2. MODEL HEALTH DISTRICTS – THE NEED…
GoI rolled out several National Health Programs to improve the
health indicators (e.g. MMR, IMR, TFR)
At present there is not even a single district in the country which
can be showcased as a Model where in all the RMNCH+A services
and National Health Programs are delivered as per the protocols
& guidelines of GoI or the State
District being the fulcrum of service delivery, it needs to deliver
services as a role model which can be replicated
Some of the initiatives which can show quick results can be –
MDR, CDR, NCD clinics etc.
Kayakalp is a good beginning and we need to build upon such
initiatives and create models which can be replicated
3. MODEL HEALTH DISTRICTS (MHD)
Is a Concept
Is a Role Model
A hope for poor & vulnerable
An effort to improve Quality
Gives honor and prestige to the health personnel
Develops good relations between client and service
providers
Can be developed as Knowledge Hub
4. MHD – THE PERSPECTIVES AND PHASES
The Perspectives
Client
Supervisor
Community
The Phases
Ambience
Protocols (technical and service delivery)
Sustenance
5. MHD – THE PROCESS
1. 2 Districts have been chosen in the selected States
Intervention District
Collaborative District
1. A chain of service delivery and referral have been identified in
the district from village to District Hospital (SC – 24x7 PHC –
CHC – DH)
2. Situation analysis through available data in terms of
RMNCHA and other disease control program indicators,
district planning, financial expenditure, blood bank
functionality, quality process, community linkages, assured
referral was undertaken
5. Identification of local partners working in the state. All
planning and improvement activity shall be undertaken in
collaboration with them/State and MoHFW
6. MAJOR FOCUS AREAS IN MHD
RMNCHA – MDR, CDR, JSY, JSSK, RBSK, RKSK
Quality Assurance Standards
Effective Community Process
Non-Communicable Diseases Screening
Operationalizing health facilities
Strengthening District Hospitals
Grievance redressal system
Assured referral linkages
7. MHD – THE IMPLEMENTATION PLAN
Gap identification and action points for strengthening - OPD, IPD, LR,
OT, Lab and infection prevention services, with an aim to get QA
certification as per GOI guidelines
Developing facility and service area specific SOPs so as to reach the
defined quality standards
Capacity building of HR for improving the clinical practices
Advocacy with district authorities for improving infrastructure related
gaps
Putting in place an assured and effective referral linkages and GRS
Holding meeting at SC with ASHA/AWW and other relevant community
stakeholders for improving community processes
Strengthening implementation of key national programs like JSY, JSSK,
RBSK,ARSH etc.
Guidance in creating model MCH wing, if sanctioned in the district
8. MHD – SUSTENANCE
Supervision, review and corrective actions
Concurrent and periodic review of services being rendered
Defined checklist
Analyze against set protocols
Find gaps
Make a time-bound roadmap (action plan) for gap filling
with a nodal person to monitor the progress
Continue review for timely implementation and
sustenance of corrections achieved
9. PERFORMANCE INDICATORS
Maternal Health
Percentage ANC registration against estimated pregnancies
Percentage of ANC 3 check up against reported ANC
registration
Number of cases of pregnant women with obstetric
complications attended at public institutions ( HMIS )
Percentage institutional deliveries reported against reported
deliveries
Proportion of C-sections per month at FRUs ( HMIS )
Child Health
Bed occupancy rate at SNCU
Neonatal mortality rate at SNCU
Newborns breastfed within one hour of birth against
reported live Births (HMIS )
10. PERFORMANCE INDICATORS
Family Planning
Proportion of postpartum IUD inserted (PPIUD) in
institutional deliveries (HMIS)
Facility Functionality
IPD and OPD per 1000 population
Major surgeries per 100000 population
HR
Gynecologists, Pediatricians and Anesthetists posted in
non-FRUs
Other
Number of patients transported per ambulances per month
Percentage of utilization of untied funds
Percentage of mothers who received JSY incentives, out of
total institutional deliveries (in public health facilities)
(HMIS)
11. EXPERIENCES FROM MHD IMPLEMENTATION
Bihar
State has identified nodal persons for monitoring of MHD
activities and they are periodically monitoring the work at
districts
State level orientation of all Dy.S and HM of Bihar on
Junk disposal process has been completed
Aurangabad DH has prepared Room wise SOPs
Training of cleaning staff at DH, Aurangabad has been
completed on infection prevention protocols
Ambience of Block CHC of Aurangabad has improved
significantly. The improvement at DH, Aurangabad is
comparatively slow, the DM has formed a team for
monitoring the work
12. EXPERIENCES FROM MHD IMPLEMENTATION
Odisha
The DM, Kandhamal has been sensitized and impressed upon
the importance of the MHD initiative. Monthly review meetings
under the chairmanship of DM are taking place
The HM of the DH, Phulbani has been appointed as the nodal
person by the DM to monitor the progress of MHD activities in
all the identified facilities
Massive cleanliness and junk disposal drive was organized in
the DH involving the housekeeping staff, staff from ANM, GNM
school and NGOs. Similar exercise was carried out at CHC and
SDH under direct supervision of CMO
Beautification of DH by creating small gardens is underway in
collaboration with Horticulture dept.
Jharkhand
At DH, Jamshedpur room-wise SOPs have been prepared.
The work on improving the ambience is moving at a slow pace
at the DH, Jamshedpur
