Country Team Action Plan

Bihar, INDIA

Tracks 1 & 2

2

Where are we now?Current levels of

accomplishment/Progress and challenges since Bangkok 2007

Health Indicat

or

India(Presen

t)

Bihar (Present

)

Goal 2011

CPR 47% total,

28% total, 24%

limiting, 4%

spacing

31% total26%

limiting, 5%

spacing

Tracks 1 & 2

3

Where do we want to be?GOAL

Increase CPR from 28% to 31% by 2011

• Increase birth limiting from 24% to 26% by 2011

• Increase birth spacing method use from 4% to 5% by 2011

•Total case load expected: Approx. 2 million new clients

Track 1 4

What are the gaps (1)?Current Situation

– Space constraints prohibit retaining women after delivery

– Shortage of trained Human resources

– Supervisory limitations – Govt. service providers not

trained in PPIUD – Provider prefer to deliver

permanent methods

Track 1 5

What are the gaps (2)?Current Situation

– Low level of rapport and trust in client-provider interaction

– Lack of male/family involvement

– Non involvement of RMPs– Inadequate monitoring and

supervision – Less use of data for feedback in

monitoring – Prevalent superstitions and

doubts about modern methods

Track 1 6

What are the gaps (3)?Current Situation

– Misconceptions about “delay” of first pregnancy versus “spacing” and “limiting” births

– Breaks in service delivery due to floods every year

– Limited involvement of private sector providers

– Issues in supply chain management – Client attrition due to migration – Competing health priorities (polio/JSY)

with limited health resources

Track 1 7

What interventions can we use to close the

gap?

•Task shifting/Task sharing

•Increased involvement of private sector in service delivery

Track 1 8

Task shifting/Task sharing

Track 1 9

Action steps for Task shifting/Task sharing

• In service training on Contraceptive Updated counseling to ANM/ASHA (Volunteers)/AWW

• Review and revise job description for ASHA/AWW/ANM

• Provide supportive supervision

• Post-Partum Home visit to be mandatory by AWW/ASHA and monitored by ANM

Track 1 10

Action steps for Task shifting/Task sharing

(continued..)• Incentivise post partum

home visits by ASHA and AWW

• Include and prioritize FP in VHND agenda

• Training of ANM on post partum IUCD insertion

• Utilize opportunity for counseling for IUCD/other modern methods in institutional deliveries.

Track 1 11

What are the possible challenges to the

intervention?Challenges Solution

Government approval for job revision

Advocacy, Sharing of evidence

Resistance from govt. providers on task sharing /shifting

Reward, Award & Recognition to providersExposure Visits

Ensuring supplies and distribution

Logistics Planning and Supply chain management

Quality maintenance at scale

IP training and supply. Operationalize QAC

Track 1 12

Who are the possible partners, allies, and

stakeholders?Sl#

Areas Partners

1 Policy and Funding

MOHFW, MOWCD (Center & State), UNFPA,DFID, BMGF, PACKARD, WHO, Unicef

2 Technical Assistance

Development Partners( JSK, UNFPA,Path finder, PFI, PACKARD,BMGF,DFID, B TAST ,CARE, PSI)

3 Services CARE, Janani, PSI, Path finder, other NGOs, MOHFW,MOWCD

4 Advocacy Elected Representatives, SHGs and CBOs.

Track 1 13

Involvement of Private Sector

Track 1 14

Action steps for Increasing involvement of private

sector• Advertisement in local and national news

papers and media during June (State Directorate).

• Stake holders consultation( IMA/FOGSI) DGFW – State IMA/FOGSI President.

• Provision of Funds in PIP.

• Approval from GOI for resource fee for Pvt. Service providers

• Competency Assessment of providers/training

• Empanelment of selected providers (DGFW).

Track 1 15

Action steps for Increasing involvement of private

sector, cont’d• Contact government in other states (state PS) to facilitate empanelment of service providers.

• TOR (Government and FOGSI).

• Target 38 district/534 blocks (CMO).

• Operational Plans (# of clients, support staff, equipments, supplies)

• Design mobile teams for FDFS (fixed day fixed site) service

Track 1 16

What are the possible challenges to the

intervention?Challenges Solution

Existing GOVT doctors might complain about involvement of outsiders

Sensitization of government doctors

Physical verification and payments

Third party verification/ on spot verification

Adequate number of clients

Strengthen BCC

Compliance with Government norms regarding standards and practice

Training programs

Private providers’ expectations

Counseling

Track 1 17

Additional points for involving pvt. sector

• Pvt. Sector involvement for birth spacing methods– Injectible contraceptives– IUCD– Oral Pills– Condoms– SDM/LAM

• Action plan to be determined

Track 1 18

Thanks