Norway India Partnership Initiative (NIPI)

23/09/2008 ::  

Background

The Prime Minister of Norway, Mr. Jens Stoltenberg, visited Delhi in December 2005 to attend GAVI board meeting, and met the Prime Minister of India, Dr. Manmohan Singh, to discuss areas of bilateral cooperation between Norway and India. The Norway-India Partnership Initiative (NIPI) for MDG 4 follows the understanding between the two governments to collaborate toward the reduction of child mortality in India.

The Millennium Development Goals are universally accepted common development goals towards which all governments are mutually accountable. The Governments of the Republic of  India (GoI)  and Government of the Kingdom of Norway (GoN) are equally responsible for contributing towards reaching these goals and have agreed to work together as partners to achieve the MDG 4.

The NIPI is intended to provide an up-front, catalytic and strategic support and accelerate the implementation of the National Rural Health Mission (NRHM 2005-2012) in five states that comprise of 40% of India’s total population and account for around 60% of child deaths: Uttar Pradesh, Bihar, Madhya Pradesh, Rajasthan and Orissa. About 2.4 million children under the age of five die every year in India, of which 1.4 million die in the 5 NIPI focal states.   

NIPI will be implemented as a part of the National Rural Health Mission (NRHM), which is the overarching, comprehensive, nation-wide and long-term health plan of the country.

 
The 5 focus states
The Partnership effort would be focused on 5 states of India, namely, Uttar Pradesh, Bihar, Madhya Pradesh, Rajasthan & Orissa. These States together contribute almost 60% of country’s infant deaths (Panel). These states pose an enormous challenge in implementation because of the socio-economic status, large inequalities, weak health system and poor program management capacity. India’s success in achieving MDG 4 depends on the impact of the child health programs in these states.

Value addition of NIPI to the national effort

The Norway-India Partnership Initiative will provide technical cooperation which is co funded through Government of Norway & Government of India The contribution of the  Government of Norway  is  around USD 80 million for 5 years (2006-2011). Even though this would form a relatively a modest supplement to the budget for NRHM/RCH II, it would add a great value because of the way in which this resource is proposed to be utilized.

The Partnership inputs would complement the national efforts and stimulate acceleration of NRHM implementation for MDG 4 by providing flexible support to enable implementation and innovation, and to resolve bottlenecks. In addition, the Partnership will provide access  and feed-back to international experiences and expertise.

The Partnership is being used to attain and sustain a rapid scaling-up of implementation to achieve MDG 4. Efficiency comes with speed and maintaining the momentum of action is crucial for a mission approach. Any delay in responding to the program needs with urgency, quality and flexibility has a price in the form of lost opportunity to save lives. The additional support will provide a strategic and focused complement to the national efforts.

The value addition to the national effort to reduce child mortality would be achieved by focusing the partnership on four areas:

1. Strengthen a new government initiative, an independently managed enabling network, to facilitate the delivery of MDG 4 related services.
2. Test and introduce new ways for scaling up quality services by primary health workers (ASHA - Accredited Social Health Activist), including their support needs and referral requirements (‘ASHA chain’).
3. Recruitment of private sector into the delivery of MDG 4 related services.
4. As the implementation of the NRHM-MDG 4 related activities unfold, there will be a continued need to explore new opportunities as they arise. The partnership will operate on flexible basis providing up front catalytic financial support, and facilitate engagement of international and national expertise as deemed necessary.

Outcomes

•  Sustaining routine immunization coverage rate in the country at 80% or more from 2007 onwards.
•  Saving an additional half a million under-5 children each year from 2009 onwards.

By virtue of the innovative nature of this initiative and by demonstrating its successful implementation, the Partnership would contribute to

• Subsequently improve the performance of the health system as a whole in India
• The development of best procedures for large scale roll-out of interventions addressing MDG 4 also in other countries.

OVER ARCHING APPROACH

All activities undertaken under NIPI shall be directed towards fulfilling the goals and objectives of NRHM, and in consonance with other program documents including RCH II program implementation plans (PIPs) of the Centre and States, the Multi-year plan (MYP) for Universal Immunization Program and the State Immunization PIPs. The Partnership recognizes the National Population Policy, Five Year Plan Documents, National Health Policy and the National Plan for Action for Children documents as the important guiding charters. These will be carried out within the implementation framework the same, with the full participation of the State Governments and stakeholders.

NIPI would aim to strengthen inter-sectoral linkages, at all levels, especially with the ICDS system, water-sanitation functionaries and Panchayati Raj institutions. Collaboration and synergistic cooperation with professional organizations, NGOs, development partners and centres of excellence, among others, would be actively sought and embraced to have maximum possible positive impact on child health.

EQUITY
The Partnership is deeply committed to an equity-driven approach and it would endeavour to draw upon and enhance the strong equity rubric of the NRHM.

The Preamble of NRHM states, ‘The Goal of the Mission is to improve the availability of and access to quality healthcare by people, especially for those residing in rural areas, the poor, women and children’.  The Mission focuses on the rural population where the real child health challenges, and inequities, are. Its vision statement underpins the priority given to states with ‘weak public health indicators and / or weak health infrastructure’.  The five states chosen for NIPI are among the most backward in terms of socio-economic indicators.

In addition to the pro-poor planning and implementation, both the NRHM Implementation Framework and the RCH II national PIP mandate equity-sensitive monitoring. States would report on coverage indicators disaggregated by vulnerable groups (SC/ST, BPL) as benchmarks. NIPI monitoring framework would encompass these and other indicators to assess the reach of the programme among the poor people and the vulnerable groups.

Institutional and oversight arrangements
  The NIPI envisages formation of the following institutional structures:
• A Joint Steering Committee (JSC) as the central decision making body responsible for the implementation of NIPI in accordance with this Joint Statement. Its major tasks shall be providing coordination and oversight for the planning, implementation, dissemination, and execution of NIPI as well as approving new Agencies.

• A Programme Management Group (PMG) as a forum for dialogue to form a platform for coordination between NIPI, NRHM leadership and other stakeholders, on integration of activities with the NRHM operational framework.  The PMG will discuss key technical issues, review progress, make proposals to and advice the JSC as it relates to pertinent programmatic matters within NIPI. 

• A Secretariat to execute decisions made by the JSC and to provide secretariat functions to the JSC and PMG. 

In addition to the above, an International Strategy Group (ISG) has been established. The ISG will advise NIPI, its Secretariat, and Agencies on global best practices towards reaching the MDG4.  At the same time the ISG will help disseminate lessons of the NIPI and the NRHM to the international community.

Periodic independent evaluation of the process and performance of the activities under the Partnership will be conducted.

The progress of the Initiative would be reviewed at the level of the Prime Ministers of Norway and India.

IMPLEMENTATION
Currently, UNICEF and WHO have been invited as implementing agencies. UNOPS has been identified as the Local Fund Agent (LFA) for routing the funds. NIPI will also identify other organisations as implementing, facilitating or collaborating agencies  as NIPI progresses.

The activities under the present Initiative would form a part of the NRHM district/state plans and implemented through agencies and in close cooperation with the Child Health Resource Network & NIPI Secretariat.

Although a broad framework of activities is outlined in NIPI, there will be flexibility to refine the approaches at the state/national level to respond to the changing needs of the program.

For further reading click Norway –

NIPI Project Document

NIPI Fact Sheet