Increasing the Availability of Skilled Birth Attendance in Rural India

Key considerations in the availability of skilled birth attendance will be a critical component in national efforts towards ensuring universal health coverage in India. This paper aims to examine opportunities for strengthening skilled birth attendance at the primary level by (a) exploring relevant models of rural primary and community-level skilled attendance, both India and internationally, that have achieved positive health outcomes; (b) assessing the current skilled birth attendance coverage in India and means to achieving greater coverage of skilled attendance and enhanced linkages in the continuum of care; and (c) recommending opportunities and required investment for scaling-up skilled attendance within NRHM. Our primary research highlights immediate requirements for more targeted systems strengthening, particularly for sub-centres that can provide intranatal care, and for PHCs depending on their delivery caseload and accessibility to other referral facilities. This requires significantly more strategic planning at the district level, and creating or reinforcing full-time support structures that can focus on quality assurance of care, including training and skills development, facility quality management, and linkages between care provider

Model Districts as a Roadmap for Public Health Scale-Up in India: Strategic planning experience from Assam

Providing at-scale, high-quality public health services in rural India is one of the country’s greatest challenges. In 2005 the Ministry of Health and Family Welfare (MOHFW), Government of India, launched its flagship programme the National Rural Health Mission (NRHM) to improve rural access to quality primary health care. At the request of the MOHFW, the Earth Institute, Columbia University, has been convening an International Advisory Panel (IAP)1 that meets biannually to review NRHM progress, and the panel conducted a mid-term evaluation of the NRHM in 2009. The evaluation demonstrated that coverage of high-priority interventions remains inadequate, the quality of programming is insufficient, efficient management and governance is lagging, and deeprooted inequities further complicate delivery and uptake (Paul et al. 2011, Bajpai et al. 2009). The MOHFW and the IAP determined that efforts required to strengthen health systems towards meeting health Millennium Development Goals before 2015 would best be piloted and scaled-up as regional models, given India’s size and the wide variances in health system performance, disease burden, and socio-cultural, political, and economic contexts

Model Districts as a Roadmap for Public Health Scale-up in India

While India has experienced some improvements in health indicators in recent years in terms of Millennium Development Goals 1, 4, and 5, the country still has some of the lowest indicators for reproductive and child health in the world. Public investment in primary health care must increase to achieve health targets, and the health system needs to be reformed to ensure efficient and effective delivery of high quality health services. While the Government of India's National Rural Health Mission (NRHM), launched in 2005, has made great strides in improving access to quality primary healthcare in rural areas, significant gaps remain. The Model Districts project is a joint initiative between the Earth Institute, Columbia University, and the Ministry of Health and Family Welfare, Government of India. Its goal is to demonstrate which health and nutrition interventions are required to narrow policy practice gaps in the NRHM in five regionally representative districts across India. The project's strategy is to target interventions and additional public health spending at the intersection of the six building blocks of health systems strengthening (infrastructure, data management, governance, financing, supply chain management, and frontline health worker capacity) and five areas along the continuum of care for mothers and children (antenatal care, safe delivery, immediate postnatal care, early childhood development and nutrition, and routine and sick child care). The Model Districts scale‐up model is supported by a robust baseline and monitoring and evaluation plan, pilot interventions at the block level, growth and expansion to the district level based on learning exchanges within and across districts, and finally national level scale‐up through policy adaptation and replication. This working paper signifies the beginning of the Model Districts project's contribution to research on the health system strengthening requirements for rural India, and is intended for use in policy making and health programming

Institutionalizing Provider-Initiated HIV Testing and Counselling for Children: An Observational Case Study from Zambia

Background: Provider-initiated testing and counselling (PITC) is a priority strategy for increasing access for HIV-exposed children to prevention measures, and infected children to treatment and care interventions. This article examines efforts to scale-up paediatric PITC at a second-level hospital located in Zambia’s Southern Province, and serving a catchment area of 1.2 million people. Methods and Principal Findings: Our retrospective case study examined best practices and enabling factors for rapid institutionalization of PITC in Livingstone General Hospital. Methods included clinical observations, key informant interviews with programme management, and a desk review of hospital management information systems (HMIS) uptake data following the introduction of PITC. After PITC roll-out, the hospital experienced considerably higher testing uptake. In a 36-month period following PITC institutionalization, of total inpatient children eligible for PITC (n = 5074), 98.5 % of children were counselled, and 98.2 % were tested. Of children tested (n = 4983), 15.5 % were determined HIVinfected; 77.6 % of these results were determined by DNA polymerase chain reaction (PCR) testing in children under the age of 18 months. Of children identified as HIV-infected in the hospital’s inpatient and outpatient departments (n = 1342), 99.3 % were enrolled in HIV care, including initiation on co-trimoxazole prophylaxis. A number of good operational practices and enabling factors in the Livingstone General Hospital experience can inform rapid PIT

Know your heritage, Obbasa Ain Gallit: We Continue

Three members of Extending the Link (ETL), an on campus student documentary team, will focus on the value of knowing your own heritage and using it as inspiration for respecting others. The motivation for this Thursday Forum comes from ETL\u27s eighth film, Obbasa Ain Gállit: We Continue, which shows the path of modern indigenous communities, through the lens of the Sámi. Obbasa Ain Gállit: The last recognized indigenous group in Europe, the Sámi reside in Sápmi (Norway, Finland, Sweden, and Russia). Additionally, there is a large Sámi-American population in the United States, specifically in Minnesota, near Minneapolis, St. Paul, and Duluth. In the fall of 2014, the twelve-member team filmed throughout Minnesota. In December, five members of the Extending the Link team traveled to Norway and Sweden to meet with members of the Sámi community, including Sámi Parliament members, teachers, authors, and artists. The Sámi have fought to preserve their heritage, language and culture despite heavy pressures from national governments and colonization to assimilate to modern society. The Sámi have combated traditional stereotypes, environmental destruction, and language loss. Through perseverance and pride in their people, they have successfully brought their Sámi culture and values into the 21st century.The Sámi story illustrates the importance of knowing one\u27s own heritage, including the history of the land one calls home. The Sámi show how indigenous narratives have survived through every wrinkle in earth\u27s time, and will continue on through the modern pursuit of preserving land and cultural traditions

Scaling up paediatric HIV care with an integrated, family-centred approach: an observational case study from Uganda.

Family-centred HIV care models have emerged as an approach to better target children and their caregivers for HIV testing and care, and further provide integrated health services for the family unit's range of care needs. While there is significant international interest in family-centred approaches, there is a dearth of research on operational experiences in implementation and scale-up. Our retrospective case study examined best practices and enabling factors during scale-up of family-centred care in ten health facilities and ten community clinics supported by a non-governmental organization, Mildmay, in Central Uganda. Methods included key informant interviews with programme management and families, and a desk review of hospital management information systems (HMIS) uptake data. In the 84 months following the scale-up of the family-centred approach in HIV care, Mildmay experienced a 50-fold increase of family units registered in HIV care, a 40-fold increase of children enrolled in HIV care, and nearly universal coverage of paediatric cotrimoxazole prophylaxis. The Mildmay experience emphasizes the importance of streamlining care to maximize paediatric capture. This includes integrated service provision, incentivizing care-seeking as a family, creating child-friendly service environments, and minimizing missed paediatric testing opportunities by institutionalizing early infant diagnosis and provider-initiated testing and counselling. Task-shifting towards nurse-led clinics with community outreach support enabled rapid scale-up, as did an active management structure that allowed for real-time review and corrective action. The Mildmay experience suggests that family-centred approaches are operationally feasible, produce strong coverage outcomes, and can be well-managed during rapid scale-up

Obbasa Ain Gàllit: We Continue

In May of 2014, the ETL team determined that the project they were to focus on for the following academic year would be indigenous issues. In researching indigenous populations, it was decided that the story should capture issues of the Sàmi people. As the only recognized indigenous community of Europe, the film explores the modern history of the Sámi people as they create their own pathway in the modern world. In a story about both resistance and survival, the documentary shed light on dying cultures and the necessity of tradition and the interconnectedness of all people. The subtle approach to the issues of indigeniety, cultural diversity, and heritage loss provided a stark contrast to the previous films efforts at presenting an issue of social justice

Ger Kler: A Journey of Untold Strength

ETL\u27s seventh documentary highlights refugee issues, both in the United States and abroad. The team focused specifically on the Karen population, a group of people who live on the border of Burma and Thailand as a result of a drawn out civil war and genocide. ETL chose this topic because of the misunderstanding surrounding refugees and chose this population because of the large Karen refugee population that lives in the Twin Cities