Unique integration of programmes across key departments to improve health, nutrition services

Showing the way in implementing the much-talked about convergence of schemes for better results, the Andhra Pradesh government has initiated a unique integration of programmes across key departments to improve health, nutrition, water and sanitation services offered to women and children.

And, the State government’s strategy to improve the health and nutrition status of women and children — inter-departmental coordination — has attracted the attention of the Centre too. The strategy is being studied by the Union Ministry of Health and Family Welfare for possible replication elsewhere. The 12th Plan also focuses on convergence of programmes.

Realising that it would not be able to achieve the health-related millennium development goals (MDGs) by 2015 at the current pace of decline in maternal mortality ratio (MMR) and infant mortality rate (IMR), the State government worked upon the scheme that would fast-track the improvement of maternal and child health indicators without any duplication of efforts by various departments.

To rope in SHGs

The added advantage in the process is attaining a demand-driven mode of service delivery that is more sustainable than the programme-driven mode where the results depend on the managers. The State government will involve the self help groups (SHGs) to mobilise and bring about behavioural changes among user groups and create a groundswell of demand for these services.

A combination of mobile technologies and Geographical Information System (GIS) will be utilised to establish a harmonised information system to monitor service delivery and track outcomes.

Andhra Pradesh has been able to achieve a total fertility rate of 1.8, which is less than the replacement level; has introduced emergency transport service (available on 108); and introduced Fixed Day Health Services (available on phone 104).

Despite these gains, at the current rate of decline in major health indicators, there is a fair chance that the MDGs would be missed as the MMR (per lakh live births) is 134 as against the national average of 212 and target of less than 100 by 2015; and the IMR (per 1000 live births) is 46 as against the national average of 50, far behind the target of 23 as per the MDGs. Similarly, over 42 per cent children are malnourished and 59 per cent pregnant women are anaemic in the State.

“Though each department has been achieving excellent results independently, we have reached a plateau as far as implementation of programmes is concerned and the gains are not very high. Remember we are dealing with people and not just figures, so we did realise something more had to be done,” Ajay Sawhney, Principal Secretary (Health) Andhra Pradesh — who was instrumental in drawing up the convergence plan (now a government order) — told The Hindu from Hyderabad. Incidentally, his wife Nilam Sawhney heads the Women and Child Department in the State.

As per the convergence strategy, 20 key interventions have been identified for reduction of MMR, IMR and malnutrition: age at marriage, early registration of pregnancy and births, anaemia among pregnant women, institutional delivery, early initiation of breast feeding, complementary feeding, awareness against sex selection abortion, new-born care and care of adolescent girls.

The interventions will be monitored by convergence committees at all levels and the district level report will be sent to the Commissioner (Health and Family Welfare). Formats will be prescribed for monitoring relevant indicators and the community will be involved — particularly the SHGs and voluntary organisations using appropriate tools. Convergence committees will be functional from village level.

MCP card

The use of maternal and child protection (MCP) card will be a powerful convergent tool as it covers all components for delivering quality services. There will be a common database of beneficiaries as part of a harmonised MIS from which each of the departments (Health, Medical and Family Welfare, Women Development and Child Welfare and Rural Development) can access information.

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