Soon-to-Be Graduated City of Kanpur Shares Implementation Learnings with Two New Uttar Pradesh Cities

Dec 7, 2021

Contributors: Sheela Rawat, Amit Bajpai, Amit Kumar, Anil Dwivedi, Vivek Dwivedi and Deepti Mathur

Etawah and Farrukhabad officials attend coaching session with AD Health & Family Welfare in Kanpur, on the TCI model.

The Challenge Initiative’s (TCI’s) ‘business unusual’ approach supports deep engagement with city governments to widen the impact of its evidence-based family planning (FP) and adolescent and youth sexual and reproductive health (AYSRH) interventions. Cities that “graduate” from TCI’s direct support effectively sustain the interventions through coaches embedded within the health system that are recognized as TCI “alumni.” This recognition positions these graduated cities as learning laboratories from which newer TCI cities can observe and learn.

Kanpur, a TCI-supported city in Uttar Pradesh, is nearing graduation from TCI direct support and recently shared what it learned from its implementation experience with two sister cities, Etawah and Farrukhabad. Soon after joining TCI in March 2021, key representatives from Etawah and Farrukhabad were invited by TCI-trained Kanpur city master coaches on a study tour to witness firsthand how Kanpur implemented TCI’s high-impact interventions.

At the beginning of the study tour, Additional Director (AD), Kanpur, Dr G. K. Mishra laid out his expectations and emphasized:

An essential component of a successful urban family planning program is its data reporting and management mechanism. I encourage new cities to develop a HMIS [health management information system] FP data-flow plan representing the entire process of data collection from field to HMIS upload, and submit it to Divisional Urban Health Consultant, Kanpur. Post review and completeness of the data, the Kanpur division will use it for decision-making for all the health programs of the division.”

After participating in a mini-university and the study tour, Etawah and Farrukhabad have been able to not only rapidly scale up the high-impact interventions but also achieve promising results. Dr. Sushil Kumar, Nodal Officer of Etawah, and Rajeev Pathak, District Urban Health Coordinator (DUHC) of Farrukhabad, discussed how both learning opportunities contributed to their success.

Dr. Kumar shared:

Etawah has a population of 300,000 people and yet has only four urban primary health centers (UPHCs). Added issues of staff crunch, COVID vaccination drive, low capacities of ANMs [auxiliary nurse midwives] and ASHAs [accredited social health activists] on the subject of family planning and low levels of awareness and acceptance of family planning by urban slum population were some of the challenges faced by us when we joined the TCI.
NUHM [National Urban Health Mission] and TCI oriented all the new joining cities through a mini university platform on the family planning best practices. It was interesting to note that our peers, nodal urban officers, ACMOs [Assistant Chief Medical Officers], etc. from TCI’s experienced cities had taken time out of their busy schedules to share with us key lessons and tips that could help our cities increase family planning uptake. Later, AD Sir from Kanpur invited our team to experience the implementation of best practices. We returned [to our own cities] rich with learnings and presented the same in the DHS [District Health Society] meeting. Encouraged by the response at the DHS platform, we formed a quick plan and worked with TCI team towards capacity building of providers and community health workers, use of data for decision-making, quality assurance of services, regularizing Antral diwas (FDS), form a city coordination committee, to name a few of the best practices that we put in place. It is because of the first-hand experience of seeing it in a city and then learning from TCI coaches with the help of the ‘how to do’ toolkit that we could streamline some processes and get started right away. We were delighted to observe a 242% (5,272) increase in the annual family planning client volume from the baseline (1,540) at the city level by August 2021, as recorded in the HMIS.”

Pathak added:

Hearing about the levers of success from fellow government counterparts during the mini university and then during the study tour increased the confidence level of all city officials as they saw change within the system made by the change makers of the system.”

He shared that Farrukhabad made an action plan wherein the city focused on:

  • Orienting Medical Officers in-Charge (MoICs) and pharmacists on ensuring sufficient stock of family planning supplies by coaching MoICs to delegate indenting and procurement of family planning supplies to pharmacists, who then distribute them to ANMs and ASHAs.
  • Referring to the high-impact interventions on TCI University and reaffirming roles and responsibilities of staff nurses, ANMs and ASHAs to implement them.
  • Coaching MoICs to regularly review family planning data, identify gaps and carry out mid-course corrections.
  • Validating data from UPHCs before inputting into the HMIS.
  • Ensuring timely family planning reporting from each UPHC and timely HMIS reporting.
  • Forming quality improvement committees (QICs) at each UPHC and monitoring their work.

This focused plan made Farrukhabad one of the best-performing cities among TCI’s new cities. According to the HMIS, TCI best practices have contributed to a 27% (5,869) increase in annual family planning client volume at the city level comparing baseline (4,608) to August 2021.

Both Dr. Kumar and  Pathak cannot wait to see the achievements that their cities will continue to accomplish after receiving more TCI coaching and mentoring support in the coming months.