Improving linkages between primary healthcare services and the community: Overcoming the last mile delivery challenges in Indian context
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1 Improving linkages between primary healthcare services and the community: Overcoming the last mile delivery challenges in Indian context Dr. Mrunal Shetye Country Lead, Maternal, Newborn and Child Health India Country Office Bill & Melinda Gates Foundation Bill & Melinda Gates Foundation 1
2 340 million Bill & Melinda Gates Foundation 2
3 CHINA INDIA UP + BIHAR USA 1.36 billion 1.25 billion 340 million 316 million Bill & Melinda Gates Foundation 3
4 Maternal deaths Neonatal deaths Under five deaths 20,000 2,32,000 4,26,000 India burden 44% 33% 36% Global burden 7% 9% 7% Bill & Melinda Gates Foundation 4
5 50% children not immunized* 5% mothers receive full ante natal care 30% currently married women use modern contraceptives 40% children exclusively breastfed* *For Bihar the full immunization rates are 60% and children exclusively breastfed are 53% Bill & Melinda Gates Foundation 5
6 80% Shortage of Specialists at secondary health care centers Poor health infrastructure plagues these two states 50% Shortage of nursing staff at primary and secondary health centers 40% Shortage of Doctors at primary health care centers Bill & Melinda Gates Foundation 6
7 In this scenario, is it possible to bring the basic preventive services closer to the community? Bill & Melinda Gates Foundation 7
8 VHND acts as a link between the community and facility to provide easily accessible health services ANMs AWWs Village health & nutrition day Sub-Center Primary Healthcare Center Secondary Healthcare Center Tertiary Healthcare Center ASHAs Eligible couple Pregnant woman Delivery Child years<5 Adolescent girl Bill & Melinda Gates Foundation 8
9 WHAT HAPPENS AT A VHND? Pre During Post 1 FLWs match due lists, prepare microplans Bill & Melinda Gates Foundation 9
10 Bill & Melinda Gates Foundation 10
11 AAA meeting Bill & Melinda Gates Foundation 11
12 WHAT HAPPENS AT A VHND? Pre During Post 1 FLWs match due lists, prepare microplans Bill & Melinda Gates Foundation 12
13 WHAT HAPPENS AT A VHND? Pre During Post 1 FLWs match due lists, prepare microplans 2 Block level officials ensure supply and availability of essential drugs and equipment Bill & Melinda Gates Foundation 13
14 WHAT HAPPENS AT A VHND? Pre During Post 1 FLWs match due lists, prepare microplans 2 Block level officials ensure supply and availability of essential drugs and equipment 3 ASHAs, AWWs responsible for beneficiary mobilization Bill & Melinda Gates Foundation 14
15 Bill & Melinda Gates Foundation 15
16 WHAT HAPPENS AT A VHND? Pre During Post VHND 1 FLWs match due lists, prepare microplans 4 ANMs responsible for service delivery 2 Block level officials ensure supply and availability of essential drugs and equipment 3 ASHAs, AWWs responsible for beneficiary mobilization Bill & Melinda Gates Foundation 16
17 Bill & Melinda Gates Foundation 17
18 Bill & Melinda Gates Foundation 18
19 Bill & Melinda Gates Foundation 19
20 Bill & Melinda Gates Foundation 20
21 Bill & Melinda Gates Foundation 21
22 GupShup Potli Bill & Melinda Gates Foundation 22
23 WHAT HAPPENS AT A VHND? Pre During Post VHND 1 FLWs match due lists, prepare microplans 4 ANMs responsible for service delivery 2 Block level officials ensure supply and availability of essential drugs and equipment 3 ASHAs, AWWs responsible for beneficiary mobilization Bill & Melinda Gates Foundation 23
24 WHAT HAPPENS AT A VHND? Pre During Post VHND 1 FLWs match due lists, prepare microplans 4 ANMs responsible for service delivery 2 Block level officials ensure supply and availability of essential drugs and equipment 3 ASHAs, AWWs responsible for beneficiary mobilization 5 6 FLWs fill in monitoring checklists Filled-in checklists reviewed by block and district level officials Bill & Melinda Gates Foundation 24
25 Bill & Melinda Gates Foundation 25
26 WHAT HAPPENS AT A VHND? Pre During Post VHND 1 FLWs match due lists, prepare microplans 4 ANMs responsible for service delivery 2 Block level officials ensure supply and availability of essential drugs and equipment 3 ASHAs, AWWs responsible for beneficiary mobilization 5 6 FLWs fill in monitoring checklists Filled-in checklists reviewed by block and district level officials Bill & Melinda Gates Foundation 26
27 How does one reach 152,550 villages? Bill & Melinda Gates Foundation 27
28 How does one train 495,000 front-line workers? Bill & Melinda Gates Foundation 28
29 UP example Q VHND launched in UP Predominantly RI 2015 New guidelines & Government Orders rolled out Q VHND strengthening campaign Training of 300,000 FLWs initiated Bill & Melinda Gates Foundation 29
30 INPUT TO IMPACT PATHWAY INPUT OUTPUT OUTCOME IMPACT VHNDs organized every month at village level Provision of quality health and nutrition services Identification and management of high risk cases Improved outcomes in terms of reduction in maternal and infant mortality Bill & Melinda Gates Foundation 30
31 IMPROVED AVAILABILITY AND SERVICE DELIVERY OF ANCSERVICES UP example Weight Measurement BP Measurement Q1'15 (58) Q4'16 (47) 0 Q1'15 (58) Q4'16 (47) Equipment Available Service Delivered Equipment Available Service Delivered Blood test to measure Hb Urine test to measure glucose & albumin Q1'15 (58) Q4'16 (47) Equipment Available Service Delivered Q1'15 (58) Q4'16 (47) Equipment Available Service Delivered Source: External evaluation survey conducted by Sambodhi
32 UP example IMPROVED FP, NUTRITION AND RI SERVICES Family Planning Services at VHNDs 100 Maternal Nutrition Services RI at VHNDs Condoms available OCPs available ECPs available Q1'15 (58) Q4'16 (47) 0 IFA distributed Supplymentary nutrition to pregnant woman Q1'15 (58) Q4'16 (47) 0 Immunization of children Q1'15 (58) Q4'16 (40) Source: External evaluation survey conducted by Sambodhi Bill & Melinda Gates Foundation 32
33 GOING FORWARD Further capacity building of state and district level staff for better monitoring and FLWs for improved service delivery Digital tracking of services through VHND app Potential to use this platform to roll out NCD screening and injectablesfor family planning Bill & Melinda Gates Foundation 33
34 ASHA CRP AWW ANM Nurse mentor THANK YOU Bill & Melinda Gates Foundation 34
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