part of their field program.
• Mr. David Addison from the Office of Inspector General, The Global Fund visited
the PFI office as part of the program audit on 2nd of November 2007. He conducted
a detailed review of the program, MIS and finance of the Global Fund Round 4 and
Round 6.
• A two day meeting of Private Sector Partnership to fight against HIV/AIDS,
Tuberculosis and Malaria was organized by the Global Fund in New Delhi on 13th
-14th December, 2007. The Global Fund partners in the South and West Asia
cluster, NACO, CCM, UNAIDS, ILO and representatives from the private sector
participated in the meeting.
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• The Global Fund organised a conference on Financial Management under
Performance-Based Funding, 25 to 27 July, 2007 in Hotel Oberoi, Kolkata India
during 25th – 27th July 2007. Many countries presented their experiences in
implementation of the program. PFI shared its experience as a Principal Recipient
from India on ‘Coordination to Ensure Good Reporting – Issues, Challenges and
Practices’ in the workshop.
• WHO South East Asia Region organised a workshop in Bangkok to address capacity
development in grant negotiation and implementation in collaboration with The
Global Fund South West Asia cluster. The workshop deliberated on the problems
faced by countries in grant negotiation and implementation. Signing of grants after
approval got often delayed because of the negotiation processes. Representatives
from the countries of Afghanistan, Bangladesh, Bhutan, India, Iran, Nepal, Pakistan,
Srilanka, Maldives, and Thailand attended the conference. Population Foundation
of India and Tata Institute of Social Sciences as NGO Principal Recipients participated
in the workshop.
Be Positive (Venilla’s story – in her own words)
I am Vennila, I am a 29 year old woman living with my three sisters in Vepanamputhur village
few kms away from Namakkal district in Tamil Nadu. My father is in real estate business and
my mother is a house wife. I got married in 1997, when I was doing my graduation. My
husband owned a lorry. I have a 9 year old son. Currently, I am working as In-charge Counsellor
in Treatment Counselling Centre, Namakkal.
In 2001 my husband was very sick, he was tested and found to be HIV positive. The doctors
asked me and my son to take the test too. I was found HIV positive and my son was negative.
When they told me I was HIV +, I thought it is probably a kind of blood group. During the
counselling given to me at voluntary counselling and testing center (VCTC) they explained that
what is HIV and what it does to my body.
I was in complete shock and even before I could understand the implications of the test in my
life my husband passed away – it only took two months time. In all those times of sadness
there was one comfort – my son’s HIV status is negative.
After the death of my husband, my in-laws were not supportive and were not willing to share
the property with me and my son. My parents supported me.
For me, the biggest challenge was accepting my own HIV status – as after my husband’s death,
I believed that there was no purpose in living. My son was my only hope and reason to
continue to live. My mother, who is my biggest strength, motivated me to get qualified better.
I voluntarily worked for an NGO Anbukarangal as an out reach worker providing service for
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PLHIV in 2001. I joined a support group of people living with HIV - HIV Ullor Nala Sangam
(HUNS) in 2003. This was a moving experience, I had friends who were positive too and I felt
that I am not alone. When INP+ became part of the first consortium to support treatment
program of the government, by virtue of being the staff at HUNS I was initiated into ACT
project in 2005. As I was a good speaker and made friends easily, they chose me to be the peer
treatment Counsellor.
After joining Treatment Counseling Centre, my first training on Treatment Education was EHS’s
counsellors/social worker training on ART & Adherence provided in early 2006. I was trained
as the master trainer through the trainings of Engender Health Society focusing on HIV treatment
education and counseling. I also was part of the follow up training which was provided in last
2007. Training in my mother tongue Tamil helped me and my team to improve our counseling
on ART, adherence, side effects, resistance and positive living to PLHIV’s accessing our centre.
The follow up training helped me to understand the various opportunistic infections and the
second line drugs.
Living with HIV for many years, I would like to say that if one has proper information, HIV is
like any other long term illness like Diabetes or Hypertension - we can also continue to live
just like others. Life is the same for everyone - a varied mixture of happiness and sorrow. As
a positive person, I am able to think positively at any point of time, even in the worst situation,
my confidence level can equal or is even much better than a person without HIV.
My aspirations are high; I want to be a role model for the entire HIV positive community in the
country or may be even the world. I am currently on first line drugs for HIV. I take it as if it is
my only option; I am completely dedicated in my adherence to the drugs so that I can postpone
taking the 2nd line drugs as far as possible. I am hopeful that I can see my son graduating from
college and making his life better- so it is my aspirations that keep me going, I don’t miss my
drugs.
I was a simple village woman, my house and my family was my boundary, nothing existed
beyond them. My life with HIV has taught me to move beyond these boundaries and while
taking care of my son, I am also able to help people like me -who are HIV positive to live
healthy lives.
A Success Story at Navjeevan CCC
I am Gopal, 50 years old. I used to work as truck cleaner which was the only source of income
for my family. I have four children. I worked hard day and night. But I was not keeping well
from the last few months. Often, I was getting fever and diarrhoea.
But I did not pay any attention to it and did not go to the hospital. I kept taking medicine from
the local chemist shop and continued with my work. As a result, my health deteriorated day
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by day and it got so serious that finally my neighbors had to take me to the hospital where they
got my blood test and other tests done. The doctor gave me medicines for one week but after
few days I became sick again. I was taken to the hospital for the second time. This time the
doctor told me to go for HIV test. I went for it reluctantly and the test results revealed I was
HIV positive.
I was shocked and I did not know what to do. I sat down right there and cried the whole day.
One of the outreach workers of the CCC and asked me, ‘why are you crying’? Then I told him
that I am HIV positive and please do not come near me. But he came and sat near me and gave
me a card of Navjeevan CCC and suggested that I should come to the centre. I had lost all my
hope at that time and was thinking of dying as I thought no one will accept me and I will not
be able to live a normal life again.
But meanwhile a thought came to my mind that who will look after my children after my
death. Since the outreach worker motivated me, I decided to go and see the centre. I went
there and what I saw was unbelievable. There, all PLHIV are treated like normal patients with
much love and concern. There, I saw many patients like me , and all the staff were very
compassionate. I registered my name in the centre and they made me understand the value of
life and that AIDS is not the end of life.
They even introduced me to other people like me, the living examples. Since I was very weak
they admitted me there for two days and every day they provided me with counselling, medicine
and good nutrition. I felt a ray of hope in my life. I felt as if I have got my life back. Yes,
Navjeevan centre gave me a new life! Today I look at my life positively and live POSITIVELY.
I have started my ART and am living happily with my children. I wholeheartedly thank Navjeevan
CCC staff and the people behind the centre who are working for this noble cause.
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Publications during the year
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2007-2008
State of Health in Bihar
A comprehensive and user friendly document, ‘State of Health in Bihar’ was published in
October 2007. This publication brings out the realities of the health and population scenario
of the state of Bihar based on latest data. It reflects the current context of the health status and
the gaps and priorities, which need to be addressed in a development-oriented approach. The
publication is meant to be a comprehensive reference for policy makers, the state government,
district administration, planners, programme managers and NGOs for the State of Bihar.
Infant and Child Mortality in India
PFI undertook an exercise to provide indirect estimates on vital rates of mortality (Infant and
Child Mortality) for the states and districts of India based on the 2001 Census data in the year
2007. The publication on Infant and Child Mortality in India: District Level Estimates was
brought out in May 2008. This publication would be useful to the academia, researchers,
policy makers, planners and programme managers involved in the process of development.
Reducing Infant Mortality in Bihar
This publication was brought out by Population Foundation of India’s Regional Resource Centre
(RRC) Team. In Bihar approximately 16 infants of less than one year age die every hour and
approximately 400 infants die every day due to lack of health services. The state accounts for
22.9% infant deaths (01 year) against the all-India figure of 18.5%. This publication depicts the
grim realities by comparing the state scenario with global and all India situation using selected
indicators in the districts of Bihar.
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The Future Population of India: A Long-range Demographic View
India’s population passed the one billion mark in 2000 and this year, the
country celebrated its 60th year as an independent nation. Its population is
likely to surpass China’s as the World’s largest within next 20 years. All of
this leads quite naturally to the question: how large might the population
of the world’s largest democracy become? This is the question that the
Population Foundation of India and the Population Reference Bureau,
Washington D.C have aimed to address in an exercise to project India’s
population for the long term. This exercise culminated in the form of a
publication ‘The Future Population of India: A Long Range Demographic
View.’.
HIV/AIDS in India;
Facts, Figures and Response to HIV/AIDS in Uttar Pradesh
and
Facts, Figures and Response to HIV/AIDS in Bihar
Three chart books on HIV/AIDS in India, Uttar Pradesh and Bihar
jointly prepared by Population Foundation of India (PFI), New
Delhi and Population Reference Bureau, Washington D.C.,USA
are intended to present the facts of HIV/AIDS in a clear and
concise format for the use of NGOs, journalists and all those
who work in the field of HIV for quick reference to facts about
HIV in India. PFI and PRB have been bringing out such chart
books for India and states since 2003 in a bilingual format, Hindi
and/ or the official state languages to be of use to as wide an
audience as possible.
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Good Practices: In Facilitating Access to Care and Treatment - A Study of District Level
Networks for People Living with HIV/AIDS
This study was conducted by Population Foundation of India in coordination with INP+
under the project “Access to Care and Treatment” in six HIV high prevalence states in India
funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria under Round 4 grant. PFI
and INP+ identified, during their field visits, 23 district level networks (seven in Andhra
Pradesh, five in Maharashtra, six in Tamil Nadu, three in Karnataka and two in Manipur) and
two Treatment Counselling Centres in Tamil Nadu as having evolved good practices that
could serve as models for replication and scaling-up. As a result, PFI in association with
Solidarity and Action Against the HIV Infection in India (SAATHII) documented this study
based on evidence generated from the organizations, their beneficiaries and external
stakeholders, using qualitative research techniques. It is useful for networks of people living
with HIV/AIDS across the country and to managers implementing care and support programmes.
The study entitled Setting up Guidelines for Providing Care and Support Services including
Palliative Care for People Living with HIV/AIDS was conducted by PFI under the project
“Access to Care and Treatment” in six HIV high prevalence states in India funded by the
Global Fund to Fight AIDS, Tuberculosis and Malaria under Round 4 grant. PFI identifies
integral elements of the programme needing special attention and facilitates special studies to
improve coverage, effectiveness and ultimately help the beneficiaries. The findings and
conclusions of the study would be of use to NACO/SACS and other organizations/centres
involved in care and support programmes for people living with HIV/AIDS.
The study on Assessing PLHA Expectations Regarding Care and Support Services with a view
to Strengthen Networks of PLHA was conducted to explore the nature and range of expectations
of the PLHA with regard to the treatment, care and support services with a view to strengthening
the capacity of DLN to meet these expectations and enable DLNs to make an action plan. It
provides a strategic direction to the networks of PLHA in providing quality care and support
services to PLHA. PFI conducted this study among PLHA, local service providers and DLN
staff in Tamil Nadu, Karnataka and Andhra Pradesh. The findings of this study would be
useful to INP+/PFI in designing strategies for strengthening the capacity of DLNs and effectively
addressing the expectations of PLHA regarding treatment, care and support services.
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Jharkhand
Population Foundation of India
(Packard Project)
C/o Mr Dawlal Mohta
E-38, Ashok Vihar, Post Argora
Ranchi – 2, Jharkhand
Tel: 0651-2242338
Email: pfijharkhand@gmail.com
Bihar
Population Foundation of India
(Packard Project)
123-A (1st Floor)
Pataliputra Colony
Patna-13
Tel: 0612-6510312
Population Foundation of India
(Regional Resource Centre)
123-A (1st Floor)
Pataliputra Colony
Patna-13
Tel: 0612-2270634
Chhattisgarh
Population Foundation of India
C-5 & C-6, Sahni Vihar
Raipur-492006
Chhattisgarh
Tel: 0771-4013065
PFI STATE OFFICES
Andhra Pradesh
Population foundation of India
Andhra Pradesh State Coordination
Office
House no. 6-1-282/F, Street no.5,
Padmarao Nagar
Secunderabad – 500025
Ph.no. 040-65999770
Email: pfiapsco@yahoo.com,
pfiapsco@gmail.com
Manipur
Population Foundation of India
Saga Road
Thouda Bhabok Leikai (Near Royal
Sound)
P.O. Imphal- 795001, Imphal West,
MANIPUR
Ph.no. 0385-2445072
Email: pfimanipur@rediffmail.com
Tamil Nadu
Population Foundation of India
Old no. 89, New no. 109
South West Boag Road
T. Nagar,
Chennai - 600017
Ph.no. 044-24329074
Email: pfichennai@gmail.com
Karnataka
Population Foundation Of India
“SAURABHA”1657/A, 3rd Cross,
Prakash Nagar, Rajaji Nagar, 2nd Stage
Bangalore-21
Ph: 080-41285706
pfibangalore@gmail.com,
ka_sco@yahoo.com
Maharashtra
Population Foundation of India
604, Raiker Chambers
Govandi, Mumbai-400088
Ph.no. 022-65029710
Email: mahapfi@gmail.com
Nagaland
Population Foundation of India
Nagaland State Program Coordination
Unit,
OC-15, 2nd floor, Naga Shopping
Arcade,
Near Town Hall. ,
Dimapur – 797112, Nagaland.
Tel: 03862 – 234009
popfound_nagaland@yahoo.co.in
PFI REGIONAL OFFICES
Rajasthan
Population Foundation of India
Plot no. 66, Geejgarh Vihar,
Hawa Sadak,
Jaipur – 302019
Ph: 0141-2210680
Email: pfirajasthan@gmail.com
Madhya Pradesh
Population Foundation of India
M – 6 and 7
Guru Kripa complex
Plot no. 9 – 10
M.P. Nagar Zone – 1,
Bhopal
Ph.no.0755-2550647
Email:pfi.madhyapradesh@gmail.com
Uttar Pradesh
Population Foundation of India
A-743, Ground Floor
Indira Nagar
Lucknow-206016
Ph: 0522-2353838
Email: pfiuttarpradesh@gmail.com
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annual report
2007-2008
DELHI OFFICE
Mr A.R.Nanda
Mr.S.Ramaseshan
Dr. Kumudha Aruldas
Dr. Almas Ali
Ms.Sona Sharma
Dr.S.G.Neogi
Dr.Lalitendu Jagatdeb
Mr.R.R.Subramanian
Mr. CSN Murthy
Ms.Chandni Malik
Mr.Satyavrat Vyas
Mr Nihar Ranjan Mishra
Debabratta Bhuniya
Ms.Lopamudra Paul
Ms. Sudipta Mukhopadhyay
Mr. Satya Ranjan Mishra
Mr Rakesh Kumar
Ms Shrabanti Sen
Dr. Mary Verghese
Mr. S. Vijayakumar
Mr.Subrat Mohanty
Dr.Phanindra Babu Nukella
Ms Aparna G.
Ms Rashmi Sharma
Bijit Roy
Tripti Chandra
Neeraj Mishra
Ritu Kumar Mishra
Sangeeta Shrivastava
Milan Rana
Mr. Sushil Kr. Pandey
Sanjeev Ranjan
Mr. Sunil Kr. Singh
OUR TEAM
Executive Director
Secretary & Treasurer
Additional Director
Senior Advisor (Part time)
Joint Director (Advocacy & Communication Div)
Joint Director (Programme Div)
Joint Director (Monitoring & Evaluation Div)
Administrative Officer
Finance Officer
Programme Officer (Advocacy & Comm)
Programme Officer (Program Div)
Programme Officer (M & E)
Programme Associate (PD, RRC, CSR)
Programme Associate (M & E)
Project Manager (Packard)
Project Manager (Packard)
Sr Project Manager (Scaling up)
Project Manager (Scaling up)
Project Director (Global Fund HIV/AIDS)
Sr. Grants Manager (GF)
Sr. Program Manager (GF)
Sr. Strategic Information & Evaluation – Manager (GF)
Sr. SIE – Associate (GF)
Sr. Program Associate (GF)
Prog. Associate (GF)
Prog. Associate (GF)
SIE – Associate (GF)
SIE – Associate (GF)
Admin. Cum Proc. Officer (GF)
Accounts Officer (GF)
Accounts Officer (GF)
Asst. Accounts Officer (GF)
Jr Associate – HR cum Procurement (GF)
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Ms.Manju Sharma
Mr. P J Sekhran
Ms. Veena Gopal
Ms.Prema Ramesh
Ms.Jolamma Jose
Mr.A Ramanathan
Ms.Leelamma Mathew
Ms.Usha S Nair
Mr.Rakesh C Joyal
Mr.Joseph George
Mr.Shailender S Negi
Mr.Mohan Singh
Mr.P.K.Paul
Mr.Venkatachalam
Mr.Arogya Dass
Mr James Anthony
Mr. P. Narayanan
Mr. Shyam Lal
Ram Narayan
Gourav Sindhi
Ms.Kanta
Mr.Kamlesh Kumar
Mr.Sanjay Ekka
Mr.Vijender Kumar
REGIONAL/ STATE TEAMS
Bihar
R.U Singh
Matish Kumar
Sanjay Kumar Singh
Amrit Kumar Rawat
Sudhir Kumar
Arun Kumar
Jharkhand
Nikita Sinha
Aprajita Mishra
PRO
Executive Assistant (To ED)
Personal Secretary
Sr. PA cum Prog. Assistant
Pa Cum Prog. Assistant
Jr Accounts Officer
Assistant Accountant
Recep. Cum Tel. Operator
Assistant Librarian
Record Clerk
System Administrator
Daftri
General Maint.Exec.
General Maint. Assistant
Driver (ED)
Driver (GF)
Messenger
Messenger
Messenger (GF)
Messenger (GF)
Pantry Attendant
Helper
Mali
Helper
Honorary Advisor (For Bihar and Jharkhand)
Coordinator (RRC)
State Project Coordinator (Packard)
State Project Associate (Packard)
Project Associate ( Admin & Finance )
Project Associate ( IT )
State Project Coordinator (Packard)
State Project Associate (Packard)
annual report
2007-2008
107
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annual report
2007-2008
Chhatisgarh
Mr Jagannath Kompella
Mr Suraj Baghel
Andhra Pradesh
Mr. Vikas Panibatla
Ms. Neela Santhi R.
Tamil Nadu
Mr. K. Balasubramanian
Mr. Alwin Leone Das D.
Karnataka
Mr. A. S. Kulloli
Mr. Prasad Kumar A
Manipur
Ms. Archana Oinam
Mr. Yumnam Sanjoy Singh
Maharashtra
Mrs. Rohini Gorey
Ms Vijaya P. Kanase
Nagaland
Mr. Veswukholu Everista Kapu
Mr. R. Vitsiatho Nyuwi
Rajasthan
Dr. Sudhir Verma
Ramesh. C. Parmar
Ashish Kumar Amber
Subhash Kumar Sharma
Madhya Pradesh
Md. Raza Ahmed
Achint Verma
Mini Ramchandran
Uttar Pradesh
Mukta Sharma
Rajeev Kumar Singh
Durga Prasad Gupta
Training Coordinator (RRC)
Junior Consultant (RRC)
State Programme Coordinator (GF)
Asst. State Prog. Coordinator (GF)
State Programme Coordinator (GF)
Asst. State Prog. Coordinator (GF)
State Programme Coordinator (GF)
Asst. State Prog. Coordinator (GF)
State Programme Coordinator (GF)
Asst. State Prog. Coordinator (GF)
State Programme Coordinator (GF)
Asst. State Prog. Coordinator (GF)
State Programme Coordinator (GF)
Asst. State Prog. Coordinator (GF)
Honorary Advisor fir Rajasthan
Regional Coordinator (GF)
Asst. Regional Coordinator (GF)
Technical Assistant (GF)
Regional coordinator (GF)
Asst. Regional Coordinator (GF)
Technical Assistant (GF)
Regional coordinator (GF)
Asst. Regional Coordinator (GF)
Technical Assistant (GF)
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Population Foundation of India
B-28, Qutab institutional Area, Tara Crescent,
New Delhi