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TCIHC Coaching Empowers Mau to Scale-up Family Planning High Impact Interventions
The Challenge Initiative for Healthy Cities (TCIHC) works with city governments in Uttar Pradesh, India, to implement and  sustain reproductive health solutions through its innovative coaching model. Recently, five additional cities, including Mau, joined the partnership to receive TCIHC coaching support. 

The TCIHC coaching model is structured to support all levels of the hierarchical government health system. This includes support at the city officials' level and urban primary health center (UPHC) level, including Auxiliary Nurse Midwives (ANMs) and Accredited Social Health Activists (ASHAs). as in other TCIHC-supported cities, TCIHC followed its coaching model in Mau to provide conceptual and practical 'know-how' and transfer capacity to local government stakeholders so they can implement high-impact interventions. Mau began implementing in January 2021.

Two government functionaries from Mau recently shared changes they have witnessed as a result of TCIHC's coaching. Dr. P. K. Rai, Additional Chief Medical Officer/Family Planning Nodal officer shared:

Before we joined hands with TCIHC, we were not regular in validating mapping and listing of slums areas. As a result, we were unaware of the health needs of the left-out population. Though urban ASHAs were onboard, they were untrained in family planning. It was mostly the oral contraceptive pills or tubectomy that we offered as a choice to the women. With TCIHC coaching, we have learnt to identify such gaps across the service delivery points, demand generation, reporting, etc.

We learnt that to activate UPHCs for provisioning long-acting clinical methods, service providers need to be trained on new contraceptives and reoriented on IUCD. We took this requirement to the CMO [Chief Medical Officer] who supported us to formulate a training plan. We also conducted a joint visit with TCIHC coaches to the UPHC to oversee the facility, assess FP stock and review progress. We have started taking measures on all fronts. We just printed urban health index register (UHIR) for distribution to ASHAs. All of these steps are expanding access to quality family planning services and yielding good results. However, more work is required to reduce gaps. TCIHC has pioneered a new way of thinking and working in us; I am confident our partnership with TCIHC will help the urban poor to meet their family planning needs."

Dr. Jawed Akhtar, Medical-Officer-In-Charge (MOIC) of the Bharhu ka Pura UPHC, echoed similar sentiments: "TCIHC offers a unique coaching approach. TCIHC has coached us on identifying gaps and opportunities for improving family planning services. For example, we could not start Antral diwas (Fixed Day Static service) at our UPHC as our staff nurse and ANMs were untrained. We had a dysfunctional autoclave [used for sterilizing medical instruments and supplies]. We identified such gaps by using the facility readiness checklist of TCIHC. We learnt that there are line items in the PIP [the government of India's planning and budgeting process] which we could utilize to equip the facility. TCIHC also coached us on HMIS reporting and data validation practices. Today, as a focal person for the UPHC, I ensure that quality family planning services are provided to clients by following all the protocols set by the government of India. I am glad that we have TCIHC's support to efficiently and effectively drive the urban family planning program in Mau."

TCIHC's coaching support has also positively impacted Shimla Yadav, an ANM at the Bharhu ka Pura UPHC, who shared: "[The] TCIHC team coached me on how to strengthen the capacities of ASHAs, how properly fill the UHIR register and utilize it for decision making. I am transferring these skills to my ASHAs. It is only after the TCIHC intervention that ASHAs of our UPHC have received UHIR."

The HMIS data below indicates that TCIHC's coaching activities are beginning to show results as Mau is on a progressive path. All four UPHCs in Mau are observing a substantial growth in family planning services uptake as apparent from January to June 2021 data in comparison to the same period the previous year. UPHCs of Mau are lined up for district quality assurance committee (DQAC) visits and certification, which will enable its UPHCs to add IUCD services to the basket of choice of family planning methods.


The city of Mau has embraced TCIHC's high-impact interventions and started to fill critical gaps in demand generation activities and quality of family planning services. Furthermore, the city is preparing to take steps to improve the use of data for decision-making, combat family planning supply stock-outs, procure the needed equipment for family planning service delivery, strengthen data quality mechanisms, and initiate a visit of DQAC to its UPHCs for assessing quality standards - all while having to address several other competing health priorities, including COVID-19 care and treatment needs.

For reading this story on TCI University please https://tciurbanhealth.org/tcihc-coaching-empowers-mau-to-scale-up-family-planning-high-impact-interventions/

PSI-TCIHC works with city governments to advance the cause of family planning. To know more about our work, visit https://tciurbanhealth.org/india-toolkit/ and https://tciurbanhealth.org/topics/india/.

Ujjain Dispensary Lady Health Visitor Becomes Preferred Family Planning Counselor
A long queue stood outside the counseling room at the Chhatrichowk civil dispensary in Ujjain, Madhya Pradesh. But Maya Yogi, a lady health visitor (LHV) stationed there, was in no hurry. She knows how important it is to allow each client the time they need for often culturally sensitive discussions about family planning. She believes that establishing good rapport with clients and allowing sufficient time for an in-depth conversation helps reduce anxiety and eliminate their fears. 

When The Challenge Initiative for Healthy Cities (TCIHC) helped the dispensary initiate a fixed day static/family planning day (FDS) approach, the team found that Maya was well-suited to be trained on IUCDs and Antara. Once re-oriented, she was given the basket of choice job aid and also trained on effective counseling skills. Maya was already a good counsellor and these new opportunities developed her interest further in family planning.

Maya often tells her clients they have nothing to worry about and gives them her phone number to call her anytime if they are confused or need help. She believes it is important for a service provider to gain the trust of a woman.

"After all, her body will undergo changes initially. So, there is a lot of fear of the unknown, even when a woman comes on her own to adopt a family planning method. During a counseling session, I not only describe how a method works but also detail out possible side effects that can occur in the beginning as the body adjusts to a contraceptive. I prefer to use educational materials and job aids to ensure that the client has all of the information needed to make an informed decision. No two clients are the same. I first gauge the knowledge level of the person and then address their queries and concerns regarding family planning methods. This builds trust between my clients and me. I make it a point to clear misconceptions pertaining to contraceptive methods by giving easy to understand examples. Once the clients have accurate information about the methods, they agree and accept the method they want to use."

The compassion and empathy with which Maya counsels women has not only earned her respect but has made her a preferred family planning service provider. As a result, she was recognized and celebrated by the Ujjain city government for her contributions to the city's family planning program. In just one year, she has helped 523 women adopt a contraceptive method of their choice.

For reading this story on TCI University please visit https://tciurbanhealth.org/tcihc-urban-tales-ujjain-dispensary-lady-health-visitor-becomes-preferred-family-planning-counselor/.You can read all previous stories also at https://tciurbanhealth.org/topics/india-urban-tale/.

PSI-TCIHC works with city governments to advance the cause of family planning. To know more about our work, visit https://tciurbanhealth.org/india-toolkit/ and https://tciurbanhealth.org/topics/india/.

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

For reading this story on TCI University please https://tciurbanhealth.org/soon-to-be-graduated-city-of-kanpur-shares-implementation-learnings-with-two-new-uttar-pradesh-cities/

PSI-TCIHC works with city governments to advance the cause of family planning. To know more about our work, visit https://tciurbanhealth.org/india-toolkit/ and https://tciurbanhealth.org/topics/india/.

In Their Own Words: NUHM Deputy CMO in Mathura Likes Innovations Found in TCI University
Dr. Pravin Kumar Bharti is the Deputy Chief Medical Officer and Nodal Urban Health with the National Urban Health Mission (NUHM) in Mathura (Uttar Pradesh, India). He has six years of experience across a wide spectrum of urban health issues. He recently sat down with The Challenge Initiative for Healthy Cities (TCIHC) to share his experience with TCIHC and TCI University (TCI-U). TCI-U includes an India toolkit, which has codified high-impact approaches (HIAs). These approaches are being scaled up through TCIHC in three states: Uttar Pradesh, Madhya Pradesh and Odisha. The India toolkit features 15 HIAs, which strengthen service delivery and supply, demand generation and advocacy components of family planning and adolescent and youth sexual and reproductive health (AYSRH) interventions. The toolkit provides standardized and contextualized information, resources and 'how-to-do' guidance, which can be easily customized to meet the city requirements for rapidly scaling up evidence-based family planning and AYSRH interventions. In 2019, the government of Uttar Pradesh, Madhya Pradesh and Odisha endorsed and approved the high impact approaches and tools of TCIHC, expanding the reach and ultimately impact of them. 

When did you first learn about TCIHC and TCI-U?

In February 2019, TCIHC had organized a State Conclave where the state of Uttar Pradesh endorsed nine HIAs [high-impact approaches] of TCIHC. This is where I first learned about TCI-U. At that time, I was holding the position of District In-Charge, Control Room, Mathura. As a result of my interest in family planning and urban health, I was nominated by CMO [Chief Medical Officer], Mathura, to participate in the State Conclave. As soon as I returned [from the State Conclave], I registered myself and my colleagues on TCI-U with the support of TCIHC City Manager."

What motivated you to first use TCI-U?

I developed a keen interest in TCI-U when during a meeting in March 2019 with the Chief Medical Officer, he required some job-aids related to Accredited Social Health Activists (ASHA) and he asked TCIHC City Manager for support. TCIHC City Manager quickly browsed TCI-U and downloaded the required information from the resource section linked to the HIA [high impact approach] on Urban ASHAs. I was impressed. And, from that day onwards, I have kept hard copies of the HIAs on my desk and access them on TCI-U as well."

How have you used TCI-U?

The high impact tools have helped my department understand fixed day static/family planning day (FDS) approach, role of Mahila Arogya Samiti in demand generation for family planning, importance of convergence between various departments for improving family planning indicators, use of family planning data, funds allocated under Program Implementation Plan (PIP), etc. Moreover, I have downloaded government approved materials like - 'All method poster' from TCI-U; this poster is now displayed in all Urban Primary Health Centers of Mathura. Even this poster is used on FDS days and routine service days as well in Outreach Camps to counsel clients on family planning methods. I have also downloaded the 'Pregnancy screening checklist,' which was given to staff nurses and community health workers to identify potential clients. TCI-U has helped me improve family planning practices across cadres, including NUHM [National Urban Health Mission] staff to field-level workers. I also navigate TCI-U to learn other countries' innovations and ideas also."

What are your overall impressions of TCI-U?

Urban family planning requires a lot of innovations and TCI-U is one such platform that provides innovative proven approaches. I like everything about TCI-U because it helps to understand our roles better, provides ways to get quick results and offers solutions to overcome potential challenges. That it is my job to improve family planning indicators and take decisions. TCI-U helps me do that. I have taken a couple of assessments related to the HIAs and earned certificates, which I find to be the most exciting part. TCI-U is a well-structured website, which provides comprehensive information and resource materials."

Like Dr. Bharti, around 35 government officials are registered on TCI-U from Mathura and most of them have completed the assessments for the high-impact approaches and received certificates.

For reading this story on TCI University please https://tciurbanhealth.org/in-their-own-words-nuhm-deputy-cmo-in-mathura-likes-innovations-found-in-tci-university/

PSI-TCIHC works with city governments to advance the cause of family planning. To know more about our work, visit https://tciurbanhealth.org/india-toolkit/ and https://tciurbanhealth.org/topics/india/.

ASHA Helps Woman Move Beyond Just Surviving to Live Life to the Fullest
Accredited Social Health Activists (ASHAs) are empowering women like Rani Burman living in Madhya Pradesh, India, to seek a better tomorrow. The Challenge Initiative for Healthy Cities (TCIHC) supports local governments in Indian states like Madhya Pradesh to strengthen the capacity of urban ASHAs to provide quality family planning counseling and referrals to meet the needs of women like Rani. 

"I was flying on my new scooty; my dreams were turning into reality. Life was a Bliss! All thanks to Pooja Didi. Yet I clearly remember the day when Pooja Didi first visited me. I was eating only rice. She had asked, 'Why are you eating only rice? You have small children; you must eat a healthy and balanced diet.' My eyes had welled up and she sat there quietly. Once I felt better, I shared that ever since the birth of my second daughter financial hardships increased for us. My husband and in-laws wanted a male child so my husband did not spare money for us; instead, he spends most of his earnings on alcohol. Today I at least had rice to eat. Pooja Didi comforted me and left with a promise to return."

From that day, she would visit me often, sometimes to give iron-folic tablets or to immunize my children or to just inquire about my health. One day, she cited her example and encouraged me to work and earn for the family. I told her that I had completed my secondary education but my husband does not like the idea of my working outside of the house. Didi jolted me to think of making a change in the drudgery of my life. One afternoon, when Didi came, my husband was home. She checked about children's health and started a conversation around the importance of family planning and also prodded upon the idea of my working outside of the house. She reasoned without fear that these two decisions will only make life better for us. My husband was moved. A few days later, I asked my husband if I could look for a job. To my surprise, he gave his nod. I soon found one and gradually found a better one as a receptionist at a hospital. Pooja Didi was elated!"

Financial independence boosted my confidence. I started expressing myself. I told my husband that I know that the family desires to have a male heir but given that we already have two daughters and our income is also not sufficient to support this current family of six members including his parents. Thus, we must do something about family planning as we cannot bear the cost of upbringing one more child. My husband approved and asked me to inquire all about family planning from ASHA Didi. Next time, when Pooja Didi visited us, she explained all the family planning choices and clarified our doubts. We decided to adopt a permanent family planning method as we wanted to be free."

These two decisions have changed my life. Not only am I free from the constant pressure of producing a male child but I have become independent too and also gained respect from my family and society. I am determined that my daughter will do advanced studies and become a doctor or a police officer. I have learnt not to fear life but to live life."

To learn more about the impact of urban ASHAs and how to adopt or adapt this high-impact approach, check out Enabling Urban Accredited Social Health Activists.

For reading this story on TCI University please visit https://tciurbanhealth.org/tcihc-urban-tale-asha-helps-woman-move-beyond-just-surviving-to-live-life-to-the-fullest/You can read all previous stories also athttps://tciurbanhealth.org/topics/india-urban-tale/.

PSI-TCIHC works with city governments to advance the cause of family planning. To know more about our work, visit https://tciurbanhealth.org/india-toolkit/ and https://tciurbanhealth.org/topics/india/.

 
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