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Weekly update on COVID-19 achievements

Date: Week starting June 12, 2020

Weekly performance reporting on COVID-19 support

Indicators Baseline (as on

30th April)

Past Week’s

Achievements*

Cumulative

Achievements

(from start

through COB

Thursday)

Target for the

entire project

Additional

Information

Number of people directly benefited

through USG interventions (e.g.,OPDs,

helplines, chatbots etc.) Note:do not

include mass and social media.

34,093

47,707 2,46,404 27,500 -Layered on

Pulse

oximetry-1500

(556)

HRP -1000

(1074)

and HBYC-

25000

(2,44,774)

platform

Number of facility-based health workers

(doctors, nurses, CHOs, pharmacists,

ANMs, MPWs, and Anganwadi center

workers) trained to prepare for and

respond to COVID-19 with USG support.

Disaggregated by RCCE, surveillance,

case management, IPC and/or WASH

3,959 145 5409 1500 -Layered on

LaQshya

(4242), NBSU,

FPC, and Safe

delivery app

(1167)

Number of community frontline workers

(ASHAss, TB champions, community

volunteers, sanitation workers, etc.) trained

to prepare for and respond to COVID-19

with USG support. Disaggregated by,

RCCE, surveillance, case management,

IPC and/or WASH

1,555 105 2780 12,330 -12000

Layered on

FPLMIS

(2065)

330 through

HRP (715)

Number of facilities supported with USG

resources (including TA, training, supplies

of COVID-19 medicine, ventilators, PPE,

etc) and able to respond COVID-19

300 0 399 122 -Layered on

LaQshya

IPE Global will leverage existing state and district level activities to integrate COVID-19 response measures.

These activities will include:

1. Strengthening infection prevention control and practices at the facility level through self-administered

audits and checklists under LaQshya:

2. Strengthening Universal Precautions at the individual healthcare provider level using self-learning safe

delivery Apps:

3. Daily tracking of cases of Acute Respiratory Infections (ARI) in Health and Wellness Centers and

promoting hand washing practices:

4. Dissemination of available COVID-19 risk-communications and guidelines among healthcare

functionaries and communities:

5. Risk mitigation and action planning

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Key achievements:

Continued support for strengthening Infection Prevention & Control (IPC) Standards

under QUICK Initiative - Uttarakhand

1. Development of checklist to assess the Triage

and support areas related to IPC in the labor

room. Checkpoints from the LaQshya

checklist were reviewed to develop the

checklist. A total of 7 checkpoints were

included for assessing Triage areas and 16

checkpoints were included for assessing

support areas related to IPC in the labor room.

2. Analysis of assessment scores related to

Infection Control reported from the 14 labor

rooms and 7 maternity OT’s in this month.

These assessments were conducted by the

facility teams led by the Staff Nurse In-charge

for Infection Control. There have been

positive improvements in the overall scores

as displayed below.

3- Webinar Session was conducted with the

LaQshya Facility to discuss IPC related gaps

and solutions and discuss the LaQshya

assessment checklist on Triage & Support Areas related to IPC. The Webinar was attended by participants

from LaQshya facilities in both the Aspiration Districts.

4- Follow up visit to LaQshya facilities in Haridwar district to support the IPC activities and prepare the

facilities for LaQshya certification. Supportive supervision for NBSU strengthening was also done during the

visit to LaQshya facilities.

5- Briefing meeting with state MH division to share updates from the LaQshya facilities and discuss

presentation on provision of RMNCAH+N services during & post COVID-19 pandemic prepared by Vriddhi

State Team.

Figure 1: Discussions on Gaps & Actions related to IPC facilitated by DTC in Haridwar

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Strengthening SNCU by improving clinical services through SNCU Quality of Care Index

(SQCI) –Jharkhand

In the recent Sample Registration Survey (SRS) data released by Registrar General of India (RGI) neonatal

mortality of Jharkhand has shifted from 29 to 30, which is a concern for the state and to improve the situation

the National Health Mission has initiated immediate

capacity building measures along with review of

programs and activities. Since SNCU caters to sick

newborns and to reduce the mortality there, child

health cell of NHM Jharkhand with support from

USAID Vriddhi has conducted review cum

orientation meetings for 12 SNCUs in 2 batches

consisting of 6 SNCUs in each batch. The first &

second batch having 6 SNCUs were taken up on

15th & 16th June 2020. The third batch will be

conducted on 19th June 2020. Due to the COVID

pandemic it was decided to conduct review through

web portal for which the project team provided support.

The project team also prepared the presentations for the

review, where the SNCU quality of care index (SQCI)

data was used for review. The main objective behind

this activity was to sensitize health service providers

about improving clinical management in SNCUs

through SQCI, so that morbidity & mortality can be

reduced in SNCU and at home after the newborns are

discharged.

Figure 2: Handholding by DTC Dr Abhishek Nautiyal at NBSU during Facility Visit

Figure 3: Dr. D. P. Taneja, STO, USAID Vriddhi facilitating session

Figure 4: Participants from SNCU RIMS along with nurse mentor of MNH resource center during Webinar

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Review cum orientation meeting - 15th June 2020

6 SNCUs (RIMS Ranchi, Patliputra Medical College Dhanbad, Palamu Medical College, Hazaribagh Medical

College, Dumka Medical College & District Hospital Bokaro) participated. There were 24 logins and 52

participants in the review, the participants were HOD - Neonatology, Asstt. Professor (RIMS), Deputy

Superintendent, DRCHO, Medical Officers, District Data Manager, Hospital Manager & Staff Nurses of all the

facilities. The session was for 2 hours starting from 11 am.

Review cum orientation meeting - 16th June 2020

6 SNCUs (District Hospital Gumla, Simdega, West Singhbhum, Latehar, Koderma & SDH Ghatshila – East

Singhbhum) participated. There were 28 logins and 52 participants’ viz.Deputy Superintendent, DRCHO,

Medical Officers, District Data Manager, Hospital Manager & Staff Nurses of all the facilities. The session was

for 2 hours meeting and began at 11 am.

The presentation was divided in two parts. The first part covered the need of SQCI and focused on 7 Quality

indicators, its meaning, calculation and composite index. The second part of the presentation was on individual

SNCU’s performance from April 2019 to March 2020. Quarterly performance status for individual SNCUs were

presented for January - March 20 in comparison to their performance in previous quarter. Analysis and action

points based on 7 quality indicators were also presented.

Capacity building of service providers on COVID-19 and infection control modules of

SDA, Odisha

DHH Kalahandi has already received national LaQshya and NQAS certification whereas another two FRUs

SDH Dharmagad and CHC Kesinga are in the process of quality improvement for LaQshya certification. To

sustain the quality of services in the DHH and improve the quality of services in the other two health facilities

continuous state level mentoring and monitoring visits are being conducted by State NHM and LaQshya TSU

supported by Vriddhi team. However, COVID19

outbreak and restricted movement remote

mentoring support is being provided by the State

team using ICT platforms. As a part of this remote

mentoring support State Vriddhi team in

collaboration with state NHM team and facilities

team organized an online session on Safe Delivery

Application (SDA) for clinical staffs on 12th June

2020 at 12:00 PM.

Total 33 participants from all three facilities

participated. The participants included O& G

specialists, staff nurses, hospital manager, DHH,

Junior hospital manager from the SDH and Block

Program Manager, Kesinga. Vriddhi team members conducted the session at State head quarter using zoom

platform. Detail description of Safe Delivery App and its usefulness in learning clinical skills related to safe

birthing practices was provided along with the installation procedure of the app. The newly added COVID-19

and infection control modules were emphasized, and the participants were suggested to complete these two

modules at the earliest and share their score in the respective district WhatsApp group. Various resource

materials and the self-assessment provisions of each learning modules were explained, followed by Q&A

session.

Safe Delivery Application is found to support doctors and nurses in continuous self-learning of key technical

skills related to safe birthing practices in a health facility set up at their own convenience and time. In addition,

continuous learning using SDA would improve the staff competency which may in turn help them score high

during the OSCE assessment done as a pre-requisite for LaQshya certification.

Figure 5: Vriddhi team orienting the participants on SDA

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Online orientation of service providers on SDA with focus on COVID-19 and infection

control modules - Odisha

DHH Boudh is a LaQshya prioritized health facility and there are no other functional FRUs in the district.

DHH Boudh has been assigned for KAYAKALP assessment by the State NHM. The facility team had also

expressed their interest in quality

improvement of RCH services. In

order to expedite the gap closure in

quality of services as per LQshya

guidelines, improvement in staff

competencies in clinical services,

facility team in collaboration with

LaQshya TSU supported by

USAID Vriddhi team conducted an

online orientation of staff on newly

added COVID19 modules and the

pre-existing infection control

modules of Safe Delivery App

(SDA) on June 17, 2020 at 12:00

PM using zoom platform. A total

10 participants attended the training

which included O& G specialists,

staff nurses working in LR and OT and the hospital manager, DHH Boudh.

During the training session participants were explained about: -

• Process of Safe Delivery App installation

• Usefulness of SDA in promoting self-paced learning on clinical skills related to safe birthing practices.

• Demonstration of the newly introduced COVID-19 and infection control modules

• Self-assessment available in each learning module

The participants were suggested to complete these two modules at the earliest and share the score with

state TSU. The participants were informed that the use of SDA can improve their confidence in managing

complications in LR and OT. In addition, continuous learning using SDA would improve their competency

which may in turn help them score high during the OSCE assessment (pre-requisite for LaQshya certification).

Leveraging virtual platform for strengthening LaQshya support mechanism in

Chhattisgarh

COVID-19 pandemic has restricted field movement which

adversely affected the support system institutionalized in

LaQshya operational guidelines. The structured mentoring

support is the key driver towards LaQshya certification. Amid

COVID-19 pandemic, Vriddhi have been interacting with

facilities using various ICT platforms.

Process adopted:

• Facility latest LaQshya assessment score was used to

identify key gap areas and a facility interaction was

initiated to identify operational challenges in traversing the

gaps.

• Interaction with facility Laqshya nodal officer, concerned

quality circle members and program managers to discuss

the low hanging fruits and non-resource intensive tasks to

be addressed on priority.

Key Activity held: Strengthening

quality assurance mechanism and

documentation process of prioritized

facilities towards LaQshya

certification

Key stake holder: Deputy Director

Maternal Health, State consultant

Maternal Health, District Nodal

LaQshya Facility in-charge, Hospital

consultant and State technical team

Vriddhi IPE Global.

Figure 6: Vriddhi Staff during orientation

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• Sharing resource materials like SOP, guidelines, Process

map audit forms and other related documents.

• Technical support on use of ALAP (Accelerated LaQshya

Action Plan) and Outcome indicators to strengthen review

mechanism

• Planning for state level technical support for the priorities

facilities like training on RMC (respectful maternity Care,

Quality management and conducting Rapid improvement Cycles)

Expected outcomes

• Improved linkages with priorities facilities and strengthen the support mechanism

• Help facilities to identify their areas of improvement

• Enable facilities to leverage resources available with LaQshya certified facilities.

Online training on LaQshya, Jharkhand

The pandemic has disrupted the LaQshya activities in the facilities across the state and to put the activities back

in track Vriddhi state team in collaboration with maternal health cell of NHM Jharkhand has prepared a plan of

action for resuming essential health services under RMNCH+A during COVID times.

As part of the action plan 8 batches of online trainings on various LaQshya related topics were planned out of

which 4 batches were conducted earlier (two batches each day) on 10th and 11th June 2020. The remaining 4

batches of training were conducted on 17th & 18th June respectively. The objective of the training was to improve

the knowledge of the staff engaged in delivery services in labour room and operation theatres for providing better

care to beneficiaries.

2 batches of online trainings were conducted on all the days using zoom platform. All the 74 LaQshya facilities

(including 6 medical colleges) of the state were divided into batches according to their districts. Details of the

training batches along with topics covered are mentioned below:

Date Training Batch Training Topic User Logins

17th June’20 Batch 1 (11am – 1 pm)

& Batch 2 (3 pm – 5

pm)

• Training Documentation

• SoP for Labour Room (LR) and Maternity

Operation Theatre (MOT)

• Respectful Maternity Care (RMC)

implementation and documentation

• Biomedical Waste Management (BMW)

64 & 102

respectively

18th June’20 Batch 1 (11:30 am –

1:30 pm)

LaQshya Online Portal 138

Batch 2 (3pm- 5pm) Objective Structured Clinical Examination (OSCE),

Document for Certification

99

Multiple participants from single logins were also reported during the event

The participants for the sessions included, Deputy Superintendents of district hospitals, medical officer in charges

from CHCs , medical officers of labor rooms (LR), district data manager (DDM), hospital manager(HM), district

quality consultant, block data manager (BDM), LR and operation theatre staffs nurses.

The trainings were facilitated by Medical Officer in-charge of Maternal Health Cell, Maternal Health Consultant

and State Technical Officer, Vriddhi. One of the sessions (Day 2 – batch 1) was facilitated by LaQshya Program

Management Unit (LaQshya-PMU) a part of MoHFW, GoI.

Prioritize facilities: DH Durg, DH

Narayanpur, DH Kawardha, DH

Bijapur, DH Kanker, CHC Bilha and

CHC Nagri

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Highlights of the training sessions: -

• Start preparing respective SOPs. The SOP should include the major heads discussed in the training session

like – triaging, clinical processes, patient safety, equipment maintenance, RMC, quality improvement, BMW

etc.

• Arrange all the trainings as per LaQshya checklist and document them.

• Facilities identified for Kayakalp awards should focus on LaQshya certification on priority.

• LaQshya online portal and the usage of online data at 3 levels i.e. facility, district and state were explained.

• Facilities not yet registered on the portal were instructed to do the same within next 7 days.

• Participants were trained on OSCE processes for clinical skill assessment of LR and MOT staffs

• Documents required for certification like Annexure C, Key Performance Indicators (ie. Section H of the

assessment checklist) and Patient Satisfaction Survey was explained

Ensuring FP commodities at HWC, Manipur

In the state of Manipur, only district level trainings

have been conducted so far and the frontline health

workers’ (ANM/ ASHA) training was yet to be

started. But due to lockdown the said training were

unable to begin. During this period the Community

Health Officer (CHO) of Health & Wellness Center

(HWC) Tendongyan informed the State Nodal

Officer (SNO) FP, regarding stocks out status of FP

commodities in her HWC and about the similar

status at the parent store i.e CHC Sekmai CHC. The

same information was further provided to the state

FPLMIS consultant by the SNO and were asked to

intervene. Consultant was already aware about the

similar situation in many of the facilities as the

storekeepers were unable to come and received

stocks from their respective parent store (DWH) in-

spite of repeated reminders.

The issue of stock out was taken up by the state

FPLMIS consultant in coordination with the staffs of

the district DFWO office. In order to operationalize

the FP commodity supply, DFWO advised his staffs to

calculate the approximate stock requirement for each

facility by referring respective number of eligible

couples. Also, staffs were advised to make the list of

storekeeper/ pharmacist of the district who had

attended the district level training from the state

FPLMIS consultant and to give a round of follow up

calls to each one of them. During the telephonic

follow up it was found that the FPLMIS trained

pharmacist at the CHC was not in-charge of the FP

supply at the facility.

Figure 7: ANM Training by Vriddhi Staff

Figure 8: ANMs receiving stocks after the training

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Taking the opportunity, the FPLMIS consultant requested the CHC staffs and all the ANM/CHO to participate

in the training. One pharmacist of the CHC, one pharmacist & two ANMs of three HWC attended the training

(as CHOs are on duty at covid quarantine center). Training was conducted with actual practice and with real

stock in hand and thus ensuring the said HWC received their required stocks.

LaQshya Mentoring Visit to CHC Hodal, Haryana

USAID Vriddhi state team extended support in

assessment and mentoring of CHC Hodal,

Palwal for its preparedness for LaQshya

certification on DD-MH, Haryana’s request. A

mentoring visit was conducted on 12th

June,2020 to the LR of the LaQshya facility,

assessment was done using the checklist and

the LR scored 74% in the assessment.

Participants in the LaQshya assessment were

District Quality Manager, Senior Medical

officer and 4 Staff Nurses. LaQshya Feedback

was shared with Civil Surgeon Palwal, PMO

and Staff of CHC Hodal in the debriefing

meeting. Based on the assessment scoring for

LR, LaQshya score card was developed and

shared by the state team. The LaQshya

assessment sheet, LaQshya LR score card and written feedback for action were shared with DD MH at the state

level and Civil Surgeon Palwal.

Field Testing of New Sessions for Family Participatory Care – “Care of Newborns during

COVID Pandemic” - Haryana

In view of the COVID pandemic, Vriddhi Project has developed 2 FPC sessions on “Care of Newborn during

COVID Pandemic” and “Preparing for discharge and care for newborn at home”. These videos contain

information for parents addressing their concerns for newborns during the COVID pandemic. The first video

Session 1A includes information on steps to prevent COVID infection in care givers and subsequent

transmission to newborns, special precautions in SNCU while newborn is admitted, learning use and disposal of

mask and continuation of routine care including breast milk, KMC etc. Session 1A must be done after the

Session 1 at admission. The second video Session 4A includes information on Preparing for discharge and care

of newborn at home. It includes information of following the birth and routine immunization, continuation of

exclusive breast feeding, limiting exposure of newborn to outsiders and precautions to be taken by care givers.

Session 4A has to be conducted at the time of discharge along with session 4 of FPC.

The Vriddhi team developed Handouts for Session 1A and Session 4A which provides instructions for staff

nurses on how to conduct the session. The field testing of these materials was done in District Hospital

Mandikhera, Mewat. The session orientation was conducted for SNCU staff including 1 paediatrician, 1 SNCU

incharge MO, 1 medical officer and 2 staff nurses.

The feedback from field testing orientation of SNCU staff

• The videos cover the required messages for parents during COVID as this was a missing piece of

information and the SNCUs do not have BCC material for the same.

• The language used is easy and messages are clear.

• The staff felt the pace of the video is slow but may be appropriate for mothers.

• The handouts are useful and appropriate for conducting the discussion

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LaQshya Follow Up with DH Ropar, Punjab

USAID Vriddhi project is providing technical support to the state health department of Punjab for LaQshya follow

up. The support is being provided in identification of facilities for LaQshya follow up, these facilities include

district hospitals of both the Aspirational Districts. On June 12, 2020, LaQshya follow up meeting was done with

DH Ropar using Zoom platform. This follow up meeting was attended by State Health Department, District Health

Department & USAID Vriddhi Project.

Figure 9: Screen shot of LaQshya follow up with Dr Ropar, Punjab on June 12, 2020

Initiation of newly added module (videos) in FPC at SNCU Chamba, Himachal Pradesh

On 18/06/2020, orientation and handholding of staff nurses-SNCU, nutritional counsellor and SNCU DEO were

done for the newly added videos in FPC in this time of COVID pandemic.

In addition to this, project staff facilitated the FPC sessions along with new videos related to COVID for the

caregivers.

Figure 10: Session on FPC by USAID Vriddhi Staff in Chamba

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Monitoring of ARI Cases

Vriddhi team from National level is regularly tracking ARI cases from 19 Health and Wellness centres. Total 52

cases of ARI screened in this week and 8 cases were diagnosed as pneumonia.

Chart 1: Daily incidences of ARI cases (12th to 17th June 2020)

Chart 2: Weekly Incidences of ARI Cases

Effects of COVID-19 on RMNCH+A, TB, HIV and other essential health

services in project geography:

Impact on RMNCH services in project states

All states are developing operational plans to further ensure the continuation of essential RMNCH services, in

areas outside the containment zones.

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9

1

109

12

12

0

2 21

0

2

4

6

8

10

12

14

12-Jun 13-Jun 14 Jun (Sunday) 15-Jun 16-Jun 17-Jun

Total Screened Pneumonia cases

121

88

54 53 61 5676

62 69 72 6552

15 7 6 7 8 9 10 12 6 10 16 8

0

50

100

150

27 Mar-2Apr

3-9 Apr 10-16Apr

17-23Apr

24-30Apr

1-7 May 8-14May

15-21May

22-28May

29 May -4 Jun

5-11 Jun 12-17thJune

Total Screened Pneumonia cases

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Feedback obtained from project states on status of RMNCH services-

Outreach services

Antenatal Care

services

Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) are yet to start and are being

planned on separate days for cluster of PW and Village Health, Sanitation and

Nutrition Day (VHSND) activities have started in states of Odisha & Jharkhand

using the staggered approach*.

Home visits ASHA home visits for COVID screening are also being used for postnatal mother.

From 18th June 2020, Sahiyas in Jharkhand state have started conducting House-to-

House survey of High-Risk age group for NCD to prevent Covid-19 morbidity and

mortality.

Odisha state too has started integrated surveillance for COVID-19, active case

finding for TB, screening for NCD, surveillance and sensitization for NDD and

IDCM

Routine

Immunization

outreach services are being done using staggered approach*

HBYC services ASHAs are making home visits along with COVID screening. Supportive

supervision of Sahiya on hold from March 2020 in all three implementation districts

of Jharkhand has now resumed .

Family Planning Home Delivery of Contraceptives by ASHAs is ongoing in all states and refilling

of condom boxes are being done. Condom box being placed at public places like

petrol pump and bus stand

Facility services

ANC services continue to be provided on walk in basis using staggered approach* and following

physical distancing norms. OPD footfall has been less.

Institutional

deliveries

All states have identified facilities both COVID and Non COVID for provision of

institutional deliveries and services remain uninterrupted. Delivery load has been

less. Though Volume of overall institutional deliveries has shown a further decline

in June 2nd week compare to March & April.in state of Chattisgarh

Newborn care Birth doses continue uninterrupted, as does promotion of Breast-feeding practices

with early initiation of breast feeding and Kangaroo Mother Care.

Immunization

services

are being provided at facilities, for walk-in beneficiaries.

Admission to SNCU continues as per existing guidelines. There is no disruption of services & FPC

Services are functional using the physical distancing norms .

In Jharkhand SNCU (Rajmahal) remains closed as is converted to ICU, Covid with

SNCU. Staffs deputed in Covid-19 duties.In Himachal Pradesh too one SNCU at

Medical college Nerchowk Mandi, is not functioning as facility is a dedicated

COVID Hospital.

Family Planning

services

Sterilization PPIUCD IUCD Injectables services are provided on demand. Fixed Day

Camps for Sterilization are not being held. PPIUCD Services is satisfactory but

overall coverage of FP Services has declined.

In Jharkhand Antara supply has now been received and distribution from state to

facility level started and Antara services resumed. Sterilization services stopped.

Supplies of FP commodities are affected from divisional stores in MP on account of

focus on COVID related logistics; there is a shortage of Injectables in Assam.

*Staggered approach- Where adequate seating for beneficiaries and caregivers with physical distancing is

ensured

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Additional visual support:

Figure 12: Father of a newborn providing

KMC at SNCU Hazaribagh, Jharkhand

Chhattisgarh- FPC has wider impact on post discharge follow up of neonates

Figure 11: ARI Screening at HWC Partan,

Hazaribagh, Jharkhand

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Odisha- Use of Pulse oximeter at HWC,

luningakala, Odisha (Child screened positive) Pneumonia screening at HWC Cheema, Chamba, Himachal Pradesh