DRAFT for Discussion - Parivartan

Concept Note for Scaling up HNS Integration Model

Discussion Document July 30
th
, 2014
What is HNS integration
Integrating and institutionalising Health, Nutrition and Sanitation related issues into JEEViKA supported
community based institutions such as Self Help Groups (SHGs), Village Organizations (VO), Cluster Level
Federations (CLF) and Block Federations (BF)
The HNS integration model is based on facilitated participatory learning and action cycles with womens
groups that focuses on creating a space for discussion where women are able to identify and prioritise
problems and advocate for local solutions on issues related to maternal and new-born health.
This is based on a human-rights-based approach and principle of community participation, which is proven
and recognized widely and by different agencies.
This approach leads to increase access to timely and appropriate health care, and address underlying
determinants of health, and other non-health factors such as gender and equity
What are the benefits of the HNS integration
Implementation of community mobilization through facilitated participatory learning and action cycles
with womens groups is recommended* to improve maternal and new-born health, particularly in rural
settings with low access to health services**.
HNS integration would focus on following areas under maternal and new-born health within 1000
days cycle from pregnancy to 2
nd
birthday of the child***. Following specific key priority issues related
to Maternal, Newborn and Child Health****, Nutrition and Sanitation (MNCHNS) would get covered
through the HNS Model
Maternal Health - Antenatal care including check-up, institutional delivery, post natal care including post partum family
planning,
New-born/child health - immunization, reduction of infections through umbilical cord care, preventing hypothermia (by
promoting Kangaroo Care and delay in bathing of the new-born),
Nutrition - Promotion of adequate and appropriate nutrition during pregnancy, early and exclusive breastfeeding till 6
months and complimentary feeding after 6 months
Sanitation - safe storage of water, and hand washing so as to avoid diarrhoeal episodes, and ORS and Zinc
supplementation
* WHO (2014), WHO recommendation on community mobilisation through facilitated participatory learning and actions cycles with women groups for maternal and newborn health, Geneva,
WHO
**high on the new born mortality, low to medium on the maternal health
***addressing 1000 days cycle can help to break cycle of poverty and hunger; and have economic benefits at the micro as well as macro level (www.1000days.org)
****12 issues related to maternal and child health have been identified as the key issues which have high mortality and morbidity impact (PopulationCouncil, 2012)
What are the key strategies of HNS integration
Capacitating grassroots level health facilitators*
Assisting VO to identify and recruit appropriate women as Saheli**
Capacity building of Sahelis on the technical content*** and facilitation skills**** using HNS compendium consisting of 8 modules on key HNS issues listed in the
earlier page
Onsite mentoring and supervision of the Sahelis for performance enhancement
Empowering community group members to collect and review data on key health and sanitation issues and undertake planning and solution mapping using self-review
planning and monitoring tools
Engaging Community group leaders-Capacitating SHGs group leaders to collect data on the maternal, newborn and child health access related information using
pictorial tools (Swasthya Samiksha Form-SSF)
Building capacities of the Social Action Committee members at the VO level to review SSF data
Capacity building of the SAC members to plan and undertake actions at their level such as collective action for making service providers accountable for HNS
services, Group members themselves becoming active health advocates in the community
Review of the data at the CLF level and solution plan, Identify issues for local level advocacy
Inter-linkages with the health care providers*****
To have an interface with the front line workers: by participation of FLW in the group meeting, and for finding common solutions for issues being faced improve
access
To provide feedback on the quality^
Monitoring and supervision
Collection of the data on the process (for process monitoring) and health outcome monitoring for feedback and course correction
*Facilitated PLA approach is proven to achieve as per various CMmodels (Makwanpur & Ekjut trial), Saheli, with abilities and training in participatory communication techniques, She will be trained to have a grasp of perinatal health issues and
some knowledge of potential interventions (Manandhar DS, Osrin D, Shrestha BP, Mesko N, Morrison J, Tumbahangphe KM et al. Effect of a participatory intervention with womens groups on birth outcomes in Nepal: cluster-randomised
controlled trial. Lancet. 2004;364(9438):9709. and Tripathy P, Nair N, Barnett S, Mahapatra R, Borghi J, Rath S et al. Effect of a participatory intervention with womens groups on birth outcomes and maternal depression in Jharkhand and
Orissa, India: a cluster-randomised controlled trial. Lancet. 2010;375(9721):118292. doi:10.1016/S0140-6736(09)62042-0.; More NS, Bapat U, Das S, Alcock G, Patil S, Porel M et al. Community mobilization in Mumbai slums to improve
perinatal care and outcomes: a cluster randomized controlled trial. PLoS Med. 2012;9(7):e1001257. doi:10.1371/journal.pmed.1001257)
**Evidences fromthe Parivartan show that Saheli performance is affected by characteristics such as age, education etc.
***Delivery of technical content is found to be key to achieve the desired outcome/results
****-facilitation skills are found to be important to bring change in the health outcomes
^- evidence show that where the quality of services is poor, women may understandably choose not to use them despite mobilization efforts.
Identification of
Sahelis
Training on HNS
modules
Training on
facilitation skills
Collection of MIS Data
VO/ Group
Leaders
SHG
CLF
self review of
data,
planning and
monitoring
Participatory
learning and
action cycles
Behaviour
Change
Greater access
to the health
care
Change in social
norms
Interactions with
the FLW
Improved
quality and
availability of
services
Community
led Advocacy
Meeting with
Block level or
Sub-center
health platforms
Planning with
the state and
district
JEEViKA team
Saheli on Board
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Community level
Actions
Collective
action
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Training and
mentoring
Supervision and monitoring
Health Outcome data/ Learning
Feedback/ revisions
Reporting and
feedback
Role played
by Parivartan
Savings/ Increased income
Jeevika Livelihood
promotion
PATHWAYS
of
PROPOSED HNS MODEL
1
2
3
4
5
6
7
8
9
# Strategies/ Activities
JEEViKA
Institutions
Preparatory Phase (4 Months)
Implementation Phase (14
Months)
Consolidation Phase (4 Months) Integration of HNS in JEEViKA
Integration Process Overall Time Period - 24 Months*
For More Details - Annex 1, 2 and 3
*For integration of HNS Agenda in JEEViKA, the overall time period is 24 Months. Though according to operational plan and strategies, time period may be changed as WHO (2014) recommended to
have an impact, the time period of the intervention should be no shorter than three years.
H
R

S
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State Level Team
District Level
Team
Block and Village
Level Team
For More Details - Annex 4
Indicator Rationale Who will collect Frequency of collection Data Analysis Plan Sharing with JEEViKA
# groups where Health Module
rolled out
The number of groups where
health modules are rolled out.
This gives a clarity on groups the
module rollout due and plan
accordingly
Health Mobilizer Once in a quarter This data will be used to
triangulate with Health
behaviours over time and changes
impacted with module rollout.
The data will be
shared with JEEViKA
on quarterly basis and
analysis will shared
on six monthly basis.
% Registered for ANC
% registered for ANC in first
Trimester
% women received for IFA
% women consumed IFA
% institutional Delivery
% of Couples using Family
Planning
% mothers providing EBF (0-6
Months)
% of mother providing semi solid
food (7-12 Months)
These indicators are measured to
understand the changes in the
health behaviours (service
seeking / practices ) at the group
level
Health Mobilizer 100% at the starting of
the programme.
1/3rd groups every
quarter.
100% at the end of two
years.
The first 100% data will be used
as a baseline.
The quarterly data collected over
the groups will be compared with
the baseline data and progress in
the health behaviours is
triangulated.
At the end of two years 100%
data will be recollected and
compared with baseline as well as
quarterly data to understand the
impact of modules
M&E Framework for HNS Integration