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Popfocus 2009 October December English PFI |
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Volume XXII; No.4 October–December 2009
THE POPULATION FOUNDATION OF INDIA NEWSLETTER
Positive Voices from the Field
Population Foundation of India
organized a national consultation
on “Promoting Access to Care
and Treatment: Positive Voices
from the Field” during December
9-11, 2009 at Vishwa Yuvak
Kendra, New Delhi. Around 350
representatives from 14 state
PLHIV networks, where Population
Foundation of India and its partner
agencies operate, participated in the
event along with representatives from
NACO and SACS, bilateral and
multilateral agencies as well as
government departments providing
information on welfare schemes.
Ms Aradhana Johri, Joint Secretary,
Department of AIDS Control, Ministry
of Health and Family Welfare, was the
Chief Guest and Mr Patrice Coeur-
Bizot, UN Resident Coordinator and
UNDP Resident Representative in
India was the Guest of Honour at the
consultation.
Release of two documentary films “With Your Head Held High” and “Something New
in My Life” by Ms Aradhana Johri (third from left), Joint Secretary, Department of
AIDS Control, Ministry of Health and Family Welfare
The objectives of the national
consultation were to share the
experiences and initiatives undertaken
under the programme as a public-
private partnership model in
improving access to care and
treatment. The consultation brought
together a rich mix of individuals and
stakeholders engaged with the cause
of HIV/AIDS. The consultation
The session on ‘Universal Access to Treatment, Care and Support’ chaired by
Dr Damodar Bachani, Deputy Director General, NACO
Inside
National Dissemination Workshop
on the Ekjut Trial: Saving
Maternal and Newborn Lives
...3
Communitization Initiatives
in Bihar: Challenges Ahead
...5
SAMVEDNA: Setting New
Benchmarks to Ensure Safe
Motherhood
...6
Quality Family Planning Services
through Boat Clinics
...8
Swastha Aangan: Promoting
Healthy Families
...10
PFI Participation in XXXI
Annual Conference of IASP
...11
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From the Executive Director’s desk...
As the world moves into the new decade, there will
be more number of people living in urban areas
than in rural areas. In fact, the 20th century witnessed a
rapid growth in urban population. According to India:
Urban Poverty Report 2009, the next few decades will
see unprecedented scale of urban growth in the
developing world including those in Asia and Africa
continents.
With India becoming increasingly globalized and urban,
there is also an increase in the number of poor people
living here. As per the latest NSSO survey reports there
are over 80 million poor people living in the cities and
towns of India. The slum population is increasing day
by day. The ratio of urban poverty in some of the larger
states is higher than that of rural poverty leading to the
phenomenon of ‘Urbanization of Poverty’. Urban
poverty poses the problems of housing and shelter, water,
sanitation, health, education, social security and
livelihoods along with special needs of vulnerable groups
like women, children and aged people. Poor people live
in slums which are overcrowded, often polluted and lack
basic civic amenities like clean drinking water, sanitation
and health facilities. Most of them are involved in
informal sector activities where there is constant threat
of eviction, removal, confiscation of goods and almost
non-existent social security cover.
With growing poverty and slums, physical inability, social
discrimination by education, caste, sex and economic
stratification increases the gap between demand and
inadequate supply of services. Besides, the physical and
social factors due to lack of access to money, the poor
are unable to use health services and have less access to
the facilities in the public or private sector. Cost is a
greater barrier than the physical access to health
providers. There is no provision in the government
programme for the unorganized sector to get access to
medical benefits while the organized sector employees
have provisions for medical benefits. It is important to
set aside the misconceptions that have prevented the
health needs of urban populations from being fully
appreciated. The most urgent need is to acknowledge
the social and economic diversity of urban population,
which include large groups of the poor whose health
environments differ little from those of villagers.
Population Foundation of India recognizes the complex
issue of urban poverty and the urgent need to focus on
this extremely important but neglected population and
is in the process of developing programmes focusing
on the same with a multi-dimensional, rights-based,
bottom-up and gender sensitive approach.
A. R. Nanda
2
provided a platform for PLHIV to have direct interface
with the government and the private sector agencies
for livelihood options and availing social security schemes.
It also provided an opportunity to PLHIV to exhibit their
talents and learn from each other.
In the inaugural session Mr Taufiqur Rahman, Regional
Leader of the Global Fund for AIDS, Tuberculosis and
Malaria (GFATM) announced ‘up-scaling support’ for India.
Mr K K Abraham, General Secretary, Indian Network for
People Living with HIV (INP+) pointed out that the District
Level Networks of positive people are the ‘key’ to the success
in care and treatment.
Important and informative sessions were held on crucial issues
related to HIV. The session on “Universal Access to
Treatment, Care and Support” was chaired by Dr Damodar
Bachani, Deputy Director General, NACO. Panelists were:
Dr Rajesh Gopal, Gujarat State AIDS Control Society;
Dr Ashok Rau, Freedom Foundation; Dr Priyo Kumar,
JN Hospital, Manipur; and Ms Saroja Puthran, KNP+. The
session highlighted some of the unique efforts made by Gujarat
State AIDS Control Society, an ART centre in Manipur and
the Freedom Foundation in the area of care and support.
The session on “Community Based Care and Role of
Networks” was chaired by Dr Anjali Gopalan, NAZ
Foundation. The panelists were: Mr Umesh Chawla,
India HIV/AIDS Alliance; Ms Kavita Chandok, I-TECH;
Mr VS Gurumani, PCI; Dr Sanghamitra Iyengar, Samuha
Samraksha; and Ms U Kasthuri, District Level Network,
Ariyalur. The session brought forward different aspects:
how communities can be engaged in caring, rehabilitating
and normalizing the lives of those infected and affected by
HIV. It also brought out some powerful stories from the
exemplary work being done by the Positive Networks both
in creating awareness and helping positive people lead a
life of hope and dignity.
The session on “Role of Law in Promoting and Protecting
Rights of PLHIV” was chaired by Dr Alka Narang, UNDP.
Ms Shivangi Rai, Lawyers Collective, Mr V Palani,
TANSACS and Ms Kousalya, PWN+ were the panelists.
The session had presentations and a number of testimonials
from PLHIV. The focus of the session was to draw attention
to gaps in the legal framework and to create sensitivity,
awareness and an all-pervasive culture that could honour
the basic human rights of the HIV community, be it at
home, in the community, at the work place or at any service
delivery point.
It was followed by a session on “Social Security Schemes
and Health Insurance”, which was chaired by Dr Indrani
Gupta, Institute of Economic Growth (IEG). The panelists
were: Dr Anit Mukherjee, NIPFP, Dr Nishant Jain, GTZ,
Ms Debapritya Sen, PSI and Mr Jagdish Saini, DLN, Jalore.
The session discussed at length the need for having a strong
social and insurance sector that could cater to the needs of
those infected with HIV. It highlighted the challenges in
creating this protective shield and the issues that some of the
existing schemes had to go through before they could refine
and introduce the schemes amongst the target audience.
Contd. on page 7
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National Dissemination Workshop on the Ekjut Trial:
Saving Maternal and Newborn Lives
Over the past few years, PFI has
been facilitating scaling up of
innovative practices in the field of
Reproductive and Child Health (RCH)
and Young People’s Reproductive
and Sexual Health (YPRSH) in India.
One such initiative is the Ekjut trial
on “Improving maternal and
newborn health through the
empowerment of tribal
communities” in the backward
districts of Jharkhand and Orissa. The
trial was piloted by Ekjut, a
development organization with a
strong field presence in the states
of Jharkhand and Orissa, in
collaboration with the Centre
for International Health and
Development, University College
Dignitaries at the inaugural session
evaluated to assess the impact of the
intervention.
London (UK), Peri-natal Care Project
(Bangladesh) and Women and
Children First (UK). Women’s groups
set up by PRADAN, other local
organizations and Ekjut were engaged
in this effort to bring about improved
maternal and newborn health
outcomes through the process of
community empowerment.
The primary outcome indicators were
neonatal mortality and maternal
depression. Neonatal mortality was
much lower in the last two years of
the trial and there was an equally
impressive reduction in moderate post
natal maternal depression in the 3rd
year of the intervention. Significant
changes in home care practices were
The cluster randomized controlled
trial was conducted in three
contiguous districts in Jharkhand
and Orissa (West Singhbhum and
Saraikela-Kharswan in Jharkhand
and Keonjhar in Orissa), where
approximately half of the population
belongs to tribal communities. After
a prospective baseline of nine
months, Ekjut facilitated the
also observed. Put through an equity
lens, the results showed that the
maximum benefit accrued to the
most marginalized women in the
community. Women’s agency and
decision making powers also
increased over a span of three years
and there was diffusion of impact
beyond the group members to the
whole village.
intervention for three years
(2005–2008) and subsequently it was
To share the experience, study
design, results and lessons learnt from
the trial, PFI in partner-
ship with Ekjut and its
partners organized a one
day national dissemi-
nation workshop on ‘The
Ekjut Trial: Saving
Maternal and Newborn
Lives’ on December 9,
2009 at the Gulmohar
Hall, India Habitat
Centre, New Delhi. It was
attended by key national
Dr Syeda Hameed, Member, Planning Commission,
Government of India and Dr Prasanta Tripathy,
and international stake-
holders. The event began
Secretary, Ekjut at the photo exhibition
with the inauguration of
a photographic exhibition titled
“Stories of Hopes and Change”,
which provided a glimpse of the Ekjut
trial and field areas as seen through
the lens of a budding photographer,
Mr. Sudharak Olwe.
Dr. Syeda Hameed, Member,
Planning commission, Government
of India, who was the Chief Guest for
the event, inaugurated the exhibition
and set the stage for a successful
workshop by chairing the inaugural
session. The inaugural session began
with Dr. Arundhati Mishra, Additional
Director, PFI, welcoming the
participants, sharing the workshop
objectives, providing a brief back-
ground of the Ekjut trial and
highlighting PFI’s objectives of
supporting successful pilots in the field
of reproductive health and population
for scaling up in India.
This was followed by a presentation
by Prof. Anthony Costello, Director,
Centre for International Health and
Development (CIHD), University
College, London, UK, who provided
a global perspective on maternal
and newborn health vis-à-vis the
Millennium Development Goals and
emphasised the importance of
reaching out to the poorest quintile
for addressing health inequities.
Dr Prasanta Tripathy, Secretary, Ekjut
shared the trial design and a snap shot
situational analysis with some
important baseline indices and a brief
about the partnering communities.
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He also shared the history of
inception of Ekjut and rationale for
starting the trial.
While addressing the distinguished
invitees Dr. Syeda Hameed in her
keynote address said that the Ekjut
initiative reached out to “people living
on the edge”, trying to empower
them through experiential learning,
plugging into the knowledge of the
communities, without sending top-
down dictates for change. This
“participatory learning and action”
approach has made the processes
sustainable. She felt that the strategic
decision of Ekjut to base itself in the
Districts rather than in the Capitals
was a very good decision since the
differences in the socio- economic-
infrastructure conditions between
state capitals and the districts were
staggering. She added, there was a
need to have life-missions like
those undertaken by SEARCH
(in Gadchiroli) or Ekjut (in Jharkhand/
Orissa), and believed that such efforts
could make a dent and needed to be
“upscaled”. She also appreciated
that the Ekjut trial had recognized
“Post Natal Depression”, which was
generally considered to be an urban
phenomenon/ disease of the “better
off people”.
Followed by the inaugural session,
there were two sessions based on the
trial. One on ‘The Processes and
Results of the Ekjut trial’ chaired by
Ms. Ros Davies, Women & Children
First (WCF), London, UK and the
other on ‘Results of the Ekjut trial’
chaired by Dr. H. P. S. Sachdev,
former National President, Indian
Academy of Paediatricians (IAP) and
co-chaired by Mr. Tom Thomas,
Chief Executive, Praxis, India.
Highlighting the processes followed
during the Ekjut trial, Ms. Suchitra
Rath (Process Evaluation Manager,
Ekjut) described the Participatory
Learning and the stepwise Action
Cycle followed by the Ekjut team
during the process of community
mobilisation and empowerment.
Dr. Audrey Prost (Lecturer
in International Health, CIHD,
University College, London, UK)
detailed the trial analysis and shared
the results outlining impressive
newborn mortality reduction and
moderate post natal depression
as primary outcome indicators.
Dr. Nirmala Nair, Technical Manager,
Ekjut outlined the possible
mechanisms of change.
In the concluding session “The Way
Forward: Possibilities of Scaling Up”,
Mr. A. R. Nanda, Executive Director,
PFI and Ms. Poonam Muttreja,
Country Director, MacArthur
Foundation shared their views on the
Ekjut trial and its possibilities and
scope for scaling up in India.
Mr. Nanda scanned through various
trials in India and other South Asian
countries and stated that community
mobilisation involving women’s
groups, as shown in the Ekjut trial,
can be an effective complementary
strategy to other models like the
SEARCH’s home based care model.
He said that the participatory learning
approach cycle could be used in high
mortality settings to reduce high
neonatal mortality in the rural areas
of the country and suggested that the
policy makers must pay attention to
this in order to attain the MDG goals.
He further identified the surveillance
system and equity impact of the trial
as promising practices that could be
considered for scaling up.
Ms. Poonam Muttreja appreciated the
basic principle of this intervention i.e.
empowerment of women leading to
their increased agency and improved
health indicators. Exhorting the
relevance of this principle she urged
the audience to bring collective action
and women’s empowerment back on
to the national and the global agenda.
She also highlighted the need to assess
the “surveillance system” as a cost
effective mechanism for capturing all
births and deaths, especially in the
context of scaling up.
PFI Participation in the 5th Asia Pacific Conference
on Reproductive and Sexual Health and Rights
The 5th Asia Pacific Conference on Reproductive and Sexual Health and
Rights (APCRSHR) was held from October 18-20, 2009 in Beijing, China
jointly organized by China Family Planning Association (CFPA), International
Planned Parenthood Federation (IPPF), IPPF East and South East Asia,
Oceania Region (ESEAOR), China Population Association (CPA), United
Nations Population Fund (UNFPA), Partners in Population and Development
(PPD), Sociology for Women and Gender Research Association of Chinese
Association of Sociology (SWGRA, CAS) and National Population and
Family Planning Commission of China (NPFPC). The Conference provided
a common platform for all stakeholders to exchange experiences and discuss
strategies in reproductive health in countries of Asia and Pacific. The agenda
included calling attention of the international community towards
reproductive health issues, and facilitate the attainment of MDGs in the
Asia and Pacific Region on schedule.
Ms Lopamudra Paul, Research Associate (Monitoring and Evaluation), PFI attended the Conference and presented a paper on
‘Women Empowerment and Change in Perception on Reproductive Health in West Bengal, India.’ The objective of the paper
was to empower the health status of women in West Bengal and to make them aware about their reproductive health and rights,
family planning, contraceptive choices, health seeking behavior etc. The National Family Health Survey – III (2005-06) and the data
from the field through Focus Group Discussions (72) and in-depth interviews (30) conducted amongst currently married women in
five districts of West Bengal, was used for the paper. The study revealed that after intervention the young women were more aware
of their RH and other health issues such as age at marriage, educational level and of contraceptive choices’.
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Communitization Initiatives in Bihar: Challenges Ahead
T he State of Bihar, with a
population density of 880
persons per sq. km. has recorded the
highest decadal growth during the
nineties (Census, 2001) with around
33% of its population below
poverty line. The major health and
demographic indicators of the State
like infant mortality rate, maternal
mortality ratio, total fertility rate, etc.
are much higher than at all India level,
which reflect poor health status in the
State. Amongst the major States, the
Human Development Index (HDI) in
Bihar has been the lowest for the last
three decades (UNDP, 2001). The
recent National Family Health Survey
(NFHS-III, 2005-06) indicates some
improvements in immunization
coverage, contraceptive use,
institutional deliveries and the
proportion of women, who have
awareness about HIV/AIDS.
However, malnutrition among
children and women has increased.
The prevalence of certain vector
borne diseases, communicable
diseases and water borne diseases is
also high in the State.
There are substantial gaps in health
sector infrastructure and essential
health requirements in terms of
manpower, equipment, drugs and
consumables in primary health care
institutions. There is a drastic decline
in public health facilities for treatment
of non-hospitalized ailments in both
rural and urban areas. There are also
substantial gaps in sub-centers,
primary health centers, and a very
large gap in community health
centers along with shortage of
manpower, drugs and equipments for
Primary Health Care and inadequate
training facilities. Other factors
affecting the health status include:
very high fertility rate; low level of
institutional deliveries; high level of
maternal deaths; very low coverage
of full immunization; low level of
female literacy; and poor status of
family planning programme.
With the upgradation of health
infrastructure such as recruitment of
doctors on contract, outsourcing
diagnostic facilities, availability of free
medicines, provision of ambulance
services and through a mechanism of
web-based monitoring, better health
outcomes are expected in the State.
In a span of about a year, manifold
increase in OPD attendance has been
reported at the CHC/Block/PHC
level. A significant increase has also
been noted in terms of number of
patients attending government health
facilities, except at health sub-centre
level. In spite of appointment of
doctors and specialists at a large scale,
there is a need to appoint 5% more
Medical Officers at the PHC level,
60% Surgeons, 70% Obstetrics /
Gynecologists, 76% Pediatrician and
46% Physicians in order to fulfill the
gaps of human resources at different
levels. There is also need to recruit
13% more ANMs and 33% more staff
nurses at different levels to make the
health centers fully functional (State
Health Society, Bihar, 2009).
The eleventh five year plan for the
State aimed to reduce IMR from
present 61 to 29 by the end of
Eleventh Plan. It is to be achieved
through emphasis on home based
newborn care, improving breast
feeding practices, integrated
management of neonatal and
childhood illnesses and increasing
immunization coverage. With the
efforts of the State, an increase in
immunization coverage has already
been observed. The goal of reducing
MMR from 371 per 100,000 live
births to123 by the end of the 11th
Plan is a formidable task. Yet, the
State would be making all efforts to
achieve that goal. With the
operationalization of Janani Evam Bal
Suraksha Yojana, the institutional
deliveries are increasing significantly.
Besides, efforts are being made to
improve antenatal care, provide
skilled attendance at delivery and
enhance facilities for emergency
obstetric care. The State is also trying
to reduce TFR from 4.0 to 3.0 by
the end of Eleventh Plan through
behavioral change communication to
bring about increase in the age at
marriage of girls, delaying first child
birth, greater male participation and
meeting the unmet need for family
planning through improved
infrastructure and organization of
family planning camps and other
service delivery measures.
The National Rural Health Mission,
the flagship programme of the
Government of India has been a
facilitating factor and is expected to
improve the health system of the
State further. In Bihar, NRHM has
been launched to provide accessible,
affordable, accountable, effective and
reliable primary health care facilities,
especially to the poor and vulnerable
sections of the population. The aim
is to bridge the gap that exists in rural
health care services through the
creation of a cadre of Accredited
Social Health Activists (ASHAs),
improved hospital care and
decentralization of programmes at the
district level to improve intra and
inter-sectoral convergence and
effective utilization of resources.
Further, an overarching umbrella has
been provided to the existing
programmes of health and family
welfare including RCH-II, malaria,
blindness, iodine deficiency disorders,
Filariasis, Kala Azar, T.B., Leprosy
and integrated disease surveillance.
The State has made remarkable
progress over the last three years by
adopting and implementing different
strategies at different levels resulting
in significant decrease in MMR and
IMR. The MMR has come down to
312 from 372 against 254 of India
and IMR has decreased to 56 from
62 against 53 of all India but still there
is need to plan and implement the
programmes effectively as the TFR
has increased to 3.9 from 3.7 against
2.7 of all India level and coverage of
full ANC has come down to 3.9%
from 4.3%. The National Disease
Control Programme is also showing
significant result.
Though several efforts are being
made towards improving the health
service delivery at one level, no
effort had been made towards
“communitization”, one of the most
important components under NRHM
and strengthening the public health
system. Since the launch of
the NRHM, no Village Health &
Contd. on page 7
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SAMVEDNA: Setting New Benchmarks
to Ensure Safe Motherhood
H igh maternal and infant
mortality has plagued the state
of Rajasthan for years. Skilled birth
attendance (SBA) has been accepted
as a key action strategy towards
reducing MMR. Proportion of births
attended by skilled health personnel
is both an indicator and a target
towards achieving the MDG goal.
Provision of SBA for reducing
maternal mortality and morbidity and
making the public health system
functional has been a challenge.
National Rural Health Mission
(NRHM) implementation framework
calls for public private partnership for
health systems strengthening.
However, there are only a few
examples in the country which
demonstrate such a partnership. The
Skilled Birth Attendance model
supported by PFI has been an effort
towards this end.
PFI has been supporting the Skilled
Birth Attendance model in three
districts of Rajasthan: Ajmer,
Jhunjhunu and Tonk, since October,
2004 with technical and capacity
building support from ARTH,
Udaipur. The model provides for
delivery of a continuum of maternal-
child care services including round the
clock (24/7) basic obstetric care with
basic laboratory services along with
active and assisted referral for
emergency obstetric care through
resident Nurse Midwives. The two
health-centers, one each at district
Tonk (Ranoli) and at district
Jhunjhunu (Dhanuri) of Rajasthan
state have been providing quality safe
maternal and child health care
services for last five years. Each health
center is providing broader primary
health service package to a core
population of 5,000 and specified
maternal and child health services to
a larger 15,000 population. Each
project village has a Village Level
Motivator or link worker to support
the nurse midwife in conducting
outreach clinics, raising awareness on
RCH and motivating community for
availing services.
Ever since their establishment, the
health-centers have been evolving and
responding to the emerging needs of
the people in the area. Over the
years, the project, through its
intensive capacity building activities
for the staff and continual up-
gradation and augmentation of basket
of services offered, has been setting
up higher and higher benchmarks
regarding quality of care in maternal
and neo-natal health and has created
a niche for itself.
Ante-Natal and Delivery Care
As a result of intensive capacity
building of nurse midwives and the
village level link workers under the
project, the centres are well equipped
to provide quality ante-natal care,
which includes provision of basic
laboratory testing services at the door
step of the beneficiaries during the
field clinics.
Early detection and registration of
pregnancy is critical to ensure delivery
of ANC services and timely detection
of abnormalities and complications.
Early detection of pregnancy also
provides women with control over
their pregnancy and reproductive
lives. ‘Nishchaya’ kits to detect
pregnancy at the field level have been
supplied and the village level
motivators have been trained to
conduct the test and counsel women
both before and after the test.
Iron Deficiency Anemia (IDA) during
pregnancy is one of the major
contributors to maternal mortality.
Early detection of IDA and timely
intervention is important. Now,
facilities for hemoglobin estimation
and blood grouping and typing are
available to the clients at their
doorstep. The hemoglobin levels are
tracked over the pregnancy period.
Besides, each pregnant woman is
counseled for proper nutrition,
adequate rest and delivery at the
health centre. The foetal growth,
weight gain and blood pressure are
regularly monitored for each pregnant
woman registered with the centre.
Delivery Services
Another benchmark has been set up
with regard to delivery services. Nurse
Midwives are providing technically
sound 24 x 7 delivery services, which
include evidence based management
of first to third stage of labour,
management of breach and twins
presentation – a common obstetric
complication, managing obstetric
emergencies like Ante-partum
and post partum hemorrhage,
preeclampsia, retained placenta and
obstructed labour. Now, with intensive
trainings of nurse midwives, the two
centres are providing all these critical
services, which are not available, in
many cases, even at the PHC levels.
All essential and emergency drugs are
available in sufficient quantities and
the hygiene and sanitation standards
maintained are enviable. As a result,
the centres are attracting increasing
number of deliveries.
Neo-Natal Health and
Newborn Care
Several new initiatives have been
taken up for newborn care especially
for low birth weight (LBW) babies and
premature babies. Breast feeding is
initiated within one hour of birth and
colostrum feeding is ensured.
Kangaroo bags have been provided
to prevent the new born from
hypothermia. The nurse midwives are
trained to identify and manage the
problems of the new born.
Family Planning and
Contraception
Providing women control over their
reproductive lives is one of the thrust
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areas for PFI. PFI strives to achieve
the same through promotion of
contraceptives through informed
choice giving the women, right to
choose the method that suits them.
Continual expansion of the basket of
choices, therefore, becomes essential
for this. With this view, the two health
centres have started providing
injectable contraceptives (DMPA) as
a part of basket of choices offered.
DMPA injections can prevent
pregnancy for three months.
Checklists have been developed to
ensure proper administration of the
method. This is being done under
expert supervision of medical officers,
technical guidance and monitoring by
experts from ARTH (Udaipur), the
technical support agency for the
project.
Contd. from page 2
Two documentary films “With
Your Head Held High” and
“Something New in My Life”
were released at the national
consultation.
The PLHIV were at the centre stage
of the national consultation. The goal
was to bring out the positive voices
from the field. The PLHIV shared
their experiences, positive speakers
inspired others and made the
consultation lively through singing,
dancing and other cultural events.
Contd. from page 5
Sanitation Committees have been
formed in the State, except at a few
places, where organizations namely
PFI and Lepra Society have formed
the VHSCs by implementing their
own projects. Only 28% of Rogi
Kalayan Samitis are functional, out
of that 26 are functional at District
hospitals, 51 at CHC level and 389
at PHC level. No special initiatives
have been made towards social audit.
PFI-RRC advocated with the State
Government for the initiation of
communitization process under
NRHM. The Draft National Health
Bill, 2009 also gives thrust to
communitization and a detailed
guideline has been drafted for
Emergency Contraception
The Nurse midwives also provide
services of emergency contraception
to avoid pregnancy within first 72
hours of unprotected sex. This
enables women to have better control
over their reproductive decisions.
E-pills, as they are popularly called,
have been supplied to health centres
and nurse midwives have been trained
to ensure proper prescription and
prevent misuse.
Medical Termination of
Pregnancy (MTP) Services
In its constant endeavour to give more
and more power to women regarding
their reproductive lives and decisions, the
project centres have applied for
registration with the Government of
Rajasthan as registered centres for MTP.
State Level Expositions
State level expositions were
conducted in all the six high
prevalence states in 2008 and 2009
on various themes related to HIV/
AIDS. These expositions provided a
platform for PLHIV involved in the
program to share their experiences
to a broad range of stakeholders.
Representatives from District Level
Networks (DLNs), Positive Living
Centres (PLCs), Community Care
Centres (CCCs), Comprehensive
Care and Support Centres (CCSCs),
ART Centres, State AIDS Control
Societies, senior officials from various
ensuring community involvement in
strengthening public health system in
India. In order to ensure the outcomes
envisaged for NRHM and providing
quality and accountable health
services, which are catering to the
needs of the poor and vulnerable
sections of the society, the state
government realized that the
community monitoring of health
services is an important component
for achieving these results.
The State Government decided to
initiate the process of community
based monitoring of health services
as a step towards communitization.
PFI was requested by the State Health
Society Bihar to provide technical
support to implement the CBM
process in the state and carry forward
Janani Suraksha Yojana (JSY)
Accreditation
The need for JSY accreditation of the
health centers was felt for the benefit
of mothers. Both the NGOs worked
hard to get the accreditation. With the
help of ARTH and PFI, Apno
Swasthya Kendra run by SRKPS
in Dhanuri at Jhunjhunu got
accreditation under JSY in December
2008. Shiv Swasthya Kendra run by
Shiv Shiksha Samiti in Peeplu at Tonk
got accreditation under JSY in
February 2009. With the accreditation
of the centres, the number of women
preferring the paid services of the
health centres over the free facilities
has increased significantly, and that
speaks a lot about quality of services
being delivered at the two centres
under the project.
government departments, colleges,
banks, NABARD, NGOs and the
media participated in these events.
The state expositions were conducted
not only to share the best practices
and to motivate the PLHIV but also
to recognize the efforts and hard work
of the staff of the service delivery
points. To encourage them, various
competitions such as games, slogans,
posters, music, rangoli, role play on
nutrition and quiz were organized.
The participants actively participated
in these competitions and were given
due recognition through prizes and
certificates.
the process as PFI was the National
Secretariat for implementing the
first phase of Community Based
Monitoring in nine states with support
from the MoHFW, Government of
India. PFI organized a State Level
Consultative Meeting on Community
Based Monitoring (CBM) of Health
Services under NRHM. Based on the
recommendations of the consultative
meeting, PFI facilitated the process
for the preparation of detailed Plan
of Action for initiating Community
Based Planning and Monitoring of
Health Services in the state. The
State Government has decided to
implement the CBM process in the
three selected districts on a pilot basis
and the preliminary activities have
already been initiated by the State
government.
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Quality Family Planning Services through Boat Clinics
The Population Foundation of
India in partnership with the
Centre for North East Studies and
Policy Research (C-NES) is
implementing a project, “Mobilizing
the Unreached: Using Behaviour
Change Communication and
Ensuring Quality Family Planning
Services through Boat Clinics in
Assam” for a period of three years
from September 2009. The project
covers a population of 1 lakh on
islands in the Brahmaputra river in
five districts of Assam. The goal of
the project is to ensure improvement
in family planning/RCH status of
vulnerable populations from the
islands known as chars, saporis on
the Brahmaputra river in Assam.
The project has started its activities
during the quarter October–
December 2009. The objectives of
the project are:
• Increasing awareness on
reproductive health and family
planning issues among eligible
couples (women and men in the
age group of 15-49)
• Enabling behaviour change
through a need based compre-
hensive communication package
• Building sustainable local capacities
in interpersonal communications
including counseling skills,
delivering quality family planning
services and in effective
documentation
• Improving availability and
accessibility of modern
contraceptives to eligible couples
including services for IUD
insertion, injectables and
establishing effective linkages for
sterilization services
• Documenting learnings, processes
and best practices for scaling up
The C-NES has been implementing
preventive and promotive health
campaigns through specially designed
boats since May 2005 on islands,
locally known as ‘chars or saporis’,
formed by the mighty Brahmaputra
river. The programme has been
up-scaled to five more districts in
March 2009 and over 120000
people have been reached for health
checkups including immunization,
ante-natal care and post natal care.
The organization is currently
operating ten boats covering
approximately 400 islands in
10 districts. Presently these camps
and campaigns are carried out in
collaboration with NRHM, district
administration, health department
and UNICEF. In the proposed project
area, three boats are currently owned
by C-NES.
Selected Area and Target group:
The area selected for the programme
is 117 villages/islands in the five focus
districts of Dibrugarh, Tinsukia,
Dhemaji, Sonitpur and North
Lakhimpur of Assam covering a
population of 1,01,578. The districts
from upper Assam are predominantly
tribal in nature and inhabited by
Mishings followed by Hindus of
Assam, Biharis, Muslims, Ahoms,
Nepalese and the tea plantation tribal
communities, while the districts of
lower Assam are mainly inhabited by
the Muslim migrant communities
from Bangladesh.
Rationale for the project: The boat
clinics have come in to being, to reach
out to the most vulnerable and
deprived population. They are
designed with sufficient facilities to
provide basic health care in the char
villages. They have cabins for nurses,
doctors and other members of the
team and an examination room with
table and a small laboratory. Each
boat (covering one district) has a team
of two medical officers, three nurses,
a coordinator and three community
workers. Some of these boats have
night halt facilities and hence they can
reach at the remote areas. In the
districts where there are lesser
number of chars/saporis, camps are
held once or twice every month in
every village, while in the districts
where there are larger number of
chars, villages are selected depending
upon criteria such as lack of access
to Government run sub centers or
remoteness of the char. The entire
programme is managed by a
Programme Management Unit
(PMU).
However, while regular service
provision continued, there was a felt
need to raise awareness levels on the
issues related to reproductive health
and rights with a focus on provision
of quality family planning services to
increase off take of RH services and
Boat serving the community
8
RCH Service in progress
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improve health seeking behaviour in
the community. The programme has
so far not included any significant
behaviour change communication
(BCC) component, which had also
been identified as a major gap in the
efforts. PFI felt there was a clear and
felt need for integrating provision of
quality reproductive health and
family planning services, effective
counseling and behaviour change
communication components to the
existing health care provision through
Boat Clinics.
The following activities will be
undertaken for the project:
• Recruitment of staff and
identification of change agents
• Community Needs Assessment
through ASHAs
• Capacity building on family
planning services of ASHAs and
TBA training
• Development of a BCC package
to enable behavioural change
• Documentation and production of
a film on project activities with
dissemination
The major outcome indicators of the
project will be:
• Percentage increase in knowledge
of service providers on RH and FP
issues
• Percentage increase in knowledge
of eligible couples on RH and FP
issues
• Number and percentage of eligible
couples aware of all choices of
modern methods
• Number and percentage of
couples/women offered basket of
choices of FP methods
• Percentage of eligible couples
regularly using modern methods of
contraception
The BCC tools will be continuously
used through ongoing programmes
reaching a large population and
benefiting communities in the process.
Simultaneously, efforts would also be
made to advocate with the Assam
State Government to expand the use
of the materials to the entire state.
Strengthening local capacities will
ensure a cadre of trained qualified
service providers and change agents
in the community, who can continue
to take the work forward. This will
ensure sustainability of the project even
after phasing out.
Workshop for Journalists in Ranchi
A journalist or a social worker has to face many questions on the political process. How can one track the
performance of MPs/MLAs? How can one hold them accountable to the promises they make? Most importantly,
how can one engage with the legislative process and legislators?
To address the need, Population Foundation of India has been disseminating the information to NGOs and
media professionals through publications and capacity building programmes on the role of Parliamentarians in
addressing the issue of health and population in India. The entire effort was aimed to build perspective of
members on Reproductive Health/Family Planning issues, undertake advocacy with legislators and create a
platform for building accountability of elected members.
A one day workshop was held in Ranchi on October 6, 2009 in partnership with PRS Legislative Research
with the objectives of building skills on using existing information on legislators effectively, sharing NGO
examples in advocating with legislators in Jharkhand and the areas of reporting on accountability issues of
elected representatives. In the workshop, the work of legislators and the legislative bodies, various avenues of
engagement with legislators and the legislative process were shared among the participants. It also shared
various data on Parliament with the journalists, which helped them to compare the data with the neighboring
states to understand the performance of legislators. While sharing their experiences and ideas, the participants
pointed out that, despite the huge opportunity for media in engaging with the legislators and the parliament
system, advocacy is limited due to high focus on geographical and political situations of the state. The workshop
highlighted the challenges in advocating with elected members, such as lack of forums for interface between
the elected and the civil society members in the state, though the journalists in the state were highly aware
about the role and functions of the elected members.
The workshop was very informative and useful to the participants. There is a need for collective effort at the
state level by the Journalists, NGOs and the organizations like PFI and PRS. The Journalists felt that the
workshop generated possibilities for developing useful stories on legislators and opened up avenues for discussing
the same at the district level.
PFI in partnership with PRS has brought out publications namely, Health Legislations in14th Lok Sabha,
Activity of MPs in 14th Lok Sabha related to RCH and Youth and Comparison of Election manifestos of major
political parties.
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Swastha Aangan: Promoting Healthy Families
The Tata Chemical Society for
Rural Development (TCSRD) has
successfully completed two years
(November 2007 to October 2009)
of the Swastha Aangan project, which
is being implemented in 40 villages
in Gunnour block, Badaun district,
U.P. covering a population of
approximately 75,000.
The project, “Swastha Aangan –
Promoting Healthy Families” aims to
achieve sustainable improvement in
RCH indicators through consolidation
of the gains and learning of the
first phase of the project (Intensive
Family Welfare Programme (IFWP),
implemented from December 2001
to April 2007 in 50 villages) and by
building mechanisms, processes and
linkages with community based
organizations and other institutions.
In a bid to bring about these
developments, the project specific
objectives are to:
– Create community based
mechanisms and linkages for
increasing access to quality RH/
FP services
– Bring about desired behaviour
changes among eligible couples
(women in the age group of
15-49) through integrated
IEC package and increasing
involvement of different stake-
holders at the family level on
Family Planning/ Reproductive
and Child Health
– Promote use of modern
contraceptives by eligible couple by
providing a basket of choice
through strengthening Parivar
Kalyan Kendras and appropriate
referrals, and
– Document learning, processes and
good practices for replication and
scale up.
TCSRD took the initiative of training
Village Health and Sanitation
Committees (VHSCs) through a five
day workshop at Village House,
facilitated by Dr. Mazhar Rashidi and
Mr. Rajiv Mishra from Pratinidhi
organization in Lucknow. VHSCs
were oriented on how to develop a
link of ownership and responsibility
between the community and the
health system by assessing the needs
of the community and communicating
the same to health system delivery
vehicle to strengthen the existing
health system in providing health
services in a way acceptable and
accessible to the local population.
The workshop was attended by
ASHAs, VHSC members, health
workers and field coordinators.
The management of the training was
decided and responsibilities were
divided into teams. Each team made
a presentation on ‘Problems faced
in conducting the VHSC meeting.’
It was followed by a discussion on
disseminating information about
evolution, objectives, role and
responsibilities and importance of
adult learning education in VHSC.
The participants were oriented about
the processes of VHSC meeting such
as identification of health needs,
NHRM concepts, role and
responsibilities of VHSC members,
preparation of health plans and the
present health problems in the Gram
Sabha meetings.
The utility of GATHER (G-Greet,
A-Ask, T-Tell, H-Help, E-Explanation,
R - Return) technique was discussed
with the participants. VHSCs were
selected for field visits based on their
functioning status and efficiency in
maintaining of registers [Faridpur
VHSC – (Functional), Mehua VHSC
(Not functioning properly) and
Noopur (poorly functioning)].
The participants were divided into
teams and sent to villages namely
Mehua, Noorpur and Faridpur to
interact with VHSC members and
identify the health issues on which
prioritization was done through VIPP
cards along with planning.
Each team gathered community
members at a common place in the
village. A president was selected for
the regulation of the meeting and for
documentation in the register.
Problem chart prepared by the VHSC
members was discussed in the
meeting and the agenda for the
next meeting was then fixed. The
problems were identified, were put
into a Prioritization Matrix (PM) which
includes identification of problem,
prioritization of the problems,
resources available, responsibility of
the resources taken, follow-up,
support and timeline. Based on this,
a planning for the next six months
was done and responsibilities were
given to each member.
The following were the major health
issues identified from the above three
villages:
• Doctors at CHC not attending to
the patients
• Difficulty in adoption of family
planning methods
• Lack of transportation to take
delivery case on time
• No proper distribution of ration of
high energy and protein
supplements to malnourished
children by Aganwadi workers
• Irregular visit of ANMs
• Lack of distribution of tablets
for prevention of Malaria by
Government
• Poor Sanitation
• No contact numbers of the doctors
and ANMs of CHC
The participants were oriented about
different Government schemes by
Mr. Manoj Sharma, the District
Programme Manager (NHRM),
Dr. Chadda, the state coordinator
(NHRM), Dr. Sanjeev Belwal (MOIC
Gunnaur). ASHAs and health
coordinators discussed their problems
with them and they were given
assurance for the support.
Outcomes of the Training:
• The Coordinators were aware
about various processes of training
after the field visit.
• Through prioritization matrix,
health problems were identified by
the villagers themselves and a
planning for the next months was
done with the help of VHSC
members.
• Field Coordinators learned the art
of facilitation, organizing VHSC
meetings, identifying problems and
its solution through participatory
rural approach.
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PFI Participation in XXXI Annual Conference of IASP
The 31st Annual Conference of
the Indian Association for the
Study of Population (IASP) was held
at Sri Venkateswara University,
Tirupati during November 3-5, 2009.
The conference began with the
presidential address by Prof Arvind
Pandey, IASP on “Population
Transition and Disease Burden in
India: Challenges to Social and
Health Policy.” This was followed by
the key note address by Dr. Nesim
Tumkaya, UNFPA Country
Representative to India. The
conference was attended by over 300
researchers, teachers, policy and
programme managers from various
organizations and universities such as
UNICEF, UNFPA, ICRW, IIPS, PFI,
AIIMS, Intra Health, ISEC, TISS,
JNU, BHU etc.
Population Foundation of India (PFI)
had an impressive participation in
various sessions of the conference.
• “Meeting Millennium Development
Goals (MDGs) – India’s Child
Survival Programme: Managerial
Challenges and Perspectives” By
Dr Lalitendu Jagatdeb, Joint
Director (Monitoring &Evaluation),
PFI and Ms Mridu Pandey,
Programme Associate (Programme
Development), PFI (Presented in
the technical session).
• “Design Effect and Non-Sampling
Error of NFHS-3 Survey” By
Dr S.K. Mondal, Sr. Manager
(Knowledge and Research
Management), PFI (Presented in
the panel discussion).
• “Burden of Non-Communicable
Diseases in India: A New
Dimension in Epidemiological
Transition” By Ms Lopamudra
Paul, Research Associate
(Monitoring & Evaluation), PFI
and Mr Nihar Ranjan Mishra,
Programme Officer (Monitoring &
Evaluation), PFI (Presented in
poster session).
• “Child Nutrition, Immunization and
Care” – Technical session chaired
by Dr Lalitendu Jagatdeb, Joint
Director (Monitoring & Evaluation),
PFI.
PFI also sponsored a special session
on “Methodological Issues related to
Large Scale Sample Surveys in India”.
It was suggested to constitute a
national committee to recommend
study design for large scale surveys
including variables and their
comparability.
Meeting Millennium Development Goals –
India’s Child Survival Programme: Managerial Challenges and Perspectives1
T he past few decades have
witnessed increasing concerns
among developing countries including
India on poor state of health
and development of children.
To underscore the need to position
child survival at the heart of
international agenda, reducing child
mortality has been focused as one of
the eight Millennium Development
Goals (MDGs). India as a signatory to
Millennium Summit Declaration
aims at achieving the MDGs by 2015.
The fourth MDG refers to reduction
in child morbidity and mortality.
Although overall gains in child survival
in India have been impressive, infant
and child mortality levels are still high.
India’s IMR still stands at a staggering
over 50 deaths per thousand live
births. Of the estimated 9.7 million
children in the world dying before
completing five years of age, 2.1
million or 21 percent, are in India. The
scale and diversity of India present
a huge challenge in addressing
development goals including child
survival.
With this background the paper was
prepared using analysis of the
secondary data like NFHS, SRS,
district level information etc. Findings
from various studies and successful
case studies had also been reviewed
and provided concrete recommen-
dations and strategies, which could
have both policy and programmatic
implications. The paper also looked
at the role of different departments
in exploring the possibilities of
community participation, public
private partnership and modifications
to assist the health department in
bringing its people healthcare services
and save the dying children.
The summary of the paper is given
below:
• Major Causes of Infant and Child
Mortality:
– Diarrhea, preventable childhood
diseases, food insecurity
– Lack of male involvement in
MNCHN programmes and poor
social status of women
– Lack of community based
monitoring mechanism and
community ownership
– Poor health care infrastructure
and quality of care
– The malnutrition lifecycle
– Poor management of existing
financial and human resources
• Managerial perspectives and
recommendations:
– Needs for political will to scale up
successful programmes
– Addressing shortage of skilled
health professionals by PPP
– Traditional Birth Attendants
(TBAs) as Skilled Birth Attendants
to ensure better birth planning
and complication readiness
– Community monitoring like the
one in Tamil Nadu and Kerala can
go a long way in improving
service delivery
– Enhancing capacity to use
information to support child
health programmes
1 An abstract of the paper presented in
the 31st Annual Conference of Indian
Association for the Study of Population
(IASP), Nov. 3-5, 2009 by Dr Lalitendu
Jagatdeb, Joint Director (Monitoring &
Evaluation), PFI and Ms Mridu Pandey,
Programme Associate (Programme
Development), PFI.
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We welcome...
Ms Mohini Kak, who has joined the
Foundation as Project Director (Scaling
up Division) on 5th October, 2009.
Dr Sanjay Pandey, who has joined the
Foundation as Chief of the Party (Health
of Urban Poor/USAID) on 12th October,
2009.
Dr Shalini Verma, who has joined the
Foundation as Senior Research Advisor
cum New Programme Development
Manager on 12th October, 2009.
Mr Pradeep Kumar, who has joined
the Foundation as S.I.E. Associate
(Global Fund) on 12th October, 2009.
Ms Jayati Sethi, who has joined the
Foundation as Programme Associate on
23rd November, 2009.
Mr Shariq Jamal, who has joined the
Foundation as Programme Associate
(Global Fund) on 25th November, 2009.
Dr G S Joshi, who has joined the
Foundation as Project Manager (Mewat)
on 1st December, 2009.
Ms Nidhi Bakshi, who has joined the
Foundation as HR cum Administrative
Officer on December 3, 2009.
Mr Pritam Prasun, who has joined the
Foundation as Programme and Monitoring
and Evaluation Officer (Mewat) on 18th
December, 2009.
We bade farewell to...
Mr R Subramanian worked with
PFI as Administrative Officer on
31st December, 2009. He retired
from PFI after 33 relentless years
of service. Mr A R Nanda,
Executive Director, PFI honored
him with memento at a function
organized at PFI on 31st December,
2009. We, the PFI staff wish him
a happy and peaceful retired life.
Mr Rakesh Kumar
worked with PFI for
Scaling Up Division as
Sr. Project Manager on
3rd October, 2009.
Editorial Guidance
Mr A.R. Nanda
Ms Sona Sharma
Editor
Ms Chandni Malik
Editorial Assistance
Ms Jolly Jose
Editorial Committee
Ms Usha Rai
Dr Almas Ali
Dr Lalitendu Jagatdeb
Dr Sharmila G. Neogi
Published by
Population Foundation of India
B-28, Qutab Institutional Area
New Delhi-110016, India
Tel: 91-11-43894100
Fax: 91-11-43894199
e-mail: popfound@sify.com
website: www.popfound.org
Designed & Printed by Communication Consultants Tel: 91-11-24610176, 9811074665
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