maternal & child health bolangir

21
DR. BHUPUTRA PANDA MATERNAL & CHILD HEALTH: SCENARIO AND LESSONS LEARNED FROM BOLANGIR, ODISHA

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Status of maternal and child health programmes in Bolangir, Odisha

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Page 1: Maternal & child health bolangir

D R. B H U P U T RA PA N DA

MATERNAL & CHILD HEALTH: SCENARIO AND LESSONS LEARNED FROM

BOLANGIR, ODISHA

Page 2: Maternal & child health bolangir

BOLANGIR

Page 3: Maternal & child health bolangir

ABOUT BOLANGIR

• Geographical Area: 6575 sq. kms.

• Population: 1,648,997 

• Child Population (0 to 6 yrs.):  216,320

• About 88% of population live in rural area

Page 4: Maternal & child health bolangir

MATERNAL HEALTH STATUS

• Mothers who received 3 or more ANC: 83.8%

• Mothers who have received at least one TT injection: 99.2%

• Mothers who have consumed IFA for 100 days or more: 23.8%

• Institutional Delivery: 80.1%

• Mothers who have received PNC after 48 hrs of delivery: 86.5%

• Maternal Mortality Ratio: 234

Page 5: Maternal & child health bolangir

CHILD HEALH STATUS

• Full Immunization: 79.5%

• Neonatal Mortality Rate: 71

• Infant Mortality Rate: 97

• Under Five Mortality Rate: 111

Page 6: Maternal & child health bolangir

PREVIOUS AND ONGOING INTERVENTIONS BY PHFI-UNICEF

• Assessment of Supportive Supervision strategy of Routine Immunization in Odisha-A randomized post-test study, 2011-12

• ToT to about 175 master trainers across the state on IMNCI basic health worker and follow up supervision, 2012-13

• Evidence based IMNCI, RI, and VHND service delivery through health system strengthening-an external monitoring demonstration project, PHFI, Ongoing project

Page 7: Maternal & child health bolangir

• 8 of 14 blocks in the district were identified as sample blocks based on WHO 30 cluster sampling

• Baseline survey was completed in July and August 2013 to assess the existing practices in RI, VHND and IMNCI

• Standard RI, VHND and IMNCI supervision checklists were used for data collection

• Data analysis was done using SPSS statistical software to analyze the data of baseline and every quarter

ABOUT ONGOING INTERVENTION

Page 8: Maternal & child health bolangir

INTERVENTION PACKAGE

• Extensive field visits to RI, VHND and IMNCI sessions accompanied by internal monitors

• Hand-holding support provided to supervisors provided on site on supportive supervision

• Capacity building of front line health workers and supervisors

• Techno-managerial support for quality improvement of the programmes

• Advocacy at district and sub district levels for convergence and health systems strengthening

Page 9: Maternal & child health bolangir

PROGRESSIVE OUTPUT OF INTERVENTION

• One year of intervention has been planned, of which we are currently in the last quarter

• Data from the field is analyzed every quarter

• Trend from the analysis is reflected in the following slides

Page 10: Maternal & child health bolangir

FROM ROUTINE IMMUNIZATION

Basel

ine

(N=32

)

1st Q

uarte

r (N=

8)

2nd

Quarte

r (N=

8)

3rd

Quarte

r (N=

9)88

92

96

10098

96

92

100

Vaccine Availability

In %

Basel

ine

(N=32

)

1st Q

uarte

r (N=

8)

2nd

Quarte

r (N=

8)

3rd

Quarte

r (N=

9)0

40

80 99 100

100 100Availability of Syringes

In %

Basel

ine

(N=32

)

1st Q

uarte

r (N=

8)

2nd

Quarte

r (N=

8)

3rd

Quarte

r (N=

9)0

40

8063 63

82 78

Availability of MCP Cards

In %

Basel

ine

(N=32

)

1st Q

uarte

r (N=

8)

2nd

Quarte

r (N=

8)

3rd

Quarte

r (N=

9)0

40

8098 100

6389

Availability of Drugs

In %

Page 11: Maternal & child health bolangir

Baseline (N=32)

1st Quarter (N=8)

2nd Quarter (N=8)

3rd Quarter (N=9)

0

20

40

60

80

100

72

25 25

67

Availability of Counterfoils

In %

04080 81

63 5088

Availability of functional hub cutter

In %

Baseline (N=32)

1st Quarter (N=8)

2nd Quarter (N=8)

3rd Quarter (N=9)

0

20

40

60

80

100

47

100

50

78

Use of Tally Sheet

In %

Baselin

e (N

=32)

1st Q

uarte

r (N=

8)

2nd Quar

ter (

N=8)

3rd Q

uarte

r (N=

9)0

40

80100

63 5078

Cutting syringe after use

In %

FROM ROUTINE IMMUNIZATION

Page 12: Maternal & child health bolangir

FROM ROUTINE IMMUNIZATION

Baseline (N=32)

1st Quarter (N=8)

2nd Quarter (N=8)

3rd Quarter (N=9)

0

20

40

60

80

100

50 5063

78

AVD Implementation

In %

Baselin

e (N

=32)

1st Q

uarte

r (N=

8)

2nd Quar

ter (

N=8)

3rd Q

uarte

r (N=

9)0

40

80 81 75 88 89

Segregation at Source

In %

Baseline (N=32)

1st Quarter (N=8)

2nd Quarter (N=8)

3rd Quarter (N=9)

0

20

40

60

80

10081

1338

78

Delivery of 4 key messages

In %

04080

3125 50

89

Asking beneficiaries to wait 30 mins

In %

Page 13: Maternal & child health bolangir

FROM VHND

0

40

80 75 8161

82

Presence of Health Supervisor

In % 0

4080

11

52 6282

Session Site (Anganwadi Centre)

In %

Baselin

e (N

=32)

1st Q

uarte

r (N=

21)

2nd Quar

ter (

N=13)

3rd Q

uarte

r (N=

17)0

4080 66 47 62 70

Availability of Examination Table

In %

04080

31 22 31 35

Availability of screens for Privacy

In %

Page 14: Maternal & child health bolangir

FROM VHND

Baselin

e (N

=32)

1st Q

uarte

r (N=

21)

2nd Quar

ter (

N=13)

3rd Q

uarte

r (N=

17)0

40

80 73 5683 78

Availability of Diagnostic Equipment

In %

Baseline (N=32)

1st Quarter (N=21)

2nd Quarter (N=13)

3rd Quarter (N=17)

020406080

100

71

45

7963

Availability of Drugs

In %

Baseline (N=32)

1st Quarter (N=21)

2nd Quarter (N=13)

3rd Quarter (N=17)

0

20

40

60

80

100

37

63 64 65

Relevant History Taken

In %

Baseline (N=32)

1st Quarter (N=21)

2nd Quarter (N=13)

3rd Quarter (N=17)

020406080

100

72

38

6276

Abdominal Palpation Done and Recorded

In %

Page 15: Maternal & child health bolangir

FROM VHND

04080

1247 54

71

Urine Examination Done and Recorded

In %

04080

37 38 50 53

Privacy Ensured During Exam-ination

In %

Baselin

e (N

=32)

1st Q

uarte

r (N=

21)

2nd Quar

ter (

N=13)

3rd Q

uarte

r (N=

17)0

40

8065 54

77 66

Counseling

In %

Baseline (N=32)

1st Quarter (N=21)

2nd Quarter (N=13)

3rd Quarter (N=17)

020406080

10081

5369

53

Group meeting conducted with Women

In %

Page 16: Maternal & child health bolangir

FROM VHND

Baseline (N=32)

1st Quarter (N=21)

2nd Quarter (N=13)

3rd Quarter (N=17)

0102030405060708090

100

56 5261 57

Availability of Contraceptives

In %

Baseline (N=32)

1st Quarter (N=21)

2nd Quarter (N=13)

3rd Quarter (N=17)

0102030405060708090

100

78

28

9282

Family Planning Counseling

In %

Page 17: Maternal & child health bolangir

FROM IMNCI

Baseline (N=64)

1st Quarter (N=29)

2nd Quarter (N=18)

3rd Quarter (N=24)

0

20

40

60

80

100

12

28 3954

Home visits as per IMNCI guidelines

In %

Baseline (N=64)

1st Quarter (N=29)

2nd Quarter (N=18)

3rd Quarter (N=24)

0

20

40

60

80

100

25

3439

50

IMNCI assessment sheets filled up

In %

Baseline (N=64)

1st Quarter (N=29)

2nd Quarter (N=18)

3rd Quarter (N=24)

0

20

40

60

80

100

2731

28

46

IMNCI monthly reporting done

In %

Baseline (N=64)

1st Quarter (N=29)

2nd Quarter (N=18)

3rd Quarter (N=24)

020406080

100

35

4747

56

Skill of worker for 0 to 2 months children

In %

Page 18: Maternal & child health bolangir

FROM IMNCI

Baseline (N=64)

1st Quarter (N=29)

2nd Quarter (N=18)

3rd Quarter (N=24)

020406080

100

28

3540

56

Skill of worker for 2 months – 5 year children

In %

Baseline (N=64)

1st Quarter (N=29)

2nd Quarter (N=18)

3rd Quarter (N=24)

0

20

40

60

80

100

53

6 8

Availability of IMNCI Board

In %

Baseline (N=64)

1st Quarter (N=29)

2nd Quarter (N=18)

3rd Quarter (N=24)

0

20

40

60

80

100

5458

61

34

Availability of Drugs

In %

Baseline (N=64)

1st Quarter (N=29)

2nd Quarter (N=18)

3rd Quarter (N=24)

75

80

85

90

95

100

85

96

9492

Availability of Forms and Formats

In %

Page 19: Maternal & child health bolangir

SUMMARY OF INDICATORS  Continuously Improving Fluctuating Not Improving

RI

• Vaccine availability at session site • Availability of MCP Cards • AVD Implementation

• Availability of syringes and drugs • Use of counterfoil  

• Delivery of 4 key messages • Waste Disposal  • Asking beneficiaries to wait for 30

mins after vaccination   

• Availability of hub cutter    • Visit of health supervisor    • Use of Tally Sheet    

VHND

• Visit of health supervisor• Availability of VHND

drugs• Group meeting with men

• Availability of examination table and screens

• Ensuring privacy • Visit of ICDS supervisors

• Availability of other essential logistics

• Counseling of beneficiaries

• Participation of PRI Members

• Implementation of VHND Duelist• Group meeting with

women 

• Relevant history taking prior to 1st ANC

   

• Recording fetal heart sound    • Abdominal palpation    

IMNCI

• Home visits• Availability of IMNCI

drugs • Availability of IMNCI Board

• Filling up of assessment sheets• Availability of other

support logistics 

• Monthly reporting    • Skills of workers    

Page 20: Maternal & child health bolangir

WAY FORWARD

• To conduct an end line survey in the month of October and evaluate the output of the project intervention

• Scale up the best practices and replicate the model across the state for health systems strengthening

Page 21: Maternal & child health bolangir

THANK YOU