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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.

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.
  • Transcript

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