MYRADA HEALTH PROGRAMMES

MYRADA JEEVA CHAITANYA ANEMIA PILOT PROJECT

Funding partner:                NRHM – GOK- Health & FW dept.

Technical partner –           Dept. of Community Health, St. John’s Medical College, Bangalore
Year of initiation:                April 2010
Project period:                    3 years (ending March 2013)
Coverage area                    Aurad taluk –            150 villages, 1 town
Molkalmuru taluk – 109 villages, 2 towns
Kollegal taluk –        307 villages, 1 town

Project Description:          Pilot project to institute a set of sustainable protocols and approaches that will assist the existing health system to address anemia in vulnerable groups more effectively.

Key interventions

1. Fill up gaps in current govt. program
1. Distribution of Iron tablets ( IFA) and Albendazole – stock tracking, supplies, storage
2. Observed compliance of consumption of IFA tablets.
3. Generate community awareness on anemia, details of IFA tablets, and importance of deworming.
2. Prepare community based institutions to assist govt. health systems in tracking of anemia

- SHGs/ VHSCs/ GP/ SDMC

3. Facilitate convergence of health, education and WCD depts. at all levels
4. Individual tracking of all anemia cases

Achievements so far

1. Baseline survey in all three taluks in collaboration with St. John’s Medical College. The key results are depicted below:

2. Completed listing of all target group populations – see table below.

3. Referral of severe anemic cases for further treatment – a total of 1449 ____ cases of severe anemia (< 7 gm/dL) were identified and referred.
4. Development of IEC material – posters, flyers, handbook for ASHAs.
5. TOT for ASHA training – 35 master trainers trained by St. Johns Medical College.
6. Finalization of tracking tools – Adolescent health card, child anemia card, anemia tracking formats for the field level workers.
7. Mass deworming program – conducted on January 9, 2011. A total of 78864 from the target group were given single dose of Albendazole in a joint program with Health dept, Anganwadi centres and Schools.

Key issues that emerged from year 1

• Burden of anemia – The baseline survey revealed that the problem of anemia in these three taluks was worse than the findings of the NFHS 3 survey
• Awareness of anemia is very poor in the community and is of low priority amongst the health providers.
• Community very responsive to learning about anemia and participating in programs.
• Most health facilities did not have adequate stocks of IFA or Albendazole. Majority of the PHCs did not have working equipment to test Hemoglobin. Existing mechanism to track stocks from sub centre to district level is inadequate.

Comments
At Govt. level

• Budget cut in 2nd year – modified program
• Delays in payments
• Issues related to regular drug supplies – IFA and albendazole

Myrada

• All staff in place – though there is a need to reduce staff in order to demonstrate replication by the government.

Current year focus on
Convergence of Health, Education and WCD depts.: in order to facilitate ASHA workers, anganwadi teachers and school teachers to track identified cases of anemia in pregnant women, children below 5 years and adolescent girls respectively, using the tracking tool developed in the pilot study. All these three groups will have to be trained in using the tracking package and tool, and assisted up by our staff where required.

Mass deworming program: We were successful in deworming over 75000 persons in January 2011 through a one day program. This activity needs to be repeated once in 6 months in order for the target group to benefit from deworming. The next date fixed for this is July 11, 2011 (2nd Monday in July).  We will need to discuss the preparatory plan for this with the Health department, including adequate supply of Albendazole.

Operational research topics: as planned in the pilot proposal, there is a need to study the effectiveness of alternate formulations/ dosages of IFA for better compliance. St. Johns Medical College has identified 2 areas for study – use of double fortified salt/ or “microshakti” in anganwadis for children below 5 years; and adding a nutrition supplement to identified anemic pregnant women (ragi based high iron powder mix)

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MYRADA SOUKHYA PROGRAMMES

Funding partner:    1. Karnataka Health Promotion Trust (KHPT) – (Bill & Melinda Gates Foundation)                  
2. Karnataka State AIDS Prevention Society (KSAPS)

Year of initiation:         1.    February 2004 (KHPT)
2. October 2009 (KSAPS)

Project period:            1)     8 years (ending March 2012) (KHPT)
2)        3 years (ending March 2012) (KSAPS)

Coverage area        Gulbarga –                9 towns
Yadgir –                     4 towns                                 
Bellary –                    10 towns
Chitradurga:             8 towns
Kolar:      -                      6 towns
Chikballapur -           6 towns

Project Description:          Targeted intervention with female sex workers and MSMs in urban locations of 6 districts. (Components: Outreach; STI management; community mobilisation; enabling environment.)

Current year issues

• It was decided earlier that Myrada would withdraw from direct implementation of targeted interventions based on the following logic:

Myrada had developed a CBO called Soukhya Samudhaya Samsthe ( SSS) in each of the districts in order to promote a local level institution to take over responsibility of its own community’s health needs. Myrada’s role as an institution is to promote local institutions and then only provide support when required. In order for the local institution to manage, Myrada decided to withdraw from direct implementation one year ahead of schedule.

• In the case of Kolar and Chikballapur, the contract has been signed between Myrada and KSAPS till March 2012. As soon as SSS in these districts are empanelled with KSAPS, future contracts will be signed directly between SSS and KSAPS.
• In Chitradurga, SSS is already empanelled with KSAPS. They have recently signed the contract for 3 project units (1 project unit per 1000 FSWs as per NACO guidelines) in the district with KSAPS. All staff will be hired by them. Myrada has deputed one staff as program manager to assist them for one year. His salary will be reimbursed by SSS to Myrada.
• In Bellary, the contract will be signed between KHPT and SSS for this year. The project has now been divided into 4 units. Since Belaku SSS  BSSS) has not yet got their Section12A certificate for tax exemption, Myrada will sign a three month tripartite agreement with KHPT and BSSS to facilitate FCRA fund flow. However, all implementation will be done by BSSS. Myrada has deputed one documentation officer staff to Belaku SSS for one year. Her salary will be reimbursed by BSSS to Myrada.
• In Gulbarga, the project has been divided into 4 units – 3 for Gulbarga, and 1 for Yadgir districts. Jeevan Jyoti Mahila Abhivrudhi Samsthe SSS (JJMAS) has applied for Section12 A certificate for tax exemption and completed their scrutiny. In the interim period, Myrada will sign a three month tripartite agreement with KHPT and JJMAS to facilitate FCRA fund flow. However, all implementation will be done by JJMAS. Myrada has deputed one program manager and part time accounts staff to JJMAS for one year. Their salary will be reimbursed by JJMAS to Myrada.
•  All other staff hired by Myrada previously to implement the Soukhya project in different districts have completed their contract periods and have been relieved. Some of them have joined SSS as staff.

Myrada has reduced direct staff positions from 76 in 2010-2011 to 10 in 2011-2012 for all the Soukhya projects.

A summary of projects for the current year is in the table below:

Soukhya Project achievements: (April 2010-March 2011)

Myrada has documented our learnings through 2 technical papers in December 2010 that need to be disseminated further amongst key stakeholders.

Action points

• While the SSS in all 6 districts have now directly been linked to getting TI projects from KSAPS/ KHPT, there is still a need to continue to provide them support for institutional capacity building. Through the CDC supported program, Myrada has hired CIDORR, Kamasamudram to provide this support till September 2011.
• There needs to be some thought on how SSS, as an institution, can function more like a CMRC by expanding its portfolio beyond HIV AIDS projects. Chitradurga SSS has shown some progress in terms of starting a tailoring training program for children of sex workers, and SSS Kolar has taken up some assignments to audit other SHGs in the district. One area that can be explored is the new initiative of the central government to promote SHGs to manufacture sanitary napkins for adolescent health programs. Another possible venture is the production of a ragi based high nutrition mix for pregnant women through SHGs and Soukhya groups.
• The technical support unit of NACO has acknowledged that the Soukhya group model is worth replicating in other areas. However, there needs to be some advocacy with NACO for understanding and buying into this model.

MYRADA KHPT SAMASTHA PROJECT

Funding partner:    Karnataka Health Promotion Trust (KHPT) – (USAID/ PEPFAR)

Year of initiation:    April 2007
Project period -       ends September 2011

Coverage area        Gulbarga –    134 core villages + 134 care villages (6 taluks) –
Bellary –        62–core villages + 30 care villages

Project Description:          Rural prevention (TI for sex workers and prevention for gen. population) + Care and support: Outreach based palliative care for PLHA and OVC
Care villages - Outreach based palliative care for PLHA and OVC

Staff:  6 at district level, 10 taluk supervisors
Community based link workers - 115

Project achievements:

Comments
The project period ends in September 2011. There is informal talk that there may be a no-cost extension till March 2012, though this has not been finalized. 
KHPT has not communicated any future plan in these districts.

From Myrada’s point of view, there has not been any major value added in implementing this project.  It has been a “prescribed” project where Myrada was told what to do , and not allowed to add any value or innovation.

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MYRADA CDC Programme

Funding partner:    Centers for Disease Control – GAP (PEPFAR)

Year of initiation:    October 2005 (5 year project) + 1 year no-cost extension
Project period:                    Ending September 2011-

Coverage area:       Chamrajnagar –       100 high risk villages in 4 taluks
Mandya –                  100 high risk villages in 7 taluks
Bidar –                       100 high risk villages in 5 taluks  
Kodagu –                   64 high risk villages in 3 taluks                
All 4 districts –          116 RRCs
Outreach VCTC –    1 team in 4 districts

Project Description:         

Field based working pilot models for mainstreaming activities – link worker program; Red Ribbon club, outreach VCTC, Nemmadi groups.

Staff:  Coordinators –4; Supervisors/Trainers: 16; VCT team: 8; Central staff – 4
Community based Link workers - 60

Strategy of rural programme in the current year

• Substituting link workers with ASHAs.
• Handing over referral responsibilities to VHSC committees
• Integrating youth programs into regular curriculum
• Formation of Nemmadi groups – small groups of PLHIVs based on the self help group model.

KEY ACHIEVEMENTS (October 2010 – March 2011)

Link worker scheme model

In contrast to the targeted KHPT and NACO style link worker program, Myrada CDC program has had a comprehensive approach- worked with general community, SHGs, GPs and ASHAs. As part of our withdrawal strategy, 74 ASHAs have been inducted to do the link workers activities with the hope that they will be able to continue to do so after project period. That has allowed us to reduce the link workers from 120 last year to 60 this year.

SHGs
- In the past 3 years, over 10000 SHGs were trained using the 3 flip book module. All SHGs were asked to make an action plan to respond to RCH and HIV needs of their members and community. This is being followed up regularly.
Youth-Based Programs

• Under the Red Ribbon Club initiative, 116 RRCs have been formed. The members of the RRC undergo a specific curriculum called “Celebrating Life” (C Life primer) to address vulnerabilities faced by young people with respect to health.
• Out of school youth in the link worker villages have also been trained using the C Life primer

Working with high risk groups

• Identified 2666 (estimated 2482 FSWs) in 364 working high risk villages. Established rapport and linkages for regular health checkups and condom distribution.

Community based care and support for PLHAs and OVCs

• Identified a total of 1507 PLHIVs and 1036 OVCs in 4 districts.

Outreach voluntary counselling and testing model

• over 50000 persons ( including >8500 pregnant women ) were tested through the outreach VCT teams in Mandya, Chamrajnagar, Bidar and Coorg. MOU signed with KSAPS for them to supply all consumables and kits.
• Severe kits shortage for past 6 months – testing hampered.
• This activity has been stopped since April 2011, and Myrada has requested KSAPS to absorb the trained counsellors and lab. Technicians (8 persons).

Technical assistance:

1. Assistance to GSACS, Goa – TI capacity building; evaluation
2. Technical assistance to select district level positive networks affiliated to KNP+
3. Assistance to other agencies – Avert Society, Maharashtra, APAC , Tamil Nadu
4. Providing resource persons for NACO led trainings in the area of community outreach and mobilisation.

Products developed over the project period

• Kannada version of the 3 module SHG training module (adapted from TNSACS module).
• Gram Panchayat training manual
• Rural risk assessment manual
• Celebrating Life curriculum for youth– 2 trainers manual and 1 student handbook
• Wall cum flip chart on basics of HIV
• STI booklet
• ASHA training manual
• Link worker strategy and operational guidelines
• Red Ribbon Club guidelines
• Outreach VCTC guidelines

Issues

This program is in the no-cost extension phase which ends September 2011.
Implemented in 364 villages across – Bidar, Chamrajnagar, Mandya and Kodagu districts.
This program has been seen by CDC as a model to demonstrate how rural HIV programs (link worker program of NACO) can be integrated into the NRHM program. This now has to be advocated to NACO, NRHM and other agencies.
CDC – GAP, USA has hired Family Health International (FHI) to conduct an in depth evaluation of this program. This evaluation will begin after September 2011. However, the process of developing the evaluation protocols has begun already, and these will have to be approved by NACO and CDC.

CDC India is keen on working out a modality of extending minimal support for another year through one of its other partner’s funds to allow Myrada to consolidate the integration model. When this comes through, then Myrada will have an opportunity to document this model and present it to others.

This is another example of a program with several learnings that can be incorporated into the national program. There needs to be a concerted attempt for advocacy at different levels.

MYRADA VHSC CAPACITY BUILDINGPROJECT

Funding partner :   KHSDRP
Year of initiation:    April 2010
Project period:        2 years (ending March 2012)
Coverage area        Bellary district
Gulbarga sub division

Project Description:          Capacity building of VHSC members and hand holding for one year using KHSDRP training manuals

Key interventions

1. Baseline information
2. VHSC and ARS capacity building -3 days per VHSC
3. Hand holding- bi monthly meetings

Project Achievements; April 2010—March 2011.
 

                   A PHCF INOVATION PROJECT

Funding partner:                KHSDRP
Year of initiation:                April 2010
Project period:                    2 years (ending March 2012)
Coverage area        A)Vector borne diseases
2 PHCs, Guidbanda, Chikballapur
2 PHCs, Malur, Kolar (now shifted to Mulbagal)
B)Maternal health
3 PHCs, Kollegal, Chamrajnagar
4 PHCs, Sedam, Gulbarga

Project Description:          Community mobilisation to access services and demonstrate sustainable interventions to control vector borne diseases and reduce maternal mortality.

Key interventions

1. Baseline survey
2. Line listing of all fever cases  and pregnant women
3. Training of SHGs, GP,s VHSCs- local response to these problems
4. Follow up of dengue, malaria, Chickungunya cases and high risk pregnant women.

Maternal Health Report  in Kollegal & Sedam

Total no. of pregnant women registered:             1873
Total no. recd at least 3 AN care:                          520 (27.7 %)
Total pregnant with identified high risk               213
Anemia                                                          144
High BP                                                         39
Premature labour                                            8
Bleeding                                                           5
Total deliveries                                                         1608
Institutional                                                   1328
No. of women with anemia treated                      142

Vector borne diseases in Guidbanda, &, Malur

Before the intervention Malaria positive cases were 276 in two PHCs after our intervention only 15 cases (in 2 PHC)
During the year no dengue fever and Chikungunya cases found in those PHCs
Compared to previous year the fever cases down from 22150 to 8710
VHSC taking responsibility to remove the stagnant water, purchased phenol and bed nets. SHGs taken credit and purchased 455 bed nets.
Now fever cases are immediately refer to the hospital or the PHC facilities

Overall Comments for VHSC and PHCF proejcts

1. A one off program – no innovations allowed after govt. restructured the proposal to suit its needs.
2. No added value to Myrada except for buy in from govt. that Myrada is involved in health programs.
3. Delay in reimbursements in all 4 areas poses difficulties to local team to advance large amounts and wait for over 6 months to get reimbursements. (Kolar has waited for 1 year; Gulbarga for 6 months)