Report from Community and Country Level

Consultations on GMAP2 “Action and Investment

to defeat Malaria (AIM)” in India

16th-19th June 2014

Prepared for

Roll Back Malaria Partnership

Submitted by:

Swiss Tropical and Public Health Institute

Consulting LLP

Facilitated by:

Version: 22

nd August 2014

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1. Introduction

1.1 Community Consultation Overview

The engagement visits to Guwahati and Nagaon District in Assam State were scheduled on 16-17th

June. Assam is in the North-East of India and shares international borders with Bhutan and Bangladesh.

The North-East is a high endemic region of the country with problems of accessibility, socio-political

situation and inhabited by several ethnic groups. Besides, in some areas the infrastructure and health

systems are yet to optimal. For reasons of both security and distance the engagement visits took place in

Nagaon District in Assam.

Discussions were firstly held with 18 people at village level including:

• Community members

• Community Development Workers (Accredited Social Health Activists (ASHAs), Anganwadi

Workers (AWW) and

• Front line workers (Auxiliary Nurse Midwives, Multipurpose Workers, Surveillance Workers,

Surveillance Inspector, laboratory technician and others) from sub-centre and block-PHC

level

Discussions were also held with 15 district and state level employees including:

• District staff (Joint Director of health services, District Health Officer, District Assistant Malaria

Officer, District Project Officer, Malaria Technical Supervisor, Surveillance Inspector &

support staff)

• State Vector Borne Disease Control Programme and Regional Office for Health and Family

Welfare, Government of India (GoI): Joint Director of Health Services (State Programme

Officer), Public health consultant and Regional Director

A list of participants can be found in Annex 1. Pictures of the engagement visits and the consultative

meeting in New Delhi can be found in Annex 5. Abbreviations are listed at the end of the document.

1.2 Background information

The journey from Delhi to Nagaon was ac.4 200 km round trip and served as an important reminder of the

sheer scale of the challenge to provide basic services in this sub-continent of 1.27 billion people.

Nagoan is a district with a population of approximately 3,007,000. According to Annual Health Survey

2012-13 (GoI), the crude death rate is 8.0, infant mortality rate is 64 per 1000 live births and maternal

mortality ratio remains high at 251 per 100,000 live births. The crude birth rate is 23.7 and total fertility

rate is 2.8. The district comprises 11 Block-PHC areas, 7 of which are considered to be at risk of malaria.

The Block PHC that was visited covers 93 villages. In addition, the district has 5 Community Health

Centres, 30 Primary Health Centres, 4 Subsidiary Health Centres, 367 sub-centres, and covers 1871

villages.

The District has made progress to reduce malaria cases and deaths since 2008. District records indicated

that no malaria death was reported so far in 2014. The district mainly cultivates tea, but also rice and

there are some challenges to control breeding sites caused by irrigation methods, as well as by standing

water. The foothills that are fraught with remoteness and even riverine areas remain particularly at high

risk as the environment provides mosquitogenic conditions. The district is neighboured by two

mountainous, heavily forested and highly inaccessible districts viz. Karbi Anglong and North Cachar Hills,

which are making slower progress and have yet to optimize their health systems (limited health

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infrastructure and human resources). The rural, male population in the area moves frequently between

the districts in search of casual work on the tea plantations, and there are frequent (imported) cases from

other districts.

As in other parts of India, the majority of health care expenditure continues to be out of pocket, which

often renders facility-based services inaccessible to the poorest. Even though malaria drugs are free in

the public system, the costs that people face to reach facilities are a barrier in themselves. Moreover, the

procurement and supply system is mostly centralized and remains severely challenged resulting in

situations when drugs or other needed supplies may be simply unavailable, especially at peripheral

levels. This compromises the extent to which community level workers and first line health workers can

actually provide services at the point of need.

In India, there are important networks of community workers including ASHA, AWW, Surveillance

Workers and extension workers from other departments like Forestry and Agriculture. In addition, there

are first line health workers, including Multipurpose Workers (MPWs) and Auxiliary Nurse Midwives

(ANM) at village sub-centres and primary health care level. All these cadres can receive and give public

malaria drugs and play a role in testing, treating and reporting malaria. The AWW are extension workers

of the Department of Women and Child Development under the scheme of Integrated Child Development

Services who are trained in IMNCI, deliver immunisations and monitor child development. The ASHAs

were originally created to provide RMNCH services, including family planning, ante- and post-natal care,

advice on breast-feeding and sanitation. They are also involved in giving immunisations. The ASHAs are

holders for provisions at community level, e.g. Oral Rehydration Salts, Iron Folic Acid Table, disposable

delivery kits, contraceptives, polio drops etc.

1.3 Summary of key themes emerging from engagement visit and implications for AIM

Reaching the poorest community members with effective personal protection tools. All those

consulted drew attention to the imminent monsoon, and flagged the increased risk of malaria at this time

of year. The district staff and first line health workers reported that bed net coverage (own/provided free of

cost by State Government/GoI previously) is quite high in the district and people generally use bed nets.

Many of the plain nets have been bought privately and there has been no LLIN distribution for two years.

The LLIN distribution strategy of 2 nets per household (with an average of 5 members) is insufficient;

although where distributed their benefits were noted. The householders always tried to purchase

additional nets for children and other family members as many live as joint families. To make these other

nets more effective, there are initiatives by the State Govt. when community development workers

arrange camps where the nets can be treated with insecticide. One such camp was held recently to be in

time for the impending rainy season. During such initiative, the support of local village leaders is sought.

The presence of local leaders, public health authorities present opportunities to meet and exchange with

them. Awareness raising activities are also carried out, including underlining how bed-net use also has

benefits against other vector-borne diseases (in addition to benefits of IRS, minor environmental

management of stagnating water, overall sanitation, etc.). The respondents conceded that the interruption

to LLIN distribution and reliance on privately bought nets meant that many households, including poor

households located in swampy areas by the river or close to other standing water sites, did not have

them.

� Implications: AIM needs to remain mindful that the poorest are most affected by malaria and

face challenges to gain access to basic services. Therefore, universal coverage through LLIN

distribution campaigns (with adequate LLINs) must be stressed. The poorest households must be

reached through these campaigns and health promotion efforts. It is particularly important that

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AIM highlights equity, using data to target interventions and monitoring those reached in terms of

their gender and socio-economic status, and other vulnerability in terms of economic activity like

shifting cultivation, labour in tea estates/mining & development projects, etc. rather than just as

numbers.

Multisectoral action and partnership at district and primary health care level for Early Diagnosis

and Complete Treatment (EDCT) and Integrated Vector Management (IVM). The state, district and

primary care level respondents all explained that every June

before the onset of the monsoon a major multisectoral effort is

made on the part of the Ministries of Health, Education,

Agriculture, Women and Child Development, Environment and

Forests. Their workers collaborate to carry out IRS and

awareness-raising activities with school children, farmers and

labour and other community members. LLINs are also distributed if they are available. This distribution is

focused on areas of greatest need. Camps for insecticide treatment of community owned bed nets are

also held with multisectoral participation.

This combined multisectoral effort was reported to have become a routine that works well. Other

examples of multisectoral collaboration were also mentioned, such as the engagement of forestry

department workers to test, treat and track malaria in remote forest areas.

The front line health workers from the Block-PHC described how they had entered into a partnership with

the nearby Tea Estate which runs a hospital for its workers and their families. In addition to formal

workers, the plantation attracts a large number of casual labourers, many of whom carry malaria parasites

and who are not covered by the scheme. These workers visit the public system when they fall sick.

Recognising the favourable manpower and mobility (availability of vehicle) at the Estate the Block PHC

MO provided the staff there with training and DDT from the government. They jointly carry out biannual

IRS and supervision thereof. In addition, the Tea Estate provides refreshments during awareness-raising

activities in the villages. Block-PHC staff is granted access to come to the estate at the end of the working

day when the harvested leaves are weighed and wages paid out to workforce. They use this window of

opportunity to conduct health promotion with the labourers and to particularly encourage the casual

labour to visit them for health services, use bed nets, allow spraying team for IRS.

� Implications: Examples of partnership that had arisen through opportunities at district and

primary health care level were noted as possible avenues for longer term collaborative

commitments to and ownership of malaria control. In the guidance AIM provides on forming and

working in partnership, attention must be paid to the varying needs for information about

partnership at community, primary care, district, state and national level.

Bottlenecks with the supply chain for drugs and commodities. The community members, community

development and first line health workers all drew attention to problems in the supply and availability of

drugs and other commodities. These were echoed by staff at district and state level who underlined

specific challenges with forecasting, timely and correct receipt of orders, constrained ability to act flexibly

and respond to upsurge in cases/outbreaks and underscored that dealing with procurement and supply

chain issues absorbed a lot of their time. Steps are being taken to ensure buffer stocks of antimalarial

drugs are held with the malaria technical supervisors at Block-PHC level for rapid deployment in the case

of any upsurge/outbreak.

“Partnership is about working with the people who live here. It is about helping the village and looking for ways to solve the problems we face” ASHA during consultation

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The community members explained that there are community representatives on the facility governing

committee (RKS) and that they are informed when supplies arrive and distributed. The community

workers described how not having the test kits or treatment for malaria eroded community confidence and

left them feeling demotivated. In spite of community representatives in the stakeholder committees like

RKS, VHSNC, the community is still challenged in accessing timely and quality healthcare services when

needed (e.g. within a day of onset of fever) and the channels for addressing such issues require much

strengthening towards accountability for the provision of service delivery. Whilst health promotion

activities are increasingly on demand generation for services/health products, commensurate supply

situation is yet to be realized on ground.

� Implications: AIM must address the challenge of procurement and supply chain management

and provide examples of creative ways that stakeholders at different levels have found to

overcome this well-recognized bottleneck. It must provide pointers for strengthening community

and civil society involvement in the governance of equitable service provision; using local

channels including media to bring issues to the attention of a wider audience; lobbying local self-

governments (village/tribal council) and local politicians and administrators. Innovative concepts

like district score cards need also to be show-cased.

Challenges of surveillance, case reporting and manpower. The former was largely seen to be caused

by the lack of manpower and resources, especially in hard to reach areas. The important efforts being

made by sub-centre surveillance workers were recognised. The point was, however, raised that they can

only cover a maximum of 20 km a day. Only at block-PHC level does the malaria technical supervisor

have a vehicle, something that was recently introduced with GFATM funding. The malaria technical

supervisor oversees the surveillance carried out by surveillance workers and community workers, as well

as supervising other activities including IRS. In addition, the MPWs conduct fortnightly active surveillance.

In Nagaon district the posts are quite well filled, although this is often not the case. The other community

development workers are involved in passive surveillance and report their cases to the sub-centre. Case

reporting from even certain private facilities, like Christian Rural Mission Hospital and tea estates, to

district level seemed to function well. In total the PHC-Block that was visited has 24 reporting centres.

Data was being analysed and used at district level.

The ASHA described how they receive a basic incentive that was recently increased, but still amounts to

INR 1100/- only per month. They can top this up through the provision of specific services to a certain

annual ceiling. According to the national guidelines, ASHA and other community workers should be

equipped with RDT and a blood slide. If the RDT is positive, then they should give antimalarial drugs. If

the RDT is negative, the slide should be sent for cross-checking. The reality is that RDTs are often not

available and such workers can only test with slides that require transmission to functional laboratory

(requiring time and cost). They fill out a form with the patient details, and wrap the slide in it. The

information from the form is taken up in the next level reporting at sub-centre level. The ASHA should get

the form that she submitted back for her information, although this remains a constraint. More generally,

the ASHA complained of being overloaded with tasks and admitted to investing less time on malaria now

that there were less positive cases for which they could get the extra incentive from providing treatment.

The district and state level respondents stressed that whilst community workers are vital, they also have

their limitations and require a lot of supervision. They were of the opinion that community workers

struggled with the concept of there being P. falciparum and P. vivax, and conveying the importance of

continuing treatment for the latter for 14 days and that community compliance remained variable.

� Implications: AIM must provide examples of successful surveillance systems and how the

generated data can be used to inform the response. It needs also to show the role that

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community level workers can play in surveillance and the 3Ts, whilst also being mindful to their

limitations and the need for further capacity building, supervision and quality assurance. It can

point to and align with recommendations of the Global Health Workforce Alliance to bring

community based workers into a suitable policy framework tailored to ensure their supervision,

adequate remuneration/performance incentives and provision with needed equipment, within a

coordinated national health workforce effort.

Working across borders and reaching mobile, migrant populations: The discussions with state level

authorities additionally revealed how the shift in focus to an end goal of elimination would require much

stronger inter-district and inter-state collaboration. They explained how steps are being taken to facilitate

this through joint planning, and joint implementation of activities such as spraying. They also raised the

concern that to achieve elimination would ultimately involve working together with stakeholders across

international borders. They reported that some high level efforts had been made between the

Governments of India and Bhutan, but that these are yet to be translated into any concrete action.

Involvement of NGOs is desirable especially to reach out in remoter areas. The state is facing challenges

in providing services in the remote areas and underlined the immense importance of both international

and national NGOs and their networks for provision of technical assistance, capacity building and service

implementation. The state level workers were concerned that if the security situation were to decline

further, then even NGOs would face constraints to implement properly in the foothills. They reported that

the NGO sector with community based presence and experience is perceived to be hard–working and are

willing to cater to difficult areas, and that they generally have high acceptance in communities. The

respondents recognised that otherwise the only potential service providers would be the owners of small

chemist shops whom they are currently considering to equip with RDTs and antimalarials to complement

the work of community workers at village/hamlet level. In addition, they flagged the potential of the new

law in India that obliges companies to invest 2% of their profit in Corporate Social Responsibility. In

Assam, the State govt. has already approached successful companies and requested funding support for

service provision in a certain number of villages. They stressed the importance of clear messages, and

making the company concerned feel responsible so they will invest in the villages in the long term.

� Implication: The AIM needs to provide guidance on how to strengthen collaboration across

international borders and how this can be translated into action at state and district boundaries. It

needs to give an input on strategies for strengthening inter-district/inter-state collaboration too,

provide examples of the barriers that are and can prevent this and show how they may be

overcome through the use of case studies.

2. Overview of the consultative meeting

The consultative meeting was convened in New Delhi by Caritas-India on 18-19th June 2014. A total of 35

participants took part from Arunachal Pradesh, Assam, Gujarat, Madhya Pradesh and Odisha, which

have varying levels of infrastructure and capacity, and face differing burdens of malaria. The participants

came from state, district and community level and included public, private, mission and community level

health workers, representatives of research & academia, non-governmental organisations, corporate

sector, development partners and the Government of India. The agenda of the two day meeting can be

found in Annex 2.

2.1 Objectives of the consultative meeting

The main objectives of the community level consultation were to:

� Enable country stakeholders to help set the agenda for the next iteration of the Global Malaria

Action Plan

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� Help to better position malaria within the country’s broader development context

� Learn how other programs have successfully engaged communities e.g. polio, HIV/AIDS, TB,

MCH, etc.

� Create a shared understanding of the current status of the country’s response to malaria

� Identify high priority actions for progress towards control/elimination goals

� Sensitize country stakeholders for the future implementation of AIM

� Network, build relationships, and identify new opportunities for partnership

2.2 Key national opportunities and challenges prioritized for discussion

After the official opening and introduction to the AIM process, a presentation was given on the

engagement visits and the observations from the discussions with community members, community

development workers, first line health workers and district and state level respondents during the

engagement visit. In addition, the findings from the SEA regional consultation were also briefly presented.

In a moderated session the participants jointly agreed on five topics that they thought it would be most

beneficial to discuss during the consultation. These topics were:

1. Opportunity to optimise and strengthen community involvement

2. Challenges in surveillance, M&E, case-reporting, use of data for decision-making and

priority setting

3. Challenges in procurement and supply chain management

4. Challenges to build partnerships/put multisectoral action into practice

5. Opportunity to harness available wealth to increase domestic investment in health,

including malaria

2.3 Summary of key points emerging from the consultative meeting

The participants worked in multi-constituency groups including for example, representatives of

Government, Development Partners, Research, Civil Society and the Private Sector. Firstly, the different

ways being invested in the fight against malaria were outlined by various constituencies.

After this, each topic was discussed in the group. The participants described what was currently being

done from their constituency and how well it was working. After each session the groups did a gallery

walk and looked at the work of their colleagues. They then proceeded to prioritise actions to enable them

to move forward on this topic. The list of priority actions is in Annex 3. In a further session, the participants

reviewed the actions and differentiated them into those that could be put into practice right away and

those where more guidance is needed.

Optimising community involvement: Consultative meeting re-emphasized the importance of making

sure preventive tools meet household requirements e.g. need for larger nets as well as availability of

quality EDCT services at village level, PHC/CHC; of ensuring that IEC/BCC campaigns are designed to

reinforce the messages of care providers (Community Workers), and care seekers (key populations like

women and children, shifting cultivators and the community at large); as well as the potential of moveable

health camps to reach mobile, migrant populations.

Overcoming challenges of surveillance, M&E, reporting and use of data: Participants at the

consultative meeting stressed the need to simplify reporting tools and guidelines for use by community

workers; to strengthen the system to ensure prompt feedback and responses based on data regarding

outbreaks, stock-outs and for greater recognition of the special support that is required to implement

active surveillance in remote areas.

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Overcoming challenges in procurement and supply chain management: The need to provide case

studies from countries that have decentralised their procurement systems, created dedicated human

resources to deal with procurement and supply chain issues and established standard storage practices

at sub-national level was raised with the objective of uninterrupted supply of commodities on the ground

and their optimal utilization. In addition, attention could be given to demonstrating the value of facilitating

open communication between different stakeholders, e.g. between Governments and manufacturers

regarding net specifications, expectations of price and delivery times.

Overcoming challenges in strengthening multi-sectoral partnership: Participants at the consultative

meeting requested guidance on seeking partners that share a common goal to ensure “buy in”; on how to

formalise partnerships is to better manage expectations; on how to work together and give each other

feedback in the spirit of partnership; how to simplify procedures to enhance flexibility and facilitate timely

response and flow of funds.

Harnessing investments through advocacy: Whilst those consulted at community level gave mixed

response regarding support from administrators/politicians, the state and district level participants were

quick to point out the importance of winning over district magistrates and local politicians to ensure

continued investment in malaria in the long term. All concurred that malaria remains an important priority

at the moment, but could foresee that as progress continued and cases decline then this could become a

challenge. As the progress in malaria control is achieved, the need for further developing technologies for

mapping risk areas and tool that can be used to look for parasites in asymptomatic carriers at community

level, etc. in addition to vital work that is being done to monitor drug and insecticide resistance in the

region, and surveillance, IVM, IEC/BCC, etc. would require substantive investments.

Lessons from other programmes: The participants saw many lessons that malaria could learn from

polio and family planning programmes especially from the way the polio movement managed to mobilize

the community through effective IEC/BCC and engage the private sector. They expressed that in many

high areas, malaria is still considered to be a fact of life, and that mobilisation has yet to take the shape of

an effective ‘movement to defeat malaria’. They suggested improved IEC/BCC and the joint packaging of

interventions to counter malaria and TB at community level. More importantly they stressed that all

programs need to work together to continue to improve the quality of public health services.

2.4 Areas where AIM could potentially provide useful guidance

� How to mobilise resources more effectively

� How to improve procurement and supply chain system/ find ways to get round bottlenecks; ensure

efficient forecasting, inventory management

� How to achieve greater transparency of data regarding investments in health and development from

public and corporate sources

� How to create powerful messages and undertake effective advocacy and especially lobbying to tap

into CSR and convince administrators/politicians of the continued need to invest in malaria

� How to choose partners strategically, mutual benefits of partner involvement, for example to set up

PDPs, simplifying procedures for greater flexibility in partnership, share/receive data across sector,

set up platforms to give feedback on partnership

� How to implement across borders, e.g. reach mobile migrant populations

� How to strengthen regulation of drug quality (counterfeits etc.)

� How to work more closely with traditional healers, other local care providers at community level; and

how to ensure rational treatment and case reporting by private healthcare service providers

� How to generate evidence, and establish best practices and ensure that these are taken up in policy

recommendations

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3. Assessment of the success of the consultative process

Feedback given by the participants was positive. Both the

organisers and the participants were grateful to have been

consulted and thought that the discussions had been very rich.

A contact list was shared with all participants and the meeting

already seemed to have tangible benefit by providing a platform

for convergence of national to state to district to block to

community level stakeholders for productive exchange, for

example by bringing the Government, and private sector net

providers and civil society, community worker together, as well

as putting the manager of a rural mission hospital in touch with

state, NGO and private sector participants.

A total of 33 people were spoken to during the engagement visits of which 15 were women (45%). A total

of 35 people from 60 invited attended that national consultative meeting (60% attendance rate). This may

in part be explained by the rather short notice given for the consultation. 15 (42%) of them were female. 9

(25%) of them were from national government level (MOH, national malaria program, other programs,

head of finance department), 8 (33%) were from state district or PHC level, 6 (17%) from NGOs, 4 (11%)

first line and community workers. 4 (11%) from the private sector, 4 (11%) from research the rest <10%

were development partners. The participants list can be found in Annex 4. The other indicators

concerning whether topics from community level were discussed at national level, actions steps

suggested and areas where AIM could provide guidance were all fully met.

“In our group, we all had different hats on but had common goals & objectives to achieve – hence, we started to see things from each other’s perspective and discussed ways to deal with issues that can seem insurmountable”

Consultation participant’s feedback

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Annex 1: Engagement visit participant list

Community Members, Community Workers & Sub-centre level Workers

Name Designation

Mrs. Drea Digal Community member

Ms. Sushila Digal Community member

Mr. Uttam Digal Community member

Mrs. Sushanti Digal AWW

Mrs. Purnima Goswami ASHA

Mrs. Jilimai Balari ASHA

Mrs. Akela Barela ASHA

Mrs. Sumitra Singh ASHA

Mrs. Dipen Tarang Multipurpose Worker

Mrs. Gita Rani Bhattacharya Auxiliary Nurse Midwife

Mr. Riyadul Islam Surveillance Worker

Mr. Kaira Kanta Barnati Surveillance Worker

Sri. Pranab Kalita Support staff

SIMONABASTI BLOCK P.H.C

Dr. Tarkeswar Borua Medical Doctor and Manager

Sri Dhruba Jyoti Saikia Malaria Technical Supervisor

Sri. Mahendra Kakati Laboratory Technician

Sri. Ananta Bora Surveillance Inspector

Sri. Tridib Sarman Block Accounts Manager

NAGAON DISTRICT STAFF

Dr. Dilip Sarma Chief Medical & Health Officer

Mr. R. Thangal Joint Director Health services

Mrs. Santana Barman District Medical Officer

Alhilal Samir Hussain Malaria Inspector

Mrs. Shahnaz Begum District Project Officer (Consultant)

Mr. A. Hengda AMO

Jeban Bordoloi SMI

Mr. Hi. Lal. Hussain SMI

Chandra Kalita HA

Pradip Das Store Keeper

Utpal Demassa S.W

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STATE VBDCP, Govt. of Assam and ROH&FW (GoI)

Dr. Biren Kumar Baruah Joint Director Health services (Malaria) [SPO, NVBDCP]

Dr. K. Barman PH consultant

Mrs. L. Basumatary In charge Director of Health services, Govt of Assam

Dr. Partha Jyoti Gogoi Regional Director, ROH&FW, GoI

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Annex 2: Agenda of consultative meeting

Time Session Speakers/Facilitators

09.00-09.15 Welcome of participants (introduction of new

participants), status, updated agenda

RBM Partnership/Swiss TPH

Time Session Speakers/Facilitators

08.30-09.00 Registration

09.00-10.20 • Opening remarks

• Address

• Executive Director, Caritas India

• Deputy Director, RBM Partnership

• Director, NVBDCP

• Joint Secretary, MOH&FW

• Spl. DG (PH)

• Additional Secretary & MD, NHM

• Director General Health Services

• Secretary, DHR & DG ICMR

• Secretary, M0H&FW

10.20-10.30 • Vote of thanks • Caritas India/Swiss TPH

10.30-10.45 • Photo session, Refreshment Break Participants

10.45-10.50 Logistics announcements Caritas India

10.50-11.15 Orientation to AIM including:

• Overview of the AIM Development Process

• Link to the Global Technical Strategy for

Malaria

• Purpose of Country Consultation

• Consultation Objectives

RBM Partnership/Swiss TPH

11.15-11.45 Presentation of key findings from SEA Regional

Consultation

RBM Partnership/Swiss TPH

11.45-12.30 • Malaria situation in India: challenges,

opportunities and way forward

• Country Specific Prioritization of challenges

or opportunities in the effort to control and

eliminate malaria

Director, NVBDCP

Moderated Discussion

Moderator: RBM Partnership/Swiss

TPH/NVBDCP/Caritas India

12.30-13.00 Introduction to groups and breakout session

methodology, start of group discussion of first

priority issue

RBM Partnership/Swiss TPH

13.00-14.00 Lunch

14.00-15.15 Completion of group discussion. Gallery Walk.

Feedback and Plenary Discussion

Group work [Moderator: RBM

Partnership/Swiss TPH/Caritas India]

15.15-15.30 Tea Break

15.30-17.00 Group Discussion of second priority issue

Gallery Walk. Feedback and Plenary Discussion

Group work

[Moderator: RBM Partnership/Swiss

TPH/Caritas India]

17.00- 17.30 Wrap up Group rapporteur

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Time Session Speakers/Facilitators

09.15-10.30 Group discussion on third priority issue, Gallery

Walk and Plenary Discussion

Group work

[Moderator: RBM Partnership/Swiss

TPH/Caritas India]

10.30-11.00 Refreshment Break and Gallery Walk

11.00-12.30 Group discussion on fourth priority issue, Gallery

Walk and Plenary Discussion

Group work

[Moderator: RBM Partnership/Swiss

TPH/Caritas India]

12.30-13.30 Discussion on Accelerating Action

• Looking across the list of actions identified,

which ones can you (as a country) begin to

take action on immediately with the

resources you have available?

• Which actions would benefit from guidance,

best practices, or other resources that could

be included in AIM?

• Are you able to share any lessons learned

that could be relevant to other countries?

Moderator:

RBM Partnership/Swiss TPH/

NVBDCP/MOH&FW/Caritas India

13.30-14.00 Evaluation Participants

14.00-15.00 Lunch

15.00-16.00 Wrap up session

• Opening remarks

• Outcomes of consultation; Review of purpose

of AIM

• Staying involved in the development of AIM

• Additional Director, NVBDCP

• Deputy Director, State VBDCP,

Odisha

• Deputy Director, RBM Partnership

• Closing remarks • Executive Director, Caritas India

• Director, NIMR

• Director, NVBDCP

• DGHS, Dte. General of Health

Services

• Secretary, Ministry of Health &

Family Welfare

• Official close • RBM Partnership/Swiss TPH/Caritas

India

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Annex 3: Priority Actions identified at the consultation

Priority Actions for Strengthening Community Involvement:

1. Provide need-based training to strengthen skills of ASHA/CHV/VHSC and other related front line

workers

2. Involve community more closely in selection of ASHA/CHV/Health workers

3. Provide ASHA/CHV and others with supervision, support, peer mentoring, recognition, incentives

4. Ensure uninterrupted supply of drugs and other commodities at village level

5. Address the need for uninterrupted supply of power and water

6. Ensure availability of equipment at facility level

7. Develop quality content for IEC/BCC in local languages

8. Involve community in health planning

9. Ensure nets and other products meet household requirements eg. size

10. Strengthen monitoring and evaluation at community level and establish self-monitoring systems

11. Strengthen collaboration with other sectors, eg. forest department workers are being/can be engaged

12. Set up health camps and agree referral points to reach mobile, migrant populations

Priority Actions to overcome challenges of surveillance, reporting and use of data for decision-

making/priority setting

1. Put dedicated manpower for data management in place at PHC level /district level; data compilation,

analysis and feedback at PHC level using computerised system

2. Look again at the coverage areas of the ASHA and expectations of their role in surveillance

3. Put transport in place to facilitate surveillance in remote areas

4. Fill empty posts and provide incentives so active surveillance takes place; Put technical manpower at

various levels

5. Strengthening of health infrastructure – microscope, power back-up, etc

6. Simplify reporting tools and translate to local language

7. Make MIS user-friendly both offline and online; ensure locally suited internet connection

8. Ensure timely availability of adequate funding

9. Use data to map areas of high risk where focused interventions are needed

10. Integrate data from non-govt., private sector, tertiary institutions; encourage through advocacy case

reporting by private sector

Priority Actions to overcome challenges of procurement and supply system

1. Prepare and execute guidelines, policy, SOP etc for procurement; explore all mechanisms to ensure

uninterrupted service delivery and universal coverage with effective preventive and curative

mechanisms

2. Ensure Quality Assurance mechanisms are in place; establish dedicated laboratories for quality

check of malaria and other health products

3. Set up standard storage facility at state, district and block levels

4. Put technical manpower for PHPM at various levels

5. Strengthen communication between Government and manufacturers regarding net specifications,

expectations of price and delivery times

15

Priority Actions to Strengthen Partnership

1. Identify specific areas where partnership would be beneficial

2. Study guidance on effective partnership – be clear about the motivations/barriers for entering into

partnership

3. Assess capacity of potential partners; Look for partners according to common goals and needs to

ensure “buy in”; clarify basis of the partnership to manage expectations

4. Treat each other as partners – understand context about late report, sub optimal deliverables, delays

in release of funds, etc.

5. Simplify procedures to enhance flexibility and facilitate timely response and flow of funds

6. Set up a platform for exchange for feedback to bring improvements

7. Put clear practical plans in place for long term sustainability (if one partner withdraws)

8. Monitor the on-going benefits of the partnership and whether it is cost-effective and meeting the

desired quality, timeliness, etc.

9. Strengthen coordination between partners at various levels; undertake advocacy to strengthen

political will for partnership

10. Put technical manpower advocacy, coordination and partnership building at various levels.

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Annex 4: List of participants at consultative meetings

Name Designation Organization Place

Shri Lov Verma Secretary MOH &FW Delhi

Dr. Jagdish Prasad DGHS MOH & FW Delhi

Dr. Inder Prakash DDG (PH) Director General

of Health Services Delhi

Ms. Kavita Singh Director Finance National Health

Mission Delhi

Fr. Frederick D'Souza Executive Director Caritas India Delhi

Dr.A.C.Dhariwal Director NVBDCP Delhi

Dr. G. S. Sonal Addl. Director NVBDCP Delhi

Dr. Avdhesh Kumar Addl. Director NVBDCP Delhi

Dr. Sher Singh Addl. Director (PH) NVBDCP Delhi

Dr. S.N. Sharma Joint Director NVBDCP Delhi

Dr. Partha Jyoti Gogoi Regional Director Assam ROHFW Assam & AP

Dr. C. Zarzoliana State Programme Officer SVBDCP Aizwal,

Mizoram

Dr. MM Pradhan Deputy Director NVBDCP Odisha

Dr. Sreya Pradhan Sr. Research Officer, CCM NVBDCP Odisha

Ms. Geetanjali Pati ASHA NVBDCP Odisha

Smt. Mamta L. Dattani DMO SVBDCP Gujarat

Mr. Mahendra Singh Thakur MTS Baihar SVBDCP Balaghat,

Bhopal,MP

Mr. Pratyush Panda Regional Head CSR

ACC Limited,

Regional Office-

North

Delhi

Ms. Madhvi Aggarwal Intern CSR ACC Limited Delhi

Mr. Raj Shankar Ghosh Deputy Director, Vaccines Bill & Melinda

Gates Foundation Delhi

Dr. Neena Valecha Director NIMR Delhi

Dr. Anup Anvikar Scientist NIMR Delhi

Dr. S.K. Sharma Scientist-F NIMR Delhi

Dr. B.N. Nagpal Scientist-F NIMR Delhi

Mr. Bulu Terang District Project Officer,

IMCP-II Jirsong Asong Assam

Ms. Theiolin Chyrmang ASHA NVBDCP Meghalaya

Sr. Juliana Vas Field Supervisor, IMCP-II JUST Tripura

Dr. P.C. Bhatnagar Director, Communicable

Diseases VHAI Delhi

Ms. Mehak Nanda Manager

Vestergaard

Frandsen India

Pvt. Ltd.

Delhi

17

Dr. Shampa Nag Project Director Caritas India Delhi

Ms. Rody Gangte Project Manager Caritas India Delhi

CA Jasmit Kaur Grants & Finance Manager Caritas India Delhi

Mr. Nipun Wadhwan Finance & Accounts Officer Caritas India Delhi

Ms. Suchandra Nandi DEO Caritas India Delhi

Ms Jyoti Nagwansi Secretarial cum Accounts

Assistant Caritas India Delhi

Mr. Stephen Gangmei Regional Project Manager Caritas India Delhi

18

Annex 5: Pictures of the engagement visits and the consultative meeting

19

20

List of Abbreviations

ACT Artemisinin-based Combination Therapy

API Annual Parasite Incidence

ASHA Accredited Social Health Activist

BCC Behaviour Change Communication

CBO Community Based Organization

CCM Country Coordinating Mechanism

CHV Community Health Volunteer

CSO Civil Society Organization

CSR Corporate Social Responsibility

DDT Di-chloro Di-phenyl Tetra chloro ethane

DMO District Medical Officer

DPMU District Project Management Unit

EDCT Early Diagnosis and Complete Treatment

FBO Faith Based Organization

FS Field Supervisor

GF The Global Fund

GFATM The Global Fund to fight AIDS, Tuberculosis and Malaria

GoI Government of India

HHs Households

HIS Health Information System

HMIS Health Management Information System

HR Human Resource

HSS Health Systems Strengthening

HW Health Worker

IEC Information, Education and Communication

IDSP Integrated Disease Surveillance Programme

IMNCI Integrated Maternal Neo-natal Child health Initiative

IRS Indoor Residual Spraying

ITN Insecticide Treated (bed) Nets

IVM Integrated Vector Management

LLIN Long Lasting Insecticidal Nets

LSCM Logistic Supply Chain Management

LT Laboratory Technician

M&E Monitoring and Evaluation

MIS Management Information System

MOF Ministry of Finance

MOHFW Ministry of Health and Family Welfare

MPW Multi Purpose Worker

MTS Malaria Technical Supervisor

NGO Non- Governmental Organization

NHM National Health Mission

NIMR National Institute of Malaria Research

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NRHM National Rural Health Mission

NVBDCP National Vector Borne Diseases Control Programme

NVBDCSP National Vector Borne Disease Control Support Project

PHC Primary Health Care

PPM Pooled Procurement Mechanism

PPP Public Private Partnership

PSM Procurement and Supply Management

PSCM Procurement & Supply Chain Management

RDT Rapid Diagnostic Test

VBDCP Vector Borne Disease Control Programme