The following activities will be undertaken under UDAAN (ARSH) Program in the state of Uttarakhand.
a) Block Level Coverage Through NGOS
Presently the UDAAN (ARSH) program is supported by the 12 FNGOs in all the 27 blocks of 4 districts namely Dehradun, Haridwar, U. S. Nagar and Nainital. Further, state proposes to expand the UDAAN program in remaining 9 districts by covering 15 new blocks . Considering the feedback from GoI level state reworked on the FNGO model in new blocks and decided to involve DARC with additional staff at district and block level to effectively implement the UDAAN program with reduced budget. The involvement of ASHA Support System ARSH program will foster better convergence among PGEs and ASHAs at the village level and will benefit the adolescents through multipoint contacts and coverage.
ARSH trained M.O’s and paramedics at the block level would be assisting the DARC in community activities like Health Camps and a fixed incentive from the respective DARC budget head would be given as per the guidelines to give a uniform colour to all ARSH activities.
Therefore in total the FNGOs or DARCs will be working in 27 Existing + 15 Additional Blocks = 42 Blocks as per the appraisal document form GOI.
b) ARSH – URBAN Health Services
The state proposes to strengthen ARSH services for the URBAN SLUMS adolescent population through the existing and proposed Urban health centres running in PPP mode. The existing staff of 21 UHC, already functioning in three districts have been trained on ARSH and are delivering AFHS . The state proposes to expand this by recruiting peer group educator support system on the lines of MAS. The trainings for this Adol. Peer group would be conducted by the trained UHC staff and ARSH District Counsellor & Coordinator ( DCC) under the supervision of SNA . The budget proposed for these activities as follows:
c) Involvement of ASHA Support System (DARC) in Management of Field Activities
State reworked on the existing implementation model of UDAAN (ARSH) program and revised the strategy for better involvement of ASHA Support System at all levels for increasing level of community participation and mobilization.
The block level staff of UDAAN project will report to the District Counsellor & Coordinator (DCC-ARSH) of DARC and to the CMO of the respective District. The DCC will be responsible for the convergence with the SHG for the Health camps and tracking of the referrals. Implementation of the WIFS and the advocacy meeting on MH , will be part of his job responsibility. He will also be actively involved in data collection from the blocks and other sources and submitting the same to the CMO office and the SNA. Those FNGOs who will not be interested in the revised program implementation strategy will be replaced at the block level by the DARC of that district. Hence, all the 13 DARCs will be provided with district level staff to support the implementation of UDAAN Program at block and sub-block level. Hence state proposes the following budget for involving 13 DARCs in management of UDAAN (ARSH) program .
d) State Adolescent Health Resource Centre ( SNA)
In order to provide the technical assistance to UKHFWS, the state health society, state proposes to continue the contract of the current State Nodal Agency as State Adolescent Health Resource Centre at the state level. The SNA will undertake the activities related with technical assistance, capacity building, innovations for effectively implementing the UDAAN (ARSH) program and will help the state mission of NRHM in periodic review of the program through regular monitoring and evaluation at every level of implementation. The SNA will organise convergence and induction workshops at the state and district level to build an enabling environment for ARSH program through interdepartmental convergence and effective partnership management with FNGOs and DARC working at block and district level. A separate note on SNA job responsibilities and achievement for the FY-2011-12 ,is being provided as per the appraisal note PIP-2012-13. The progress chart of SNA in the year-2011-12 has also been very satisfactory.
The programme implementation plan has been thoroughly and minutely followed at the field level and every detail is being adhered to because of intense monitoring and facilitations by SNA.
It includes facilitation for signing of MOU by FNGO & CMO's, release of budgets, training and conceptualizing the programme for NGO functionaries of the block though proposal development workshops where a very positive and enabling discussion was held between state functionaries and the FNGO in the light of technicalities & ARSH PIP 2011-12.
This was followed by structuring of timelines and TOT of FNGO workers to implement the programme at block levels. The formats of Monthly Monitoring timelines, collection of data and scrutinizing of travel plans is being done by SNA in a facilitative manner.
The SNA has successfully conducted over 90% of training targets for state Health service providers a summary of which is listed below.
SNA- ARSH Achievements-2011-12
||Achievement of SNA FY-2011-12
||SNA conducted orientation workshop on ARSH to the FNGOs of 15 up scaled blocks of USNAGAR, NAINTAL and HARDWAR.
||TOT of Block Coordinators and Field Trainers (5 Days)
||SNA conducted TOT for 134 Field staff
( B.C. & FT's) of 27 blocks (99% Achieved)
||MOs Trained for Block Level AFHS
||123 out of 135 M.O.'s are trained of CHC/PHC of all the 4 districts ( 91% Achieved)
||UHC-MOs Trained for AFHS at Urban areas
||19 out of 21 M.O's are trained of UHC to cover the Urban Adol. Population
||Paramedics (ANM/LHV/SN/Pharmacist/MHS) Trained for AFHS at Block level
||745 out of 810 paramedics of CHC/PHC are trained on ARSH (91% achieved)
||Training of UHC -ANM & C.M.
||76 out of 84 ANM & C.M. are trained of 21 UHC in the state.( 90% achieved)
||MOs Trained for AFHS at DH/SDH/ICTC Level.
||18 out of 39 M.O.'s trained of D.H.(ongoing trainings- SPIP-2011-12,)
||DIET & ICTC counsellors Trained for AFHS
||50 out of 60 DIET trainers (83% achieved) and 18 out of 22 ICTC counselor trained (81% achieved)for AFHS.
||Convergence -1 State and 4 district level
||Successfully conducted state level and district level convergence meet with various department like ICDS,NYK,Education, PRI etc.
||SNA monitor FNGOs activities on monthly basis and Quarterly joint monitoring are done with District Health Department.
SNA has also monitored AFCC of 27 blocks as directed by the State.
||ARSH Help Line within Adol. Health Resource Centre
||Established and functional in Dec'2011
Convergence with other Department like education, NACO,ICDs, PRI, NSS, NYK, ATI etc has been very high on ARSH agenda and state & District level convergence workshops very conducted successfully. ARSH supplementary PIP had the mandate of setting up a call centre for ARSH which has been successfully completed and an average of 25 call/day is already being covered in first two months of its inception. The Principal Secretary Health inaugurated it himself and the event were highly covered by media. Uttarakhand has implemented a very intense IEC and BCC campaign and SNA has been assisting the state in distribution and proper utilization of IEC at the periphery. Currently they doing an audit of utilization of IEC distributed to FNGOs and at AFCC. The State run AFCC setup in 27 blocks which were audited by SNA in the month of December 2011 and a list of factors needing attention and correction was presented to the CMOs. Currently they are facilitating filling up of identified gaps and setting up of District Hospital AFCC's in 13 District Hospitals as part of the mandate of supplementary PIP 2011-12.
e) Capacity Building of Service Providers through SNA
State Nodal Agency will provide support to the UKHFWS in conducting the trainings of Block and district level staff of FNGOs and DARCs who are working on UDAAN program in 42 blocks along with the Medical and Paramedical Staff in 15 new blocks of remaining 9 districts. Considering the intensity of upscale which is almost two folds of existing coverage and the limitation of funds, state does not propose the training of service providers of the existing 27 blocks and district level AFCCs along with staff of 30 Mobile Health Clinics who were trained or would be trained during current financial year of 2011-12. A total of 139 ARSH Mobilizers & Coordinators along with 75 MOs and 450 Paramedics of 15 additional blocks are proposed to be trained by the SNA
f) Capacity Building of Service Providers of Urban Health Centres for AFHS
The State proposes to upscale ARSH services to the underserved adolescents of Urban slums who live in highly vulnerable conditions and needs medical attention and counselling services.The program would run on the same lines as that of the block, but at a reduced scale considering that it caters to a smaller area and lesser population. The proposed budget for the TOT for the UHC personal to train the PGEs of their slum is as follows:
g) Capacity Building of School Health Team for providing ARSH Services
The state proposes to utilize the services of School Health teams during lean periods for giving ARSH services in the uncovered blocks of remaining nine districts. Two M.O. from the 27 School Health teams would be given 3 days training by the SNA ,who will in-turn provide ARSH services in coordination through DCC- ARSH and directives of the CMO . For better convergence of the school health programme ,the DCC will be organizing Health camps and workshops for Adolescent of repective districts by utilizing the ARSH trained medical officers of school health teams during their lean period. Community mobilization for these programmes will be assisted by the AWW/ASHA/ ANM of the concerned village. The trainings for the medical officers of the school health teams will be organized by SNA ,in coordination with the CMO. AS per the suggestion in Appraisal note-2012-13, we have incorporated ARSH activities for School health teams.
h) Toll Free Help Line for Adolescent’s Counselling within State Adolescent Resource Centre
A toll free counselling helpline for the adolescents is recently started within the State Adolescent Health Resource Centre. The toll free number for this helpline is 1800-180-1200. This is a 4 terminal helpline with three male and three female counsellors and the calls are attended between 08:00 AM till 08:00 PM seven days a week by these 6 tele-counselors. In response to the query in the appraisal note PIP-2012-13, that the average call rate for the helpline is 25 calls per day, also 6 tele-counselors are required to enable 2 male and two female tele-counselors in the evening shift when the call rate is higher and we hope to have more calls in the next year. The proposed budget for this helpline for the next FY is mentioned in the following table:
i) Mobile Task Force within SNA for Sensitizing Adolescents in Degree Colleges/Institutes/NCC/NSS
The existing activities of UDAAN (ARSH) program are mainly limited to rural areas through block and sub-block level interventions through FNGOs or DARCs. State proposes to cover the female adolescents studying in Degree Colleges, Engineering and Management Institutes and those who are enrolled with NCC, NSS and Red Ribbon Clubs. They will be sensitized on essential life skills for sexual and reproductive health and to stay away from STIs including HIV. Considering the uneven and scattered locations of these institutes across the 13 district, state propose for a mobile task force with a dedicated vehicle on rental basis, having One male and Two female counsellors cum trainers, to conduct 200 sessions with this sub-group of population. This task force will be a part of State Adolescent Health Resource Centre within the SNA.
j) Establishment of 15 New AFCCs at Block level & 2 at State Medical Colleges and Strengthening of Existing 40 AFCCs
There are 27 existing AFCC at the block PHC and CHC level in all the blocks of four districts. The 13 district level AFCCs will also be started by 15th February, 2012 as an activity of supplementary PIP for the current fiscal. Therefore, in total 40 AFCCs will be functional in the state by the end of this financial year. The AFCC will be utilised by the block level ARSH project staff as their office and a weekly clinic other than the regular OPD hours will be organised as a special Teen Clinic for adolescents. State proposed to expand the UDAAN (ARSH) program in 15 additional blocks of remaining nine districts, hence, the AFCC to provide AFHS in these blocks is also proposed. State has also planned to establish 2 AFCC at State Medical Colleges for better coverage for referral patients. A recurring cost for running 57 AFCC’s for the current year is given below . The budget for both ( 40 existing and 17 new AFCC’s) for the next fiscal is mentioned in the following table:
In lieu of the appraisal note PIP-2012-13,we would like to clarify that we are providing for recurring cost only for the AFCC. A ward boy compensation of Rs.50/ per clinic has been retained as ,he is supposed to stay back after his designated duty hours and absence of any incentive may prompt him to dessert the premises, which may be detrimental for the smooth function of the clinic.
k) Red Ribbon Clubs :
Red Ribbon Clubs have been established under the SACS. The SNA will ensure that effective linkages are established with the existing red ribbon clubs, so that coordinated messages can be communicated to the communities.
l) WIFS (Weekly Iron & Folic Acid Supplement) & Menstrual Hygiene
GoI has approved a scheme for promotion of menstrual hygiene among adolescent girls in the age group of 10-19 years. Five districts have been selected in Uttarakhand in the first phase of implementation of this programme. This programme offers an excellent opportunity to reach out to adolescent girls in the community with key messages on menstruation, fertility awareness and other related issues. This programme also introduces availability of sanitary napkins at a highly subsidised cost. WIFS would be strengthened by PGE and ANM/ASHA/AWW linkages at the AFC and AFCC by the DCC- ARSH.
m) Incentives for Service Providers and Motivators to improve access to AFHS
Uttarakhand is a state where we are striving and trying various promotional strategies to fill the gaps of inadequate manpower in public health sector. Nevertheless, those who are positioned as public sector health care providers are over burdened. In the current scenario, this has been observed that assigning the extra duties other than their regular working hours for Teen Clinics at the AFCC is not fruitful due to lack of willingness of the health care providers. Hence, state propose to have the provisions for incentives for service providers working in the AFCCs to devote extra hours of work for AFHS. Despite all efforts at supply and demand side the geographical conditions and travelling time to the AFCC has restricted the state’s efforts to motivate and bring the adolescents to access AFHSs at the AFCC. Hence, in order to improve the access to AFHS and to incentivise the motivators to bring more and more adolescents to the AFCC, the state propose the incentive of Rs. 50/- per adolescent for the motivator who can be anyone like ANM/ASHA/ASHA Facilitator/Motivators etc. The proposed budget for service provider incentives is given in the following table:
Here we have decreased our proposed budget in accordance to the decreased scope of ARSH programme in remaining 9 district, but we would like to retain the incentives for all the service providers as in this difficult ,geographical areas of Uttarakhand, some cash compensation is required for any proposed deviation from their fixed travel routines. The motivator incentive is also meant for the travel expense of the motivator and the client. The sum of Rs.500 for the ICTC at the district AFCC functioning 6 days a week, has been proposed in accordance to your appraisal note-2012-13. These DH AFCC’s would be counsellor based on all week days and a medical officer would be available once a week.
n) IEC and BCC for UDAAN Program
IEC and BCC are the most important component of any health program designed to address any particular health related issues in the community. The IEC provides the information about the program, its activities and service delivery points while the BCC Campaigns are designed to bring the necessary changes in the treatment seeking behaviours of the target population. Hence, considering the same factors for UDAAN (ARSH) program, state proposes the following budget for identified IEC and BCC activities to impart treatment seeking behaviours and to create enabling environment for adolescent and their special needs among the other community members: