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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/.

The 2BY2 Matrix Helps ASHAs and ANMs Aligarh, India, Prioritize Family Planning Clients
The Challenge Initiative for Healthy Cities (TCIHC) has been improving the family planning knowledge and skills of urban Accredited Social Health Activists (ASHAs) since it began supporting local governments across three states in India in 2017. To further strengthen the health system and support urban ASHAs and Auxiliary Nurse Midwives (ANMs) - who supervise ASHAs - TCIHC introduced its "2BY2" matrix to help prioritize potential family planning clients as well as meet their other health needs more efficiently. In a recent interview, Dr. Lalit Kumar, the Joint Director of Health and Family Welfare in Aligarh, explained the impact the 2BY2 matrix is having. 

Urban ASHAs in Aligarh have been successfully coached through the Lead, Assist and Observe (LAO) [coaching] model of TCIHC. The program's MIS [management information system] data indicate that the LAO model is improving ASHA's knowledge of family planning, attitude towards counseling skills and require minimal support in terms of planning and monitoring. ... TCIHC team had, hence, decided to move to the next step with devising a tool, which helps 'prioritize.' TCIHC has helped us understand how significant it is to track eligible couples for family planning. This 2BY2 matrix has given us guidance on how to increase efficiency of ASHA, without investing additional resources and increase their reach not only for family planning but for other health areas, like routine immunization also."

The Aligarh Division government was so impressed after TCIHC introduced the 2BY2 matrix in November 2019 that it has now diffused it to non-TCIHC supported cities in the division.

The tool amazed us! It aggregated users and non-users of family planning by ASHA, which in turn, supports understanding of family planning uptake by ANM. Aggregation by age/use at the ANM level establishes service uptake for each of the urban primary health centre (UPHC). The tool signals UPHCs that are performing well in terms of family planning uptake and UPHCs that have a large population of the target audience with unmet need. We could draw out a priority list of ASHAs and ANMs who are performers and those who require mentoring and monitoring. We realized that such a customized tool that drives a 'culture of prioritization' has never been introduced before. Our AD (Additional Director) was impressed so much so that she wanted to replicate this in three non-TCIHC cities, namely Kasganj, Etah and Hathras of Aligarh division. She issued a circular to District Magistrate / Chief Medical Officers (CMOs) of those districts to implement this immediately. Following this, I worked in collaboration with TCIHC City Manager to rollout the 2BY2 matrix in the three selected non-TCIHC cities."

To date, 396 ASHAs and 85 ANMs have been oriented on the 2BY2 tool to help identify eligible family planning clients and/or areas or populations requiring more efforts for voluntary family planning adoption.

When on a visit to Pala Sahibabad UPHC, I observed a 2BY2 matrix in an ANM's hand and, at that time, she told me that, '2BY2 is an amazing tool. Now, I do not sift through various registers of ASHAs as this matrix provides clear information on which ASHA requires more support.'

The 2BY2 matrix has been introduced across all 31 TCIHC-support cities and has already shown great success in instituting a culture of prioritization and data for decision-making, using available data sources and health system structures, which helps ensure sustainability.

For reading this story on TCI University please https://tciurbanhealth.org/the-2by2-matrix-helps-ashas-and-anms-aligarh-india-prioritize-family-planning-clients/

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

TCIHC Coaching on Quality of Care Leads to the First UPHC in Uttar Pradesh Earning Coveted NQAS Award
The coaching support provided by The Challenge Initiative for Healthy Cities (TCIHC) to city governments in Uttar Pradesh (UP) emphasizes the importance of quality of care as a key pillar in providing voluntary, informed choice family planning services. 

As a result, city governments have built management and coordination mechanisms that enhance the quality and availability of family planning services. The TCIHC-supported city of Gorakhpur illustrates the local government's commitment to improved quality of care after receiving TCIHC coaching.

In March 2021, the Basantpur urban primary health center (UPHC) in Gorakhpur became the first UPHC in Uttar Pradesh to earn a National Quality Assurance Standards (NQAS) award. NQAS certification is the highest-ranking quality accreditation in India. Only a minuscule percentage of UPHCs have NQAS certification.

Dr. Pallavi Srivastava, Medical-Officer-In-Charge at the Basantpur UPHC, shared how TCIHC-supported high-impact interventions related to quality family planning service delivery has also led to an increase in the uptake

"Four years ago, our entire focus was on immunization. At that time, our staff was untrained on contraceptive methods; the UPHC did not have any IUCD insertion kit. In fact, the OPD [outpatient department] load was only 20-30 patients as compared to this day when the OPD load has increased by many folds - no less than 100 patients visit the UPHC every day."

Dr. Srivastava believes the coaching that she and the entire staff of the Basantpur UPHC received from TCIHC has made all the difference, especially in improving the quality of care that they provide - which contributed significantly to them earning the NQAS award.

She explained that family planning is a critical component of the NQAS checklist, which has more than 1,500 quality indicators, including family planning, maternal and child health (MCH), counseling and Family Planning Logistics Management Information System (FPLMIS) indenting, appropriate and timely health management information system (HMIS) updates, commodity availability and patient satisfaction response forms. Dr. Srivastava said: "Before engagement with TCIHC, we did not have any Quality Improvement (QI) committee, nor did any District Quality Assurance Committee (DQAC) visit ever happen. With TCIHC coaching, we coached our community health workers, like ANMs (auxiliary nurse midwives) and ASHAs (accredited social health activists), on identifying and prioritizing FP clients, online indenting, etc. TCIHC coached us on its Quality Assurance high-impact approach, and demonstrated the utility of the quality assessment checklist in identifying gaps and resolving them. We formed a Quality Improvement (QI) committee with their support and started regular QI meetings. We noticed how the quality assessment checklist made it easy for us to identify gaps. All of these efforts played a crucial role in helping us achieve the NQAS status."

Dr. Jaswant Kumar Mall, Divisional Consultant of Quality Assurance of Gorakhpur oversaw the NQAS preparations for the UPHC and he believes that other UPHCs could learn from Basantpur's experience and also earn NQAS certification. He shared that to achieve similar success other UPHCs should:

  • Continually refresh the skills of staff by having them attend refresher courses and new training
  • Strengthen the capacity of ASHAs
  • Regularly discuss issues related to family planning client mobilization in ASHA-ANM meetings
  • Regularly use the QI checklist to identify gaps and address them during QI committee meetings

He noted that information and guidance on all of these success factors are available in TCI University.


As a result of these efforts, TCIHC has contributed to a 94% increase in annual long-acting reversible contraception (LARC) client volume at the city level in Gorakhpur from 3,222 users at baseline to 6,239 users in June 2021 (Figure 1). This increase accounts for 61.5% at the UPHC level from 2,808 LARC users at the baseline to 4,534 users in June 2021.

Facilitating the local governments' ability to implement proven quality of care interventions can effectively activate the local health system to provide quality family planning services in a sustainable manner.

For reading this story on TCI University please visit: https://tciurbanhealth.org/pdfviewer/gorakhpur-tales-of-impact/#page=

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/.

Prioritizing Health Care Workers and Client Safety in Muzaffarnagar During COVID-19

Dr. Rajeev Niga left early one morning back in June 2020 for his job as Nodal Officer for Family Planning & Immunization in Muzaffarnagar city, Uttar Pradesh. On his way, he looked out at the deserted road from his car and thought about how COVID-19 had made life an emergency drill for medics and community health workers in his city, throughout India and around the world. These thoughts left him feeling overwhelmed but also renewed his focus and commitment to the health care staff in his city.

He shared his reflections from that morning recently with The Challenge Initiative for Healthy Cities (TCIHC):
"Although services had resumed at the urban primary health centers (UPHCs), the safety of the service providers, field-level workers and community is still a big challenge. The situation could be overwhelming to think about but then I remind myself that COVID-19 is a shared challenge. And, I'm proud that I can be of service to my community in this time of need."

When he reached the Sarwat UPHC in Muzaffarnagar city, he felt an immediate need to motivate his staff as he felt that they must be experiencing similar feelings. He later mentioned this concern to the TCIHC team, who coached him on the benefits of holding monthly review meetings with facility staff, including monthly meetings with Auxiliary Nurse Midwife (ANMs) and Accredited Social Health Activists (ASHAs). These monthly meetings are a TCIHC best practice that have been adopted by the Uttar Pradesh state government. Dr. Nigam immediately put this best practice into action: "We conducted UPHC level meetings with facility staff, ANMs and ASHAs. We told them that this is the time when the community needs us the most. We have to provide services to everyone by taking all safety measures as we do not know whether someone is infected or not. We reinforced the importance of using face masks during their service hours, avoiding touching one's face, washing hands frequently with soap and maintaining two meters distance at all times while dealing with clients in the UPHC."

During a recent ASHA-ANM meeting, he continued to reiterate and reinforce COVID-19 prevention strategies: "During household visits, [ASHAs should] inform people that their safety is our priority and that all safety measures are being implemented in the UPHCs towards ensuring safe health care services, including safe IUCD and Antara services."

Dr. Nigam concluded that meeting by distributing reusable masks, gloves and soap to ASHAs and ANMs provided by TCIHC. These regular ASHA-ANM meetings ensure that everyone is not only counseling the community on safety measures but also modeling the behavior that they wish to see. Dr. Nigam explained:

"All service providers wear face masks, gowns, gloves and cover their head while providing clinical family planning services - IUCD insertion and dispensing Antara injectable. In case of any doubts about a patient being infected or not (with COVID-19), the service provider conducts a rapid antigen test and provides clinical services while awaiting the results of the test, which come back within half an hour."

Dr. Nigam believes strongly that family planning services cannot be stopped during COVID-19 when they are needed the most. In fact, he has reminded his staff to inform clients who want permanent methods that they are still available in the district hospital, and can be performed after testing for COVID-19.

Dr. Nigam's commitment to his staff's safety and the safety of the community is commendable. He understands the value of holding regular meetings with staff at the UPHC to truly listen and hear their concerns and encourage them to remain steadfast in adhering to the safety measures. Due to the combined efforts of Dr. Nigam and his team, the four TCIHC-supported UPHCs of Muzaffarnagar continue to regularly provide family planning services, including clinical methods.

For reading this story on TCI University please visit: https://tciurbanhealth.org/urban-tales-prioritizing-health-care-workers-and-clients-safety-in-muzaffarnagar-up-during-covid-19/ 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/.

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/.

 
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