State Plan of Operation UNICEF Maharashtra

Transcription

1 State Plan of Operation UNICEF Maharashtra

2 State Plan of Operation Maharashtra Samir Ghosh Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 2

3 SPO OUTLINE Executive summary 1. Introduction 8 Plan Strategy Government cooperation NGO cooperation 2. The plan 13 Intervention for age group under 3 years Intervention for age group 6-14 years Intervention for age group years 3. Sector-wise Plan 16 Child Development & Nutrition Child Environment Child Protection Education Health HIV/AIDS 4. Integrated Monitoring & Evaluation Framework Conclusion 176 Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 3

4 Executive summary Situation of Children and Women The state presents a paradox. Despite the economic progress made by the state the progress on key indicators for women and children has remained far from satisfactory. There seems to be a slow down or even stagnation on indicators that reflect the quality of life. The Infant Mortality rate has remained stagnant around 48 per 1,000 live births with around 31 in urban and 58 in rural areas; every second child in the state is in moderate or severe malnutrition with 76% of under threes suffering from anemia. While the general sex ratio has declined from 934 in 1991 to 922 in 2001, there has been a sharper decline in the sex ration among children under 6 years from 946 to 917 in the same period. 65% of marriages are of girls below 18 years of age of which 34% being girls below 15 years. While 86% of boys and 78% of girls between the age of 6 to 14 years are reported to be attending schools, the quality of education has been a major concern in the state. The deteriorating water quality 39% of the tubewell water tested is found to be unsafe for drinking and the depleting water table further compounds the problem. The state is also facing the major challenge of HIV/AIDS; 60% of the HIV cases in India belong to the state and the disease threatens to undermine all other developmental gains in the state. Child labour, trafficking and children on the streets are also major concerns in the state. There are wide variations in these figures between the districts with some districts fairing very poorly. Major State Initiatives: The state government has taken a number of important steps to tackle these challenges. The State Population Policy announced in May 2001 has set ambitious targets; the chief minister has also initiated and intensive campaign to prevent child marriages. The state government has also announced policies on children and women indicating its determination to improve their status. Concrete steps have also been taken to address the issue of quality education and reaching out to the children that still remains outside the education system. The only state in the country which has enacted a law on water, steps have been taken to ensure its implementation. The Gadge Baba Gram Swachata Abhiyan, a unique campaign to bring Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 4

5 about a clean environment and promote health, hygiene and sanitation has had a great impact on communities. UNICEF Cooperation: UNICEF has had a very strong partnership with the government in planning and implementing programmes for children and women. The major focus of UNICEF programming in the state has been to help the districts evolve innovative and viable models for decentralised community managed programming across sectors. Integration of micro planning and development and village development plans, participatory development training programmes and facilitating the active participation of women, youth and children in mainstream programming have been the key features of the partnership. The Primary Education Enhancement Project being implemented in Chandrapur and Yavatmal districts, the Schools in Development project with children as change leaders taken up in 10 districts, the Maternal and Child Health and Nutrition training implemented in another 10 districts and the empowerment of women through SHGs taken up in eight districts have become models for scaling up. The Women s Right to Life and Health Project being implemented in the three Border District Cluster Strategy has also provided valuable lessons in dealing with the issue of maternal mortality. Similarly the AIDS Prevention Education Programme has now been scaled up to cover all secondary schools across the state. The strong networking with NGOs in close collaboration with the state on issues related to child protection lays the foundation for the next programming cycle. Programming for Based on extensive consultations and taking into account the GOI-UNICEF Country Programme Recommendations the following will be the priorities for the state: Reduction in IMR and Malnutrition among U3s and ensuring their proper growth and development Ensuring that all children in selected districts receive quality elementary education Reduction in incidence of HIV/AIDS among adolescents and young people (10 to 24 yrs) and prevention of transmission from mother to child Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 5

6 Evolving appropriate strategies and action to protect children from abuse and violence Empowering families and communities with appropriate knowledge and skills for the better care and protection of children, expanding partnerships as a way to leverage resources for children and to scale up interventions and strengthening the knowledge base on children so as to inform policy, support programme formulation and enhance monitoring capacity will remain as the key outcomes of the programme. The current programming activities will be used as the foundation to launch the new programmes. Decentralized community base convergent programming will remain central strategy. The Integrated Early Child Development strategy will be the base for programming for U3s. The key programmes will include: 1. Reproductive and Child Health will be implemented in the three BDCS districts of Nanded, Latur and Osmanabad. The Women s Right to Life and Health project will be an essential component. Community, especially women s, mobilization and their active participation in the planning, implementation and monitoring of the programmes will be the focus. Strengthening of the delivery system through training and capacity building as well as through supply of critical items will be part of the programme. The state will also be working on evolving an urban model for RCH implementation. Strengthening routine immunization and supporting the Polio Plus project will also be key components of the health sector. 2. Child Development and Nutrition: The focus will be to build on the MCHN initiative by facilitating better planning and coordination among the ICDS and Health sectors. The focus will be largely in the eight districts of Marathwada where malnutrition is a serious problem and a major initiative to tackle the problem has already been initiated.. Focus will be on empowering families and communities to adopt the right feeding and caring practices to ensure that children grow and develop to their full potential. The anemia control programme will be implemented in Nashik and the three BDCS districts while the UNICEF will support the Vitamin A programme across the state. UNICEF will also work closely to Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 6

7 strengthen the implementation of ICDS III. The sector will work with close coordination with the Health and the Child Environment programmes. 3. Child Environment will work very closely with the Health and CDN sectors addressing issues of water quality and promotion of personal, household and environmental hygiene and sanitation. Support to the Sector Reforms district project and the total sanitation campaign as well as the Gadge Baba Swachata Abhiyan will be a key component. Capacity will also be built in these districts for participatory planning in support of decentralized community managed programmes. Lessons learned in water harvesting will be promoted. 4. Prevention of Mother to Child Transmission of HIV/AIDS will continue to be a priority. Programming for the 6-14 years will include: 1. Education where the focus will be to improve the teaching learning process in schools to ensure adequate learning achievements. The Primary Education Enhancement Project being implemented in Chandrapur and Yavatmal as well as the Janshala projects being implemented in Nashik and Thane will provide the base for evolving appropriate strategies. Support will also be provided to evolve appropriate learning and teaching programmes for difficult to reach children, especially living in tribal and urban slums. Experimental projects will be taken up for them. Th overall focus will be to reach out to girls. 2. Child Environment sector will support the school water and sanitation activities including providing life skills to children. The Schools in development project that has evolved in the state during the last four years will be the key strategy that will be used. Programming for the year olds will include: 1. The AIDS Awareness education programme in secondary schools; and 2. The prevention of HIV in adolescents and Young people: Working closely with the Maharashtra State AIDS Control Society UNICEF will evolve programmes to reach out to existing of network of youth and women and scale up the experience across the state. Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 7

8 IMEP In order to ensure that Unicef s action benefit children rather than just bureaucracies and institution. The entire plan has been conceived under the Integrated Monitoring And Evaluation Program (IMEP). Key to the planning strategy has been under the following thrust: 1. Child-focused programming implies that Strategic Results (around which SP strategies have been developed) describe as much as possible tangible changes in the status of children. 2. Making Strategic Results child-focused ensures that improvements in the conditions of children are primary criteria for measuring the success of programmes or projects 3. Even if gaps to fulfill the rights of children are at the institutional or governance levels, it would still be advised to position institutional and governance results at the outcome rather than strategic result level 4. Institutional and governance factors are determinants of national capacity to address the needs of children. Consequently, results achieved at these levels should not be considered as an end. Geographic coverage: UNICEF will largely focus on 12 of the backward districts where efforts will be made to develop a holistic community based programming process. The lessons learned from these districts will be scaled up across the state. The partnership will continue to build capacity of NGOs and bring them to a close partnership with government programming. Emphasis will also be on bringing in more partners and allies including the larger civil society in support of the programme. Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 8

9 1. Introduction 2 Plan Strategy The State Plan of Operations (SPO) of Maharashtra is inline with the overall strategy of Result Based Management (RBM) adopted for the Master Plan of Operations (MPO), which is the National perspective plan of Unicef India. RBM is intended to serve as a blue print for managers to help them focus on measuring and reporting on outcomes throughout the life cycle of the policy, programme or initiative. The main purpose that RBM intends in this plan is to help in the following parameters: Describe clear roles and responsibilities for the main partners involved in delivering the policy, program or initiative a sound governance structure; Ensure clear and logical design that ties resources to expected outcomes a results based logic model that shows a logical sequence of activities, outputs and a chain of outcomes for the policy, program or initiative; Determine appropriate performance measures and a sound performance measurement strategy that allows managers to track progress, measure outcomes, support subsequent evaluation work, learn and, make adjustments to improve on an ongoing basis; Set out any evaluation work that is expected to be done over the lifecycle of a policy, program or initiative; and Ensure adequate reporting on outcomes. With successfully developed and included in the work plan this framework should represent: 1. An understanding between partners and stakeholders on what them aim to achieve, how they plan to work together to achieve it and how they will be measured and reported on outcomes over the stated and agreed period of time. 2. a tool for better management, learning & accountability throughout the life cycle of a policy, program or initiate and changes thereon. 3. an early indication that the policy, program or initiative is setup logically with a strong commitment to results and thus a good chance to succeed. Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 9

10 The RBM framework has been used in the plan exhibiting the prime focus on age i.e under 3, 6-14, years. However, it has also been exhibited sector wise keeping the focus on age and the sector as an intervention strategy. Thus typically the RBM in the plan views 4 major sections i.e. 1. Strategic results / key results 2. Outcome level 3. Output 4. Activities Which strategic results and outcome are that main focus that needs to be achieved as a overall national / state objectives, it is expected that Unicef is but one of the partners along with the Government as well as other players to achieve this goal. It s only at the activity, level that the specific Unicef niche will be measured. Separate log frame has also been developed defining the indicators means of verification and assumptions for achievements. The work plan will further break the activities into task assigning specific responsibility time frame and the budget. Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 10

11 2 Government cooperation The Government of Maharashtra s perspective can be assessed from various documents of consultation that has taken place over a period of one and half years, both sectorally and comprehensively. From the remarks of the principal secretary planning, it can be noted that the Government was keen that the State Plan of Operation (SPO) should be in synchrony with the tenth five-year plan. The critical issue of sustainability and participation needs to be assessed and modalities for scaling up should be worked out clearly. He also emphasized that adequate documentation and advocacy plan should be developed. Strategies should be developed to look into the problems in a holistic manner especially problem such as child labour which cannot be addressed in isolation. Further, replication of successful pilot needs to be done with substantive documentation. Thus Government looks forward for Unicef s cooperation in finalizing projects for international funding to get over the problem of resource crunch. All the pilot projects taken up as research projects need to be integrated with SPO. Keeping in view the above comments the Government cooperation is specifically sought as depicted below: 1. The Government will be responsible for implementation of sectoral and inter-sectoral programs in line with age focus plan under the Results Framework as discussed during the consultation. 2. In order to enhance convergence of services and shaping of plan to district specific settings the precise details of individual programs will be prepared in consultation at the level of district authorities. Details of commitment within each program will be included in the overall plan of action at the state and district levels. 3. In order to have timely information on movement and use of equipment, supplies and cash grants in implementing the SPO, a system of administrative reporting and monitoring will be instituted for each program and project at state and district level. 4. The Governemnt of Maharashtra and implementing departments at the district levels will provide periodic status reports to Unicef on each Unicef assisted program activities. Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 11

12 5. Key indicators of social, physical and financial progress will be developed for each activity showing the expected and achieved objectives. Unicef and GOM will mutually agree on the Proforma to be used and frequency of reporting. 6. A mid-term review of program will be carried out as per the IMEP schedule towards the end of 2005 to identify the achievement and constraints, assess program strategies, identify lessons learned and indicate critical changes that may be necessary for program cooperation and modification if any. 7. Evaluation of results of different components including impact analysis will be undertaken by individual experts / institutions identified for the purpose jointly by Unicef and concerned departments. The reports prepared will be made available to DWCD, Sectoral department, and Unicef to help and guide corrective actions. Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 12

13 2 NGO cooperation Unicef Maharashtra has been working closely with NGO as a partner. It was unique methodology adopted wherein NGO has been instrumental in bridging the gap between the Government machinery and the people. NGOs have been by-n-large playing the role of demand generation by the active participation of villagers through the village micro-plan. To that extent Unicef has made the value added contribution of not only selecting of the NGOs but also providing them with appropriate training and integrating their services down to the village level. It is planned that the same model will continue for the plan period as well. However some of the lessons learned from the previous cooperation are as follows: 1. NGOs run the risk of the credibility of their presence in a community while implementing short-term programs. 2. Frequent changes in the implementing strategy disturb the equilibrium of the program and affects staff motivation. 3. Most of the NGOs would prefer training in process documentation in the next cooperation period. 4. Strategies to convert Samaj Mandal / Chawdi into Family Welfare Centre. 5. Educational fair 6. Associate school with Anganwadi (pilot project) for better monitoring and community ownership. 7. Research on sustainability on youth group and case study of Parisar Mandal. On the basis of the SPO document, and in accordance with the result frame work the cooperation of the NGOs will be mostly at the activities level which will contribute to the output level. The details will be worked out during the work plan workshop whereby specific expectations from the NGOs will be crystallized. Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 13

14 2. The plan The stated SPO has been prepared under the result based management and accountability framework, which is primarily due to the following reasons: 1. To strengthen planning through clear definitions of programme outputs, outcomes and strategic results. 2. To improve coordination of monitoring, evaluation and research activities, setting priorities in data collection and facilitating collaboration with Unicef and with partners 3. To increase accountability, defining Unicef s role and responsibilities very clearly and, setting basis for project and programme evaluation, in general, and Unicef s performance assessment, in particular. 4. To ensure efficient use of data in decision making by synchronizing data collection and decision making opportunities. Accordingly the following diagram gives the details of the RBM framework both in terms of age focus and sector focus. Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 14

15 RBM framework Sector RBM 0-3 years 6-14 years years Strategic Result Outcome Integrated Early Childhood Development Output Activities Input Strategic Result Outcome Health Output Activities Input Strategic Result Outcome Child Development & Nutrition Output Activities Input Strategic Result Outcome Child Environment Output Activities Input Strategic Result Outcome Education Output Activities Input Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 15

16 Strategic Result Outcome Child Protection Output Activities Input Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 16

17 3. Sector-wise Plan Child Development & Nutrition Child Environment Child Protection Education Health HIV/AIDS Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 17

18 Child Development & Nutrition Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 18

19 (I) CHILD DEVELOPMENT & NUTRITION 1. SITUATION ANALYSIS 1.1 NATIONAL LEVEL STATUS Some 30 million (47 percent) of the 64 million under 3 year (6-35 months) olds are malnourished; 11.5 million severely malnourished; 47 million (74 percent) are anemic. There has been only a marginal improvement in the percent of children malnourished, decreasing from 52% to 47% of India s children under three years from to The decline has been less than one percentage point per year. Disaggregated data suggest higher malnutrition in rural populations (49.6 against 38.4 percent in urban areas), households of urban poor and from those belonging to Scheduled Castes (53.5 percent), Scheduled Tribes (55.9 percent) and among those with illiterate mothers (55.9 percent) and among those will illiterate mothers (55.0 percentage). Traditionally, it was reported that close to 33% of children born in India are of low birth weight. Recent NFHS-2 data suggest that the proportion could be still as high as 22% although this is probably an underestimate since data are available only for 25% of infants. The proportion is 6% in China ad Thailand, 8% in Indonesia and 9% in Malaysia. Only 50 percent of all households are currently using iodized salt. There are additional implications as well of the lifting of the ban of iodized salt. A critical requirement for making major progress on malnutrition is improvement in early childcare practices. Care for girls and women during pregnancy and lactation; their physical health and nutritional status, autonomy and respect in the family and considerations of workload and time. Birth spacing, delayed age at first birth and equal access to education are also essentials element of care practices. STATE LEVEL STATUS The child survival indicator Maharashtra is very critical and needs special and focused strategies to address them. The situation of women and children in Maharashtra is as follows: Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 19

20 50% of children under age 3 are moderately to severely malnourished in Maharashtra. Proportion of low birth weight babies is % of children between 6 to 35 months of age are anemic. Progress in reducing malnutrition has been relatively slow. IMR: 49% Neonatal deaths are over 60% of infant deaths. LBW incidence is 25%. Sagging immunization levels. Poor feeding and caring practices among the 0-3 years old children contributing to a large extent to high levels of malnutrition 50% (NFHS II) Anemia among women 49%. Adolescent anemia 68%. 2. MAJOR INTERVENTIONS DURING LAST MPO A Major activity has been on the joint training of ICDS and health functionaries focusing on pregnant mothers and children below 3 years and helping them develop and implement common plans of action. This 6-days training is being implemented in the districts of Nashik, Thane, Latur, Nanded, Osmanabad, Aurangabad and Gadchirolli and discussions have been on to introduce this in the World bank supported ICDS (III). More than 3500 anganwadi workers and ANMs have been trained during the year The programme has also been initiated in two blocks each of Yavatmal and Chandrapur districts integrating this with the micro planning process under the Primary Education Enhancement project. Adolescent Girls Anemia Control Programme has been initiated in Nashik District and will be introduced in Nanded, Osmanabad, Latur and Mumbai during this year covering both schooling and non-schooling girls. Early Childhood Care for Survival Growth and Development is being implemented through the SNDT University in four ICDS projects of Mumbai with the goal of developing appropriate training modules for effective interventions for children three years. UNICEF during 2001 will also be supporting the training of untrained anganwadi workers through an 18-day foundation course and will also work closely with the government in strengthening and capacity building of anganwadi workers training centers (AWTCs). Strengthening of the Vitamin A supplementation across the state. Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 20

21 UNICEF in collaboration with Department of women & Children, GOM focused on following key areas: Strengthening ICDS Support in development and finalization of the project proposal for World Bank supported ICDS III. Series of consultations were facilitated with technical experts, NGOs and Government functionaries to prepare the framework for the proposal. One of the major break through has been: - First State of focus on Urban ICDS in the proposal. - Excellent co-ordination with sectoral departments such as Health / DWCD / Urban / Rural / Tribal etc. to work put the strategy for implementation. Supported the social assessment study for ICDS III, which was judged the best in the country. Development of decentralized training strategy for ICDS III. Up gradation of existing MLTC & AWTC. Orientation and training of Deputy CEOs ICDS and AWTC on early Childhood care for Survival Growth and Development focus on under 3 years. Commissioned Research proposal with TISS to study quali9tative aspects of ECE imparted in AWW/NGOs of Mumbai. Study completed and findings to be incorporated in ICDS III. Commissioned Research with TISS to study the impact of training on AWWs performance and workload. Study under completion. The Action Research project with Department of Post Graduate Studies and Research in Home Science SNDT Women s University is working in urban blocks to enhance the capacities of AWW and mothers to improve growth of children (0-2) years. Training manual is being developed for AWW on specific inputs on (0-2) years based on this experiment. Excellent urban projects, which could be replicated through, trained AWW and mother leaders from the project areas. It is a pilot project country, which focused on feeding and caring practices. The project of improving the early childhood stimulation in children through care, implemented by Centre for Learning Resources (CLR), Pune in collaboration with Urban ICDS in Hadapsar Block. Another pilot project in the country to look at 0-2 for psychosocial development. MCHN Joint Training at block/district level in coordination with Health and ICDS (AWW & ANM) for effective delivery of services and reach out to the targeted group. Almost 50% Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 21

22 districts being covered through creation of resource persons from ICDS, Health & NGOs to support trainings in district/blocks. These trainers could be used to support the decentralized training in the blocks. Strengthen alliance to reach out to (0-2) The Breastfeeding Promotion Network of India (NGO by Pediatricians) Maharashtra Branch has been actively involved in sensitizing the medical fraternity/ngos/government functionaries of Health, ICDS, Corporate Sectors and Academic Institutions to strongly promote breastfeeding practices among mothers of Rural and Urban Maharashtra. Effort is to reach out to more professional from medical field in different districts of Maharashtra to influence Breastfeeding practices. The BPNI Maharashtra branch is now working in highrisk districts to focus on 0-2 years, sensitizing of crèche workers association and training and organization of traditional Malishwali basis as agents of change in the communities. The Maharashtra branch is extremely active and participates in policy decisions. Support to ACASH an NGO actively involved in promotion of breastfeeding by sensitizing Elected Representatives, community health workers and other NGOs in the field. Specific initiatives to address micronutrient deficiencies The project on reduction of Nutritional Anemia among adolescence is a district-based intervention in Nashik rural/urban/tribal focusing on girls (14-18) years, school going and non-school going. This project envisages girls empowerment, their improvement in the nutritional and health status and participation in the development process. A long-term impact could be informed adolescence and reduction of LBW. This project is implemented by Zilla Parishad Nashik involving Health/ICDS/Education and specific urban initiative through Municipal Corporation. The reduction of LBW project is being implemented by the PSM Department of B.J. Medical College. Pune as an experimental; and collaborative project is being planned in Nandurbar. Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 22

23 3. LESSONS LEARNT AT STATE LEVEL If systems are sensitized and they are convinced along with strong community process, the initiative is sustainable. Special efforts are still needed to network with more partners and strengthen their capacity to reach out to unreachable. System s capacity to be strengthened by training and education so that they are capable to implement child friendly initiatives. Need to support Government to develop viable MIS which facilities programmatic decision sand empowers programmes managers. Special efforts are needed to facilitate Inter-sectoral convergence. State level advocacy efforts to be strengthened in context of rights based programming. More action research to be supported in specific areas (0-2) years. Assessment of feeding and caring practices. Process documentation and dissemination at all levels to be strengthened for influencing policies, programmes and thus implementation. Strengthening women s participation in ICDS and micronutrients and health programme through formation and strengthening of self help groups (SHG)/CBO. The SHGs to be involved in caring and feeling practices for optimal development of children s mental and social abilities. 4. PROGRAMMING IN OUTPUTS: The existing positive feeding caring practices would be assessed and documented. Pilot innovation projects on the topic would be scaled up and integrated in the mainstream. Families would be knowledgeable on danger signs, home care management and would do timely referrals. Families would be familiar and practice home hygiene. PHCs and other local health centers would be geared to handle emergency neonatal and pediatric emergencies.. Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 23

24 Communities would be enabled to promote, protect, support and monitor services by established community planning, implementation and monitoring system for reporting on neonatal and IMR. State nutrition policy would be rejuvenated. Access to services for HB estimation would be in place. Access to services deworming and management of anemia would be in place. Access to and participation in adolescent peer group would be in place. Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 24

25 Results frame work State program of operations (Maharashtra) All children, adolescents, young people expectant & nursing mothers with their rights to survival, development, protection & full participation is ensured in the state public policies All children from < 3 years of age with their rights guaranteed and effectively implemented All children and adolescent of school going age (6-14 yrs.) included in the state public policies ensuring their healthier growth to develop their full potentials Every adolescent & young people is protected against HIV and his right to education, health, livelihood, social justice and full participation guaranteed (10-24 yrs.) SR 1 Every child survives and grows to its full potential SR 1 Every child enjoys learning SR 1 Every adolescent and young people has capability to protect him/herself from HIV SR 2 Every mother survives & is cared for SR 2 Every child protected from abuse and exploitation SR 2 Every adolescent and young people has access to services/ condoms SR 3 Government system and civil societies are responsive to the needs and rights of the young people SR 4 Every adolescent and young people is protected from coercive sex SR 5 Specially vulnerable adolescents and young people are protected Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 25 SR 6 Every adolescent girl will have the right level of hemoglobin (12 gms >)

26 Child Development & Nutrition - Results Framework Maharashtra Strategic result Every child survives and grows to its full potential. Outcome Output Families adopting positive feeding & caring practices Improved quality of MCP session Empathetic & skilled staff in place Facilities adequate with equipment & with regular supplies Families & caregivers practicing positive infant & young child feeding & caring, influence other care givers & the community to adopt positive practices The existing positive feeding caring practices assessed & documented Pilot innovation projects (Urban, rural/tribal) scaled up & integrated in the mainstream Every child has access to quality services Every family has access to safe water Families knowledgeable on danger signs, home care management and timely referrals Families practicing home hygiene practices Families empowered for acre of pregnant women & children under the age of 1 Establish community planning, implementation & monitoring system for reporting on new natal & IMR Competencies of PHCs & other health services strengthen to acre for pregnant women & children under 1 PHCs & other local health centers are geared to handle emergency neonatal & pediatric emergencies Adequate health & ICDS infrastructure including water, toilet & sanitation facilities Community to promote, protects, support & monitor services Improved use of MIS for planning, evaluation, monitoring & feed backs at all levels Communities aware about MCH, HIV/ AIDs, nutrition, sanitation & hygiene, trafficking & sexual exploitation issues & disaster preparedness Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 26

27 Activity Develop appropriate tools for training & for ensuring that quality care reaches the child Community monitoring of nutrition & health status Enhance capacity of caregivers including fathers, Government functionaries & women s group Integrate vertical programs like Vitamin A, nutritional anemia, infant young child feeding, pulse polio etc into IECD framework Building capacity within families using positive deviance approach Facilitate & strengthen use of MIS for planning, evaluation, monitoring & feed backs at all levels Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 27

28 Child Development & Nutrition - Results Framework Maharashtra Strategic result Every mother survives & is fully cared for Outcome Responsive legislation policies and procedures in place Output Communities knowledgeable about legislation, policies and procedures Think tank in place to review, guide and influence policies and legislation A strong database with a system of updating in place Improved use of MIS for planning, evaluation, monitoring & feed backs at all levels Activity Improve quality of MCP sessions by providing minimum integrated package with special focus on care component of mother and child Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 28

29 Child Development & Nutrition - Results Framework Maharashtra Strategic result Every adolescent girl will have appropriate HB level (12 gm and above) Outcome Every adolescent girl will have a positive selfesteem Every adolescent girl & her family will practice good personal hygiene Every adolescent girl & her family will be knowledgeable about iron rich food Every adolescent girl would be knowledgeable about her HB level (Anemia) Output Access to & participation in adolescent peer groups Creation of awareness through school curriculum or life skills education Access to services for HB estimation State nutrition policy rejuvenated Access to services for de-worming & management of anemia Sensitive, informed & supportive community Increased local availability of iron rich food Access to toilet facilities & adequate water supply Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 29

30 LOG FRAME FOR STATE PLAN OF ACTION All children from < 3 years of age with their rights guaranteed and effectively implemented No. Levels Indicators MOV Assumptions 1.1 SR 1 Every child survives and develops IMR reduced to its full potential All children in school Outcome Every family practicing appropriate feeding and caring practices Percentage of families knowledgeable about proper feeding and caring practices. Proportion of mothers initiating breast feeding within half an hour of delivery Proportions of infants below 6 months on exclusive breast feeding Proportion of mothers providing complementary feeding from 6 months onwards Monitoring of growth chart Number of deliveries by trained person Output Improve quality of MCP sessions Number of MCP sessions held Resource persons of MCP National health survey records Human development report ICDS records MIS records of health department of GOM Available records with ANM and at Panchayat MIS records of health department Effective implementation of SJSY, SJSRY Effective implementation of SSA, NH Program Successful micro planning ICDS strengthen Women s group developed with regularity of meetings Availability of growth chart Mother s trained to interpret the growth chart Proper awareness and mobilization of participants for MCP sessions Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 30

31 sessions Proportion of children immunized, receiving vitamin A, receiving treatment for minor ailments Empathetic and skilled staff in place Specially designed training program implemented by the Government as a measure of staff development Facilities adequate with equipment and with regular supplies Adequate health and ICDS infrastructure including water, toilet and sanitation facilities in place Families and caregivers practicing positive infant and young child feeding and caring, influence other caregivers and the community Adequate funds allocated by the state Government Timely supply of equipments and other necessitates District offices have adequate knowledge on the existing and available infrastructure of all ICDS centers in the district. The infrastructure of all ICDS centers is equipped with basic minimum facilities as prescribed in the mandate Families with positive care giving practice identified by the NGOs/ CBOs/ Panchayats A sharing mechanism developed and implemented on a regular basis ICDS records Timely supply of Vitamins A Referral system strengthened Timely immunization with cold chain maintained Records of training program with course content Government budget and public expenditure statement District office records available Sample survey report of selected ICDS centers Records maintained by NGOs/ Panchayats Records on number of sessions held, visits undertaken by the facilitator Effective sensitization method used in the training Proper channeling of young doctors energy and enthusiasm Supply chain management system developed District database sedated regularly Survey research framework prepared and implemented NGOs/ CBOs identified and oriented to act as facilitators for encouraging families Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 31

32 The existing positive feeding caring practices assessed and documented Pilot innovative projects scaled up and integrated in the mainstream Every child/ women has access to quality services Allocation of funds for assessment Job allotted to specialized agencies for assessment of feeding and caring practices as well as documentation Number of districts adopting the innovative projects Adequate funds allocated for the specific innovative projects, which is incorporated in the state health plan. Persons identified for implementation of the project. A minimum package focusing on must learn skills in use Community aware of child rights Quality services defined and understood by all implementing authorities Every family has access to safe water Proportionately increased number of potable water source available within reasonable distance Proportionate reduction in water borne disease Families knowledgeable on danger signs, home care management and timely referrals Increased proportion of deliveries conducted by trained person Government financial report Assessment report from expert agency TOR for assessment ready State health plan document Minutes of the meeting with GOM Quality service manual developed District / block records of number of new water sources developed Records on incidences of water bond disease at PHC/health centers Health department MIS records Village micro plan Partner agency for documentation identified and appointed as per TOR Proper policy advocacy strategy developed and follow up with government All agencies agreeing to a common agenda of Quality services Regular maintenance of water sources Drought proofing measures implemented properly Strategies to strengthen PHCs/ HCs in place Regularity of MCP Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 32

33 Proportionate increase in number of emergencies handled at the referral center Reduction in the proportionate number of maternal deaths and increased number of mothers seeking timely care Families observing home hygiene practices Proportionate number of families having soaking pits Proportionate number of families using appropriate drinking water storage Proportionate number of families using sanitary toilets Proportionate number of families taking part in Gram Swachhata Abhiyan Urban indicators to be Community promotes, protects, supports and monitor services developed Active community participation in evolving a community mechanism for monitoring. Proportionately increased number of community volunteers trained in repair and servicing of drinking water source. Community actively promoting home hygiene. PHC / HC record regarding hygiene related diseases Unicef survey report Micro plan document. Records maintained by the training authorities at block/district level Government authorities/ NGOs. programs Regularity of ANM visits and work monitored Regularity of MCP sessions Village/ community undertaken micro plan Appropriate micro planning training imparted to the community. Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 33

34 1.1.4 Families empowered for care of pregnant women and children under the age of Establish community planning, implementation and monitoring system for reporting on neonatal and IMR Increase in number of families attending health clinic Number of families taking benefit from SJSY and SJSRY schemes Increase in number of children attending ICDS centers Decrease in IMR Decrease in MMR Decrease in number of normal deliveries Proportionate increase in the number of deliveries by trained person Increase in number of breast feeding after child birth Increase number of pre natal check ups Increase attendance in MCP sessions Community micro plan Training of identified people / CBOs from community on neonatal and IMR issues Panchayat samiti discussing on issues related to IMR and MMR Special monitoring group identified by Panchayat Existing active SHGs Records of PHC Panchayat records Loan records of bank ICDS records PHC records MIS records of health department Government of Maharashtra Community micro plan document Record of number of training programs (Government/ Unicef/ NGOs) Minutes of the meeting of Panchayat samiti Minutes of the meetings of Health centers accessible and within reasonable distance Availability of doctor MCP session being held regularly and families attending them Functional ICDS center Regular maintenance of PHC records Effective implementation of micro planning training at community level Appropriate fund allocation by Government Involvement of NGOs Panchayat samiti giving appropriate importance to IMR and MMR issues Appropriate awareness Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 34

35 1.1.5 Competencies of PHCs and other health services strengthen to care for pregnant women and children PHCs and other local health centers are geared to handle emergency neonatal and pediatric emergencies Every family practices correct home care management and timely referral implementing and monitoring IMR and neonatal issues SHGs promoted / established specifically for IMR and neonatal issues Allocation of budget by the Government for strengthening the PHCs Regular training and updating of the PHC staff Adequate supply chain management in place Periodic visit of senior district authorities Increased number of emergency cases handled at PHC and local health center level Timely supply of necessary supplies and equipments Skilled professional and workers available at PHC/ health center Proportionate increased number of families undertaking neonatal care at health centers Proportionate increased SHGs Records of number of new SHGs Government annual expenditure document Records for number of training programs for PHC staff Stock records from supply chain management department Visit report at the PHC Daily medical records of PHC MIS records of GOM Stock records at PHC / health center Daily medical record of PHC MIS records of GOM ICDS records created amongst women Effective functioning of women s group Appropriate emphasis given by the government for upgrading and updating PHCs in their plan document Appropriate and user friendly supply chain management system developed Senior Governemnt official taking interest in visit to PHCs Appropriate emphasis given by the government for upgrading and updating PHCs in their plan document Appropriate and user friendly supply chain management system developed Effective MCP sessions and families motivated to attend the sessions Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 35

36 1.1.7 Every family practices good personal and home hygiene Communities promoting, supporting and monitoring services / coverage number of families encourage and practice breast feeding within half an hour of child birth Proportionate increased number of families having pregnant women at home has safe delivery kit Proportionate increased number of families having proper water storage and toilet facilities Proportionate number of families having socking pits Proportionate number of families using appropriate drinking water storage Proportionate number of families using sanitary toilets Proportionate number of families taking part in Gram Swachhata Abhiyan Urban indicators to be developed Community micro plan Training of identified people / CBOs from community on issues related to mother and child Panchayat samiti discussing on issues related to IMR and Delivery records of ANM Unicef survey records PHC / HC records regarding hygiene related diseases Unicef survey report Community micro plan document Record of number of training programs (Government/ Unicef/ NGOs) Minutes of the meeting of Panchayat samiti All families with pregnant women identified and supplied with the safe delivery kit Effective community group mobilized who would function as facilitator for promotion of safe habits Regularity of MCP sessions Village/ community undertaken micro plan Effective implementation of micro planning training at community level Appropriate fund allocation by Government Involvement of NGOs Panchayat samiti giving Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 36

37 MMR Special monitoring group identified by Panchayat Existing active SHGs implementing and monitoring IMR and neonatal issues SHGs promoted / established specifically for IMR and neonatal issues Minutes of the meeting of SHGs Records of number of new SHGs appropriate importance to IMR and MMR issues Appropriate awareness created amongst women Effective functioning of women s group Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 37

38 1 All children from < 3 years of age with their rights guaranteed and effectively implemented No. Levels Indicators MOV Assumptions 1.2 SR 2 Every mother survived and fully PHCs strengthen cared for appropriately Responsive legislation policies and procedures in place Communities knowledgeable about legislation, policies and procedures Number of mothers dying during child birth on decrease Maternal mortality rate on decrease Number of mothers attending pre, post and peri natal care centers on increase Government committees established with appropriate representation of multi disciplinary experts Seminars / workshops held to discuss on the subject and prepare framework Appropriate method of media campaigns designed by GOM and Unicef Actual campaign on legislation through various media Preparing brief and easy to Records of MMR during childbirth Records on percentage of attendance in prenatal /postnatal care clinics. Appropriate GR of GOM identifying the representatives in the committee TOR of the committee Minutes of the meetings of the committee Seminar/ workshop proceedings Unicef records on the subject as policy advocacy measure Campaign framework document MOUs of media agency undertaking the campaign TOR of consultant making the Political commitment towards enacting and enforcing of the legislation Committee meets regularly and work towards submitting their recommendations in a time bound manner Unicef takes appropriate policy advocacy measure and brings appropriate partnership between Governemnt, civil societies and NGOs on the legislation issue GOM has enacted the appropriate legislations Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 38

39 Think tank in place to review, guide and influence policies and legislation A strong database with a system of updating in place understand points regarding legislations for the benefit of the community Appointing of a committee for drafting policies and procedures to enact the legislation Appropriate policies and procedures drafted by the Governemnt through a drafting committee Mechanism designed by the GOM for implementing the legislation Community awareness program undertaken by NGOs / CBOs with Unicef support A multi disciplinary group established comprising of representative from NGOs, CBOs, academics, media and international organization including Unicef Periodic group meeting is held Government take cognizance of the group Database management framework ready Specific responsibility for management of database system established Training of all agency brief Government GR for appointing the committee Draft policies and procedures Implementing agency defined by the Government and record available Records from NGOs/ CBOs and Unicef MOV to be developed later All agencies and individual agree to form a common platform on the issue MOU of agency for preparing the database management system Number of training programs held of different agency responsible for providing data Allocation of budget by the Government Funding agency / Unicef providing support for the database management framework Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 39

40 1.2.2 Every family practices good personal and home hygiene Every family aware of danger signs and ensure timely referral Every women/ family practice good feeding and caring practices during pregnancy and lactation Communities promote and adopt right practices including prevention of teenage pregnancies responsible for feeding data Number of people / children on decrease for hygiene related diseases. (diarrhea, skin diseases etc.) Percentage of people seeking medical help for hygiene related diseases before reaching danger signs Awareness among people absent danger signs Families have access to poverty reduction programs thus no. of women can stay off work full time/ part time during pregnancy and lactation Number of families knowledgeable regarding importance about good nutrition during pregnancy and lactation. Number of teenage marriage Number of teenage mothers Number of couples using contraceptive methods Number of couples aware of the available choice of contraceptive methods. Awareness regarding consequences/ risks related to health of teenage mothers and Records of people suffering from hygiene related diseases. (Diarrhea, skin disease etc) from PHC/ health online Records at PHC/referral centers Rate of death due to hygiene related diseases. Attendance at awareness program Attendance of pregnant women at prenatal/ postnatal clinics. Number of breast feeding mothers Number of children/ infants with proper milestones/ growth Random feedback on nutritional status of pregnant and lactating mothers. Records from marriage offices Records from PHCs People/ communities are made aware regarding importance of hygiene in good health through awareness programs. Availability of PHCs/ referrals centers in close vicinity (about 5 km.) Awareness program conducted for explaining danger signs. Availability of prenatal/ postnatal clinics. And awareness programs on good feeding and caring practices. Awareness and health education program available to the communities Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 40

41 their children. 1 All children from < 3 years of age with their rights guaranteed and effectively implemented No. Levels Indicators MOV Assumptions 1.3 SR 3 Every child/ women has access Availability of MCH program to quality services High quality mother child protection sessions held regularly Number of children / women attending MCH program Number of children/ women attending Number of MCP sessions held Resource persons of MCP sessions Proportion of children immunized, receiving vitamin A, receiving treatment for minor ailments Empathetic and skilled staff in place Number of trained / qualified staff in the centers Facilities receiving needed equipment Number of existing and supplies in adequate quantities. equipments and supplies visà-vis Number of required equipment Adequate health/ ICDS structure including water and toilet facilities and supplies District offices have adequate knowledge on the existing and available infrastructure of all ICDS centers in the district. The infrastructure of all ICDS centers is equipped with basic minimum facilities as prescribed in the mandate Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 41 Records of PHC Records of MCH program run by NGO/CBO MIS records of health department ICDS records Proper awareness and mobilization of participants for MCP sessions Timely supply of Vitamins A Referral system strengthened Timely immunization with cold chain maintained Records of centers Availability and accessibility of training facilities. Records of equipment in Funding/ financial assistance service centers available. District office records available Sample survey report of selected ICDS centers Evaluation of health/ ICDs structures Random feedback regarding health/ ICDs structures at various levels. District database updated regularly Survey research framework prepared and implemented Funding/ financial assistance available

42 1 Every adolescent and young person is protected against HIV and his right to education, health, livelihood, social justice and full participation guaranteed. (10-24 years) No. Levels Indicators MOV Assumptions 1.4 SR 6 Every adolescent girl will have the right level of hemoglobin (12 gms>) Every adolescent girl will have positive self esteem Access to and participation in adolescent peer group. Increased proportion of PHCs having facilities for Hb test Percentage of adolescent with HB level 12 gms > on increase Increased proportion of families are knowledgeable on right Hb level of adolescent girls Access to poverty reduction program Increase number of awareness program on nutrition/ health/ gender issues Proportionately increased number of girls completing school education. Proportionately increased numbers of families are aware of girls education and nutrition. Increased number of adolescent peer group in the Records of Hb tests at PHCs/ health centers with 12 gms> Random check / survey for testing the Hb level of 12 gm> Records of sessions for adolescent girls on proper nutrition Records of awareness program on health of adolescent girls Random of program for reduction of gender bias Random check/ survey to assess attitudinal changes. Availability of HB testing Accuracy of HB testing Inputs on nutrition during adolescent for girls Programs on health of adolescent girls Program for reduction of gender bias and attitudinal changes School attendance record. Effective women s and empowerment program. Implementation of Life Skills Education. A community meeting records. Adequate promotion for formation of adolescent Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 42

43 community having regular meeting Every adolescent girl and her family will Increase in knowledge of good practice good personal hygiene hygiene practices Availability of water and sanitation Access to toilet facilities and adequate Increase in number of toilets. water supply Increase in number of developed water sources Creation of awareness through school Increase life skills education curriculum or life skills education sessions in schools Rejuvenated State nutrition policy A committee appointed by the Government to review State nutrition policy. Review committee report Sensitive, informed and supportive community Every adolescent girl and her family will be knowledgeable about ion rich food Increased local availability of iron rich food Every adolescent girl would be knowledgeable about her Hb level Proportionality increased number of people in the community are knowledgeable and observed good personal and home hygiene practices. Increased number of potable water sources. Increase in consumption of iron rich food (poverty reduction) Increase access to SJSY schemes Records of awareness sessions at PHC Block office/panchayat records. groups by facilitating agencies. Trained manpower Adequate allocation of Fund. Records of syllabus Trained manpower Records of lesson planning Review committee report. Adequate importance given on the situation of nutrition by the Government. Record on reduction of communicable and water bond diseases. Government record of drinking water sources. Records of awareness sessions on nutrition at PHCs Number of beneficiaries of poverty reduction program Increase in number of visits Consumption of iron tablets/ green vegetables Proportionately increased number of girls completing Effective awareness program carried by the Government/NGOs / CBOs,. Trained manpower Funds for poverty reduction program Availability of iron tablets / green vegetables School attendance record. Effective women s and empowerment program. Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 43

44 (Anemia) school education. Implementation of Life Skills Education Access to services for Hb estimation Increased no. of PHCs PHC record on assets and Skilled manpower for empowered for Hb testing facilities. undertaking Hb testing. facilities. Regular supplies Access to services for deworming and management of anemia Increased number of girls having access to nutritional program. Families empowered through poverty reduction program and aware on the protection of the girl child. Proportionately decrease in number of cases of malnutrition deaths and lactating mothers. PHC record on cases of anemia Adequate supply of deworming medicines. Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 44

45 Child Environment Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 45

46 Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 46

47 (II) CHILD ENVIRONMENT 1. SITUATION ANALYSIS NATIONAL LEVEL STATUS There had been a consistent improvement in the coverage in terms of access to safe drinking water. Some 83% of habilitations are fully covered, 15% are partially covered and only 2% of habitations are not covered. However, physical access does not always result in use. The MICS 2000 shows that about 80 percent of the population is taking their drinking water from a protected source (hand pump of piped water supply), leaving around 20 percent of the population using drinking water from unprotected sources, either by choice or by compulsion. Some 250,000 children under-5 years die annually from water borne diseases. The sustainability of water sources and supply is under threat due to environmental degradation because of over exploitation of ground water and salt-water intrusion into aquifers. Quality of drinking water is threatened by the presence of arsenic and fluoride in parts of the country. Drought of drinking water is threatened by the presence of arsenic and fluoride in parts of the country. Drought in many parts of the country, which are supposed to have achieved improved access tom drinking water, is now an annual occurrence. Drought mitigation can no longer be responded to on an emergency basis alone. Trends in sanitation coverage show a slow but steady increase, at over one percent per annum. According to MICS 2000, the proportion of households using toilets is around 37 percent nation-wide 19 percent in rural areas and 80 percent in urban areas. STATE LEVEL STATUS 50% of households have a source of drinking water within the premises. 47% of households in Maharashtra use a toilet or latrine facility. Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 47

48 The school Health & sanitation Programme has been the major success. Being implemented in the districts of Aurangabad, Pune, Nagpur, Jalna, Bhandara, Ahmednagar, Mumbai, Chandrapur and Yavatmal. The project aims at providing life skills to children while bringing about behavioral changes in families and communities. Water quality, personal and environment hygiene are essential components. The project also promotes construction of toilets; vermin culture and soak pits in schools and communities. 284 officials of the GSDA and 75 MJP engineers participated in the 6-day human resource development training. The CDD- WATSAN project initiated in Aurangabad covered the whole district through the Jeevan Dhara project. The project is also now been initiated in Nagpur. Sanitation Parks have been set in Aurangabad, Nashik and Pune. UNICEF has also been supporting various events that provide opportunities for children to voice their views and be heard. In the Water Sector, Sustainability has been seen as a major concern as the state struggles with 5500 tanker fed villages. Rainwater Harvesting is being considered as a serious option for both water security and recharge measures. The issue of water Quality will be the second major issue where the State has three problems Fluoride, salinity and Iron. The State is focused on Fluoride by tanking a complete survey of the two districts, Yavatmal and Chandrapur where the problem persists. The random sampling of water revealed that 39% of the sources were bacteriological contaminated. Water Quality monitoring on the bacteriological front is being considered as a community initiative. 2. MAJOR INTERVENTIONS DURING LAST MPO UNICEF support to the Water Sector ill the mid 1990s was hardware in nature focused mainly on drilling, standardization of hand pumps and operation and maintenance of the same. During this period indigenous equipment was developed for drilling. Hydro fracturing was introduced as a means of rejuvenation and support was provided for the same. In the field of sanitation, support was limited to promoting twin pit latrine with a high subsidy component both at the community and individuals household level. Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 48

49 For the period the new inputs for the water were: Rainwater Harvesting Unconventional means for water recharge Water Shed Water Quality On the sanitation Front, support was provided to the State s sanitation programme for training of engineers and masons for the construction of the twin pit latrine. The State s Programme with high subsidy failed to have an impact. Serious rethinking was required at this stage as the number of water supply schemes failed to meet their objectives due to high operational and maintenance costs. Subsequently, the sector reform criteria were adapted for all the 33 districts in the State. 3. LESSONS LEARNT AT STATE LEVEL Rainwater could be established with strong NGO support Technically sound. More time for settling. Unconventional measures and various Government agencies working together could provide quick development. Water Quality linkage with disease has helped cross section of grassroots level workers undergoing simultaneous training has shown results. Low cost sanitation measures like vermin culture and soakage pits have met with success but more information on low cost toilets is required. Some demonstration on community toilets has been acceptable. More need to be undertaken. School in Development has probably been the best one for behavioral change in children and communities. Children have played a major role in introducing concept of vermin culture and soak pits to families, plus enhancing personal and environmental hygiene. Sant Baba Gadge Abhiyan has possible shown better results and has helped to promote the sector reform strategy. Sector Reform awareness has been generated and support is required to this initiatives. Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 49

50 4. PROGRAMMING IN OUTPUTS Families would have access to poverty alleviation program. Communities would be aware regarding water legislation. Each family would have access to safe water. Each family would be observing home hygiene practices. Adequate school infrastructure including water, toilet and sanitation would be in place. Community would be able to promote, protect, support and monitor services. Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 50

51 Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 51

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53 Results frame work State program of operations (Maharashtra) All children, adolescents, young people expectant & nursing mothers with their rights to survival, development, protection & full participation is ensured in the state public policies All children from < 3 years of age with their rights guaranteed and effectively implemented All children and adolescent of school going age (6-14 yrs.) included in the state public policies ensuring their healthier growth to develop their full potentials Every adolescent & young people is protected against HIV and his right to education, health, livelihood, social justice and full participation guaranteed (10-24 yrs.) SR 1 Every child survives and grows to its full potential SR 1 Every child enjoys learning SR 1 Every adolescent and young people has capability to protect him/herself from HIV SR 2 Every mother survives & is cared for SR 2 Every child protected from abuse and exploitation SR 2 Every adolescent and young people has access to services/ condoms SR 3 Government system and civil societies are responsive to the needs and rights of the young people SR 4 Every adolescent and young people is protected from coercive sex SR 5 Specially vulnerable adolescents and young people are protected SR 6 Every adolescent girl will have the right level of hemoglobin (12 gms >) Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 53

54 Results frame work State program of operations (Maharashtra) All children from < 3 years of age with their rights guaranteed and effectively implemented SR 1 Every child survives and grows to its full potential Family to practice positive feeding and caring practices Improved quality of MCP session Empathetic & skilled staff in place Facilities adequate with equipment and with regular supplies Adequate health and ICDS infrastructure including water, toilet and sanitation facilities Families & caregivers practicing positive infant & young child feeding and caring, influence other care givers and the community. The existing positive feeding caring practices assessed and documented Pilot innovative projects (Urban, Rural/tribal) scaled up and integrated in the mainstream Every child has access to quality services Every family has access to safe water Families knowledgeable on danger signs, home care management and timely referrals Families observing home hygiene practices Community promotes, protects, supports and monitor services Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 54 Families empowered for care of pregnant women & children under the age of 1 Establish community planning, implementation & monitoring system for reporting on new natal and IMR Competencies of PHCs & other health services strengthen to care for pregnant women & children under 1 PHCs and other local health centers are geared to handle emergency neonatal and pediatric emergencies

55 Results frame work State program of operations (Maharashtra) All children and adolescent of school going age (6-14 yrs.) included in the state public policies ensuring their healthier growth to develop their full potentials SR 1 Every child enjoys learning Supportive Government policies, plans and guidelines in place Enabling family environment Child friendly schools promoting life skills Every child has access elementary school A think tank in place to guide and influence policies A strong usable data base Family not using children for household work at the cost of education and childhood Families have access to poverty alleviation program Appropriate curriculum/ syllabus Adequate school infrastructure including water, toilet and sanitation School feeding program with purpose and dignity An upper primary school available within 3 kms. Availability of school with competent teachers Active education committees/ PTA Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 55 School promoting & practicing co-curricular activities, fine arts & physical education

56 Child s Environment - Results framework Maharashtra Strategic result Every child survives and grows to its full potential Every child enjoys learning Outcome Every child has access to quality services Enabling family environment Child friendly schools promoting life skills Output Every family has access to safe water Families have access to poverty alleviation program Adequate school infrastructure including water, toilet and sanitation Family observing home hygiene practices Community awareness on water legislation Community promotes, protects, supports & monitor services Activity Capacity building of community through micro planning Evolving community monitoring system Facilitating liquid and solid waste management program Facilitating life skills program Preparation of community drought preparedness models Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 56

57 LOG FRAME FOR STATE PLAN OF ACTION All children from < 3 years of age with their rights guaranteed and effectively implemented No. Levels Indicators MOV Assumptions 1.1 SR 1 Every child survives and IMR reduced develops to its full potential All children in school Outcome Every family practicing appropriate feeding and caring practices Percentage of families knowledgeable about proper feeding and caring practices. Proportion of mothers initiating breast feeding within half an hour of delivery Proportions of infants below 6 months on exclusive breast feeding Proportion of mothers providing complementary feeding from 6 months onwards Monitoring of growth chart Number of deliveries by trained person Output Improve quality of MCP sessions Number of MCP sessions held Resource persons of MCP sessions Proportion of children immunized, receiving vitamin A, receiving treatment for minor National health survey records Human development report ICDS records MIS records of health department of GOM Available records with ANM and at Panchayat MIS records of health department ICDS records Effective implementation of SJSY, SJSRY Effective implementation of SSA, NH Program Successful micro planning ICDS strengthen Women s group developed with regularity of meetings Availability of growth chart Mother s trained to interpret the growth chart Proper awareness and mobilization of participants for MCP sessions Timely supply of Vitamins A Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 57

58 Empathetic and skilled staff in place Specially designed training program implemented by the Government as a measure of staff development Facilities adequate with equipment and with regular supplies Adequate health and ICDS infrastructure including water, toilet and sanitation facilities in place Families and caregivers practicing positive infant and young child feeding and caring, influence other caregivers and the community The existing positive feeding caring practices assessed and documented ailments Referral system strengthened Timely immunization with cold chain maintained Adequate funds allocated by the state Government Timely supply of equipments and other necessitates District offices have adequate knowledge on the existing and available infrastructure of all ICDS centers in the district. The infrastructure of all ICDS centers is equipped with basic minimum facilities as prescribed in the mandate Families with positive care giving practice identified by the NGOs/ CBOs/ Panchayats A sharing mechanism developed and implemented on a regular basis Allocation of funds for assessment Job allotted to specialized Records of training program with course content Government budget and public expenditure statement District office records available Sample survey report of selected ICDS centers Records maintained by NGOs/ Panchayats Records on number of sessions held, visits undertaken by the facilitator Government financial report Assessment report from Effective sensitization method used in the training Proper channeling of young doctors energy and enthusiasm Supply chain management system developed District database sedated regularly Survey research framework prepared and implemented NGOs/ CBOs identified and oriented to act as facilitators for encouraging families Partner agency for documentation identified and appointed as per Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 58

59 Pilot innovative projects scaled up and integrated in the mainstream Every child/ women has access to quality services agencies for assessment of feeding and caring practices as well as documentation Number of districts adopting the innovative projects Adequate funds allocated for the specific innovative projects, which is incorporated in the state health plan. Persons identified for implementation of the project. A minimum package focusing on must learn skills in use Community aware of child rights Quality services defined and understood by all implementing authorities Every family has access to safe water Proportionately increased number of potable water source available within reasonable distance Proportionate reduction in water borne disease Families knowledgeable on danger signs, home care management and timely referrals Increased proportion of deliveries conducted by trained person Proportionate increase in number of emergencies handled at the referral center Reduction in the proportionate number of maternal deaths and expert agency TOR for assessment ready State health plan document Minutes of the meeting with GOM Quality service manual developed District / block records of number of new water sources developed Records on incidences of water bond disease at PHC/health centers Health department MIS records Village micro plan TOR Proper policy advocacy strategy developed and follow up with government All agencies agreeing to a common agenda of Quality services Regular maintenance of water sources Drought proofing measures implemented properly Strategies to strengthen PHCs/ HCs in place Regularity of MCP programs Regularity of ANM visits and work monitored Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 59

60 Families observing home hygiene practices Community promotes, protects, supports and monitor services Families empowered for care of pregnant women and children under the age of 1 increased number of mothers seeking timely care Proportionate number of PHC / HC record Regularity of MCP families having soaking pits regarding hygiene sessions Proportionate number of related diseases Village/ community families using appropriate Unicef survey report undertaken micro plan drinking water storage Proportionate number of families using sanitary toilets Proportionate number of families taking part in Gram Swachhata Abhiyan Urban indicators to be developed Increase in number of families attending health clinic Number of families taking benefit from SJSY and SJSRY schemes Increase in number of children attending ICDS centers Decrease in IMR Decrease in MMR Decrease in number of normal deliveries Proportionate increase in the number of deliveries by trained person Increase in number of breast Records of PHC Panchayat records Loan records of bank ICDS records PHC records MIS records of health department Government of Maharashtra Health centers accessible and within reasonable distance Availability of doctor MCP session being held regularly and families attending them Functional ICDS center Regular maintenance of PHC records Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 60

61 Establish community planning, implementation and monitoring system for reporting on neonatal and IMR Competencies of PHCs and other health services strengthen to care for pregnant women and children feeding after child birth Increase number of pre natal check ups Increase attendance in MCP sessions Community micro plan Training of identified people / CBOs from community on neonatal and IMR issues Panchayat samiti discussing on issues related to IMR and MMR Special monitoring group identified by Panchayat Existing active SHGs implementing and monitoring IMR and neonatal issues SHGs promoted / established specifically for IMR and neonatal issues Allocation of budget by the Government for strengthening the PHCs Regular training and updating of the PHC staff Adequate supply chain management in place Periodic visit of senior district authorities Community micro plan document Record of number of training programs (Government/ Unicef/ NGOs) Minutes of the meeting of Panchayat samiti Minutes of the meetings of SHGs Records of number of new SHGs Government annual expenditure document Records for number of training programs for PHC staff Stock records from supply chain management department Visit report at the PHC Effective implementation of micro planning training at community level Appropriate fund allocation by Government Involvement of NGOs Panchayat samiti giving appropriate importance to IMR and MMR issues Appropriate awareness created amongst women Effective functioning of women s group Appropriate emphasis given by the government for upgrading and updating PHCs in their plan document Appropriate and user friendly supply chain management system developed Senior Governemnt official taking interest in visit to PHCs Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 61

62 PHCs and other local health centers are geared to handle emergency neonatal and pediatric emergencies Every family practices correct home care management and timely referral Every family practices good personal and home hygiene Increased number of emergency cases handled at PHC and local health center level Timely supply of necessary supplies and equipments Skilled professional and workers available at PHC/ health center Proportionate increased number of families undertaking neonatal care at health centers Proportionate increased number of families encourage and practice breast feeding within half an hour of child birth Proportionate increased number of families having pregnant women at home has safe delivery kit Proportionate increased number of families having proper water storage and toilet facilities Proportionate number of families having socking pits Proportionate number of families using appropriate drinking water storage Proportionate number of families using sanitary toilets Proportionate number of Daily medical records of PHC MIS records of GOM Stock records at PHC / health center Daily medical record of PHC MIS records of GOM ICDS records Delivery records of ANM Unicef survey records PHC / HC records regarding hygiene related diseases Unicef survey report Appropriate emphasis given by the government for upgrading and updating PHCs in their plan document Appropriate and user friendly supply chain management system developed Effective MCP sessions and families motivated to attend the sessions All families with pregnant women identified and supplied with the safe delivery kit Effective community group mobilized who would function as facilitator for promotion of safe habits Regularity of MCP sessions Village/ community undertaken micro plan Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 62

63 1.1.8 Communities promoting, supporting and monitoring services / coverage families taking part in Gram Swachhata Abhiyan Urban indicators to be developed Community micro plan Training of identified people / CBOs from community on issues related to mother and child Panchayat samiti discussing on issues related to IMR and MMR Special monitoring group identified by Panchayat Existing active SHGs implementing and monitoring IMR and neonatal issues SHGs promoted / established specifically for IMR and neonatal issues Community micro plan document Record of number of training programs (Government/ Unicef/ NGOs) Minutes of the meeting of Panchayat samiti Minutes of the meeting of SHGs Records of number of new SHGs Effective implementation of micro planning training at community level Appropriate fund allocation by Government Involvement of NGOs Panchayat samiti giving appropriate importance to IMR and MMR issues Appropriate awareness created amongst women Effective functioning of women s group No. Levels Indicators MOV Assumptions 2.1 SR 1 Every child enjoys learning, Implementation of UEE has access and completes good quality elementary education Percentage of children enrolled in primary schools Elements of quality education included in learning Proportion of children achieving 80% on competency based testing Proportion of tribal children attending schools Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 63 Number of children completing 4 th grade Records from schools / education department Sample survey of selected schools Random feedback from children education

64 2.1.1 Every child is supported by an enabling family environment Family not using children for household work at the cost of education and childhood Families have access to poverty alleviation program Every child has access to a primary and upper primary school Proportion of families being knowledgeable of their role in child development Percentage pf families having access to poverty alleviation program Families taking part in adult literacy program Proportion of children enrolled in the school Proportionate reduction in child labour in the local market / agricultural field Proportionate increase in girl child going to school Families not employing children for household work Proportion of families benefited from poverty reduction program Proportion of families increase in household assets Availability of different poverty alleviation program Active Panchayat samiti Proportionate and progressive reduction in child labour Proportion of children enrolled Sample survey of knowledge level parented on their role in children s progress Records of loan / subsidy in the lead bank for the village/ community Attendance at the adult literacy program School enrollment register Register of housing societies keeping statistics of children working within the society Unicef sample survey report Records at the block development office Records at Panchayat office Records of loan/ subsidy at the lead bank handling poverty reduction program Reports available on child labour School enrollment register Register of housing societies Government / NGOs undertaking awareness program on families supporting role towards child development Availability of poverty reduction program Government / NGOs initiating adult literacy program Families aware of law against child labour Proper enforcement of law against child labour Families knowledgeable about different poverty alleviation program and their eligibility criteria Appropriate propagation by Government / NGOs for creating awareness regarding poverty alleviation program Availability of primary schools within reasonable distance. Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 64

65 A primary school is available within 1.5 kms and upper primary school available within 3 kms Availability of school with competent teachers Child friendly schools promoting life skills in place in the school Proportionate reduction in child labour in the local market / agricultural field Proportionate increase in girl child going to school Families not employing children for household work Government allocating appropriate budget to fulfill the requirement within the plan period Constituting a task force towards achieving the result in providing the schools within stipulated time Proportionate increase in number of teachers training institutions Completing the filling up of all the vacant positions in the school Proportionate increase in appointment of lady teachers Proportionate increase in Government budget towards teachers salary Number of sessions taken for promoting life skills education in schools SCERT promoting life skill keeping statistics of children working within the society Unicef sample survey report Expenditure statement of department of education, GOM GR from GOM constituting the task force Statistics of increase number of teachers training institutions Statistics of annual turn over of trained teachers from institutions Advertisement by public service commission for recruitment of teachers Syllabus of school education includes life skills training Village micro plan Families aware of law against child labour Proper enforcement of law against child labour A strong political will to achieve UEE Availability of sufficient number of training institutes Appropriate budget allocation by the Government towards teachers salary Availability of oriented and trained teachers to teach life skills to children Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 65

66 Appropriate curriculum/ syllabus being used Adequate school infrastructure including water, toilet and sanitation School feeding program with purpose and dignity training Community monitoring mechanism in place Appropriate syllabus prepared for use Proportionate increase in the Government education budget and its utilization Proportionate number of children with adequate weight as per age Reduction in school drop outs Increased motivation of the children to attend the school Better all round performance of the children Active education committees/ PTA Community managed village education plan School promoting and practicing cocurricular activities, fine arts & physical education Supportive legislation, policy and plans implemented Increased number of districts implementing Schools In Development projects Increased number of schools promoting and practicing life skills education Government committees established with appropriate representation of multi disciplinary experts School syllabus content Expenditure statement of department of education in GOM Growth chart of the children Expenditure statement of the agency providing mid day meals School stock records School attendance register Performance record of the children Department of education has a list of schools for infrastructure development program and has send to finance Schools are supplied with growth chart that is maintained properly Availability of midday meals program in the school Motivated teachers and good team work Documented micro plan Micro planning training being imparted to the community District education office records Number of training programs on Life skills education Number of teachers trained in life skills education Appropriate GR of GOM identifying the representatives in the committee TOR of the committee District authorities giving sufficient importance to cocurricular activities and life skills education Political commitment towards enacting and enforcing of the legislation Committee meets regularly Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 66

67 A think tank in place to guide and influence policies Seminars / workshops held to discuss on the subject and prepare framework A multi disciplinary group established comprising of representative from NGOs, CBOs, academics, media and international organization including Unicef Periodic group meeting is held Government take cognizance of the group A strong usable data base Database management plan ready for implementation Database management framework ready Specific responsibility for management of database system established Training of all agency responsible for feeding data Minutes of the meeting of the committee Seminar/ workshop proceedings Unicef record on the subject as policy advocacy measure and work towards submitting their recommendations in a time bound manner Unicef takes appropriate policy advocacy measure and brings appropriate partnership between Governemnt, civil societies and NGOs on the legislation issue MOV to be developed later All agencies and individual agree to form a common platform on the issue MIS plan document MOU of agency for preparing the database management system Number of training programs held of different agency responsible for providing data Allocation of budget by the Government Funding agency / Unicef providing support for the database management framework Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 67

68 Child Protection Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 68

69 (III) CHILD PROTECTION 1. SITUATION ANALYSIS 1.1. NATIONAL LEVEL STATUS India has the largest number of child labourers in the world, estimated at between 44 to 100 million depending on the definition used. There continues to be high incidence of child labour and out-of-school children in India. There are several reasons ranging from poverty to the failure of policies especially to universalize elementary education. The problem is compounded by and also a consequence of caste, gender, ethnicity and other social and economic disparities. It is estimated that in six cities of India there are about 100,000 children who are victims of sexual exploitations. The number is likely to be gross under estimate given its limited coverage. Many cities in India have become the destination for cross-border trafficking of children, primarily for prostitution. Children and women in particular have been affected by situations of conflict within the country. Despite visible signs of improvement, the internal security situation in parts of India continues to be a cause for concern to Government. Violence and conflict affecting women and children are reported in Jammu & Kashmir and in parts of the North East, Andhra Pradesh, Bihar, Madhya Pradesh, Maharashtra and Orissa STATE LEVEL STATUS 5% of children aged 5 to 14 years in Maharashtra work as child laborers. Children in need of special protection and care include the most vulnerable categories of children whose rights are violated. These include children working in hazardous occupations, domestic child labour, children who are trafficking, sexually exploited, street children, children in institutions and other vulnerable children whose right are continuously denied. Despite Maharashtra being rich economically and culturally, the state still accounts for 9.5% of working children million children have been estimated to be working as per the 1991 census out of the 11.2 million in the country. Maharashtra ranks 4 th in the state. Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 69

70 Official s statistics reflect that 34% of children between 6 to 14 years have dropped out and thus about 65 lakh children are not in school who are either child labourers or have the potential to become one. 1,20,000 children have been sexually exploited and or trafficked out of the 500,000 children in prostitutions in India, which is about 41%. Out of these 70,000 are street children in India, 100,000 are in Mumbai alone. Destitute, abandoned and orphaned children in institutions number 84,724 in the state. Most of these children are excluded from mainstream social programmes and are thus denied their most basic of rights like education, access to health care, security and shelter. These children thus represent the most vulnerable of the un-reached population. Within these groups, the girl child bears the burnt of patriarchal and feudal value systems, and is thus a victim of sexual exploitation, abuse and gender discrimination. Such denials amount to failure to meet the obligation under the international covenant on civil and potential rights, legal instruments both national and state and the Convention on the rights of the Child. 2. MAJOR INTERVENTIONS DURING LAST MPO Prevention and rehabilitation of child labour Pilot community based projects. Influencing policies and review and amendment of legislation and rules. City level action for children in distress street children. Initiating and facilitating networking among NGO s Government departments and civil society to address issues of child rights, street children, child sexual abuse and child trafficking. Strengthening of Juvenile system children in institutions and promotion of non-institutional services. Prevention and rehabilitation of child trafficking and children in prostitution. Children affected by HIV/AIDS. Advocacy and accelerating CRC implementation support to the Child Rights Cell in the Department of Women and Child Development. PAST COOPERATION Successful print media campaign on child labour, with CACL leading to action by volunteer groups to work with NGOs in their task towards the prevention and rehabilitation of child labour. Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 70

71 State wide training of Labour inspectors, NGOs and others on prevention of child labour to widen the protective safely net. Demonstration of innovative community based strategies on child layout Parbhani, Aurangabad and Bhiwandi, children working in slaughterhouses, children working in Power looms in Bhiwandi. The Parbhani project is a good model demonstrating the convergence of various government departments like Health, Education, Urban development and civil society including elected representatives in jointly addressing the problem. Review and amendment of Child Labour Act (1986) rules and adoption of the same support in the amendment of women s policy and the children s policy. Review of JJA and ITPA rules. Landmark High court judgment to institutionalize CRC in the training pf Judges, formation of a committee to oversee the functioning of institutions for children. Networking against trafficking and child sexual abuse NACSET has collaborations in 22 districts and has been able to advocate the cause right up to the CM with the support of Principal Secretary DWCD. Making health services accessible to street children Opening up of the Municipal Hospital (Nair Hospital) to make health services accessible to street children a collaborative effort between BMC, AAMRAE and UNICEF. Establishing Child line in the hospital premises of Nair Hospital. Forging linkages on accelerating child right in Pune, Mumbai and Nashik. Thorough support to Networks between NGO s, government partners and civil society. Innovative programming on child s right to participation in Thane district. Support to Child Line in four cities Nagpur, Pune, Mumbai and Sholapur. Emergency response to children affected by earthquake Bal Sangopan Yojana a scheme, which prevented the institutionalization of children, now implemented in 1 district. Strategy adopted Government as an emergency response. First state to have Child Rights Cell. Strengthening of the Juvenile Justice System JJA implementation study in the state, training on JJA to all 30 boards and superintendents of Govt. run homes, sensitization training to Probation Officers and care takers of home, interactive workshops for adolescent girls of institutions etc. Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 71

72 Based on a state consultation of UNICEF with NGOs and Govt. experts to identify key thrust areas and interventions to address the same, five major groups were identified as key issues these are as follows: 1. Children under the juvenile justice system. 2. Children who need care and protection. 3. Children affected by HIV/AIDS. 4. Children out of school Child labour. 5. Child sexual abuse / exploitation and child trafficking. The SPO will be addressing these areas during LESSONS LEARNT AT STATE LEVEL Growing awareness of CRC not seen only as morally binding but legally as well. Citing of the CEDAW in the Visakha case to pass a ruling, public interest litigation, actions by FACSE against the Swedish couple, Bhiwandi, children s aid society. Issues such as exploitative child labour, child trafficking, child sexual abuse openly addressed by government and civil society. Rehabilitation of child labour is possible in the poorest of communities if all sectors come together (district administration, key sectors and civil society). While Education is the key strategy, other issues such as women s empowerment, vocational training, and poverty alleviation strategies should also be in place. Recognition of the role of NGOs in both programmes design, demonstration of innovative strategies and advocacy as a key and important partner. Advantages of networking alliances to create a wider safety net for children in need of special protection and care such as CCVC, ARC, LVSS, FACSE, NACSET. Importance of advocacy with other influential systems such as judiciary, Policy and others. Absence of reliable data as the basis of programming. Need for the documentation and dissemination of cost effective and sustainable strategies for wider replication and as tool for advocating with policy makers. Above interventions can help. Wide spread media campaign and sensitization training for functionaries, teachers, hospital staff etc. Absence of reliable data. Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 72

73 4. PROGRAMMING IN OUTPUTS A strong database would in place by targeting sources for proactive interventions. Quality primary education, enrollment and prevention of school dropouts would be ensured. Child friendly judiciary and police would be in place by building capacities of allied systems. Community based safety network (vigilance) through state and district networks on trafficking on child protection would be present and public discourse/debates through sensitized and responsive media. CBO/ SHGs would be in place monitoring child protection issues and would have access to dropping centers with opportunities for recreation/counseling facilities. Legislation on child labour with mandatory regulation would be place. Networks for prevention and protection of child abuse and exploitation as well as for rehabilitation of such victims would be developed. A strong database would be in place. Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 73

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75 Results frame work State program of operations (Maharashtra) All children, adolescents, young people expectant & nursing mothers with their rights to survival, development, protection & full participation is ensured in the state public policies All children from < 3 years of age with their rights guaranteed and effectively implemented All children and adolescent of school going age (6-14 yrs.) included in the state public policies ensuring their healthier growth to develop their full potentials Every adolescent & young people is protected against HIV and his right to education, health, livelihood, social justice and full participation guaranteed (10-24 yrs.) SR 1 Every child survives and grows to its full potential SR 1 Every child enjoys learning SR 1 Every adolescent and young people has capability to protect him/herself from HIV SR 2 Every mother survives & is cared for SR 2 Every child protected from abuse and exploitation SR 2 Every adolescent and young people has access to services/ condoms SR 3 Government system and civil societies are responsive to the needs and rights of the young people SR 4 Every adolescent and young people is protected from coercive sex SR 5 Specially vulnerable adolescents and young people are protected Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 75 SR 6 Every adolescent girl will have the right level of hemoglobin (12 gms >)

76 Results frame work State program of operations (Maharashtra) All children and adolescent of school going age (6-14 yrs.) included in the state public policies ensuring their healthier growth to develop their full potentials SR 2 Every child protected from abuse and exploitation Supportive & pro-active legislation policies and procedures with effective implementation and monitoring Every child s right to individuality & participation is respected with access to priority services/ system Sensitized & aware communities actively supporting prevention of trafficking & abuse of children Sensitized & empowered families/ communities with positive outlook for better protection of children Pro-active alliances / partners in place Rules/ policies to facilitate in place Legislation on child labour with mandatory regulation in place Think tank to review guide & influence policies Enabling networks for prevention, protection & rehabilitation developed Modules prepared & incorporated in the curriculum of training of allied services A strong database Target sources are for proactive interventions Ensured quality primary education, enrollment & prevention of school dropouts Child friendly judiciary and police Capacitated allied system in place Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 76 CBO/ SHGs monitoring child protection issues Access to dropping centers with opportunities for recreation / counseling facilities Community based safety network (vigilance) State & district networks on trafficking on child protection established Public discourse/ debate through sensitized & responsive media

77 Child Protection - Results Framework Maharashtra Strategic result Every child protected from abuse and exploitation. Outcome Supportive & proactive legislation & policies to prevent child labour with effective implementation & monitoring Every child s right to individuality & participation is respected with access to priority services/ system Sensitized & aware communities actively supporting prevention of trafficking & abuse of children Sensitized & empowered families/ communities with positive outlook for better protection of children Proactive alliances / partners in place Output Rules / procedures to facilitate in place Legislation on child labour with mandatory regulation in place Think tank to review guide & influence policies Enabling networks for prevention, protection & rehabilitation developed A strong database Target sources for proactive interventions Ensured quality primary education, enrollment & prevention of school dropouts Child friendly judiciary & police Capacitated allied system in place CBO/ SHGs monitoring child protection issues Access to dropping centers with opportunities for recreation/ counseling facilities Community based safety network (vigilance) State & district networks on trafficking on child protection established Public discourse/ debate through sensitized & responsive media Modules prepared & incorporated in the curriculum of training of all allied services Improved use of MIS for planning, evaluation, monitoring & feed backs at all levels Communities aware about MCH, HIV/ AIDs, nutrition, sanitation & hygiene, trafficking & sexual exploitation issues & disaster preparedness Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 77

78 Activity Community based convergent model of elimination & rehabilitation of working children in abattoirs of Parbhani, Aurangabad and Thane Support to the Finnish committee for UNICEF funded project for the elimination and rehabilitation of children working in power looms Bhiwandi and Malegaon Support to the Harvard/ UNICEF collaboration project in the elimination & rehabilitation of children working in the Zari industry in Mumbai slums Support forum against domestic child labour *BHU) Mumbai to highlight the rights violation of domestic child workers and to bring about a public Support media initiatives to highlight issues regarding the violation and abuse of children s rights Support the state DWCD in rehabilitation of rescued minors from CSEC with counseling and other services Pune & Mumbai Contribute to the NHRC study on trafficking of women & children in Maharashtra Facilitate the mobilization of CSWs to prevent trafficking of minor & second generation trafficking Mumbai red light areas & Ahmednagar Anthropological study of CSWs to better understand reasons for migration/ trafficking & develop interventions at Support NACSET NGOs/ CBO forum against trafficking in all districts of Maharashtra Support SHG linkage with/ as child protection committees to prevent the exploitation & abuse of children. Nasik/ Parbhani Facilitate institutionalized training support of both police and judiciary through the official academic training institutes Facilitate an epidemiological study of children of CSWs to understand the prevalence of HIV/ AIDs and establish the correlation if any Support the development of a module on child for child sexual abuse, which will be integrated into all other training. Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 78

79 2 Every child in the school going age (6-14) with its rights protected and progressively fulfilled. No. Levels Indicators MOV Assumptions 2.2 SR 2 Every child protected from abuse, exploitation and violence Sensitized & empowered families/ communities protecting children CBOs/ SHGs monitoring child protection issues Access to drop in centers with opportunities for recreation/ counseling facilities Proportion of reduction in the reported cases of child abuse, exploitation and violence Increased awareness regarding child rights and abuse in society in general and children in particular Families having access to poverty reduction program including adult literacy and health Number of functional community vigilance squad Number of actively functioning networks established Funds allocated by Government for drop-in centers NGOs are encouraged for opening of drop-in centers Child friendly judiciary and police Number of children rescue and prevented from trafficking Number of cases registered under CLPR act and number of children rescued Every child s right to individuality and participation is respected with access to priority services/ system Increased proportion of children in school and participating in various activities of their choice Records with police, NGOs/ CBOs Random feedback on abuse related behavior and its consequences Publicity to case studies on the issue Local government record sources Records at Panchayat level/ district level Number of drop in centers Number of beneficiaries at drop in centers Records at Police station Records with NGOs involved in the child protection issues Records of education department (GOM) Awareness program in place and on rise regarding child rights regarding abuse etc Availability of poverty reduction program Adequate training being imparted to the community vigilance squad Trained manpower Awareness regarding drop in centers Police authority registering the complaint of the complainant without prejudice Effective school leadership promoting and practicing all round development curriculum Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 79

80 A strong database Network and coordination for data collection between Governemnt, NGOs and CBOs Planning for creating database Database management plan ready for implementation Database management framework ready Specific responsibility for management of database system established Training of all agency responsible for feeding data Target sources for proactive interventions Ensured quality primary education enrollment and prevention of school dropouts Increased number of schools using child participation method of teaching Increased number of schools facilitating Life skills education Increase number of children enrolled for primary education Increase number of drop outs Child friendly judiciary and police Number of children rescue and prevented from trafficking Number of cases registered under CLPR act and number of children rescued Access to drop in centers with opportunities for recreation/ counseling facilities Funds allocated by Government for drop-in centers NGOs are encouraged for opening of drop-in centers Directory on service by Government / NGOs/ CBOs Annual report on situation document (current) MIS plan document MOU of agency for preparing the database management system Number of training programs held of different agency responsible for providing data District education office records School records on cocurricular activities Records of education department Records at Police station Records with NGOs involved in the child protection issues Number of drop in centers Number of beneficiaries at drop in centers Allocation of budget by the Government Funding agency / Unicef providing support for the database management framework Promotion of co-curricular activities by the district authorities with adequate budget allocation Effective implementation and monitoring of SSA (UEE) Police authority registering the complaint of the complainant without prejudice Trained manpower Awareness regarding drop in centers Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 80

81 2.2.3 Supportive legislation, policies and plans implemented Government committees established with appropriate representation of multi disciplinary experts Seminars / workshops held to discuss on the subject and prepare framework Rules/ policies to facilitate in place Proportion of children enrolled in the school Proportionate reduction in child labour in the local market / agricultural field Proportionate increase in girl child going to school Families not employing children for household work Legislation on child labour with mandatory regulation in place Appropriate method of media campaigns designed by GOM and Unicef Actual campaign on legislation through various media Preparing brief and easy to understand points regarding Appropriate GR of GOM identifying the representatives in the committee TOR of the committee Minutes of the meeting of the committee Seminar/ workshop proceedings Unicef record on the subject as policy advocacy measure School enrollment register Register of housing societies keeping statistics of children working within the society Unicef sample survey report Campaign framework document MOUs of media agency undertaking the campaign TOR of consultant making Political commitment towards enacting and enforcing of the legislation Committee meets regularly and work towards submitting their recommendations in a time bound manner Unicef takes appropriate policy advocacy measure and brings appropriate partnership between Governemnt, civil societies and NGOs on the legislation issue Families aware of law against child labour Proper enforcement of law against child labour Government enacting law with appropriate measures for positive discriminations towards promoting education of girl child GOM has enacted the appropriate legislations Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 81

82 Credible knowledge management in place to review guide and influence policies Enabling networks for prevention, protection and rehabilitation developed legislations for the benefit of the community Appointing of a committee for drafting policies and procedures to enact the legislation Appropriate policies and procedures drafted by the Governemnt through a drafting committee Mechanism designed by the GOM for implementing the legislation Community awareness program undertaken by NGOs / CBOs with Unicef support A multi disciplinary group established comprising of representative from NGOs, CBOs, academics, media and international organization including Unicef Periodic group meeting is held Government take cognizance of the group Increased number of voluntary networks on child protection issues Common training imparted to the network organizations Increased number of issue based program run by NGOs / the brief Government GR for appointing the committee Draft policies and procedures Implementing agency defined by the Government and record available Records from NGOs/ CBOs and Unicef MOV to be developed later All agencies and individual agree to form a common platform on the issue Network meeting reports of Unicef Records of number of training programs funded by Governemnt/ Unicef Newspaper/ magazine clippings NGOs/ CBOs willingness to come to a common platform for networking Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 82

83 Modules prepared and incorporated in the curriculum of training of allied services Proactive alliances and partnerships in action Community based safety network (vigilance) State and district networks on trafficking on child protection established Public discourse/ debate through sensitized and responsive media Sensitized and aware communities actively supporting prevention of trafficking and abuse of children civil societies Inclusion of relevant topics related to child protection in training of allied services State, Community and media come together for proactive action on issues related to child protection Syllabus/ training content of allied service Records of joint efforts planned by all alliances Vigilance squads established Number of vigilance squads at Panchayat Number of village squads in the communities Increased number of agencies coming to network at state and district level Enforcement authority are able to effectively utilize the services and expertise of the network Increase number of debates on topic in media Increased number of families / community volunteers taking initiative in reporting the case with enforcement agency Families having access to poverty reduction program including adult literacy and health District database on number of recognized agencies working in child protection Records from enforcement agencies Records of print/ electronic media Records form enforcement agency Local government record sources Flexibility of the Governemnt to restructure the course content of civil services All alliances willing to partner and agreeing to common agenda A strong culture of CBOs All alliances willing to partner and agreeing to common agenda Method of reporting made easy Availability of poverty reduction program Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 83

84 Child friendly judiciary and police Number of children rescued and prevented from trafficking Number of cases registered under CLPR act and number of children rescued Capacitated allied system in place State, Community and media come together for proactive action on issues related to child protection Capacity building of allied partners Records of enforcement agency (GOM) Records of joint efforts planned by all alliances Number of issue based capacity building training Appropriate sensitization training given to enforcement agency All alliances willing to partner and agreeing to common agenda Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 84

85 Education Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 85

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87 (IV) EDUCATION 1. SITUATION ANALYSIS 1.1. NATIONAL LEVEL STATUS School attendance rates have risen sharply over the past six years. According to NFHS, in 1993, 68% of children between 6-14 years of school were attending school. By 1999, this had risen to 79%. Even though enrolment among boys continues to be higher than among girls, the gap is narrowing. Between , there was a 7-percentage point increase point in boys attendance and a 15-percentage point increase for girls. As a result, in , 74% of girls and 83% of boys between 6.14 years were attending school. The attendance rate, however, drops off sharply to 49% between the ages of years. Of the 200 million children in the age group 6-14 years, 80 million (40 percent) are out of school. Of these, 26 million (13 percent) have never attendance school and 74 million (37 percent) dropped out of primary school. This means that only half of the remaining, namely 100 million, are completing primary school. There is much that needs to be done to improve the school infrastructure, access and retention of children in schools. For example, even though 94% of India s rural population has a primary school within a walking distance of one kilometer, there are at least 100,000 habilitations without this kind of physical access. Girl children remain particularly disadvantaged as a result. Efforts are needed to improve the quality of education, reduce the burden of education, introduce joyful learning into schools and enhance learning achievements among children STATE LEVEL STATUS Literacy rate in Maharashtra is 77% which ranks 2 nd amongst 14 major States. Male-Female literacy differentials persist, but have narrowed over the past decade. Maharashtra male literacy rate is 86%. Maharashtra female literacy rate is 68%. 61% of males and 43% of females in Maharashtra completed primary school. Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 87

88 School attendance rates in Maharashtra are 84% for boys and 79% for girls between 6-17 years of age. Inter-district female literacy differentials are high. Maharashtra ranks 3 rd in immunization coverage with 78% of children aged months are fully immunized. Maharashtra average is 36 points higher than national average. Progress in reducing malnutrition has been relatively slow. The situation in Maharashtra vis-à-vis EFA goals are concerned, appears satisfying in the first area, i.e. Enrolment. More than 60,000 schools (64,918) in the state (ZP, Municipal councils and Corporations) with 1,22,91,000 children and around 3 lakh teachers and newly introduced schemes like Vast Shala and Mahatma Phule Education Guarantee Scheme (which ensures reach of Primary Education to each and every out-of-school child) confirms the reach or existence of educational facilities in almost all parts of the state. However, one cannot overlook the in accessible pockets. Mumbai city itself is an example where many settlements lack spaces for schools and children have no where to go. Constraints / Limitations Access Enrolment (NER) Attendance (Role of Incentive Schemes) Lack of School Efficiency resulting in weak completion rates at every phase QUALITY A major Problem Joyful Education strategies initial success adoption even in SMART PT but short-lived results. Absence of Life Skills Approach. Ineffective In Service Training need for review. Teachers vacancies, absence in the classrooms, no substitute teachers during long leaves. Limited community participation. Education appears to be the responsibility of the Education department alone. VECs formed but all are not active. Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 88

89 2. MAJOR INTERVENTIONS DURING LAST MPO Primary Education Enhancement Programme (PEEP) covers 28 blocks of Chandrapur and Yavatmal districts. The active involvement of about 20,000 youth in the micro planning process now covering more than 1800 villages has successfully brought the community and the schools on a common platform with the common objectives of ensuring universal elementary education (UEE). The women s self help groups being formed are also taking keen interest in not only schools activities but also in health, ICDS, water and sanitation programmes. The project has also trained all VEC members and is also running 300 alternate learning centers for children who are unable to attend schools. The joint UN ASHA Project is being implemented in the 11 tribal blocks of Thane and Nashik districts. The project will be expended to cover all blocks of these districts from April The lessons learnt from the PEEP project will be key strategies in this project. Joyful Education for Quality Aspects is being implemented in 14 blocks of Sholapur district. UNICEF support to Pratham in Mumbai continues. Activities include running of balwadi centers, bridge course for non-schooling children and para teachers in municipal schools. Close to 1000 out of school children are provided learning opportunities with the help of NGOs in Pune, Nashik and Mumbai districts. Activities for over all educational improvement have been initiated in 12 residential tribal schools in Nagpur Division. UNICEF MAHARSHTRA last 10 years Close collaboration with SCERT. Publication of variety of advocacy materials VEC hand book etc. Promotion of Competency based Learning partnership with GOM: support to Amravati Division for last 1 year. POA for EFA released in Rejuvenation of Joyful Education strategies with incremental approach (which did offer a breakthrough in the otherwise stagnant boring environment in the schools 11 districts). Support and participation in the initial SMART PT programmes. Support to various in-service training programmes, example: Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 89

90 Directors, Dy. Directors DEOs, BEOs Extension Officers Kendra Pramukhs Teachers VEC members, elected representatives NGO representatives Efforts to involve people from different strata of the society. District level conferences of EFA Advocacy efforts. Promotion of convergence approach with other sectors water/sanitations, child labour etc. Collaborations/Sharing with DPEP. Primary Education Enhancement Programme 2 districts (improvement in achievement levels, community ownership through micro planning strategies, Women s empowerment. All out-ofschool children traced. ALS opened. Introduction of variety of creative activities). ASHA Jt. UN now stabilized in Thane, Nashik Districts efforts were made since Emphasis on Life Skill Approach and Introduced of socially relevant education School In Development or Jeevan Shala. Exposure trips Government Officials, NGO representatives, elected representatives. Efforts to improve quality of education in Tribal (Ashram Schools), Urban Education Pratham, Mumbai corporation, Municipal Councils in Vidharbha area, Western Maharashtra. AIEP Area Intensive Education Project Dharni, Chikhaldara 5 years. PIED Project for Integrated Education for Disabled Palghar, Masvan 5 years. Approximate expenditure in the last 10 years is 10 million Dollars. Emphasis has been on: Capacity Building / Skill Development. Attitudinal change Motivational trainings Management Excellence. Introducing different training methodologies. Community Processes Micro planning. Convergence of various services. Advocacy EFA. Expanding Horizons Experiments in Jeevan Shala. Promotion of Reading Habits at various levels: strengthening Libraries. Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 90

91 3. LESSONS LEARNT AT STATE LEVEL Focus versus attempting to work in too many areas. Limited number of districts versus too many districts. No strong monitoring mechanisms) failed to motivate GOM to establish EFA No Database - cell for data base and monitoring. No major research Weak linkages with ECE. No linkage with Middle/High School. 4. PROGRAMMING IN OUTPUTS Appropriate curriculum/syllabus would be developed. Adequate school infrastructure including water toilet and sanitation would be made available. School feeding program with purpose and dignity would be carried on. Active education committees/ptas would be in place. Schools promoting and practicing co-curricular activities would be fine arts and physical education. An upper primary school would be available within 3 km. Availability of school with competent teachers would be in place. Families have access to poverty alleviation programs and thus would not be using children for household work at the cost of education and childhood. A strong database would be available. A think tank would be in place to guide and influence policies. Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 91

92 Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 92

93 Results frame work State program of operations (Maharashtra) All children, adolescents, young people expectant & nursing mothers with their rights to survival, development, protection & full participation is ensured in the state public policies All children from < 3 years of age with their rights guaranteed and effectively implemented All children and adolescent of school going age (6-14 yrs.) included in the state public policies ensuring their healthier growth to develop their full potentials Every adolescent & young people is protected against HIV and his right to education, health, livelihood, social justice and full participation guaranteed (10-24 yrs.) SR 1 Every child survives and grows to its full potential SR 2 Every mother survives & is cared for SR 1 Every child enjoys learning SR 2 Every child protected from abuse and exploitation SR 1 Every adolescent and young people has capability to protect him/herself from HIV SR 2 Every adolescent and young people has access to services/ condoms SR 3 Government system and civil societies are responsive to the needs and rights of the young people SR 4 Every adolescent and young people is protected from coercive sex SR 5 Specially vulnerable adolescents and young people are protected Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 93 Results frame work SR 6 Every adolescent girl will have the right level of hemoglobin (12 gms >)

94 State program of operations (Maharashtra) All children and adolescent of school going age (6-14 yrs.) included in the state public policies ensuring their healthier growth to develop their full potentials SR 1 Every child enjoys learning Supportive Government policies, plans and guidelines in place Enabling family environment Child friendly schools promoting life skills Every child has access elementary school A think tank in place to guide and influence policies A strong usable data base Family not using children for household work at the cost of education and childhood Families have access to poverty alleviation program Appropriate curriculum/ syllabus Adequate school infrastructure including water, toilet and sanitation An upper primary school available within 3 kms. Availability of school with competent teachers School feeding program with purpose and dignity Active education committees/ PTA Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 94 School promoting & practicing co-curricular activities, fine arts & physical education

95 Results frame work State program of operations (Maharashtra) All children and adolescent of school going age (6-14 yrs.) included in the state public policies ensuring their healthier growth to develop their full potentials SR 2 Every child protected from abuse and exploitation Supportive & pro-active legislation policies and procedures with effective implementation and monitoring Every child s right to individuality & participation is respected with access to priority services/ system Sensitized & aware communities actively supporting prevention of trafficking & abuse of children Sensitized & empowered families/ communities with positive outlook for better protection of children Pro-active alliances / partners in place Rules/ policies to facilitate in place Legislation on child labour with mandatory regulation in place Think tank to review guide & influence policies Enabling networks for prevention, protection & rehabilitation developed Modules prepared & incorporated in the curriculum of training of allied services A strong database Target sources are for proactive interventions Ensured quality primary education, enrollment & prevention of school dropouts Child friendly judiciary and police Capacitated allied system in place Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 95 CBO/ SHGs monitoring child protection issues Access to dropping centers with opportunities for recreation / counseling facilities Community based safety network (vigilance) State & district networks on trafficking on child protection established Public discourse/ debate through sensitized & responsive media

96 Child Protection - Results Framework Maharashtra Strategic result Every child protected from abuse and exploitation. Outcome Supportive & proactive legislation & policies to prevent child labour with effective implementation & monitoring Every child s right to individuality & participation is respected with access to priority services/ system Sensitized & aware communities actively supporting prevention of trafficking & abuse of children Sensitized & empowered families/ communities with positive outlook for better protection of children Proactive alliances / partners in place Output Rules / procedures to facilitate in place Legislation on child labour with mandatory regulation in place Think tank to review guide & influence policies Enabling networks for prevention, protection & rehabilitation developed A strong database Target sources for proactive interventions Ensured quality primary education, enrollment & prevention of school dropouts Child friendly judiciary & police Capacitated allied system in place CBO/ SHGs monitoring child protection issues Access to dropping centers with opportunities for recreation/ counseling facilities Community based safety network (vigilance) State & district networks on trafficking on child protection established Public discourse/ debate through sensitized & responsive media Modules prepared & incorporated in the curriculum of training of all allied services Improved use of MIS for planning, evaluation, monitoring & feed backs at all levels Communities aware about MCH, HIV/ AIDs, nutrition, sanitation & hygiene, trafficking & sexual exploitation issues & disaster preparedness Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 96

97 Activity Community based convergent model of elimination & rehabilitation of working children in abattoirs of Parbhani, Aurangabad and Thane Support to the Finnish committee for UNICEF funded project for the elimination and rehabilitation of children working in power looms Bhiwandi and Malegaon Support to the Harvard/ UNICEF collaboration project in the elimination & rehabilitation of children working in the Zari industry in Mumbai slums Support forum against domestic child labour *BHU) Mumbai to highlight the rights violation of domestic child workers and to bring about a public Support media initiatives to highlight issues regarding the violation and abuse of children s rights Support the state DWCD in rehabilitation of rescued minors from CSEC with counseling and other services Pune & Mumbai Contribute to the NHRC study on trafficking of women & children in Maharashtra Facilitate the mobilization of CSWs to prevent trafficking of minor & second generation trafficking Mumbai red light areas & Ahmednagar Anthropological study of CSWs to better understand reasons for migration/ trafficking & develop interventions at Support NACSET NGOs/ CBO forum against trafficking in all districts of Maharashtra Support SHG linkage with/ as child protection committees to prevent the exploitation & abuse of children. Nasik/ Parbhani Facilitate institutionalized training support of both police and judiciary through the official academic training institutes Facilitate an epidemiological study of children of CSWs to understand the prevalence of HIV/ AIDs and establish the correlation if any Support the development of a module on child for child sexual abuse, which will be integrated into all other training. Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 97

98 Education - Results framework Maharashtra Strategic result Every child enjoys learning Outcome Supportive Government policies, plans and guidelines in place Enabling family environment Child friendly schools promoting life skills Every child has access elementary school Output A think tank in place to guide and influence policies A strong usable data base Family not using children for household work at the cost of education and childhood Families have access to poverty alleviation program Appropriate curriculum/ syllabus Adequate school infrastructure including water, toilet and sanitation School feeding program with purpose and dignity An upper primary school available within 3 kms. Availability of school with competent teachers Active education committees/ PTA School promoting & practicing co-curricular activities, fine arts & physical education Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 98

99 Activity Capacity building of NGOs, VECs, PTAs, teachers, supervisors & community leaders to support and monitor quality education Facilitate improved use of MIS for planning, evaluation, monitoring & feed backs at all levels Pilot and mainstream education interventions for children in deprived tribal, rural & urban slums Initiate school based learning improvement interventions program & integrating in the mainstream Facilitate the development oif an appropriate primary education program relevant to unreached Tribal children specially girls of focused districts Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 99

100 2 Every child in the school going age (6-14) with its rights protected and progressively fulfilled. No. Levels Indicators MOV Assumptions 2.1 SR 1 Every child enjoys learning, has Implementation of UEE access and completes good quality elementary education Every child is supported by an enabling family environment Family not using children for household work at the cost of education and childhood Percentage of children enrolled in primary schools Elements of quality education included in learning Proportion of children achieving 80% on competency based testing Proportion of tribal children attending schools Proportion of families being knowledgeable of their role in child development Percentage of families having access to poverty alleviation program Families taking part in adult literacy program Proportion of children enrolled in the school Proportionate reduction in child labour in the local market / agricultural field Proportionate increase in girl child going to school Families not employing children for household work Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at Number of children completing 4 th grade Records from schools / education department Sample survey of selected schools Random feedback from children education Sample survey of knowledge level parented on their role in children s progress Records of loan / subsidy in the lead bank for the village/ community Attendance at the adult literacy program School enrollment register Register of housing societies keeping statistics of children working within the society Unicef sample survey report Government / NGOs undertaking awareness program on families supporting role towards child development Availability of poverty reduction program Government / NGOs initiating adult literacy program Families aware of law against child labour Proper enforcement of law against child labour

101 Families have access to poverty alleviation program Every child has access to a primary and upper primary school A primary school is available within 1.5 kms and upper primary school available within 3 kms Availability of school with competent teachers Proportion of families benefited from poverty reduction program Proportion of families increase in household assets Availability of different poverty alleviation program Active Panchayat samiti Proportionate and progressive reduction in child labour Proportion of children enrolled in the school Proportionate reduction in child labour in the local market / agricultural field Proportionate increase in girl child going to school Families not employing children for household work Government allocating appropriate budget to fulfill the requirement within the plan period Constituting a task force towards achieving the result in providing the schools within stipulated time Proportionate increase in number of teachers training institutions Records at the block development office Records at Panchayat office Records of loan/ subsidy at the lead bank handling poverty reduction program Reports available on child labour School enrollment register Register of housing societies keeping statistics of children working within the society Unicef sample survey report Expenditure statement of department of education, GOM GR from GOM constituting the task force Statistics of increase number of teachers training institutions Families knowledgeable about different poverty alleviation program and their eligibility criteria Appropriate propagation by Government / NGOs for creating awareness regarding poverty alleviation program Availability of primary schools within reasonable distance. Families aware of law against child labour Proper enforcement of law against child labour A strong political will to achieve UEE Availability of sufficient number of training institutes Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 101

102 2.1.3 Child friendly schools promoting life skills in place Appropriate curriculum/ syllabus being used Adequate school infrastructure including water, toilet and sanitation School feeding program with purpose and dignity Completing the filling up of all the vacant positions in the school Proportionate increase in appointment of lady teachers Proportionate increase in Government budget towards teachers salary Number of sessions taken for promoting life skills education in schools SCERT promoting life skill training Community monitoring mechanism in place Appropriate syllabus prepared for use Proportionate increase in the Government education budget and its utilization Proportionate number of children with adequate weight as per age Reduction in school drop outs Increased motivation of the children to attend the school Better all round performance of the children Statistics of annual turn over of trained teachers from institutions Advertisement by public service commission for recruitment of teachers Syllabus of school education includes life skills training Village micro plan School syllabus content Expenditure statement of department of education in GOM Growth chart of the children Expenditure statement of the agency providing mid day meals School stock records School attendance register Performance record of the children Appropriate budget allocation by the Government towards teachers salary Availability of oriented and trained teachers to teach life skills to children Department of education has a list of schools for infrastructure development program and has send to finance Schools are supplied with growth chart that is maintained properly Availability of midday meals program in the school Motivated teachers and good team work Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 102

103 Active education committees/ PTA Community managed village education plan School promoting and practicing cocurricular activities, fine arts & physical education Supportive legislation, policy and plans implemented A think tank in place to guide and influence policies Increased number of districts implementing Schools In Development projects Increased number of schools promoting and practicing life skills education Government committees established with appropriate representation of multi disciplinary experts Seminars / workshops held to discuss on the subject and prepare framework A multi disciplinary group established comprising of representative from NGOs, CBOs, academics, media and international organization including Unicef Documented micro plan Micro planning training being imparted to the community District education office records Number of training programs on Life skills education Number of teachers trained in life skills education Appropriate GR of GOM identifying the representatives in the committee TOR of the committee Minutes of the meeting of the committee Seminar/ workshop proceedings Unicef record on the subject as policy advocacy measure District authorities giving sufficient importance to co-curricular activities and life skills education Political commitment towards enacting and enforcing of the legislation Committee meets regularly and work towards submitting their recommendations in a time bound manner Unicef takes appropriate policy advocacy measure and brings appropriate partnership between Governemnt, civil societies and NGOs on the legislation issue MOV to be developed later All agencies and individual agree to form a common platform on the issue Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 103

104 Periodic group meeting is held Government take cognizance of the group A strong usable data base Database management plan ready for implementation Database management framework ready Specific responsibility for management of database system established Training of all agency responsible for feeding data MIS plan document MOU of agency for preparing the database management system Number of training programs held of different agency responsible for providing data Allocation of budget by the Government Funding agency / Unicef providing support for the database management framework Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 104

105 SR Every child enjoys learning No. Activity Indicators MOV Assumptions 1 Capacity building of NGOs, Proportional number of focus Unicef assisted training manual Adequate cooperation VECs, PTAs, teachers, districts completed capacity Records of training of SCERT at Zilla Parishad level supervisors and community building training Records of training at the block education leaders Unicef supported training material office (BEO) made available for training. 2 Facilitate improved use of MIS for planning, evaluation, monitoring & feed backs at all levels 3 Pilot and mainstream education interventions for children in deprived tribal, rural & urban slums An integrated MIS plan developed Proportionately increase number of focus districts using MIS for planning, monitoring and evaluation Proportionate increase in number of DEOs using MIS for planning, monitoring and evaluation. Proportionately increase number of tribal districts implementing special intervention program Innovative pilot projects initiated by Unicef in the tribal district. MIS manual Document of MOU between Government / Unicef/ MIS expert agencies Number of MIS training/ orientation program held for district/block level functionaries in the focus district. Unicef records on special intervention program Record with BEO on special intervention program Records of tribal development department Records of Municipal Corporation regarding special intervention programs in the slum areas Records of NGOs implementing special intervention programs Allocation of fund by the Government for hardware Appropriate fund allocated by Tribal Development Department (TDD) for scaling up special intervention program in the tribal district. Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 105

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107 4 Initiate school based learning improvement interventions program & integrating in the mainstream 5 Facilitate the development oif an appropriate primary education program relevant to un-reached Tribal children specially girls of focused districts School based learning improvement program strategy prepared and made available to education department Proportionately increase number of districts in state including focus districts have implemented school based learning improvement program Appropriate primary education program strategy for tribal children developed / facilitated by Unicef. Proportionately increase number of districts in the state including all tribal districts have implemented the specially developed primary education program. Unicef school based learning improvement strategy paper District record on school implement program Unicef strategy paper on primary education. Appropriate policy advocacy measure taken by Unicef and knowledge management group (think tank) Political will towards structural change in primary education of tribal and un-reached. Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 107

108 Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 108

109 Health Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 109

110 (V) REPRODUCTIVE AND CHILD HEALTH PROGRAMME 1. SITUATION ANALYSIS 1.1. NATIONAL LEVEL STATUS India with a population of more than a Billion is full of diversity. One can see the large variation in terms of Socio-economic and demographic indicators among the states. Infant Mortality Rate: IMR, which is one of the best indicators of Socio-economic and demographic situation, has declined from 114 per 1000 Live Birth (LB) to 70 in last decades (SRS). Still, 47% of these deaths occur in first 7 days of birth. Routine Immunization: RI in India was formally launched in 1978 as Expanded Programme of Immunization, which got momentum in 1985 under the name Universal Immunization Programme (UIP). The country has achieved coverage of more than 80% by the beginning of 90s. However, due to over emphasis on Pulse Polio Immunization Programme, RI suffered a set back. Coverage Evaluation Surveys indicate that DPT3 coverage declined from 77% (95-96) to 46% (99-00). Realizing this, Govt. has started giving emphasis on RI leading to the improvement in coverage (63.6% in {00-01}). IPPI: Surveillance data indicates that hierologically proven polio cases at national level declined from 1934 in 1998 to 268 in In 2002, 28 cases (till 16 th April) are reported so far 23 from UP, from Bihar and 1 each from Uttaranchal and Maharashtra. During the last NIDs, more than 156 million children were reached. Measles: Introduction of measles vaccine in RI programme and better coverage, the reported measles cases declined from 1.6 lakh in 1980 to around in In 2000, the reported case increased to around The fact that the knowledge of many measles cases does not reach health facilities and the consequent under reporting of measles incidences is well known. The estimated figure shows that India alone contributes 27% of the global deaths caused by measles, where vitamin A, deficiency is common. In order to achieve the goals set in WHA and WSC, urban measles control strategy was initiated in In 2001, Urban Measles Campaign was cried out in 4 cities of Rajasthan, Bangalore city and 6 towns of Gulbarga covering nearly 0.5 million children in Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 110

111 age group 9 to 59 months. Measles campaign was also carried out in 7 cyclone hit districts of Orissa covering 0.7 million children in both urban and rural areas. NNT: Immunization against tetanus is the greatest public health success in history. Despite this, half of the infants born in developing countries are unprotected against tetanus and 197,000 of them die from the disease annually. In India, neonatal tetanus was a major public health problem prior to the implementation of Tetanus Toxoid (TT) immunization of pregnant women, which was introduced in early 1970 s. Rajasthan led the way for the accelerated NNT elimination initiative through the high-risk approach in the country. Nearly five million women were vaccinated. A similar initiative was taken up in 10 districts of MP, Bankura district of West Bengal and in Dhubri and Golpara districts of Assam, covering nearly 2.5 million women during MMR: National family Health Survey-2 (NFHS-2) estimates maternal mortality ratio at the national level to be 540 deaths per 100,000 live births (ranging from 428 to 653 per 100,000 live births). The NFHS-2 data show stagnation in maternal mortality reduction over the past decade and currently more than 130,000 women die each year from causes related to pregnancy and childbirth. Compared to a western country the risk of dying from a pregnancy related cause for women in the childbearing age is a 50 times higher in India. Maternal deaths are mainly related to hemorrhage, severe anemia, sepsis, eclampsia and obstructed labour. India has an estimated 110 million adolescent girls aged 10 to 19 and 55 million girls aged 15 to percent (20 million) of adolescent girls are married (53 percent or 11 million marry before age 15 years). Around 11 million (56 percent) of those married have been pregnant at least once before age 19 years. ANC: The Safe Motherhood Initiative proclaims that all pregnant women must receive basic professional antenatal care. The RCH programme recommends that as a part of antenatal care, women receive two doses of TT vaccine, adequate amount of IFA of prevent and treat anemia and at least three antenatal check-ups that include blood pressure checks and other procedures to detect pregnancy complications. However, CES 01 indicates that 56% has received ANC3+, 76% TT2+, 69% IFA. Out of these 69%, hardly 19% consumed more than 90 tables. Delivery Care & Post-natal Care: According to NFHS-2, institutional deliveries accounted for 34 percent of all deliveries. About 42 percent of women delivered with assistance from a skilled Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 111

112 attendant and post-natal care. Only 27 percent women had a post-natal check-up and the mean number of post-natal check-ups was 0.6. Each year 25 million children are born in India. Of these, some 1.8 million children die before the age on one. Of the children born every year, only 35 percent of these births are registered. The infant mortality rate (IMR) has stagnated at around 72 per 1000 live births for the past four years. The national averages however tend to mask realities: infant mortality in states such as Orissa, Madhya Pradesh, Uttar Pradesh and Rajasthan is over 80 per 1000 live births. The National family Health Survey 2 ( ) also confirms the persistence of other differentials in child survival. For instance, the IMR among Scheduled Caste and Scheduled Tribe communities is higher than among the rest of the population. Nationally, the average annual rate of reduction of IMR has declined from 3.1 percent in the 1980s to 1.8 percent in the 1990s. The important causes of child deaths in India remain pneumonia, diarrhea and neonatal sepsis, mainly because of a lack of timely attention and treatment of children and low rates of routine immunization. Equally important are the limited reach and efficacy of the health systems, sub-optimal care practices of young children, poor nutrition pre and inadequate post natal as well as deficient home health practices. Neonatal mortality poses a serious challenge. Addressing neo-natal mortality requires significantly enhanced household management of childhood illness, highly improved access to health services, including an efficiency functioning system of referral to the appropriate health facility and high rates of routine immunization. Polio vaccination coverage has increased dramatically through the national immunization days, with India headed for zero certification in Progress in sustaining routine immunization has been slow. Routine immunization coverage has declined from 60 percent in 1997 to under 40 percent in Coverage ranges from a low of 10 percent in Bihar to a high of 80 percent in Tamilnadu. India s maternal mortality rate is high 540 deaths per 100,000 live births according to NFHS- 2. The underlying causes of the high rate of maternal mortality lie partly on untimely access to health services and also significant on the less-than-equal status of women in India and the anti-female attitudes of men. Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 112

113 Within a span of just six years, the number of HIV/AIDS cases in India has grown rapidly. Estimates suggest that the number of HIV positive persons in India is 3.5 million, of whom 25% are women of childbearing age and 2% are children. Almost 90% of infected children under age five are infected through mother-to-child transmission. Around six rates in India are already experiencing a generalized epidemic with over 1 percent prevalence rate. Evidence suggests that the epidemic is now spreading even to the non-high risk population. In a country with large populations, even low HIV prevalence means that huge numbers of people live with the virus. It is estimated that in India, there are annually between 100,000 and 200,000 infected women giving birth to approximately 30,000 infected babies STATE LEVEL STATUS Infant mortality rate in Maharashtra is 48 which ranks 2 nd after Kerala. Rural-urban differential has increased over time. Rural / Urban IMR Ratio % of all births are registered in West Bengal which ranks 4 th amongst 14 major states. Progress in expanding immunization coverage has been good. It is 78% in as compared to 64% in with a difference of 14% hike. Compared to scores on National level (42% in and 35% in ) with a difference of 7% it is less than only Kerala and Tamil Nadu. High HIV-prevalence has been noted in 12 districts in Maharashtra as follows: Aurangabad Chandrapur Kohlapur Latur Mumbai Nagpur Nashik Pune Sangli Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 113

114 Satara Sholapur Thane 61% of married women in Maharashtra have heard about AIDS. Maharashtra ranks 2 nd in awareness after Tamilnadu (87%) and Kerala (87%). 33% of women who have heard about AIDS in Maharashtra have no knowledge about how to avoid it. 2. MAJOR INTERVENTIONS DURING LAST MPO Women s Right to Life and health Project is being implemented in the same districts of the Nanded, Latur and Osmanabad. The project aims at strengthening the first level referral units to deal with emergencies, thereby helping to reduce infant and maternal mortality. It also focuses on enhancing community awareness on the rights of women to life and health and enlists their active participation in fulfilling these rights. In this project, the collaboration aims at strengthening the subcentre for delivering not only preventive health care services but also basic curative services; the strengthening of select FRUs to provide comprehensive emergency obstetric care is also part of this project. The integrated management of childhood illnesses (IMCI) and newborn care (NBC) are an integral part of this project. The project further builds on the existing well established fixed-day strategy to improve the co-ordination between the health and ICDS sectors from the village to the district levels through a series of joint MCHN training and sub-centre plan preparation. The involvement of the community through the formation of community advisory boards (CABs) is also incorporated. National Immunization Days: UNICEF continues its support to the Pulse Polio programmes across the state. The Polio Eradication Initiative with mobility, planning, monitoring and process evaluation has been supported. It also supported the Measles Control Campaign in 24 towns of the state. This has been the first such initiatives in the country and could form the basis for a national initiatives. The Urban Measles Elimination Project consisting of a survey of measles cases followed by measles campaign to cover all under-5 years children in select urban areas viz. Akola (first city in the country), Malegaon, Navi Mumbai, Nanded and the 24 municipal councils of Nanded, Osmanabad and Latur has been supported. School AIDS Prevention Programme: The AIDS Prevention Education Project for secondary school students has been an important area of collaboration with the Health and Education Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 114

115 Departments of the State and BrihanMumbai Mahanagar Palika. The successful implementation of the Project in Mumbai and Pune has led to the scaling up to the project across the state. UNICEF is supporting the implementation of this project in 2700 secondary schools. Prevention of Mother to Child Transmission of HIV/AIDS: UNICEF supports a research project jointly supported with NACO and being implemented in five Medical Colleges in the state; Initial data indicates HIV Prevalence of 1% to 6% among pregnant women. Discussions are on for initiating support to a project on children affected by HIV. Adolescent Girls Initiative: The Adolescent Girls Initiatives for providing family Life Education for girls from 14 to 18 years age through capacity building of the health and ICDS systems is ongoing in Mumbai and started in Nashik with the additional components of efforts to reduce nutrition anemia among these girls. The project that aims at providing critical fife skills following the life cycle approach is being implemented in all the health posts of Mumbai city and reduces out to nonschool going adolescent girls. The KEM Medical College is the resource agency providing professional support to the project 310 public health nurses/medical officers and 6440 adolescent girls have so far been trained. The project is poised to be extended to the districts of Latur, Osmanabad and Nanded. Mother & Child Friendly Hospital Initiatives: The Mother and Child Friendly Hospital Initiative is an active collaboration for improving the quality of services for mothers and children in select hospitals of Mumbai with the aim of developing a replicable model for expansion. Senior administrators of 35 major municipal hospitals and maternity homes have been sensitized. The training module on personal growth, group evolution and friendly health care has been field-tested in 5 hospitals in Mumbai and finalized. Activities for promotion of breastfeeding and infant practices have been supported in collaboration with BPNI, ACASH and selected medical institutions. Border District Cluster Strategy: UNICEF supports the implementation of the RCH in the three districts of Latur, Osmanabad and Nanded under the Border District Cluster Strategy (BDCS). Besides strengthening the sub centre capacity to deliver quality services, the objectives also include building capacity and awareness within communities and families to articulate their heath needs and facilitate their active participation in planning, implementing and monitoring the health activities of the Health system. Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 115

116 3. LESSONS LEARNT AT STATE LEVEL Participation of youth in the programming processes helps accelerate the pace of implementation and also ensures full community participation. The experiences in Chandrapur and Yavatmal clearly demonstrate that great potential of youth in fulfilling the rights of children and women. The mobilization of poor and disadvantages women into self-help groups is perhaps the best way to organize them and mainstream them. The need is to focus on SHGs for empowerment of women and not just on micro credit. Involving NGOs (after careful screening) as resource groups to bring community and government workers into an alliance have shown promising results. Here NGOs are not directly into programme implementation but support the process of capacity building of both community and government workers. Strong networking among NGOs with active government participation has helped bring protection issues to the forefront. Need for the active participation of media is strongly felt. The recent government policies/programmes have been very supportive. Among them are the Gadge Baba Swachata Abhiyan, the Mahatma Phule Shikshan Hami Yojana as well as the State Policy on population having a strong bearing to programming. The collaboration in the past decade has shown that: Capacity building on planning and technical competencies among the health and ICDS functionaries is a crucial activity to improve the quality of services. The regularity of the Mother- Child Protection (MCP) sessions has also established that basic MCHN services reaching out to the rural population. It is possible to improve convergence between the health and ICDS systems especially at the sub-district levels. It is possible to improve convergence between the health and ICDS systems especially at the subdistricts level. Special efforts to improve measles immunization coverage in Urban areas through a campaign approach is relevant, especially because outreach health services are lacking in towns as well as in the larger cities. Pulse Polio immunization programme is well established and requires minimal support external agencies at the State level. Several large-scale campaigns, however, detract from the routine services and hence the possibility of the regular established health delivery system is affected to a certain extent. Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 116

117 Involvement of Sectors other than Health e.g. Education department in school AIDS education, can be crucial in ownership and successful expansion of the activities throughout the State. Certain initiatives e.g. Adolescent Girls Initiative, can become models for replication under national Programmes e.g. RCH and ICDS. Field monitoring, independent evaluation and active feedback of the activities of the collaboration lead to better implementation. 4. PROGRAMMING IN OUTPUTS Quality of MCP sessions would be improved. Assessment and documentation of existing positive feeding caring practices would be in place. Adequate health and ICDS infrastructure including water, toilet and sanitation facilities would be made available to every child and his family. Use of MIS for planning, evaluation and feedbacks at all levels would be improved. Communities would be aware about MCH, nutrition, sanitation and hygiene, trafficking and sexual exploitation issues and disaster preparedness. Creation of awareness through school curriculum on life skills education would be in place. Communities would be knowledgeable about legislation, policies and procedures. Communities would have access to toilet facilities adequate water supply. Communities would have access to services to HB estimation and deworming and management of anemia. A strong database would be available with a system of updating in place. Availability of iron food would be improved. Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 117

118 Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 118

119 Results frame work State program of operations (Maharashtra) All children, adolescents, young people expectant & nursing mothers with their rights to survival, development, protection & full participation is ensured in the state public policies All children from < 3 years of age with their rights guaranteed and effectively implemented All children and adolescent of school going age (6-14 yrs.) included in the state public policies ensuring their healthier growth to develop their full potentials Every adolescent & young people is protected against HIV and his right to education, health, livelihood, social justice and full participation guaranteed (10-24 yrs.) SR 1 Every child survives and grows to its full potential SR 1 Every child enjoys learning SR 1 Every adolescent and young people has capability to protect him/herself from HIV SR 2 Every mother survives & is cared for SR 2 Every child protected from abuse and exploitation SR 2 Every adolescent and young people has access to services/ condoms SR 3 Government system and civil societies are responsive to the needs and rights of the young people SR 4 Every adolescent and young people is protected from coercive sex SR 5 Specially vulnerable adolescents and young people are protected Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at SR 6 Every adolescent girl will have the right level of hemoglobin (12 gms >)

120 Results frame work State program of operations (Maharashtra) Every adolescent & young people is protected against HIV and his right to education, health, livelihood, social justice and full participation guaranteed (10-24 yrs.) SR 1 Every adolescent and young people has capability to protect, themselves from HIV Every adolescent has adequate knowledge, skills & attitude to make safer choice Every adolescent practices safe behaviour Drop out rate of girls is reduced Access to effective models for preventive education Young people feel connected to attitudinally positive adult learning centers and communities All adolescent & young people have a correct perception of their own risk Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 120

121 Results frame work State program of operations (Maharashtra) Every adolescent & young people is protected against HIV and his right to education, health, livelihood, social justice and full participation guaranteed (10-24 yrs.) SR 2 Every adolescent & young people has access to quality service Every adolescent & young people has access to condoms & youth friendly services Every adolescent & young people has access to friendly testing facilities and counseling Care and support services are available for young people with HIV/ AIDs Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 121

122 Results frame work State program of operations (Maharashtra) Every adolescent & young people is protected against HIV and his right to education, health, livelihood, social justice and full participation guaranteed (10-24 yrs.) SR 3 Government system & civil societies are responsive to the needs and right of the young people Youth friendly services accessible to adolescent & young people State capacities are adequate to respond to urgencies of epidemics Government system has accurate information/ database on HIV/ AIDs Supportive social environment for prevention of HIV Positive peer norm for safe behaviour Parents discuss sexuality with their children / adolescent Young people accepting and supporting infective peers Young people actively engaged in society issues related to young people Government & civil societies coordinate interventions as partners Comprehensive state policies on HIV/ AIDs Young people openly communicate about safe behaviour (between sexes) Politicians, media, communities openly acknowledge and discuss HIV/ AIDs Community has accurate knowledge on the situation of HIV/ AIDs among adolescent and young people Young people engaged in conceptualizing, planning, design, implementation, monitoring & evaluation of HIV prevention activities Government policies are supportive of appropriate interventions for young people Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 122

123 Results frame work State program of operations (Maharashtra) Every adolescent & young people is protected against HIV and his right to education, health, livelihood, social justice and full participation guaranteed (10-24 yrs.) SR 4 Every adolescent and young people are protected from coercive sex Every adolescent and young people has access to an effective legal system Stricter enforcement of labour laws Has awareness of risks & rights Has access to counseling on support services Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 123

124 Results frame work State program of operations (Maharashtra) Every adolescent & young people is protected against HIV and his right to education, health, livelihood, social justice and full participation guaranteed (10-24 yrs.) SR 5 Specially vulnerable adolescents & young people are protected MSM have appropriate knowledge & risk perception Orphans have appropriate knowledge & access to services Reduced vulnerability due to strict implementation of legislation on child labour Sex workers have appropriate knowledge & access to services Reduced vulnerability due to effective legislation on trafficking Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 124

125 Results frame work State program of operations (Maharashtra) Every adolescent & young people is protected against HIV and his right to education, health, livelihood, social justice and full participation guaranteed (10-24 yrs.) SR 6 Every adolescent girl will have appropriate HB level (12 gm and above) Every adolescent girl will have a positive self-esteem Every adolescent girl & her family will practice good personal hygiene Every adolescent girl & her family will be knowledgeable about iron rich food Every adolescent girl would be knowledgeable about her HB level (Anemia) Access to & participation in adolescent peer groups Access to toilet facilities & adequate water supply Increased local availability of iron rich food Access to services for HB estimation Creation of awareness through school curriculum or life skills education Access to services for deworming & management of anemia State nutrition policy to be rejuvenated Sensitive, informed & supportive community Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 125

126 Health - Results framework Maharashtra Strategic result Every adolescent girl will have appropriate HB level (12 gm and above) Every mothers survives & is cared for Outcome Every adolescent girl will have a positive selfesteem Every adolescent girl & her family will practice good personal hygiene Every adolescent girl & her family will be knowledgeable about iron rich food Every adolescent girl would be knowledgeable about her HB level (Anemia) Responsive legislation policies and procedures in place Output Access to & participation in adolescent peer groups Creation of awareness through school curriculum or life skills education State nutrition policy rejuvenated Access to services for HB estimation Think tank in place to review, guide and influence policies and legislation Sensitive, informed & supportive community Access to toilet facilities & adequate water supply Increased local availability of iron rich food Access to services for de-worming & management of anemia A strong database with a system of updating in place Communities knowledgeable about legislation, policies and procedures Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 126

127 Health - Results framework Maharashtra Strategic result Every child survives and grows to its full potential Outcome Family to practice positive feeding and caring practices Families & caregivers practicing positive infant & young child feeding and caring, influence other care givers and the community Every child has access to quality services Families empowered for care of pregnant women & children under the age of 1 Competencies of PHCs & other health services strengthen to care for pregnant women & children under 1 Output Improved quality of MCP session Empathetic & skilled staff in place Facilities adequate with equipment and with regular supplies The existing positive feeding caring practices assessed and documented Pilot innovative projects (Urban, Rural/tribal) scaled up and integrated in the mainstream Every family has access to safe water Families knowledgea ble on danger signs, home care management and timely referrals Families observing home hygiene practices Adequate health and ICDS infrastructure Community including water, promotes, toilet and protects, Copyright - Shodhana Consultancy Pvt. sanitation Ltd. Visit us at supports 127 and facilities monitor services Establish community planning, implementation & monitoring system for reporting on new natal and IMR PHCs and other local health centers are geared to handle emergency neonatal and pediatric emergencies

128 Child Development & Nutrition - Results Framework Maharashtra Strategic result Every mothers survives & is cared for Responsive legislation policies and procedures in place Outcome Output Communities knowledgeable about legislation, policies and procedures Think tank in place to review, guide and influence policies and legislation A strong database with a system of updating in place Improved use of MIS for planning, evaluation, monitoring & feed backs at all levels Activity Improve quality of MCP sessions by providing minimum integrated package with special focus on care component of mother and child Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 128

129 Strategic result Every adolescent girl will have appropriate HB level (12 gm and above) Outcome Every adolescent girl will have a positive self-esteem Every adolescent girl & her family will practice good personal hygiene Every adolescent girl & her family will be knowledgeable about iron rich food Every adolescent girl would be knowledgeable about her HB level (Anemia) Output Access to & participation in adolescent peer groups Creation of awareness through school curriculum or life skills education Access to services for HB estimation State nutrition policy rejuvenated Sensitive, informed & supportive community Increased local availability of iron rich food Access to services for deworming & management of anemia Access to toilet facilities & adequate water supply Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 129

130 3 Every adolescent and young person is protected against HIV and his right to education, health, livelihood, social justice and full participation guaranteed. (10-24 years) No. Levels Indicators MOV Assumptions 3.1 SR 1 Every adolescent and young Decreased number of Records of testing centers Availability of reliable testing people has capability to protect reported cases in HIV/ AIDS of HIV/ AIDS centers and facilities him/herself from HIV Individuals willingness to go Every adolescent has adequate knowledge, skills and attitude to make safer choice Every adolescent practices safe behavior Increase number of awareness program Increase consumption of condoms Increase number of cases registered against drug abused Strict enforcement of drugs use Increased knowledge regarding safe behavior among adolescent Decrease number of reported cases Drop out rate of girls is reduced Increased number of girls completing high schools Access to effective models for preventive education Increased number of formal/ non-formal providing preventive education Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at Records of HIV/AIDS awareness program Records of consumption of condoms Records of enforcement agencies on drug related matter Records of consumption of condoms Number of awareness program on safe sexual behaviour to specifically targeted groups by various agencies Records of education department (GOM) Attendance/ data available in formal/ non-formal institutions for testing Youth friendly services and counseling facilities available Easy availability of condoms at convenient outlets Multiple and interesting awareness program through audio visual media Positive discrimination measures adopted by the Government for education of girl child Government reviewing the content and methodology of existing curriculum.

131 3.1.5 Young people feel connected to attitudinally positive communities and adult learning centers All adolescent and young people have a correct perception of their own risk Increased number of young people attending to adult learning centers Free and frank discussion on sexual health in the family Increase knowledge regarding safe behavior among adolescent Decrease number of reported cases Increased number of adolescents and young people are motivated to visit the sex clinics Records of attendance at the adult learning center Records of consumption of condoms Number of awareness program on safe sexual behaviour to specifically targeted groups by various agencies Effective adult learning center in the community run by Government and NGOs Easy availability of condoms at convenient outlets Multiple and interesting awareness program through audio visual media Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 131

132 3 Every adolescent and young person is protected against HIV and his right to education, health, livelihood, social justice and full participation guaranteed. (10-24 years) No. Levels Indicators MOV Assumptions 3.2 SR 2 Every adolescent and young people has access to quality services Every adolescent and young people has access to condoms and youth friendly services Every adolescent and young people has access to friendly testing facilities and counseling Care and support services are available for young people with HIV/ AIDS Increase in number of adolescents completing high school Increase in Governemnt budget for programs related to adolescent in various sectors (education, health, livelihood social justice) Increased number of NGOs/CBOs promoting programs for adolescent and young people Increase in consumption of condoms Increase in adolescent group counseling Increase in number of adolescent group for testing Increase in number of care and support service centers Accessibility of service centers Public opinion/ bias on decrease Records of schools/ Governemnt education department Records of Government program Records of program by NGOs/ CBOS Number of condoms utilized from Records of health centers/ counseling centers/ test centers Number of service centers with health department (GOM) Fund availability Availability of services and funds Centers/ services Availability of services and funds Availability of services and funds Trained manpower Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 132

133 3 Every adolescent and young person is protected against HIV and his right to education, health, livelihood, social justice and full participation guaranteed. (10-24 years) No. Levels Indicators MOV Assumptions 3.3 SR 3 Government system and civil societies are responsive to the needs and rights of the young people Youth friendly services accessible to adolescent and young people Parents discuss sexuality with their children/ adolescent Young people openly communicate about safe behavior (between sexes) State capacities are adequate to respond to urgencies of epidemics Increase in number of civil societies working for adolescents and young people Increase in funds for adolescent related Governemnt program Access to employment oriented education/ training for adolescent. Increase in number of service centers Training for parents decrease stigma to discuss Increase knowledge regarding safe behavior among adolescent Decrease number of reported cases Increased number of adolescents and young people are motivated to visit the sex clinics Increase number of Crisis intervention centers Records of CBOs/ NGOs working for adolescent Government financial reports Governemnt program for adolescent Records of health department GOM Number of training sessions for parents Records of consumption of condoms Number of awareness program on safe sexual behaviour to specifically targeted groups by various agencies Number of crisis intervention centers Availability of funds Availability of programs Availability of funds Availability of manpower Funds Manpower (trained) Easy availability of condoms at convenient outlets Multiple and interesting awareness program through audio visual media Adequate allocation of fund by the Government Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 133

134 Crisis & epidemic handling Crisis handling plan plan in place document of GOM Young people accepting and Increase in number of young District/ block education A strong sensitization supporting infective peers people completing education/ working Increased number of social groups records community program towards attitudinal change Politicians, media, communities openly Increased number of Records of Panchayat Strong political will acknowledge and discuss HIV/ AIDS community discussions on community meeting Adequate media alliance HIV/AIDS minutes Responsive and sensitized Increased number of Newspaper clippings media questions raised in the Available audio visual assembly and parliament materials Increased coverage in media Government system has accurate Proper Governemnt Records of data collection Allocation of funds information/ database on HIV/ AIDS database in place Government publication on status of HIV/AIDS through health department network and coordination with NGOs/ CBOs Young people actively engaged in Increased number of SHGs Records on number of Promotional program for for society issues related to young people on issues related to young SHGs SHGs people Records of informal youth Micro planning including Increased number of Kishore/ Kishori groups discussing issues related to sexual health group young people Community has accurate knowledge on Increase acceptance of Records at PHC/ Allocation of funds for the situation of HIV/ AIDS among people with HIV/AIDS and NGO/CBOs regarding awareness programs adolescent young people decrease stigma various aspects of Infrastructure and trained Increase attendance at counseling/ testing centers HIV/AIDS manpower Supportive social environment for Increase in number of service Records of health Availability of funds Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 134

135 prevention of HIV/ AIDS Government and civil societies coordinate interventions as partners Young people engaged in conceptualizing, planning, design, implementation, monitoring and evaluation of HIV prevention activities centers Increased number of young people attending to adult learning centers Free and frank discussion on sexual health in the family Increased coordination between Government and civil societies through various programs, seminars, conferences and workshops Increase participation of young people in HIV prevention activities Increase expertise among youth regarding HIV prevention Increased number of training program for youth Positive peer norm for safe behavior Increase knowledge regarding safe behavior among adolescent Decrease number of reported cases Increased number of adolescents and young people are motivated to visit the sex clinics Comprehensive state policies on HIV/ AIDS Formation, implementation and monitoring of HIV/ AIDS department GOM Records of attendance at the adult learning center Records on coordinating committees composition and work Records of conferences, seminars, training programs Records of composition of various Government committees/ NGOs/ CBOs working for HIV prevention Number of training programs Records of consumption of condoms Number of awareness program on safe sexual behaviour to specifically targeted groups by various agencies Availability of manpower Effective adult learning center in the community run by Government and NGOs Proactive bureaucracy Availability of expertise Allocation of funds Opportunities for training for young people on HIV prevention Easy availability of condoms at convenient outlets Multiple and interesting awareness program through audio visual media HIV/AIDS policy document Political will Public opinion Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 135

136 Government policies are supportive of appropriate interventions for young people state policy Government committees established with appropriate representation of multi disciplinary experts Seminars / workshops held to discuss on the subject and prepare framework Appropriate GR of GOM identifying the representatives in the committee TOR of the committee Minutes of the meeting of the committee Seminar/ workshop proceedings Unicef record on the subject as policy advocacy measure Political commitment towards enacting and enforcing of the legislation Committee meets regularly and work towards submitting their recommendations in a time bound manner Unicef takes appropriate policy advocacy measure and brings appropriate partnership between Governemnt, civil societies and NGOs on the legislation issue Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 136

137 3 Every adolescent and young person is protected against HIV and his right to education, health, livelihood, social justice and full participation guaranteed. (10-24 years) No. Levels Indicators MOV Assumptions 3.4 SR 4 Every adolescent and young people is protected from coercive sex Every adolescent and young people has access to an effective legal system Formation of legislation/ policies for protection from coercive sex Increased number of adolescent and young people are encouraged to go to enforcement agencies Stricter enforcement of labour laws Sensitized employer and a strong labour union Employees aware of labour laws Increased number of cases in the labour court being addressed in time bound manner Has awareness of risks and rights Increase in number of service centers Increased number of young people attending to adult learning centers Free and frank discussion on sexual health in the family Has access to counseling on support services Increase in number of service centers Draft plan preparation Policy document Enforcement agency records Number of cases registered and disposed in the labour court Records of health department GOM Records of attendance at the adult learning center Records of health department GOM Formation of relevant committees/ acceptance in principle Youth friendly enforcement agency A pro labour union Sincere and honest employer Availability of funds Availability of manpower Effective adult learning center in the community run by Government and NGOs Availability of counseling centers Availability of support services Availability of funds Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 137

138 3 Every adolescent and young person is protected against HIV and his right to education, health, livelihood, social justice and full participation guaranteed. (10-24 years) No. Levels Indicators MOV Assumptions 3.5 SR 5 Specially vulnerable adolescents and young people are protected MSM have appropriate knowledge and risk perception Orphans have appropriate knowledge and access to services Reduced vulnerability due to strict implementation of legislation on child labour Sex workers have appropriate knowledge and access to services Reduced vulnerability due to effective legislation on trafficking Formation of legislations and policies for specially vulnerable group (girl child, disabilities, tribal children, MSM, children of sex workers, orphans and working children) Increase in knowledge of MSM on HIV prevention Increase in knowledge of orphans Increase in utilization of services Decrease number of child labour Increase in number of children suffering from HIV Increased number of programs run by Government / NGOs for sex workers Increased number of agencies coming to network at state and district level Enforcement authority are able to effectively utilize the services and expertise of the network Reduced number of trafficking and increased number of rescue cases Draft plan preparation / policy statement Media coverage Records on sessions on HIV prevention Records on awareness program Records on beneficiaries Records of labour department Records of HIV testing centers Government and NGOs records of awareness program District database on number of recognized agencies working in child protection Records from enforcement agencies Formation of relevant committees/ acceptance in principle A strong media campaign promoting rights of MSM Availability of awareness program/ other support services Strict enforcement of labour law Adequate allocation of budget for service centers for sex workers All alliances willing to partner and agreeing to common agenda Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 138

139 3 Every adolescent and young person is protected against HIV and his right to education, health, livelihood, social justice and full participation guaranteed. (10-24 years) No. Levels Indicators MOV Assumptions 3.6 SR 6 Every adolescent girl will have the right level of hemoglobin (12 gms>) Every adolescent girl will have a positive self esteem Access to and participation in adolescent peer group Every adolescent girl and her family will practice good personal hygiene Increased proportion of PHCs having facilities for Hb test Percentage of adolescent with HB level 12 gms > on increase Increased proportion of families are knowledgeable on right Hb level of adolescent girls Access to poverty reduction program Increase number of awareness program on nutrition/ health/ gender issues Proportionately increased number of girls completing school education. Proportionately increased numbers of families are aware of girls education and nutrition. Increased number of adolescent peer group in the community having regular meeting. Increase in knowledge of good hygiene practices Availability of water and sanitation Records of Hb tests at PHCs/ health centers with 12 gms> Random check / survey for testing the Hb level of 12 gm> Records of sessions for adolescent girls on proper nutrition Records of awareness program on health of adolescent girls Random of program for reduction of gender bias Random check/ survey to assess attitudinal changes. Availability of HB testing Accuracy of HB testing Inputs on nutrition during adolescent for girls Programs on health of adolescent girls Program for reduction of gender bias and attitudinal changes School attendance record. Effective women s and empowerment program. Implementation of Life Skills Education. A community meeting records. Adequate promotion for formation of adolescent groups by facilitating agencies. Records of awareness Trained manpower sessions at PHC Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 139

140 Access to toilet facilities and adequate water supply Creation of awareness through school curriculum or life skills education State nutrition policy to be rejuvenated Sensitive, informed and supportive community Every adolescent girl and her family will be knowledgeable about ion rich food Increased local availability of iron rich food Every adolescent girl would be knowledgeable about her HB level (Anemia) Increase in number of common toilets Increase in number of water connection Increase life skills education sessions in schools A committee appointed by the Government to review State nutrition policy. Review committee report. Proportionality increased number of people in the community are knowledgeable and observed good personal and home hygiene practices. Increased number of potable water sources. Increase in consumption of iron rich food (poverty reduction) Increase access to SJSY schemes Records of plan Fund availability Records of syllabus Records of lesson planning Trained manpower Review committee report. Adequate importance given on the situation of nutrition by the Government. Record on reduction of communicable and water bond diseases. Government record of drinking water sources. Records of awareness sessions on nutrition at PHCs Number of beneficiaries of poverty reduction program Increase in number of visits Consumption of iron tablets/ green vegetables Proportionately increased number of girls completing school education. Effective awareness program carried by the Government/NGOs / CBOs,. Trained manpower Funds for poverty reduction program Availability of iron tablets / green vegetables School attendance record. Effective women s and empowerment program. Implementation of Life Skills Education. Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 140

141 Access to services for HB estimation Increased no. of PHCs empowered for Hb testing facilities. PHC record on assets and facilities. Skilled manpower for undertaking Hb testing. Regular supplies Access to services for deworming and management of anemia Increased number of girls having access to nutritional program. Families empowered through poverty reduction program and aware on the protection of the girl child. Proportionately decrease in number of cases of malnutrition deaths and lactating mothers. PHC record on cases of anemia Adequate supply of deworming medicines. Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 141

142 HIV/ AIDS Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 142

143 (VI) HIV - AIDS 1. SITUATION ANALYSIS 1.1. NATIONAL LEVEL STATUS According to World Health Organization estimates, India now contributes more than half of those infected with HIV in South and Southeast Asia. The first HIV-positive person and the first AIDS case in India were both reported in Since then, HIV has reached every state and union territory of the country; no part of India is free from this epidemic. AIDS Cases As of April 30, 1995, a total of 1,108 AIDS cases had been reported from different parts of the country. Maharashtra and Tamil Nadu have contributed most of the AIDS cases, reporting 288 and 372 cases respectively. These numbers in no way represent the true scenario, however. As in the other parts of the world, the number of reported cases in India represents only a small fraction of actual AIDS morbidity. According to estimates based on HIV prevalence, the actual number of AIDS cases in India could be within the range of 10,000 to 20,000. Though the reported number of AIDS cases does not tell us anything about the magnitude of the problem, it does highlight the trends of HIV infection when considered in terms of annual number of cases reported. Epidemiologic analysis of the reported AIDS cases in terms of age distribution reveals that the disease is primarily affecting people in the sexually active and economically productive age group, those aged 15 to 50 years of age. This finding will have grave implications in terms of the socioeconomic impact of this epidemic in India. More male AIDS cases have been reported than female, with a male-to-female ratio as high as 2:1. It is estimated that heterosexual transmission contributes as much as 78% of the total number of infections. It is disturbing to note, however, that approximately 12% of people with AIDS seem to have acquired HIV infection through the transfusion of blood and blood products. This figure may be due to the fact that the AIDS cases that are now being reported represent those who may have acquired HIV infection seven or eight years ago, when the blood safety program was still in its developmental phase. Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 143

144 With the intensive implementation of the blood safety program during the past few years, this figure of 12% infection through blood and blood products is bound to decrease in the future. HIV Infection By April 30, 1995, a total of 18,222 people had been confirmed as HIV positive, out of a total number of approximately 2.5 million people tested. However, the number of infections represents only the tip of the iceberg. Over the past decade, HIV has continued to spread among the different populations at risk at different rates. The trends have been similar to those observed among similar risk behavior groups in other parts of the world. In fact, the geographic spread in India has been quite uneven and variable, as it has been determined in large part by the extent of distribution and pattern of risk behaviors in different areas. This, in turn, results from determinants such as socioeconomic conditions, sociocultural patterns, urbanization, industrialization, and migration. The pattern of HIV infection in the country amply illustrates the paramount role of these determinants in the spread of the virus in different geographic terrain and areas. Trends among High-Risk Behavior Groups In the late 1980s, the sero-surveys done among commercial sex workers (CSWs) in a few Indian cities showed alarming trends. In Bombay, for example, one of the so-called epicenters of this epidemic in India, the HIV prevalence rate among CSWs had risen from 1% in 1987 to 51% by the end of The city has one of the largest organized brothel-based sex industries, with approximately 60,000 to 70,000 CSWs. In the city of Vascodegama, the prevalence among this group of workers had increased from 2.2% in 1990 to 26.5%. Studies conducted among CSWs in the red light districts of other cities also indicate high levels of HIV infection. This is exemplified by the situation in Surat and Rajkot in Gujarat, where seropositivity rates of 18.5% (1992) and 23% (1993) have been reported among brothel-based CSWs. STD clinic patients represent another group at higher risk for acquisition of HIV infection, since the predisposing factors for the transmission of HIV and STDs are similar. Sentinel surveys conducted among STD clinic attendees have further corroborated the findings among the other high-risk groups and have proved that infection is spreading swiftly in these risk groups. In Bombay, the HIV point prevalence among STD clinic attendees rose from 23% to 36% within the span of just one year, from 1993 to During that same time period, on the eastern coastline in the city of Vizac, HIV infection levels increased from 2.3% to 7.8%. In southern India, in the city of Madras, the prevalence has by and Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 144

145 large remained at 6.5%. Other areas that have reported high levels of HIV infection among STD clinic attendees are: Aurangabad (6%), Nagpur (6.8%), Tirupati (5.8%), Hydrabad (4.7%), and Manipur (4.8%). These statistics reveal that the virus has reached almost all parts of the country in various degrees. Another group of workers at higher risk for HIV infection are truck drivers, in part because they are away from their families so often. A sentinel survey done on the highways near the city of Tiruchirapalli in Tamil Nadu showed an HIV prevalence level of 2.7%. Similarly, in another study of truckers in northern India, the level of HIV infection has been found to be approximately 1.5%. These infected truck drivers-who generally come from rural areas-may unwittingly be helping the virus to spread from urban to rural areas. In the northeastern states, the primary mode of transmission has been through sharing of injection equipment among drug users. This is unlike other parts of the country, where transmission has occurred primarily through heterosexual sex. The prevalence of HIV among injection drug users (IDUs) has risen from less than 1% in 1988 to more than 55.8% in The trends in the other northeastern states like Nagaland and Mizoram are similar. These observations, taken from throughout the country, clearly point to the ways that the epidemic is spreading in India. The virus has not only a wider geographic spread, but it is also increasing among different risk groups, as well as moving into the general population through sexual transmission. Although the trends show increased rates of HIV infection in nearly all parts of the country, the level of epidemic in terms of actual magnitude of infection varies from state to state and district to district. While there are certain states-such as Maharashtra, Tamil Nadu, Manipur, and Nagaland-where the epidemic is in fairly advanced stages, in some of the northern states, the epidemic may be considered in its early stages STATE LEVEL STATUS Maharashtra is home for 60% of the AIDS affected people. There is a rapid spread of the disease, which calls for urgent attentions and increased action. 12 of the 35 districts in the State have been declared as high prevalence district. 60% of the new cases are those in the years group; 61% of the married women have heard of HIV and overall 33% of women who have heard about AIDS; have no knowledge about how to avoid it. Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 145

146 The State ranks 5 th in HIV AIDS awareness 4 th. The age group of young people from vulnerable communities face risk of HIV/AIDS and need special protection. Though reliable statistical information is not available, Maharashtra has a high number of HIV positive mothers in Antenatal care leading to a rise in the number of HIV + children. Many children who are sexually exploited are infected by HIV/AIDS and vulnerability high due to migration, children on streets, children in prostitution, tourism especially in coastal areas, industrialization etc. There is a no policy related to HIV / AIDS in Maharashtra. 2. LESSONS LEARNT AT STATE LEVEL There is a need for more counseling and support groups. Family based cares needs to be promoted. Community animators require training, Strong linkages with key partners need to be developed to promote home-based care. Medical fraternity requires proper and intensive education on all aspects of HIV/AIDS. 3. PROGRAMMING IN OUTPUTS Government systems and civil societies are responsive to the needs and rights of the HIV mother and her family. Government based guidelines and policy are in place. Community based care and support models are in place. Appropriate ARV therapy is available. Every woman is knowledgeable about PMTCT services. Every HIV + woman avails VCCT services. Family/couple friendly services are in place. Intermediate families and communities would be supportive of pregnant women who are HIV positive. Every women knows how to avoid unwanted programme. Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 146

147 Evidence based policy on PMTCT would be in place. Replicable comprehensive integrated district model of 3-prong strategy implementation. Communities do not discriminate affected families. Any case of discrimination is documented and challenged. All mothers till age of 6 months would practice exclusive breast-feeding. Every man (father-to-be) would be knowledgeable about HIV/AIDS and assumes responsibility for health of wife and children. A strong knowledge base regarding HIV/AIDS is in place. Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at 147

148 Results frame work State program of operations (Maharashtra) All children, adolescents, young people expectant & nursing mothers with their rights to survival, development, protection & full participation is ensured in the state public policies. All children < 3 years of age with their rights guaranteed and effectively implemented All children and adolescent of school going age (6-14 yrs.) included in the state public policies ensuring their healthier growth to develop their full potentials Every adolescent & young people are protected against HIV and his right to education, health, livelihood, social justice and full participation guaranteed (10-24 yrs.) SR 1 Every child survives and grows to its full potential SR 1 Every child enjoys learning SR 1 Every adolescent and young people has capability to protect him/herself from HIV SR 2 Every mother survives & is cared for SR 2 Every child protected from abuse and exploitation SR 2 Every adolescent and young people has access to services/ condoms SR 3 Government system and civil societies are responsive to the needs and rights of the young people SR 4 Every adolescent and young people is protected from coercive sex SR 5 Specially vulnerable adolescents and young people are protected SR 6 Every Infant/Child under 3 is protected against HIV Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at SR 7 Every adolescent girl will have the right level of hemoglobin (12 gms >)

149 Results Matrix HIV/AIDS GOAL Every adolescent is protected against HIV infection (Age for UNICEF: 10-24) Strategic Results Intermedi ate & Shortterm Results UNICEF Legend Every adolescent has the capability to protect himself or herself from HIV Every adolescent has adequate knowledge Have the skills and attitudes Every adolescent practices safe behaviour YP have a correct perception of their own risk YP feels connected to trusted adult school, and communities Vulnerability of adolescent girl UNICEF Effective models for preventive education UNICEF Drop out rate of girls is reduced UNICEF UNICEF Every adolescent has access to services/condoms Every adolescent is accessing youth friendly services including STI Every adolescent is able to access condoms easily Has access to friendly counseling and testing facilities Care and support services are available for YP with HIV/AIDS Every adolescent is protected from coercive sex Every adolescent has access to an effective legal system Stricter enforcement of labor laws Has awareness of risks and rights Has access to counseling and support services Especially vulnerable YP (EVYP) are protected MSM have appropriate knowledge a risk perception IDU have appropriate knowledge and access to services Sex workers have appropriate knowledge etc and access to services Orphans Trafficking reduced vulnerable Working children UNICEF-Education Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at UNICEF Priority CP 2003 UNICEF UNICEF-PMTCT UNICEF UNICEF-PMTCT UNICEF-NE UNICEF-CP UNICEF-CP & Education Govt. systems & civil societies are responsive to YP s rights (enabling environment) Youth friendly services accessible to adolescents in every community Govt. policies are supportive of interventions for YP UNICEF States capacities are adequate /in place to respond (urgency of epidemic, evidence based, resources) Civil society and govt. coordinate partners interventions UNICEF Govt. systems have accurate information/database on HIV/AIDS & YP UNICEF There is a policy on YP & HIV in place comprehensive/ vulnerable Social environment supports HIV prevention YP support positive peer norm for safe behaviour YP openly communicate about safe behavior (between sexes) Positive peer norms for safe behavior Politicians, media, communities speak out and lead the response to HIV/AIDS Parents discuss sexuality with their children/adolescents Communities/NGOs have accurate knowledge on the situation of HIV/AIDS among YP YP accepting and supporting infected peers YP actively engaged in society issues related to YP YP engaged in conceptualizing, planning, design, implementation, Evaluation of HIV prevention activities UNICEF UNICEF UNICEF UNICEF

150 Every Infant/Child < 3 is protected against HIV Every woman takes necessary steps to prevent HIV infection for self and child Every woman is knowledgeable about HIV Every positive woman prevents HIV transmission to her child Every woman is knowledgeable about PMTCT services Every father (to be) takes necessary steps to prevent HIV infection (self/fly) Assumes responsibility every father for health of wife & children (sees MCH as his business) Every woman and young person has access to comprehensive RCH services Evidence-based policy on PMTCT (including IF) is in place UNICEF Every HIV affected family has access to care and support service UNICEF Appropriate ARV therapy is available for and children Community based cares and support models Every woman perceives herself to be vulnerable Communities do not discriminate affected families Family/Couple friendly services are in place (particularly VCCT All mothers till age 6 months practice exclusive BF Every (+) woman avails VCCT services Family/Couple friendly services are in place (particularly VCCT) Immediate families and communities are supportive of pregnant women who are HIV positive UNICEF (+) Women benefit from: - Confidentiality - Informed consent - Informed choice Every man (father to be) should be knowledgeable about HIV Replicable comprehensive integrated District model of 3 Prong strategy implementation Empathetic and skilled staff is in place UNICEF Any case of discrimination is documented and challenged Knowledge base Govt. based guidelines and policy are in place CARE Peer support groups are established (IF, counseling etc) Govt. systems and civil societies are responsive to the needs and rights of the HIV mother and her family Govt. guidelines and policies that have consequences on and HIV Govt. addresses vulnerability issues Every (+) woman knows how to avoid unwanted pregnancy Legal support to (+) women and families Copyright - Shodhana Consultancy Pvt. Ltd. Visit us at Support system/ referral System/safety net/ Linkages with # social services