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(A Successful Strategy
Repliicated)
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In its endeavour to considerably decrease
the total fertility rate (TFR) and to enhance the reproductive
health of women in the state of Uttar Pradesh, SIFPSA
has been implementing several innovative strategies. Experi-
ence with family planning programme implementation has
clearly indicated that a single strategy for the whole
state will not succeed because use of contraception is
an extremely personal issue and one that is inextricably
interwoven with an individual's socio-religious beliefs.
Another lesson learned is the need for developing and
involving the private sector for awareness generation
and advocacy leaving the govern- ment to gear up its service
delivery system. |
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Decentralized Planning |
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SIFPSA recognizes that, to be really
effective, reproductive health strategies must become
area specific, taking into account the peculiar needs,
problems and priorities of different sections of the community.
Such strategies have their roots in decentralized participatory
planning whereby all the stakeholders in the district
from both the public and private sector, pool their collective
wisdom and experience and commit themselves to a specific
action plan. In March 1998, SIFPSA launched 6 District
Action Plans (DAPs) as a pioneering experiment in this
direction. The districts selected were Aligarh, Allahabad,
Meerut, Rampur, Sultanpur and Varanasi. |
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Formulated after a district level workshop,
each DAP entailed district level programme implementation
and fund management through an autonomous society the
DIFPSA under the chairmanship of the District Magistrate.
SIFPSA set up a Project Management Unit (PMU) in each
district to support DIFPSAs and to act as a monitoring
and problem-solving unit. |
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A
Marked Improvement |
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The DAP intervention demarcated clear-cut
strategies to ensure that existing resources in the district
were channelised to create positive synergy. The performance
of the DAPs was evaluated after one year of implementation
and the results have been encouraging. By the end of the
first year, in 6 DAP districts, 800 religious leaders
attended meetings on FP, 4,500 pradhans attended training
programmes, all workers in private and public sectors
were imparted interpersonal counselling skills training,
792 female workers received IUCD insertion training, 1,128
integrated RCH camps were conducted and 28 NGO projects
as well as 3 dairy. |
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Cooperative projects covering a population
of 17.9 million were implemented. The family planning
performance of the DAP districts improved considerably.
Sterilization performance in these districts improved
by 38.5 percent in two years and services were provided
to around 400,000 contraceptive users. |
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DAPs Replicated |
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Realistic planning, close monitoring
and district ownership have contributed to the gains in
performance of the DAP districts. Since this model has
given good results, SIFPSA has decided to extend the DAP
approach to all 29 districts in phases. |
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In four of these,viz. Agra, Bareilly,
Firozabad and Saharanpur, workshops were held for objective
setting and strategy development during January — February
2000. |
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The workshops were organized by the
Chief Medical Officers(CMOs). They were attended by all
stakeholders : key health functionaries of the district
including the District Magistrate, CMO, Deputy CMOs, Medical
Officers In Charge (MOICs), District Health, Education
and Information Officer (DHEIO), representatives from
leading NGOs and other private institutions; functionaries
of development departments like cooperatives, panchayati
raj, & resource persons from SIFPSA The workshops had
been so designed that participants were first briefed
on the latest district specific data on FP and MCH indicators
which revealed the unmet need for family planning & maternal
& child health services. This was followed by a presentation
by the CMO on the status of public health facilities and
personnel available, revealing gaps in infrastructure
and service delivery. |
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Once these presentations were made,
the participants divided into smaller groups for more
in-depth discussion on the objectives and strategies required
to achieve them. Each district specific plan was then
written up, detailed operational plan drawn up, budgeted
and funded by SIFPSA. These DAPs have started from 1 December,
2000. |
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| The DAPs have been truly
participatory in design, spirit and implementation. |
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Innovative Features |
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Assessment of training
needs |
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Curriculum
developement |
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Selection
of master trainers |
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Selection
and upgradation of training sites |
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Selection
of lead trainers |
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Training
of lead trainers |
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Training
of ANMs / LHVs at upgraded clinic sites |
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Practice
on pelvic models |
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Actual
IUCD insertion to clients under observation |
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Distribution
of IUCD insertion kits and gloves |
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Follow-up
in the field by RFWTC staff |
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Reorientation
training during follow-up |
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Certification
of ANMs / LHVs as performing to standard
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Improved outreach services
for MCH in a DAP district |
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