NIPI Retreat

The Retreat was organised in two parts consisting of a field visit and technical discussions. In addition, the Rajasthan NIPI launch took place on the July 25, 2007 in Jaipur.

About the Retreat:

Field Visit: July 25, 2007
The field visit was aimed at providing an exposure to the functioning of the health system in the state to the delegation from Norway, who is members of the Joint Steering Committee (JSC), the highest decision making body for NIPI. The delegation included Dr. Tore Godal, Special Advisor to Prime Minister of Norway, H.E. Ambassador Sigrun Møgedal, Ministry of Foreign Affairs, Norway, Dr. Rick Klausner, International Health Advisor, GAVI and  H.E. Jon Westborg, Ambassador of the Kingdom of Norway to India and co-chair JSC, and Mr. Jan Håkon Olsson, Counselor, NIPI, Royal Norwegian Embassy, New Delhi. The team was accompanied by the NIPI secretariat team.

The exposure was organized through visits to:

-A 30 bedded block Community Health Centre (CHC) at Behror, Alwar District, Rajasthan;
-A six bedded Primary Health Centre (PHC) in Achlor, a Panchayat Headquarters in Jaipur district;
-A Health Sub-centre in Dhand village, catering to approximately 5000 population in 4-5 villages; and
-Visit to a community near the sub centre to interact with mothers who have delivered recently.

The Chief Medical officer of Alwar District and Jaipur district along with RCH and immunization officers, District project Management Unit(DPMU) in charge facilitated the visit.

The team was able to observe and understand the implementation of Janani Suraksha Yojana (JSY), a scheme for promoting institutional delivery under the National Rural Health Mission (NRHM), through interaction with the Medical Officer, PHC, Auxiliary Nurse Midwife(ANM), Accredited Social Health Activist (ASHA), Lady Health Visitor(LHV), and other  staff in the respective facilities. The DPMU team explained the mechanism of managerial support provided by them, especially for transfer of funds to the JSY beneficiaries and management of records and registers. The alternative vaccine management system and issues related to immunization were clarified by the respective staff.

The exposure visit to the field was greatly appreciated by the visiting team. This enabled the team to make purposeful suggestion on the proposed NIPI activities for 2007-08 and aspects that can bring value addition by NIPI to the child health interventions under National Rural Health Mission (NRHM). 

The field visit was followed by an intensive interaction between the visiting JSC team and NIPI secretariat. The meeting was significant since this was the first formal meeting after Mr. P.K. Hota (Former Secretary Health and Family Welfare, Government of India), took over as Director, NIPI Secretariat in April 2007. The team gained an understanding of the rationale behind the action plan proposed by NIPI Secretariat and made valuable suggestions for further refining the same.

The day concluded with a dinner where the Principal Secretary, Health and Family Welfare, Government of Rajasthan along with NRHM Mission Director and a few key staff from the health directorate, who had informal interactions with the visiting team and NIPI Secretariat.

Retreat: July 25, 2007

The second part of the retreat was an open forum organized with an objective of gaining a better perspective on the state Program Implementation Plans (PIPs) with special focus on child health under NRHM and how these child health plans find a fit with the NIPI action plan. The forty participants included representatives from the five NIPI states, members of professional bodies like Breast Feeding Network, National Neonatology Forum, INCLEN, National Institute of Health and Family Welfare, Indian Pediatrics Association and representatives from implementing agencies such as USAID, CARE, PATH, Public Health Foundation of India, GTZ, UNICEF and WHO.

The session opened with an introduction to NIPI followed by presentation by the state governments and discussion. The retreat discussion highlighted the following issues in the proposed NIPI activities:

• The Child Health Resource Network (CHRN) at the state, district and block level will be embedded in the existing NRHM framework and Project Management Unit (PMU) structure and will have a focus on strengthening the managerial capacity of the health system for child health at these levels.
• The District arm of the CHRN will be platform for providing partnership development and development of an integrated approach to child health plan. The focus of the block CHRN will be to build capacity of the block health team to develop their own plan based on reliable data.
• An integrated package of interventions will be implemented in two districts (selected by the state) from the five states, which will strive to provide a model for up scaling child health interventions in the states.
• ASHA empowerment will be through building their capacities and skill up gradation in Home based Newborn and Child Care (HBNCC) which will complement the IMNCI efforts.
• The advocacy effort, innovations and research will be taken up in collaboration with professional bodies and academic institutions and through Public private partnership.
• The techno managerial support at district and block level placed by NIPI will address link between the maternal and child health.

Table 1. Key Child Health Indicators in five states (NFHS 3)

Highlights of state presentations –

• The child health is gaining more visibility in the state program implementation plans.
• While NRHM has brought the focus to state and district level, the current child health focus has further decentralized to block level.
• The five NIPI states have begun the process of identifying the gaps that are critical for effective program implementation. E.g. requirement for managerial and accounting staff at district and block PMUs.
• The states have begun to place staff with diversified professional background at the block level as per NRHM framework.
• The support from NIPI could be in terms of developing MIS which will facilitate decision making effective, at the various levels.
• States are exploring diverse mechanisms of providing incentives to the institutions for stimulating better performance.

The presentation by the states gave an indication that NIPI funded interventions could bring value addition to their effort.

The retreat concluded with remarks from the various representatives, especially focusing on what could be done to strengthen the effort.