How the City of Amroha is Sustaining Impact After Graduating from TCI Direct Support

Contributors: Anupam Anand, Samarendra Behera and Parul Saxena

Coaching new ASHAs during an ASHA and ANM meeting in Amroha.

The goal of The Challenge Initiative (TCI) is to support the greater self-reliance of local governments to scale up family planning and adolescent and youth sexual and reproductive health (AYSRH) high-impact interventions (HIIs), leading to sustained improvements in urban health systems and increased use of modern contraception, especially among the urban poor. From the onset of engagement with TCI, the local government is set on a path towards self-reliance to transform and sustain an impactful urban family planning program. In February 2021, five cities in Uttar Pradesh, India, successfully transitioned to the graduation phase of TCI, no longer requiring direct coaching and technical support from TCI.

Ahsan Ali, an Urban Health Coordinator with the National Urban Health Mission (NUHM) in Amroha, is a master coach for the graduated city. He recently shared his thoughts on how the city is doing after graduating from TCI.

Since the inception of TCI, we have considered the initiative a part of NUHM. In February 2021, Amroha moved to the graduation stage. And since then, we have not faced any major challenge. Since graduation, I have mainly utilized approaches such as using data effectively, fixed-day static (FDS) service, strengthening urban ASHAs and convergence for implementation and to coach staff of the health department. The best part is without any follow-up every Thursday all urban primary health centers (UPHCs) are organizing weekly FDS/Antral diwas because facility staff, ANMs (auxiliary nurse midwives), and ASHAs (accredited social health activists) are well-coached on their responsibilities, and FDS reports are timely submitted to us.

In large convergence platforms, like District Health Society, NUHM, and FP Review meetings, I present urban family planning data and ensure action points are developed and adhered to. Based on family planning HMIS data, I prioritize low-performing UPHCs and, along with Nodal Sir [another master coach], plan a regular visit to the facilities. Through these joint visits, I coach UPHC staff and support them in mitigating challenges. Recently, I resolved the supplies issue by taking the support of the FPLMIS Manager, also coached by me. He reoriented the UPHC staff on the online indenting process, and this step has improved the family planning results of low-performing UPHCs.

TCI gave us a mantra to leverage the support of other departments, which has shown positive results after graduation especially. The quarterly city coordination committee meetings are conducted timely, and I ensure that representatives of other departments accomplish tasks assigned to them.

The only challenge we have faced is to coach newly appointed urban ASHAs regularly, as this is not a stable position. For this, we took advantage of the ASHA and ANM monthly meeting as a capacity-building platform to mentor new ASHAs on family planning counseling skills through ANMs. We ensure that in each ASHA and ANM meeting, staff from NUHM department participates and coaches the community health workers on any relevant health topics and sets their monthly priorities.

Moving forward, we are strengthening the use of the 2BY2 prioritization tool to assist ASHAs to prioritize their family planning clients, and help make timely decisions based on the aggregated 2BY2 matrices.”

TCI’s master coaches are ensuring that the impact created during TCI’s direct engagement is sustained. Their continued role in capacity transfer, decision-making and oversight of implementation of the high-impact interventions is making a noticeable increase in Amroha’s annual family planning client volume at the UPHC and city level – which includes UPHC and district level facilities.

The graph below shows the 40% and 14% increase in annual client volume at the UPHC and city level, respectively, for two fiscal years (i.e., from April 2019-March 2020 to April 2020-March 2021). Similarly, HMIS data on intrauterine contraceptive devices and Antara (injectable contraceptive) uptake at the UPHC and city level in the last six months after graduation indicates that the city’s performance following the worst period of the COVID-19 pandemic is back on track both at the UPHC and city level.