Evaluation of Immunization Training of Medical Officers, Cold Chain Handlers and Technicians

Size: px
Start display at page:

Download "Evaluation of Immunization Training of Medical Officers, Cold Chain Handlers and Technicians"

Transcription

1 vkjksx;e~ lq[kleink National Institute of Health and Family Welfare, New Delhi Evaluation of Immunization Training of Medical Officers, Cold Chain Handlers and Technicians Collaborative study by NIHFW, WHO Country Office for India and UNICEF

2 Evaluation of Immunization Training of Medical Officers, Cold Chain Handlers and Technicians Principal Investigators Professor Jayanta K Das, Director, NIHFW Dr Stephen Sosler, Deputy Project Manager, WHO Country Office for India Chief Investigators Professor M Bhattacharya, Head, Department. of CHA and Nodal Officer, Immunization, NIHFW Dr Renu Paruthi, Training Focal Person, WHO Country Office for India Co-Investigators Professor Utsuk Datta, NIHFW Dr Gyan Singh, NIHFW Dr Sanjay Gupta, NIHFW Dr Renu Shahrawat, NIHFW Dr Nanthini Subbiah, NIHFW Dr Arindam Ray, WHO Country Office for India Dr P Deepak, NIHFW

3 Preface The National Institute of Health and Family Welfare (NIHFW) has been involved in capacity building of health functionaries by conducting various in-service training programmes on different health topics for state and district level health managers, faculty of training institutes and programme managers. For the immunization programme, NIHFW has conducted the training of trainers' courses for immunization training of medical officers (29-1) and vaccine and cold chain handlers (21-11). NIHFW with WHO Country Office for India and Ministry of Health & Family Welfare (MoHFW) and partner agencies had conducted the Performance Assessment of Health Workers' Training in Routine Immunization in India (29). The findings of the study were used to improve the training of health workers in immunization subsequently. By end December 211, nearly half of the 6 medical officers and more than 43% of the 3 cold chain handlers in the states had been trained, it was decided to conduct an integrated evaluation of these trainings for better utilization of resources. The training status of district cold chain technicians was included in this study so that it would give us an indication of their performance requirements and training needs in the field. NIHFW is currently working on setting up a National Cold Chain and Vaccine Management Resource Centre (NCCVMRC), NIHFW and a National Cold Chain Training Centre (NCCTC) at State Health Transport Organization (SHTO), Pune for trainings of cold chain technicians and vaccine and and logistics managers. This report provides the conclusions derived from the evaluation study and frames recommendations for the national and state governments to improve the progress and quality of training, knowledge, skills and practices of medical officers and cold chain handlers, and overall support for the immunization programme. We are thankful to the MoHFW, WHO Country Office for India, UNICEF, state governments and other development partners for their enthusiastic participation in the study and their valuable insights in making this exercise meaningful. We hope that the results of this study will be helpful in reviewing and improving immunization training in the future. Jayanta K Das Director, NIHFW ii

4 Foreword The Ministry of Health & Family Welfare (MoHFW), Government of India (GoI) has provided additional resources through the National Rural Health Mission to all the states and declared as the year of Intensification of Routine Immunization. In this context, WHO, UNICEF and other partners have supported capacity building of the health service providers at all levels through the development of training materials for training of health workers, medical officers and cold chain handlers such as immunization handbooks for health workers and medical officers, handbook for vaccine and cold chain handlers, facilitators' guides and training kits. The National Institute of Health and Family Welfare (NIHFW) with support from WHO Country Office for India and UNICEF has trained 15 trainers of medical officers and 1728 trainers of cold chain handlers. Till date, 32 medical officers and 24 cold chain handlers have been trained in the country. Assessing the impact of training on the performance of medical officers and cold chain handlers is an important step towards assuring the quality of immunization services in the country. We are grateful to the GoI for facilitating and supporting this study. On the lines of the health worker's training evaluation study conducted in 29, this study also is an excellent illustration of a wider partnership and coordination between the NIHFW, state governments and development partners. We hope that this report will be a useful guide for the states to improve their future training activities and the quality of the overall immunization programme. Mr Louis-Georges Arsenault UNICEF India Representative Dr Nata Menabde WHO Representative to India iii

5 Table of contents Topics Page Abbreviations 2 Executive summary 5 Chapter-1: Introduction, rationale and objectives 18 Chapter-2: Methodology 21 Chapter-3: Study results 26 Chapter-4: Conclusions and recommendations 7 State specific recommendations from the study 82 Annex-1: Study tools for phase-1 study 14 Annex-2: Study tools for phase-2 study 121 Annex-3: List of study team members for ph-1 and ph-2 study 141 1

6 Abbreviations ABSA ADS AEFI ANM ANMTC AP ARV AS ASHA AVD AWW AYUSH BCG BDO BEE BEmOC BPM BTF CCH CDPO CFC CFW CHC CHO CMO CSSM DF DIO DL DPM DPT DTC DTO DTT EVM FAQ FIR FSR GJ Attirikt basic shiksha adhikari Auto disable syringes Adverse events following immunization Auxiliary nurse midwife Auxiliary Nurse Midwife Training Centre Andhra Pradesh Anti-Rabies Vaccine Assam Accredited social health activist Alternate vaccine delivery Anganwadi worker Ayurveda Unani Siddha Homeopathy Bacillus Calmette-Guerin Block development officer Block extension educator Basic Emergency Obstetric Care Block programme manager Block-level Task Force Cold chain handler Child development programme officer Chloro Fluoro Carbon Commissioner (Family Welfare) Community health centre Community health officer Chief medical officer Child Survival and Safe Motherhood Deep freezer District immunization officer Delhi District programme manager Diphtheria Pertussis Tetanus District Training Centre District training officer District training team Effective vaccine management Frequently asked questions First Information Report Field Survey Register Gujarat 2

7 GoI Gps HA (M) HA (F) HEEO HepB HFWTC HI HIV HMIS HQ HR HR Hws ICC ICDS ILR IMNCI IPC IO JE KA Kva LHV MCHIP MCP MCUP MCTS MH MHS MN MO MoHFW MOIC MP MPHS (M) MPW NCC NGO NIHFW NIPI Government of India Gram Panchayats Health Assistant (Male) Health Assistant (Female) Health extension education officer Hepatitis B Health & Family Welfare Training Centre Health inspector Human Immunodeficiency Virus Health Management Information System Head Quarters Haryana Human resources Health workers Investigator cum computer Integrated Community Development Scheme Ice lined refrigerator Integrated management of newborn and childhood illnesses Inter-personal communication Immunization officer Japanese Encephalitis Karnataka Kilo Volt Ampere Lady health visitor Maternal Child Health Immunization Programme Mother and child protection Measles Catch Up Campaign Maternal & Child Tracking System Maharashtra Male health supervisor Manipur Medical officer Ministry of Health & Family Welfare Medical officer In-charge Madhya Pradesh Multipurpose health supervisor (Male) Multipurpose worker National Cadet Corps Non-Government Organization National Institute of Health and Family Welfare Norwegian-Indian Partnership Initiative 3

8 NRHM NPSP OD OJT OPV PHC PHN PIP PIR PNA PPC PRI RCH RI RIMS SCCO SEPIO SHG SHTO SIHFW SMO ToT TA/DA UIP UNICEF UP VMAT VVM VPD VHND WB WHO WIC WIF WMF WR National Rural Health Mission National Polio Surveillance Project Odisha On-job training Oral polio vaccine Primary health centre Public health nurse Programme Implementation Plan Preliminary Information Report Performance needs assessment Post-partum clinic Panchayati Raj Institution Reproductive child health Routine immunization Routine Immunization Management System State cold chain officer State expanded programme of immunization officer Self help group State Health Transport Organization State Institute of Health and Family Welfare Surveillance medical officer Training of trainers Travel allowance / Dearness allowance Universal Immunization Programme United Nations International Children's Emergency Fund Uttar Pradesh Vaccine management assessment tool Vaccine vial monitor Vaccine preventable disease Village Health & Nutrition Day West Bengal World Health Organization Walk-in cooler Walk-in freezer Wastage multiplication factor Wastage rate 4

9 Executive Summary Background Under the NRHM program, initiatives were taken for capacity building of the health service providers at all levels. Immunization-specific training of medical officers started in 29 after the handbooks, facilitators' guides and training kits were developed and printed by GoI. The states started training the medical officers in 29-1, after all the 15 trainers of the medical officers were trained in 25 courses organized by NIHFW and WHO India NPSP. By January 212, around 5% of medical officers were trained in the country. The cold chain handlers' training started in after the handbooks were developed and printed by GOI in 21. A total of 221 state trainers were trained in National ToTs (21-11). Another 157 district level trainers were trained by state training teams in 211. By January 212, 43% of the 33 Cold Chain handlers were trained. Cold Chain technicians were being trained by State Health Transport Organization (SHTO) Pune since 199 but the training stopped in between from 2 to 26. However, the progress in training varied from state to state. Therefore, it was decided to study the training system and the processes followed in select good performing states and some weak performing states to identify the factors affecting the progress and quality of training. A need was also felt to assess the effect of training on the performance of the medical officers and cold chain handlers. The study was proposed by the immunization division, MoHFW and was conducted by NIHFW in collaboration with WHO India NPSP and UNICEF. 5

10 Objectives The overall objective was to study the processes and factors affecting the progress, performance and quality of training on immunization for medical officers, cold chain handlers and technicians. The specific objectives of the study were as follows: 1) To identify factors affecting differential progress between states in RI training of MOs and cold chain handlers 2) To identify factors affecting the quality of training 3) To assess the knowledge, skills and practice of medical officers, cold chain handlers and technicians related to immunization 4) To make recommendations for improving future training of medical officers, cold chain handlers and technicians Methodology The first two objectives were studied in the first phase between February and March and the second and third objectives formed part of phase-2 study conducted in April and May 212. For the first phase, Twelve states were selected for desk review and field visits on the basis of MO-training progress by selecting four states (randomly) from each group of states with less than 4%, 4-7% and more than 7% MOs trained. For the second phase, six out of the original twelve states were selected (two from each category) mainly by excluding those states where training of medical officers was conducted recently for Measles catch-up campaigns. Then 12 districts, two from each of the six states, with moderate training coverage (one near and one away from state headquarter) were selected. Selection of states Phase-1 study Phase-2 study MO-Training < 4% Uttar Pradesh, Madhya Pradesh, West Bengal, Gujarat Uttar Pradesh and West Bengal MO-Training 4-7% Odisha, Manipur, Maharashtra, Delhi Madhya Pradesh and Odisha MO-Training >7% Andhra Pradesh, Assam, Haryana, Karnataka Andhra Pradesh and Maharashtra Study tools were developed for in-depth interviews, observations and records reviews during both phases of the study. 24 study teams were identified amongst officers from NIHFW, WHO, UNICEF, MCHIP, NIPI and state officials. During first phase, field visits were made to each of the twelve states for two to three days by a two member team to conduct in-depth interview of SEPIO, State Cold Chain Officer (SCCO), Director-SIHFW, 6

11 Director-FW, MD-NRHM / other state level officials and trainers of the state/regional training centers. During the second phase, field visits were conducted to each of the 12 districts for three to four days by a two member team to conduct in-depth interview of DIO, DPM, cold chain technician, MOs, Cold chain handlers, HWs and trainers of the MO and Cold chain handlers. The sample size was 4 (1 during first and 3 during second phase of the study). The sample included both trained and untrained Mos, Cold chain handlers and cold chain technicians. After data validation, state wise data was compiled and analyzed based on each objective of the study. Salient findings of the study Medical officers training 1.Factors affecting progress in immunization training of medical officers in the states i. Enabling factors Four states Andhra Pradesh (AP), Assam, Karnataka (KA) and Haryana (HR) had trained more than 7% MOs. Major factors responsible for good progress in training in these states were identified as follows: Review of progress in training Top priority was given to tracking and completion of immunization training during review by MD-NRHM/Director FW in AP and HR. There was proactive involvement of Director FW, MD-NRHM, and SEPIO in KA and Assam to facilitate the progress of training. Monitoring the quality of training Good monitoring was done by the state and district officials e.g. use of 'SKYPE' for online monitoring of training in Karnataka and monitoring of training in districts by SIHFW in AP. Decentralization of training Decentralization of MO-training to district level expedited the progress of training in Andhra Pradesh, Assam, Karnataka and Haryana. (West Bengal is exception). 7

12 Pool of trained trainers Large pool of trainers helped to improve the training progress. ii. Barriers and issues in the progress of training Planning and coordination of training Priority was not given to training in the states with weak progress; there was no accountability for not attending the training. A database of trained personnel was not maintained. Trainings were cancelled due to poor attendance of MOs. Lack of coordination was found between SIHFW and state/district offices to follow up on the training nominations and progress. Training infrastructure and facilities There were less number of training centres and lack of training infrastructure with no stay facility in majority of districts and in three states of Delhi, Gujarat and Manipur. There was shortage of trainers with vacancies at SIHFW; too many training courses in HFWTC/SIHFW. Lack of trainers was noticed as they were posted in NRHM and not available for actual trainings. Implementation and monitoring of training Inadequate attendance of MOs was due to shortage of doctors in some states. MOs were not relieved for three days due to other priorities such as outbreaks, floods, school health programme and pressure to utilize PIP funds. CMOs were reluctant to spare MOs frequently as service delivery in PHC suffered, especially in last quarter of the financial year. No system of regular reporting and no mechanism for regular monitoring of training were in place. Release of funds and financial norms Delay in release of funds from NRHM office was reported as the reason for slow progress. RCH training norms were not followed and participants were not given TA/DA and trainers honorarium as per RCH norms. No trainings were conducted from April to June because funds were released from GoI in June. In-house trainers were not given honorarium leading to reluctance to train. 8

13 2. Factors affecting the quality of medical officers training Overall quality of training was found to be good as gathered from the trainers and the trainees. I. Enabling factors Profile of trainers and medical officers Right types of officers were trained as trainers for MOs. They were faculty of training centres; medical colleges; SEPIO / Programme Officers; CMO / DIO / DTO; Paediatrician; Senior Medical Officers; Divisional Coordinators; NPSP SMOs; Retired Senior Health Officer etc. The Medical Officers who were involved in immunization program were trained as MO (PHC/CHC); contractual doctors; AYUSH Doctors and MOs of hospitals. Involvement of trainers Adequate numbers of trainers were involved on all three days during last three batches in all states except Maharashtra where only one trainer was involved. Training methodology Interactive training methods as per facilitators guide and training kits were used in all states. Transport was provided for the field visits to practice supervision. The immunization handbook and handouts were given as a part of the training. Training kit and CD with films was used. Pre and post test was done and feedback received from the trainees. Certificate was given to each participant. Follow-up on feedback of trainees Corrective actions were taken after feedback from the participants. Training days were arranged such that the 3rd day was Immunization day. Quality of lunch and organization improved. More emphasis was given to supervision. Training was made more participatory. Disturbance due to noise was reduced. Involvement of SIHFW SIHFWs in Andhra Pradesh, Assam, Delhi and Gujarat proactively coordinated the immunization training for MOs in the state. 9

14 ii. Barriers and issues in the quality of training Training facilities Lack of training, hostel and mess facilities observed in the states of Delhi, Manipur and Gujarat were barriers. Lack of involvement of SIHFWs SIHFWs in five states of Uttar Pradesh, West Bengal, Haryana, Karnataka and Manipur were not at all involved in coordinating and monitoring the immunization training. Availability of trainers Shortage of trainers was reported in Delhi, Gujarat, West Bengal, Odisha, Uttar Pradesh and Andhra Pradesh. Trainers were not present in full strength in Madhya Pradesh and Maharashtra. Reasons given were mainly transfer of trained trainers to other positions leading to shortage. Inclusion of immunization training in induction training of MOs Though all states except Delhi, Manipur and Assam had a policy for induction training of MOs varying from 2-6 weeks, only half to one-day sessions were allocated to immunization which was inadequate. 3. Knowledge and practices of medical officers in immunization i. Knowledge level of trained and untrained medical officers To assess their knowledge level, all the MOs were asked 1 open ended questions from the immunization handbook. They were scored based on the correct responses. Comparison was made between the trained and untrained medical officers. Trained medical officers performed better than performance of the MOS in Uttar Pradesh, Maharashtra and Odisha was the lowest compared to rest of the states. ii. Practices of trained versus untrained medical officers in PHCs Good practices Monitoring and using data for action after training Performance of trained MOs in data analysis from the routine reports on immunization coverage, drop-outs and left-outs was better when compared to untrained MOs. The difference in their performance was statistically significant. 1

15 Conducting review meetings Review meetings were held at block/phc levels in all the states. The frequency was monthly in majority of the blocks and the participants were mainly HWs and ASHAs/AWWs. The feedback from data analysis was shared by the trained MOs with health workers during monthly meetings, to improve coverage. Conducting supervision and on the job training All MOs who conducted supervisory visits gave good examples of problem solving and provided on the job training during supervision. Community involvement and communication activities After training, MOs supported various communities' involvement activities e.g. addressed various meetings in the community to educate the caregivers and the frontline workers. The MOs visited resistant families with local influential persons to counsel and motivate them. Supervisors' opinions All DIOs noted improvement in the performance of MOs after training in areas of cold chain maintenance, monitoring and supervision, community mobilization and injection safety. Health workers' opinions Health workers were able to appreciate change in the attitude of MOs following training. They came up with examples of on-the-job training provided, various topics discussed during the review meetings and activities conducted by the MOs for improving community involvement. Gaps in immunization practices after training Inadequate involvement in RI-Microplans Majority of medical officers had no role in micro-planning; it was prepared by PHN, LHV, MHS, MPHS (M), BEE, BPM and Community Health Officer. ANM roster and AVD plans were available in all the states. West Bengal performed poorest in availability of maps, estimation of beneficiaries and plans for supervisory visits. Lack of supervisory visits Though plans for supervisory visits were available in all the states except West Bengal, no records to support supervisory visits were available in majority of the PHCs. 11

16 Inadequate monitoring and using data for action after training All trained MOs were not analyzing the routine reports to calculate the immunization coverage (%), drop-outs and left-outs. Coverage monitoring chart was not available in majority of the PHCs. AEFIs and VPDs Majority of the PHCs had not reported any AEFIs or VPDs during the last three months. Immunization waste management in the PHC Waste disposal was poor in all the states, though little better in PHCs with trained MOs. Waste disposal pits were not used properly. There were reports of burning waste and discarding syringes in to the pit. iii. Programme support to the MOs Guidelines for fund utilization Clear guidelines for fund utilization for immunization activities were available with majority of the MOs. Some issues were highlighted as delayed or no receipt of funds from district for mobility for supervision; for AVD and for ASHA. Supervision of MOs Majority of the medical officers were visited by the district immunization officers in last three months. Supervisors guided the MOs on microplanning, cold chain, using data for action, injection safety and waste management issues etc. Role of the DIOs in immunization program management Majority of DIOs were conducting supervisory visits, organizing review meetings and analyzing the data from monthly reports. But the coverage monitoring chart was displayed by only two out of 11 district immunization officers. iv. Need for additional immunization training Majority of MOs felt the need for additional training in immunization. Untrained MOs asked for complete RI training while majority of trained MOs asked for refresher training at district level as HWs were to be trained repeatedly. Areas were specified as microplanning/planning, cold chain, logistics management, new vaccines, community involvement, records, reports and using data for action, AEFI, updates and changes in guidelines, waste disposal and role of AYUSH doctor. 12

17 Key recommendations for improving training of MOs Establish state/district training cell with one officer designated as training coordinator to coordinate for all programmes; improve coordination among SIHFW, NRHM and directorate and ensure that overlapping with other trainings is avoided Review the progress of training as part of regular program reviews at state and district level. Devise mechanisms to ensure adequacy of batch size and mandatory attendance of nominated participants Strengthen and involve SIHFWs to coordinate and monitor the immunization training. Integrate immunization training in the induction training program for medical officers Training database should be maintained by the state and district training centres. Regular reporting of training should be ensured through HMIS Develop training infrastructure in all districts. Provide hostel and transport facilities in Delhi, Gujarat and Manipur. Districts with trained MOs, good training and residential facilities should be made training centres for MO training e.g. Hoshangabad in Madhya Pradesh Address shortage of faculty and staff at the training centres by hiring on contract basis under NRHM. Training cadre/faculty should be full time, regular and if required, transfer to other training centres only Conduct state ToT to increase the pool of trainers at the state and in all regional training centres. Provide regular refresher training to master trainers/ faculty members of SIHFW. Involve medical college faculty in all training courses on immunization Training monitoring should be institutionalized. Use of technology e.g. SKYPE should be encouraged. Involve the state trainers to monitor trainings at regional and district level. District trainers should follow-up the trainees on the job Revise financial guidelines for immunization trainings in line with RCH training norms. The budget of MOs training to be included in the state PIP of so that all MOs are trained by 213 end. Train the untrained MOs including AYUSH MOs and organize refresher course at the district level. Encourage all MOs in addition to the MO-I/Cs to be actively involved in micro-planning, monitoring and supervision activities 13

18 Address non-training factors affecting the immunization services as release of funds, supply of logistics and conduct of supervision at all levels to enable the MOs to translate the training into good practices Cold chain handlers training 1. Factors affecting progress in CCHs training The progress of training was good in all states except Uttar Pradesh and Karnataka. Major reasons for good progress were: Regular reviews by Commissioner Family Welfare (CFW) and SEPIO and intensive monitoring by dedicated person at state level Trained trainers in adequate numbers were available in all the states visited Training was decentralized to district level Development partners mainly UNICEF supported ToTs for CCH training in seven states Reasons for slow progress were cited as delay in translation and printing of handbooks; HR shortage and SCCO on leave. 2. Factors affecting the quality of cold chain handlers training Quality of training was found to be good, as gathered from the trainers and the trainees. Duration of training was two days in nine states and one day in Delhi, Manipur and Uttar Pradesh Number of Cold Chain handlers per cold chain point were two or more in eight states Handbook was translated and printed/available in local language in all states except in AP and MN where the participants were comfortable in English Training was residential in all states except GJ Three or more trainers were involved per batch for both days in all states 3. Knowledge and practices of cold chain handlers after training The trained cold chain handler had better knowledge and skills in all areas (storage of vaccines and diluents, maintenance of equipment, recording of temperatures and stock registers etc.) as compared to untrained handlers Knowledge and skill levels remained poor for both trained and untrained handlers in recording of diluents details in stock register and contingency actions, conditioning of ice packs and freezing of ice packs in deep freezers 14

19 Cold chain technicians training i. Positive observations All cold chain technicians had minimum required qualifications and were in-charge of only one district All were trained for repair and maintenance of ILRs/DFs Maharashtra technicians also repaired and maintained hospital equipment Few of the cold chain technicians were also involved in vaccine management duties The technician with a WIC under his charge had received trainings for repair and maintenance of WIC/WIF and also for the servo stabilizers (for use with WIC/WIF) All technicians except one had tool kits All were satisfied with the quality of trainings received at SHTO, Pune ii. Areas of concern One technician was not trained to repair 1 kva voltage stabilizers used with ILRs / DFs Three cold chain technicians trained for WIC/WIF were currently posted in districts without WIC/WIF. They were also not trained in repair and maintenance of servo stabilizers Training has not been provided for all the different types and brands of voltage stabilizers available in the field A technician each gave incorrect answers to two questions directly related to his job responsibilities. This indicates non-application in actual work of knowledge gained during training or the requirement of short refresher trainings to update knowledge after every few years. TA/DA receipt / reimbursement issues have been reported by two of the eight technicians Most of the technicians did not have dedicated rooms to be used as workshops/offices. They also did not have easy access to transportation to travel to repair broken down machines/ compressors and other spare parts High breakdown instances / rates for haier equipment and chintz stabilizers reported by at least two of the eight CCTs Many spare parts used commonly for minor repairs were neither available with technicians nor at state level 15

20 Key recommendations for improving training of CCHs and technicians Cold chain handlers (CCH) A one-day refresher course may be recommended for cold chain handlers trained for two days provided proper data base of trained cold chain handlers is available The cold chain handlers training should be followed by intensive supportive supervision and on job training to ensure that knowledge and skills acquired are used in the actual settings Cold chain technicians (CCT) For optimum utilization of resources, states may post technicians trained in repair and maintenance of WICs/WIFs to districts with WIC/WIF. They should receive training on servo stabilizers before or immediately after getting posted to these districts Trainings on different types/brands of 1kVA voltage stabilizers need to be organized for technicians who have not received the training Training to be urgently organized for repair and maintenance of haier equipment and chintz stabilizers Refresher trainings need to be organized for technicians regularly as per training needs assessment Supply of spare parts for minor repairs should be made regular TA/DA reimbursement issues of CCTs should be taken up by states and districts regularly. States and districts should ensure dedicated room as workshop for the technician along with priority allocation of four wheeler vehicle for transportation of ILRs/DFs and heavy spare parts Way forward National level Revise and update the training materials for MOs based on feedback received Streamline the reporting of RI training, may include under HMIS State level Establish state training cell to coordinate with all the programme officers and SIHFW Develop / improve training infrastructure in SIHFW and all the districts Training database of health service providers should be maintained by district training centres and SIHFW Give priority and ensure mandatory attendance of MOs through some orders from state 16

21 Include RI training as a part of induction training of MOs Conduct state ToT to increase the pool of trainers at training centres and conduct refresher training for master trainers at SIHFW Develop systematic monitoring plan by state officials to facilitate training process and ensure quality of training District level Invite more nominations for better participation After training ensure follow-up and on-the-job training by the district level officers Ensure that quarterly RI review meetings are held and are used to review the training issues identified through supervision visits Provide mobility support to the MOs and other supervisors at block/phc level to ensure supervision Encourage all MOs in addition to the MO-I/Cs to be actively involved in micro-planning, monitoring and supervision activities Organize refresher course at the district level for all MOs in RI including new vaccine being introduced and capacity building of HWs to utilize VHND for increasing awareness 17

22 Chapter-1 Introduction, rationale and objectives Introduction Expanded Programme in Immunization started in India in It was renamed as Universal Immunization Programme in 1985 to progressively cover the whole country. Immunization performance is regularly assessed through UIP review meetings and joint review missions organized by the Government of India (GoI) with states and partners. A national UIP review was also conducted in India in 24, covering six states selected on the basis of various criteria. These reviews have noted strengths in UIP performance in India notably in the better performing states - as well as many constraints which need to be addressed. Immunization training of MOs and health workers was conducted as part of CSSM and RCH programmes. Impact evaluation of RCH training conducted in 24 revealed inadequate practical hands on exposure. For medical officers: Immunization handbooks, facilitators' guides and training kits were developed and printed by GoI in the last quarter of 28. Training plan was prepared based on the training load of around 6 MOs and around 1 training centers identified at state and divisional levels. As a first step, National Workshop for 4 master trainers was held at NIHFW during 9-11 September, 28. During 18

23 29, all the 15 trainers of the medical officers were trained in around 25 Training of Trainers (ToT) courses organized by NIHFW and WHO-NPSP. The states started training the MOs in For vaccine and cold chain handlers: Handbooks in English and Hindi were developed and printed by GoI in June 21. The States had to translate the handbook in other local languages. At least one cold chain handler per ILR point (PHCs and CHCs) with 2% extra as reserve and all handlers at district/divisional/regional and state vaccine depots to be trained. There were 221 state trainers were trained in National ToTs (21-11). There were 157 district level trainers were trained by state training teams in 211. For cold chain technicians (CCT): There are about 46 CCTs in the country. SHTO, Pune (supported by UNICEF and GoI) has been conducting training since early 199's for cold chain technicians in (a) repair and maintenance of ILRs/DFs, (b) repair and maintenance of WICs/WIFs, (c) repair of different types of voltage stabilizers and (d) installation and maintenance of solar refrigerators. No training was held from Rationale Only 5% of 6 MOs were trained in the country in two years, by January 212. The progress in training varied from state to state. It was felt important to identify the factors affecting the progress and quality of training by studying the training system and the processes followed in select good performing states and some weak performing states. Need was also felt to assess the effect of training on the job performance of the MOs. By January 212, Only 43% of 33 CCH were trained in one and half years, However, progress in training was different among states. Need was felt to identify factors affecting progress and quality of training as also the effect of training on job performance of CCH. 19

24 Almost all CCTs were trained on repair and maintenance of ILRs/DFs; many technicians posted at divisional/regional and state stores were trained in repair and maintenance of WICs/WIFs. Only a few technicians were trained in repair of voltage stabilizers. It was planned to assess training needs of cold chain technicians to prepare future training programmes and also identify systemic factors affecting their performance in the field. Objectives The overall objective was to study the processes and factors affecting the progress, performance and quality of immunization training of medical officers, CCH and technicians. Specific objectives (1) To identify factors affecting differential progress between states in RI training of MOs and cold chain handlers (2) To identify factors affecting the quality of training (3) To assess the knowledge, skills and practice of MOs, CCH and technicians related to UIP (4) To make recommendations to improve future training of MOs, CCH and technicians 2

25 Chapter-2 Methodology Methods and materials The study was conducted in two phases 1. Phase -1 was conducted for 2 February to 7 March Phase -2 was conducted for 23 April to 25 May 212 Sampling technique 1) Selection of states for phase-1 study (to cover specific objectives 1 and 2) Map-2.1: Selection of 12 states for phase-1 of Training Map-2.1: selection evaluation of 12 states study for phase-1 study Training progress of all the states was reviewed. Twelve states were selected for desk review and field visits on the basis of MO-training performance. Four states were selected randomly from each group of states with MO-training coverage of < 4%, 4-7% and >7%. Kerala and I < 4% 4% to 7% Tamil Nadu where RI training was conducted recently before introduction of pentavalent vaccine were excluded. (Table 2.1) Table 2.1: Categorization and selection of states for phase-1 study Category A MO-Training < 4% UP, MP, WB, Gujarat Category B MO-Training 4-7% Odisha, Manipur, Maharashtra, Delhi Category C > 7% MO-Training >7% AP, Assam, Haryana Karnataka 21

26 2) Selection of states and districts for phase-2 study (to cover specific objectives 2 and 3) a) Out of original 12 states, six states were selected mainly by exclusion criteria Assam, Haryana, Manipur and Gujarat recently completed MCUP in the whole state or many districts were excluded. Delhi being small state with doctors mainly posted in dispensaries and Karnataka recently retrained all its doctors was also excluded. The selected states were Uttar Pradesh, West Bengal, Madhy Pradesh, Odisha Andhra Pradesh and Maharashtra. b) Based on MO-Training coverage, these states were grouped in three categories. For these six states, mapping of all districts was done based on training coverage. From each state, two districts with moderate training coverage, one near state head quarter and the other away from state head quarter were selected. (Table 2.2) Table 2.2: Selection of states and districts for phase-2 study Category A MO-Training < 4% Uttar Pradesh Ferozabad and Jaunpur West Bengal Category B MO-Training 4-7% Madhya Pradesh North Hoshangabad 24-PGS and and Satna Murshidabad Odisha Ganjam and Khurda Category C MO-Training >7% Andhra Pradesh Krishna and Medak Maharashtra Raigad and Washim c) In each district, it was decided to select The DIO, DPM and CCT Ten MOs to be selected randomly from list of trained and untrained MOs (including three-four MOI/Cs and one-two urban medical officers) Six Cold Chain handlers available at cold chain points Five ANMs/LHVs being supervised by MOs Regional/district trainers for MO/CCH, if available in the district 22

27 I Study population At state level, it comprised of SEPIO, SCCO, Director SIHFW, Director FW, MD- NRHM and trainers of the state training centers. At district level, it comprised of DIOs, DPMs, MOs, cold chain h a n d l e r s, c o l d c h a i n technicians, ANMs/LHVs and trainers of the district/regional training centers. Map-2.2: Selection of 12 districts for phase-2 of Training evaluation study Category A (<4%) Ferozabad, Jaunpur (Uttar Pradesh) 24-PGS North, Murshidabad (West Bengal) < 4% 4% to 7% > 7% Category B (4% to 7%) Hoshangabad, Satna (Madhya Pradesh) Ganjam, Khurda (Odisha) Category C (>7%) Krishna, Medak (Andhra Pradesh) Raigad, Washim (Maharashtra) Sample size Table 2.3: Number and category of Respondents interviewed at each level N Category of respondents Number/ unit as planned SEPIO SCCO Trainers of MOs Trainers of CCH Director State/Regional Trg Institute MD-NRHM / Director FW Total number of respondents DIO DPM Trainers of MOs Trainers of CCH Cold chain technician Medical officers (PHC) Cold chain handlers ANMs and LHVs Total number of respondents State level 1 per state 1 per state 2 per state 2 per state 1 per state 2 per state District level 1 per district 1 per district 1 per district 1 per district 1 per district 1 per district 6 per district 5 per district 26 per district Total number interviewed

28 Data collection methods and procedures Techniques of interview, observation and desk review of records were used to collect data. Planning meeting for the training evaluation study was held on 25 January 212 at NIHFW with participation from GoI and partners along with faculty of NIHFW. Phase-1 study protocols and tools were finalized and shared with all the study team members during briefing meeting held at NIHFW on 15 February 212. The following tools were developed to meet the objectives of the study (Annex-1): Study tool-1 for State EPI Officer and SCCO Study tool-2 for State level Trainers of Cold Chain Handlers Study tool-3 for Trainers of State Training Centre for MO training Study tool-4 for the Director of State Training Centre Study tool-5 for Director FW and MD-NRHM Twelve study teams were identified amongst officers from NIHFW and partners. Field visits were made to each of the twelve states for two to three days by a two member team to conduct in-depth interview of SEPIO/SCCO/Director-SIHFW/Director-FW/MD-NRHM/other state level officials and trainers of the state/regional training centers during 2 February to 7 March 212. Data collected during field visits was analyzed to identify the factors affecting the progress and quality of training. Meeting was held at NIHFW on 1 April 212 with faculty of NIHFW, partners and GoI to share the results from Phase-1 study and finalize the plan for second phase of the study. Phase-2 study protocols and tools were finalized and shared with all the study team members during briefing meeting held at NIHFW on 2 April 212. The following tools were developed to meet the objectives of the study (Annex-2): Study tool-1a for District Immunization Officer (DIO) Study tool-1b for District Programme Manager (DPM) Study tool-2a for Trainer of Medical Officer (MO) Study tool-2b for Trainer of Cold Chain Handlers (CCH) Study tool-3 for District Cold Chain Technician (CCT) 24

29 Study tool-4 for MO (Block/PHC) Study tool-5 for CCH (Block/PHC) Study tool-6 for ANM/LHV being supervised by the interviewed medical officers. Twelve study teams were identified amongst officers from NIHFW and Partners. Field visits were conducted to each of the twelve districts for three to four days by a two member team to conduct in-depth interview of DIO, DPM, cold chain technician, medical officers, cold chain handlers, HWs and trainers of the MO and CCH during 23 April to 25 May 212. List of study team members is given at Annex-3. Data validation and data analysis Data validation exercise was conducted for all the data collected. This included cross checking and matching the data from hard copies in to the soft copies and clarifications sought after interacting with the investigators. Then, state wise data was compiled and analyzed based on each objective of the study, leading to preparation of graphs and tables for inclusion into the report. 25

30 Chapter-3 Study results The observations from the study are presented under the following four sections as follows: PART-1: General profile of all the respondents of the study PART-2: Results from evaluation of MO training in immunization. These are organized under the following heads: 1. Factors affecting differential progress between states in RI training of MOs 2. Factors affecting the quality of immunization training of MOs 3. Knowledge, skills and practices of MOs in immunization. PART-3: Results from evaluation of cold chain handlers training PART-4: Results from evaluation of cold chain technicians training 26

31 PART-1: General profile of the respondents of the study State immunization officers: Twelve state immunization officers were interviewed. Seven out of twelve SEPIOs had post graduate qualification in public health or child health. All SEPIOs had more than two years of public health experience. Nine out of twelve SEPIOs had additional charge of RCH, NRHM or other programs except Assam, Manipur, Uttar Pradesh. State cold chain officers: Twelve state cold chain officers were interviewed. Ten of them were trained as trainers for cold chain handlers either at national or regional level. In Uttar Pradesh and Haryana, they had recently joined. The training of cold chain handlers was being coordinated by either SEPIO or SCCO at the state level. District immunization officers: Eleven district immunization officers were interviewed. Majority of DIOs (8/11) had less than two years of job experience. In two states of Andhra Pradesh and West Bengal where the MO training was decentralized to district level, the DIOs were also trainers of MOs. District programme managers: Eight out of eleven DPMs had more than two years of job experience. Medical officers: One hundred fourteen medical officers were interviewed. there were 51 MOs in-charge (45% of total MOs) and 63 were other MOs.There were 92% Mos who were MBBS and 8% AYUSH; 82% had rural posting and 18% had urban posting, 79% had regular posting while 21% had contractual appointment. Seventy two per-cent MOs had >two years of job experience and 32% had >1 years of job experience. Out of 114 MOs interviewed, 68 (6%) were trained and 46 were untrained. Out of 68 trained MOs, 3 were MOI/C and 38 were MOs. Out of total 51 MOI/Cs, 3 (59%) were trained and 21 (41%) were untrained. Out of total 9 regular MOs, 55 (61%) were trained and 35 (39%) were untrained. Trained medical officers included MO (PHC/CHC); Contractual doctors; AYUSH Doctors; MOs of hospitals. The medical officers involved in immunization program were trained. 27

32 Trainers of medical officers: MO trainers were available in all the 12 states and in six districts of three out of six states visited (Andhra Pradesh, West Bengal and Odisha). Trainers were faculty of training centres; medical colleges; SEPIO / programme officers; CMO / DIO / DTO; pediatrician; senior MO; divisional coordinators; NPSP SMOs; retired senior health officer etc. Right types of officers were trained as trainers for MO. Trainers of cold chain handlers: Trainers were SEPIO / SCCO; MO / DIO / CCT / RM / store in-charge; Faculty from SIHFW / DTC Fig.3.1: % of trained and untrained MOs 46, 4% 68, 6% Trained Untrained / HFWTC; programme officers; pharmacist; medical college faculty. Cold chain handlers: Seventy-six cold chain handlers were interviewed. Out of which 82% were in service for more than 1 years while 65% were incharge of cold chain for more than two years; 16% were pharmacists, mainly in Andhra Pradesh while 59% were ANM, LHV or Male MPW. Out of 76 CCH interviewed, 54 (71%) were trained. Trained cold chain handlers were ANM / LHV; pharmacist (in seven states); MO; BEE / PHN; MHS / MHW. Out of the repondent cold chain handlers 35% had been made incharge of cold chain in the past two years. Health workers: Out of 61 Health workers interviewed 81% had more than five years of job experience. 28

33 PART-2: Medical officers training in immunization 1. Factors affecting differential progress between states in RI training of MOs MO training progress in 12 states: Before the study, three categories were formed based on MO training progress in the states. Category A had <4% coverage, category B had 4-7% and category C had >7% MOs trained. Each category had four states. After the phase-1 study, two states of Uttar Pradesh and West Bengal remained in category A, while Gujarat and Madhya Pradesh moved to category B. From category B, Maharashra and Manipur moved to category C while Delhi and Odisha remained at the same place. Haryana and Odisha showed reduced progress due to increase in training load. Figure 3.2- MO-training progress in 12 states Category A-<4% Category B-4-7% Category C->7% WEST BENGAL GUJA RAT UTTA R P RA DE S H MA DHY A P RA DE S H ODISHA MA NIPUR DE LHI M A HA RA S HTRA HA RY A NA K ARNA TA K A A S SA M A NDHRA P RA DE S H % MO trained as of Dec'11 % MO trained as of Mar'12 29

34 Table 3.1: Categorization of states before and after the phase-1 of training evaluation study Name of the states Before the study After the study Category A: <4% UP, WB, MP, Gujarat UP, WB Category B: 4-7% Delhi, Manipur, Odisha, Maharashtra MP, Gujarat, Odisha, Delhi, Haryana, Category C: >7% AP, Assam, Karnataka, Haryana AP, Assam, Karnataka, Maharashtra, Manipur West Bengal and Uttar Pradesh were the lowest performing states with only 29% and 35% of MOs trained respectively. No of trainers of MO in immunization training trained since 29: National level 178 (Highest number from Uttar Pradesh- 7) State level 773 (Highest number from Assam- 286 and then West Bengal-142) Though large number of trainers were trained in Uttar Pradesh and West Bengal, the progress of training was slow. SEPIOs attended training of medical officers: Five SEPIOs Delhi, Andra Pradesh, Haryana, Manipur, Maharastra were trained as trainer for MO training. Additional four SEPIOs had observed MO training Gujarat, Odisha, Uttar Pradesh and Karnataka Three states of Assam, Madhya Pradesh and West Bengal had new SEPIOs who joined less than one year back. In these states, the MO training was mainly coordinated by the earlier SEPIOs who were trained. All SEPIOs involved in MO training were exposed to MO training as trainers or observers. Coordination of MO training at the state level: MO training was coordinated at the state level by SEPIO in five states of Haryana, Manipur, West Bengal, Karnataka and Assam; by the state training coordinator in three states of Uttar Pradesh, Odisha, Maharashtra; by the state NRHM consultant in Madhya Pradesh; by SIHFW/HFWTC in three states of Aadhra Pradesh, Delhi and Gujarat. Coordination of MO training by SEPIOs led to good progress in MO training (West Bengal was exception). 3

35 Table 3.2: Relation between coordination and progress of MO training in the state MO training coordinated at state level State EPI officer State Trg coordinator/ State NRHM consultant SIHFW/HFWTC States HR, MN, WB, KA and AS UP, OD, MH, MP AP, DL and GJ Progress of training Good in all states except WB Slow in UP, MP, OD Slow in GJ Support of development partners mainly WHO Country Office for India and UNICEF was available for technical assistance and monitoring in all states except Haryana, Delhi and Manipur. Training centre at the state headquarter was not available in MP, GJ and MN, MP had state level training centre in Gwalior. Fig3.3: Trg Centre available at state level Fig3.4: SIHFW coordinated training for the state No. of States No. of States Category A Category B Category C Category A Category B Category C No Yes No Yes State training centre was coordinating immunization training in four states of DL, GJ, AP and Assam. It was involved in conducting TOT for MO training in MP, MH and OD. SIHFW was not at all involved in UP, WB, HR, KA and MN. Table 3.3: Involvement of SIHFW in medical officers training SIHFW coordinated MO training in the state AP, Assam, DL and GJ SIHFW conducted TOT for MO training MP, MH and OD SIHFW not at all involved in MO training UP, WB, HR KA and MN 31

36 In Andhra Pradesh and Assam, the progress of MO training was good due to the proactive involvement of SEPIO as well as the SIHFW. In Haryana, Karnatka and Manipur, SEPIOs were very pro-active. It was a missed opportunity to not involve the SIHFW in Uttar Pradesh and West Bengal where the progress in training was very slow. Number and level of training centres involved AND the progress of MO-training Delhi and Manipur being small states had only one training centre at the state level. Regional training centres were conducting MO training in Madhya Pradesh, Uttar Pradesh, Maharashtra, Gujarat and Odisha. MO training was decentralized to the district level in Andhra Pradesh, Assam, Karnataka, Haryana and West Bengal. Table 3.4: Progress of MO training based on number and level of training centres in the state Venue of MO training State level Regional level States (no. of Trg centres) DL (1), MN (1) MP (3), GJ (5), OD (7), UP (11), MH (7) Progress of Trg. On track/good Slow in all states (35-54%) except MH (71%) District level AS (27), AP (23), HR (21), KA (3), WB (19) Good in all states (64-99%) except WB (29%) Training progress was better in states where it was decentralized to district level and more numbers of training centres were involved. (Except WB) Fig.3.5: No. of training centres used 5 for MO training 5 Fig.3.6: Venue of MO training 4 4 No. of States 3 2 No. of States Category A Category B Category C Category A Category B Category C Less than or More District level Regional level State level Reporting of MO training progress from all the states was ad hoc, as and when asked from national level. There was no system of regular reporting of training from the state to the national level. 32

37 Monitoring of MO training was conducted by only four out of 12 states. There was a system to compile monitoring feedback in Andhra Pradesh, Karnataka and Haryana (not in Manipur). SEPIOs of Eight states informed the reasons for not conducting monitoring; SEPIOs of three states informed about the feedback system and the major issues identified. The states conducting monitoring of training had good progress in MO training. Table 3.5: Monitoring of immunization training of MO, feedback and issues Reasons for no monitoring in 8/12 states System to provide feedback in AP, Karnataka and Haryana Major issues identified No monitoring plan and no funds earmarked for monitoring RI training Training centres are far off from state HQ. M a n y o f f i c e r s h a v e additional charge Feedback is provided to SEPIO and Commissioner FW Reports submitted to MD (NRHM) for use in review meetings. CMO and DIO were also provided with copies for local action. SEPIO takes action on feedback from partners and RCHOs. T r a i n i n g starting late and ending early Other RI related trainings for medical officers were held in last two years on measles catch-up campaigns, AEFI and HepB in all states except Odisha. Except measles catch-up training, other trainings were of short duration for orientation only. Reasons for the variable progress in training as informed by SEPIOs Box 3.1: ON TRACK progress in AP, Assam, HR and MN Proactive involvement of Director FW, MD-NRHM, SEPIO and Director SIHFW Top priority given to TRACKING and completion of immunization training during review by MD-NRHM/Director FW 33

38 Box 3.2: FAST Progress in Karnataka was declared as the Year of Immunization in Karnataka. Finances were made available. Good support from DHOs and RCHOs. Non cascade, special RI training plan was made by the state for all the MO, irrespective of previous RI training history. Instead of calling MOs to State/Regional training centers, all were trained in their own districts. Good monitoring by the state and district officials e.g. use of 'SKYPE' for online monitoring of training. Barriers and suggestions to improve the training progress and quality: SEPIOs came up with the following barriers and suggestions to improve the progress and quality of training: Table 3.6: Barriers for slow progress and suggestions by SEPIOs to improve the progress and quality of MO-training Barriers for slow progress in training Training was not a priority in slow performing states. Less no of Training centres and lack of trainnig infrastructure. No accountability for not attending the training. Shortage of doctors in the state, so not relieved for training. MOs not relieved for three days due to other priorities as dengue outbreak, floods. Multiple training courses for MOs. Too many training courses in HFWTC/SIHFW Delay in release of funds from NRHM office. Suggestions Give priority to MO training and ensure mandatory attendance. I m p r o v e t r a i n i n g infrastructure in all districts. State training cell with one coordinator to coordinate with all agencies and SIHFW. Training plans should not clash with other training courses. SIHFW to be functional and responsible for all training centers in the state. SIHFW should maintain a training database. Include RI training as a part of induction training of MOs. 34

39 Funding norms less than RCH training norms followed. Pressure to utilize PIP funds in March. School health programme for three months. No activity from April to June because funds were released from GoI in June. Conduct state ToT to increase pool of dedicated trainers at training centres and conduct refresher training for the master trainers at SIHFW. Invite more nominations for better participation. Include reporting of RI training under HMIS. Follow-up and OJT by the District level officers. Systematic monitoring plan with fund support in PIP to facilitate training process and ensure quality. Institutionalize monitoring of training. Use the state trainers to monitor training. 2. Factors affecting the quality of immunization training of medical officers Role of SIHFW in coordination and monitoring of immunization training activities. Though SIHFWs in six out of twelve states i.e. Andhra Pradesh, Assam, Gujrat, Haryana, Karnataka and West Bengal had the control of all the training centers in the state, in three states of Haryana, Karnataka and West Bengal, they were not at all involved in immunization training. Training policy for induction training of MOs Nine out of twelve states (except Delhi, Manipur and Assam) had policy for induction training of MO. Duration of induction training was days in Karnataka, Madhya Pradesh, Maharashtra and West Bengal; days in Andhra Pradesh, Gujrat and Odisha; four-six weeks in Haryana and Uttar Pradesh. Half to one day sessions were allocated to immunization in all these states. 35

40 Training facilities Delhi and Manipur did not have hostel and mess facilities, so no residential arrangements were made. Gujarat had no training facility at state level, the training courses were conducted in hotels after getting exceptional approvals from the state authorities. Electricity back up was not available in Madhya Pradesh and Odisha. Training, hostel and mess facilities were available in nine out of twelve states. No.of States Fig.3.7: Residential facilities for MO training Category A Category B Category C No Yes At district level, five out of six districts had training centre but training was residential only in one out of six districts (Ganjam in Odisha). Reasons given for not staying overnight were that majority of MOs stayed near the HQ; suitable trainnig. centre with accommodation facility not available. Number of trainers involved Three or more trainers were involved on all three days during last three batches in all states except Maharashtra where only one trainer was involved. Training methodology All states gave I MM handbooks, handouts and certificates to all participants; conducted pre and post test evaluation and improved training based on feedback received from the participants; used the training kits with games and CDs with films during the training; organized field visit and provided transport. Maharashtra was not using interactive training methods in 4/7 sessions; Uttar Pradesh and Gujarat were not using interactive methods in 3/7 sessions. Based on feedback by participants, trainers took actions for improving the food and organization of training, methods made more participatory and included examples of practically showing formats and verifying in field. All states were following the training guidelines and majority of the state and district trainers were using interactive training methods as per the facilitators' guide. 36

41 Problems faced by trainers There were no issues in six states. Other states/districts reported issues of shortage of trainers / not available in full strength; inadequate attendance of MOs in training; only one training hall, group work is difficult; no accommodation facilities; shortage of funds and handbooks. Quality of training as perceived by the trained Mos Majority (78%) of the 68 trained MOs attended training six months to two years back. Venue of training for 63% was state or regional level, for 34%, district level and for 3% in West Bengal it was sub-district level. Duration of training was three days according to 9% MOs; however, 1% had attended two days training (West Bengal, Odisha and Uttar Pradesh). Three or more trainers were available on all days of training according to majority (86%) of MOs. Immunization film was shown during training according to 75% of MOs. Field visit was organized during training according to 9% of the MOs. 88% MOs reported to have received the certificate and 99% reported to have received immunization handbook during training. At the time of study, immunization handbook was available at the PHC with 51% of the trained MOs. Quality of training as perceived by majority of the trained medical officers was good. Field visit was not conducted for all sessions in UP and WB. Handbook units found most useful Majority of the trained MOs found cold chain and logistics unit to be most useful, followed by immunization schedule and F A Q s, p l a n n i n g / microplanning, records, reports and using data for action etc Fig. 3.8: State-wise quality of training as perceived by MOs Immunization film shown during the training Certificate distributed during training Field visit organized during training for supervision Imm Handbook received during training Uttar Pradesh West Bengal Madhya Pradesh Odisha Andhra Pradesh Maharashtra Handbook units found most difficult to understand by MOs Planning/microplanning was found difficult by 1/4th of participants to understand the calculations of vaccines for number of sessions; followed by cold chain and logistics/stock management and records, reports and using data for action. 37

42 Handbook units found difficult to impart training to by few trainers on microplanning and VPD surveillance. Fig3.9: Immunization handbook units found usefuland difficult by MOs and trainers 28 Cold Chain & Logistics Imm schedule & FAQs 13 Microplanning Using data for action 3 9 Safe Injection & waste Disposal 6 MOs found Useful AEFIs MOs found difficult Community mobilization 3 4 Trainers found difficult 3 Supervision Box 3.3: Training handbook used as a resource after the training Medical officers used the handbook To provide orientation/training to all HWs / HAs on all topics and training to cold chain handlers As a reference for cold chain, micro planning, community involvement, records, reports and using data for action, injection safety, handling AEFIs etc. Displayed the immunization schedule and used FAQs for client counseling and referral As a guide for supervision during VHND visits, for doses calculation, schedule, AEFIs and for HepB introduction 38

43 Box 3.4: Examples of measures taken by the MOs to improve immunization after training Microplanning improved, due list prepared by ANM one day before the session, AVD plan initiated. Number of sessions/month decreased from six to four Trained ANMs on cold chain and improved arrangement of vaccines in ILR, preparation of contingency plan, maintenance of temperature chart, conditioning of ice packs and defrosting. Improved logistics management avoided stock outs and reduced vaccine wastage Trained ANMs on safe injection practices and improved injection technique and site of administration; writing date and time of reconstitution; ensuring that measles vaccine is used within four hours. Ensured use of hub cutter and disinfection of waste before disposal Guided health workers on AEFIs. Kept emergency drugs and counseled the parents on AEFIs. Analyzed the data to facilitate reporting of AEFI Community mobilization and communication with community improved by tracking dropouts through service registers and meeting parents. Involved Maulana in Muslim areas and NCC cadets for mobilization. Motivated HWs to communicate key IPC messages at the session site and follow-ups after vaccination Supervised HWs, conducted session monitoring and on- job-training by using monitoring checklist. Supervisory visits reduced to two sessions per day. Trained ANMs to prepare coverage monitoring chart and keep counterfoils in tracking bag. Monitored routine immunization in review meetings 39

44 Difficulties faced by MOs during training Jaunpur MOs informed unavailability of electricity (training conducted in open varandah space); session started at 12:3pm (average duration of training was three hours/day) with field visit for one hour and non residential training (travel distance of 4-45 kms one way was a disadvantage). Some informed that the training was very compressed in time. Suggestions given by MOs to improv future immunization training Three days training can be taken as base training. Practice sessions and field visits must be increased. More detailed session on planning and logistic management. Refresher / reorientation of already trained persons for one day, once a year in a decentralized manner at a place nearer to the PHC. Post training follow up is recommended. Suggestions given by trainers for future training courses Course contents for addition / modification Add chapters on new vaccine introduction; special strategy for urban areas; immunization for HIV and premature / malnourished; emerging diseases HMIS / MCTS; measles catch-up and national as well as state specific scenario, data and guidelines; procurement policies Add injection administration techniques from HW handbook Include how to prioritize issues following desk review Facilitate developing RI monitoring plan, orientation on NRHM formats and RIMS/ HMIS needed Coverage evaluation methods, rapid assessment New MCP card VPD surveillance to be made simpler to understand; more informative, case management latest protocols to be added. JE should be dealt in more detail AEFI: AEFI chapter needs to be updated with details of AEFI treatment (cross reference with measles catch-up guidelines give more clarity on AEFI investigation PIR, FIR, etc., amount of antigen required for potency check. Treatment of anaphylaxis to be clearer and elaborate with dose of adrenalin and other drugs. Add contents of AEFI treatment kits and media handling post AEFI 4

45 Cold chain contents should tally with that in Cold Chain Handler handbook. Domestic refrigerator use conflict with storing AVS, ARV; role of MOs to be clarified, more actionable orientation; financial management issues; cold chain hold over time for haier ILR is 24hrs only; domestic refrigerator (In chiller tray, should not keep anything) Unit on community participation to be more detailed as the major reason for poor coverage in RI is lack of community involvement Training methodology Micro-planning every exercise should be done by every person Increase duration of training to four to five days, more time for field visits. Day three should coincide with session day. Refresher training for one day Maintain training data base to avoid duplication in online portal with free access. Certificate should be delivered following satisfactory discharge of responsibilities based on new training methods imparted. Classroom, hostel and transport facilities are required at the training center in Delhi, Gujarat and Manipur. Districts with trained MOs and excellent training and residential facilities should be made training centres for MO training e.g. Hoshangabad in Madhya Pradesh. More trainers required in Gujarat and Haryana, as a number of untrained doctors need to be trained. Funds: Increase DA for participants in Haryana, Gujarat and Manipur. Increase honorarium of trainers in Maharashtra and MP. Funds should be provided as for IMNCI and BEmOC training. 41

46 3. Knowledge, skills and practices of MOs in immunization I. Knowledge level of trained and untrained medical officers To assess their knowledge level, all the MOs were asked ten open e n d e d q u e s t i o n s f r o m t h e immunization handbook. They were scored based on the correct responses. Comparison has been made between the trained and untrained medical officers as follows: Fig.3.1: Assessing knowledge All MOs-Trained vs. Untrained (% MOs answered correctly at-least 5 out of 1 questions) Trained MO Untrained MO Uttar Pradesh West Bengal Madhya Odisha Andhra Maharashtra Pradesh Pradesh 13, 4 12, 9 8, 9 8, 8 13, 8 14, 8 N1, N2= Category A Category B Category C Total MOs interviewed = 114 (68 trained & 46 untrained) Note : N1=Trained MOs interviewed, N2 = Untrained MOs interviewed Total questions : 1 a) Percentage of MOs who answered correctly at least five out of 1 questions It was definitely higher for trained MOs as compared to untrained MOs in all the six states studied. All districts except two i.e. Jaunpur in Uttar Pradesh and Satna in Madhya Pradesh had improved scores after training The p ercentage of in-charge MOs who answered correctly at least five out of ten questions, it was higher for trained MOs as compared to untrained MOs in five out of six states except Maharashtra. All districts except three i.e. Jaunpur in Uttar Pradesh, Satna in Madhya Pradesh and Washim in Maharashtra had improved scores after training The p ercentage of non-in charge MOs who answered correctly at least five out of ten questions, it was higher for trained MOs as compared to untrained MOs in all the six states studied. All districts except four i.e. Jaunpur in Uttar Pradesh, Satna in Madhya Pradesh, Khurda in Odisha and after training Fig.3.11: Assessing knowledge incharge trained MO vs. incharge untrained MO (% MOs answered correctly at-least 5 out of 1 questions) Incharge trained MO 75 5 Raigad in Maharashtra had improved scores Uttar Pradesh West Bengal Madhya Odisha Andhra Maharashtra Pradesh Pradesh N1, N2= 4, 2 4, 4 4, 4 4, 2 7, 6 7, 3 5 Incharge untrained MO Category A Category B Category C Total incharge MOs interviewed = 51 (3 trained & 21 untrained) N ote : N1=in-charge trained MOs interviewed, N 2 = in-charge untrained MOs interviewed Total questions : 1 42

47 b) Comparative mean score of MOs based on correct answers (Add total score of each MO, divide by number of MOs = Mean score) Comparative mean score of total medical officers was definitely higher for trained MOs as compared to untrained MOs in all the six states studied. The range for trained MOs was three to six and for untrained MOs, it was two to three. All districts except two i.e. Jaunpur in Uttar Pradesh and Satna in Madhya Pradesh had improved scores after training Comparative mean score of in-charge MOs was definitely higher for trained MOs as compared to untrained MOs in all the six states studied. The range for trained MOs was three to seven and for untrained MOs, it was three to four, all districts except three i.e. Jaunpur in Uttar Pradesh, Satna in Madhya Pradesh and Washim in Maharashtra had improved scores after training Comparative mean score of non in-charge MOs was definitely higher for trained MOs as compared to untrained MOs in all the six states studied. The range for trained MOs was three to six and for untrained MOs, it was one to three. All districts except two i.e. Jaunpur in Uttar Pradesh and Satna in Madhya Pradesh had improved scores after training 1 Fig. 3.12: Assessing knowledge all MOs-trained Vs untrained (MOs answered correctly - comparative mean score) Trained MO Untrained MO Uttar Pradesh West Bengal Madhya Odisha Andhra Maharashtra Pradesh Pradesh N1, N2= 13, 4 12, 9 8, 9 8, 8 13, 8 14, 8 Category A Category B Category C Total MOs interviewed = 114 (68 trained & 46 untrained) Note : N1=Trained MOs interviewed, N2 = Untrained MOs interviewed Total questions : 1 Fig. 3.13: Assessing knowledge incharge trained MO vs. incharge untrained MO 1 (MOs answered correctly - comparative mean score) Incharge trained MO Incharge untrained MO Uttar Pradesh West Bengal Madhya Odisha Andhra Maharashtra Pradesh Pradesh N1, N2= 4, 2 4, 4 4, 4 4, 2 7, 6 7, 3 Category A Category B Category C Total incharge MOs interviewed = 51 (3 trained & 21 untrained) Note : N1=in-charge trained MOs interviewed, N2 = in-charge untrained MOs interviewed Total questions : 1 43

48 Table 3.7: Question wise comparison: Percentage of MOs who answered correctly (trained vs untrained) SN Question UP WB MP UP OD AP UP MH T U T U T U T U T U T U N= What vaccines can be given to a child who comes for the first time at 16 mths? How many minimum sessions are required per year to fully immunize all infants in a hard to reach village with population of less than 1? What is most important criterion to prioritize subcenters for action? Which vaccines are sensitive to freezing? How will you prevent f r e e z i n g o f f r e e z e sensitive vaccines in PHC and during vaccine distribution? How are the diluents of BCG and Measles stored before use? What is minimum stock level to place an order? What are serious AEFIs? How do you calculate Drop-out rate between DPT1 and DPT3? What tools are used to track drop-outs? Though responses were better in trained MOs as compared to untrained MOs, the responses to questions 7, 8 and 1 were very poor in majority of the states. WB performed well in all questions; AP in five questions; MP and OD in four questions each and MH in three questions. Performance of UP MOs in terms of knowledge gain was lowest. 44

49 ii. Practices of trained versus untrained MOs in PHCs Comparison was made between trained and untrained MOI/Cs in various immunization components RI-microplan 1 8 t 6 n e rc e P4 2 Fig. 3.14: Percent RI microplan components available at the PHC Map of Catchment area ANM work-plan / roster Estimation of beneficiaries and Logistics AVD plan to supply the vaccines Uttar Pradesh West Bengal Madhya Pradesh Odisha Andhra Pradesh Maharashtra N = Category A Category B Category C Fig. 3.15: Day-wise plan for supervisor field visits available at PHC (% of PHC where day-wise plan for supervisor field visits available) MOIC trained 5 1 Uttar Pradesh West Bengal Madhya Odisha Andhra Maharashtra Pradesh Pradesh N1, N2= 4, 2 4, 4 4, 4 4, 2 7, 6 7, 3 Category A Category B Category C Total MOs interviewed in PHC = 51 (3 trained & 21 untr ained) Note : N1=Trained MOs interviewed in PHC, N2 = Untrained MOs interviewed in PHC MOIC untrained Table 3.8: Availability of micro-plan components in PHCs with trained (T) and untrained (U) MOs RI-Microplan available at the PHC Map of catchment area Estimation of beneficiaries ANM work plan or roster AVD plan to supply vaccines Day wise supervisory plan Special plan for high risk and hard to reach areas UP WB MP UP OD AP UP MH All microplanning components were available in UP. Special plans for hard to reach areas were available only in very few PHCs. ANM roster and AVD plans were available in all the states. WB performed poorest in availability of maps, estimation of beneficiaries and plans for supervisory visits. Fig. 3.16: Special plan for high risk and hard to reach areas available at PHC (% of PHC where special plan for high risk & hard to reach areas available) 25 MOIC trained Uttar Pradesh West Bengal Madhya Odisha Andhra Maharashtra Pradesh Pradesh N1, N2= 4, 2 4, 4 4, 4 4, 2 7, 6 7, 3 Category A Category B Category C Total MOs interviewed in PHC = 51 (3 trained & 21 untr ained) Note : N1=Trained MOs interviewed in PHC, N2 = Untrained MOs interviewed in PHC MOIC untrained Though WB MOs showed improved knowledge after training, they were not involved in microplanning. UP had microplans may be due to guidelines from the state and partner support. 45

50 Role of MOs in micro-planning and reasons for in-complete RI micro-plans Majority of MOs had no role in micro-planning; it was prepared by PHN, LHV, MHS, MPHS (M), BEE, BPM and Community Health Officer. Reasons for incomplete micro-plans were given as: no formats / guidelines received from district/state; not aware of the need; not aware of map; logistic calculation was done on the basis of previous month; not aware about estimation of beneficiaries and beneficiary list. At some PHCs, logistics estimation was done in 29; microplan was not revised / updated in subsequent years, only roster was prepared. According to some MOs, ANM diary was the only plan; unlike polio, RI microplan was not mandatory; it increased the workload of ANMs and overall emphasis on RI by the district / state level was not high. Very few MOs supervised the process of preparation of the plan; built capacity of staff and provided hands on training during preparation of microplans; reviewed microplans and coordinated corrective action; calculated number of sessions required; identified missed villages, high risk and low coverage areas for inclusion. Supervisory visits by MOs Plan for supervisory visits was available in all PHCs of MH, majority of PHCs in MP and UP followed by AP and OD. It was not available in WB. Difference between PHCs with trained and untrained doctors was seen only in UP. Percentage of MOs who conducted at-least five supervisory visits was lowest in WB and MP. N1, N2= Fig. 3.17: Supervisory visits conducted by MOs during last 3 months Uttar Pradesh West Bengal Madhya 9, 2 (% MOs with at-least 5 supervisory visits conducted to SC/Session site ) MOs trained Pradesh 38 Odisha 62 MOs untrained 88 Andhra Pradesh 25 Maharashtra Category A Category B Category C Total 1, 8 5, 9 8, 8 13, 8 14, 8 59, 43 Total MOs interviewed = 114 (68 trained & 46 untrained) Note : N1=Trained MOs interviewed, N2 = Untrained MOs interviewe d 42 Reasons given by MOs for <four supervisory visits in last three months were shortage of doctors, no mobility support, busy in OPD and clinical work. 46

51 Records available to support supervisory visits: No records were found in majority of the PHCs, followed by filled in checklist/monitoring format, movement register, supervisory report and diary of MO. Fig. 3.18: Records availability at PHC to support supervisory visits N1, N2= Filled in checklists/monitoring format 16, 6 MOs trained MOs untrained Supervisory reports Movement re gisters Any other No records 1, 4, 1, 3 34, Total MOs inter viewed = 114 (68 trained & 46 untrained) Note : N1=Trained MOs interviewed, N2 = Untrained MOs inter viewed 47

52 Box 3.5: Examples of improved practices after training (problem solving and on-job-training during supervision) As informed by the MOs Immunization schedule: Clarified vaccines to be given in case of skipped doses; how long the measles and BCG vaccine be given. Asked HWs to give vaccine to children with minor illness. Cold chain maintenance at session site: Prevention of exposure to sun light; vaccines storage and keeping vaccine in proper manner; VVM to be maintained, placing vaccine carrier in shade; keeping reconstituted vials on icepack, open vial policy and AVD to reach in time. Safe injection practices: Corrected route, site and technique of injection administration; positioning of child; BCG and measles have to be used within four hours; hand washing; no cleaning with spirit; not to touch the needle. Demonstrated use of hub-cutter and observed for correction; waste disposal as per guidelines. Communication and social mobilization: Supervised giving four key messages to parents and tracked mobilization by ASHA, defaulter counseling and counseling after AEFI; visited the houses of migratory and resistant population with ANM and AWW and convinced the unimmunized/resistant for vaccination. Emphasized on due list of beneficiaries to be prepared and used to mobilize drop outs by ASHA / AWW. Previously sessions were conducted at CHC only, now MO sorted out the problems and sessions are being conducted in the field also. Records and reports: Explained formats, promoted updating of counterfoil and explained use of tracking bags; reporting AEFIs. ANM was told to enter in immunization register as soon as child is immunized. ASHA was told to update simultaneously. Show causing for not updating register, MCTS updating. Asked supervisors to monitor, helped them to arrange session in systematic manner. 48

53 As informed by the HWs Mos taught how to prepare due list; indent vaccines as per due list; maintain cold chain at session site. Power shortage in one block was solved by arranging for back up generator and funds. Checked for time of reconstitution written on BCG and measles vials; checked entries in register for corrections at the spot. Demonstrated injection technique for DPT, Measles, HepB; how to use hub cutter and dispose off waste at session site. Informed about new schedule and four key messages for RI; scheduling for over aged child; contraindication of any vaccine, AEFI management, motivating community. Helped to tackle families resisting immunization by visiting their homes and counseling reluctant parents; assure parents for minor AEFI. Monitoring and using data for action after training Analysis of the routine immunization data from the subcentres was done by health supervisor mainly, followed by MOI/c/MO, BPM/BEE/BPO, PHN, statistical staff/data operator/icc investigator cum computer and IO. Data was analyzed from the routine reports for immunization coverage, drop-outs, left-outs; vaccine wastage, shortage of vaccines, sessions held versus planned, target etc. Coverage monitoring chart was available only in 24% (12 out of 51) PHCs, only in MP and OD. 32 Fig. 3.19: Health staff conducting the analysis of data from routine Fig. 3.2: Analysis of routine reports being done (% of PHCs where routine reports are being analyzed) MOICs trained MOICs untrained Immunization Coverage Drop-outs Left-outs N1, N2= 2,16 17, 1 13, 9 Health Supervisor MOI/c/MO BPM/BEE/BPO PHN Statistical staff IO Total MOICs interviewed in PHC = 51 (3 trained & 21 untrained) Note : N1=Trained MOICs interviewed in PHC excluding missing val ues, N2 = Untrained MOICs interviewed in PHC excluding missing values 49

54 Data was analyzed subcenter wise for immunization coverage; shared feedback of drop outs/left outs during monthly meetings; conducted reason analysis for low immunization coverage and took action depending on reasons e.g. arranged additional sessions in low coverage areas; asked supervisors, ANM, ASHA and AWW to focus on unimmunized; increased mobilization by ASHA and influential leaders for low coverage areas, planned special sessions if drop outs were high; sent MO, HEEO, HA, H/I to Nomadic and resistant areas for mobilization; arranged for another ANM on immunization days where ANM work load was very high; used due list and counter foils to identify drop outs and track them. Conducting review meetings Review meetings were held at Block/PHC in all the states. They were not held in few blocks of MP, MH and WB. Frequency was monthly in majority (73%) of the blocks. No significant difference was seen between trained and untrained MOI/C. Participants during the review meetings were mainly HWs followed by ASHAs, AWWs, PRIs and others as BPM, BEE, CHO, PHN, MO and MPW. Records of immunization review meetings which were available were mainly for attendance followed by minutes and agenda. Topics discussed as per MOs were subcentre wise immunization coverage, drop-out rates, supervisory Fig. 3.21: Immunization review meetings are held at Block/PHC findings, problems faced by HWs, data of MCTS and others as infant and (% of PHC where immunization review meetings are held) MOIC trained Uttar Pradesh West Bengal Madhya Odisha Andhra Maharashtra Pradesh Pradesh N1, N2= 4, 2 4, 4 4, 4 4, 2 7, 6 7, 3 Category A Category B Category C Total MOs interviewed in PHC = 51 (3 trained & 21 untr ained) Note : N1=Trained MOs interviewed in PHC, N2 = Untrained MOs interviewed in PHC 1 1 MOIC untrained Fig. 3.22: Participants attending immunization review meetings MOIC trained MOIC untrained Health workers ICDS workers ASHA PRI members Total review meetings held = 35 (22 trained MOICs & 13 untrained MOICs) Note : N1=Trained MOICs interviewed in PHC excluding missing values & review meetings not held, N2 = Untrained MOICs interviewed in PH C excluding missing values & review meetings not held 5

Performance Assessment of Health Workers Training in Routine Immunization in India

Performance Assessment of Health Workers Training in Routine Immunization in India 1 Performance Assessment of Health Workers Training in Routine Immunization in India (WHO and NIHFW collaborative study) Study Report December, 2009 2 Study Report December-2009 Performance Assessment

More information

CHAPTER 30 HEALTH AND FAMILY WELFARE

CHAPTER 30 HEALTH AND FAMILY WELFARE CHAPTER 30 HEALTH AND FAMILY WELFARE The health of the population is a matter of serious national concern. It is highly correlated with the overall development of the country. An efficient Health Information

More information

Dr. Ajay Khera Deputy Commissioner Ministry of Health and Family Welfare, Government of India February 17 th, 2012

Dr. Ajay Khera Deputy Commissioner Ministry of Health and Family Welfare, Government of India February 17 th, 2012 Dr. Ajay Khera Deputy Commissioner Ministry of Health and Family Welfare, Government of India February 17 th, 2012 1 What has India achieved so far? Goals Achievements National Rural Health Mission (By

More information

Rural Health Care System in India

Rural Health Care System in India Rural Health Care System in India Rural Health Care System the structure and current scenario The health care infrastructure in rural areas has been developed as a three tier system (see Chart 1) and is

More information

To evaluate the impact of NRHM interventions, by Agencies outside the Government, and make recommendations on:

To evaluate the impact of NRHM interventions, by Agencies outside the Government, and make recommendations on: TOT OF ZONAL AGENCIES To evaluate the impact of NRHM interventions, by Agencies outside the Government, and make recommendations on: The institutional mechanisms and monitoring systems that have been put

More information

Rural Health Care System in India. Rural Health Care System the structure and current scenario

Rural Health Care System in India. Rural Health Care System the structure and current scenario Rural Health Care System in India Rural Health Care System the structure and current scenario The health care infrastructure in rural areas has been developed as a three tier system (see Chart 1) and is

More information

Training of Trainers of Medical Officers in Immunisation. 20 th to 22 nd April, 2009 Venue: NIHFW. Report

Training of Trainers of Medical Officers in Immunisation. 20 th to 22 nd April, 2009 Venue: NIHFW. Report Training of Trainers of Medical Officers in Immunisation 20 th to 22 nd April, 2009 Venue: NIHFW Report NATIONAL INSTITUTE OF HEALTH AND FAMILY WELFARE NEW DELHI Training of Trainers of Medical Officers

More information

Rural Health Care System in India. Rural Health Care System the structure and current scenario

Rural Health Care System in India. Rural Health Care System the structure and current scenario Rural Health Care System in India Rural Health Care System the structure and current scenario The health care infrastructure in rural areas has been developed as a three tier system (see Chart 1) and is

More information

Models of Supportive Supervision for IMNCI Implementation in Selected Districts of Bihar, Orissa and Rajasthan in India

Models of Supportive Supervision for IMNCI Implementation in Selected Districts of Bihar, Orissa and Rajasthan in India 224 Indian Journal of Public Health Research & Development. January-March 2013, Vol. 4, No. 1 Models of Supportive Supervision for IMNCI Implementation in Selected Districts of Bihar, Orissa and Rajasthan

More information

PRESENTATION ON UNIVERSAL HEALTH COVERAGE

PRESENTATION ON UNIVERSAL HEALTH COVERAGE PRESENTATION ON UNIVERSAL HEALTH COVERAGE MEGHALAYA Date:09/01/2014 Introduction General Background Indicator Meghalaya India Demographic Profile* State Population Total (in lakhs) 29.64 12101. 02 State

More information

Growth of Primary Health Care System in Kerala-A comparison with India

Growth of Primary Health Care System in Kerala-A comparison with India Growth of Primary Health Care System in Kerala-A comparison with India Dr. Suby Elizabeth Oommen Assistant Professor Department of Economics, Christian College, Chengannur, Alappuzha, Kerala, INDIA, 689121

More information

Janani Suraksha Yojana (JSY) State Institute of Health & Family Welfare, Jaipur

Janani Suraksha Yojana (JSY) State Institute of Health & Family Welfare, Jaipur Janani Suraksha Yojana (JSY) State Institute of Health & Family Welfare, Jaipur JSY A safe motherhood intervention, replacing the National Maternity Benefit Scheme, under NRHM 100 % centrally sponsored

More information

Chapter II. Health Care System in India

Chapter II. Health Care System in India Chapter II Health Care System in India Chapter II HEALTHCARE SYSTEM IN INDIA 2.1- Introduction: Healthy citizens are the greatest assets any country can have Winston S. Churchill Health is a state subject

More information

Workload and perceived constraints of Anganwadi workers

Workload and perceived constraints of Anganwadi workers Workload and perceived constraints of Anganwadi workers Damanpreet Kaur, Manjula Thakur, Amarjeet Singh, Sushma Kumari Saini Abstract : Integrated Child Development Service scheme is most important nutritional

More information

EXIT STRATEGIES STUDY: INDIA BEATRICE LORGE ROGERS, CARISA KLEMEYER, AMEYA BRONDRE

EXIT STRATEGIES STUDY: INDIA BEATRICE LORGE ROGERS, CARISA KLEMEYER, AMEYA BRONDRE EXIT STRATEGIES STUDY: INDIA 1 BEATRICE LORGE ROGERS, CARISA KLEMEYER, AMEYA BRONDRE Overview of India Study 2 One program (CARE); one sector (health) Four states: AP, Orissa, Chhattisgarh, UP India contrasts

More information

National Rural Health Mission (NRHM) State Institute of Health & Family Welfare, Jaipur

National Rural Health Mission (NRHM) State Institute of Health & Family Welfare, Jaipur National Rural Health Mission (NRHM) State Institute of Health & Family Welfare, Jaipur NRHM N Newer Initiatives. R Rural Poor Population H Holistic Holistic Health Package. M Monitoring mechanisms To

More information

Health Manpower Planning

Health Manpower Planning Health Manpower and Management 10.5005/jp-journals-10055-0013 1 Rajoo S Chhina, 2 Rajdeep S Chhina, 3 Ananat Sidhu, 4 Amit Bansal ABSTRACT Manpower is the most crucial resource toward delivery of health

More information

Study Team. Bella Patel Uttekar Sandhya Barge Yashwant Deshpande Vasant Uttekar Jashoda Sharma Shweta Shahane

Study Team. Bella Patel Uttekar Sandhya Barge Yashwant Deshpande Vasant Uttekar Jashoda Sharma Shweta Shahane Study Team Bella Patel Uttekar Sandhya Barge Yashwant Deshpande Vasant Uttekar Jashoda Sharma Shweta Shahane PREFACE JSY, Janani Suraksha Yojana, is an integral component of the National Rural Health Mission,

More information

National Rural Health Mission District Sriganganagar Proposed NRHM PIP for the Financial Year

National Rural Health Mission District Sriganganagar Proposed NRHM PIP for the Financial Year National Rural Health Mission District Sriganganagar Proposed NRHM PIP for the Financial Year 2010-11 District :-Sriganganagar A RCH - TECHNICAL STRATEGIES & ACTIVITIES (RCH Flexible Pool) A.1 MATERNAL

More information

International Journal of Academic Research ISSN: : Vol.2, Issue-4(5), October-December, 2015 Impact Factor : 1.855

International Journal of Academic Research ISSN: : Vol.2, Issue-4(5), October-December, 2015 Impact Factor : 1.855 Gopi M, Research Scholar, PG and Research department of Social Work, Sacred Heart College Tiruppattur,Vellore ( Dist ),Tamil Nadu. Dr. J Henry Rozario, Associate Professor Department of Social Work, Sacred

More information

STATE HEALTH SOCIETY, PUNJAB

STATE HEALTH SOCIETY, PUNJAB STATE HEALTH SOCIETY, PUNJAB GUIDELINES FOR FAMILY HEALTH CAMPS National Rural Health Mission, Department of Health and Family Welfare, Punjab 1 INDEX Content Page No. Objectives and Framework of the camp

More information

MOTHER AND CHILD TRACKING SYSTEM (MCTS)

MOTHER AND CHILD TRACKING SYSTEM (MCTS) MOTHER AND CHILD TRACKING SYSTEM (MCTS) 12/11/2013 Training Report Goa NATIONAL INSTITUTE OF HEALTH AND FAMILY WELFARE NEW DELHI MCTS Goa training Conducted by NIHFW (12 th - 13 th November, 2013) Introduction

More information

INTRODUCTION. 76 MCHIP End-of-Project Report. (accessed May 8, 2014).

INTRODUCTION. 76 MCHIP End-of-Project Report. (accessed May 8, 2014). Redacted INTRODUCTION Between 1990 and 2012, India s mortality rate in children less than five years of age declined by more than half (from 126 to 56/1,000 live births). The infant mortality rate also

More information

NIHFW Newsletter. Participation of the Institute in the 6th Common Review Mission (CRM) under NRHM

NIHFW Newsletter. Participation of the Institute in the 6th Common Review Mission (CRM) under NRHM NIHFW Newsletter Quarterly Newsletter of the National Institute of Health and Family Welfare, Vol. XIV, No. 4, October-December, Participation of the Institute in the 6th Common Review Mission (CRM) under

More information

MEETING THE NEONATAL CHALLENGE. Dr.B.Kishore Assistant Commissioner (CH), GoI New Delhi November 14, 2009

MEETING THE NEONATAL CHALLENGE. Dr.B.Kishore Assistant Commissioner (CH), GoI New Delhi November 14, 2009 MEETING THE NEONATAL CHALLENGE Dr.B.Kishore Assistant Commissioner (CH), GoI New Delhi November 14, 2009 Presentation Outline 1. Background 2. Key Initiatives of GoI 3. Progress 4. Major challenges & way

More information

UNIVERSAL HEALTH COVERAGE AND INNOVATIONS IN HEALTH SECTOR OF TRIPURA.

UNIVERSAL HEALTH COVERAGE AND INNOVATIONS IN HEALTH SECTOR OF TRIPURA. UNIVERSAL HEALTH COVERAGE AND INNOVATIONS IN HEALTH SECTOR OF TRIPURA. Date : 20 th January, 2014 OBJECTIVES 1. Equity in access to health. 2. Social Health Protection (Non-exclusion and non-discrimination).

More information

Part 1. Rural Health Care System in India 1. Table 1. State-Wise Area, Districts and Villages in India 28

Part 1. Rural Health Care System in India 1. Table 1. State-Wise Area, Districts and Villages in India 28 CONTENTS Page List of Abbreviations Highlights ii vii-x Part 1. Rural Health Care System in India 1 Part 2. Detailed Statistics Section I. Demographic Indicators Table 1. State-Wise Area, Districts and

More information

Guidelines for preparation of AWP&B for the year

Guidelines for preparation of AWP&B for the year Guidelines for preparation of AWP&B for the year 2017-18 Annexure-I The guidelines for preparation of comprehensive Annual Work Plan & Budget for the year 2017-18 in the prescribed format are given below:-

More information

Continuum of Care Services: A Holistic Approach to Using MOTECH Suite for Community Workers

Continuum of Care Services: A Holistic Approach to Using MOTECH Suite for Community Workers CASE STUDY Continuum of Care Services: A Holistic Approach to Using MOTECH Suite for Community Workers Providing coordinated care across the continuum of maternal and child health in Bihar, India PROJECT

More information

Reproductive & Child Health. State Institute of Health & Family Welfare, Jaipur

Reproductive & Child Health. State Institute of Health & Family Welfare, Jaipur Reproductive & Child Health Program State Institute of Health & Family Welfare, Jaipur What is RCH.? Reproductive & Child Health program is a model developed through experiments in paradigm shifts, Clinic

More information

Aegis Skills Edge Pvt. Ltd.

Aegis Skills Edge Pvt. Ltd. Aegis Skills Edge Pvt. Ltd. Access Aegis Livelihoods Skills Consulting Edge Pvt. India Ltd. Private Limited Agency Access Aegis Livelihoods Skills Consulting Edge Pvt. India Ltd.- Private through Limited

More information

Study Team. Bella Patel Uttekar Nayan Kumar Vasant Uttekar Jashoda Sharma Shweta Shahane

Study Team. Bella Patel Uttekar Nayan Kumar Vasant Uttekar Jashoda Sharma Shweta Shahane Study Team Bella Patel Uttekar Nayan Kumar Vasant Uttekar Jashoda Sharma Shweta Shahane PREFACE JSY, Janani Suraksha Yojana, is an integral component of the National Rural Health Mission, launched in April

More information

VITAMIN A SUPPLEMENTATION

VITAMIN A SUPPLEMENTATION VITAMIN A SUPPLEMENTATION RESULTS FROM THE 2010 SUSTAINABILITY STUDY Assessing the Sustainability of the Jharkhand District Vitamin A Supplementation Program Prakash Kotecha Iqbal Syed Chandranath Mishra

More information

Madhya Pradesh Public Health Workforce

Madhya Pradesh Public Health Workforce Madhya Pradesh Public Health Workforce I. Overview of Public Health Workforce Madhya Pradesh has a population of 72.59 million out of which 72.6 % is the rural population with the following public health

More information

TRAINING ON WATER, SANITATION, AND HYGIENE (WASH) TO THE FRONTLINE WORKERS (FLWS) IN A RURAL SET UP

TRAINING ON WATER, SANITATION, AND HYGIENE (WASH) TO THE FRONTLINE WORKERS (FLWS) IN A RURAL SET UP Management TRAINING ON WATER, SANITATION, AND HYGIENE (WASH) TO THE FRONTLINE WORKERS (FLWS) IN A RURAL SET UP Shyama Prasad Chattopadhyay *1 *1 MA(Economics), MBA, Assistant Professor, IIHMR University,

More information

Environmental Impact Assessment

Environmental Impact Assessment Annual Report 2006-2007 Environmental Impact Assessment Introduction Keeping in view the tenets of Sustainable Development, it has been realized that all developmental efforts need to be harmonized with

More information

UNICEF LAO PDR TERMS OF REFERENCE OF NATIONAL CONSULTANT (NOC) COMMUNICATION FOR DEVELOPMENT (C4D) IN IMPROVING ROUTINE IMMUNIZATION

UNICEF LAO PDR TERMS OF REFERENCE OF NATIONAL CONSULTANT (NOC) COMMUNICATION FOR DEVELOPMENT (C4D) IN IMPROVING ROUTINE IMMUNIZATION UNICEF LAO PDR TERMS OF REFERENCE OF NATIONAL CONSULTANT (NOC) COMMUNICATION FOR DEVELOPMENT (C4D) IN IMPROVING ROUTINE IMMUNIZATION UNICEF H&NH Outcome: UNICEF H&N OP #: 3 UNICEF Work Plan Activity: Objective:

More information

MOTHER AND CHILD TRACKING SYSTEM (MCTS)

MOTHER AND CHILD TRACKING SYSTEM (MCTS) MOTHER AND CHILD TRACKING SYSTEM (MCTS) 10/26/2013 Training Report Leh Division NATIONAL INSTITUTE OF HEALTH AND FAMILY WELFARE NEW DELHI MCTS Leh training Conducted by NIHFW (24 th October- 25 nd October

More information

Table 1. State-Wise Area, Districts and Villages in India 14. State-Wise Rural and Urban Population as per 1991 and 2001 Census

Table 1. State-Wise Area, Districts and Villages in India 14. State-Wise Rural and Urban Population as per 1991 and 2001 Census CONTENTS Page Part 1. Rural Health Care System in India 1 Part 2. Detailed Statistics Chapter I. Demographic Indicators Table 1. State-Wise Area, Districts and Villages in India 14 Table 2. State-Wise

More information

Skilled-Birth Attendant(SBA) Training Program :Need of Restructuring and Strengthening to reduce IMR & MMR

Skilled-Birth Attendant(SBA) Training Program :Need of Restructuring and Strengthening to reduce IMR & MMR Skilled-Birth Attendant(SBA) Training Program :Need of Restructuring and Strengthening to reduce IMR & MMR in Madhya Pradesh Dr. Surya Bali MD,DHHM,MHA(USA) Additional Professor Community & Family Medicine

More information

International Journal of Health Sciences and Research ISSN:

International Journal of Health Sciences and Research   ISSN: International Journal of Health Sciences and Research www.ijhsr.org ISSN: 2249-9571 Original Research Article Effectiveness of Self Instructional Module (SIM) on Current Trends of Vaccination in Terms

More information

Health and Nutrition Public Investment Programme

Health and Nutrition Public Investment Programme Government of Afghanistan Health and Nutrition Public Investment Programme Submission for the SY 1383-1385 National Development Budget. Ministry of Health Submitted to MoF January 22, 2004 PIP Health and

More information

POST-GRADUATE DIPLOMA IN PUBLIC HEALTH MANAGEMENT ( )

POST-GRADUATE DIPLOMA IN PUBLIC HEALTH MANAGEMENT ( ) m NIHFW POST-GRADUATE DIPLOMA IN PUBLIC HEALTH MANAGEMENT FOR SELF SPONSORED CANDIDATES (2018-19) (Offered by the Ministry of Health and Family Welfare, Government of India) The National Institute of Health

More information

SWASTHYA PRASHIKSHAN KENDRA, HARYANA

SWASTHYA PRASHIKSHAN KENDRA, HARYANA WALK-IN-INTERVIEW Swasthya Prashikshan Kendra General Hospital Campus, Sector -6, Panchkula SIHFW Haryana aspires to invite qualified and experienced professionals to fill up the following post purely

More information

SECTION-III. A: Location, Population Coverage and Years of Functioning of Urban Health Posts and Urban Family Welfare Centres

SECTION-III. A: Location, Population Coverage and Years of Functioning of Urban Health Posts and Urban Family Welfare Centres SECTION-III Analysis and Findings: A: Location, Population Coverage and Years of Functioning of Urban Health Posts and Urban Family Welfare Centres The Table 1 shows the number of urban family welfare

More information

Technology can help India leapfrog in Addressing Healthcare Challenges

Technology can help India leapfrog in Addressing Healthcare Challenges Technology can help India leapfrog in Addressing Healthcare Challenges Authors Name - Dr. Sanjiv Kumar & Dr. Nishikant Bele Indians have provided substantial inputs to digital revolution across the world.

More information

WHAT WORKS IN INFANT AND YOUNG CHILD FEEDING (IYCF):

WHAT WORKS IN INFANT AND YOUNG CHILD FEEDING (IYCF): January 18 Photo credit: Ravi S Sahani/Alive & Thrive WHAT WORKS IN INFANT AND YOUNG CHILD FEEDING (IYCF): Strengthening Operational Programme Elements to Deliver IYCF Services at Scale in India ADVANCING

More information

DOI: /jemds/2014/1887 ORIGINAL ARTICLE

DOI: /jemds/2014/1887 ORIGINAL ARTICLE EVALUATION OF ASHA PROGRAMME IN SELECTED BLOCK OF RAISEN DISTRICT OF MADHYA PRADESH UNDER THE NATIONAL RURAL HEALTH MISSION Bhagwan Waskel 1, Sanjay Dixit 2, Rama Singodia 3, D.K. Pal 4, Manju Toppo 5,

More information

Evaluation Of Immunization Coverage By Lot Quality Assurance Sampling In A Primary Health Center Area

Evaluation Of Immunization Coverage By Lot Quality Assurance Sampling In A Primary Health Center Area ISPUB.COM The Internet Journal of Public Health Volume 1 Number 1 Evaluation Of Immunization Coverage By Lot Quality Assurance Sampling In A Primary Health Center P BS, Gangaboraiah, U S Citation P BS,

More information

STRATEGY/ACTIVITIES Reporting Month (Dec. 09) Year to Quarter (Cumulative upto Dec. 09) Budget Allotted as. Opening Balance.

STRATEGY/ACTIVITIES Reporting Month (Dec. 09) Year to Quarter (Cumulative upto Dec. 09) Budget Allotted as. Opening Balance. Format of Financial Management Report to be submitted by the States/UT Health/RCH Societies to Centre on Quarterly basis National Rural Health Mission (including NDCPs) ("Name of the State/UT") State Health/RCH

More information

Guidelines for Performance based Payment for ASHA under National Leprosy Eradication Programme

Guidelines for Performance based Payment for ASHA under National Leprosy Eradication Programme Guidelines for Performance based Payment for ASHA under National Leprosy Eradication Programme Introduction: Under Health System, Multi-purpose Workers (MPW- Male & Female) at the sub- centre act as the

More information

Innovation Pilot Proposal by Uttar Pradesh

Innovation Pilot Proposal by Uttar Pradesh Innovation Pilot Proposal by Uttar Pradesh Enhancing facility community processes to improve early eclusive 1. Contet, Rationale Problem Statement According to recent data from the Rapid Survey on Children

More information

Nutrition Moves. States create promising change in India

Nutrition Moves. States create promising change in India Nutrition Moves States create promising change in India Acknowledgements The case studies presented in this publication are a testimony to the commitment by India s state governments to accelerate progress

More information

India FP Country Summary, March 2017

India FP Country Summary, March 2017 India FP Country Summary, March 2017 MCSP / Kanika Bajaj India Selected Demographic and Health Indicators Indicator Data Indicator Data Population (1) 1,210,854,977 U5MR (per 1,000 live births) (2) 49

More information

Government of Andhra Pradesh Commissioner of Health & Family Welfare Recruitment Notification

Government of Andhra Pradesh Commissioner of Health & Family Welfare Recruitment Notification Government of Andhra Pradesh Commissioner of Health & Family Welfare Recruitment Notification 1. ASHA Programme Manager Requirement post 1 Qualification: MBBS / AYUSH / Nursing Graduate with Post Graduate

More information

GoI-UNDP Disaster Risk Management Programme. Project Management Board (PMB) GoI-UNDP Disaster Risk Management Programme [ ] Agenda Notes

GoI-UNDP Disaster Risk Management Programme. Project Management Board (PMB) GoI-UNDP Disaster Risk Management Programme [ ] Agenda Notes 3 rd Meeting of the Project Management Board (PMB) GoI-UNDP Disaster Risk Management Programme [2002-2007] Agenda Notes Part I 21 st December, 2004, New Delhi NDM Division, Ministry of Home Affairs, North

More information

Rojgar Samachar, Government Jobs, Employment News Weekly: February 1 to February 7, 2016

Rojgar Samachar, Government Jobs, Employment News Weekly: February 1 to February 7, 2016 1 Rojgar Samachar, Government Jobs, Employment News Weekly: February 1 to February 7, 2016 Indian Space Research Organization Recruitment 2016 for 185 Junior Personal Assistants, Stenographers & Assistants,

More information

PART 1. RURAL HEALTH CARE SYSTEM IN INDIA

PART 1. RURAL HEALTH CARE SYSTEM IN INDIA PART 1. RURAL HEALTH CARE SYSTEM IN INDIA Rural Health Care System the structure and current scenario The primary health care infrastructure in rural areas has been developed as a three tier system and

More information

I. PROFORMA FOR PROGRESS REPORT

I. PROFORMA FOR PROGRESS REPORT PART 3. ANNEXURES I. PROFORMA FOR PROGRESS REPORT PROFORMAE FOR REPORT ON RURAL HEALTH STATISTICS (As on 31 st March, 2017) 141 GENERAL INSTRUCTION FOR FILLING THE PROFORMA 1. Please read all columns carefully

More information

ELECTION COMMISSION OF INDIA

ELECTION COMMISSION OF INDIA ELECTION COMMISSION OF INDIA Nirvachan Sadan, Ashoka Road, New Delhi 110001 No. 590/Training/Fund/2012 Dated 12th September, 2012 To, Subject: Madam / Sir, 1 The Chief Electoral Officers (All States /

More information

Universal Health Coverage Manipur. Dr Suhel Akhtar, IAS Principal Secretary (Health & FW) Government of Manipur

Universal Health Coverage Manipur. Dr Suhel Akhtar, IAS Principal Secretary (Health & FW) Government of Manipur Universal Health Coverage Manipur Dr Suhel Akhtar, IAS Principal Secretary (Health & FW) Government of Manipur Overview Goal Essential factors for UHC State profile Health System Strengthening in the State

More information

Janani Suraksha Yojana ( JSY )

Janani Suraksha Yojana ( JSY ) Concurrent Assessment of Janani Suraksha Yojana ( JSY ) in Selected States Bihar, Madhya, Orissa, Rajasthan, Uttar United Nations Population Fund - India Concurrent Assessment of Janani Suraksha Yojana

More information

International Journal of Health Sciences and Research ISSN:

International Journal of Health Sciences and Research  ISSN: International Journal of Health Sciences and Research www.ijhsr.org ISSN: 2249-9571 Review Article Human Resources for Health in India: An Overview K S. Nair Former Faculty, Department of Planning & Evaluation,

More information

Person contacted Dr. Nagpal (BMO) & Mr. Jugal Kishore (DAC), other staff.

Person contacted Dr. Nagpal (BMO) & Mr. Jugal Kishore (DAC), other staff. Sub: Tour Report of Dr. Arshid Nazir, Assistant Programme Manager, Maternal Health & ASHA. In compliance to order no. 202 of 2015 dated 31-03-2015, block wise supportive supervision of district Udhampur

More information

Improving Quality of Maternal and Newborn Health in India

Improving Quality of Maternal and Newborn Health in India Improving Quality of Maternal and Newborn Health in India Fact Sheet: January 2017 Partners: Government of India (GoI), State Governments of Rajasthan, Maharashtra, Uttar Pradesh, Jharkhand, Andhra Pradesh

More information

ASSESSMENT OF KNOWLEDGE AND PERFORMANCE OF AYUSH DOCTORS POSTED IN COLLOCATION UNDER NATIONAL RURAL HEALTH MISSION IN UDAIPUR DIVISION, RAJASTHAN

ASSESSMENT OF KNOWLEDGE AND PERFORMANCE OF AYUSH DOCTORS POSTED IN COLLOCATION UNDER NATIONAL RURAL HEALTH MISSION IN UDAIPUR DIVISION, RAJASTHAN Original Article ASSESSMENT OF KNOWLEDGE AND PERFORMANCE OF AYUSH DOCTORS POSTED IN COLLOCATION UNDER NATIONAL RURAL HEALTH MISSION IN UDAIPUR DIVISION, RAJASTHAN Arun Kumar 1, Keerti 2, Chandra Prakash

More information

Application Form For JAPAN s Grant Assistance for Grassroots Projects (GGP)

Application Form For JAPAN s Grant Assistance for Grassroots Projects (GGP) Application Form For JAPAN s Grant Assistance for Grassroots Projects (GGP) Attachment: Check List for Documents to be attached Embassy of Japan in India, The Consulate-General of Japan, Kolkata The Consulate-General

More information

BIOMEDICAL WASTE MANAGEMENT: AWARENESS AND PRACTICES IN A DISTRICT OF MADHYA PRADESH

BIOMEDICAL WASTE MANAGEMENT: AWARENESS AND PRACTICES IN A DISTRICT OF MADHYA PRADESH ORIGINAL ARTICLE. BIOMEDICAL WASTE MANAGEMENT: AWARENESS AND PRACTICES IN A DISTRICT OF MADHYA PRADESH Manoj Bansal 1, Ashok Mishra 2, Praveen Gautam 3, Richa Changulani 3, Dhiraj Srivastava 4, Neeraj

More information

Effectiveness of Structured Teaching Programme on Bio-Medical Waste Management

Effectiveness of Structured Teaching Programme on Bio-Medical Waste Management IOSR Journal of Nursing and Health Science (IOSR-JNHS) e-issn: 2320 1959.p- ISSN: 2320 1940 Volume 3, Issue 3 Ver. II (May-Jun. 2014), PP 60-65 Effectiveness of Structured Teaching Programme on Bio-Medical

More information

Improving Home Visits and Counselling by Anganwadi Workers in Uttar Pradesh

Improving Home Visits and Counselling by Anganwadi Workers in Uttar Pradesh Improving Home Visits and Counselling by Anganwadi Workers in Uttar Pradesh Technical Brief December 202 Background Some of the major health challenges that the Government of India (GOI) is addressing

More information

Study Team. Bella Patel Uttekar Sandhya Barge Wajahat Khan Yashwant Deshpande Vasant Uttekar Jashoda Sharma Balaji Chakrawar Shweta Shahane

Study Team. Bella Patel Uttekar Sandhya Barge Wajahat Khan Yashwant Deshpande Vasant Uttekar Jashoda Sharma Balaji Chakrawar Shweta Shahane Study Team Bella Patel Uttekar Sandhya Barge Wajahat Khan Yashwant Deshpande Vasant Uttekar Jashoda Sharma Balaji Chakrawar Shweta Shahane PREFACE JSY, Janani Suraksha Yojana, is an integral component

More information

Evaluation of the Norway India Partnership Initiative

Evaluation of the Norway India Partnership Initiative Evaluation Department Evaluation of the Norway India Partnership Initiative for Maternal and Child Health Annexes 4-12 Report 3/2013 Norad Norwegian Agency for Development Cooperation P.O.Box 8034 Dep,

More information

Sudan High priority 2b - The principal purpose of the project is to advance gender equality Gemta Birhanu,

Sudan High priority 2b - The principal purpose of the project is to advance gender equality Gemta Birhanu, Sudan 2017 Appealing Agency Project Title Project Code Sector/Cluster Refugee project Objectives WORLD RELIEF (WORLD RELIEF) Comprehensive Primary Health Care Services For Vulnerable Communities in West

More information

Joint Secretary (AYUSH)

Joint Secretary (AYUSH) Integrating ti AYUSH in Health Research, Teaching and Practice Dr. D. D. Sharma Joint Secretary (AYUSH) 1 Preamble AYUSH: indigenous, time-tested, tested, cultural-friendly, socially acceptable, holds

More information

National Quality Assurance Standards for AEFI Surveillance Program

National Quality Assurance Standards for AEFI Surveillance Program National Quality Assurance s for AEFI Surveillance Program (2016) Ministry of Health & Family Welfare Government of India 2016 National Quality Assurance s for AEFI Surveillance Programme Ministry of

More information

Professional Development and Training Services

Professional Development and Training Services Professional Development and Training Services Request for Proposal (RFP) Reference Number: RFP-2018-03_SED Key deadline Date Any questions to Learning Links Foundation 1 April -2018 Response to questions

More information

SCHEME OF GRANT-IN-AID FOR PROMOTION OF AYUSH INTERVENTION IN PUBLIC HEALTH INITIATIVES.

SCHEME OF GRANT-IN-AID FOR PROMOTION OF AYUSH INTERVENTION IN PUBLIC HEALTH INITIATIVES. SCHEME OF GRANT-IN-AID FOR PROMOTION OF AYUSH INTERVENTION IN PUBLIC HEALTH INITIATIVES. 1. Introduction There are approximately 7.00 lakh institutionally qualified AYUSH practitioners located in urban,

More information

Capsular Training on Skilled Birth Attendance: Lessons from an Operations Research Study in Bahraich District, Uttar Pradesh

Capsular Training on Skilled Birth Attendance: Lessons from an Operations Research Study in Bahraich District, Uttar Pradesh Capsular Training on Skilled Birth Attendance: Lessons from an Operations Research Study in Bahraich District, Uttar Pradesh Background Objectives Capsular Training Approach End of project brief Access

More information

Jhpiego in India Factsheet: January 2017

Jhpiego in India Factsheet: January 2017 Jhpiego in India Factsheet: January 2017 Background India is a country of more than 1.2 billion people 1, second only to China in the world s most populated countries. India boasts of the earliest Family

More information

Solomon Islands experience Final 5 June 2004

Solomon Islands experience Final 5 June 2004 Solomon Islands experience Final 5 June 2004 1. Background Information Solomon Islands is a Pacific island nation with a total population of 409,042, an annual growth rate of 2.8% and a life expectancy

More information

Hospital Standards by Bureau of Indian. BIS Standards considered very resource. No such standards for primary health care

Hospital Standards by Bureau of Indian. BIS Standards considered very resource. No such standards for primary health care Indian Public Health Standards State Institute of Health & Family Welfare, Jaipur Existing Standards Hospital Standards by Bureau of Indian Standards (BIS) BIS Standards considered very resource intensive

More information

( ) MANAGERS MANUAL. Community Monitoring of Health Services Under NRHM

( ) MANAGERS MANUAL. Community Monitoring of Health Services Under NRHM (2005-2012) MANAGERS MANUAL Community Monitoring of Health Services Under NRHM Managers Manual on Community based Monitoring of Health services under National Rural Health Mission Drawing from NRHM Framework

More information

Integrated Child Development Services Scheme. Monitoring Visits. (Four Year s Time Interval Revisiting Exercise) 2008/ /12.

Integrated Child Development Services Scheme. Monitoring Visits. (Four Year s Time Interval Revisiting Exercise) 2008/ /12. Not to be Quoted Report No 34(1/2013-14) Integrated Child Development Services Scheme Monitoring Visits (Four Year s Time Interval Revisiting Exercise) 2008/09 2011/12 A Report Central Monitoring Unit

More information

The Indian Institute of Culture Basavangudi, Bangalore RECENT DEVELOPMENTS IN MATERNITY AND CHILD WELFARE SERVICES IN INDIA

The Indian Institute of Culture Basavangudi, Bangalore RECENT DEVELOPMENTS IN MATERNITY AND CHILD WELFARE SERVICES IN INDIA The Indian Institute of Culture Basavangudi, Bangalore Transaction No. 27 RECENT DEVELOPMENTS IN MATERNITY AND CHILD WELFARE SERVICES IN INDIA By DR. SARYU BHATIA THE INDIAN INSTITUTE OF CULTURE 6, North

More information

UNIVERSAL HEALTH COVERAGE AND INNOVATIONS IN HEALTH SECTOR IN TRIPURA

UNIVERSAL HEALTH COVERAGE AND INNOVATIONS IN HEALTH SECTOR IN TRIPURA UNIVERSAL HEALTH COVERAGE AND INNOVATIONS IN HEALTH SECTOR IN TRIPURA Date : 9 th January, 2014 Tripura: A snap-shot Population 2014: 3893229 (Census 11 including Growth Rate) Rural Population : 83 % Sex

More information

Discussion Paper on Health Statistics

Discussion Paper on Health Statistics Discussion Paper on Health Statistics National Statistical Commission (NSC), in its report for 2010-11, recommended the following data sets pertaining to health statistics, as the core statistics i) Health

More information

A STUDY OF HEALTH CARE SERVICES IN TRIBAL AREA. Dr. Tukaram Vaijanathrao Powale

A STUDY OF HEALTH CARE SERVICES IN TRIBAL AREA. Dr. Tukaram Vaijanathrao Powale A STUDY OF HEALTH CARE SERVICES IN TRIBAL AREA Research Paper : Dr. Tukaram Vaijanathrao Powale Assistant Professor of Economics Late Babasaheb Deshmukh Gorthekar Mahavidyalaya, Umri, Dist. Nanded - 431807

More information

MAKING REACHING EVERY DISTRICT OPERATIONAL. A step towards revitalizing Primary Health Care

MAKING REACHING EVERY DISTRICT OPERATIONAL. A step towards revitalizing Primary Health Care MAKING REACHING EVERY DISTRICT OPERATIONAL A step towards revitalizing Primary Health Care Summary document of lessons learned from Nigeria, 2009 TABLE OF CONTENTS INTRODUCTION...1 MAKING REW OPERATIONAL,

More information

A Review on Health Systems in Transition in Myanmar

A Review on Health Systems in Transition in Myanmar A Review on Health Systems in Transition in Myanmar Resources and Services Dr. Nilar Tin Physical and human resources Physical Resources Capital stocks and investment no: of Infrastructure (as of 2013)

More information

Monitoring report of No-Scalpel Vasectomy Camp cum Training at Urban Family Welfare Centre, Porompat (23 rd to 27 th March 10)

Monitoring report of No-Scalpel Vasectomy Camp cum Training at Urban Family Welfare Centre, Porompat (23 rd to 27 th March 10) Monitoring report of No-Scalpel Vasectomy Camp cum Training at Urban Family Welfare Centre, Porompat (23 rd to 27 th March 10) 1) Monitoring Team (i) Dr. Y. Ibechaobi Devi - Nodal Officer Family Planning,

More information

Subject: Monitoring of the ICDS Training Programme: Minutes of the first quarterly review meeting during Regarding

Subject: Monitoring of the ICDS Training Programme: Minutes of the first quarterly review meeting during Regarding BY Email/Post F.No.19-1/2008-TR Government of India Ministry of Women & Child Development (ICDS Training Division) 1 st Floor, Hotel Janpath Janpath, 110 001 11 Sept 2009 Subject: Monitoring of the ICDS

More information

Child Survival among Urban Poor- Challenges and Approaches for Involving Pediatricians

Child Survival among Urban Poor- Challenges and Approaches for Involving Pediatricians Child Survival among Urban Poor- Challenges and Approaches for Involving Pediatricians IAP Central Zone Workshop February 9th, 2006 Shreemaya Residency, Indore Dr. Siddharth Agarwal Urban Health Resource

More information

Welcome to this meeting on July 21, 2017

Welcome to this meeting on July 21, 2017 Welcome to this meeting on July 21, 2017 Sudhir Misra Department of Civil Engineering Kanpur 208016 REGIONAL HUB & TECHNICAL CENTRE (UNDER MINISTRY OF HOUSING & URBAN POVERTY ALLEVIATION) IIT KANPUR Dr.

More information

ICDS in India: Policy, Design and Delivery Issues

ICDS in India: Policy, Design and Delivery Issues ICDS in India: Policy, Design and Delivery Issues Naresh C. Saxena and Nisha Srivastava Abstract India s excellent economic growth in the last two decades has made little impact on the nutrition levels

More information

Greetings. from SIHFW! SIHFW, in. working. increased Evaluation. UNICEF, the. would solicit. SIHFW. We. This issue. Director.

Greetings. from SIHFW! SIHFW, in. working. increased Evaluation. UNICEF, the. would solicit. SIHFW. We. This issue. Director. SIHFW Rajasthan Electronic Newsletter Vol. 4 /Issue 2 (July to September 2015) SIHFW: an ISO 9001: 2008 certified Institution From the Director s Desk Dear Readers, Greetings from SIHFW! SIHFW, in coordination

More information

JOB ADVERTISEMENT Multiple Vacancies for Basic Health Unit-Peshawar (a Health Project)

JOB ADVERTISEMENT Multiple Vacancies for Basic Health Unit-Peshawar (a Health Project) JOB ADVERTISEMENT Multiple Vacancies for Basic Health Unit-Peshawar (a Health Project) An INGO working in KPK in multiple sectors is requesting current resumes from interested candidates for multiple vacancies

More information

OCIAL ACCOUNTABILITY SOUTH ASIA SUSTAINABLE DEVELOPMENT DEPARTMENT

OCIAL ACCOUNTABILITY SOUTH ASIA SUSTAINABLE DEVELOPMENT DEPARTMENT OCIAL ACCOUNTABILITY SOUTH ASIA SUSTAINABLE DEVELOPMENT DEPARTMENT Social Accountability Initiatives in South Asia Since 2005 a unique effort to initiate and mainstream Social Accountability (SAc) initiatives

More information

Reflection of Integrated Child Development Services (ICDS) in Implementation of Services at Bishnah and Purmandal Block, Jammu

Reflection of Integrated Child Development Services (ICDS) in Implementation of Services at Bishnah and Purmandal Block, Jammu Kamla-Raj 2012 Stud Home Com Sci, 6(1): 27-32 (2012) Reflection of Integrated Child Development Services (ICDS) in Implementation of Services at Bishnah and Purmandal Block, Jammu Shashi Manhas, Annpurna

More information

Request for Qualifications: Designing impact evaluations for Gram Varta and Nodal Anganwadi Centre initiatives under SWASTH, Bihar, India

Request for Qualifications: Designing impact evaluations for Gram Varta and Nodal Anganwadi Centre initiatives under SWASTH, Bihar, India International Initiative for Impact evaluation Improving lives through impact evaluation Request for Qualifications: Designing impact evaluations for Gram Varta and Nodal Anganwadi Centre initiatives under

More information