 |
PFI Annual Report 2008-2009 |
|
|
1 Pages 1-10 |
▲back to top |
|
|
1.1 Page 1 |
▲back to top |
Annual Report
2008
POPULATION FOUNDATION OF INDIA
B-28, Qutab Institutional Area
Tara Crescent, New Delhi - 110016
Phone: 43894100, Fax: 43894199
E-mail: popfound@sify.com, Website: www.popfound.org
2009
Population Foundation of India
|
|
1.2 Page 2 |
▲back to top |
annual report
2008-2009
Annual Report
2008-2009
Population Foundation of India
|
|
1.3 Page 3 |
▲back to top |
Vision
Promoting, Fostering and Inspiring sustainable and balanced
human development with a focus on population stabilization
through an enabling environment for an ascending quality of life
with equity and justice.
Mission
PFI will strive to realize its Vision by promoting and formulating
gender sensitive and rights based population and development
policies, strategies and programs.
To this end, it will
? collaborate with central, state and local government
institutions for effective policy planning, formulation and
facilitation of program implementation.
? extend technical and financial support to individuals and
civil society institutions and promote innovative
approaches.
? undertake and support systems, action, translational and
other forms of operational research.
? create awareness and undertake informed advocacy at
community, regional, national and global levels for socio-
cultural and behavioural change.
? focus on un-served, under-served areas and vulnerable
sections of society and address the challenges of an
emerging demographic transition.
? mobilize financial and human resources from all sources
both national and international.
CONTENTS
annual report
2008-2009
PFI Governing Board and Advisory Council
vi
Governing Board Chairperson's Address
ix
From the Executive Director's Desk
xiii
Programmes during the year:
(A) Reproductive and Child Health Intervention/Action Research Projects:
(i) RCH Projects with Corporate Sector
- Swastha Aangan – Promoting Healthy Families in Uttar Pradesh
3
- Naya Savera II – Building on Gains and Addressing Gaps in Reproductive 5
Health and Family Planning in Rajasthan
- PARIVARTAN – A Family Welfare and Population Development Project in 7
Rajasthan
- Improving Reproductive and Child Health Status of the Tribals in 8
Noamundi Block in West Singhbhum District of Jharkhand
(ii) RCH Projects with NGOs
- Total Management of Essential RCH and Primary Health Care through 11
Public-Private Partnership: A Model and Innovative Project in Karnataka
- Advocacy to Action: Promotion of Maternal and Neonatal Survival in the 13
Tribal Areas of Rayagada District in Orissa
- Promotion of Family Initiatives to Address Family Planning and 14
Reproductive and Child Health Needs, through Increased Male
Participation in Uttar Pradesh
- Intervention Study among Adolescents, Pregnant and Lactating 16
Mothers to Reduce Prevalence of Anaemia in Haryana
- Improvement of Maternal and Child Health through Life Cycle Approach 18
in Jharkhand
- SAMWEDNA: Sub-center as Agency for Maternal Wellbeing, 19
EmpowermentDemonstrated through NGO Assistance
- Instituting Rational Use of Drugs (RUD) in Reproductive and Child Health 20
Care in FPAI Cilinics in India
- SWABHIMAN: Urban Reproductive and Child Health Programme with an 21
Empowerment Approach in Delhi
- Evidence Based Advocacy for Maternal and Child Health amongst the 24
Urban Poor of Vadodara city in Gujarat
- Reducing Reproductive Morbidity in Married Young Women in Rural 25
Maharashtra
- A Model Initiative to Ensure Quality Family Planning Services in 28
Uttarakhand
iii
|
|
1.4 Page 4 |
▲back to top |
annual report
2008-2009
- Increasing Awareness of and Access to Contraception for Married 30
Adolescents Awareness on Reproductive and Sexual Health and
reduction of Iron Deficiency Anaemia among Adolescent Girls of
Ganjam District of Orissa
(iii) MCH Star Projects
- Capacity Building and Institutional Strengthening
33
- Concurrent Evaluation of Mukhya Mantri Janani Sishu Swasthya 34
Abhiyan (MMJSSA—JSY) in Jharkhand—A collaborative study by PFI
and IndiaCLEN
- Evaluation of the Reach and Effectiveness of Behaviour Change 34
Communication Campaign under NRHM
(iv) New Initiatives in the Coming Year
- Improving Reach and Access of Reproductive and Child Health and 37
Family Planning services with quality of care in Haryana
- Mobilizing the Unreached: Using Behaviour Change Communication 38
and Ensuring Quality Family Planning Services through Boat Clinics in
Assam.
- Radio Programme, Babli Boli
39
(B) Advocacy and Communication Projects
- Sustainable Action against Declining Sex Ratio at Birth in Haryana, 43
Himachal Pradesh and Punjab
- Advocacy for building supportive policy and programme environment 44
on rights based population and family planning /reproductive health
issues in India
- Regional Resource Centres (RRCs) for Bihar and Chhattisgarh
48
- Scaling Up Pilot Projects in Reproductive Health and Adolescent Health 51
in India
- Community Based Monitoring of Health Services under NRHM
55
- The Tenth JRD Tata Memorial Oration
57
- Regional Conference in Chandigarh
59
- The Fourth JRD Tata Memorial Award on Population and Reproductive 61
Health Programmes
(C) Endline Evaluations and Research Study
- Intervention Study Among Adolescents, Pregnant Women & Lactating 67
Mothers to Reduce Prevalence of Anaemia-A Contributory Factor of
Maternal Morbidity and Mortality in Gurgaon, Haryana: An Endline
Evaluation
iv
annual report
2008-2009
- Strengthening NGO Capacity to Improve Maternal and Child Health 70
Status in Jharkhand through a Life Cycle Based Approach
- Infant and Child Mortality in India: State Level Estimates by Religion, 72
Caste, Education and Occupation
(D) HIV/AIDS Programme
-
The Global Fund Round 4 and Round 6 HIV/AIDS Programme
75
Publications during the year
79
Accounts
85
PFI addresses
105
Our Team
106
List of Donors during 2008-2009
111
PFI Meetings
112
v
|
|
1.5 Page 5 |
▲back to top |
annual report
2008-2009
PFI GOVERNING BOARD AND
ADVISORY COUNCIL
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, 2009 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 (ex-officio)
annual report
2008-2009
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, 2009 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
vi
vii
|
|
1.6 Page 6 |
▲back to top |
Governing Board Chairperson’s Address
annual report
2008-2009
It is my pleasure to welcome you to the Annual General Body Meeting of the
Population Foundation of India.
As PFI stands at the threshold of its 40th year, it is appropriate to take stock of how far
we have come, not just as an organization, but also as a nation, as far as the issue of
family planning and reproductive health and rights go.
Over the decades, there has been a considerable increase in contraceptive use in
India. The direction, emphasis and strategies of the Family Welfare Programme have changed over
time. 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, legitimately, 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 programme approach.
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 reproductive
health 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. This resulted in a shift in implementation from centrally fixed targets to target-free
dispensation through a decentralized and participatory approach. The target-free approach was recast
as the “community needs assessment” approach.
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 (2002-2007) 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 adolescent reproductive health,
unintended pregnancy and access to safe abortion are addressed. Counselling, access to and provision
viii
ix
|
|
1.7 Page 7 |
▲back to top |
annual report
2008-2009
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.
PFI has consistently strived to carry out its core mandate of population stabilization, capacity building,
Reproductive and Child Health (RCH) services and communication as well as intervention research
through a number of programs in the country. There is renewed emphasis on family planning, which, in
lieu 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 other needs in
respect to health issues in general and reproductive health in particular.
The renewed emphasis on client- centered 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 gender sensitive and
rights based population and development policies, strategies and programs. 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, 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 for the above mentioned issues are a central feature of PFI's agenda.
Therefore, 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 Issues, networks, alliances and coalitions to advocate on key issues, 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.
x
annual report
2008-2009
The changing scenario 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
PFI 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 MacArthur
Foundation, Sir Dorabji Tata Trust and Population Reference Bureau.
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 PFI.
Hari Shankar Singhania
Chairperson
September, 2009
xi
|
|
1.8 Page 8 |
▲back to top |
From The Executive Director's Desk
annual report
2008-2009
Greetings from the Population Foundation of India!
The year 2008-2009 has been both challenging and exciting at the Foundation.
The total income of the Foundation during the Financial Year 2008-09 was
Rs 5632.01 lakhs (previous year Rs 3331.05 lakhs) and total expenditure during the
year was Rs 5452.46 lakhs (previous year Rs 3098.06 lakhs).
The Foundation continued to implement various programmes in accordance with its vision, mission and
focus areas of intervention. Considering the fact that the status of Young People's Reproductive and
Sexual Health (YPRSH) is an important component of reproductive and child health situation in India,
PFI conducted a scan of successful innovations on YPRSH across the country. The prime objective for
this scan was to identify successful pilots on adolescent reproductive and sexual health with the
potential for going to scale. These promising practices were from both Government and NGO sectors
from different states. In total 60 pilots were identified from the scan. Based on the information in the
available documents and the potential for going to scale, 10 pilots were selected.
The Population Foundation of India organized a regional conference on 'Health, Population and Social
Development issues in Punjab, Himachal Pradesh and Haryana' with a focus on sex ratio issues/female
foeticide at Chandigarh on October 23-24, 2008. The objectives of the workshop were to get a clear
perspective of the demographic and health transition process in Haryana, Himachal Pradesh and
Punjab, draw attention to the issue of child sex ratio and review efforts to curb sex selective practices
and pre-birth elimination of females, and recapitulate initiatives by the State Governments on
population and health issues. The two-day regional Conference brought together administrators,
social scientists, academicians, scholars, national/international institutions and NGOs concerned with
these issues, for discussion on demography, health and social development - achievements, gaps and
future plan of action.
The Foundation has brought out a publication titled Corporate Social Responsibility: Package on
Reproductive and Child Health/Family Planning. The package provides guidelines for various aspects
of project proposal development, information on RH/FP and related issues, insights into project
implementation, monitoring mechanisms and scaling up. One of the constraints for the corporate
sector to take on programmes related to RCH and Family planning effectively, is a dearth of guidelines
to conceptualize and implement the programmes. The module was developed after extensive
deliberations and covers major aspects of reproductive and child health over nine sections.
The Foundation is initiating an innovative project 'Production and Management of a Radio Programme
for Rural Women and related Community Based Activities' with funding from UNDP, India and National
AIDS Control Organization (NACO), New Delhi in five districts of Rajasthan (Alwar, Ajmer, Jaipur,
xii
xiii
|
|
1.9 Page 9 |
▲back to top |
annual report
2008-2009
Jodhpur and Barmer) and two districts of Bihar (Sita Marhi and East Champaran) starting from June
2009 onwards for 15 months.
The 52 episode radio programme, Babli Boli will be a step towards integration of Family Planning/RCH
and HIV/AIDS issues by including messages on reproductive health and family planning services
together with information on HIV/AIDS to increase awareness about health risks and motivate
behaviour change among the vulnerable and general population, especially among women and youth.
A new programme with a focus on using Behaviour Change Communication and ensuring quality Family
Planning services through Boat Clinics in Assam has been initiated and will be implemented in
collaboration with Centre for North East Studies and Policy Research (C-NES). in the coming financial
year. The project would aim to build on the health services provided by the boat clinics on the islands of
the Bramhaputra River in Assam, identify the unmet needs for family planning among eligible couples
and increase awareness on the same, along with making services available. 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.
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
Reproductive and Child Health Intervention/Action
Research Projects
xiv
|
|
1.10 Page 10 |
▲back to top |
RCH Projects With
Corporate Sector
annual report
2008-2009
Joint Initiatives of PFI with Corporates
Swastha Aangan: Promoting Healthy Families in Uttar Pradesh
“Aangan” literally means courtyard, the warmest central place in a home, where family
members (predominantly the women folk) meet, unwind, share and learn. It thus also
becomes a place where all pressing issues including health matters are discussed. The
concept has been adapted, in a project by Tata Chemical Society for Rural Development
(TCSRD), rightly christened, “Swastha Aangan - Promoting Healthy Families”. Swastha
Aangan ensures community dialogue and advocacy to realize their health needs, rights and
take judicious decisions and actions for holistically improving the health status especially of
the women and children. Planned for three years from November 2007 to October 2010, the
project is being implemented in 40 villages in Gunnour block, Badaun
district, U.P. covering a population of approx. 75,000.
The project aims to achieve sustainable improvements in reproductive
and child health indicators through consolidation of the gains and
learning of the 1st phase of the project, Intensive Family Welfare
Programme (IFWP), implemented from December, 2001 to April, 2007
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
reproductive health/family planning services
? Bring about desired behaviour changes among eligible couples (women in the age
group of 15-49 years) through integrated IEC package and increasing involvement of
different stakeholders at the family level on Family Planning/ Reproductive and Child
Health
? Promote use of modern contraceptives by eligible couples by providing a basket of
choices through strengthening Parivar Kalyan Kendras and appropriate referrals,
and
? Document learning, processes and good practices for replication and scale up
3
|
|
2 Pages 11-20 |
▲back to top |
|
|
2.1 Page 11 |
▲back to top |
annual report
2008-2009
Five training programmes on family planning, maternal health, child health and HIV/AIDS were
organized to build the capacity of project staff. Preparation of village health plans and formation of
village health committees along with one day trainings on health seeking behaviour, reproductive
and child health, family planning was also organized. This was followed by a two day training
programme for ASHA workers/village level motivators. A five day training workshop on
strengthening VHSCs and developing documentation skills was organized for field coordinators. A
two day Dai training was also organized.
Important health days and events were celebrated such as the World's AIDS
Day, World Population day, World Water and Sanitation Day, World
Breastfeeding Day etc. Puppet shows focusing on ANC, PNC, family
planning and immunization were staged during such events. Regular one to
one and group meetings were conducted and wall writings done. Bleaching
powder procured from government centers was provided to the villages for
addressing the issue of water and sanitation. VHSC meetings to share
progress on RCH indicators were regularly conducted. VHSC keenly carried
out regular participatory needs assessments to plan future courses of
action. VLMs regularly go on house to house visit and mahila mandal
meetings. Seeds have been distributed in every quarter to encourage the
concept of kitchen gardening. This is an attempt to restore balanced diet and nutrition among
families and encourage intake of leafy greens to prevent anaemia among ANC/ PNC women and
children. Sterilization camps have also been conducted.
The mobile health van continues to deliver services in remote areas. There were 439 mobile health
camps in the year. Institutional deliveries rose from 73 last year to 341 in March 2009. 1912 eligible
couples have been counseled for family planning issues. 10 cases for NSVs and 118 for tubectomies
have been referred. 499 children were fully immunized by the end of March 2009.
Success Stories
? In Faridpur VHSC of Gunnaur Tehsil, 15 institutional deliveries have taken place within a
quarter. An ASHA with the help of a swasthya mitra has been able to encourage institutional
deliveries despite initial backlash from Dai community and family members.
? In VHSC Gunnaur Semla, the ANM was absent for six months hampering the routine
vaccination and ANC/ PNC services. The VHSC members approached the CMO and wrote
letters to the Secretary along with Field Coordinator. The efficient working of the VHSC
ensured reinstating of ANM in the village.
Establishing VHSCs and conducting regular meetings has been a challenge which TCSRD has been
able to overcome. Two trainings have been conducted, which really built immense capacity of
communities in conducting VHSC meetings efficiently. A microplan is developed for each month,
which chalks the route of the mobile van and ensuring coincidence of mobile health clinic with VHSC
meeting date. The PRI members' attendance was low initially, which was improved by sending them
invitation postcards at the beginning of each month. The post card carries the message of
immunization status in village and the date, time and venue of the place. The meetings are
4
annual report
2008-2009
coordinated by ASHA workers and the project coordinators.
“Parivar Kalyan Kendras (PKKs)” in villages (centers for social marketing) faced a lot of challenges
and initial non acceptance from the community itself. To overcome this, community members were
trained as entrepreneurs and counseled on how a social marketing center could act as a means to
livelihood and better living. Till now 50 PKKs have been developed but the challenge continues and
efforts to overcome the same are ongoing.
Naya Savera II – Building on Gains and Addressing Gaps in Reproductive Health and
Family Planning in Rajasthan
The project was initiated in August 2008 for a period of 4 years.
The present project is a sequel to the previous four year project
implemented by JK Lakshmi Cement in 10 villages of Sirohi
district covering a population of approx. 30,000 which ended
on July 31, 2008. The objective of the first phase was to
increase availability and access to primary health care with a
focus on RCH services. The end line evaluation showed that
there was considerable improvement in key RCH indicators like
ANC, safe delivery, institutional delivery and child
immunization. It showed that there were improvements in
proportion of women using oral pills and undergoing
sterilization. However, due to cultural barriers and lack of good
infrastructural facilities, acceptance of male sterilization and
Cu-T has been quite low. It has, therefore, been felt that a structured programme that repositions
the family planning programme by offering a basket of choice with “quality of care” was needed.
The current phase was thus designed taking this into consideration. It also focuses on involving
adolescents in order to prepare them for responsible parenthood. The second phase also focused
on documentation of the learnings', processes and good practices for further replication and
expansion. In addition to the old villages, six new villages were included in this phase. Objectives of
the current programme are to:
? ? Increase the acceptability of and access to family planning methods by informed choice.
? ? Provide quality reproductive and child health services in underserved areas through mobile
clinic and linkages with the government.
? ? Prepare unmarried adolescents, both boys and girls, in the age group of 12 to 19 years, for
responsible parenthood by increasing their knowledge on ARSH issues through community
participation.
? ? Document the learning, processes and good practices for replication and scale-up.
The project activities began from August 1, 2008. The project staff and VLMs were appointed. The
selected VLMs act as ASHAs and anganwadi workers. The baseline evaluation demonstrated that 55
percent of girls were married off before the age of 18 and majority of them had borne children within
two years of marriage. Though 90 percent of women had registered for ante-natal check up during
5
|
|
2.2 Page 12 |
▲back to top |
annual report
2008-2009
their last pregnancy, only about 41 percent received the three minimum prescribed ANC checkups,
signifying high drop outs. Only 39 percent of women reported using a modern contraceptive
method. Awareness among adolescents about puberty was high but most of the girls faced
restrictions during menses. Awareness about RTI and STI was also found to be quite low with 19
percent for girls and 18 percent for boys. Exposure of women to mass media was found to be quite
low with 89 percent never reading newspapers, 90 percent never listening to radio and 63 percent
never watched television.
The new phase of the project has added a new set of objectives with focus on increasing health
system engagement in provision of reproductive health services through strengthening Village
Health and Sanitation Committees, preparing adolescents for responsible parenthood, and
supplementing government efforts at providing quality reproductive health services in un-served
and underserved areas. A planning meeting was organized by PFI at JK Laxmi Cement in December,
2008. The project team finalized strategies for
adolescent health, capacity building of the
project staff, IEC and Behaviour Change
Communication (BCC), service delivery in un-
served/underserved areas and strengthening
of Village Health and Sanitation Committees.
MIS has been accordingly modified in
consultation with the project team.
Preliminary meetings of Mahila Mandals and
Navyuvak Mandals were organized to brief
them of the project objectives, strategies,
services and increase their awareness and
knowledge on RCH.
Capacity building of project staff was done on
adolescent health issues covering basic life
skills, gender, reproductive and sexual health
and reproductive rights. They were also trained on VHSC formation and documentation. Activities
such as house to house visits for counseling eligible women, formation and orientation of VHSCs,
formation of adolescent groups for girls and boys and their orientation on health and reproductive
health issues were initiated. IEC activities including screening video films on reproductive and child
health, utilization of cable network for giving information on health and RH issues and celebration of
events like breast feeding week, were also initiated in the project areas.
The strategy for providing medical services in new project villages through mobile health team was
finalized in consultation with PFI in December 2008. Stakeholders' meetings and project awareness
activities were done. Full fledged services with a focus on reproductive health and family planning
counseling covering the entire area were initiated from January 2009. During April 2008- March
2009, 379 ANCs were reported and 362 women availed the delivery services from government
institution,163 children were immunized and there were 922 users of family planning methods. In
addition, social marketing of contraceptives through depot-holders was initiated with procurement
of 4320 pieces of Ustad (Condom) and 600 cycles of Pearl (OCP).
6
annual report
2008-2009
PARIVARTAN – A Family Welfare and Population Development Project in Rajasthan
The project `Parivartan' is being implemented by PFI in collaboration with JK Tyres & Industries Ltd.
in 60 villages in Rajsamand block of District Rajsamand, Rajasthan covering a population of 40,813.
This five year project started in July 2004 and is now in its last year of operation.
The objectives of the project include
? Building the capacity of community level volunteers on issues related to general health and
hygiene including RCH and ensure their involvement in making services available on a sustainable
basis at the grass root level,
? Raising awareness and knowledge of the community stakeholders on RCH issues and general
health through IEC and BCC programmes,
? Providing quality RCH services in the target areas through mobile van and
? Organizing socio-economic development activities in the target villages to enhance the
effectiveness and acceptability of the programme.
The main strategy adopted for realizing the above objectives and to make them sustainable, was
identification and capacity building of village level motivators, raising awareness and knowledge of
communities and provision of basic quality RCH
services. The focus was on maternal health, family
planning methods, spacing between children,
awareness about minimum age for marriage,
keeping records of births and deaths, vaccinations,
child care and nutrition.
During the year 2008-09 the main focus was on
capacity building, behaviour change
communication activities and awareness
generation. Various capacity building, BCC and
awareness generation activities were undertaken,
which included training programmes for staff,
camps for eligible women, adolescents and children
under 15 years of age in each project village, nukkad
nataks on RCH themes, house to house contact of
target women as a part of BCC activity, where they were counseled on family planning, new born
care, care during pregnancy and an intensive drive to promote Non-Scalpel Vasectomy (NSV)
through government institutions.
A review meeting was organized in December 2008 where it was decided to plan out the IEC/BCC
component in detail and JK Tyre would take the initiative in forming Village Health and Sanitation
Committees in each village in the project area. In this context the coordinators from the Parivartan
project also attended a five-day training workshop on strengthening Village Health and Sanitation
Committees and documentation skills organized at Tata Chemicals Ltd., Babrala in March 2009. Six
adolescent awareness camps were organized for 139 class X students at Government schools to
increase their awareness on health, physical and mental changes in the body and make them
understand the process of menstruation, conception and prevention of unwanted pregnancy.
7
|
|
2.3 Page 13 |
▲back to top |
annual report
2008-2009
School Health Camps were also organized at six
government schools focusing on nutrition,
environmental sanitation and personal hygiene. More
than 250 students benefited from these camps.
Rallies by school children were initiated to generate
public awareness on the benefits of a small family, child
nutrition, education and environmental issues.
Reproductive Health Awareness camps were also held in
50 villages (18 from Phase I and 32 from Phase II).
Screening of film shows on health issues were
organized in 13 project villages. Ex-MLA, Block
Development Officer and the village Sarpanches
attended the health and awareness camps. As a
continuity of socio-economic development programs, four community water points (panghat) were
constructed in four project villages. Mobile health camps were also organized where ANC services,
post natal care services and treatment for RTI/STI were provided.
Efforts at awareness generation through various activities have resulted in increased awareness and
sensitization of the community. There were 1821 institutional deliveries during the year and had 1555
PNC check-ups within 24 hours of birth. About 2676 couples have adopted modern family planning
methods. Strategy to involve males in family planning has also yielded results with growing
acceptance of NSV.
Improving Reproductive and Child Health Status of the Tribals in Noamundi Block,
West Singhbhum District of Jharkhand
It has been over two years since the project commenced in May 2007 covering 34 villages of
Noamundi Block of West-Singhbhum with a population of 30,000. The broad objectives of the
project are to:
? ? Generate awareness among eligible couple (women in the age group 15-49 years) on use of
modern contraceptives for family planning and child spacing and issues related to maternal
and child health
? ? Increase use of modern contraceptives by eligible couples by providing a basket of choices
through social marketing and improving access to both male and female sterilization
? ? Create community based mechanisms and linkages for improved health services and
referrals for maternal and child care
? ? Build awareness and capacities of adolescents in contraception and neonatal care for
sustaining positive health seeking behaviour
A formal launch of the project took place at the Baraibaru subcentre in May 2008. Deputy District
Commissioner (DDC), CDPO, CMOs, MOIC, Civil Surgeon along with ANMs and community members
were present at the launch ceremony.
8
annual report
2008-2009
Meetings were held with each of 27 VHSCs, where efforts were made to link VHSCs with banks for
getting a grant of Rs 10,000/- from the government under the NRHM
A training for 21 Saahiyaas was organized in Badajamda PHC in coordination with the block and
district government functionaries. Saahiyaas were informed about their health and hygiene, roles
and responsibilities and the importance of family planning. A special training on the pregnancy test
using the pregnancy test kit (Nischay) was done. This was followed by a convergence meeting of
Saahiyas with ANMs of the respective villages in Barajamda PHC to ensure better coordination
between them.
In the training organized at KGVK, which was attended by 21 VHSC members, the concept of total
village management and roles and responsibilities of VHSCs were discussed. 44 VHSC meetings were
held in the project villages for the members to update their knowledge on various developmental
issues and make them aware of their responsibilities towards their respective villages. Exposure visit
for 17 Saahiyas was organized in Rajendra Institute of Medical Science (RIMS), Ranchi for learning
about need of quality health services in institutions.
National Safe Motherhood day was observed on 11th April, 2008 wherein awareness generation
activities were carried out and IEC materials displayed. World population day, breast feeding week
and world nutrition week were commemorated in Patita and Baraiburu PHC areas. World Filaria
Awareness Day, World AIDS Awareness Day and Pulse Polio Campaign were also observed.
An awareness generation campaign was conducted on health, sanitation and the importance of safe
water. Thereafter a drive was carried out for village cleanliness which included chlorination of
potable water sources, following which water drainage channels were constructed.
Audio-visual shows on health, HIV/AIDS, immunization and livelihood issues were organized in the
villages. Nukkad nataks were organized in the project villages on the issue of alcoholism. Three Bal
melas were organized for the school children on the importance of sports, health and hygiene, with
active participation. General knowledge tests were organized on health practices. IEC kit was
distributed to Saahiyas and a meeting with peer educators was also organized during the quarter.
Saahiyas carried out house to house visits and maintained cohort registers. Obstetric cases were also
regularly monitored through home visits. Data collected by saahiyas was regularly monitored by
cluster supervisors. Household surveys for CNA and microplanning
was done to identify children in the age group 1-5 years to give the
first dose of de-worming.
Mobile health camps were regularly organized along with house
visits in the project area. 575 pregnant women were identified of
which 235 have completed full 3 ANC during April 2008 - March
2009. IFA tablets were provided to 1469 beneficiaries and 1072
mothers have been administered TT II. There were 231 new
contraceptive acceptors (128 Condom users, 63 IUD insertions)
taking the tally to 853 new users in the project so far.
9
|
|
2.4 Page 14 |
▲back to top |
annual report
2008-2009
Corporate Social Responsibility: Package on Reproductive and
Child Health/ Family Planing
PFI identified a dearth of guidelines to conceptualize and implement the programmes as one of the
constraints for the corporate sector to take on programmes related to RCH and Family planning
effectively. As a step towards filling in this identified gap and with the aim of increasing corporate
participation in RCH and family planning programmes, an assistance package on RCH for corporate
houses on reproductive health has been developed. As a background, available material on CSR and
health developed by various agencies was reviewed and exploratory visits were made to some of the
corporate partners of PFI to understand the needs. A questionnaire was developed and shared with
a larger segment of corporate sector to determine the type of on-going CSR activities particularly in
reproductive health (RH) and family planning and understand how the gaps in knowledge acted as a
constraint to implement RH/FP programmes. Based on the needs and issues identified, a framework
for the various sections of the module was developed. The module was conceptualized with nine
sections, each covering the following key topics related to reproductive health.
Section I: Reproductive Health
Reproductive Health
Safe Motherhood
Safe Abortion
Family Planning or Planned Parenthood
Infertility and Assisted Reproductive Technology
Reproductive Tract Infection
Section II: Child Health
Neonatal Care
Immunization
Child Nutrition
Acute Respiratory Infection
Diarrhoea
Fever
Section III: Adolescent Health
Section IV: Ageing
Section V: Hygiene & Sanitation
Section VI: Gender
Gender issues
Violence against Women and
Reproductive Health
Section VII: Advocacy &Communication
Communication for Behaviour & Social Change
Counseling
Advocacy
Section VIII:Quality Of Care
in Reproductive
And Child Health Care Services
Section IX: Project Design and Management
Writing Project Proposals
Project Planning, Monitoring & Evaluation
Scaling up Management Framework
Community Needs Assessment
The package provides guidelines for various aspects of project proposal development, information
on RH/FP and related issues, insights into project implementation, monitoring mechanisms and
scaling up.
10
RCH Projects with NGOs
annual report
2008-2009
Total Management of Essential RCH and Primary Health Care through Public-Private
Partnership: A Model and Innovative Project in Karnataka
This project is being implemented by Karuna Trust, Bangalore, a pioneer NGO in the field of Public
–Private Partnership in India.
Karuna Trust has been handed over the total management of 25 PHCs in Karnataka and nine PHCs in
Arunachal Pradesh by the respective state governments in addition to five PHCs in Orissa. PFI joined
hands with Karuna Trust in this initiative in implementing the programme 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, attempts 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-centers catering to a population of approximately 2,00,000. The
aim is to facilitate development of adequate capacity of managers, service providers at all levels,
including awareness among communities and to strengthen community governance mechanisms
for effective functioning of the primary health care systems and community involvement.
The specific objectives of the project are to (i) manage routine functioning of select government
Primary Health Centers and strengthen them into model PHCs,
(ii) maximize utilization of RCH services at the sub-centers of the
select model PHCs and (iii) influence and facilitate change for
improved health seeking behaviour in the communities covered
by the model PHCs. The project, launched in May 2006, has
completed three years. The project has made remarkable
progress since inception.
The focus during the year 2008-2009 was to facilitate Karuna
Trust in scaling up the model to other states of the country. The
Scaling up division at PFI with overall guidance from
Management Systems International, Washington D.C. USA
facilitated a series of workshops on visioning, documentation
11
|
|
2.5 Page 15 |
▲back to top |
annual report
2008-2009
and organizational development. The capacity
building initiatives included a two day training
workshop for PHC staff in Health Management
Information System (HMIS) developed by Indian
Institute of Management, Bangalore, two one-day
orientations for Village Health & Sanitation
Committees members, orientations for members of
self help groups on community health insurance and
other health facilities being made available at PHCs
and Sub-centres. Capacities were built on manual
vaccum aspiration technique and IUD insertion to
enhance the gamut of and quality of services at the
PHCs.
An exhaustive training needs assessment and 'on the job' training sessions were undertaken by
Karuna Trust in November 2008. Five out of seven PFI PHCs were visited. The team identified
training/ orientation/refresher training needs in maternal and child health and immunization.
RTI/STI, HIV/AIDS, mental health and other national health programme to enhance the quality of
services being delivered by them.
Day long Arogya melas (Health Fairs) were organized to generate health awareness along with ANC
and PNC services. The fairs were a big hit and attracted large number of people from the surrounding
areas. One important innovation has been the celebration of 'Simantha,' a customary celebration of
fertility of a woman when she becomes pregnant for the first time. The 'Simantha' was observed at
PHC SRR Pura for the first time to raise awareness among first time pregnant women about the
importance of care during pregnancy, ANC, safe delivery and PNC.
During the year, the Trust also undertook a detailed survey of laboratory facilities at the seven PHCs.
Reagents, testing kits for pregnancy and HIV have been supplied. The testing facilities for diagnosis
of RTI/STI have been further strengthened.
PFI also supported the Trust in procurement of two ambulances in order to improve mobility of
medical teams at remotely placed PHCs. During the year, the project PHCs provided treatment
facilities to 1,18,228 out patients and 5,447 in patients of which 25,622 availed RCH services including
ANC, Delivery, Abortions and MTPs, PNC, FP, RTI/STI/HIV diagnosis, child immunization/treatment
for childhood illnesses. There has been a remarkable increase in the proportion of institutional
deliveries with many PHC reporting more than 95 percent institutional deliveries. During the year,
more than 6000 new couples were protected with a continuous supply of modern methods of
contraception. An exhaustive review of the project was undertaken at PFI in December 2008. The
review highlighted achievements under the project.
A state level sharing of Karuna Trust experience and performance workshop was held at Bangalore
on 27th June 2008. The meeting was chaired by Secretary Health, Govt. of Karnataka and was
attended by more than 150 participants from the government, corporates, philanthropic
organizations and the media. Dr. Kishore Murthy, Director, Institute of Health Management and
12
annual report
2008-2009
Research (IHMR), Bangalore presented the findings from the recently conducted evaluation study
supported by PFI. The sharing workshop was followed by an Institutional Development Framework
(IDF) workshop in November 2008 as an extended support to Karuna Trust towards scaling up of the
PPP model. The workshop helped Karuna Trust to identify areas for strengthening like human
resources and organizational structure and documentation.
Advocacy to Action: Promotion of maternal and neonatal survival in the tribal areas
of Rayagada district, Orissa
The project is being implemented by Orissa Voluntary Health Association (OVHA) since October
2006 covering a population of 33000 in 60 remote villages of Bissamcuttack block of Rayagada
district in Orissa for a period of 3 years with the objectives to:
? Facilitate the process of ensuring essential antenatal care, intra natal, post natal care and
impart education to the young women and expectant mothers on all aspects of pregnancy,
hygiene and newborn care.
? Ensure effective links for referral system and encourage institutional delivery of high-risk
pregnancies and obstetrical emergencies.
? Elicit active community participation and ownership through involvement of community
stakeholders.
? Promote modern family planning practices through information sharing on various
contraceptive choices to eligible couples.
? ? Document and disseminate lessons learnt at the state level.
The initiative aims to address the three critical delays responsible for maternal and neonatal deaths,
namely, the delay in decision making, delay in transportation and delay in getting services at the
health centers.
The baseline survey showed that the knowledge of five cleans for safe delivery was 15%, coverage of
full ANC was 16% and 87% of deliveries were taking place at home. The proportion of mothers feeding
colostrum was 83%, the coverage of primary immunization was found to be 28%. Knowledge of at
least one modern method of contraception was 93%. The contraceptive prevalence rate was 33.5%.
A cadre of 60 community health volunteers (CHVs), one from each village, were identified and
trained on government schemes, reproductive health issues using
CNA formats for collection of household data. The tracking of
pregnant women for ANC and safe delivery was initiated. The
project also focused on training the Traditional Birth Attendants
(TBAs) as a lot of deliveries were taking place at home. Need based
IEC material was developed and meetings were organized with
community stakeholders (pregnant and lactating women, ANMs,
ASHAs, PRI members etc.).
The programme ran smoothly as per plan till mid 2007. Thereafter
due to a management crisis in OVHA the programme was put on
hold for about a year. PFI in collaboration with Voluntary health
13
|
|
2.6 Page 16 |
▲back to top |
annual report
2008-2009
Association of India, (VHAI) New Delhi facilitated resolution of this crisis
satisfactorily and project activities resumed in mid 2008. Fresh
recruitments were made for vacant positions in the project and a
refresher training programme was organized in three phases for CHVs to
re-orient them on the various aspects of the project, importance of
reproductive and child health care, quality data collection, maintenance
of village level registers etc. Essential drugs, as per the requirement were
also procured. IEC activities included street plays on maternal and child
health and distribution of IEC materials through Village Health Resource
Centers in all the project villages. Health melas for adolescents were
initiated to create awareness on increasing the age at marriage and
delaying first conception.
The village level data is now maintained and updated by CHVs through
periodic CNA. The project has developed good liaison both with block
and the district level authorities.
During the year 2008-2009, 1413 ante natal cases were registered out of
which 278 cases were registered within 12 weeks. 22 high risk pregnant
women were identified and referred to CHC and Mission Hospital, Bissam Cuttack. 38 women
received three PNC check ups. Services for family planning were also initiated. 168 women received
OCPs. 600 condoms were distributed and 33 CuTs were inserted. 14 cases of NSV and 3 cases of
tubectomy were reported.
Promotion of Family Initiatives to Address Family Planning and Reproductive & Child
Health Needs, Through Increased Male Participation in Uttar Pradesh
Population Foundation of India started implementing this three year project in October 2006 in
association with Center for Rural Entrepreneurship and Technical Education (CREATE), Uttar
Pradesh.
The project is an action research demonstration project on 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. The project caters to a population of 70,000 approximately
covering 60 villages in Rajgarh block of Mirzapur district.
The main objectives of the project are:
? Enhancing the knowledge, attitude and practices on family planning, safe motherhood and
child health practices among eligible couples and especially men in the family.
? 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.
? Facilitating provision of services for safe motherhood and primary immunization.
? Documenting and disseminating the lesson learnt.
14
annual report
2008-2009
The baseline survey conducted in 2007 showed that the institutional deliveries were only 13.2
percent with ANC coverage of 22 percent. Safe home deliveries were just 14.4 percent. Complete
routine immunization was just 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.
The project strategy comprises selection of and capacity building of a cadre of trained male and
female link workers, who reach out to eligible couples along with other stakeholders like mothers-in-
law, PRI members etc. Under the project, 60 Lady Link Workers (LLWs) and 25 male Link Workers
(MLWs) were selected. During 2008-2009, trainings were held for the male and female link workers
on various issues like management information system, behavior change communication for
reproductive and child health and family planning.
Extensive IEC and BCC activities were carried out in which 106 street plays, 65 film shows and 41
mobile exhibitions were organized on reproductive health, child health, adolescent health and
family planning. Monthly house-to-house visits were carried out for follow-up of contraceptive users
and to motivate non-users to adopt any of the spacing methods or permanent method of
contraception, especially male sterilization. Mobile exhibitions were effectively used to display all
relevant IEC materials and to provide need based counseling. Pamphlets on various issues were also
distributed during these shows. Group meetings with the community, including adolescents, were
held, which aimed at generating discussion on reproductive health, child health and family planning.
There was extensive social marketing of oral pills, condoms and Dai Delivery Kits (DDKs). 85 local
shopkeepers from the project villages were motivated to keep social marketing materials. The social
marketing materials were made available to these shopkeepers by the project supervisors. The
clients were regularly informed about the various products available. 1521 condoms, 962 condoms
and 282 DDKs were sold during the year 2008-09. Emergency fund was also utilized for the
emergency transportation for safe delivery.
The MIS for the project was reviewed to validate the data in reporting formats. Focus was given on
documenting case studies and maintaining daily diary.
During the year 2008-09, the project successfully reached out to 288 new eligible couples taking the
cumulative figure to 9596. 837 new couples were supplied with condoms, 579 new clients started
using contraceptive pills, 246 CuTs were inserted, 429 women underwent tubectomy and 19 Non-
Scalpel Vasectomies were conducted. 427 children, in the age group 0-23 months, completed routine
immunization. About 53 percent of the deliveries occurred in the institutions during this period. The
services, including antenatal, postnatal, child immunization and family planning were provided in
coordination with government health functionaries so as to avoid duplication.
The documentation report of the key processes involved in the project was brought out as PFI
publication.
15
|
|
2.7 Page 17 |
▲back to top |
annual report
2008-2009
Intervention Study among Adolescents, Pregnant and Lactating Mothers to Reduce
Prevalence of Anaemia in Haryana
Intervention Study among adolescent, pregnant and lactating mothers to reduce prevalence of
anaemia – a contributory factor of maternal morbidity and mortality was implemented by Sukarya,
Gurgaon in 10 villages in Gurgaon district covering a population of approx. 30000 for a period of
three years from May 2006 to June 2009 with a goal of reducing the prevalence of Iron Deficiency
Anaemia among the girls in the age group of 13-18 years and pregnant and lactating mothers. The
objectives were to:
? Measure the prevalence of anaemia in the target group
? Understand the knowledge, attitude and practices in
consuming iron rich food and the health seeking behaviour
? Create awareness on anaemia and its adverse effects and
methods of prevention and treatment
? 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 anaemia level, networking with health and integrated child development schemes (ICDS) for
better accessibility to iron folic acid (IFA) tablets and holding nutrition demonstrations for healthy
culinary practices.
The field staff (CHVs) and supervisors were selected and trained on issues like nutrition, sanitation,
family planning, anaemia, communication skills and capacitated to carry out effective behaviour
change communication. The field supervisors were also trained in Hb assessment and field
implementation. A baseline survey showed that 58.5% of the adolescents, 54.85% of pregnant
women and 51.6% lactating women had knowledge of anaemia. 41.1% of the pregnant women and
57.9% of the lactating women identified lack of nutritional food as the root cause of anaemia. 35% of
the unmarried adolescent girls had anaemia. 58.9% (almost 2/3rd) of pregnant women and 51.2% of
lactating women were found to be anaemic.
During the year 2008-2009, two refresher training programmes
were organized on behaviour change communication and
promotion of kitchen gardens. Capacity building
workshops/activities were organized on various themes for all of
the project staff in addition to regular updating and hand holding
of community health workers at the field level. In order to foster
cross learning, the community level functionaries along with the
Sukarya project staff were taken for exposure visits to other
project villages. Exposure visits to other organizations viz, IHMP,
16
annual report
2008-2009
Pune, SMILE Foundation, New Delhi, Rajasthan University
Women's Association (RUWA), Institute of Health Management
Research (IIHMR) and Bhoruka Charitable Trust, Jaipur, were
organized for project staff to learn about health programmes and
the projects being implemented by them.
Meetings with stakeholders like PRI members, anganwadi
workers, ICDS and district health officials are held periodically to
discuss the programme and supply issues. Self Help Groups and
adolescents groups have been formed to increase community
involvement in an organized way. House to house visits to counsel
target beneficiaries have been taking place regularly.
A film on anaemia “Jab Jago Tab Savera” was prepared and is being shown frequently in all the
project villages. Sukarya has brought out a recipe book for iron rich preparations from locally
available foods. 200 recipe books have been printed and distributed. 10 radio jingles were developed
on anaemia reduction and are quite popular. A series of slogans, poster competitions and quiz
competitions on health and nutrition were organized in each of the ten project villages to bring
about desired behaviour changes.
Sukarya procured 1000 kg of double fortified salt (common salt fortified with iodine and iron). The
salt looks, tastes and smells exactly like common salt. 350 iron karahis were procured for distribution
as a measure to promote healthy cooking practices. PFI supported the twin activities in form of a
subsidy. Till March 2009, 297 iron pans and 1076 kgs of health salt had been sold among the target
population.
Observance of Nutrition Demonstration Week is continuing as per the plan. 51 Nutrition
demonstrations have been organized till March 2009 along with cooking competitions. A Nutrition
Demonstration Workshop was organized at Bandhwari village with five eminent nutritionists on
panel. The participation of eminent nutritionists added to the credibility of the workshop and helped
clarify several myths and misconceptions prevailing among the community regarding various foods
and food habits.
Health camps have been organized through mobile van in project villages. It focuses on
identification of anaemic cases among the target population: adolescent girls, pregnant and
lactating women through estimation of their haemoglobin level followed by counseling on dietary
intake and supply of IFA tablets. During the year, a total of 420 anaemic cases were identified during
the camps of which 39 severely anaemic cases were referred while the rest were provided
counseling and IFA tablets. A total of 3001 haemoglobin tests done under the project and 1237
women were supplied with IFA tablets and 469 adolescent girls were given de-worming tablets.
The project has been, through its innovative approaches and activities, able to bring about
noticeable behaviour changes. Looking at the various project performance indicators, it could be
averred that the project has been able to achieve most of the targets envisaged in the project. The
end-line evaluation of the project was carried out to assess the achievements of the project.
17
|
|
2.8 Page 18 |
▲back to top |
annual report
2008-2009
Improvement of Maternal and Child Health through Life Cycle Approach in
Jharkhand
PFI in association with Child in Need Institute (CINI), Jharkhand and Nav Bharat Jagriti Kendra (NBJK)
Jharkhand had implemented a five year intervention in Jharkhand. The project rendered services to
a population of 85,000. Sir Dorabji Tata Trust joined in this
collaboration and provided part of the financial support to this
initiative.
The goal of the project was to strengthen the NGO capacity in the
state of Jharkhand and to implement RCH programmes through
Life Cycle Approach to bring about improvement in the RCH status.
To achieve the same, it aimed to build capacities of its four partner
NGOs and implemented the Life Cycle based interventions on
adolescent health and MNCHN in Churchu Block of Hazaribagh
district through one of these partners. It thereby also documented
and disseminated the lessons learnt, which were integral to the
project.
The project was implemented in three phases over a period of five years. It has now reached a
successful end. The key activities of the project were:
Block Level review meetings - Government schemes such as JSY and untied fund for Village Health
and Sanitation Committee (VHSC), monthly service delivery reports were shared and status of
Saahiya training under NRHM and availability of medicines for conducting health camps were
discussed.
Training and Capacity Building – training sessions were conducted and modules have been
developed under NRHM for the training of Saahiyas by Government of Jharkhand with the help of
CINI on maternal and child health, nutrition and general health.
Exposure visit of VHSC team from Gumla (comprising project coordinator, supervisor and health
workers) was organized to the project area. The VHSC representatives were oriented on the concept
of VHSCs, Federation, roles and responsibilities of VHSC members and various government schemes.
They were also trained on Indian Public Health Standards (IPHS) for PHCs, sub-centers and micro
birth plan for JSY beneficiary. VHSCs also prepared the village health plan and selected the
community based monitoring teams at village level.
Community groups - Adolescent groups were trained on nutrition and ICDS scheme, health and
hygiene, RTI/STI, menstrual cycle, etc. The mahila mandals were also oriented on similar issues. The
VHSC Federation took initiative in linking VHSCs with banks so that VHSCs could avail untied funds
under the NRHM scheme. In the VHSC meetings the issues of community health problems like
malaria, JSY, registration of Federation and opening of bank account for the Federation were
discussed. At the villages level, VHSC meetings were conducted where strategies onto combat the
problems were discussed. The VHSCs also liaisoned with the PHCs and sub-centres to obtain supplies
of bleaching powder.
Communication and IEC: Important days such as Breast feeding week, Nutrition week and World
AIDS Day were celebrated in the project villages. Awareness on issues was done through group
18
annual report
2008-2009
meetings, rallies and inter-personal communication focusing key messages along with door to door
campaigning.
Health Camps – Health camps were slowly phased out. As a sustainability strategy, ANMs were
activated through community to take on provision of services in these areas. VHSCs took active role
in facilitating these health camps and ensured smooth medicine supply from government
functionaries. Verbal autopsy was conducted for investigating the reasons of infant and maternal
mortality in the project area. Analysis for the same was done and shared with the community.
During 2008-2009, a total of 1804 pregnant women were identified of which 1235 pregnant women
were early ANC registration candidates. Number of deliveries after full 3 ANC has increased from 1159
to 1564 in this year. Number of institutional deliveries was 586 as compared to 394 in the last year. A
total of 24 infant deaths occurred in the year. This year the total number of new condom acceptors
was 3821. New CuT acceptors were 223, new OCP acceptors were 1601 and 462 underwent
sterilization.
The project has been completed with successful establishment and functioning of VHSCs making the
villages of Churchu Block in Hazaribagh – Jharkhand, self sustainable and empowered.
SAMWEDNA - Sub-center as Agency for Maternal Wellbeing, Empowerment
Demonstrated through NGO Assistance
Skilled birth attendance (SBA) has been accepted as a key action strategy towards reducing
maternal mortality since 2004. The Nurse Managed Health Centres model, piloted by ARTH, Udaipur
(Rajasthan), has been successfully demonstrating provision of a continuum of maternal-child care
services including the round clock basic obstetric care, basic
laboratory services and active and assisted referral. The current
phase of the project started in April 2008, and is being
implemented by two partners: Shikshit Rojgar (SRKPS) in
Jhunjhunu and Shiv Shiksha Samiti in Tonk district of Rajasthan.
The specific objectives of the current phase of the project are to (a)
demonstrate that an NGO managed sub health center can provide
comprehensive health services with emphasis on safe
motherhood and family planning services; and (b) document the
model and undertake advocacy for repositioning the role of sub
centers in primary health care through public private partnership.
During the year, several initiatives were taken to make the centers self sustainable along with
persistent advocacy with the government for scaling up the model. The Jhunjhunu centre run from
village Luna was shifted to village Dhandhuri to increase the overall catchments area and provide
safe delivery services to difficult and remotely placed villages. Similarly, three new villages were
added to the Tonk center. Another initiative has been provision of specialists' services on specified
week days at both the centers. Also, a concerted campaign has been carried out to publicize the
basket of services being offered by the centres. The basket of services has also been expanded with
inclusion of emergency contraception, injectable contraceptives etc. The community health
workers are now being remunerated based on their performance. Efforts are on for getting MTP
centre certification from the government.
19
|
|
2.9 Page 19 |
▲back to top |
annual report
2008-2009
One of the major achievements during the year has been accreditation of the two centers under the
Janani Suraksha Yojana resulting significant increase in the number of deliveries at these centers.
ARTH continued to provide training and other technical support to the project. Capacity of project
staff, incuding Village Level Motivators (VLMs) has been built in pregnancy testing with the supply of
pregnancy testing kits (Nishchaya). A training of trainers (ToT) for the project staff was organized by
PFI at JK Laxmi Cements Ltd. (a PFI partner implementing the Naya Savera Project in Sirohi district of
Rajasthan) on adolescent reproductive and sexual health to facilitate systematic roll out of the ARSH
component. Efforts are on at integrating ARSH, school health, public health and hygiene
components with the existing model.
The two centers continued to provide quality delivery and family planning services during the year.
They catered to 5020 patients at health centers and 2407 during field visits by the nurse midwives. A
total of 2407 basic laboratory tests were conducted. The midwives conducted 194 deliveries and
provided post natal care to 352 women within seven days of delivery. The VLMs have been providing
continuous supply of contraceptives to about 1000 eligible couples.
Instituting Rational Use of Drugs (RUD) in Reproductive and Child Health Care in FPAI
Clinics in India
The project was implemented by Family Planning Association of India (FPAI), Mumbai for a period of
18 months during October 2006 to December 2008. The objectives of the project were to (a) carry
out baseline survey to assess the existing prescribing practices and drug store management along
with the availability of drugs, (b) train medical officers (MOs), branch managers, storekeepers and
paramedics in RUD in RCH, and (c) assess the impact of training and guidelines on prescribing
practices and drug costs.
The key component of the project comprised capacity building of project staff of 10 branches of FPAI
on the issue of rational use of drugs. A baseline assessment done by FPAI for 13 clinics showed that all
the clinics were purchasing drugs through local suppliers as per requirement of their centers
(decided by Medical Officer). Most centres had adequate storage space and a refrigerator.
Variations in prescription practices were observed and mostly branded drugs were provided. ORS
was available in most clinics, un-indicated antibiotics were given for diarrhoea and a wide range of
anesthetics and analgesics were used in the clinics.
Workshops were held in April 2007 in New Delhi for 30 participants from northern states and in June
2007 in Bangalore for 45 participants from southern states. Participants included medical officers,
branch managers, store keepers and volunteers. Delhi Society for Promotion of Rational Use of
Drugs (DSPRUD) and Karnataka State Promotion of Rational Use of Drugs (KSPRUD) functioned as
master trainers. Separate plenary sessions for medical officers and storekeepers were organized
focusing on the basic concepts and need for rational use of drugs, existing system of selection,
quantification and procurement of drugs etc. The Standard Treatment Guidelines (STGs), to be used
by medical officers, was released.
During the period April 2008 to December 2009, a format for developing the action plan was shared
with the 27 branches. Sample BIN Card was also distributed to all the branches and the same has been
20
annual report
2008-2009
adapted by them. Each branch prepared an essential drug list and ensured adequate supply for
purchasing of drugs. A task force from the staff of FPAI branches was set up to monitor the progress
of plans. A field visit showed that the branches had an essential drug list along with a procurement
policy depending on their drug requirement, accessibility of drugs from the government and client
inflow.
A survey of six clinics showed that BIN Card system was being regularly followed and the medical
officers were well appraised with the Standard Treatment Guidelines. It also showed an
improvement in average number of drugs prescribed. It was seen that the percentage of drugs
prescribed by generic names had improved and was found comparable to a national standard in
most of the clinics. An improvement was found in the average consultation time for services. It
highlighted that there is a need for periodic and systematic review of the systems as per
standardized formats and check lists. This was discussed with senior management of FPAI. PFI also
carried out a visioning exercise for FPAI in September 2008 in Mumbai. This helped in clarifying,
refining the model, identification of stakeholders, need for documentation and also highlighted the
advocacy FPAI would need to do for scaling up.
A qualitative endline evaluation of the project was assigned by PFI to an external consultant. The
study was done in December 2008 covering six branches: New Delhi, Mumbai, Bellary, Lucknow,
Bhopal and Gwalior, of the 26 branches where the project was implemented. The various methods
used were desk reviews of reports, records and other documents, in depth interview with key
stakeholders, prescription analysis and study of systems and procedures of procurement and
storage of drugs.
The key findings were that there was a decrease in use of injections and average cost of treatment.
Though there was a lot of variation found in what is prescribed and recognized by each branch as
essential drug list, there was an improvement in labeling. Patient's knowledge about dosage of
drugs however varied from clinic to clinic. It was low in clinics located in backward region. The
assessment also showed improvement in procurement procedures and quality of services. There is a
need to have an intensive follow up mechanism with trained staff was identified as an important
element in institutionalizing RUD. Overall, the project has been quite successful in setting up systems
for institutionalizing RUD in project branches of FPAI.
SWABHIMAN: Urban Reproductive and Child Health Programme with an
Empowerment Approach in Delhi
SWABHIMAN or dignity is a pre-requisite to honorable and healthy
living. SMILE Foundation, with support from Population Foundation of
India (PFI), has initiated the project on health and empowerment of
women with a special focus on the girl child under its special
programme, SWABHIMAN two years ago in Delhi and NCR. The project,
SWABHIMAN aims to cover about 78000 under-privileged population
residing in slums and urban-rural hinterland of Delhi. The Project
focuses on girl child /young women with an objective of empowering
them and enabling them as change-agents to improve health seeking
behaviour in the community.
21
|
|
2.10 Page 20 |
▲back to top |
annual report
2008-2009
The broad objectives of the project are to generate
awareness on issues related with reproductive health,
provide RCH and general health services through mobile
van, sensitize adolescent on gender issues and impart life
skill education to them in a bid to empower them.
Besides awareness generation, advocacy and
empowerment programmes, SWABHIMAN also seeks to
address issues of domestic violence, female foeticide,
infanticide, sexual harassments, rape and abuse - linking up
with institutional supports available for redressal. In
addition, the project has the component of provision of
comprehensive reproductive and sexual health services
through a mobile clinic inclusive of a mobile medical team led by a qualified lady doctor. There is a
wide network of community educators and SWABHIMAN volunteers deployed in the community for
project activities. It involves four implementing organizations at community levels across the
selected pockets of East and South Delhi.
This year's highlights in terms of activities carried out under the project are mentioned below:
Capacity building
Training of SWABHIMAN Health Volunteers (SHVs) and CHEs: All the four partners conducted two day
training sessions for their SHVs in June 2008. The trainings focused on ‘HIV and Sex and Sexuality'. A
two-day refresher training was organized for CHEs and Project Coordinators with resource persons
from New Opportunities for Women (NOW). The training focused on reproductive health issues and
life skills. Trainings were organized for SHVs on adolescent health issues including sex and sexuality
through use of diagrams, discussions, sharing of field experiences, hygiene during menstruation,
career development and counseling. They were also trained in performance of street plays by a
professional theatre group 'Mahak.'
Project Coordinators from SMILE Foundation and partner organizations participated in a two day
workshop in June 2008 organized by PFI. The participants learned about documenting success
stories, writing reports, brochures, newsletters and the significance of photographs in reports, etc.
New members were promptly oriented about the project and issues.
Exposure Visits: Exposure visits were organized for adolescents and women as a means of
empowerment. The adolescents from Chhatarpur village were taken on an exposure visit to the PHC
to familiarize them with the services available there. Similarly, adolescents and women from other
partners were taken to different institutions such as bank, courts and municipal corporation offices.
Exposure visits to courts were organized to understand legal system, procedures and terms.
IEC/BCC activities
The project has a dedicated website, which is regularly updated. Street plays were staged to draw
22
annual report
2008-2009
the attention of the community on violence against women and maternal health issues. Banners
have been developed on HIV/AIDS, nutrition, immunization etc. These banners were put up in the
community by partner NGOs. Partners also organized special awareness sessions on HIV/AIDS and
care of pregnant women. The “Girl child week and National Nutrition Week” were also celebrated by
organizing a Low-Cost Nutritional Recipe contest as well as the World Human Rights day, World AIDS
Day, International Womens Day. The newsletter, SWABHIMAN- living with pride and dignity was
published and circulated widely.
Stakeholders meetings
Stakeholders' meetings continued in all the four project areas. The issues discussed were child
abuse, domestic violence and deliveries at home, sanitation, child labour and dropouts of children
from school. The meetings were attended by municipal councilors of the area. Forms for the Ladli
scheme were made available and registrations for Janani Suraksha Yojana (JSY) were done. All
agreed to support CHEs in their work, reporting cases of violence against women and promoting
family planning and safe motherhood in the community.
MIS strengthening
Under the guidance of PFI and SMILE Foundation, all partners are maintaining records of cases,
meetings, pregnancy registrations, immunization, counseling and eligible couples for family
planning. Concentrated efforts are being made to document case studies and success stories.
Health seeking behavior and service off take
Counseling and service provision through house to house visits and mobile health clinic have been a
regular feature. New service points were decided in consultation with community members at
Chattarpur, Nebsarai and Begumpur. This increased the number of patients and in turn improved
health seeking behaviour. There has been a good response to project awareness and empowerment
initiatives.
During the year 2008-2009, total number of patients availing services from mobile van increased
from 1773 to 7615, number of patients availing RCH services from mobile van increased from 2008 to
3980. Institutional Deliveries increased from 179 to 481. Among pills, condoms, IUDs and
tubectomies, the increase in usage was substantial with condom increasing from 755 to 1714, pills - 83
to 366, IUDs - 31 to 162, tubectomy -32 to 448. 165 RTI/STI cases were reported and treated and 1174
children fully immunized.
Increased Visibility
The SWABHIMAN project has been extensively covered by various media like the Aaj Tak television
news channel, Doordarshan, The Washington Post Newspaper.
23
|
|
3 Pages 21-30 |
▲back to top |
|
|
3.1 Page 21 |
▲back to top |
annual report
2008-2009
Evidence Based Advocacy for Maternal and Child Health amongst the Urban Poor of
Vadodara City in Gujarat
The project is an initiative taken up by PFI in 15 slums of Vadodara covering a population of 50,000 in
collaboration with Sahaj-Shishu Milap, a community based organization in Vadodara, Gujarat aims
to improve reproductive and child health status amongst the urban poor of Vadodara through
evidence based advocacy for maternal and child health. The project was initiated in May 2007 for a
period of 18 months i.e. upto October, 2008, which was further extended for another 8 months to
achieve all the set objectives.
The main objectives of the project are (a) determining the maternal and child health status in the
slums of Vadodara, (b) examining the quality of health services being used by urban poor and
ascertain approximate costs for availing these services, (c) using the information for advocacy at city
and state level to strengthen the related public health programmes, schemes and improve quality
and accessibility of the services, (d) identifying and training the community health workers to
provide basic health education, provision of primary services for common illnesses and link
community with the public delivery system in the city, and (e) increasing community's access to
quality health services through the municipal corporations' service delivery system.
The strategy adopted is a process of learning and acting by the communities through a Participatory
Action Research (PAR) to address various issues identified. Involvement of the communities through
PAR helped in empowering the people and raises their concerns themselves. On the basis of the
evidence collected, advocacy was done with policy makers, health service providers within the
public and private sectors; members of local government at the ward, district and corporation levels;
civil society organizations working on similar issues; academicians and researchers and the media. At
the community level women, men, children as well as families and other social groups were actively
involved. Both these efforts not only facilitated the formulation of appropriate policies and
programmes but also their effective implementation and regular monitoring.
During the year 2008-2009, the focus of the project was on capacity building and facilitating
advocacy efforts of the community. The Community Health Workers (CHWs) in each of the 15 slums
were trained on maternal and child health and their capacity was built on gender issues, reproductive
and sexual rights, growth monitoring, JSY, Chiranjivi Yojana (CY) and child health issues including
breast feeding, importance of feeding colostrums, early initiation of breast feeding and counseling
on child nutrition. Traditional Birth Attendants (TBAs) in the area were oriented on Janani Suraksha
Yojana and Chiranjivi Yojana with government functionaries as resource persons. A six day intensive
orientation workshop on 'Interviewing Skills in Survey Research' was organized for the peer
educators in August 2008 on child health issues. To build the capacity of the project staff, two
refresher training programmes on neonatal care, male and female reproductive systems, family
planning, abortion, anaemia, uterus prolapse, infertility and HIV/AIDS were held. A detailed analysis
campaign viz. Anna Suraksha Abhiyan was launched along with partners from Action Aid, CSJ, HRLN
etc to assess the problems faced by slum dwellers for obtaining below poverty line (BPL) status and
availing benefits of Janani Suraksha Yojana and the Chiranjivi Yojana in order to follow-up with the
concerned authorities. Leaflets have been published by Sahaj giving details and provisions of these
schemes for general awareness.
24
annual report
2008-2009
A facility survey of 11 city based hospitals (both government and private) was conducted to find out
the status of services provided by them. The findings from the survey are being analysed currently.
Attempts were made to revive the Anganwadis in slums and a team comprising community
representatives and project staff contacted Bachawad Health Center to discuss about setting up of
an Anganwadi centre in their slums with mobile health camps at regular intervals to provide ANC,
PNC and immunisation services. Meetings were organized to raise awareness among women about
the symptoms, causes and means of prevention and treatment of RTIs/STIs (including importance of
partner treatment). Two `Jan Samvad', a dialogue between the elected representatives and
representatives of the Basti Development Committees, were organized to discuss the unavailability
of BPL ration cards, non-existence of Anganwadis in some areas, blocked drainage, insufficient
water supply and poor accessibility to health facilities. Follow-up meetings were also held with their
respective Corporators. Walkathon and slogan competitions were organized to create awareness on
reproductive health issues. Several meetings of the Community Development Committees were
organised to discuss the issues of immunisation, ANC, PNC and nutrition.
Advocacy campaigns continued during the year including a workshop on “Urban Health: Context,
Challenges and Way Forward” aimed at identifying and highlighting health issues in urban areas,
analyzing recent policy documents, laws for health sector regulation, public health insurance and
public-private partnership in the context of overwhelming contribution of private sector in urban
health delivery and deciding on a common plan of action. The workshop was attended by over thirty
eminent activists from across the country. A decision was taken to prepare a position paper on Urban
Health and a specific analysis of NUHM and start a dialogue with government (Central and State) by
August 2009 on regulation of the health sector and documentation of various initiatives in urban
health (both negative and positive, government or corporation system). The executive summary of
the NUHM was translated in Gujarati to facilitate discussions at the community level as part of overall
advocacy efforts.
The evidence collected from the grassroots level is being increasingly used by the community for
advocacy at higher levels to secure services and supplies for better RCH. The Jan Samvads and state
level consultations and networking with NGOs working on urban health, has helped highlight the
special problems, situations and needs of the urban poor.
Reducing Reproductive Morbidity in Married Young Women in Rural Maharashtra
The project is a multisite action research project implemented by
Population Foundation of India , Institute of Health Management,
Pachod, and 5 field NGOs namely, Sanskruti Samvardhan Mandal,
Nanded; Gram Vikas Mandal, Beed; Apeksha Homoeo Society,
Amravati; Youth Welfare Association, Buldana; and Late Shriram
Ahirrao Memorial Trust, Dhule covering a population of 100,000 for
a period of 3 years since January 2008. The project aims to
demonstrate a model with specific interventions to improve the
sexual and reproductive health of married young women in five
vulnerable districts of Maharashtra. The project envisages
25
|
|
3.2 Page 22 |
▲back to top |
annual report
2008-2009
identifying and tracking a cohort of all married young adolescent women in the project area with the
objectives of:
? Delaying median age at first conception by one year
? Increasing contraceptive use to delay first conception by 10 percent as compared to baseline
? Reducing prevalence of anaemia among young married women by 20 percent as compared
to baseline
? Increasing treatment utilization behaviour for RTI, post abortion complications and post
natal complications by 20 percent from the baseline
? Increasing proportion of pregnant young women receiving minimum 3 ante-natal check ups
by 20 percent from the baseline
? Increasing proportion of institutional deliveries by 20 percent from the baseline
Major components of the project include:
? Primary level care for improved sexual and reproductive health of married young women
including nutrition education, detection and treatment of anemia, maternal health services,
family planning , RTI / STI detection and treatment and HIV/AIDS awareness and counseling
? Behaviour change communication (BCC) for creating a demand for services and influencing
behavioural change and gender sensitization
? Community based surveillance for tracking RH status of all married adolescents
? Skill building of implementing agencies in development of systems, mechanisms to plan,
implement action research project on reproductive and child health and its monitoring and
evaluation and advocacy
As a technical agency, IHMP is responsible for sustained capacity building support to NGO partners.
As the programme involves intensive training inputs and skill enhancement on a sustained basis, a
training calendar was developed along with the training curricula for the project staff. After intensive
training of staff recruited by the five partner NGOs, census was successfully completed in all the
project villages which involved mapping and listing of all the households in the villages and interview
with target couples.
A baseline survey showed that about 21 percent of the married adolescent girls (MAGs) interviewed
were illiterate and 67 percent of the MAGs had mild to severe anaemia. The mean age at marriage
was 15.5 years with the lowest age at marriage being 10 years. The
average interval between marriage and first conception was 10.2
months. Out of the married adolescent girls who were pregnant at
the time of survey, 59 percent were registered in the first trimester.
13 percent of the married adolescents, who conceived had
abortion, 89 percent of which were spontaneous.
Training programmes for project staff on basic technical and
conceptual issues on RCH, liaison with the government system,
adolescent health issues, project goals, strategies and roles of
different functionaries were organized. Capacity building was also
26
annual report
2008-2009
done on issues of programme planning, monitoring, evaluation and behaviour change
communication at IHMP Pachod. A refresher training programme was conducted for the ANMs of
the partner NGOs. They were trained for using the Sahli's Haemoglobinometer and strips for
detection of urine sugar and albumin. ANMs were also updated on antenatal check-ups.
84 Village Health Sanitation Committees (VHSCs) and 258 youth groups have been formed across
project villages with active involvement and representation of panchayat members, opinion leaders
and women and youth. There are over 6000 members in the youth groups. 107 young married
couples have been identified as SATHI couples with the support and active involvement of the VHSC
members. The couples will act as change agents and depot holders for contraceptives. MAGs are
being identified through surveillance and registered with the project. The MAGs are followed up on a
continuous basis. One depot holder for contraceptives has been identified in each village.
Periodic quarterly review meetings were held in Pune, Nanded and Amravati, where programmatic
and finance related issues were discussed and decisions were taken with common consensus on
important issues. The review meetings were followed by a field visit and provided opportunity for
cross learning.
On site review and facilitation of partners was taken up in September 2008 by field coordinators
from IHMP. It was observed that there is a need for improving the quality of clinical services provided
by ANMs, data quality in surveillance registers, communication skills of the workers and increased
linkage with the government system. Thus, a training programme was organized for ANMs on
technical skills like estimation of height, weight, blood pressure etc.
As part of the facilitation for scaling up, a national dissemination workshop on Making Married
Adolescents Matter - Needs, Interventions and Policies for Married Adolescents' was held on August
21, 2008 at the India International Center, New Delhi to share the experience of implementing the
Safe Adolescent Transition and Health Initiative (SATHI) across various settings. The event was
organized jointly by the Directorate of Health Services, Maharashtra, Institute of Health
Management, Pachod (IHMP) and Population Foundation of India (PFI) and supported by the John
D. and Catherine T. MacArthur Foundation and Sir Dorabjee Tata Trust. Important stakeholders from
civil society and the government including Mr Amarjeet Sinha, Joint Secretary, Ministry of Health and
Family Welfare attended the workshop. The proceedings of the workshop have been printed and
circulated widely.
86 SATHI Kendras have been set up in almost all the project villages and are functional, where MAGs
and their spouses can access reading materials on RH issues and also receive counseling from the
SATHI couples. The MAGs are being benefited by the IEC material available at these centres.
Group meetings with MAGs are being organized by female supervisors, where MAGs are benefited
from counseling. Similarly, male supervisors are organizing meetings with spouses of MAGs. All the 5
partners are regularly organizing Couple Workshops where in couples participate. A total of 71 such
workshops were held. Workshops with the mothers-in-law are also being held in all the five sites. The
MIS registers for community organizers, referral cards and service registers were printed and
provided to all partners. MAGs are being monitored for anaemia, abortions, post-abortion
complications and RTIs/STIs.
27
|
|
3.3 Page 23 |
▲back to top |
annual report
2008-2009
During the period under report, a total of 2244 MAGs were registered through surveillance. Out of
the 1722 MAGs, who were visited, 795 were anaemic as per self reported symptoms. 120 abortions
were reported of which 67 (more than 50%) had complications. 493 MAGs reported having RTI/STI as
per self reported symptoms and were treated at the 92 RTI/STI clinics organized by the project staff,
where specialized services of a gynaecologist were provided.
A Model Initiative to Ensure Quality Family Planning Services in Uttarakhand
The project commenced in September 2008 for a period of four years and is being implemented in
collaboration with the Rural Development Institute (RDI) at Himalyan Institute Hospital Trust (HIHT),
Dehradun, Uttaranchal. The project aims at developing and implementing an innovative model of
'Quality' family planning services in Doiwala block of district Dehradun and adjoining slums of
Rishikesh, covering a population of about 2,00,000.
Specific objectives of the project are:
? Identifying the unmet needs for contraception among the eligible couples
? Enhancing awareness among eligible couples for family planning through appropriate
communication strategies for behaviour change
? Reinforcing service providers' (ANMs/Nurses, ASHAs) capacities in counseling and quality
services for family planning including infertility
? Providing a basket of choices of safe and effective, family planning methods (including non-
scalpel vasectomy, female condoms, injectable contraceptives, emergency contraception
etc) to the eligible couples of the area.
? Documenting the process and results of the intervention and share the learning with various
stakeholders including Government.
The project strategy involves generating awareness among eligible couples on reproductive health
and family planning to enable them to make an informed choice of contraceptive methods. In
addition, the access to quality contraceptive services (both through government sector and through
the service set up by HIHT) will be increased. The volunteers will take on social marketing for pills and
condoms. HIHT will also supplement provision of quality family planning services through three
clinics in the area with a full time gynaecologist, who will provide sterilization and MTP services. The
basket of choice will also be widened in these clinics with inclusion of female condoms, injectable
contraceptives and emergency contraceptives. Other related
services like treatment of RTI/STI and infertility will also be
strengthened in the clinics. The service providers will be trained on
better provision and counseling for these services.
Efforts would be made to ensure male involvement. Referral for
ICTC services from the project area will be done to HIHT hospital.
HIHT's telemedicine services will be utilized for intensive
counseling and training with the community groups.
One of the innovations in the project is the establishment of a
Technical Resource Cell at HIHT for family planning with experts
28
annual report
2008-2009
from community medicine, obstetrics and gynecology, surgery and
nursing as members. The cell takes a lead on training, research and
providing technical support for development of tools, materials
and protocols. The cell provides guidance for the project and
monitors the quality of family planning services.
Over the period of September 2008 and March 2009, project staff
including the project officer, senior coordinator and five area
coordinators were recruited and oriented to the project. Training
was also held for the area coordinators on quality family planning
services, various methods of contraception, community
mobilization, BCC, NRHM and micro-planning. A Detailed
Implementation Plan (DIP) was developed for the project and shared with resource cell members
and in-charge of Doiwala CHC.
IEC materials in the form of games, posters and pamphlets were developed under the project on
methods of contraception, quality of care in family planning services and male involvement. Wall
paintings were completed in the project area. 20 flex hoardings were put up at important areas on
quality family planning. A facility survey was undertaken to assess the adequacy of manpower and
infrastructure and the quality of the family planning services delivered. Mapping was done to identify
the family planning services available in the government facilities in the project area.
Family planning and counseling services were provided at HIHT through health facilities and the field
staff. Provision of treatment of infertility was also started by the establishment of Intra-Uterine
Insemination (IUI) services at HIHT under the department of Obstetrics and Gynecology.
Networking with government officials was done through meetings with Joint Director (RCH) of the
State Government for the supply of contraceptives. Meetings were also held with CMS, Doiwala and
Medical officers of PHCs under the project areas for better coordination while delivering quality
family planning services.
Some of the key findings of the baseline survey recently carried out for the project area are:
? About 56 percent of the eligible women surveyed got married between the age 18-21 years
and about 53 percent of the total women gave their first child birth by 21 years of age. About
45 percent of the women were found to have 3 or more children.
? The awareness about all modern methods of contraception is quite high at about 92 percent.
The Contraceptive Prevalence Rate (CPR) for any method was found to be 51.5 percent
among the study population. It was also found that among the current users, majority
adopted spacing methods, i.e., condom (21.7%), followed by OCP (7.2%) and Copper – T (1.7%).
The unmet need for contraception was 49.1 percent.
? Only 10 percent of the women were offered the basket of choice of family planning methods.
76 percent of the women received check-up before adopting modern contraceptives and
about 45 percent women received follow-up services.
? The most common reasons cited for discontinuation were desire to conceive (39%) and
method failure (20%).
29
|
|
3.4 Page 24 |
▲back to top |
annual report
2008-2009
The project endeavours to complement the government programme by reinforcing the skills of
service providers (ANMs/ Nurses, ASHAs) and delivering quality services for family planning with
basket of choices.
Increasing awareness of and access to contraception for married adolescents
awareness on Reproductive and Sexual Health and reduction of Iron Deficiency
Anaemia among Adolescent Girls of Ganjam District of Orissa
The project, implemented by Multi Applied System (MAS), addresses a group of adolescent girls
aged between 12-19 years in 25 villages in Ganjam district of Orissa and reduce the prevalence of
anaemia through control of hookworm infestation. The project also aims to empower the target
group with knowledge on ARSH/family planning issues with a larger objective of reducing maternal
and infant mortality in the state over a period of three years.
Objectives of the project are to:
? Demonstrate a model for reducing the prevalence of Iron Deficiency Anaemia (IDA) among
adolescent girls in the age group of 12-19 years through control of worm infestation and BCC
for hygienic practices
? Empower adolescent girls with increased knowledge on IDA and reproductive and sexual
health and family planning
? Enable development of scaling up strategy based on the project outcomes
? Increase awareness of and access to contraceptives for married adolescents below 19 years
of age
The project was initiated in May 2008 and the
project staff was recruited and oriented to the
project activities. A total of 109 Community Health
Mobilizers (CHMs) were selected to cover all
hamlets. Training programmes were conducted
for CHMs, AWWs and ASHAs to orient them on the
project plan, maintaining health cards and
undertaking IEC activities.
House listing of 25 project villages was completed.
It included the socio-economic and health profile
of 2380 adolescent girls. Listing was done for
married adolescents in all the villages. After one
round of preliminary meetings with SHGs/ Mahila
Mandals, they were oriented and mobilized to
support the programme. Hb test and stool test were completed for 2296 and 739 adolescents
respectively.
A baseline survey conducted among 350 adolescent girls (12-19 years) showed that a majority
30
annual report
2008-2009
(94 percent) were washing hands before taking
food but only about 5 percent were using soap. 21
percent adolescent girls were found to be using
toilet facilities and 23.4 percent adolescent girls
reported washing hands with soap after
defecation.16 percent adolescent girls were aware
about the family planning methods and 46 percent
were aware about the consequences of early
pregnancy. Out of married adolescent girls (total 24
in number) only 17 percent were using any
contraceptive method. Haemoglobin testing was
also done for 2156 adolescents, only 0.74 percent
had normal (>12.0 gram/decilitre) Hb level, 63.5
percent had mild anaemia (10.01-12.0
gram/decilitre), 34.88 percent had moderate
anaemia (7.01-10.0 gram/decilitre) and 0.83 percent had severe anaemia (<7.0 gram/decilitre).
Health cards were distributed to adolescents and counseling for IDA and its prevention was also
done at the time of distribution.
A two day workshop was organized to build the capacity of the CHMs on Inter Personal
Communication wherein 48 CHMs were present. 88 health camps were organized in the project
villages and around 6000 patients received free treatment in health camps. IFA, Albendazole and
Metronedazole tablets were distributed to the adolescents (in co-ordination with AWWs so as to
avoid any duplication in distribution). The supply of IFA has been obtained from Block PHC and AWC.
During the IFA distribution, the field coordinators contacted adolescents personally and explained to
them about the health card, their Hb and stool test reports and advised them to consume IFA and de-
worming tablets. Adolescents consumed de-worming tablets in the presence of the field
coordinators.
IEC materials on adolescent health were collected from the government departments. Flipcharts on
hookworm transmission, which is one of the primary causes of anaemia, were developed and used as
part of the training material for CHMs and educating the target beneficiaries. A booklet for CHMs
was completed and was used in the trainings.
The project has established good liaison with the government sector. The District Health
Administration extended their co-operation for the camps through PHCs. Drugs for the camps were
also purchased from Community Development Medicinal Unit (CDMU) and received from block PHC
as their initial contribution. The project has also collaborated with ICDS in their awareness campaign
for adolescent girls under Kishori Shakti Yojana. MAS provided technical input for organizing quiz
competition for adolescents in the Ganjam block. On CDPO's request, the project staff facilitated 22
such camps. The AIR, Behrampur was contacted and request was made to include awareness
programmes for the adolescents. Attempts were made to coordinate with District Drinking Water
and Sanitation Mission. UNICEF has been approached for promoting Total Sanitation Campaign
(TSC) in project villages and also among school children.
31
|
|
3.5 Page 25 |
▲back to top |
MCH STAR Projects
annual report
2008-2009
Capacity Building and Institutional Strengthening
The Maternal and Child Health Sustainable Technical Assistance and Research (MCH-STAR) is a USAID
initiative to improve policies, programme approaches and resources in the areas of maternal,
neonatal, child health and nutrition (MNCHN) in India. The MCH-STAR Initiative aims to strengthen the
capacities of premier Indian institutions (PFI, PHFI, IndiaCLEN, CINI and SIFPSA) in the areas of
research and evaluation, policy analysis and advocacy and in responsive technical assistance for
MNCHN. MCH-STAR's goal is to provide sustainable technical leadership of global standards.
PFI is one of the institutions selected as an SSI for this effort. The objective of the project is to position
Population Foundation of India as one of the leading national NGOs in the field of maternal, newborn,
child health and nutrition programmes, policies and research. This will be achieved by:
? Strengthening expertise and leadership in PFI nationally and in Uttar Pradesh and Jharkhand
for providing technical assistance in MNCHN activities of the state governments
? Providing appropriate infrastructure support that will increase efficiency in research, policy
analysis, advocacy and technical assistance in MNCHN at PFI
? Creating a resource/data base to organise work related to MNCHN that will increase efficiency
? Supporting learning / dissemination of information and advocacy efforts related to MNCHN
On signing of the Task Order for this project on 29th September 2008, discussions were held with MCH-
STAR to work out the implementation plan. Sub-committees were formed to review the library
system, website design and uploading the relevant materials. The infrastructural needs of both Uttar
Pradesh and Jharkhand offices were reviewed. Initial pre-workshop planning meeting was held with
MCH-STAR for orienting all staff on research methodologies, monitoring quality of care, financial
monitoring and cost analysis. Some of the related documents that would be useful in designing the
workshop e.g., the indicators used in PFI projects, quarterly expenditure reports etc were shared.
Key PFI staff was exposed to the trainings/ capacity building initiatives such as World Bank training on
monitoring and evaluation and training on systematic review.
The process of monitoring and evaluation of current projects involving PFI staff has been initiated. The
other MCH STAR projects such as BCC evaluation and JSY, have been helpful in building capacity of the
PFI staff. Planning for another project on Birth Preparedness/Complication Readiness (BPCR) is in
progress.
33
|
|
3.6 Page 26 |
▲back to top |
annual report
2008-2009
Concurrent Evaluation of Mukhya Mantri Janani Sishu Swasthya Abhiyan
(MMJSSA—JSY) in Jharkhand—A Collaborative Study by PFI and IndiaCLEN
A new evaluation was initiated in collaboration with IndiaClen to study the reach, effectiveness and
impact of the Janani Suraksha Yojana (JSY) which is named as “Mukhya Mantri Janani Shishu
Swasthya Abhiyan (MMJSSA)” in Jharkhand. The JSY scheme aims to increase the number of
institutional deliveries in an effort to reduce maternal mortality. This study will provide feedback and
recommendations to programme managers and policy makers in Jharkhand to make necessary
improvements/modifications in strategies that will lead to improved maternal and newborn health
outcome through a more effective JSY scheme. The major objectives of the study are (a) coverage
evaluation i.e. reach of the scheme to the marginalized and hard to reach segments of the population,
including tribal and below poverty line and to understand the determinants of utilization and non-
utilization of the scheme (b) process evaluation i.e. effectiveness of the scheme, which involves to (i)
evaluate processes involved in planning, management and inter-sectoral coordination in MMJSSA-
JSY, (ii) identify the strengths and limitations, problems faced and local innovations of the
programme, (iii) assess social mobilization strategies in place to create awareness and increase
MMJSSA-JSY demand in the community and (iv) assess the referrals and quality of care provided at
the health facility.
To achieve the objectives, both quantitative and qualitative tools are being used. The study is being
conducted in six districts i.e. three tribal districts, two non-tribal districts, and one district having one
major urban area. The quantitative component of the study is based on secondary analysis of data
collected at the state and district levels. Qualitative techniques will comprise in-depth interviews,
focus group discussions and health facility observations.
An MoU was signed with MCH-STAR in September 2008 and several meeting with state officials in
Jharkhand were held. A meeting was also held with Joint Secretary and the proposal was presented.
The Central Co-ordinating Team (CCT) members were identified and have been involved in fine-tuning
the study instruments. Workshops were also conducted to finalize the research tools and the tools
were pre-tested at Ranchi. The operational manual has been developed. A regional workshop was
held in March 2009 wherein all the study tools were finalized. The data collection was done with the
help of partner medical colleges of IndiaClen (RIMS, Ranchi). The data entry is in progress and
provisional findings of the study are expected by September 2009 and the final report will be ready by
October 2009. The findings will be widely disseminated among various stakeholders of the
programme.
Evaluation of the Reach and Effectiveness of Behaviour Change Communication
Campaign under NRHM
The Ministry of Health and Family Welfare (MoHFW), Government of India, initiated an integrated
Behaviour Change Communication (BCC) campaign using television, radio and print media to improve
knowledge and practice of key maternal, neonatal, child health and nutrition related behaviors, and to
promote various National Rural Health Mission (NRHM) schemes and programmes among key target
audiences. The main themes of the campaign were age at marriage, family planning and birth spacing,
34
annual report
2008-2009
antenatal care, immunization, newborn care, Janani Suraksha Yojana (JSY scheme) and the role of
ASHA and the NRHM. In all, the campaign used 16 television, seven radio and 11 print ads.
At the request of the Ministry, USAID's Maternal and Child Health Sustainable Technical Assistance
and Research (MCH-STAR) Initiative commissioned a study through the Population Foundation of
India (PFI) to assess the reach and effectiveness of the BCC Campaign.
The objectives of the concurrent evaluation were to: (a) evaluate the extent of reach/visibility and
exposure of the target audiences to the campaign; (b) evaluate target audience recall,
comprehension and interest in the theme and aired TV and radio ads; (c) assess the effects of the
campaign on the perceptions of policy makers and program managers; (d) provide feedback to
MoHFW for improving their communication strategy. This was a national level study conducted
across 18 districts spread over 11 states in India. The sample study states were West Bengal, Karnataka,
Maharashtra, Tamil Nadu, Haryana, Uttar Pradesh, Orissa, Chhattisgarh, Madhya Pradesh, Mizoram
and Bihar. PFI contracted the ORG Centre for Social Research, a division of A C Nielsen ORG-MARG Pvt
Ltd, to execute the study.
The methodology of the study consisted of both quantitative and qualitative techniques. Structured
interviews were conducted at the household level for quantitative data. Under the qualitative
process of data collection, in-depth interviews were carried out with policy makers and programme
managers including Health Secretaries, NRHM Directors and officials of the IEC/BCC cell from the
states. Semi-structured interviews with service providers and influential persons were also
conducted. Approximately 3,600 currently married women (15-29 years), 1,800 currently married
men (husbands of women aged 15-29 years) and 360 influencers (mothers-in law/fathers-in-law) were
covered under the study.
PFI provided overall management and technical oversight to the study and received technical and
financial support from MCH-STAR and USAID. The scope of work included finalization of study's
terms of reference, selection of an agency to conduct the research, technical support in study design,
research tools and analysis, field monitoring and ensuring high quality and timely results and report
and their dissemination.
The co-ordination with multiple stakeholders i.e.,
the research agency, MCH-STAR, USAID and
MoHFW, was a challenge to PFI. This was very
successfully addressed by a well managed
consultative process. A presentation on the key
findings and recommendations was first made to
USAID and the study is being recognized as a
model for other partner organizations.
Subsequently, a presentation was made to the
Ministry of Health and Family Welfare. The
following are the important key findings and
recommendations.
35
|
|
3.7 Page 27 |
▲back to top |
annual report
2008-2009
Key Findings:
• The majority of the target audience was exposed to media, primarily TV. The most popular
channel among women and men was DD National.
• The reach of radio spots was low at 15%.
• The reach of television spots was quite at 64%.
• The maximum proportion of target audience watching a particular TV spot was 30%.
• The spots on family planning and antenatal care had maximum reach among both men and
women.
• Nearly a quarter of the target audience had watched four or more TV spots.
• The majority could recall the messages conveyed and most of them liked the spots.
• Among those who did not like the spots, language was the major complaint.
• Between 40% and 60% of mothers-in-law who were exposed to the spots discussed the
contents with their daughters-in-law.
Conclusions and Recommendations:
• The campaign had a wide reach among target audiences.
• “NRHM logo promotion” was a definite outcome of the ads.
• States expressed interest in getting involved in the campaign and willingness to adapt mass
media spots and interpersonal communication (IPC) activities to local context/language.
• Village functionaries such as ASHAs had higher recall of the messages, who can now interpret
and promote messages through complementary IPC.
• Respondents felt the campaign should focus on a few themes at a time with higher frequency
of broadcast for greater recall and comprehension.
• States suggested that the spots be in local languages for better understanding by the viewers/
listeners.
• It is important to monitor the frequency of ad airing by various channels to ensure the MoHFW
funds are well spent.
The findings and recommendations of the evaluation have been well received by the MoHFW and are
likely to be useful in the development of the upcoming communication strategy by the Ministry.
The evaluation has been recognized as a model project for outstanding performance by USAID and
MCH-STAR. In this connection, the Foundation has received an award along with a Certificate of
Appreciation from MCH-STAR.
36
New Initiatives in the Coming Year
annual report
2008-2009
Improving Reach and Access of RCH and FP Services with Quality of Care
The Foundation is initiating this project in partnership with SUKARYA, a Gurgaon based NGO, in 28
villages of Nuh and Taoru blocks of Mewat district of Haryana covering a population of about 50,000.
Mewat was selected as the area is challenging with poor health and reproductive health indicators. It
dominated by Meo tribes (comprise 67% of population) with low female literacy (24%) and large family
size. The area also has poor status of RCH services and low awareness levels with predominantly male
dominated society.
The project focuses on improving reproductive and child health status in the predominantly Meo
areas through effective BCC and community processes along with provisioning of quality
reproductive health services. This project will be unique in nature as in addition to giving technical and
financial support to the partner organization, PFI will take a lead in directly implement some of the
field activities in the project. The key components taken on by PFI are capacity building, research and
advocacy in addition to providing sustained capacity building and backstopping to the project with
the help of other resource agencies. The key objectives of the project are to:
? Assess the needs of the community on RCH and family planning.
? Create and strengthen community based mechanisms and linkages for increasing access to
Quality of Care in reproductive health/family planning services.
? Promote positive behaviour changes among eligible couples (wherein the women in the age
group of 15-49 years) through IEC/BCC activities to:
improve couple communication
empower women for decision making on Reproductive health/ Family Planning.
enable increased demand for and utilization of Reproductive health/ Family Planning
services.
? ? Increase access to quality reproductive and child health services/ family planning services with
emphasis on marginalized populations.
? Establish a model with promising practices for scaling-up.
37
|
|
3.8 Page 28 |
▲back to top |
annual report
2008-2009
The key activities envisaged include a complete community needs assessment (CNA) and
communication needs assessment on RH/FP issues, formation or activation of village health and
sanitation committees (VHSCs) and community structures e.g.: SHGs and their sensitisation on RH/FP
needs, quality services and government schemes.
The CHWs/ ASHAs will be identified and trained on RH/FP issues, behaviour change communication,
record keeping, interpersonal communication, quality of care and establishing community based
distribution mechanism.
The project also envisages increasing access to safe delivery by training Dais and advocacy with the
government system for improving quality of services in addition to the supplementation of service
provision through mobile clinic and linkages with government and ICDS centres.
Multiple media approach in BCC/IEC activities for involvement of stakeholders and families is planned
based on the emerging communication needs. Recognising the role of men in decision making on
women's health issues, the project aims to approach males through male volunteers for group
counselling on RH/FP and gender issues.
Networking and liaison with the health system along with a sustained advocacy with the community
to improve the reach and effectiveness of the services will be an integral component of the
programme.
The project will be an opportunity for PFI to test innovative approaches and try out various tools and
strategies. It will also give an opportunity for documentation of good practices for wider
dissemination and scaling up.
Mobilizing the Unreached: Using Behaviour Change Communication and Ensuring
Quality Family Planning Services through Boat Clinics in Assam
The Foundation in partnership with Centre for North East Studies and Policy Research (C-NES) is
implementing this project for a period of 3 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 objectives are to:
? Increase awareness on reproductive health and family planning issues among eligible couple
(women and men in the age group 15-49 years of age).
? ? Enable Behavior Change through a need based comprehensive communication package
38
annual report
2008-2009
? ? Build sustainable local capacities in, Interpersonal Communication including counseling skills,
in delivering quality family planning services and in effective documentation
? ? Improve availability and accessibility of modern contraceptives to eligible couple including
services for IUD insertion, injectables and establishing effective linkages for sterilization
services
? Document learnings, processes and best practices for scaling up
The organization has been running boat clinics to reach out to the most vulnerable and deprived
population living on islands cut off from the main lands by the river Brahmaputra called Chars, Saporis.
The boats are designed with sufficient facilities to provide basic health care in the Char villages.
However, while regular service provision continues, there is 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 reproductive health services and improve health-seeking behavior in
the community. There was also a felt need to strengthen, effective counseling and behavior change
communication components in the existing health care provision through boat clinics.
The present proposal seeks to address these gaps through behaviour change communication,
capacity building, provision of quality family planning and reproductive health services and effective
counseling. The key activities for which PFI will provide support include training and skill building of
state and district level family planning counselors, community needs assessment through ASHAs,
capacity building of the project staff and the ground level workers on the issues of interpersonal
communication, counseling and effective use of IEC tool, management information system and
documentation.
The project also integrates the component of capacity building of providers towards provision of
family planning services. Development of a need based BCC package to enable behaviour change and
carrying out BCC/IEC activities to increase the involvement of stakeholders and families are the other
important focus areas of the project. A strong element of documentation has been integrated into the
project with a view to capture the learnings' for replication and scale up.
Radio Programme, Babli Boli
The Foundation is initiating an innovative project 'Production and Management of a Radio
Programme for Rural Women and related Community Based Activities' with a grant from UNDP, India
and National AIDS Control Organization (NACO), New Delhi in five districts of Rajasthan (Alwar, Ajmer,
Jaipur, Jodhpur and Barmer) and two districts of Bihar (Sita Marhi and East Champaran) starting from
June 2009 onwards for 15 months.
The 52 episode radio programme, Babli Boli will be a step towards integration of Family
Planning/RCH and HIV/AIDS issues by including messages on reproductive health and family planning
39
|
|
3.9 Page 29 |
▲back to top |
annual report
2008-2009
services together with information on HIV/AIDS to increase awareness about health risks and
motivate behaviour change among the vulnerable and general population, especially among women
and youth. The radio programme will focus on rural women. However, the focus would be on young
rural women in the age group of 15 to 29, vulnerable groups of women including wives of migrant
labourers and sex workers etc and people living with HIV/AIDS, especially pregnant women in rural
areas. The secondary audience will include service providers, influencers, opinion shapers and leaders
including media and faith based leaders.
The radio programme will be centrally produced in an engaging drama format by PFI in
association with Swarsudha Entertainment Pvt Ltd, New Delhi. The programme will be broadcast by
NACO in Rajasthan, Bihar, Uttar Pradesh, Madhya Pradesh, Himachal Pradesh, Uttarakhand,
Jharkhand and Chhattisgarh, using the All India Radio network. Around 700 Listeners' Club, 'Babli
Clubs' will be formed at the district level in association with seven partner NGOs as part of community
based activities to enhance the reach and effectiveness of the radio programme. Village level
community mobilizers, trained in RCH and HIV, would act as Club Leaders, who would be responsible
for the formation and maintenance of Listeners' Club. To assess the impact of the radio programme, a
rigorous monitoring and evaluation plan will be put in place in addition to an external final evaluation.
Advocacy and Communication Projects
40
|
|
3.10 Page 30 |
▲back to top |
annual report
2008-2009
Advocacy and Communication Projects
Sustainable Action Against Declining Sex Ratio at Birth in Haryana, Himachal
Pradesh and Punjab
The Population Foundation of India in partnership
with Voluntary Health Association of Punjab (VHAP) and
Social Uplift through Rural Action (SUTRA) has been
undertaking advocacy campaign on the issue of declining
sex ratio since 2003. In the year 2004, with the collaboration
of the above partner agencies, PFI implemented a campaign
on 'Moving from advocacy to action on the issue of Missing
Girls' in two districts of Punjab (Fatehgarh Sahib and
Patiala), two districts of Haryana (Ambala and Kurukshetra)
and 55 Gram Panchayats of Dharmpur and Nalagarh Blocks
of Solan district and Nahan block of Sirmour district in
Himachal Pradesh under the project sanctioned by the Ministry of Health and Family Welfare as part of
the UNFPA Country Program 6. After the completion of the campaign, it was felt that the efforts
should be continued at the ground level in order to sustain the change and make an impact at the
district level.
With a goal to improve the child sex ratio in the states of Haryana, Himachal Pradesh and
Punjab, PFI has undertaken the project, 'Sustainable Action against Declining Sex Ratio at birth in the
States of Haryana, Himachal Pradesh and Punjab' this year in February 2009 in association with the
same partner organizations. The main objectives of the project are to (i) continue to raise awareness
among communities around relevant laws in favour of safe abortions and against sex selective
abortions, (ii) develop capacities of local institutions of governance like panchayat to monitor the sex
ratio at birth and involve them in campaign against sex selective abortion, (iii) provide support and
strength at the community level through peer groups like Mahila Mandal to help women take
independent decisions against sex selective abortion and in favour of safe abortion, (iv) monitor
43
|
|
4 Pages 31-40 |
▲back to top |
|
|
4.1 Page 31 |
▲back to top |
annual report
2008-2009
public institutions like govt. health facilities, Anganwadi centres etc. to ensure necessary support and
services as a measure to reduce sex selective abortions, (v) sensitize the para-medical staff like ANM,
MPHWs and ASHAs, about their roles and responsibilities towards this issue, and (vi) work intensively
with a young target group to bring about change in attitude of individuals and families.
An MoU has been signed with both SUTRA, Himachal Pradesh and VHAP, Punjab and Haryana in
February 2009. Project activities such as liaisoning and advocacy with Kanya Bachao Samiti members,
identification of villages based on low sex ratio, formation of clusters etc. have been initiated in 40
villages in Punjab and Haryana and 55 Gram Panchayats in Himachal Pradesh.
Advocacy for building supportive policy and programme environment on rights based
population and family planning /reproductive health issues in India
PFI has been 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 policies and programmes on population and family
planning/reproductive health, with a focus on young people.
The key objectives are to:
1. Support and sustain advocacy at the national and state levels (in Bihar and Jharkhand) by further
capacity building of institutional partners.
2. 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) programme.
3. Strengthen regional advocacy for supportive policy and programmes 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 and RCH-II
3. Creating resource pool of individuals and NGOs for advocacy
4. Providing technical support to the state governments to effectively implement sexual and
reproductive health programmes
Some of the key interventions during the period under report were:
Interventions for Youth: The Jharkhand Youth Policy
In Jharkhand, the Foundation provided technical assistance to the State Government for formulating
44
annual report
2008-2009
the Jharkhand Youth Policy. The state youth policy has been approved by the Jharkhand Government
in July 2008. PFI is continuing its technical assistance to the State Government in developing the Youth
Policy Implementation plan. In consonance with this, two regional workshops were organized during
the period under report for Kolhan region (at Jamshedpur on 20th February 2009) and for Chotnagar
(at Hazaribag on 24th February 2009) in collaboration with the Department of Youth, Art and Culture,
Government of Jharkhand, NGOs, youth and youth based organizations to collate inputs for the
Implementation Plan. All the consultations will be completed by September 2009 and a compiled draft
implementation plan will be submitted to the state government for further action.
As part of its advocacy role, the Foundation continued its technical assistance with the Department of
Youth, Art and Culture, Government of Jharkhand for setting up the Youth Resource Centers in the
state. The Department has approved the formation of five Youth Resource Centres, which include one
Sate Resource Centre in Ranchi and four Regional Resource Centres in Chaibasa, Palamu, Hazaribagh
and Dumka respectively. The Deputy Commissioner of Chaibasa and Deputy Commissioner of
Hazaribagh have provided the land for Regional Resource Centres (RRCs).
In Bihar, the Foundation is advocating with the state government for the formal approval of Draft
Youth Policy for Bihar. In response to the invitation from the Department of Human Resources
Development, Government of Bihar and Department of Youth, Art, Culture and Sports Affairs, PFI
facilitated a discussion on the Draft Youth Policy in the context of National Youth Policy on Education
Day November 11-12, 2008.
Technical Support to National Cadet Corps of Jharkhand for Formulation and Institutionalization of
Life Skills Education in NCC Curriculum
Based on the past experience of two batches of training on Life Skills Education to ANOs (Associated
NCC Officers), the Foundation in collaboration with Child in Need Institute (CINI), Jharkhand and NCC
Group Commander Officer, Jharkhand, focused its effort on finalizing the Life Skills trainer's manual
during the period under report. The Foundation is in the
process of pilot testing the NCC manual with NCC cadets
and ANOs before finalization. The final manual will be
shared at the national level with NCC for
institutionalization in their training curriculum.
Capacity Building of NGOs for Effective Advocacy
through Strategic Communication and Media
A series of training workshops on Strategic
Communication for Advocacy were undertaken for
45
|
|
4.2 Page 32 |
▲back to top |
annual report
2008-2009
capacity building of NGOs working in Bihar and Jharkhand. PFI being the lead country organization for
the cause, a pool of master trainers was formed with NGO representatives from these states,
organizations working on Reproductive Health and Family Planning issues at the national level and
Population Leadership Fellows to take the effort forward in Bihar and Jharkhand using the Smart
Chart tool developed by Spitfire Strategies, USA.
A ten member team of master trainers attended the refresher training organized in Nepal and
Phillipines, who in turn trained 80 NGO representatives based in Bihar and Jharkhand on the Smart
Chart tool in four batches. The master trainers also conducted organization based training for Ram
Krishna Mission Sarada Math (Jharkhand), Ghogardiha Prakhand Samaj Vikash Samiti (Madhubani,
Bihar) and partner members of Center for World Solidarity (Patna, Bihar) on the tool.
Two training programmes were organized for journalists in Bihar and Jharkhand on Smart Chart tool
by Manthan Yuva Sansthan on behalf of PFI. The objectives of the trainings were to build the capacity
of rural journalists in tracking health issues and advocate the availability of health services at the
community level through media.
Advocacy with Parliamentarians
PRS Legislative Research (PRS) an independent initiative at the
Centre for Policy Research (CPR), New Delhi aims to strengthen
legislative process in India by making it better informed, more
transparent and participatory. PRS is a non-partisan
organisation, which has been providing inputs to Members of
Parliament. It also has the experience in tracking developments
in Parliament on a daily basis. PFI through a two-year support to
PRS intended to engage with policy makers on substantial
issues of national policy.
As an outcome of the effort, PRS conducted an orientation programme for PFI staff, journalists/NGO
representatives of Bihar and civil society group on understanding Parliament and engaging with policy
makers in the process of law making. PFI in collaboration with PRS, has prepared Issue Briefs on
NRHM-decentralized system, sex selection in India, safe abortion services in India, youth in India and
neo-natal mortality in India. Parliament Tracking was also undertaken on reproductive and child health
2008 budget session and youth related issues 2008 budget session for wider dissemination.
Community Newspaper
As part of the Community Radio programme on 'Reproductive Health and Family Planning'
implemented with Manthan Yuva Sansthan, Ranchi, Jharkahnd in Lohardaga district of Jharkhand,
46
annual report
2008-2009
handwritten newspapers, 'Apni Awaz' and 'Samkaleen Patra' were designed and
displayed in prominent places of 15 villages of Kisko block of Lohardaga district,
Jharkhand and Danapur block of Patna district, Bihar. These newspapers carried
the news of health, nutrition and welfare schemes of the government as well as
the problems people face on the issues and its solutions. The newspapers were
published by the community involving youth from the locality for the benefit of
the community.
Advocacy for Reproductive and Sexual Health
The Foundation 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” was formed in Bihar to mobilize and undertake initiatives for intensive advocacy campaign on
the issue. As a result of these efforts, the two-child norm was withdrawn from the state Municipal
elections in Bihar. However, the coalition is advocating for repealing the two child norm from the
panchayat elections in Bihar and other states of India.
Two skill building workshops were conducted on 'Two Child Norm and Family Planning Insurance
Schemes' by the Secretariat. The coalition also facilitated the formation of state level network on
Matritwa Swasthya Adhikar Manch in Jharkhand.
Technical Assistance for District Health Action Plans in Bihar
As part of the implementation of NRHM in Bihar and on request of the state government (State Health
Society) and UNFPA, PFI provided technical assistance and facilitated the development of the District
Health Action Plans for Supaul and Purnia districts of Bihar. The process of preparation of DHAPs
involved participatory and need based approach in collaboration with district administration, line
departments, Block and District Health Societies, PRIs and NGOs. The DHAP development process is
based on the NRHM guidelines with focus on health situation analysis in these districts and the priority
areas of 2009-10.
Dais in Health Programmes of Bihar
The Population Foundation of India, as part of its advocacy role on National Rural Health Mission
(NRHM), is in the process of engaging with government and civil society organizations in
understanding the role of Dais in the current health programmes particularly under NRHM. Although
NRHM has showed significant progress in improving access to skilled health personnel and health
47
|
|
4.3 Page 33 |
▲back to top |
annual report
2008-2009
facilities, it still has a long way to go towards achieving the desired maternal health outcomes. One of
the important gaps in the programme is the unmet need particularly in the socio-demographically
backward states. It is in the unreached pockets of these states with poor health infrastructure that
women and families continue to access community level health workers particularly Dais in ensuring
timely and safe delivery of the child. However, emphasis of the flagship incentive based maternity
benefit scheme of JSY has led to the sidelining of the Dais, who continue to provide valuable services at
the community level. In order to bring back the focus on the important role of Dais, a National
Consultation was held in Delhi in 2007 towards highlighting the need for greater discussion, respect
and inclusion of Dais in the health programmes.
PFI in collaboration with SEWA took forward the effort in Bihar. The process adopted was
participatory and consultative approach, which included profile of Dais in Bihar, mapping of NGOs
working with Dais and undertaking state level consultations with Dais, NGOs and other stakeholders. It
was highlighted that Dais have played a very significant role in Bihar in providing safe deliveries. People
still continue to go to Dais for delivery and basic health care. There is an implicit trust in Dais,
particularly in the large pockets of Bihar, where institutional delivery is not possible. Dais play a crucial
role in informing ASHAs on health and antenatal/postnatal care. The role of Dais has not been limited
to delivery only.
Many continue to provide antenatal, postnatal and primary health care as well.
The consultation recommended providing better recognition to Dais from the village to state levels
with provision of social security, capacity building and supplies for providing better service at the
community level.
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
Population Foundation of India, and after a preparatory phase of two months, the RRC has been fully
functional since April 2005. The Apex Resource Centre (ARC), a technical body was created by the
Government of India to orient the RRCs. Population Foundation of India is the Regional Resource
Centre for the states of Bihar and Chhattisgarh. The RRC Bihar is supported financially by Government
of India and the RRC, Chhattisgarh is funded by PFI.
The objectives of the RRC are to (i) support for project development, training in programme and
technical areas, dissemination of relevant training and communication material, (ii) create and
facilitate access to database of technical and human resources relevant to family planning and RCH
interventions, (iii) conduct periodic field visits for technical assistance and training needs assessment
and follow-up of effectiveness of inputs, (iv) provide a platform for advocacy to facilitate GO-NGO
networking, and (v) provide inputs to Government of India to enable policy modification/ formulation
for NGO programmes. RRCs provide assistance and support to the state NGO committee, Mother
48
annual report
2008-2009
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 services as per the goals of the National
Population Policy, 2000.
? Closer linkage between the State Governments and the MNGOs/ SNGOs 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.
Regional Resource Centre, Bihar
During the year 2008-2009, seven regional thematic workshops on 'Institutional Delivery' were held at
Bhagalpur, Saran, Purnia, Bhojpur, Muzaffarpur, Gaya and East Champaran districts of Bihar. These
workshops were focused on perspective building of state health functionaries, state ministers,
MNGOs/ FNGOs, NGOs and other stakeholders on institutional delivery and developing a plan of action
for improving institutional delivery in the region. A state level thematic workshop was also organized
on 'Institutional Delivery' at Patna in March 2009. Networks with UNFPA, SIHFW, Pathfinder
International, ICRW, IPAS, Packard Foundation, Janani, BD India, UNICEF, WHO, Aga Khan Foundation
and CARE were established for the thematic workshops.
The RRC participated in the review meeting held by Government of India in April 2008 in New Delhi in
which concerns over delay in fund disbursement to MNGOs were shared with NGO Division, MoHFW
and ARC. Discussions were held on the proposed NGO – NRHM guidelines. State level staff of RRC
participated in the national level conference on 'Save the
Girl Child Campaign' in April 2008 and consultative meeting
on 'Involvement of RRCs, MNGOs/ FNGOs in Jansankhya
Sthirtha Kosh (JSK) supported Programmes' and in the
two day training on 'Strategic Communication for
Advocacy on Sexual and Reproductive Health' in July 2008
where capacity of RRC staff was built on smart chart
planning tools and its use in June 2008 at New Delhi. RRC
staff also participated in the State Nutrition Policy
Consultative meeting, organized by Social Welfare Board,
Government of Bihar held at Patna in September 2008.
49
|
|
4.4 Page 34 |
▲back to top |
annual report
2008-2009
On request from the state level authorities, field appraisals were done in 40 clinics/ hospitals
shortlisted by Regional Director (Health) under SNGO scheme. RRC, in collaboration with UNFPA
organized four block level consultative workshops and two district level consultative workshops on
'Preparation of District Health Action Plan (DHAP)' for Purnia and Supaul districts. All the block and
district level health officials participated in the workshop and recommendations were incorporated in
the respective DHAPs. The state level team of RRC facilitated the development of monitoring log-
frame tables of all FNGOs and MNGOs. A training manual on 'Quality of Care for NGOs' was also
published.
Regional Resource Centre, Chhattisgarh
In RRC Chhattisgarh, a five day training of MNGOs on 'Reproductive
and Child Health' was held in May 2008. Workshops were also
organized on 'Documentation' for the MNGOs and FNGOs. A re-
orientation programme on 'Tracking Pregnant Women and Eligible
Couple' and training on 'Financial Systems' was organized for the
FNGOs and MNGOs respectively. The MIS formats for periodical
reporting were developed and operationalized for the MNGOs,
who were made conversant with the formats. A strategic planning
meeting was organized by the RRC to review the activities of the
MNGOs and to design strategies to address the challenges faced for
service delivery. RRC facilitated the development of monitoring log-frame tables of all the FNGOs and
MNGOs. All the MNGOs/ FNGOs were sensitized to enroll as participants for the proposed public
health resource networking (PHRN) trainings to help their involvement in the district level planning.
Case studies on SEWA Counter in the government hospital and Mitanin Help-desk Centers (in Durg and
Dhamtari) were developed. RRC facilitated the development of the District Health Action Plan
(DHAPs) along with the MNGOs for the districts of Dhamtari, Bastar, Kotiya and Rajnandgaon.
Meetings were held in the districts of Kawardha, Champa, Raipur, Dhamtari, Bastar and Sarguja with
the district officials to advocate for the involvement of FNGOs/ MNGOs into various programmes at
the district level. Being a consortium partner at the state nodal agency, RRC facilitated the completion
of community based monitoring activities. RRC participated in the brainstorming session on PIP
development and advocated with the NGO division in the state for the incorporation of MNGO/ SNGO
scheme in the PIP. RRC represented in the facilitation of the state by PFI in the 4th JRD Tata award.
Networking was done with CGSACS, SHRC, UNICEF and HLFPPT and advocacy was done for the
induction of FNGOs/ MNGOs into the Jeevan Deep Samitis. Regular meetings were held with the state
NGO Coordinator to update the progress.
As an outcome of constant advocacy with the state government for release of funds to the MNGOs,
50
annual report
2008-2009
the project implementation grant was disbursed to six MNGOs. After the disbursement, visits were
made to MNGO offices to orient them about the programme and provide guidance for programme
implementation. RRC also validated the activities of 35 FNGOs and guidance was given for various
issues related to administration, programme, documentation and coordination with various health
departments. The issue of SNGO selection was raised by RRC with the State Government and the
government has agreed to initiate the same on a pilot basis in three districts.
Scaling Up Pilot Projects in Reproductive Health and Adolescent Health in India
In 2006 -2008, the MacArthur Foundation engaged Population Foundation of India (PFI) to develop
PFI as an Apex Resource Organization and “Centre of Excellence” in India for 'Scaling Up
Management' (SUM) of pilot initiatives in reproductive health and adolescent reproductive and
sexual health (ARSH) programmes in the country. During this grant period, PFI worked very closely
and in partnership with Management Systems International (MSI), a US-based MacArthur grantee
that pioneers in the SUM framework. MSI provided technical support and mentoring to transfer the
necessary knowledge and skill set required to for effective Scaling Up Management. MSI assisted PFI
to develop institutional capacity for scaling up; offered technical support and mentoring to the PFI
team to apply the skills in the field, with PFI's partners; and facilitated the process of scaling up six
MacArthur Foundation-funded innovative interventions that focused on reducing maternal mortality
and improving ARSH.
Encouraged by the intensive efforts of PFI and MSI, the MacArthur Foundation awarded the second
grant for the period from July 1, 2008 to June 30, 2010 to PFI. This current grant will help PFI to continue
the existing work as well as to take on newer initiatives in the field of Scaling Up Management in India.
Under the current grant, the technical support provided by MSI is more need based. The inputs from
51
|
|
4.5 Page 35 |
▲back to top |
annual report
2008-2009
MSI have been very useful in maintaining the quality of approach to SUM. During 2008-2009, PFI has
tried to internalize and execute SUM in both its new grant making activities as well as in the existing
grants.
The following are highlights of some activities undertaken during the year 2008-2009:
Institutionalization of Scaling Up Management within PFI
• One of the key objectives of Grant-II from MacArthur
Foundation is building sustainable capacities within PFI to
function as an independent scaling-up resource
organization and to carry out scaling-up work beyond the
grant period. In addition to identifying and facilitating
scaling up successful models on reproductive health in India,
PFI is also mainstreaming the Scaling-Up Management
framework in its grant making and project management
process. A team of technical experts is being nurtured and
developed for the purpose through series of training programmes as well as hands on
mentoring by the MSI team. The team is being trained in applying scalability assessment tools
and works on strengthening scalability components in all PFI-funded projects.
• To integrate scaling up as an integral part of the grant making processes, the PFI guidelines for
project proposal submission have been revised to include the key components of scaling up at
the outset. Also, at the preliminary screening of the proposal, utmost care is taken to look at
the proposals from the scalability perspective by both the Program Division and during the
Internal Review Meeting (IRC), a committee of key staff of PFI, which reviews new proposals
submitted for grant making every quarter. The format used by the Programme Division to
review the new proposals was modified to incorporate the scalability indicators. The unit also
provides inputs on the operational issues and challenges related to the ongoing PFI funded
projects and facilitates the processes to fill in the gaps, if any and incorporate the scaling up
components.
• In an effort to train the cadre of public health professionals in India in SUM, PFI has taken
initiatives to partner with apex academic institutions in India including Public Health
Foundation of India (PHFI, Tata Institute of Social Sciences (TISS), National Institute for Health
and Family Welfare (NIHFW), National Health Systems Resource Centre (NHSRC) and Public
Health Resource Network (PHRN). The Scaling Up team visited and presented the framework
to some of these organizations. Based on their keen interest, PFI is planning a two phase TOT
for selected faculty members of these esteemed institutions in India.
? PFI has developed tools for SUM including tools for identification and desk review of pilots/
promising practices (tested by the PFI team on internal grants and to be further field tested
52
annual report
2008-2009
and standardized for use by other grant making organizations), guidelines for exploratory
visits and rapid NGO assessment tool. PFI is also working on modifying the SUM framework
and other tools developed by MSI to incorporate experiences in India.
? To sum up, as per the goal of the project, PFI is working intensively on developing itself as a
Centre of Excellence for Scaling Up Management in India and the key activities undertaken
and planned in this direction include:
o Institutional capacity building in the area of scalability assessment, analytical
assessment from scalability perspective, developing advocacy plans, networking
strategies and resource mobilization.
o Developing advocacy materials to reach out to the pilots/ practices that have a
potential to go to scale
o Based on the experience of ARSH scan, working on scanning maternal health
programmes in India on thematic areas of newborn care, maternal mortality and
morbidity
o Planning a regional workshop on Scaling up Management to both share the
experiences in the last four years as well as invite interest from various stakeholders in
the Scaling Up Management work of PFI
? Identification of new models in reproductive health in India and continued technical support
to the existing organizations include:
? Scaling Up of the Home Based Neonatal and Child Care (HBNCC) model of SEARCH, Gadchiroli
has achieved a huge success with the Government of India integrating the model into the
eleventh five year plan. Many states have already incorporated HBNCC in their state Project
Implementation Plans (PIPs). A national resource team supported by State Resource Team is
being created to facilitate the process of HBNCC implementation in these states. The scaling
up strategy is being revisited and other options of scaling up of HBNCC are being explored.
? Safe Adolescent Transition in Health Initiative (SATHI)
implemented by Institute of Health Management,
Pachod (IHMP) has been scaled up through Randomized
Control Trial (RCT) in ten districts of Maharashtra by the
Directorate of Health Services, Government of
Maharashtra. Also the model has been scaled up in five
selected NGO sites in Maharashtra through the support
of PFI and Sir Dorabji Tata Trust (SDTT). A national
dissemination of the pilot and RCT was organized
towards the end of the project period of Grant I in New
Delhi, where key stakeholders participated. PFI and MSI
are working further with IHMP on the key recommendations of the dissemination along with
state and national level advocacy plans.
53
|
|
4.6 Page 36 |
▲back to top |
annual report
2008-2009
? Scaling up initiatives with Vimo-SEWA – a Community Based Health Insurance programme
implemented by Self Employed Women’s Association (SEWA), Ahmedabad, has been very
effective with the necessary documentation such as insurance modules, training modules and
related formats being completed. The model has been expanded to many states including
Bihar, Madhya Pradesh, Gujarat and Rajasthan during the project period. Vimo-SEWA is also
providing technical support to the Rashtriya Bima Suraksha Yojana (RBSY, a national level
insurance plan) of the Government of India. As part of the scaling up process, PFI is also
playing a key role in the formalization of Lok Swasthya Mandali (LSM) as a technical support
wing of Vimo-SEWA.
? As per the commitment to identify and scale up pilots funded by other donor groups, PFI has
also begun scaling up management work with initiatives/pilots funded by other donors
including the National and State Governments. Karuna Trust, a Karnataka based NGO and a
PFI-grantee has a promising model to improve the access to health care in many backward
districts in India through Public-Private Partnership (PPP). PFI has partnered with Karuna Trust
to add on value based activities including training of manpower. PFI and MSI are working
together to facilitate scaling up of this model through documentation, institutional
development and other technical support as they emerge during the scaling up process.
? In West Bengal, the Department of Panchayat and Rural Development initiated a Community
Health Care Management Initiative (CHCMI) to help Panchayati Raj Institutions (PRIs) to
analyze and monitor key public health indicators with a focus on maternal and child health. PFI
along with MSI and the National Health Systems Resource Centre (NHSRC) is facilitating the
development of a Scaling Up strategy to help scale up the current pilot initiative in eight
districts, to all across the state. CHCMI is very keen on PFI supporting the implementation at
scale as well.
Scan for Successful Innovations in India on Adolescent Reproductive and Sexual Health (ARSH) and
Facilitate Scaling Up
Considering the fact that the status of Young People's
Reproductive and Sexual Health (YPRSH) is an important
component of reproductive and child health situation in India, PFI
decided to conduct a scan of successful innovations on YPRSH
across the country. The prime objective for this scan was to identify
successful pilots on adolescent reproductive and sexual health with
the potential for going to scale. These promising practices were
from both Government and NGO sectors from different states. In
total 60 pilots were identified from the scan. Based on the
54
annual report
2008-2009
information in the available documents and the potential for going to scale, 10 pilots were selected.
MSI supported in identification and scalability assessment of the selected pilots.
These 10 pilots were explored further to assess their potential for scaling up. Out of the ten, three
were assessed by MSI and the remaining pilots were to be assessed by PFI. PFI shall meet the
originating organizations and request them to share documents available on these pilots (evidence
for success, process documents, costing etc.) to have a better understanding. Exploratory visits and
meetings with the selected originating organizations are planned. Based on the exploratory visits and
information available, the scalability of these pilots will be analyzed. Finally 2-3 pilots with high
potential for scaling up will be selected with whom PFI will facilitate the scaling up of the promising
practices.
Creating a Conducive Environment at the National and State Levels for Scaling-up Successful NGO
Interventions
Some ongoing and planned efforts to build a conducive environment are:
? ? Formation of a learning community and support group for the scaling up of HBNCC
? ? Sharing of SUM framework and experiences with national stakeholder groups such as AGCA
? ? Case studies on CHCMI, Karuna Trust PPP model and Health Insurance model of VimoSEWA are
in the process
? ? Similar to the YPRSH scan, a scan of maternal health programmes in the country with thematic
focus on newborn and child care is planned
? ? A regional workshop to share the experiences of PFI in the last four years is planned towards
the end of the project. The workshop will include various stakeholders dealing with large scale
programmes to share their experiences in Scaling Up
Community Based 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 and
family planning services with a special focus on 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
55
|
|
4.7 Page 37 |
▲back to top |
annual report
2008-2009
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
committee constituted by the Ministry of Health and Family
Welfare, Government of India, is mandated to spearhead the
community related initiatives under NRHM at the national level.
The group consists of eminent public health professionals associated with major NGOs. The
Population Foundation of India functions as the Secretariat for the AGCA.
The first phase of the community based monitoring of health services was initiated through the AGCA
with support from the Ministry of Health and Family Welfare, Government of India. The project as a
pilot was implemented in nine states, viz., Assam, Chhattisgarh, Jharkhand, Karnataka, Madhya
Pradesh, Maharashtra, Orissa, Rajasthan and Tamil Nadu for a period of about eighteen months from
March 2007 to July 2009. The Population Foundation of India functioned as the National Secretariat
for this project, co-supported by the Centre for Health and Social Justice (CHSJ), New Delhi.
In this phase, three to five districts were identified in each state for implementation at village, PHC,
block and district levels. Five villages in each PHC, three PHCs in each block and three blocks in each
district, leading to a total of 1620 villages, 324 PHCs and 108 blocks in 36 districts were to be covered for
community monitoring in the first phase. The main objective of the programme was to develop
synergy and partnership between the public health service providers and community to enable better
delivery and utilization of health services.
A lead NGO was identified in each of the nine states to take the project forward. These NGOs
implemented the programme in partnership with the State Governments and the block level NGO
partners. All major activities under the programme were completed in each of nine states. The main
acitivies under the programme were:
? Preparation of model community monitoring tools, training, orientation, awareness materials and
documentation formats at the national level
? State preparatory meetings and workshops
? State mentoring team formation, finalization of state appropriate frameworks
? State training of trainers – one state level workshop for Facilitators. Training of community
monitoring teams at different levels were then conducted by NGO Facilitators
? District workshop – one in each district. Formation of District Mentoring Teams
56
annual report
2008-2009
? Block level training for block community monitoring team including civil society members
? Community mobilization and formation of community monitoring committees at different levels
starting from village level
? Orientation of members of communtiy monitoring committees at all levels
? PHC and block level public hearings (Jan Sunwai/Jan Samvad)
? District level media workshops
? Block providers orientation
? Process documentation, state evaluation and state end programme workshop
An external review of the first phase of community monitoring was carried out by four experts and
NHSRC in December 2008. The main objectives of the review were to (i) capture the process and
lessons, (ii) challenges of the programme, and (iii) recommend for its institutionalization and scaling
up. Some key recommendations of the review are:
? Planning and monitoring should go together at the village level.
? Role of ASHA should be identified in planning and monitoring at the village level
? Enable need based village plan and its monitoring
? Need for substantial simplification of community monitoring process and tools
? Consider anchoring in larger communitization process and in existing arrangements in health
department
? Government of India should continue support to community action including community
monitoring for scaling up in the pilot states and initiation in the remaining states
One of the significant outcomes of the programme has been scaling up of the programme in most
states by inclusion in the state PIPs.
Based on the experience and lessons learnt from the programme, a film on 'Community Monitoring'
was developed by the Secretariat. As the Secretariat for the programme, initaiting and completing
this innovative programme has been a significant intervention for PFI. Details of the programme are
also available at the specially created website www.nrhm.communityaction.org.
The Tenth JRD Tata Memorial Oration
Under the able leadership of Mr. JRD Tata as Board Chairman, as part of PFI's advocacy programme, a
lecture series under the title “Encounter with Population Crisis” was instituted in 1990 to deliver
lectures on critical issues related to population and to carry the debate forward. The Inaugural lecture
was delivered by Dr. Norman E Borlaug, Nobel Laureate and Father of the Green Revolution. In the
silver jubilee year of the Foundation, this lecture series was rechristened as “JRD Tata Memorial
Oration”, in memory of the Founder Board Chairman of the Foundation. Some of the eminent
speakers in the past were Dr. Manmohan Singh, Mr. Chandra Shekhar, Mr. Ramakrishna Hedge, Dr.
57
|
|
4.8 Page 38 |
▲back to top |
annual report
2008-2009
Najma Heptulla, Mr. I.K Gujral, Mr. Somnath Chatterjee, Mr. Digvijay Singh, Dr. Nafis Sadik and Mr. K.C
Pant.
The tenth JRD Tata Memorial Oration on “Corporate Social Responsibility and Issues of Population
Stabilization in India” was delivered by Dr. Jamshed J Irani, Director, Tata Industries Ltd on July 22,
2008 at PHD House, New Delhi. Mr. Hari Shankar Singhania, Chairman, Governing Board, PFI presided
over the function and Mr. A R Nanda, Executive Director, PFI delivered the welcome address.
Excerpts from the Oration
Mr JRD Tata was a man deeply committed to India's national growth
and development. His concern and contribution to the cause of
social issues such as poverty, population stabilization and
unemployment is well known.
India was the first country in the world to launch a national
programme on family planning for population stabilization. Since
then the Indian family planning programme has gone through
several phases, from population control to human centered
sustainable development and recognition of the need for
comprehensive reproductive health care.
The concept of Corporate Social Responsibility (CSR) has received recognition only recently, but the
corporate sector in India, actually has a long history of commitment to social philanthropy – thanks to
the belief that the creation of wealth is primarily geared for social good. PFI has been fortunate to have
received support from the corporate sector in its activities and expected that the support not only
continues, but increases manifold in the future.
The interest shown by Mr JRD Tata in population stabilization programme
has ultimately led to the setting up of the Population Foundation of India.
The concept of 'corporate social responsibility' is not to be confused with
philanthropy. The guiding principle of all Tata communities is 'corporate
sustainability', where the corporate takes up the responsibility to ensure
good quality of life for communities where Tata operates.
The CSR is a sound investment for all business houses as the benefits of
investing in the community are manifold and it goes a long way in getting corporates valued for ethical
business practices and sustainability.
58
annual report
2008-2009
The Oration was summed up with a quote by Mr. J R D Tata, “In a free enterprise, the community is not
just another stakeholder in business, but is in fact the very purpose of its existence.”
Regional Conference in Chandigarh
The Population Foundation of India organized a regional conference on 'Health, Population and Social
Development issues in Punjab, Himachal Pradesh and Haryana' with a focus on sex ratio issues/female
foeticide at Hotel Taj, Chandigarh on October 23-24, 2008. The objectives of the workshop were to (i)
get a clear perspective of the demographic and health transition process in Haryana, Himachal
Pradesh and Punjab, (ii) draw attention to the issue of child sex ratio and review efforts to curb sex
selective practices and pre-birth elimination of females, and (iii)
recapitulate initiatives by the State Governments on population and
health issues.
General (Retd.) S.F. Rodrigues, Governor of Punjab &
Administrator, UT Chandigarh inaugurated the Conference. Dr. A R
Kiwai, Governor of Haryana, Professor Lakshmikanta Chawla, Hon.
Health Minister, Government of Punjab, Mr Deepak Sanan, Principal
Secretary, Health, Government of Himachal Pradesh and other
senior Government officials from all three states graced the
conference with their presence and active participation.
The two-day Regional Conference brought together administrators, social scientists, academicians,
scholars, national/international institutions and NGOs concerned with these issues, for discussion on
demography, health and social development - achievements, gaps and future plan of action.
Three PFI publications were released by General Rodrigues on the occasion, including a wall chart
covering key health and social development indices, the district profile for three states with key note
addresses and a report on civil society initiatives under the MoHFW/UNFPA CP6 programme.
The various sessions over two days of the conference included
presentations and discussion on demographic and health transition
in Punjab, Haryana and Himachal Pradesh, highlighting the issues and
challenges for population stabilization, health and epidemiological
transition in the three states. Deliberations were also held on policies
and programme initiatives on population/reproductive and child
health, gender discrimination, sex selection and the state:
contradictions, contestations & challenges and role and impact of
media in addressing the child sex ratio.
59
|
|
4.9 Page 39 |
▲back to top |
annual report
2008-2009
The conference was part of an annual effort of the Population Foundation of India. PFI has, in the past,
organized several state and regional level conferences as part of its advocacy efforts on health,
population and social development issues. The recommendations emerging from these conferences
are submitted to the respective state governments for framing their population policies and
programmes.
Some of the key deliberations and recommendations that emerged from the conference are
summarized below:
Overall health and demographic transition in the three states
• Punjab and Himachal Pradesh have achieved TFR of
replacement level (2.1) whereas Haryana is expected to
reach the TFR of 2.1 by 2012. In most urban areas in Haryana,
the TFR has reached the replacement level. While fertility
has declined in these states, population stabilization, issues
and challenges need to be discussed in relation to myths and
misconceptions on population stabilization including the
fact that population stabilization is not just numbers. It
includes reproductive health and quality of care in health
services as a priority.
• It is evident that in spite of declining mortality and changing morbidity patterns, the states of
Haryana, Punjab and Himachal Pradesh still have the unfinished agenda of combating
traditional infectious diseases and relatively high maternal, peri-natal and neo-natal disorders
including nutritional deficiencies which continue to contribute to a heavy disease burden.
•
Government should consider the impact of demographic transition during formulation or
implementation of any law to address the population issues of the country. Policy decisions like
two child norm are not in favour of 'people' as they deprive people from participating in local
and grassroots level governance systems and have other adverse impacts such as an
unbalanced sex ratio at birth.
On the Issue of Child Sex Ratio and Female Foeticide
• The complex socio-political reality of sex selection and gender discrimination in India requires a
multi-pronged approach which needs to take into account the whole gamut of rights of
women, the intricate interconnection of these rights, the influence of class, caste, religion and
other individual and group identities as well as the shifting heterogeneous character of the
State priorities.
• While the problem exists in educated middle and upper class, schemes promoting the girl child
60
annual report
2008-2009
have so far been aimed at the lower class. It was hence recommended that the campaigns
should focus on the educated urban middle class and that efforts must be sustained over a long
period.
• The following are needed to further the rights of women, end discrimination against women
and improve sex ratio at birth.
Need to place the problem in the broader context of discrimination of women.
Need for clarity on impact of consequences of low child sex ratio on individual women
and on womanhood as a whole e.g. violence against women.
Careful use of terminology and imagery so that it does not lead to more confusion on
the MTP Act and what it offers women and not let it translate into anti abortion
messages.
Ensure access to safe abortion services for women as per the law.
• Corporates must invest their resources in educating the girl child, providing health insurance to
girl child, sensitizing the community and other stakeholders against female foeticide.
Vocational training and more employment opportunities to females must be provided.
• Increased visibility of girls and women so as to improve their status and so that people start
valuing the girl child. Publicize stories of parents living with daughters to counter the strong
cultural belief that sons are necessary to take care of parents in their old age.
• MTP Act needs to be reviewed in the light of 'Right to Abortion’
The Fourth JRD Tata Memorial Award on Population and RH Programmes
The Population Foundation of India instituted the JRD Tata Memorial Awards in 1997 in memory of the
late Mr JRD Tata, the founder Board Chairman of the Foundation. The award is given to selected states
and districts with outstanding performance in population, reproductive health and family planning
programmes.
This year, the fourth JRD Tata Memorial Awards were given away by Shri M Hamid Ansari, Vice
President of India at an event in New Delhi organized by Population Foundation of India on January 9,
2009. The Award Committee for the fourth JRD Tata Memorial Award decided to give two state level
awards, one from the bigger states (population of 10 million and
above) and the other from the smaller states (population less than
10 million). Chhattisgarh was adjudged as the winner among the 19
bigger states and Sikkim was the winner among the 10 smaller
states. Shri P.K. Chamling, Chief Minister Sikkim and Mr. Amar
Agrawal, Health Minister, Chhattisgarh received the awards from
the Vice President of India on behalf of the award winning states.
Chhattisgarh received the award of a rolling trophy and cash prize
of Rs.15 lakhs while Sikkim received a rolling shield and cash prize of
61
|
|
4.10 Page 40 |
▲back to top |
annual report
2008-2009
Rs.10 lakhs for performance in population and
reproductive health programmes.
Mrs Nirmala Buch selected the winners.
A Technical Advisory Committee, comprising experts
from diverse academic affiliations was constituted. The
committee guided the Foundation in selection of
indicators and appropriate methodology for the
selection and finalization of the state/districts awards. A
high level Award Committee, chaired by Ms. Justice Leila
Seth, former Chief Justice of Himachal Pradesh,
comprising eminent members including Dr M S
Swaminathan, Mr B G Deshmukh, Dr Abid Hussain and
The winning states were selected on the basis of 14 indicators representing reproductive health,
gender, fertility, socio-economic development, education and state government's commitment to
the social sector. The indicators were drawn from secondary sources such as National Family Health
Surveys and Census and Sample Registration System. A major criterion for selection of states was the
'change factor' (improvements in indicators over a decade).
Chhattisgarh has made improvements in almost all the indicators considered for the 4th JRD Tata
Memorial award. Full immunization for the state improved from 20.0 percent in 1998-99 to 48.7
percent in 2005-06. Similarly for at least three ANC visits, the figure got a boost from 33.2 percent in
1998-99 to 54.2 percent in 2005-06.The state has also shown improvements in safe delivery, child
nutrition and infant mortality rate.
Among the smaller states, Sikkim has shown remarkable improvements in terms of contraceptive
prevalence rate (53.8 to 57.6), full immunization (47.4 to 69.6), at least three ANC visits (42.6 to 70.1) in
between two successive National Family Health Surveys (1998-99 and 2005-2006). The state has also
made substantial reduction in infant mortality rate and percentage of children underweight.
The first JRD Tata Memorial Awards were presented by Shri I K Gujral, Prime Minister of India in 1997.
The award for the best performing state was given to Kerala and the awards for the best performing
districts were given to three districts, namely, Palakkad in Kerala (in the large population size
category), Toothukudy in Tamil Nadu (in the medium population size category) and Kurukshetra in
Haryana (in the small population size category).
The second JRD Tata Memorial Awards were given in 2001 by Dr C P Thakur, Union Minister of Health
and Family Welfare. The award for the best performing State was given to Tamil Nadu and the awards
62
annual report
2008-2009
for the best performing districts were given to three districts, namely, Chennai in Tamil Nadu (in the
large population size category), Alappuzha in Kerala (in the medium population size category) and
Jorhat in Assam (in the small population size category). Awards to the best performing districts in the
not so good performing states were given to districts of Dehradun in Uttar Pradesh, Purbi Singhbhum
in Bihar and Cuttack in Orissa.
The third JRD Tata Memorial Award for the best performing state was given to Himachal Pradesh by
Shri Bhairon Singh Shekhawat, Vice President of India in 2003. Awards for the best performing districts
were given to three districts, namely, West Godavari in Andhra Pradesh (in the large population
category), Churu in Rajasthan (in the medium population category) and Lahul & Spiti in Himachal
Pradesh (in the small population category). Awards to the best performing districts in the not so good
performing states were also given to the districts of Ri Bhoi in Meghalaya, Ranchi in Jharkhand and
Bhagalpur in Bihar.
631
|
|
5 Pages 41-50 |
▲back to top |
|
|
5.1 Page 41 |
▲back to top |
Endline Evaluations and Research Study
65
|
|
5.2 Page 42 |
▲back to top |
annual report
2008-2009
66
Endline Evaluations / Research Study
annual report
2008-2009
Intervention Study Among Adolescents, Pregnant Women and Lactating Mothers
to Reduce Prevalence of Anaemia - A Contributory Factor of Maternal Morbidity
and Mortality in Gurgaon, Haryana
The project was implemented by an NGO, SUKARYA with technical and financial support from
Population Foundation of India for three years (May 2006-April 2009). The geographic coverage of the
project was 10 villages in two circles of ICDS project area, namely, Jharsa and Nathupur in Gurgaon
District of Haryana. The target groups of beneficiaries were adolescent girls (13-19 years), pregnant
women (15-49 years) and lactating mothers (having a child less than six months age). Objectives of the
project were to:
? Measure the prevalence of anaemia in the target groups
? Understand the knowledge, attitude and practices in consuming iron rich food and health
seeking behaviour
? Create awareness on anaemia and its adverse effects and methods of prevention and
treatment
? Prevent and treat anaemia among the target group
The project was evaluated by an external agency, Development Facilitators, New Delhi with the
overall objective of assessing the performance and impact of the project. Both quantitative and
qualitative techniques were used in the endline evaluation. Some of the key findings, promising
practices, lessons learned and recommendations were:
Key Findings:
? There is a significant reduction of anaemia - 25.6% among
pregnant women, 17.9% among lactating mothers and 9.6%
among adolescent girls. No pregnant woman was noted as
severely anaemic after the intervention. Only 1.5% among
adolescent girls and 3.8% among lactating mothers were
severely anaemic.
?Overall, while barely half of the project population had
knowledge and awareness on anaemia before intervention,
67
|
|
5.3 Page 43 |
▲back to top |
annual report
2008-2009
it considerably increased upto 80% after the intervention. This sufficiently substantiates that
project intervention has very ably generated awareness and augmented the knowledge base
of project population on anaemia and its adverse effects.
?Along with increase on knowledge on anaemia, knowledge on prevention by just correct
dietary practices has also been increased. Before intervention, only 7% adolescents knew that
less intake of nutritional foods cause anaemia, whereas 64% of the adolescents after
intervention possess sufficient knowledge that lack of it causes anaemia.
?Among the project population, not only has awareness and knowledge regarding type of food
to be consumed to reduce prevalence of anaemia increased but also corrective practices were
suitably adopted by them after the intervention. For example, an improvement in green leafy
vegetable consumption was noted among different target groups after the intervention. More
than double of the adolescent girls ( 27% to 58% ), almost three times more pregnant women
(23% to 58%) and little less than double (31%to51% ) lactating mothers were noted to be
consuming green leafy vegetables.
?After intervention, project population is noted to be hygienically very alert which was not the
case before intervention. While barely half of the populations used to wash their hands before
intervention, 63% project population are noted to be washing their hands before taking food
after the project intervention.
Promising Practices
?Formation of self help groups of women and adolescents within the community to increase
their participation in the project helped immensely to identify anaemic population, refer them
to ANMs/AWWs for IFA and further follow up with them, which is one of the most pertinent
strategic interventions that qualitatively improved the collective participation of project
women in various project activities.
?Networking with local school authorities accrued instant and desired stakeholder's support
that not only facilitated institutional back up support to project operationalisation but also
ensured legitimacy to the initiatives undertaken in the community under the project. All
possible help to organize anaemia rallies and swasthya melas in schools by the school
authorities espoused excellent example of convergence under the project.
?Under advocacy campaign for anaemia reduction, the documentary film “Jab Jago Tab Savera”
shot in the project villages could very ably sensitize the
entire community on issues of antenatal care, reasons for
anemia, prevention of anemia and important role played by
men in women's health etc. This certainly is one of the most
effective IEC interventions that has enabling effect on
project population in general and target groups of the
project in particular.
? Nutrition demonstrations organized in project villages in
order to promote intake of iron and vitamin C rich green
68
annual report
2008-2009
leafy vegetables especially among the reproductive age group
adequately motivated the project population to have healthy
eating habits and develop the habit of regular intake of iron
and vitamin rich food so as to keep themselves anaemia free
and healthy.
?Motivation to project population to switch over to swasthya
namak or double fortified salt, and distributing the salt
cheaper than other cooking salt available in the area is one of
the most desired interventions under the project to reduce
prevalence of anaemia for the entire households.
?Motivating the project population to use iron pan or iron karahi for cooking green leafy
vegetables proved to be most beneficial as majority of the project population are vegetarian.
?Giving technical training to community mobilizers on the anaemia project helped them
considerably to understand and prioritize activities under the project and troubleshoot
problems faced by the project population instantly, thereby augmenting the acceptability of
the project amongst the project population.
?Developing “Janani Record Book” under the project for pregnant and lactating women
helped to keep track and record of the haemoglobin levels of targeted groups thereby
leveraging clinical and non clinical interventions that helped to attain the project goals and
project success. Strategic documentation and follow up action were certainly very effective
practices that ensured programme success.
Lessons Learnt and Recommendations
? Under the intervention, it was learnt that networking with Government ongoing
programmes is desirable to ensure further strengthening. Concurrent interaction with
grassroots government functionaries is, therefore, also required to strengthen the linkages
with the community.
? The intervention project has not been able to reach out to non-school going unmarried
adolescent girl “Saath Saath” programme, which was initiated to attract adolescents in
general and non school going adolescents in particular to integrate them into the on-going
activities should be organized in all villages, so as to ensure maximum participation of non-
school-going unmarried adolescent girls in the project activities.
? It was learned that the involvement of male members at all levels (individual, family and
community) has been essential to bring about changes among female members in the
household and community.
? Of the two women target groups under the anaemia intervention, “pregnant women” were
69
|
|
5.4 Page 44 |
▲back to top |
annual report
2008-2009
? better outreached than the “lactating mothers” because the
pregnant women in their advance stage prefer to go to their
native/ancestral villages for delivery and tend to return late
to project villages (after their children cross the weaning
period). Efforts under intervention should have been taken
to organize more activities ostensibly meant for lactating
mothers, which could have attracted them to return early
after delivery to avail facilities created under intervention in
the project villages.
Strengthening NGO Capacity to Improve Maternal and Child Health Status in
Jharkhand through a Life Cycle Based Approach
The project was implemented by Child in Need Institute (CINI), Jharkhand with the technical and
financial support from Population Foundation of India. Initiated in 2004 for 5 years, the project
covered 88,000 population residing in 65 villages of Churchu block of Hazaribagh district of
Jharkhand. The objectives of the project were to (a) strengthen capacity of partner NGOs to provide
integrated RCH/HIV services (b) develop and implement a life cycle based community level
intervention to improve safe motherhood, child survival, achievement of fertility goals, male
participation, adolescent's informed choices about health and health delivery in one block setting (in
the block of Churchu), and (c) document and disseminate these experiences to other NGOs and
government in the state.
The project was evaluated by an external agency, Sigma Research and Consulting Pvt Ltd, New Delhi
with the overall objective of assessing the performance and impact of the project. Both quantitative
and qualitative techniques of research were used in the end-line evaluation. Some of the key findings,
promising practices, lessons learned and recommendations were:
Key Findings
?The project has recorded improvements in most of the maternal and child health indicators of
the project area. Proportion of women getting married below 18 years has reduced by 16 %.
?The Mean Children Ever Born (CEB) to the women in the age group 40-44 years has reduced
slightly over the project period. There is not much difference in the fertility levels. The
contraceptive prevalence rate (CPR) has increased from 40% to 57%. As a result, the unmet
need for contraception among women has reduced significantly to 12% from 25 %.
?Proportion of women who received antenatal check up (ANC) has increased from 56% to 92 %.
The extent of utilization of antenatal care components such as number of ANC visits, number
of TT injection received and consumption of IFA tablets has increased substantially. The
percentage of home deliveries has come down from 90% to77%. The proportion of safe
deliveries has also increased by 7% during the project period.
?The project has also established another milestone in child health. The proportion of fully
70
annual report
2008-2009
immunized children in the age group 12-23 months has increased from 33% during baseline to 73%
during the endline.
?The knowledge of unmarried youth (on family planning and HIV/AIDS) has also increased
during the project period.
?Awareness about legal age at marriage for both boys and girls has also increased during the
project period.
Promising Practices
?Community level link worker (rechristened as Saahiya by the Jharkhand Government) concept
which was introduced during the project intervention to generate demand for RCH services
later got adopted by the National Rural Health Mission (NRHM).
?Formation of Village Health and Sanitation Committee (VHSC), which met every month and
reviewed the health status of women and children of the village and performance of RCH
enhanced the community participation and ownership.
?Collection and maintenance of Village Health Kosh (used to meet emergency health expenses)
was also emerged from the community mobilization process and later on it was proved to be
responsible for better involvement of the community.
?Capacity building for the NGO staffs on RCH issues and life cycle approach helped them to have
a better understanding and to mitigate some of the problems pertaining to the same.
?Tracking of individual woman by the illiterate Saahiya was a challenge and this project
demonstrated the way to do it using a community monitoring tool.
Lessons Learnt and Recommendations
?More focused efforts required for imparting knowledge among the adolescents and ensuring
follow up after the initial training.
?Proper documentation and dissemination of project activities should have been given more
attention.
71
|
|
5.5 Page 45 |
▲back to top |
annual report
2008-2009
Infant and Child Mortality in India: State Level Estimates by Religion, Caste,
Education and Occupation
Differentials in the health status of individuals in population, in tandem with differentials in other basic
endowments, have a bearing on their pattern of access and utilization to health care services. It is the
need of the hour to examine the attainment of these indicators and the difference between caste and
religious groups in India. Understanding the need for indirect estimates for Infant Mortality Rate
(IMR) and Child Mortality Rate (CMR) by religion, caste, education and occupation, Population
Foundation of India (PFI) has undertaken the current study jointly with Dr. S. Irudya Rajan, Centre for
Development Studies (CDS), Thiruvananthapuram to provide indirect estimates on vital rates of infant
and child mortality by sex and place of residence for the states and UTs of India. The estimates were
based on the available information such as Children Ever Born (CEB) and Children Surviving (CS)
available from the Fertility Tables of 2001 Census. The state level estimates for 29 states and 6 union
territories were prepared by sex and place of residence (rural and urban). Another important
objective behind undertaking this study is to provide comparable estimates between the 1991 and
2001 Census so that they will be widely used among planners and policy makers.
The study revealed that IMR is found to be the highest among Hindus as compared to other
communities such as Muslim, Christian, Sikh, Buddhist and Jains. Among the religious communities,
the difference exists with respect to sex and place of residence. The rural IMR is slightly higher than
the urban IMR. For CMR, there is also rural-urban and sex differential among states and UTs with
respect to religious communities. Child mortality rate has reduced across sex and place of residence in
between 1991 and 2001. For India, CMR is found to be the highest for Hindus vis-à-vis other religious
communities. The rural CMR is higher than the urban CMR. The infant mortality rate for scheduled
castes is more than the national average in states like Madhya Pradesh, Uttar Pradesh, Orissa,
Rajasthan, Assam, Arunachal Pradesh, Tripura, Bihar, Chhattisgarh and Haryana. The estimates of
CMR for scheduled castes shows that Madhya Pradesh has the highest child mortality followed by
Uttar Pradesh, Orissa, Rajasthan, Assam and Arunachal Pradesh. Among the states, Goa has the
lowest CMR for the scheduled castes. West Bengal has the child mortality for scheduled castes more
than the national average as compared to states like, Madhya Pradesh, Uttar Pradesh, Orissa,
Rajasthan, Assam and Arunachal Pradesh, Bihar, Chhattisgarh, Tripura and Haryana. For all the states
and the country as a whole, IMR is consistently reducing as the level of education goes up. The IMR is
more for illiterate categories as compared to literates. There is rural-urban differential across all the
level of education. The rural IMR is slightly more than the urban IMR. There is a consistent decline in
IMR for all the educational levels across all the states and UTs in between 1991-2001. A similar trend is
also observed in case of Child Mortality Rate.
HIV/AIDS Programme
72
73
|
|
5.6 Page 46 |
▲back to top |
The Global Fund Round 4 and Round 6
HIV/AIDS Programme
annual report
2008-2009
The Population Foundation of India (PFI) is managing the Round 4
and Round 6 HIV/AIDS programmes on care and support, funded by
The Global Fund. PFI is the first civil society Principal Recipient of the
Global Fund grants in India under the Round 4 programme. PFI
complements the national programme on roll out of treatment,
care and support for People Living with HIV/AIDS (PLHIV). The
National AIDS Control Organization (NACO) is the public sector
Principal Recipient and is providing Anti-Retroviral Treatment (ART)
through the public health facilities. The PFI led Non-Governmental
Organization (NGO)/private sector consortium is providing care and
support services to People Living with HIV (PLHIV). Round 4-Access
to Care and Treatment (ACT) programme is being implemented in six high prevalence states in India
namely, Tamil Nadu, Andhra Pradesh, Karnataka, Maharashtra, Nagaland and Manipur. Round 6-
Promoting Access to Care and Treatment (PACT) programme enlarges the operational area to eight
highly vulnerable states of India namely, Uttar Pradesh, Madhya Pradesh, Rajasthan, Gujarat, West
Bengal, Orissa, Bihar and Chhattisgarh. Both the programmes aim to improve the survival and quality
of life of PLHIV and reduce morbidity and mortality associated with HIV and its transmission. The
partners of the programme are Indian Network for People Living with HIV/AIDS, Engender Health
Society, Confederation of Indian Industry, Freedom Foundation, Catholic Bishops' Conference of India
(CBCI) and Hindustan Latex Family Planning Promoting Trust (HLFPPT).
Under the ACT programme, as of March 2009, 130 District Level
Networks (DLNs) have been established and 167,815 PLHIVs have
accessed care and support services. Under the PACT programme,
68 DLNs have been established in states of Uttar Pradesh, Madhya
Pradesh and Rajasthan till March 2009. District Level Networks are
community based organizations of PLHIV and are affiliated to the
Indian Network for People Living with HIV/AIDS (INP+). DLNs enroll
PLHIV and provide psycho-social support, and conduct support
group meetings at the district and taluka levels. PLHIV are educated
and followed up on treatment and treatment adherence. They are
also educated on positive living, nutrition and preventive
74
75
|
|
5.7 Page 47 |
▲back to top |
annual report
2008-2009
behaviour. DLNs also refer women and children for testing,
Prevention of Parent-to-Child Transmission (PPTCT) and ART
services. Under the PACT programme, 56 Community Care Centres
(CCCs) have been established till March 2009 and 17,034 PLHIVs
have accessed services from these centres. Community Care
Centres are ten bedded care centres functioning in the eight highly
vulnerable states of India. CCCs work in close coordination with ART
centres. All PLHIVs initiated on ART at the public ART centres are
referred to CCCs. They verify patient address and provide out-
patient and inpatient services for minor Opportunistic Infections
(OIs), and counseling on drug adherence, nutrition and preventive
behaviour.
The HIV/AIDS programme has helped in mobilizing PLHIVs to access services and follow up for
adherence and also encouraged the involvement of family. The reinforcement counselling that takes
place at the different levels and further reinforced at the support group meetings have contributed to
increased adherence. PLHIVs associated with the programme exhibit an increased confidence, better
health, reduced morbidity, better social acceptance along with access to Government services and
other services, which help improve their lives and livelihoods. Overall, the services provided under the
ACT and PACT programmes are seen to be making a difference in the quality of lives of PLHIVs. Service
utilisation is on the increase, showing both acceptance and health seeking behaviour. The pro-
gramme has also established effective linkages and networking with NGOs and private sector for
services.
Key Highlights of the HIV/AIDS Programme
IEC material development and orientation
The peer educators felt the need for a communication tool, while interacting with the People Living
with HIV/AIDS (PLHIVs) at the grassroot level to disseminate correct information about HIV/AIDS.
Keeping this in mind, PFI has developed an informative IEC kit consisting a diary for peer educator, two
flip books on 'Living with HIV/AIDS' and 'Managing HIV/AIDS' and four leaflets on HIV/AIDS. The kit is
available in six languages: English, Hindi, Telugu, Tamil, Kannada and Marathi. This kit is meant for peer
educators engaged in providing information on prevention, treatment, care and support. These
materials are used in outreach, support group meetings and
interaction meetings of PLHIVs. PFI- PMU had organized an IEC
orientation workshop on 17th November 2008 for PFI and INP+
representatives from Round 4 and Round 6 programme units. In
continuation to the orientation, state units of Round 4 and regional
units of Round 6 held similar IEC orientation workshops in their
respective states. In these workshops the participants from District
Level Networks, Positive Living Centres, Treatment Counselling
Centres, Comprehensive Care and Support Centers and Community
Care Centres were oriented to the content, effective distribution
and use of IEC materials. Participants performed role plays using flip
76
annual report
2008-2009
charts and leaflets for better understanding of the content. IEC kits were distributed to service
delivery points in the workshop.
Exposition
Expositions were conducted in Tamil Nadu, Maharashtra, Karnataka, Andhra Pradesh, Nagaland and
Manipur. Over 100 PLHIVs from District Level Networks participated in the state level exposition
between April and July 2008. The events provided a platform for DLNs to develop a better
understanding on issues of access to care and treatment, share learnings and promote the concept of
positive living. Karnataka state unit conducted the exposition in coordination with the stakeholders
involved in the ACT programme. This was a three day programme during “World Population Day” day
observation. There were various activities such as informative sessions on topics like HIV/AIDS, STI,
population control, health and hygiene etc. Tamil Nadu state unit organized the exposition under the
theme “The Power of Positive Living” and Manipur state PFI on 'Empowerment through
participation'. A two-day exposition Programme was organized by Nagaland state unit in
collaboration with Naga Network of People Living with HIV/AIDS (NNP+) with the theme of
“Empowering People Living with HIV/AIDS”.
World AIDS Day 2008
World AIDS Day was observed on 1st December 2008 by PFI and the
partner organizations of the Global Fund Round 4 and Round 6
programme. On this event Programme Management Unit (PMU), New
Delhi released the first edition of its newsletter, 'P- ACT News' and a 'Peer
Educator Kit' on HIV/AIDS. PFI state and regional units also observed the
World AIDS day in their respective states and regions. The day was
marked by meetings, rallies, nukkad natak and candle night march in
different districts of the states. In congruence with the theme of World
AIDS Day, a one day workshop on “Take the Lead” was organized by PFI
Regional Unit, Uttar Pradesh along with Uttar Pradesh Network of Positive People (UPNP+). PFI and
UPNP+ together declared a Youth Forum which would carry out advocacy with different stakeholders
and ensure involvement of PLHIV in government welfare schemes. The Forum would act as a bridge
between the services and the community. PFI Andhra Pradesh Unit in collaboration with Freedom
Foundation organized a get together for widow women living with HIV, registered with
Comprehensive Care and Support Centre, Guntur. Nagaland, Rajasthan and Gujarat state units
observed the World AIDS Day to spread awareness about HIV/AIDS among the general community. In
Nagaland, World AIDS day was observed under the theme 'Leadership- Lead, Empower, Deliver' at
Jalukie. This day was observed for the first time in Jalukie, Nagaland.
Capacity Building
Continuing Education and Training Centres
To enhance the institutional capacity of national institutions, three Continuing Education and Training
Centres (CETCs) have been established under the programme—DESH in Chennai, Swami Vivekananda
Youth Movement (SVYM) in Mysore and Diocesan Social Service Society (DSSS) in Imphal.
77
|
|
5.8 Page 48 |
▲back to top |
annual report
2008-2009
EngenderHealth Society (EHS) trains counselors, social workers, master peer
educators and healthcare providers (doctors, nurses and paramedics) working in
the programme through the CETCs. The trained master peer educators are
supported by EHS to plan and conduct sessions. EHS backstops the master peer
educators. This involves coaching of new trainers by supporting them as they
train others, helping them in planing and conducting sessions and improving
their communication skills. To refresh and update peer educators and
counselors' knowledge and skills, three-day refresher trainings are organized by
EHS under the ACT programme in the six high prevalence states.
Operationalizing COPE package
In order to improve the quality of services at the service delivery points in the ACT
programme, a participatory quality improvement tool, Client-Oriented and
Provider-Efficient (COPE) has been developed and introduced by EHS. COPE
exercise enables staff to identify areas and issues pertaining to service delivery
which need improvement and develops an action plan. Implementing COPE package improves service
provision at the care and support facilities with ownership of the site staff, thus sustaining the quality
of improved services. Pre-testing of COPE tools was undertaken at CCSC in Guntur and PLC in
Prakasam, Andhra Pradesh in September 2008.
Computerized Management Information System (CMIS) Training
Under the Global Fund Round 6 'Promoting Access to Care and Treatment' (PACT) Programme, PFI-
PMU has developed a Computerized Monitoring Information System (CMIS) for Community Care
Centres and District Level Networks (DLNs). After pre-testing of CCC-CMIS in Meerut CCC, the first
phase of the CCC-CMIS training was organized for staff from 44 CCCs across the eight states during
January and March 2009. The CCC trained include 5 in Uttar Pradesh, 4 in Madhya Pradesh, 4 in
Rajasthan, 9 in Gujarat, 5 in Bihar, 5 in Orissa, 4 in Chhattisgarh and 8 in West Bengal. On the basis of the
feedback received in different trainings, the CMIS has been finalized and implemented.
Case Study
Akash is an eleven year old orphan on Anti-Retroviral treatment. He lives with his grandparents. He
was taking ART from Satara Civil Hospital in the state of Maharashtra. Akash's grandfather was unable
to take Akash to Satara for collecting his monthly ART medicines due to old age and health problems.
As a result, Akash defaulted and started having health problems. His grandfather was worried. He
approached the DLN at Satara. The counselor at the DLN explained to them the importance of taking
ART regularly. Akash went with his grandfather to Satara to restart his ART treatment. Akash now
takes his ART on time and has promised to never miss the dose. DLN also informed them about the
Balsangopan Yojana, a government scheme to provide education support to children and referred him
to 'Adhar Grah', a care home to take care of his needs.
78
Publications During the Year
annual report
2008-2009
Monograph on Young People's Reproductive and Sexual Health Programmes
This document, published in June 2009, provides a glimpse of selected pilots from
different parts of the country addressing various issues of young people's reproductive
and sexual health. It includes government, NGOs and corporate initiated pilots. Many
pilots featured in this document have promising practices, which could be experimented
further and be considered for scaling up. This publication will serve as a key reference
guide to the policymakers, central and state governments, donors, researchers,
programme managers and NGOs.
Engaging with Corporate Sector: Family Planning, Reproductive Health,
HIV/AIDS – 1970 - 2007
This Monograph, released on May 26, 2008 at New Delhi, consolidates the 37
years of rich experience of the Foundation with the corporate sector, various co-
operatives and trade unions from 1970 to 2007. It also documents how PFI and
corporate sector with constant interaction and dialogue have been able to
leverage upon each others strength and contribute to social development and
improving quality of life of society at large. The rich experiences include research studies, advocacy
workshops, seminars as well as field interventions.
Population, Health and Social Development: Punjab, Haryana, Himachal Pradesh,
Chandigarh
The publication, along with a wall chart mentioning indictors on population, RCH and
HIV/AIDS for the three north-western states and a UT, was brought out by PFI especially
for the regional conference held at Chandigarh on October 23-24, 2008. It contains key
notes delivered on health and demographic transition and the issues for female foeticide
along with state and district profiles with state and district maps. These profiles were
prepared by taking data from renowned secondary sources: Census, NFHS, DLHS, SRS and
Annual Sentinel Survelliance Surveys. Through this publication, PFI has made an effort to
help policy makers, planners, programmers and non-governmental organizations for
improving health and social conditions in the states of Punjab, Haryana, Himachal Pradesh and
Chandigarh. It will be useful for formulation, monitoring and implementation of policies and
programmes.
Cherishing the Girl Child: Advocacy Campaign against Sex Selection and Pre-birth
Elimination of Females
The publication, brought out by PFI for the regional conference at Chandigarh, is a
qualitative assessment by external consultants, which captures processes and efforts of
PFI and the state level partners, SUTRA and the Voluntary Health Association of Punjab,
under the advocacy campaign on Sex Selection and Pre-birth Elimination of Females'
supported by the MoHFW/UNFPA under the Country Programme 6. The publication will be
79
|
|
5.9 Page 49 |
▲back to top |
annual report
2008-2009
useful for policy makers and programme managers working on the issue of missing girls.
Regional Conference on Health, Population and Social Development with focus on the
Child Sex Ratio/Female Foeticide
The publication has the proceedings of the two-day regional conference on Health,
Population and Social Development Issues in Punjab, Himachal Pradesh and Haryana”
with focus on Child Sex Ratio /Female Foeticide held at Hotel Taj, Chandigarh on October
23-24, 2008. The conference was part of an annual effort of the Population Foundation of
India, New Delhi.
Fundamentals of Quality of Care: A Training Manual for NGOs
The Foundation, as part of its role as a Regional Resource Centre (RRC),
developed this manual for district level managers from government and civil
society including RRC trainers, MNGO and FNGO staff to monitor the quality of
reproductive health services. It covers all the generic and specific quality of
care elements within a gender sensitive and rights based framework in a
systematic manner. The manual describes the process of ensuring quality
assurance in a simple user friendly and participatory manner. The manual can
be used as a basic reference document for policy makers and civil society
institutions.
Naya Savera: Integrated Family Welfare Programme
The publication captures the successful four year journey of Naya Savera project, which
the Foundation implemented in association with JK Lakshmi Cement Ltd in Sirohi,
Rajasthan. The project has served as a real awakening for the poor and needy tribal
population inhabiting the vicinity of JK Lakshmi Cement Ltd., bringing a ray of hope for
ladies deprived of basic medical care and modern know-how of health and hygiene.
JRD Tata Memorial Award for Population and Reproductive Health Programmes
The booklet depicts information on 4th JRD Tata Memorial Awards for
Population and Reproductive Health Programmes, which were given
away at a function organized by PFI at National Cooperative Union of
India (NCUI) Auditorium, New Delhi on January 9, 2009. It provides an
overview on the significance of the award, the methodology used for
the selection of the best performing state and districts on population
and RCH programmes, indicators, indices and ranking of states for the
awards and the names and the profile of the award winners.
80
annual report
2008-2009
Making Married Adolescents Matter: Reproductive Health Needs, Interventions
and Policies
The publication has the proceedings of one-day experience sharing workshop on
“Making Married Adolescents Matter: Reproductive Health Needs, Interventions
and Policies” of the SATHI model project organized jointly by Institute for Health
Management, Pachod (IHMP), Directorate of Health Services (DHS), Maharashtra
and Population Foundation of India, held at the India International Centre on August
21, 2008. The workshop included the experiences of implementing the programme
in the rural and urban areas of Aurangabad and Pune districts of Maharashtra and
the baseline findings of the Randomised Control Trial (RCT) and the multi-site NGO
research initiative.
Prem Jyoti: Comprehensive Reproductive and Child Health Programme for Malto Tribals
in Jharkhand
The publication describes the project activities which the Foundation implemented in
association with Prem Jyoti for Malto tribals in Jharkhand with a focus on delivering basic
reproductive and child health services in 140 villages spread over in 13
cluster areas.
Continuum of Care for Injecting Drug Users (IDUs) including IDUs
living with HIV, in Imphal city, Manipur: Current Situation, Needs, and Gaps - A
Mixed Methods Study
Manipur is one of the high HIV prevalence states in India with 1.13% of the general
population estimated to be HIV-infected. In Imphal, the capital city of Manipur, the
estimated number of injecting drug users (IDUs) is about 9,000-12,000 with an
estimated HIV sero-prevalence of 19.8% (NACO, 2006).
To move towards the goal of having continuum of care for IDUs (including those living with HIV) in
Imphal city, this study was conducted to assess the current situation of the various drug and
infections-related medical/non-medical services (Govt./NGOs/CBOs/PLHIV Networks/Private sector)
available for IDUs including those living with HIV in Imphal and to identify gaps in existing
prevention/care services; and identify unmet and emerging service needs.
Reviewing Quality of Care in Community Care Centres
Population Foundation of India, for its Promoting Access to Care and Treatment (PACT)
Programme under GFATM Round 6 reviewed the quality of care provided in Community
Care Centres (CCCs) set up by the partners CBCI and HLFPPT. The purpose of this study
was to examine the quality of services provided at CCCs from the perspective of clients,
family members and service providers in order to evaluate the quality of services at the
centre and to suggest methods of strengthening and improving services. The study was
conducted at four CCCs in the states of Gujarat, West Bengal, Uttar Pradesh and Madhya
Pradesh.
81
|
|
5.10 Page 50 |
▲back to top |
Accounts
|
|
6 Pages 51-60 |
▲back to top |
|
|
6.1 Page 51 |
▲back to top |
Accounts
annual report
2008-2009
84
85
|
|
6.2 Page 52 |
▲back to top |
annual report
2008-2009
86
annual report
2008-2009
87
|
|
6.3 Page 53 |
▲back to top |
annual report
2008-2009
88
annual report
2008-2009
89
|
|
6.4 Page 54 |
▲back to top |
annual report
2008-2009
90
annual report
2008-2009
91
|
|
6.5 Page 55 |
▲back to top |
annual report
2008-2009
92
annual report
2008-2009
93
|
|
6.6 Page 56 |
▲back to top |
annual report
2008-2009
94
annual report
2008-2009
95
|
|
6.7 Page 57 |
▲back to top |
annual report
2008-2009
96
annual report
2008-2009
97
|
|
6.8 Page 58 |
▲back to top |
annual report
2008-2009
98
annual report
2008-2009
99
|
|
6.9 Page 59 |
▲back to top |
annual report
2008-2009
100
annual report
2008-2009
101
|
|
6.10 Page 60 |
▲back to top |
annual report
2008-2009
102
annual report
2008-2009
103
|
|
7 Pages 61-70 |
▲back to top |
|
|
7.1 Page 61 |
▲back to top |
annual report
2008-2009
104
PFI State Offices
annual report
2008-2009
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 Indai
(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
Rajasthan
Population Foundation of India
Plot no. 66, Geejgarh Vihar,
Hawa Sadak,
Jaipur – 302019
Ph: 0141-2210680
Email: pfirajasthan@gmail.com
Andhra Pradesh
Manipur
Population foundation of India
H. no. 9-1-104, TataChari Compound
Sarojini Devi Road
Secunderabad – 500025
Ph.no. 040-65999770
Email: pfiapsco@yahoo.com
pfiapsco@gmail.com
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
Maharashtra
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
Population Foundation of India
214, 2nd Floor, Raiker Chambers
Govandi, Mumbai-400088
Ph.no. 022-65029710
Email: mahapfi@gmail.com
Nagaland
Population Foundation of India
Karnataka
Nagaland State Program Coordination
Unit, OC-15, 2nd floor, Naga Shopping
Population Foundation Of India
Arcade, Near Town Hall. ,
“ SAURABHA”1657/A, 3rd Cross,
Dimapur – 797112, Nagaland.
Prakash Nagar, Rajaji Nagar, 2nd Stage Tel: 03862 – 234009
Bangalore-21
popfound_nagaland@yahoo.co.in
Ph: 080-41285706
pfibangalore@gmail.com
ka_sco@yahoo.com
Regional Offices
Madhya Pradesh
Uttar Pradesh
Population Foundation of India
Population Foundation of India
M – 6 and 7
A-743, Ground Floor
Guru Kripa complex
Indira Nagar
Plot no. 9 – 10
Lucknow-206016
M.P. Nagar Zone – 1,
Ph: 0522-2353838
Bhopal
Email: pfiuttarpradesh@gmail.com
Ph.no.0755-2550647
Email:pfi.madhyapradesh@gmail.com
105
|
|
7.2 Page 62 |
▲back to top |
annual report
2008-2009
Our Team
DELHI OFFICE
Mr A R Nanda
Dr Arundhati Mishra
Mr S Ramaseshan
Dr Almas Ali
Dr K K Upadhyay
Dr Subrato Kumar Mondal
Ms Sona Sharma
Dr Sharmila Ghosh Neogi
Dr Lalitendu Jagatdeb
Mr R R Subramanian
Mr C S N Murthy
Ms Chandni Malik
Mr Satyavrat Vyas
Mr Nihar Ranjan Mishra
Mr. Manoj Kandher
Ms Parul Sharma
Ms Mridu Pandey
Ms Lopamudra Paul
Mr Satya Ranjan Mishra
Mr Rakesh Kumar
Ms Shrabanti Sen
Mr Stanzin Dawa
Dr Mary Varghese
Executive Director
Additional Director
Secretary and Treasurer
Senior Advisor (Part time)
Senior Advisor cum NPD Manager
Senior Research Advisor cum Manager
Joint Director (Advocacy and Communication Div)
Joint Director (Programme Div)
Joint Director (Monitoring & Evaluation Div)
Administrative Officer
Finance Officer
Programme Officer (Advocacy and Communication)
Programme Officer (Programme Div)
Programme Officer (Monitoring & Evaluation)
Programme Associate (A & C)
Programme Associate (PD)
Programme Associate (PD)
Research Associate (M&E)
Project Manager (Packard)
Senior Project Manager (Scaling up)
Project Manager (Scaling up)
Project Manager (Scaling up)
Project Director (Global Fund HIV/AIDS)
106
Mr S Vijaya Kumar
Dr Phanindra Babu
Ms Rashmi Sharma
Ms Aparna G
Mr Sunil Kumar Singh
Ms Abhilasha M Rathod
Mr Bijit Roy
Ms Tripti Chandra
Ms Leena Krishnan
Mr Milan Rana
Mr Sanjeev Ranjan
Ms Piyali Sarkar
Ms Manju Sharma
Mr P J Sekharan
Ms Veena Gopal
Ms Prema Ramesh
Ms Jolamma Jose
Mr A Ramanathan
Ms Leelamma Mathew
Ms Usha S Nair
Mr Rakesh C Joyal
Mr Shailender S Negi
Mr P K Paul
Senior Grants Manager (GF)
Senior Manager S.I.E
Programme Manager
Senior Associate S.I.E.
Jr. Associate HR cum Procurement
S I E Associate
Programme Associate
Programme Associate
Accounts Officer
Accounts Officer
Assistant Accounts Officer
Documentation Associate
PRO
Executive Assistant to ED
Personal Secretary
Sr PA cum Programme Assistant
PA cum Programme Assistant
Jr Accounts Officer
Accountant
Recep. Cum Tel. Operator
Assistant Librarian
System Administrator
General Maintenance Executive
annual report
2008-2009
107
|
|
7.3 Page 63 |
▲back to top |
annual report
2008-2009
Mr Joseph George
Mr K Venkatachalam
Mr Arogya Das
Mr James Anthony
Mr Mohan Singh
Mr P Narayanan
Mr Shyam Lal
Mr Ram Narayan
Mr Gourav Sindhi
Ms Kanta
Mr Kamlesh Kumar
Mr Sanjay Ekka
Mr Vijender Kumar
REGIONAL/STATE TEAMS
Bihar
Mr R U Singh
Mr Matish Kumar
Mr Sanjay Kumar Singh
Mr Sudhir Kumar
Jharkhand
Ms Nikita Sinha
Ms Aprajita Mishra
Mr Debabrata Bhuniya
108
Record Clerk
Assistant Maintenance Up Keep
Driver (ED)
Driver (GF)
Daftri
Messenger
Messenger
Messenger (GF)
Messenger (GF)
Pantry Attendant
Mali
Helper
Helper
Honorary Advisor (for Bihar and Jharkhand)
Co-ordinator (RRC)
State Project Coordinator (Packard)
Project Associate (Admin & Finance)
State Project Coordinator (Packard)
State Project Associate (Packard)
State Programme Coordinator
Mr Sudhir Sharma
Mr Dattatraya Gokhale
Chhattisgarh
Mr Jagannath Kompella
Andhra Pradesh
Mr Vikas Panibatla
Ms Neela Santhi R
Tamil Nadu
Mr K Balasubramanian
Mr Alwin Leone Das D
Karnataka
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
Mr Ramesh C Parmar
State Research Officer
State Programme Coordinator
Training Coordinator (RRC)
State Programme Coordinator (GF)
Asst. State Prog. Coordinator (GF)
State Programme Coordinator (GF)
Asst State Prog. 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)
annual report
2008-2009
109
|
|
7.4 Page 64 |
▲back to top |
annual report
2008-2009
Mr Ashish Kumar Amber
Mr Subhash Kumar Sharma
Madhya Pradesh
Md Raza Ahmed
Ms Achint Verma
Ms Mini Ramachandran
Uttar Pradesh
Ms Mukta Sharma
Mr Rajeev Kumar Singh
Mr Deepak Ranjan Mishra
Mr Durga Prasad Gupta
Asst State Prog. Coordinator (GF)
Technical Assistant (GF)
State Programme Coordinator (GF)
Asst State Prog. Coordinator (GF)
Technical Assistant (GF)
State Programme Coordinator (GF)
Asst State Prog. Coordinator (GF)
Asst State Prog. Coordinator (GF)
Technical Assistant (GF)
List of Donors during 2008-09
annual report
2008-2009
International:
? GFTAM (Round IV and Round VI), GENEVE
? John T & Catherine D MacArthur Foundation, Washington DC, USA
? The Davild and Lucile Packard Foundation, USA
? MCH STAR/USAID
National:
? MoHFW, RRC Project
? UNFPA Country Programme VI
? MoHFW, NRHM Community Monitoring Project
? Sir Dorabji Tata Trust, Mumbai
? CHCMI Scaling up Project - WBSRDA (West Bengal)
110
111
|
|
7.5 Page 65 |
▲back to top |
annual report
2008-2009
PFI Meetings
Governing Board Meetings
July 22, 2008
November 3, 2008
January 9, 2009
March 24, 2009
Holding Trustees Meeting
November 3, 2008
Annual General Body Meeting
November 3, 2008
Advisory Council Meeting
March 5, 2009
Board Committee on Investment
September 2, 2008
112