JHPIEGO

USAID-NISHTHA/Jhpiego Transforming Comprehensive Healthcare in India

USAID-NISHTHA/Jhpiego support to Manipur

A. Introduction

Strong primary health care is characterized by three interrelated and interdependent functions: comprehensive care that includes promotive, protective, preventive, curative, rehabilitative, and palliative elements for individuals and families throughout the life course; addressing broader determinants of health (social, cultural, economic, and environmental factors) through multisectoral participation; and empowering individuals, families, and communities to optimize their health and well-being. Significant evidence supports that robust primary health care systems lead to improved population health outcomes, health system efficiency, health equity, and inclusive economic growth. A robust primary healthcare system is widely considered a cornerstone for achieving universal health coverage and other health-related Sustainable Development Goal (SDG) targets.

The USAID health system strengthening project NISHTHA, implemented by Jhpiego, aims to transform, redesign, and re-engineer primary healthcare to provide equitable, comprehensive, and client-centered services. Its goal is to contribute to improved health outcomes for marginalized and vulnerable populations, particularly women and girls. NISHTHA endeavors to create a strong, responsive, accessible, sustainable, and affordable primary healthcare system. This system ensures the effective delivery of reproductive, maternal, newborn, and child health services, promotes healthy hygiene behaviors, and integrates the provision of quality services for TB control.

In a world threatened by new and re-emerging infectious diseases, a robust primary healthcare system acts as the first line of defense against public health threats, disease outbreaks, and other events affecting the health system. With the arrival of the COVID-19 pandemic, NISHTHA engaged with relevant stakeholders at the state level to extend support for strengthening disease surveillance. This effort aligns with USAID’s global health security program, leveraging the primary healthcare system to bolster disease surveillance.

Climate change has profound health impacts, including heat-related illnesses, vector-borne diseases, respiratory issues, waterborne diseases, mental health challenges, malnutrition, injuries from extreme weather events, and vulnerabilities in specific populations. The importance of resilient primary healthcare systems in the context of climate change cannot be overstated. These systems serve as the first line of defense in safeguarding public health against the growing health risks posed by climate change. Considering the impact of climate change on human health, NISHTHA has initiated support to make the primary healthcare system the first responder to public health exigencies arising from climate-related challenges.

B.Technical Approach

C. Our Strategic Approach

D. Programs supported by Jhpiego/Nishtha

1. Operationalization of Health & Wellness Centres (HWCs) for delivery of CPHC services including AYUSH HWCs

2.  Integrating TB services at HWCs

3. Strengthening Public Health Surveillance – IHIP, Covid.

4. RMNCH+A services in HWCs.

5.  National Program for Climate Change and Human Health.

6. Quality Assurance in HWCs.

E. Overview on support provided in in operationalising HWCs.

NISHTHA has been the key implementing partner for the State of Manipur in operationalizing HWCs since 2018. We have provided comprehensive technical support covering almost every aspect of establishing well-functioning HWCs. This support began with enhancing the state government's capacity to address gaps in establishing a robust primary health care system, followed by providing prototypes for infrastructural upgrades and internal branding. We also focused on building the skills of health workers, supporting the rollout of actual service delivery (including an expanded package), developing monitoring and mentoring mechanisms, conducting periodic reviews, ensuring the recruitment of CHOs from Integrated Nursing Colleges, forming Jan Arogya Samiti and ensuring its functionality, and launching the Ayushman Bhavah campaign, among other initiatives.

 Key Achievements and Results

 1. Beneficiaries accessed diagnostic services at AB-HWCs   -  ( 6,50,564 )

 2. Beneficiaries accessed essential drugs at AB-HWCs  -   (4,00,605)

 3. Tele-consultations conducted  -  (63, 883)

 4. Footfalls in AB-HWCs  -  (13,42,777)      

 5. Diabetes Screening  -  (4,96,172)

 6. People attended Wellness Sessions  -  (2,73,225)

 7. Females screened for Breast Cancer - (1,73,694)

 8. Hypertension Screening  -  (5,83,346)

 9. Females screened for Cervical Cancer (33,046)                                                                                        

 10. Persons screened for Oral Cancer   -  (3,46,525)

F. Overview of support in implementing RMNCH+A Services in HWCs

Keeping HWCs as the central point, we focused on integrating the comprehensive package of healthcare services with emphasis on integrating RMNCHA services. The team has directed its efforts towards strengthening Maternal and Child Health and Family Planning services delivered through HWCs. This mechanism employed a comprehensive approach that encompassed various components, including advocacy, technical assistance, capacity building and strengthening health system ecosystem for providing comprehensive RMNCHA services under the ambit of primary health care. A key focal point of these efforts has been the empowerment of Community Health Officers (CHOs) through comprehensive capacity-building programs that encompass a wide range of healthcare domains. These programs have covered aspects such as antenatal care, management of high-risk pregnancies, childcare for management of diarrhoea and pneumonia and family planning. The training activities have been designed to augment the competencies and knowledge of the HWC team, ultimately enhancing access to quality care, ensuring drugs and diagnostic services, and contributing to improved health outcomes for both women and children. NISHTHA also involved in training healthcare providers on modern contraceptive methods and streamlining commodity management. The establishment of Family Planning (FP) corners and contraceptive boxes, and the promotion of indenting the FP commodities through the FP-LMIS (Family Planning Logistic Management and Information System) were crucial steps in enhancing accessibility and service quality.

Status of Capacity Building Activities conducted in Manipur are as follows:

Key Achievements under RMNCH program

	Supported Training on Maternal Health and Family planning for CHOs & ANMs from all 16 districts. Safe life kit box has been installed in HWCs.
	Identified 50 HWC-SC for Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) program to provide specialist service for pregnant women during ANC checkup.
	100 SC-HWCs are identified for SUMAN (Surakshit Matritva Aashwasan)
	Collaborate with MACS in capacity building of CHOs on HIV testing and reporting.
	Supportive Supervision and mentoring visit to HWCs

E. Overview of Support on implementation of Quality Assurance Program in HWCs

With the operationalization of AB-HWCs, there is a renewed focus on implementing quality assurance initiatives, including Surakshit Matritva Aashwasan (SUMAN), National Quality Assurance Standards (NQAS), and Kayakalp at HWCs. The project has provided comprehensive technical assistance to states, primarily emphasizing NQAS certification to meet the mandates set by MoHFW, GoI. This was achieved through contextualizing national guidelines, assisting in developing standardized tools/protocols/job aids for certification, and supporting the capacity building of service providers and program managers.

Key Achievements in Quality Assurance

• 25 CHOs have been trained on National Quality Assurance Standards
• Supported HWC Awang Wabagai in Imphal West District for National certification for NQAS.
• Introduced Kayakalp initiative for AYUSH-HWCs
• Support initiated for NABH certification of AYUSH-HWCs

H. Overview of support on implementation of Integrated Health Information Platform (IHIP)

NISHTHA has been the primary implementing partner in supporting the complete migration from paper-based IDSP weekly reporting to near real-time online IHIP daily reporting in January 2022. A total of 746 reporting units are mapped in IHIP, which includes 473 reporting units for Syndromic form, 145 reporting units for Presumptive form, and 128 reporting units for the laboratory form.

 Key achievements under IHIP

• Surveillance in Medical Colleges and Private Hospitals: Supported the State in mapping three medical colleges and 21 private facilities in IHIP to initiate disease reporting.
• Field Epidemiology Training Program (FETP) Training: Successfully advocated for conducting FETP training between October 2022 and January 2023. District Surveillance Officers and District Epidemiologists from all 16 districts underwent training in Outbreak Investigation, marking the first instance of FETP training conducted at the state level.
• Outbreak Investigation: Identified and managed 47 outbreaks in IHIP between January 2022 and November 15, 2023, with 45 of them concluded.
• Integration of IHIP with HWC: Trained 323 Community Health Officers (CHOs) and 230 Auxiliary Nurse Midwives (ANMs), integral members of the Health and Wellness Center (HWC) team, in IHIP reporting protocols. ANMs are mandated by the Government of India (GOI) to report in IHIP at HWC-SC, and CHOs were also equipped to assist in reporting.
• Standard Operating Procedure (SOP): Developed an SOP and video guide for completing Syndromic forms, enabling CHOs and ANMs to report effectively in IHIP.
• IHIP Review: Provided support for conducting four online and four onsite reviews across all districts to enhance disease reporting in IHIP.
• Village Mapping in IHIP: Improved mapping of villages from 50% in July 2021 to 99.80% by July 2022. Complete village mapping enables reporting units to upload cases into IHIP efficiently.
• Urban Surveillance: Facilitated the PwC team in conducting a landscape study on urban surveillance, collaborating with public and private hospitals and laboratories to assess disease surveillance status in Manipur's urban areas.
• Whole Genome Sequencing (WGS) Surveillance: Implemented WGS surveillance to identify Covid variants. As of November 15, 2023, 4493 Covid samples underwent variant testing, and the details were uploaded to IHIP. Completion of 92% of metadata in IHIP allowed reporting the outcomes of Covid cases - whether recovered or expired.
• Supported Data Analytics Training: Assisted the State in conducting Training of Trainers (TOT), Basic, and Advanced Modules on Data Analytics for members of State and District Surveillance Units.
• Baseline Assessment of Public Health Laboratories: Collaborated on conducting baseline assessments for five District Integrated Public Health Laboratories (DIPHLs) and 30 Block Public Health Units (BPHUs) under PM-ABHIM, aimed at enhancing Public Health Surveillance and managing outbreaks at early stages.
• Concept Development: NISHTHA supported in developing the concept layout for four DIPHLs, one Critical Care Block, and BPHU.

 I. Support provided during Covid 19 Pandemic

• COVID-19 Dashboard: A data analytics dashboard designed for evidence-based decision-making, linking existing data platforms. It incorporates predictive modeling to enhance capacities for an improved COVID response.
• iLEARN: A self-learning mobile-based platform for Community Health Officers (CHOs), with 201 CHOs onboarded.
• TELETRACK: A platform dedicated to monitoring home-isolated COVID cases, providing consultations with doctors and counselors. 65 cases are currently enrolled, with 32 undergoing mental health counseling, 24 received medical consultations, and 30 undergone nutrition counseling.
• Project SWARAKSHA: A digital runner-model designed to enhance vaccination coverage and confidence, supporting over 11,600 vaccinations across all districts.
• Risk Communication Materials: Development and printing of posters, banners, and handouts related to COVID-19.
• Capacity Building: Training conducted for 239 CHOs on COVID management, along with a Learning Resource Package focusing on Mental Health for COVID.
• Private Sector Engagement: Mobilization of 50 Oxygen Concentrators and 500 PPE Kits.

J. Support provided under National TB Elimination Program (NTEP) in HWCs

NISHTHA has been supporting the state in integrating TB services into HWCs. Activities facilitated by the NISHTHA team include capacity building for CHOs, identification of TB champions, and their subsequent training.

Key Achievements:

• Supported the state in implementing TB Preventive Therapy in the Bishnupur district. TPT training was conducted in February 2023, with 44 officers trained, comprising 13 Medical Officers, 33 CHOs, and 8 district officers.
• Collaborated with the State TB cell for the celebration of Nikshay Divas on the 14th of every month at HWCs.
• Supported the state in organizing an orientation on the TB Mukt Bharat Campaign on April 5, 2023. A total of 62 participants, including members of State & district TB cells and CHOs, attended the online orientation.
• Supported State to ensure that all HWCs conduct TB screening for Pregnant Women and ensure reporting in the Nikshay portal.

K. Support provided under National Program for Climate Change and Human Health

USAID-NISHTHA/Jhpiego is working closely with the National Programme on Climate Change & Human Health (NPCCHH) to address climate change and its profound impact on healthcare. The partnership aims to provide technical assistance to NPCCHH in Manipur.

The focus includes supporting the state in implementing Surveillance in the Integrated Health Information Platform (IHIP) concerning: Air Pollution related illness (ARI) Surveillance & Heat related illness (HRI) Surveillance.

In this initiative, all healthcare facilities up to the Primary Health Centre (PHC) level serve as reporting units for HRI surveillance, total 123 reporting units within the state. Moreover, the 7 District Hospitals and CHC Wangoi have been identified as sentinel sites for ARI Surveillance. The Jhpiego team has conducted orientation sessions for all these sentinel sites, marking the commencement of reporting in IHIP.

Furthermore, the state has received support in observing various days under NPCCHH, incorporating a range of community engagement activities aimed at fostering behavioral changes conducive to addressing climate-related health issues.

Glimpse from the field

IHIP Review

FETP Training

TPT Training in Bishnupur

Office memo for TB screening in HWCs

PMABHIM XV Finance Commission Workshop

Induction Training for CHOs

Child Health Training

Training on HIV testing

IHIP training at Churachandpur

IHIP Meeting at Chandel

TEAM MEMBERS of Manipur Jhpiego Team