Short Program Review India Experience and way

forward

Subodh S Gupta

WHO India

India experience Short Program Review – Child Health:

•Rajasthan•Bihar•Karnataka

1st Short Program ReviewRajasthan

• 5-days workshop

• Facilitated by experts from WHO HQ,

SEARO & WHO Bangladesh

• Followed the Global Package on SPR CH

Adaptation of SPR PackageKarnataka

• 3-days workshop

• Adaptation of worksheets and small changes in group work

Recommendations•Appointment of contractual staff to fill in gaps in

current vacancies •Rejuvenate Divisional Joint Directorate covering

seven ‘C’ districts •Prepare a dedicated HR policy for these districts

(Seven ‘C’ category districts & Bellary)

Example: SPR Karnataka

Problem•Lack of Human Resource Management in

‘C’ category districts (and Bellary)

Recommendations•SIHFW and SHSRC to develop comprehensive

supervisory checklist •Activation of district coordination committee for Child

Health (to address gap between training and implementation )

•Designate Medical colleges / other public health institutions as nodal agencies for supervision and handholding for district trainings

Example: SPR KarnatakaProblem•Supervision, monitoring and feedback of

trainings is inadequate

Rajasthan: SPR Recommendations incorporated in PIP• Strengthening of VHSC

▫ Expedite training of VHSC members▫ Develop system of monthly meeting of VHSC▫ Develop five model VHSC at block level▫ Community mobilization

• Mainstreaming of AYUSH practitioners▫ Utilize them for monitoring MNCHN services

• Efforts for convergence with ICDS▫ Monthly meeting of State Steering committee to

discuss issues related to MCHN jointly by Health and ICDS

• Training of Jan Mangal Couples for Interpersonal communication

• Strengthening of quality of trainings of frontline workers

• Rapid evaluation of IMNCI

Strengths•Participation of all important stakeholders

•Uses data for recommendations

•Group work ensures experience of people from the field is discussed

•Focus on interventions

•Adequate scope to address availability, access, quality and inequity

•Causal analysis to identify health system issues

Challenges

• Bringing all stakeholders together

• Ownership by State/ District health team

• Follow-up and action for implementing the

recommendations of the review team

• Focus on improving implementation planning

Way forward•Comprehensive package for RCH

•Package both for state and district level

•Shorter duration of review workshop

Development/ Adaptation of an

Integrated Package for RCH

Scope

•Review all the activities under current RCH programmes▫Maternal Health▫Child Health▫Adolescent Health ▫Family Planning▫Nutrition

• Levels▫State ▫District

Step 1

Step 2

Step 3

Step 4

Step 5

Are interventions reaching target population?

How well are program activities being implemented?

What are the main problems?

What are solutions and recommendations?

Follow-up of recommendations at appropriate level

Where are we?

SPR ProcessPreparatory activity by core team

SP

R W

orks

hop

Formation of groups

•Step 1 – Plenary Session•Step 2 – Life-cycle approach

▫Gp 1: Maternal Health▫Gp 2: Newborn and Child Health▫Gp 3: A) Adolescent Health, and B) Family

Planning

Formation of groups

Infant Mortality RateYear IMRSRS 2005 50/ 1000

LB

SRS 2009 41/ 1000 LB

Target 30/ 1000 LB (2010)25/ 1000 LB(2012)

Achievable

?

(SRS 09)Rural/ UrbanRural 47

Urban 31

SexMale 41

Female 42

Regions (SRS 08)

Inland Northern 59Inland Southern 47Inland Eastern 38Coastal & Ghats 24Total 52

Step 1: Where are we going?

Full Antenatal Check-up (DLHS 3)

Institutional Delivery (DLHS 3)

Full Immunization Coverage (DLHS 3)

Focus on Equity

•At present, Worksheet 4 : Best Practices & major problems

•Derived from Strengths/Gaps/ weaknesses identified in Worksheet 1A & 1B & 3.

Identifying best practices

Data sources

•Vital Statistics Registration System:▫Civil Registration System Sample

Registration System

•Survey:▫National Family Health Survey▫District Level Health Survey▫Annual Health Survey

Challenges: Adaptation

•Identifying the indicators

•Data availability for the period under

review

•Data quality of ‘Health MIS’

•Converge separate packages into one

•Converge with the existing tools for

Program Implementation Plan

Challenges: District-level SPR

•Data sources to be used

•Data related to equity

•Data quality of Health MIS•How to use the experiences of program

managers and local experts

Thank You