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Maternal Care

In the Indian context the milieu of maternal health has always been a great public health concern. A great degree of variation is observed in maternal health indicators in India among different states, rural-urban distribution patterns, rich and poor socio-economic status and level of education and availability of health services. U.P and Bihar are the least performing states in the health front according to NITI Ayog report.

Bihar is home to millions of people living on or below the poverty line – estimates vary depending on the criteria used – however, in rural parts, it can be up to 60%. Maternal and child mortality rates are higher than the national average – equating to approximately 2 mothers out of 1,000 dying in childbirth, and 4 child deaths out of every 100 born.

Our Approach

As we designed the TSU work in 2014, we postulated that in addition to direct technical assistance at frontline operational levels, sustainable change required that we catalytically engage the two programs to:

  • a) Improve public health leadership and managerial skills,
  • b) Sharpen focus on outcomes and gain ability to use data and be driven by evidence and strengthened internal accountability
  • c) Strengthen core systems within both programs to provide an enabling environment for effective implementation of RMNCHN interventions.

Scale of Intervention on the groundMaternal care Intervention on the ground

The mandate during 2010- 2013 was to engage with Health programs of the GoB to improve the coverage of a range of RMNCHN interventions at a scale of eight districts (~28 m population), using creative yet replicable ways of improving frontline worker performance, appropriate to the challenging context: sharply defined intervention priorities, better tools and job aids, skill-building, improved last-mile supervision.

It became equally clear by 2013 that the responsiveness of the FLWs and nurses to our interventions were not matched by more than a lukewarm response from the program leadership itself. Thus, the scale-up technical assistance plans evolved into a Technical Support Unit, with work under a fresh grant kicking in effectively in mid-2014 and spreading across all 38 districts of Bihar.

Innovations

1

Incremental Learning Approach- CARE India is supporting GoI to design and implement an innovative capacity building and supervision system strengthening approach called, Incremental Learning Approach (ILA) as part of the World Bank supported NNM. ILA is aimed to strengthen the knowledge and skills of field functionaries and enhance quality and content of supervision in Health program.

2

Mobile Nurse Mentoring Program- Detailed plans have been proposed for the TSU to help the GoB build robust internal mechanisms for ongoing mentoring and quality assurance, with a scope that includes intranatal and postnatal care as in the nurse/doctor mentoring interventions so far, but also expands to include other specialized areas such as SNCU care, care of the seriously sick older child, and the full range of family planning procedures and services – all under a single umbrella.

4

Quality Improvement at Health Facilities-It focus on clinical outcomes with oversight mechanisms, robust clinical documentation, ongoing clinical skilling/mentoring and the efficient management of available human resource, infrastructure, supplies.

5

Self-determined team-based goals and incentives (TBGI)- FLWs are motivated to work towards a shared dream by setting up team based goals and non-monetary incentives.

Achievements