One of the greatest challenges facing India’s current growth trajectory is maintaining an adequate public health care system that delivers services in an effective and efficient manner. Women and children living in rural areas bear the brunt of the burden of poor health services in India.
- One in every 15 Indian children dies before his/her 5th birthday. Twice as many Indian children under age 5 die each year than in any other country, and 50 infants die per 1,000 live births. (Source: World Bank)
- Close to 50% of India’s children are undernourished (Source: Government of India)
- India has more maternal deaths than any country in the world (Source: UNICEF)
- India spends 1.2% of its GDP on public health. (Source: Government of India)
- India ranks 171stout of 175 nations for public health spending (Source: WHO)
In 2005, the Government of India launched the National Rural Health Mission (NRHM) to commit increased health spending with the aim to improve the quality of health care for people in rural areas, especially the poor, women, and children. At the request of the Government of India, the Earth Institute of Columbia University has been convening an International Advisory Panel (IAP) that meets biannually to review NRHM operations, assess progress, conduct evaluations, and make policy recommendations. The Model Districts project was created to implement the recommendations from the mid-term evaluation of NRHM, conducted by the Earth Institute. The Model Districts project was commissioned with the specific aim of helping India achieve Millennium Development Goals 1, 4 and 5: improving the nutrition status of women and children and reducing maternal and child mortality by 2015.
About the Project:
The Model Districts project is launching five districts in 2010-2011 to serve as regional pilots for scaling up innovations and quality improvements targeting overall health systems strengthening across rural India. The districts were selected from states to represent a geographical region of India: Assam (Northeast); Bihar (East); UP (North); Rajasthan (West); and Andhra Pradesh (South).
Model Districts will focus on ensuring that the critical building blocks for an effective health system are in place, and will target interventions through several avenues, including: behaviour change outreach; infrastructure and supply chain management; training of health human resources to improve service delivery; improvement of management, funding, and oversight structures; and eventually ensuring that the appropriate district, state, and national level policies are in place. The Model Districts project team will provide implementation research, technical advice, monitoring and evaluation, and policy advocacy to help ensure the successful scaling up of services, and coordination of efforts in these Model Districts.
Target interventions are informed by the 2009 NRHM evaluation recommendations and baseline assessments in each district. Target interventions are piloted in one block, an administrative unit of 30 to 50 health facilities, prior to district scale-up. These interventions will focus on:
- Utilizing a public health systems approach to focus on governance, management, and intersectoral coordination between health, nutrition, education, public health engineering, and agriculture
- Increasing utilization of key health services by targeting demand-side behaviour
- Ensuring adequate levels of human and physical resources in health facilities to meet demand and provide high-quality, decentralized care for core interventions in maternal, infant, and child care
- Strengthening health worker performance management, including oversight, correctly administered incentives, and appropriate training and job support
- Increasing the availability of high-impact health interventions for mothers and children; this critical intervention mix includes: quality antenatal care, skilled birth attendance, emergency obstetric care, immediate newborn care, early and exclusive breastfeeding, appropriate complementary and supplementary feeding, management of childhood illness, and complete immunization
- Improving the quality and efficiency of health services and delivery processes, including referrals and linkages, point-of-care support, and health systems management
- Streamlining health management information systems (HMIS), particularly by utilizing mobile health (mHealth) technologies, towards data-driven decision-making in health planning and service delivery
- Integrating nutrition and health, particularly by reinforced nutrition outreach and home-based action
- Identifying successful approaches for timely adaptation and replication throughout the state and region
- Launch of the Model District in Uttar Pradesh with the District Magistrate and district representatives from health, education, and nutrition departments.
- Launch of Model District in Assam, first in the capital city of Guwahati with Chief Minister Gogoi, the NRHM state office, and other state officials, and then in Morigaon district with the District Collector, NRHM district office, and over 700 community and nutrition health workers, medical officers, and community members.
- Creating new models of governance, notably through intersectoral leadership teams at district and block, which regularly bring together the District Collector’s office and key departments for the first time (e.g. health, NRHM, social welfare, education, and public health engineering) to plan joint action focused on maternal and child health.
- Integrating IEC (information, education, and communication) efforts to focus on important health messaging; a joint district IEC team in Assam has named 2011 the ‘Year of Hygiene’ and initiated public activities on Republic Day (26 January 2011).
- Reinforcing death reporting capacity, particularly at community level, as effective, evidence-based health planning is compromised without an accurate picture of the current situation.
- Quality improvements focusing on facility sanitation, hygiene and building maintenance, utilities, human resources, space utilization, and safety were initiated in our pilot block.
- Frameworks for conducting needs assessments were provided to district and block officialsfor the first time, which have provided critical information on gaps and constraints in human resources, infrastructure, equipment, funding, and technical support.
The IKEA Foundation
The IKEA Foundation generously supports the Model Districts Health Project, with aims to reduce maternal and infant mortality in India (Millennium Development Goals 4 and 5) by 2015. The Foundation’s support seeks to strengthen India’s National Rural Health Mission, and provide efficient healthcare services, and wider access, for the millions of women and children living in rural areas. The Foundation supports the Earth Institute’s research and policy work towards in five districts across India.
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