Sure Start<br />Improved Maternal and Newborn Health through Community Action and Strengthened institutional Capacity.<br />
Sure Start: At a Glance<br />Sure Start, a project funded by the BMGF and implemented by PATH works with about 25 million ...
Objective 1:<br />Sure Start: Objectives<br />To significantly increase individual household and community actions that di...
Objective 2:<br />To enhance systems and institutional capabilities for sustained improved maternal newborn care and healt...
Empowering Communities<br />Sure Start’s approach is based on extensive engagement with rural and urban communities<br />T...
Empowering Communities: Examples of Progress<br />ASHAs: 7,540 have been trained<br />VHSCs: Strengthened 2,811 committees...
Empowering Communities: Early Indicators of Success<br />Baseline Institutional Deliveries in UP: 24% Institutional Delive...
Raising Awareness:  Examples of Progress<br />Five billboards and 750 rickshaws in each district carry MNH messaging<br />...
Raising Awareness: Early Indicators of Success<br />80% of all women in their 3rd trimester chose to receive the TT2 injec...
Managing Change<br />Working in two states and collaborating with 95 partners requires Sure Start to use innovative manage...
MIS<br />The Management Information System in UP<br />SO<br />DHS/CMO<br />RKS/MO in charge<br />VHSC/Pradhan/ANM<br />ASH...
Working with partners: Examples of progress<br />UP<br />Institutional, financial, technical and human resource management...
Working with partners: Examples of progress<br />Maharashtra<br />Regular training of partners in advocacy, financial mana...
Innovative Financial Models<br />In Maharashtra, Sure Start employs innovative models of improved MNH financing for commun...
Innovative Financial Models<br />Community-based health insurance in NANDED: 200 families have enrolled in a community-bas...
From inception, Sure Start in UP has been designed<br />to work with and build upon the NRHM<br />NRHM:2012<br />SS, UP: 2...
Similarly, in Maharashtra Sure Start is fully integrated <br />with the soon-to-be-launched NUHM<br />NUHM<br />SS, Mahara...
Challenges <br />Community behaviors and strong beliefs around MNH practices <br />Limited skills available in the field: ...
How we will measure success<br />Evidence of community action, individual knowledge and behaviour change will be collected...
How we will measure success/2<br />Evidence of concrete steps to improve MNH will be collected<br />Looking at number of v...
How we will measure success/3<br />Trends in NMR<br />Some academics are questioning the reliability of short-term fluctua...
Sure Start by PATH
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Sure Start by PATH

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Sure Start, an initiative by PATH works to promote maternal and new born health through community action in India. Get to know Sure Start better…take a look.

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  • Will mention the something along these lines­-Sure Start, by spreading awareness on government programmes that incentiviseinsitutional deliveries, has contributed to a decrease in deliveries at home.We need to add this caveat to this graph-Through spreading awareness on improved MNH and high-impact government programs such as the JananiSurakshaYojana, Sure Start is helping an increasing number of women to give birth safely in health centres or hospitals across project areas.
  • Sure Start by PATH

    1. 1. Sure Start<br />Improved Maternal and Newborn Health through Community Action and Strengthened institutional Capacity.<br />
    2. 2. Sure Start: At a Glance<br />Sure Start, a project funded by the BMGF and implemented by PATH works with about 25 million individuals and hopes to improve MNH in UP and Maharashtra by<br />Supporting relevant government health programmes<br />Empowering communities to bring about an improvement in MNH <br />Raising awareness on MNH using innovative communication techniques <br />Employing unique financial models to improve demand for and supply of MNH services<br />Ensuring a smooth flow of vital information and involving a consortium of partners in program implementation <br />Creating client provider linkages<br />Along with successes there were numerous challenges (to be discussed later)<br />
    3. 3. Objective 1:<br />Sure Start: Objectives<br />To significantly increase individual household and community actions that directly and indirectly improve maternal and newborn health<br />
    4. 4. Objective 2:<br />To enhance systems and institutional capabilities for sustained improved maternal newborn care and health<br />Sure Start: Objectives<br />
    5. 5. Empowering Communities<br />Sure Start’s approach is based on extensive engagement with rural and urban communities<br />Training ASHAs<br />Strengthening VHSCs <br />Fostering mothers’ groups<br />Empowering communities to reach out to service providers, program planners and policy makers<br />Establishing MOMs committees<br />Setting up community support groups, community action groups and volunteer groups<br />Enabling communities to to monitor the quality and acceptability of health service<br />Facilitating community-health provider dialogue<br />
    6. 6. Empowering Communities: Examples of Progress<br />ASHAs: 7,540 have been trained<br />VHSCs: Strengthened 2,811 committees and 34,000 meetings have taken place at which MNH plans were made and reviewed<br />Mothers’ groups: 80,000 meetings with 12,00,000 women<br />MOMs committees: 30 committees established <br />Volunteers:1,634 volunteers recruited<br />Community groups: 35 groups groups in Nagpur and 20 in Navi Mumbai<br />
    7. 7. Empowering Communities: Early Indicators of Success<br />Baseline Institutional Deliveries in UP: 24% Institutional Deliveries according to June 2009 MIS Report: 55.08%<br />89% VHSCs have functional transportation plans – these have been utilised by 2,934 women in June &apos;09 alone <br />US$1million accessed in the form of JSY payments<br />Steady improvement in the performance of home visits conducted by ASHAs:<br />2008<br />June 2009<br />5. Baseline Institutional Deliveries in MH: 78% <br /><ul><li>Institutional Deliveries according to MIS: 92%</li></li></ul><li>Raising Awareness<br />A range of innovative communication techniques effect change by ensuring that the right messages on a range of issues reach communities<br />Mass media campaign<br />Innovative IPC tools for home visits and Mothers Groups’ meetings<br />Wall writings<br />Reaching out to fathers<br />Use of IEC materials<br />Use of folk media<br />
    8. 8. Raising Awareness: Examples of Progress<br />Five billboards and 750 rickshaws in each district carry MNH messaging<br />Innovative letters from the unborn child have been distributed to 40,000 fathers-to-be<br />89% villages have emergency transport plans displayed in at least two prominent places<br />Increased demand for IFA tablets in Solapur<br />Increased demand for JSY payments<br />Rise in early registrations<br />
    9. 9. Raising Awareness: Early Indicators of Success<br />80% of all women in their 3rd trimester chose to receive the TT2 injections while 79% received IFA tablets, partly as a result of Sure Start efforts to raise awareness in UP<br />Partly due to innovative IPC material developed by Sure Start there has been a steady increase in attendance at mothers’ groups meetings from 5.8% in baseline to 47% in June &apos;09<br />Percentage of women attending antenatal check ups in Navi Mumbai:<br />
    10. 10. Managing Change<br />Working in two states and collaborating with 95 partners requires Sure Start to use innovative management approaches<br />The Management Information System<br />Building the capacity of partners<br />
    11. 11. MIS<br />The Management Information System in UP<br />SO<br />DHS/CMO<br />RKS/MO in charge<br />VHSC/Pradhan/ANM<br />ASHAs<br />Informationin<br />Informationout<br />Number of home visits for behaviour change communication<br />Percentage of institutional deliveries <br />Percentage of ANCs reached for institutional deliveries<br />Number of pregnant women/mother-in-laws attending MG meetings attending <br />Number of VHSCs<br />Outcome of pregnancies for mothers and newborns<br />Number of women practicing recommended behaviour<br />Information related to supplies, quality of services, availability of staff, vacancies, referrals addressed, etc.<br /> All stakeholders are being taught to interpret and use the MIS data relevant to their level<br />
    12. 12. Working with partners: Examples of progress<br />UP<br />Institutional, financial, technical and human resource management capabilities have been built<br />Example of Impact: 42 out of 55 consortium partners received programme funding from the Government and private donors due to improvements in their systems and enhanced credibility<br />PANI is replicating the Sure Start model in 4 districts through funding from CAIRN Energy India <br />
    13. 13. Working with partners: Examples of progress<br />Maharashtra<br />Regular training of partners in advocacy, financial management and improvement in capacity building<br />3 day trainings for frontline Government health workers to effectively build their capacities for the provision of antenatal care<br />Partnerships and collaboration with private practitioners for improved MNH services to the community (subsidised care, adoption of protocols and improvement in QoC)<br />CM of Maharashtra commends Sure Start in a joint advocacy event and highlighted the government’s commitment to improve MNH in the state<br />
    14. 14. Innovative Financial Models<br />In Maharashtra, Sure Start employs innovative models of improved MNH financing for communities<br />Public-Private Partnership in Navi Mumbai: collaboration between the NMMC and professional bodies of obstetricians, gynaecologists, paediatricians, dieticians and yoga trainers hospitals to provide improved MNH services<br />
    15. 15. Innovative Financial Models<br />Community-based health insurance in NANDED: 200 families have enrolled in a community-based health insurance plan<br />Emergency fund in NAGPUR: 35 emergency health funds have been established that allow the urban poor to access resources for MNH and other health needs <br />
    16. 16. From inception, Sure Start in UP has been designed<br />to work with and build upon the NRHM<br />NRHM:2012<br />SS, UP: 2010<br />ü<br />Provision for an incentive-basedheath volunteer over1000 population (ASHA) <br />Strengthening approx 7540 ASHAsusing NRHM guidelines<br />ü<br />Facilitating district, block andvillage-level planning and review.Strengthening VHSCs-30,000 meetings have taken place since September 2007<br />Decentralised planning andestablishment of Village Health &Sanitation Committees (VHSCs) <br />ü<br />Strengthening local capacitiesand partnerships with NGOsand private providers<br />Increased emphasis onpublic private partnership<br />ü<br />Systematic evidence based advocacy and communication activities for community reach and demand for quality of services <br />Sporadic IEC activities<br />ü<br />Demonstrating a system for two-way flow of information through MIS reporting and feedback mechanisms<br />Two-way information flow of data<br />
    17. 17. Similarly, in Maharashtra Sure Start is fully integrated <br />with the soon-to-be-launched NUHM<br />NUHM<br />SS, Maharashtra<br />ü<br />Public health delivery system– focusing on inadequacies,strategies to strengthen<br />Inadequacies in the public healthsystem identified through situationanalysis in the seven cities<br />ü<br />Weak management capacitiesof local municipal bodies<br />Building capacities ofthe municipal corporations<br />ü<br />Data being generatedthrough the MIS<br />No data available<br />ü<br />Testing a model on convergenceof maternal and newborn healthand HIV/AIDS<br />Convergence<br />ü<br />Strengthening client provider linkages with diverse group of providers and community level workers<br />Multiplicity of service provider<br />
    18. 18. Challenges <br />Community behaviors and strong beliefs around MNH practices <br />Limited skills available in the field: intense capacity building <br />High staff turnover: increasing as project reaches maturity <br />Ensuring quality referral services<br />Empowerment can lead to clashes <br />Fostering a positive advocacy approach among NGO partners i.e. bridging the public–private divide <br />Frequent transfers of key officials <br />Slow roll out of the government health programme<br />Maintaining motivation of the Sure Start partners and sustaining their interest <br />
    19. 19. How we will measure success<br />Evidence of community action, individual knowledge and behaviour change will be collected<br />Gauging a change in community attitudes to MNH. Analyzing community activation through VHSCs and Community Groups.<br />Collecting data on MNH becoming a health priority<br />Estimating the degree of awareness of safe birth practices , recognition of danger signs, etc.<br />Examining indirect indicators of change such as early registrations, use of IFA tablets, TT immunizations, institutional deliveries and ANC checkups, PNC check ups<br />
    20. 20. How we will measure success/2<br />Evidence of concrete steps to improve MNH will be collected<br />Looking at number of villages with emergency transportation plans<br />Examining the number of villages with easily accessible emergency information<br />Estimating the number of home visits and mothers’ groups that are sustainable<br />
    21. 21. How we will measure success/3<br />Trends in NMR<br />Some academics are questioning the reliability of short-term fluctuations in NMR<br />Baseline data suggested lower-than-expected NMR<br />Shifts in mortality may not be strong but indicators relating to attitude/behaviour change are also measures of success<br />

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