Urban Health Initiative Project

Posted by on September 4, 2014 · Leave a Comment 

Introduction: U1

Varanasi is one of the oldest cities in continuous habitation in the world, with a history dating back to more than 3000 years. It is a major religious, cultural and educational centre of India. Varanasi is also famous for its handicrafts and silk Weaving industry. Varanasi town lies between the 25o 15’N to 25o  22’ N Latitudes and 82o 57’E to 83o 01’E longitudes. The river Ganga only here flows in a south-to-north direction, having the world famous Ghats on the left bank of the river. Varanasi is well connected by road, rail and air with other parts of the country. The climate of the city, as of Northern India on the whole, is of tropical nature with extremes of temperature, varying from a minimum of 5°C in winter to a maximum of 45°C in summer.

Table: District level indicators, Varanasi

Population – District             : – 3138671 persons

Urban population-District    : – 1260571 persons

Slum population-District      : – 457568 persons

SC & ST                                 : – 436314 persons

Indicators based on DLHS-2 and DLHS-3

Introduction of UHI:

The Urban Health Initiative (UHI) is part of a five-year, four country initiative supported by the Bill & Melinda Gates Foundation in Nigeria, Kenya, Senegal, and India. UHI India is a consortium of international, national, nongovernmental, and community-based organizations working together to improve the health of the urban poor, especially in the state of Uttar Pradesh. UHI is designed to be complementary to national and state health sector plans and goals. The initiative supports the implementation and scale-up of effective evidence-based strategies, as well as the testing of promising innovations.
Objective (Vision & Goal):-

  • Urban Health Initiative
    • Urban Health Initiative (UHI) is implemented by a consortium of international, national, and community based organizations, all focused on improving urban health, especially urban reproductive health and family planning. The initiative responds to rapid urbanization and poor health indicators among the urban poor in Uttar Pradesh. The initiative is designed to be complementary and supportive of the national and state urban mission and health sector plans and goals. The initiative prioritizes the implementation and scale-up of effective evidence-based strategies which are aligned with government plans and schemes, as well as innovations that can be piloted and tested.
    • UHI Vision
      • Empowered women and men choose the timing and number of pregnancies, using providers and methods of their choice.
      • UHI Goals
  • Increase contraceptive use as a key intervention to reduce maternal and infant mortality.
  • Implement evidence-based strategies which are aligned with Government schemes and programs so that they are more likely to be replicated and scaled up to benefit greater numbers of people.

UHI Outcomesu2

  • Increased contraceptive prevalence or use, especially among urban poor.
  • Increased quality of reproductive health and family planning services at targeted sites.
  • Increased access to a broad range of contraceptive services, supplies, and counseling.
  • Sustained demand for quality contraceptive services and supplies.

Strategies:

UHI Strategies to increase contraceptive use.

Increase service access and use (Objective 1, 2, 3a):
Expand access to quality family planning services, especially sterilization, IUCD, and DMPA, in partnership with government and private providers, using the following strategies:

  • Ensure family services at the time of delivery and abortion services; and counseling prenatal, postpartum, and pre and post abortion.
  • Expand number of fixed service days, in addition to routine services
  • Ensure services are packaged along with quality counseling by community-based and clinic-based workers.
  • Expand choice of providers, including private providers, offering services at affordable prices.
  • Expand choice of methods for limiting to include IUCD, DMPA, as well as female & male sterilization.
  • Leverage support through public private partnership government schemes

 Improve supply access (Objective 3b):u3
Expand access to family planning supplies, especially for condoms and pills, through

  • Expansion of sales outlets to at least one in each slum.
  • Distribution of free supplies at service sites, work sites, and communities.
  • Leverage NACO marketing strategies for condom use for family planning in UP.

Sustain demand and long term use (objective 4): for reliable and quality services and supplies through:

  • Interpersonal communication, through community-based workers and clinic-based counselors.
  • Mid-media to market supplies and services available at specific locations, places, dates, and costs.
  • Mass media to shape demand and practice for “low demand” practices, including low season for sterilization, lower demand for IUCD and DMPA, and directly targeting traditional method users to shift to a long acting or permanent modern method.
  • Test and validate activation and mobile phone use with men as innovations for demand generation.
  • Leverage funds to increase airtime of UHI productions on TV, Radio, and local cable channels

Sustain improvements and support scale-up (Objective 5):

  • Share and disseminate implementation experience and lessons that can inform replication and scale up of successful strategies at international, national, state, city meetings.
  • Participate and support joint planning and budgeting at city, state, and national levels, which incorporates successful models for family planning and urban health.
  • Strengthen community efforts negotiate and demand reliable and quality family planning services.

OBJECTIVEu3
OBJECTIVE 1: POST PARTUM AND POST ABORTION INTEGRATION
OBJECTIVE 2: QUALITY AND EXPANDED SERVICE DELIVERY
OBJECTIVE 3: PUBLIC PRIVATE PARTNERSHIPS
OBJECTIVE 4: SUSTAINED DEMAND GENERATION 
OBJECTIVE 5: POLICY & ADVOCACYOBJECTIVE 1: POST PARTUM AND POST ABORTION INTEGRATION 
Integrate quality family planning services with maternal, newborn, post partum, and post abortion services.
UHI indicators & Milestones (performance measures as per proposal and contract with BMGF):

  • 80% of targeted high volume clinics provide integrated family planning services
  • 90% of targeted NMCH Service Delivery Points offer integrated family planning services.
  • Physicians, nurses, and counselors provide family planning counseling, IUCD insertion, sterilization, and injectables at public and private sector maternities post partum and post abortion.
  • Frontline and facility based providers give family planning services and counseling to women accessing maternal and newborn health services (prenatal and post partum).
  • Frontline and facility providers provide FP services and counseling to women accessing post abortion services.
  • State MNCH training curricula and materials reviewed to ensure family planning content.
  • Women using LAM counseled on timely transition to other modern methods before 6 months.

UHI performance indicators (added by UHI to focus program on achieving results):u4

  • People: % of post partum women (<12 months) who accepted a method before discharge from maternity; or 2) who currently use contraception.
  • People: % of post abortion women who left facility with a method; or who use contraception within 10 days post abortion.
  • Providers: Number of community-based workers (peer educators, outreach workers, AWW, etc) trained on prenatal, post partum, and post abortion family planning counseling and referral.
  • Providers: Number clinic-based workers (doctors, nurses, ANMs, and counselors) trained or mentored in post partum and post abortion family planning counseling and services, by type of provider, type of training, including post partum IUCD clinical training.
  • Facility: Number of facilities providing post partum and post abortion family planning, by method.

OBJECTIVE 2: QUALITY AND EXPANDED SERVICE DELIVERY
Expand access to quality family planning services in targeted health facilities, especially for the urban poor.
UHI Indicators and Milestones (performance measures as per proposal and contract with BMGF):

  • Providers use standardized screening tools or criteria when providing family planning services.
  • Expand or scale up delivery of family planning methods, including injectables, in targeted service points.
  • Improve counseling and client interactions and implement model QI/QA in family planning.
  • 80% of targeted clinics deliver high quality family planning services in accordance with standard operating procedures.
  • 90% of targeted family planning clinics offer at least 2 long acting methods.
  • Meet unmet need among sexually active married adolescents in slums, by Sept 2012 (moved here from Objective 4)
  • Method specific “deep dives” conducted to prioritize methods and activities to promote expanded use of each method.

UHI performance indicators (added by UHI to focus program on achieving results):

  • Expand number of family planning 1) providers; 2) places of provisioning; 4) fixed service days.
  • People: Number and % receiving family planning, by method, by source (service day or routine; public or private).
  • People: Number and % of clients who report receiving counseling and quality interaction.
  • Provider: Number of private sector doctors accredited, and empanelled and eligible to recover costs for sterilization.
  • Provider: Number of community workers (peer educators, outreach workers, AWW, etc) trained by topic.
  • Provider: Number clinic workers (doctors, nurses, ANMs, and counselors) oriented or trained by topic.
  • Facility: Number of fixed services days providing male and female sterilization, IUCD, DMPA.
  • Facility: Number of facilities that provide NSV, female sterilization, IUCD, and DMPA

OBJECTIVE 3: PUBLIC PRIVATE PARTNERSHIPS

Test novel private public partnerships and innovative private sector approaches to increase access to and use of family planning by urban poor.
(Private sector is any non-government or partially privately financed provider, worker, or facility).

UHI Indicators & Milestones (performance measures as per proposal and contract with BMGF):u5

  • 75% of total CPR increase attributable to use of private sector FP services
  • 25% of public sector facilities have contracting out or contracting in arrangements with private sector for family planning.
  • Contraceptive supply chain assessed and extended with authorized distributor at state level and stockiest in each city.
  • Increase reach of socially marketed modern contraceptives among lowest wealth quintile.
  • Expand reproductive health products and services for low income communities through market based partnerships
  • Traditional and non-traditional outlets listed, surveyed, and non-traditional outlets expanded
  • Voucher scheme operating effectively voucher scheme with private sector operating efficiently.
  • Certification of providers on quality assurance mechanisms developed and vouchers distributed and in use.

UHI performance indicators (added by UHI to focus program on achieving results):

  • People: Receipt of services and supplies from the private sector, by method
  • People: Reported purchase or use of socially marketed products, services, or vouchers, by method.
  • Facilities: Number providing subsidized or free services using schemes, including vouchers.
  • Sales outlets: Sales of condoms and pills, by type of outlet

OBJECTIVE 4: SUSTAINED DEMAND GENERATION 
Create demand for sustained use of contraceptives, especially among marginalized urban populations.

UHI Indicators and Milestones (performance measures as per proposal and contract with BMGF):u6

  • Large scale community outreach and mobilization implemented.
  • Develop, implement, and evaluate community outreach and mobilization
  • Strategic behavior change communication strategy developed.
  • Evidence-based, targeted, specific messages, campaigns, client outreach, and community mobilization interventions implemented to increase urban poor uptake of family planning services (marketing specific services).
  • Develop, implement, and evaluate demand generation campaign using mass media linked to clinics, quality of care and public private partnerships.
  • Mass media campaign launched to increase uptake of family services among the urban poor.
  • Use of PDA or mobile phone for demand generation and BCC.
  • 70% know each method of family planning; 40% say they have discussed family planning with others in past 6 months; 60% believe majority of other couples approve FP use; 35% of non-users say they are likely or very likely to use FP in next 12 months (Note: 2010 MLE data: 91% know FP methods; 94% say they have discussed family planning with others/husband in past 6 months; 90% believe majority of other couples approve FP use; % of non-users say they are likely or very likely to use FP in next 12 months; 80% exposed to family planning promotion messages on mass media and mid-media.

UHI performance indicators (added by UHI to focus program on achieving results):

  • % reporting visit of community worker at home or in community in the past 3 months.
  • Materials and events for demand for sustained FP use produced, procured, used, and distributed or aired, including: 1) IPC materials; 2) mid-media / community-media events / folk, road, puppet shows; 3) mass media events or spots.
  • % reporting influence of IPC, mid-media, and mass media in use of current family planning method.

OBJECTIVE 5: POLICY & ADVOCACY
Increase funding, financial mechanisms, and a supportive policy environment to ensure continuity of family planning supplies and services for the urban poor.
Indicators and Milestones (performance measures as per proposal and contract with BMGF):

  • 50% Increase in funding allocated to urban health, family planning and NMCH services for the poor.
  • At least one supportive policy related change for expanding method choice under MOHFW.
  • RAPID model used to inform policy makers of the potential of investment in FP, in collaboration with Futures Institute.
  • Technical and resource support provided to promote expanded access to family planning services and supplies, including injectables, presented to stakeholders.
  • Evidence based reviews of each family planning method, including injectables presented to stakeholders, through contraceptive technology updates.
  • Work with government, civil society, and women’s groups to address concerns regarding access to family planning services, supplies, and injectables. Technical and resource support provided to promote expanded access to FP services and supplies.
  • Work with policy makers to guide resource allocation decisions for family planning. Collaborate with other stakeholders to present evidence to government for increased resource allocation for FP/MNCH and for Urban Health and Family Planning.
  • Complete Stakeholder and political and policy analysis of facilitators and obstacles to scale up.
  • Media advocacy workshops to orient print and media professionals

UHI performance indicators (added by UHI to focus program on achieving results)u7

  • UHI strategies aligned with GOI and GoUP strategies, programs, and schemes
  • Number of events convened with policy makers with potential to contribute to informing policy and program decisions.
  • City-wide comprehensive city health plan facilitated and completed for at least the core cities.
  • State-wide PIP completed with UHI inputs to include plan and allocations for urban health and family planning.
  • Presentations made at city, state, national, and international meetings and documentation used to disseminate data, lessons, and implementation experience and results, to influence the spread or scale up of successful strategies or increased action to improve urban health or family planning.

Introduction:

Urban Health Initiative project Donate by CARE INDIA and Implemented by Human Welfare Association started this project from October 2014. Total staff No. 76 Pear Educator, 7 Out Reach Worker, 1 Part Time Accountant, 1 Office Boy, 1 FMDC and 1 Project Coordinator. UHI covers 61 urban slums, 167031 Population, 28523 MWRA and 27628 House Holds.

MWRA Meeting:

We organize MWRA Meeting in urban slum time to time in each month. Till March 2014 total 30 MWRA Meeting held in every slum and 423 Participants, participate in MWRA Meeting.

Chauraha Stall:u8

We organize Chauraha Stall in time to time at morning from 8:00 AM to 10:00 AM. Till October 13 to March 2014 total 68 Chauraha meeting held at Chauraha stall. 768 male counsels at Chauraha stall. Total 19 NSV done from Chauraha stall till March 2014.

Community Health day:

Time to time we organize CHD (Community Health Day) in Slum area with the help JANANI. Total 4 CHD held in different slum. 63 women counseled and 50 clients adopt DMPA injection.

Fix Service Delivery Day:

With the help of JANANI, Pariwar Sewa Kendra and District Women Hospital, we organized FSDD for MWRA (Marriage Women Reproductive Age) of slum. Till March 14 total 6 FSDD have organized in slum. Total 76 Fst (Female Sterilization)b and 6 Mst (Male Sterilization) have done during FSDD.

Method Fst NSV IUCD DMPA OCP CONDOM Total
Sep-13 5 0 20 8 7 13 53
Oct-13 12 0 30 9 4 27 82
Nov-13 55 1 57 36 22 47 218
Dec-13 119 3 76 24 24 124 370
Jan-14 92 4 118 18 57 146 435
Feb-14 105 2 110 13 46 226 502
Mar-14 95 0 125 28 55 89 392
TOTAL 483 10 530 28 215 672 2052

 From the start of project total 483 Female sterilization, 10 Male Sterilization, 530 IUCD, 28 DMPA new users, 215 OCP and 672 Condom users.

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