A young mother listens carefully to an ASHA. Photo courtesy ~ Pervez Hussain, Manager Program, Ghaziabad.

As we  approach the end of the fourth year of implementation, a reminder of the lessons learnt over these years;

a). TCIHC demonstrated 
High impact approaches (HIA) in 31 cities; ‘Fixed day static /Family planning day (FDS)’ an HIA became integral to the system. Similarly, ‘Mapping & Listing of Urban Slums’ another HIA led to 
Chief Medical Officers realign  existing resources including Accredited Social Health Activist (ASHA), urban primary health centres (UPHC). This validates that HIA’s provide crisp guidance to governments to kick-off family planning interventions at UPHC.

b). HIAs are adaptable! This got affirmed when we successfully layered on maternal and newborn health, non-communicable diseases, tuberculosis, and adolescent and youth sexual reproductive health (AYSRH) services on the urban health platform. 

c). To increase family planning reach, we 

have to intervene in sub-groups, saturate them and move on; as we did for saturating first-time parents in AYSRH cities. 

d). Lead-Assist-Observe (LAO), a low-dose-frequent-coaching model implemented by the program is improving both knowledge and counselling skills of ASHA. This has resulted in more than one lakh women being reached by ASHA and over 62,000 women availing family planning services at the UPHC (Oct-Dec.2019, HMIS).

While the demonstration of HIAs is powering absorption of the approaches in the govt. health system. In the case of LAO, we see merit in transitioning the coaching model to the system to sustain mentoring support to ASHAs. It is envisaged that graduating out of the model will create coaches within the system but will require a tool to aid the next level of coaches. The past few bridge-months have gone in rigorous preparation of the tool to support the next level of coaches. 

ASHA using a job aid to explain family planning choices to a group of women. Photo courtesy ~Vivek Dwivedi, Senior Manager - Operations, Uttar Pradesh.
Let us first understand the need for 'prioritization' this way - often an ASHA knows exactly how many women in her area are expecting and will deliver in the coming month? or how many immunization cases are pending? But in general, no ASHA will know the current number of users or non-users in her area? This is due to a paucity of a tool which limits ASHAs know-how on the current number of users or non-users of family planning in her area. Towards building coaches within the system and developing a culture of prioritisation in family planning, TCIHC devised a 2BY2 prioritization matrix, which segregates the 
population based on age and use of family planning methods. By using this, an ASHA can now prioritize the households where there is a need for family planning. And by reviewing the matrices of ASHAs, Auxiliary Nurse Midwives (ANM) can now prioritize which ASHA requires mentoring and monitoring. At a broad level, the tool signals UPHCs that are performing well in terms of family planning uptake and those that have a large base of the population with unmet need. TCIHC is driving this ‘culture of prioritization’ and has already received buy-in of many city governments. 
Early results from five AYSRH cities is propelling scale-up of the program to ten more cities in Uttar Pradesh. As a continuum to this, three cities of UP, Lucknow, Kanpur and Shahjahanpur along with TCIHC invited adolescents to be part of the City Consultation workshop aptly titled, “युवाओं की बात – युवाओं के साथ” (Yuvaon Ki Baat- Yuvaaon ke Saath). Youth representatives participated in a panel discussion on barriers to SRH services; themes included, ‘lack of agency and knowledge’, ‘cultural norms’, and ‘patriarchy’. Chief Medical Officers (CMO) of the cities committed in an open house discussion that ‘eighth of every month will 

be dedicated to facility-based Adolescent Health Day (AHD) and one of the Antral Diwas (a Fixed day static approach for spacing methods which was demonstrated by TCIHC in Phase-I) will focus on first-time parents and young married couples apart from other commitments. A significant win for TCIHC through these workshops is that General Manager, Rashtriya Kishor Swasthya Karyakram (RKSK) has extended resources towards rolling out community AHD in rest 15 TCIHC UP cities (five cities are already demonstrating AY approaches; read more on how TCIHC is reaching out to adolescents in Allahabad).

A young girl peeps into a shanty looking for her friend. Photo courtesy ~ Nitin Solanki, Senior Manager, Madhya Pradesh.
Firozabad’s city health plan for 2019-21 devised out of TCIHC’s technical support is ready to provide operational guidance to make health services available to the urban poor population. The plan is based on analytical information on facility-based performances, human resource allocations, identified areas of departmental convergence and financial utilization status. The District Magistrate of Firozabad disseminated the city health plan in the presence of CMO and representatives of other departments like Integrated Child Development Services, Municipal Corporation, and Education. This plan is a big gain for TCIHC as it signals a city’s commitment to providing family planning services to an urban poor population who otherwise are not in focus during the implementation of any scheme.  
TCI University:
Visitors from India continue to account for the largest portion of visitors for TCI University.

Most Significant Change Stories:
Following the MSC process, the Global-Level Committee of Gates Institute selected India’s entry in Systems domain, “Ensuring Spacing at Birth scheme is Catalysing ASHA’s Interest in Family Planning." Watch out for more update on this.

TCIHC’s learnings published:
Laxmi organizes community meetings to promote general health awareness and family planning services. She has helped promote family planning by building relationships with key decision makers. Visit TCI U to read the complete story.
A happy couple. Photo courtesy ~ Pervez Hussain, Manager Program,  Ghaziabad.
- Gates Institute's Kojo Lokko, Director-TCI visited TCIHC India from Feb 17-20, 2020 to discuss year 4 and 5 strategy along with discussion on graduation process and prioritization tool.

- Joint Director for Urban Health, UP visited UPHCs in TCIHC city of Prayagraj to discuss family planning service uptake and suggested increased involvement of ASHA’s for mobilizing clients for family planning services.

- A team from Health Ministry, Govt. of India visited TCIHC cities of Bhopal and Indore to learn about the implementation of urban health program and understand the functioning of Health & Wellness Centres in urban areas.
Photo Quest! A photograph competition was held recently to get people excited about their TCIHC work and give them a platform to share their work visually. Before the contest closed on Dec. 5, 2019, a daily WhatsApp campaign shared representative stock photos with TCIHC staff to spark their creativity and motivate them to showcase their work.

A total of 75 entries from 34 unique participants from 24 cities across Uttar Pradesh, Madhya Pradesh and Odisha were submitted for consideration. The winning photos were divided into two categories: Demand and Supply. All winning entries are adorning this newsletter. Hope you enjoy these naïve clicks and get a glimpse of the audience we work with!

About TCIHC!
TCIHC builds on the demonstrated success of the Bill & Melinda Gates Foundation’s 'Urban Reproductive Health Initiative', 'Expand Access and Quality to broaden method choice' and USAID’s 'Health of the Urban Poor'.  It is scaling up these proven solutions for family planning for the urban poor population. It is an unusual approach for providing life-saving reproductive health and family planning information and services to individuals, families and communities.

Mukesh Sharma, Chief of Party | Hitesh Sahni, Associate Director, Operations | Devika Varghese, Associate Director, AYSRH | Emily Das, Associate Director, Monitoring, Learning & Evaluation | Deepti Mathur, Senior Specialist, Knowledge Management | Parul Saxena, Manager, Documentation | Raj Rishi Mitra, Graphic Designer | Gunjan Razdan, Manager Support

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