AGRA URBAN HEALTH PROGRAM (AUHP)

Goal and Objectives of Agra Urban Health program

The goal of the Agra Urban Health Program is to carry out demonstration and learning activities and develop new interventions in urban slums that lead to synergistic participation of different government officials in urban slums to improve water supply, sanitation and hygiene services to urban poor.

Executive Summary of Agra Urban Health Program

SNBS is implementing the Agra Urban Health Program activities to reach out to underserved urban poor population in Rakabganj North, Yamuna Par and Bundukatra area covering approximately 1,70,000 population. SNBS was selected as a partner NGO by a Screening Committee under the chairpersonship of the Chief Medical Officer, Agra for implementation of the Agra Urban Health Program. The program implementation activities were initiated in November 2005 with 14 slums (approximate population 29,000) and gradually scaled up to cover 20 slums (40,250 population) in Rakabganj North area,15 slums with 46,700 population in Bundukatra area and 44 slums with 79,000 population in Yamuna Par area.

SNBS has conducted Mapping and Assessment of Agra slums as key resource organization, jointly facilitated by Department of Health and Family Welfare, Agra and USAID-EHP during February-April 2004. During this process, SNBS has conducted qualitative health vulnerability assessment in slums of Agra and helped USAID-EHP and Department of Health and Family Welfare, Agra in plotting of slums and existing health facilities on the map of Agra and gap identification. This analysis, along with other relevant data has been utilized for development of Urban RCH proposal for Agra city and its implementation from time to time.

Subsequently, the Agra Urban Health Program (AUHP) has been implemented as response to request of Government of Uttar Pradesh, suggesting UHRC, formally known as EHP, to initiate PPP models in Agra. UHRC initiated public-private partnership (PPP) process in consultation with the Department of Medical, Health and Family Welfare, Agra.

Based on its experience in the area of reproductive and child health, the exceptional contribution rendered in proposal development phase and its credibility in the district, the Screening Committee constituted under the chairpersonship of Chief Medical Officer, DMHFW, Agra has recommended SNBS as potential NGO for implementation of Agra Urban Health Program and for partnership with UHRC operation.

Under this partnership, SNBS has been demonstrating community mobilization for demand generation of health services and community linkages with government health facility coupled with continued gentle persuasion with government health service providers in order to increase reach of services leading to overall improvements in health services delivery coverage since November, 2005. Through this approach, SNBS has been mobilizing approximately 40,250 population in 20 slums and facilitating outreach camps through linkage with Rakabganj North D-Type Health Centre.

Apart from this, since March 2006 SNBS has been facilitating a multi-stakeholder approach for optimizing local resources and improving reach of services to approximately 46700 underserved urban poor populations residing in 15 slums under Bundukatra D-Type Health Centre catchment area. Since February 2009, SNBS has been demonstrating two approaches at Yamuna Par. Under one, SNBS has set up and managing Urban Health Centre at Naraich, Yamuna Par for providing regular OPD and outreach services to approximately 55000 population residing in 35 slums in Trans Yamuna area. The other demonstrates community mobilization for demand generation of health services and community linkages with Govt. health facility and mobilizing approximately 27000 population in 9 slums and facilitating outreach camps through linkage with government D-Type Health Centre, Yamuna Par.

Key Activities:

SNBS has undertaken the following key activities:

  • Strengthen capacity of community link volunteers and Mahila Aarogya Samities to coordinate with health service providers for outreach camps, tracking immunization coverage at slum level to minimize leftouts and dropouts, and to promote health behaviours.
  • Strengthen capacity of the link volunteers and MAS members negotiate effectively with water and sanitation service providers for the related services in their respective slums whenever required.
  • Established linkages with LadyLyall and PSM/Community medicine department of SN Medical College.
  • Established linkages with Govt. Health department for regular outreach sessions (including visits of LMO for ANC checkups during these sessions).
  • Regular participation in health rallies and pulse polio campaign as and when requested by CMO and encourage visits of CMO/Dy.CMO and other relevant Govt officials in the city/region to program slums and program activities, seek feedback and support them in disseminating best practices in different government meetings at city and region level.
  • Facilitated regular meetings of UHC level coordination committee to improve access of urban poor to health services at Bundukatra and influence CMO/Dy.CMO to replicate such a multi-stakeholder approach for optimizing local resources and improving reach of services to underserved urban poor population in other UHCs areas.
  • Strengthen project staff capacity to collect, compile and analyze service coverage data and use it for improving coverage rates, document program learning and share at appropriate forums.
  • Established linkages with other department like DUDA, Nagar Nigam, ICDS and education for addressing other development issues in the intervention slums.
  • Provided inputs to National, International organizations for developing clear understanding on community mobilization.
  • Facilitated program site visits of Govt. officials and non government organizations to observe and understand the lives of urban poor and slum dwellers and their access to health services and learning different program approaches to reach underserved urban poor population and its replication in other areas.

Community mobilization

SNBS has promoted 24 Mahila Arogya Samities (MAS) and also opened 19 bank accounts in the Rakabganj area. The capacities (Institutional, Program, Linkage and Financial) of MAS have also been strengthened. Capacity building sessions including exposure visits were also conducted both for MAS and CLVs to develop their knowledge on the different components of RCH and health fund management. BCC and IEC activities are regularly carried out in the slums to improve health and hygienic practices among the slum community improved, and generate demand for services. In Bundukatra area CLVs were selected and trained for providing community mobilization support.

Linkages with Govt. D-Type Health Centre (Rakabganj North) for health service provision 

Demand generation activities were undertaken in all 35 slums. Services were strengthened in 20 slums from DTHC Rakabganj which is a government run first tier facility.  List of eligible beneficiaries updated regularly, planned outreach clinics were organized and follow-up activities carried out especially in case of left outs and resistant households. SNBS coordinated with CMO/ACMO and facilitated visit by these Govt. officials successfully. SNBS developed linkages with the other stakeholders and local elected persons by facilitating Coordination committee meeting. Services were also strengthened from the Bundukatra DTHC to the 15 slums in the area. This was all achieved with support and mobilization of the government.

Capacity building of the program staff

Capacity building sessions for MAS, CLVS, Community Organizers and ANMs were conducted to enhance their skills on counseling and RCH components. Ongoing review meetings at various levels were conducted to assess program progress, address program issues and concerns. Review feedback and inputs from SNBS management, other stakeholders visiting the program and UHRC helped strengthen the program.

Coordination with the government department

  • Coordination with district health department was given special focus from the program inception. Regular coordination meetings were carried out right from DTHC level to District level for organizing regular outreach sessions. District Health Department officials were invited to for providing capacity building inputs to staff and assess community mobilization activities. The support to National Programs continued.
  • Meetings of Coordination committee at Bundukatra were held with multiple stakeholders such as the ward representative, CHV, Deputy CMO, AWW etc. Regular outreach clinics were held in 15 Slums in the area. The SNBS staff also supported in routine immunization in Bundukatra. For improving service coverage in catchments area regular meetings with coordination committee were organized.
  1. Coverage Area of SNBS under AUHP:

SNBS is implementing the Agra Urban Health Program to fulfill the aforementioned objectives, in 20 slum neighborhoods (or bastis) in Rakabganj North area under Approach II, covering an approximate slum population of 40,250, 44 slums in Yamuna Par under Approach I & II covering 79,186 population and 15 slums in Bundukatra under Approach III covering 46,695 population.

At Yamuna Par, SNBS is demonstrating two approaches under the Agra Urban Health Program (AUHP), since February 2009. One of them demonstrates how community mobilization for demand generation of health services and community linkages with Govt. health facility coupled with continued gentle persuasion with Govt. health service providers in order to increase reach of services and lead to overall improvements in health coverage. Through, this approach SNBS is mobilizing approximately 27000 population in 9 slums and facilitating outreach camps through linkage with D-Type Health Centre. Under the other approach, SNBS has set up and managing Urban Health Centre at Naraich, Yamuna Par for providing regular OPD services to approximately 55000 population residing in 35 slums in Trans Yamuna area in order to increase reach of services and lead to overall improvements in health coverage.

Major achievements up till date:

Achievements of SNBS in Health Service Delivery:

S. No. Health Services Achievements
1 Out Reach Camps 242
2 Pregnant immunized 3437
3 Infants immunized 23435
4 ANC Check ups 2541
5 Referral for institutional delivery 1569

Achievements of SNBS in Capacity Building of Community, Beneficiaries and Staff through interpersonal communication:

S. No. Events Achievements
1 Home visits 137583
2 MAS Meetings 4480
3 Trainings of CLVs 96
4 Trainings of MAS 84
5 Capacity Building of Staff 88
6 Community Meetings 3848
7 Thematic Group Counsellings 1728
8 Special Attention Home visits 1260

Behaviour Change Communication Activities:

S. No. Events Achievements
1 Health Awareness Camps 142
2 Magic Shows 26
3 Puppet Shows 72
4 Healthy Baby & Mother Shows 36
5 Health Rallies 24
6 Film Shows 18
7 Street Plays 12

 

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