Strengthening of Family Planning Service Delivery through 18 Urban Health Centers (UHCs) in 2 districts of Uttarakhand
Located at the foothills of the Himalayan mountain ranges, the state of Uttarakhand came into existence in the year 2000. It has a population of 10.1 million people with a decadal population growth rate of 19.17%1. It is one of the 8 Empowered Action Group (EAG) states in India. EAG States are those with high fertility rates and have been lagging in reproductive and child health. The EAG was created by the Ministry of Health and Family Welfare (MoHFW) to ensure special focus on health policies to attain India’s Millennium Development Goals (MDG 4: Reduce child mortality; MDG 5: Improve maternal health). At present, infant mortality rate in the state is 38% (SRS 2010) , Maternal mortality ratio is 359 (SRS 2007-09), contraceptive prevalence rate is 59.3% (NFHS III) and the total fertility rate is 2.6 (NFHS III).
- To provide integrated and sustainable system for primary health care delivery with focus on urban poor living in slums and other health vulnerable groups in cities.
- To enhance capacities among city stakeholders to plan and implement urban health programs.
- To strengthen linkages between communities and primary level health facilities and referral system from primary to secondary facilities.
- To improve health status of the urban poor through increased coverage of key reproductive child health services and adoption of healthy behaviors.
Working in close collaboration with the Government of Uttarakhand (GoUK), Jhpiego, under the US Agency for International Development’s (USAID) flagship Maternal and Child Health Integrated Program (MCHIP), has significantly contributed to the progress ofMNCH including strengthening of Family Planning service delivery at these UHCs.
- Setting performance standards that are constructed around clearly defined service delivery processes or a specific content area
- Implementing the standards in a streamlined, systematic way
- Measuring progress to guide the improvement process toward these standards
- Rewarding achievement of standards through recognition mechanisms
The Jhpiego team, under the USAID-supported MCHIP project, provided technical assistance to the Government of Uttarakhand in strengthening the family planning service delivery through these UHCs. A number of activities were undertaken to strengthen family planning service delivery through 18 Urban Health Centers in districts of Haridwar and Dehradun.
· Jhpiego assisted the providers in developing performance standard tool for quality FP service delivery;· Helped them conduct baseline assessment to identify the gaps and develop a UHC wise customized improvement plan;· Based on the assessment, the capacities of the service providers’were strengthened in the areas of technical knowledge and skills;· Appropriate infrastructure improvements were undertaken to ensure quality services and· Proper recording, reporting and supportive supervision mechanism was established.To start with, Jhpiego carried out a rapid assessment in January 2011,which helped in analyzing the situation in about 50% of the UHCs and identified gaps in their infrastructure, human resources, equipment and supplies; and reviewed the family planning service delivery for performance and quality of services. This assessment also served as a tool to make recommendations to the Government of Uttarakhand on the existing family planning service delivery process and identified opportunities for extending services more effectively.Following the assessment, Jhpiego used its trademark Standards-Based Management and Recognition (SBM-R) approach to bring about improvement in the quality of family planning service delivery at the UHCs.A“standards settingworkshop” was held in February 2011 to introduce this approach for improving the quality of services being provided. The following were identified as key areas for provision of quality FP services:
The workshop gave an opportunity to the participants to review the performance standardsand adapt themas per the relevance and operational feasibility for Urban Health Centers in Uttarakhand. The standards were field tested at selected facilities and inputs from service providers were incorporated before finalizing. This was followed by a one day Supportive Supervision workshop in the same month for the supervisors from the NGOs, district and state officials for orienting them and improving skills.Supportive Supervision visits were made and baseline assessment of all UHCs was facilitated to assess the current status of service delivery as per these performance standards. Jhpiego conducted trainings on Contraceptive Technology Update and Family Planning Counseling, IUCD insertion/ removal and Infection Prevention for the relevant healthcare providers from 18 UHCs of both the districts between March-May 2011. Jhpiego intermittently facilitated the concurrent progressin the strengthening of the services through review meetings of the standards achieved inSeptember and November 2011 respectively for strengthening and institutionalizing the process as well as to observe improvement with focus on service delivery and facilitating recognition of sites that meet the standards. In between, supportive supervisory visits were also conducted by the team and facilitated internal assessments. Jhpiego also developed a pool of supervisors within the UHC and GoUK system for institutionalizationand sustainability of the intervention. The standards and the verification criteria have been used as different tools by stakeholders. The supervisors have used it as a monitoring tool, the providers as a service provision checklist etc.
Consequent to the SBM-R approach, the UHCs in both the districts have shown improvement in family planning service delivery and quality of care. The following areas have shown perceptible change:
The progress in standards achieved is visible from the graph below:
The progress in service delivery is evident from the table below
SCALE UP OF ACTIVITIES