Short Program Review
India Experience and way forward
Subodh S Gupta
WHO India
India experience
Short Program Review – Child Health:
• Rajasthan
• Bihar
• Karnataka
1st Short Program Review
Rajasthan
• 5-days workshop
• Facilitated by experts from WHO HQ, SEARO &
WHO Bangladesh
• Followed the Global Package on SPR CH
Adaptation of SPR Package
Karnataka
• 3-days workshop
• Adaptation of worksheets and small changes in
group work
Example: SPR Karnataka
Problem
• Lack of Human Resource Management in ‘C’
category districts (and Bellary)
Recommendations
• Appointment of contractual staff to fill in gaps in
current vacancies
• Rejuvenate Divisional Joint Directorate
covering seven ‘C’ districts
• Prepare a dedicated HR policy for these districts
(Seven ‘C’ category districts & Bellary)
Example: SPR Karnataka
Problem
• Supervision, monitoring and feedback of
trainings is inadequate
Recommendations
• SIHFW and SHSRC to develop comprehensive
supervisory checklist
• Activation of district coordination committee for
Child Health (to address gap between training
and implementation )
• Designate Medical colleges / other public health
institutions as nodal agencies for supervision
and handholding for district trainings
Rajasthan: SPR Recommendations
incorporated in PIP
• Strengthening of VHSC
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Expedite training of VHSC members
Develop system of monthly meeting of VHSC
Develop five model VHSC at block level
Community mobilization
• Mainstreaming of AYUSH practitioners
▫ Utilize them for monitoring MNCHN services
• Efforts for convergence with ICDS
▫ Monthly meeting of State Steering committee to discuss
issues related to MCHN jointly by Health and ICDS
• Training of Jan Mangal Couples for Interpersonal
communication
• Strengthening of quality of trainings of frontline workers
• Rapid evaluation of IMNCI
Strengths
• Participation of all important stakeholders
• Uses data for recommendations
• Group work ensures experience of people from
the field is discussed
• Focus on interventions
• Adequate scope to address availability, access,
quality and inequity
• Causal analysis to identify health system issues
Challenges
• Bringing all stakeholders together
• Ownership by State/ District health team
• Follow-up and action for implementing the
recommendations of the review team
• Focus on improving implementation planning
Way forward
• Comprehensive package for RCH
• Package both for state and district level
• Shorter duration of review workshop
Development/ Adaptation
of an Integrated Package
for RCH
Scope
• Review all the activities under current RCH
programmes
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Maternal Health
Child Health
Adolescent Health
Family Planning
Nutrition
• Levels
▫ State
▫ District
Step 1 Where are we?
SPR Workshop
SPR Process
Preparatory activity by core team
Step 2 Are interventions reaching
target population?
Step 3 How well are program
activities being implemented?
Step 4 What are the main problems?
Step 5 What are solutions and
recommendations?
Follow-up of recommendations at appropriate
level
Formation of groups
• Step 1 – Plenary Session
• Step 2 – Life-cycle approach
▫ Gp 1: Maternal Health
▫ Gp 2: Newborn and Child Health
▫ Gp 3: A) Adolescent Health, and B) Family
Planning
Formation of groups
• Step 3 onwards - Thematic groups
▫ Group 1 : Monitoring & Evaluation
◦ Service Coverage
◦ Quality assurance
▫ Group 2 : Strengthening Health Systems
◦ Human Resources
◦ Supplies
▫ Group 3 : Community Empowerment
◦ Communication
◦ Community Mobilization
Step 1: Where are
we going?
Infant Mortality Rate
Year
IMR
SRS 2005
SRS 2009
50/ 1000 LB
41/ 1000 LB
Target
30/ 1000 LB
(2010)
25/ 1000 LB
(2012)
Achievable ?
(SRS 09)
Rural/ Urban
Rural
47
Urban
31
Sex
Male
Female
41
42
Regions (SRS 08)
Inland Northern
Inland Southern
Inland Eastern
Coastal & Ghats
Total
59
47
38
24
52
Focus on Equity
Full Antenatal
Check-up (DLHS 3)
Institutional
Delivery (DLHS 3)
Full Immunization
Coverage (DLHS 3)
Identifying best practices
• At present, Worksheet 4 : Best Practices & major
problems
• Derived from Strengths/Gaps/ weaknesses identified
in Worksheet 1A & 1B & 3.
Data sources
• Vital Statistics Registration System:
▫ Civil Registration System Sample Registration
System
• Survey:
▫ National Family Health Survey
▫ District Level Health Survey
▫ Annual Health Survey
Challenges: Adaptation
• Identifying the indicators
• Data availability for the period under review
• Data quality of ‘Health MIS’
• Converge separate packages into one
• Converge with the existing tools for Program
Implementation Plan
Challenges: District-level SPR
• Data sources to be used
• Data related to equity
• Data quality of Health MIS
• How to use the experiences of program
managers and local experts
Thank You