greetings to all delegates workshop on innovative programs ... · greetings to all delegates...
TRANSCRIPT
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NHM &
The EARTH INSTITUTE, Columbia University
GREETINGS TO ALL DELEGATES
Workshop on Innovative programs in e-governance -CIPS
12-13th December 2013
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NHM – so far
NRHM Launched in April 2005 By Hon’ble PM Sri. Manmohan Singh.
It was launched in November 2005 in AP.
NRHM Goals & Status as on
Prior to 2005 2012-13 NHM Goals 2017 MMR = 190 131 81 IMR = 62 43 17 TFR = 2.2 1.8 1.7
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NHM - Objectives
To provide effective health care to • the people of Medak in rural areas & remote villages • the disadvantaged groups • Women and children
Decrease MMR & IMR
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Reaching Objectives by
Improving access to institutional health care services
Enabling community ownership Strengthening public health care systems for efficient service delivery
Enhancing equity & accountability Promoting decentralization
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health status and resources
PHCs - 67 SEX Ratio - 989/1000 SUB CENTERS - 536 LITERACY Rate - 55.3% CRUDE BIRTH RATE - 17.3% CRUDE DEATH RATE - 7.2% CPR - 72.5% TFR - 1.8 IMR - 43 MMR - 131 PP Units - 3 UHCs - 4 CEMONC - 7 CHCs - 10 Area Hospitals - 3 District Hospital - 1 No .of Gram Panchayaths - 1066
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activities under nrhm – medak
Maternal Health • Institutional Deliveries • ASHAs • CEMONC • 24X7 Maternal Health Centers • JSY- JSSK • Blood Banks – Blood Storage Centers Child Health NRHM additionalities • Immunization Sub-center untied funds • RBSK VHSC Funds • SCNU HDS Funds • NRC PC&PNDT • NBSU Construction of Health Facilities. • NBCC RNTCP • NSSK NVBDCP
108 104 - FDHS
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mmr / imr in the district
• Medak District was reported to be one of the high rated district with regard of MMR/IMR. • There is commendable reduction in the MMR/IMR in the last 8 years. • MMR came down to 131 from 190 and IMR came down to 43
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Sl.No Name of the Cadre Sanctioned In positioned Vacant
1 Specialist Doctors 6 1 5
2 Staff Nurses 128 87 41
3 2nd ANMs 502 420 82
4 Theatre Assistants 4 4 0
5 ASHAs 2129 2010 119
Sl.No Name of the Cadre Sanctioned In position Vacant
1 DPMO 1 1 0
2 JBAR Coordinator 1 1 0
3 IMNCI Coordinator 1 0 1
4 District Program Officer 1 1 0
5 Accounts Officer 1 1 0
6 MIS Officer 1 1 0
7 Data Entry Operator 2 1 1
HR Under NRHM
NRHM District Program Management Unit
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support from administration
• Under the guidance & support of the District Collector there is proper utilization of funds in the Dist. • Continuous review meetings by the District Collector with line departments, SPHOs and Medical Officers has resulted in improved MCH services at Sub Center level •Effective convergence is happening at District level and village level but the convergence at Block/Mandal level is not upto the mark.
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ADDITIONAL SUPPORT IN MATERNAL & CHILD HEALTH
• SCNU = 1 : 20 bedded unit at DH Sangareddy with 14 staff Nurses and 4 Medical Officers to work round the clock. Started on 31st October 2012 and so far treated 1643 infants as on 30th Nov 2013
• NRC = 1 : 20 bedded NRC with 2 MOs and 3 Staff nurses etc. Started on 1st December 2012 and so far treated 271 children as on 30th Nov 2013 • NBSU = 6 : 4 Bedded NBSUs at Zaheerabad, Medak, Jogipet, Narayankhed, Narsapur and MCH Siddipet . Staff nurses recruited and trained and the units are functional from June 2013
• NBCC = 64 : At all delivery points. • 150 Bedded MCH ward at DH Sangareddy is under construction and expected to be completed by April 2014.
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Activities – reminder card
To remind and create a confidence with human touch
Introduced reminder card system by ASHA.
Reminder Card launched by Hon.Minister Smt.Sunitha Lakshma Reddy on 15th August 2011 and piloted in Narsapur cluster with help of CARPED, NGO which is working on health issues in the state.
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Activities – reminder card
Introduced reminder through phone (ANM Calling) in Gummadidala PHC area. All the ANMs will maintain record of the Pregnant women heath checkup due dates and they remind through phone and provide health council also.
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sms based message
Introduced SMS based message In Mirdoddi PHC area. ANMs remind the pregnant women about the health checkups by sending SMS.
These three pilots have increased the confidence among the pregnant and their family members about the health services.
Based on the success of the above pilots designed 2 innovative programs called MATRUDEVOBHAVA - AYUSHMANBHAVA for the first time in India.
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maatru devobhava
The voice message of the District Collector will be sent to all the pregnant and lactating mothers who are registered in MCTS( Mother and child tracking system). DG Synogeon a soft ware company designed this concept with support from CARPED
The pre recorded call from District Collector created confidence on utilization of public health facilities. A pilot in Dubbak CHNC was launched on 11th April 2012. Deliveries & immunization services improved commendably in the public health facilities such as Bhoompally, Timmapur. Immunization coverage gone upto 98%
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Aayushmaanbhava
Started “Aayushmaanbhava” health help line( 88854442111), initially it serves 8.00am to 8.00 pm to provide the information about the services available under NRHM such as JSY-JSSK and coordinate with the medical staff, providing the ambulance service.
This year it will be clubbed with 1098 helpline service and work round the clock the services will be provided by CARPED NGO, the pilot programme is
first of its kind.
The call center executives will call the pregnant women who are into their 8 month of pregnancy and inform them about the Govt Hospital near to them and facilities under NRHM
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progress so far
Under Matrudevobhava calls sent to 39,132 pregnant women and 34,840 lactating mothers so far. Reminders were also sent to them.
Under Ayushmanbhava 1540 pregnant women got benefitted from the helpline. Call center executives made 36,680 calls to the pregnant women informing them
to utilize public health facilities..
On random verification it was found that 61 % of the Pregnant to whom the calls were made, delivered at Govt Hospitals.
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MCRS - Status report
Efficient method to coordinate care
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MCRS uses a pragmatic approach
that leverages MCTS data
18
Pregnant Women / Infants Register with
ANM and receive services through
ANM
ANM communicates to PHC and receives medications for
distribution
PHC enters data into MCTS
MCRS downloads data from MCTS and
calculates the schedule for the Beneficiary
according to the Mother and Child delivery and immunization schedule
MCRS loads data to the
dialer
MCRS system reminds
Benificiary/ ANM/ASHA on schedule due
dates via Phone based on the Health camp
schedule
Register
AN
M
Patien
t
Docto
r
AN
M
ASH
A ASHA brings
Pregnant
Women / Infants
to PHC or sub
center for further
services
MCRS
1
2
3
4
5
6
7
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Phone reminders is the right method to
improve awareness on Govt. facilities in
rural areas
19
Reminder Mode
Pros Cons
Email Cost efficient for sender Easy to include elaborated content Digitally stored Delivery can be tracked
Most of the Patients do not have email access Accessing internet to read email is expensive
and not affordable Expects population to be literate
Text Easy to reach larger population Instantaneously delivered Delivery can be tracked Digitally stored
Patient will have to bear carrier charges to receive text
To be effective message size is limited to 50 characters
Expects population to be literate
Letters Easy to include elaborated content Physically stored
Expensive for sender Delivery cannot be tracked On-time delivery not guaranteed Expects population to be literate
Phone call Easy to reach larger population Instantaneously delivered Delivery can be tracked No Cost to Patient, as incoming is free Reaches all population irrespective of
literacy status
Relatively expensive for sender
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Calls will be made to pregnant beneficiaries
once a month and to children once in 3
months
20
Immunization At birth 6 weeks 10 weeks 14 weeks 9-12 months 16-24 months
BCG X
OPV X X X X X
DPT X X X X
Hep-B X X X X
Measles X X
JE X X
VIT A Drops X
VITA 2nd Dose X
Total Reminders 0 1 1 1 1 2
Total 6 Reminders
Pregnancy < 12 weeks 14-26 Weeks 28-34 weeks 34 weeks < 35th weeks 36th week Delivery
(40th week) Post natal
care
Regular pregnancy
X X X X X X X XX
Total Reminders 1 1 1 1 1 1 1 2
Total 9Reminders
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Project overall status
• Including pilot Total 6,25,781 contacts made
with beneficiaries
• 54116 pregnant beneficiaries and 44121 child
beneficiaries covered under the program
• We noticed significant improvement on govt.
facility deliveries and reduction in abortion
rates
• Govt. facility deliveries increased to
~2100/month from ~900/month.
• Abortions have been considerably reduced
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Deliveries at PHC
In 2013 on an average 2300 deliveries /month
conducted at Govt facilities compared to 900 in
2011-12.
Beneficiaries saved approx. Rs. 2 crore per month
by getting services at Govt hospitals motivated by
voice call of District Collector.
Kangti PHC conducted 67deliveries in October
2013
Jaheerabad CHC conducted 459 deliveries in
September 2013 with an average of 380
deliveries/month compared to 200 in 2012 * Calculated as 10,000 Rs. Per delivery
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Call Schedule
• 4 days ( Tuesday, Thursday, Friday and
Sunday) in a week as per NHD schedule
calls are made
• At least 2 attempts are made to reach
beneficiaries who do not lift the phone
• Pregnant women delivery message is
communicated monthly in 3 schedules ( 1st of
the month, 12th of the month and 20th of the
month)
• 50,000 preventive guidelines calls per month
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Data Synchronization with
MCTS
• Every week Sunday data is synchronized
with MCTS
• Data from MCTS is reviewed for accuracy
and then reconciled with the MCRS data
• If services are delivered to beneficiaries
all open reminders related to services are
closed
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MCRS Solution Key Benefits
25
MCRS is integrated with MCTS; No dual data
entry
MCRS messages are personalized and
configurable
MCRS provides a website to check the
progress
MCRS enables manual patient reminders
MCRS reminders are coordinated with Health
camp Schedule
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We established a website to
improve ease of access to timely
information • A dedicated website
(http://www.vcareconnect.com) to
monitor progress of the program
• Will provide timely access to due lists
for ANM/ASHA to coordinate
beneficiary visits to PHC/Health camp
• Will deliver timely reminder to
Beneficiaries in coordination with
NHD schedule to put preventive care
right on top of their mind
• Will provide flexible solution to remind
beneficiaries either on-demand or in
automated way
• Will provide clear and concise
statistics to put focus on the areas
lagging behind
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Data updated weekly from
MCTS
• Using Scheduled Reports section
from MCTS we download data per
subcenter in an excel sheet and
transform that data to fit Reminder
system data model
• We generate/update patient
preventive care schedule based on
latest data obtained
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Aligned reminders with NHD
schedule
• Most of rural population plan just in time, hence we align the
reminder schedule to match with NHD and delivered the message
right one day before the health camp.
• Reminders delivered will clearly describe the reason for the call as
well as articulate the benefits government program provides
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Train ASHA/ANMs on importance
registrations and due list
management
• With due list reports that will be made available online as well as
distributed physically, ASHA/ANM will be able to focus on their
priority beneficiaries
• Ability to obtain due list report by village or by ASHA or ANM or
Condition provided the flexibility staff will be looking for
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Clear and concise statistics enable
successful tracking of the program
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Deliveries at a glance
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Percentage of Deliveries
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Deliveries at PHCs
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Secondary level facilities
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The Process of MCRS
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Greeting Card
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Greeting card
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Call pattern
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Incentives Call center functions
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SKYPE
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SKYPE
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Innovative Activities taken up in the District
• Installing GPRS units in SPHO, 104 and Program Officers’ vehicles.
• At 10 PHCs AVD pilot is implemented (Supervisor delivering vaccine at villages in Auto)
• Geo tagging of all public health facilities, high load private facilities, 104,108 parking points etc.
• First round of QMS is planned in coordination with Columbia University.
• Planning a Website for DHS
• Soft copies of monthly reports, daily OP, IP particulars, availability of drugs, financial details will be uploaded in the website.
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IEC
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.
Questions/Suggestions please