Convergence of Services at the City Level:

Meeting Family Planning Needs of the Urban Poor

Evidence of Impact

As an outcome of TCI India’s advocacy efforts, the Director General, Family Welfare Uttar Pradesh, issued a letter in July 2018 to CMOs of 75 districts regarding activation of CCCs along with the structure, roles and responsibilities of the committee. Across 25 TCI India supported cities government formed and activated committee, and quarterly CCC meetings became a mandatory convergence activity of NUHM. In CCC meetings the FP achievements, issues and challenges were presented to the committee to sort solutions by seeking support from the relevant departments.

Some of the noteworthy outcomes from CCC forum are listed below:

1. In many cities self-help groups (SHGs) of NULM and AWW of ICDS were coached by ANM on motivating eligible couple from the slum areas for fixed day static services (FDS)/Antral diwas, outreach camps and urban health nutrition day.
2. In Mathura through the support of education department school teachers were oriented on family planning who later motivated parents by discussing the advantages of family planning in parent-teacher
3. In Varanasi TCI’s Male Engagement Team Leader participated in Municipal Corporation training to orient and motivate sanitation workers on family planning.
4. In many cities Jal Nigam supported in resolving UPHC water issue, UPHCs were relocated to a better place and UPHCs surrounding was cleaned up taking support of Municipal
5. In Varanasi education department demanded for initiating school health check of urban poor children the way it is organized in rural CMO Varanasi, took District Magistrate’s approval and children in urban area received health check services in their schools.

Guidance For Establishing and Strengthening Convergence

To facilitate convergence at the community level, collaboration is required at various levels as described below:

Given that FP receives little emphasis from other community functionaries, it will be important to:

1. Orient community health workers on FP: Orient all community level workers through basic training on FP, gender inclusion including AWWs and DUDA workers. Without this understanding, workers are likely to neglect FP and fail to include it as a priority for convergent action (Refer to: UHI Government approved IEC materials, for orientation on FP). Ensure that the benefits of FP and of gender integration for the health of women and children and their families are well understood by the trained AWWs and other community workers.

2. Provide a combination of integrated FP and MNCH services: Ensure collaboration among ASHA and AWWs to help in counseling pregnant women on FP when they come to the AWC for check-ups and supplementary nutrition.  CHWs should seek an opportune moment during such interactions when they can talk about gender equality. They can also engage the couple through gender sensitization games such as white and black marble game to change the mindset of son preference, Kranti Bhranti an interactive game of Rashtriya Kishore Swasthya Karyakram (RKSK).

3. Support in formation of Mahila Arogya Samiti (MAS): Encourage other frontline workers to participate in strengthening existing women’s groups to form MAS through their membership and leadership roles. With their experience and presence in the community, DUDA link workers and AWWs can help ASHAs to form MAS where there are no women’s groups. (Refer to TCI India HIA- Strengthening MAS)

4. ASHA should sensitize MAS members on gender neutrality by using IEC or simulation games. Further, during MAS members home visits, such gender sensitization games can be used to promote shared decision-making among eligible couples. Utilize group meetings. Encourage frontline workers to conduct joint meetings with MAS and use MAS as a platform to provide women with FP and maternal health information and mobilize eligible couples to demand these services. AWWs during routine UHND sessions give information on FP and other mothers’ group meetings on nutrition at the AWC.

Roles and Responsibilities

Monitoring for Convergence

The following are the indicators of level of convergence in promoting health behavior including FP:

1. Number of quarterly CCC meetings conducted at the city and ward levels
2. Number of meetings attended by representatives of each department (Health, ICDS, DUDA, Municipal Corporation )
3. Number of UNHDs and ORCs organized where FP was integrated
4. Number of MAS meetings facilitated by ASHAs and participated by other frontline workers

If the above indicators show a high level of joint activity, it would indicate an effective district and sector level convergence.

Cost Elements

The costs elements specified below can be included in the NUHM-PIP. If not budgeted, then these line-items should be budgeted in the PIP/ supplementary PIP. Costs associated with orienting DUDA link workers and AWWs in FP is not covered in the current PIP, however need based additions can be requested for inclusion in the subsequent PIP.

* Source: NHM PIP Guideline 2018-2019

The table above is indicative and illustrates the manner in which cost elements are provided in a government PIP, thus giving guidance to the audience on where to look for elements related to a particular task, such as convergence.

Sustainability

To sustain the convergence concept, utilize CCC as a platform where city specific issues can be jointly discussed and resolved with the support of all urban stakeholders and ensure this collaboration improve overall health services for the urban poor in the city. To sustain ongoing relations between frontline workers in delivering FP, maternal, infant and child health services, it is essential for their higher authorities to continue giving directives. Similarly, it is necessary to continue with reviewing of activities in monthly meetings of health and other sectors. It is also necessary to institutionalize the inclusion of more in-depth training on FP in the basic training programs of AWW’s and DUDA link worker.