AFP conducts SMART facilitation in Uttar Pradesh

Uttar Pradesh (UP) is the most populous state in India. The state has a total population of 19.96 crores (2011 census. As per the recent data available on contraceptive use (AHS 2011), the use of family planning method in the state of UP has been very low. Less than one third (32 percent) of currently married women were using any modern method of contraception which is only a 4 percentage point increase from DLHS3 (27.2 in 2007) that is in 4 years. Also, contraceptive prevalence rate (CPR) increased from 26.2 during 2002 (DLHS2) to 27.2 in 2007 (DLHS3) depicting a marginal increase of 1 percentage point in the level of CPR in almost 4 years.

Increasing CPR is at the core of the current UP Government’s agenda. Following the lead from the Mission Director, National Health Mission, Mr. Amit Kumar Ghosh, AFP partner PFI took the initiative to facilitate a SMART workshop to develop objectives that will aid in increasing CPR. The consultation was held from April 20-21, 2015. Thirty Eight representatives from civil society (Pathfinder International, JHPIEGO, FPAI, Janani, PSI, MSI, Global Health Strategies, Parivar Seva Sansthan and PFI), academicians, national health mission officials, State Innovations in Family Planning Services Agency (SIFPSA), Federation of Obstretics and Gynaecological Societies of India (FOGSI) and others participated in the facilitation.

The two day consultations deliberated on identifying objectives that will yield near term QuickWins that will contribute to increasing CPR in UP. Four key themes emerged out of the initial discussion: 1) Engagement of private providers; 2) Increasing male participation; 3) Improving counseling services; 4) Improving quality of care in family planning. Based on the thematic areas participants were divided in groups that led to the development of objectives below:

Objective 1: At least 2 private health facilities to be accredited for family planning services in 25 districts of Uttar Pradesh by October 2015: One in every five couples in UP has unmet need. Only three couple in every 100 adopts a family planning method post delivery. The four hundred and seventy five Obstetricians and Gynecologists at Community Health Centers in UP are not enough to cater to the large family planning needs of urban and rural population (Source: RHS Bulletin, March 2012, M/O Health & F.W., GOI, state FP vision 2020; AHA 2013-14).  The Government Order no. 143 provides guidelines for accreditation of private providers to provide family planning services. However, accreditation is a time consuming process and results in delays. The group developed the objective with a clear ask to the Chief Medical Officer (CMO) of 25 selected districts for nomination of assessment team by CMOs to complete assessment process and recommend at least 2 facilities in the district for accreditation within 3 months of nomination. This will enable accreditation of fifty private providers across twenty five districts to provide quality family planning services resulting in wider access to the population.

Objective 2: Provide focused training on non-scalpel vasectomy and peer to peer counseling to Multi-Purpose Worker (MPW)/ Block Community Process Managers (BCPM)/ Health Education and Information Officer (HEIO) in 5 districts by September 2015: Programs and evidence has shown that involving male peer to peer counseling have increased male involvement in family planning. In addition, male participation will also help reduce the burden on women for family planning. UP is currently in the process of hiring BCPM. This is a very good opportunity to have the BCPM cadre as motivators for male participation in family planning. The group through Technical Support Group – FP will advocate for issuance of a standing order for mandating the MPW/ BCPM/HEIO as motivators for NSV program in five districts initially. Through this order the group will propose that a focused training program on non-scalpel vasectomy and peer to peer counseling be conducted for MPWs/BCPMs/HEIOs. This is envisaged to help increase uptake of NSV services.

Objective 3: Develop a competency checklist to enhance communication/counselling skills of existing FP Counsellors by August 2015:  Family Planning counsellor plays a very important role in defining the quality of family planning program. UP has placed FP counselors in high case load facilities. Every woman and man who comes for counselling has the right to comprehensive information, which only a skilled FP Counsellor is able to provide. Evidence from private sector shows that regular assessment and systems to improve competency of providers leads to increased uptake of FP services. The FP counsellors go through the regular performance appraisal. However, the competency assessment is not included within this system of performance approval. The group through the Technical Support Group (FP) will advocate to issue a GO/Guideline for instituting continuous competency improvement of FP Counsellor. This will include a check list for quarterly competency assessment, with identified traning agency that will provide need based training. 

Objective 4: 100% fund utilization under the DQAC allocations as per GoI guidelines for improving family planning services in 5 districts by October 2015: District Quality Assurance Committee is a very good mechanism that can play the strongest role in ensuring quality of health services. Currently, following incidents of poor quality of services, the national government has laid emphasis to improve quality of services provided in public facilities. To mitigate incidences of compromised quality services, institutionalization of DQAC is important. Fund utilization ensures that activities such as review meetings, facility checks for quality and other outlined items under the DQAC is undertaken. Equitable distribution of DQAC funds to CHCs at the block level will ensure wider coverage of quality services to under privileged rural population. With the objective of ensuring improvement in quality of care through fund utilization approved for DQAC, TSG (FP) is advocating for the “Letter of inclusion of partners to CMOs from all decision makers in the proposed 5 districts for streamlining and strengthening DQACs”. This will enable in undertaking the necessary actions to improve quality in public health facilities.

AFP partner PFI will continue to collaborate and work closely with the Mission Director, NHM, SIFPSA, Technical Support Group (FP), and participants at the facilitation to achieve together the objectives developed.

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