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Weekly update on COVID-19 achievements

Date: Week starting June 19, 2020

Weekly performance reporting on COVID-19 support

Indicators Baseline

(as on 30th

April)

Past Week’s

Achievement

s*

Cumulative

Achievements

(from start

through COB

Thursday)

Target for

the entire

project

Additional

Information

Number of people directly benefited

through USG interventions (e.g.,OPDs,

helplines, chatbots etc.) Note:do not

include mass and social media.

34,093

72,075

3,18,479 27,500 -Layered on Pulse

oximetry-1500 (605)

HRP -1000 (1087)

and HBYC-25000

(3,16,787) platform

Number of facility-based health workers

(doctors, nurses, CHOs, pharmacists,

ANMs, MPWs, and Anganwadi center

workers) trained to prepare for and

respond to COVID-19 with USG support.

Disaggregated by RCCE, surveillance,

case management, IPC and/or WASH

3,959 196 7715 1500 -Layered on

LaQshya (4286),

NBSU, FPC, and

Safe delivery app

(1319)

Number of community frontline workers

(ASHAss, TB champions, community

volunteers, sanitation workers, etc.)

trained to prepare for and respond to

COVID-19 with USG support.

Disaggregated by, RCCE, surveillance,

case management, IPC and/or WASH

1,555 45 2825 12,330 -12000 Layered on

FPLMIS (2110)

330 through HRP

(715)

Number of facilities supported with USG

resources (including TA, training, supplies

of COVID-19 medicine, ventilators, PPE,

etc) and able to respond COVID-19

300 0 399 122 -Layered on

LaQshya

*Please note that these numbers should be consistent with the numbers listed in the narratives below.

Activities:

IPE Global will leverage existing state and district level activities to integrate COVID-19 response measures.

These activities will include:

1. Strengthening infection prevention control and practices at the facility level through self-administered

audits and checklists under LaQshya:

2. Strengthening Universal Precautions at the individual healthcare provider level using self-learning safe

delivery Apps:

3. Daily tracking of cases of Acute Respiratory Infections (ARI) in Health and Wellness Centers and

promoting hand washing practices:

4. Dissemination of available COVID-19 risk-communications and guidelines among healthcare

functionaries and communities:

5. Risk mitigation and action planning

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Key achievements: .

Activity-1: RMNCHA review at state level – Uttarakhand

Vriddhi Supported Maternal Health division for RMNCH+A review facilitating the video conference with all

districts.

In this review HMIS data analysis of all RMNCH+A indicators for the month of April 2019 and April 2020

were compared. Percentage change was observed in all MH indicators because of Covid-19 Pandemic. A

detailed analysis of each indicator was done and incorporated in a presentation.

District Level Support in Uttarakhand:

1. Follow up at LaQshya facilities in both the AD to discuss IPC and Triage related gaps using LaQshya

assessment checklist for the same

2. Supportive Supervision visit at sub center Jaitpur, Laksar Gaun & Sultanpur, District Haridwar on ANC Day.

ANC day (Samman Diwas) is a weekly activity being conducted on Mondays at the subcenter was monitored

and re-orientation on the key actions for prevention against Covid-19 was done for frontline workers.

Figure 1: Meeting of DTO Vriddhi with ANMs & ASHAs for mobilizing children with ARI symptoms at

RAD-G 9intervention Site at HWC PHC Magroobpur, Haridwar

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3. Supportive Supervision visit at HWC PHC Magroobpur in Haridwar (RAD-G intervention site). Meeting

was also held with ANMs and ASHAs to emphasize on mobilization of children with ARI symptoms to HWC

for proper screening & management of Pneumonia.

4. Vriddhi Project district team supported in developing Aspiration District Health Proposals, which got

approved by the empowered committee for district Haridwar for approx. 6.90 Crore, 50% of which was

released for implementing the approved activities.

Activity-2: Planning RMNCAH+N essential services during & post covid-19 Pandemic in

Jharkhand

USAID Vriddhi with MD-NHM, Jharkhand has prepared a plan of action for resuming the essential health

services under RMNCAH+N during COVID19 pandemic. The plan was prepared by the team in consultation

with the different thematic area cells. A meeting on finalizing the plan of action of RMNCAH+N essential

services was held on 19th June 2020 in RCH conference hall under the chairmanship of Mission Director (MD),

NHM Jharkhand. Child Health (CH) Cell, Maternal Health (MH) Cell, Family Planning (FP) Cell, Adolescent

Health (AH) Cell, State Data (SD) Cell, Training Cell, Urban Health (UH) Cell, Community Mobilization (CM)

Cell and team members of USAID Vriddhi team participated in the meeting. The plan of action was discussed in

detail and a few suggestions from the MD and other participants were included in the plan. Subsequently based

on the inputs the final plan was prepared and shared with the MD on the 24th of June 2020. Action has been

initiated as per the plan.

Some of the points discussed in the meeting are as follows:

• Decision to institutionalize DQCI &

SQCI and processes to be finalized.

• The MH cell needs to focus on improving

institutional delivery as planned.

• Encourage private institutions to start

delivery and the data needs to be on

monitored on regular basis.

• Procurement process of sanitary napkins

need to be started by the AH cell.

• The districts need to share procurement

plan of equipment for LR, OT & SNCU

with the state, so the gaps can be filled up.

• ANM online portal (ANMOL) is going to

start from August in 12-13 districts which

will help in micro planning. So, a successful implementation plan needs to be formulated.

• RCH Portal needs to be updated regularly which will help the state in preparing due lists for all services

under RMNCAH+N

Figure 2: State Technical Advisor, USAID Vriddhi presenting on planning RMNCAH+N services in Jharkhand during and post Covid-19 pandemic in a meeting with state health officials in RCH conference hall, Namkum under the chairmanship of Mission Director (MD), NHM Jharkhand

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Activity 3: Key activities of the week at Odisha

1) Online orientation session on Safe Delivery App (SDA) for Nabrangpur district

Online orientation for Nabrangpur district was organized on June 25 at 1:00 pm. From Nabrangpur district 16

participants including O&G specialists and staff nurses from health facilities DHH Nabrangpur, SDH Umerkote,

CHC Papadahandi and PHC Mahendri participated in the session. The detailed process of Safe Delivery App

installation using a PPT was done. The usefulness of SDA in promoting self-paced learning on clinical skills

related to safe birthing practices were discussed. Demonstration on the newly introduced COVID-19 and

infection control modules were done to

make the participants understand the

module configuration and provision of

self-assessment available in each

learning module.

2) Coordination with districts

Vriddhi team has coordinated with

DPMU Mayurbhanj and Bargarh

districts for organizing online

orientation session on SDA. DMRCH

of these districts and Hospital manager of DHHs have been consulted on the importance of online capacity

building of staff on infection control and COVID-19 prevention using SDA. The orientation for these districts

will be organized in the coming week.

3) Mentoring support to DHH Khordha:

Monthly LaQshya outcome indicators reported by DHH Khordha for the duration of Jan- May 2020 have been

reviewed in detail by state Vriddhi team and feedback has been provided to the hospital manager. Vriddhi team

is continuously providing support to DHH Khorda on gap closure in order to apply for LaQshya certification.

The facility is expected to apply for state certificate in the coming month.

4) Concurrent monitoring of HWC Guttingia and Puburia:

Facilitated monthly data reporting from Guttingia and Puburia HWCs on use of MMD Pulse-oximter and data

for May 2020 has been updated in web portal. Staffs in both HWCs were followed up for daily ARI reporting

and continue the use of pulse oximeter for Pneumonia screening. Monthly data received from both HWCs for

the month of April and May 2020 has been reviewed and analyzed.

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Activity 4: Strengthening virtual review mechanism using ALAP

(Accelerated LaQshya Action Plan) in Chhattisgarh

Introduction: Health system strengthening through use of technologies is the need of the hour in the current

pandemic and Vriddhi has come up with innovative approach to reach facilities to accelerate the LaQshya

implementation across the 58 facilities in Chhattisgarh. For the purpose of empowering facilities and improving

mentoring mechanisms, Accelerated LaQshya Action plan (ALAP) tool has been adopted by Maternal Health

Division with technical support from USAID Vriddhi.

Features: ALAP is a simple 50-point monitoring tool strategically aligned with LaQshya operational plan and

300 checkpoints of LaQshya LR & OT assessment checklists. ALAP act as a road map for facilities and

harmonizes the resources towards right direction. It not only helps in supplementing the knowledge gap among

various stake holders but also helps in aligning integrated efforts, thus maximizing the output and improving

optimal utilization of available resources for national certification.

The tool has been intended to identify gaps and action planning at facility level. And hosting it online through

Google Sheet platform would additionally help the state to track the progress of LaQshya and provide focused

support to each facility.

Process: In order to accelerate the LaQshya implementation and trigger key milestone activities during COVID-

19 pandemic, virtual sessions were conducted with 8 facilities in sequential manner to sustain the LaQshya

processes. Facility teams were contacted using ICT platform and provided them with requisite technical support

with respect to quality assurance activities and improving the facility mentoring processes.

Outcomes: Additional 8 facilities has updated their status in ALAP Google Sheet. Training on Quality

management, RMC and mapping critical process are the major concern identified.

Way forward: State will soon plan a virtual meeting with all the 58 facilities to orient them on ALAP and conduct

a progress review with the prioritized facilities.

Vriddhi would provide technical support in planning and conducting virtual training on Quality management,

RMC and maintaining essential list of documents for certification.

Activity 5:

Review of FP

including

FPLMIS in

Chhattisgarh

In accordance

with the

guideline from

GOI, regarding

availability of

FP

Figure 2 Image showing Screen shot of the ALAP. DD maternal Health and consultant Maternal Health were tracking the progress on weekly basis.

Figure 3: Hospital Consultant Bemetara updating the LaQshya key milestone activities on Google sheet ALAP. The details on ALAP has been updated, based on common inputs of the facility team and available evidence of the activities.

Figure 4: Image showing Screen shot of the ALAP. DD maternal Health and consultant Maternal Health were tracking the progress on weekly basis.

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commodities at all levels, two regional review meeting have been conducted on 23rd and 24th June to review the

FP program at Chhattisgarh using zoom platform. District and block level officials of Baster and Bilaspur division

participated in this meeting. On the request from State FPLMIS Consultant, Block level storekeepers also

participated in this meeting. USAID Vriddhi project provided stock analysis of all levels & status of HMIS

reporting and mapping for this meeting. Discussion was also done on the progress of FP services for the period

Jan to Apr 20. Both the meetings focused on ensuring FP services specially PPIUCD, IUCD and Antara.

On 23rd June 2020, 78 participants from 7 districts of Baster & on 24th, 60 participants from 5 districts of Bilaspur

participated in this zoom meeting. Following key actions related to FPLMIS were taken during this meeting –

Activity 6: Training of MCH Consultants on SQCI & LaQshya Follow up - Punjab

1. Training of MCH Consultants

Baster division

• 100 percent indenting to be done by CHC of

Kondagaon in this month.

• At least 90 percent indenting by PHC/UPHC in all

districts

• Due to network issue, Narayanpur SHC has been asked

to indent from block headquarter

• In 7 district 820 ASHAs have been mapped against

2963, within a week all the details for the mapping to

be sent.

Bilaspur division

• PHC/UPHC of Chapa and

Mungeli district to indent 100

percent by next month.

• Only 13% and 4%, HSC of

Bilaspur and Mungeli have

indented, have been asked to

improve the indenting above

50% within a month.

Figure 1 Hospital Consultant Bemetara updating the LaQshya key milestone activities on Google sheet ALAP. The details on ALAP has been updated, based on common inputs of the facility team and available evidence of the activities.

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Consultants from Maternal and Child Health division of Directorate of Health Service (DHS) Punjab were trained

on SNCU Quality Care Index (SQCI). The consultants have been made understand about the need of SQCI. During

this orientation following important topics were discussed.

A. Seven Indicators of SQCI

B. Inference from SQCI index

C. Categorization of districts according to their performance has

been overviewed, special focus was given to poor performing

districts.

D. MCH consultants were encouraged to formulate point of actions

from the SQCI dashboard and report.

E. Important issues were noted to communicate with districts.

Purpose of this activity was to start the process of handing over of

this activity to DHS Punjab.

2. LaQshya Follow up, Punjab:

Vriddhi state team has identified priority facilities

for LaQshya certification with DHS team. Due to

travel restriction it was decided that DHS Punjab

and Vriddhi team would jointly conduct follow up

with these prioritized health facilities using ICT

platforms. In this regard LaQshya follow up has

already been done with the district hospitals of

Moga (Aspirational District), Hoshiarpur,

Gurdaspur and Ropar in Punjab

During this week on June 24, 2020 LaQshya follow

up was done with DH Pathankot. The main participants of this meeting were;

• District Health Department: SMO, DFPO, AHA and Nursing sister from the District.

• Directorate of Health Services: Program Officer MCH,

• Vriddhi Team:

o State Technical Advisor

o Technical consultant.

Based on the latest LaQshya assessment of DH Pathankot, Vriddhi team facilitated technical discussion with

special focus on standards having score less than 70. District team members were encouraged to fill the gaps.

Vriddhi team also generated score card for DH which was discussed during this follow up meeting. Brief

discussion on Client Satisfaction was also done. District Team was requested to share their plan of action to

address these gaps.

Vriddhi team will continue to provide its support to DHS Punjab for LaQshya follow up using ICT platform in

coming week for few more districts.

Figure 5: Orientation of MCH Consultants on SQCI at Vrddhi Office in Punjab

Figure 6: LaQshya follow up with DH Pathankot

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Activity -7: Key activities of the week at Himachal Pradesh

1. Family Participatory Care: In continuation with the last week’s orientation on newer videos added in FPC

module, this week project staff technically facilitated session including newer modules along with existing

sessions.

2. LaQshya: Mentoring visit for LaQshya in LR and OT of AD Chamba was done on 23/06/2020, staff nurses

were oriented on importance of post-natal monitoring of mother and baby at LR Chamba. Also, refer in and

refer out cases of last quarter were reviewed and findings were shared with the Gynecologist to use this data

for further improving the referral mechanism in the field.

3. HRP: 13 new high-risk pregnancies have been registered in the app from both the intervention blocks of

the aspirational district during this week.

4. Quality Circle meeting under chairmanship of Medical Superintendent was held on 22/06/2020:

Quality Circle meeting was held under chairmanship of Medical superintendent, Pt. JLNGMCH with

participants from labour Room, maternity OT and SNCU. Project staff facilitated the meeting through

discussing the finding of DHQC and SQCI of last quarter and progress of FPC in last month. Also, the gaps

in SNCU and Labour Room pertaining to inadequacy and non-functionality of equipment’s and drugs were

discussed and enlisted. Various issues regarding improvement in quality of care in Labour room, Maternity

OT and SNCU were discussed.

Activity-8: Introduction of New Sessions on Family Participatory Care in SNCU and

NBSU - “Care of Newborns during COVID Pandemic” - Haryana

In view of the COVID pandemic, Vriddhi Project has developed 2 FPC sessions on “Care of Newborn during

COVID Pandemic”. These videos contain information for parents addressing their concerns for newborns during

the COVID pandemic. The first video Session 1A includes information on steps to prevent COVID infection in

care givers and subsequent transmission to newborns, special precautions in SNCU while newborn is admitted,

learning use and disposal of mask and continuation of routine care including breast milk, KMC etc. Session 1 A

must be done after the Session 1 at admission. The second video

Session 4 A includes information on Preparing for discharge and

care of newborn at home. It includes information of following the

birth and routine immunization, continuation of exclusive breast

feeding, limiting exposure of newborn to outsiders and precautions

to be taken by care givers. Session 4 A must be conducted at the

time of discharge along with session 4 of FPC.

The Vriddhi team developed Handouts for Session 1 A and

Session 4A which provides instructions for staff nurses on how to

conduct the session. In SNCU Mewat FPC session was conducted

with mothers on 22 June 2020, and field testing was already done

with 1 Pediatrician, 1 MO, 1 SNCU Incharge and 2 Staff Nurses.

On 25 June 2020, the orientation of the FPC session with Mothers

and staff Nurses of NBSU CHC Punhana.

The feedback from orientation

session of FPC in SNCU and NBSU

• The videos cover the required

messages for parents during

COVID as this was a missing

piece of information and the

SNCUs do not have BCC material

for the same.

• The language used is easy and

messages are clear.

• The staff felt the pace of the

video is slow but may be

appropriate for mothers.

• The handouts are useful and

appropriate for conducting the

discussion

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Activity -9: Monitoring of ARI Cases

Vriddhi team from National level is regularly tracking ARI cases from 19 Health and Wellness centres. Total 49

cases of ARI screened in this week and 9 cases were diagnosed as pneumonia.

Chart 1: Daily incidences of ARI cases (19th to 25th June 2020)

Chart 2: Weekly Incidences of ARI Cases

Effects of COVID-19 on RMNCH+A, TB, HIV and other essential health

services in project geography:

6

15

1

9

67

5

1

5

0 02

100

5

10

15

20

19-Jun 20-Jun 21-Jun 22-Jun 23-Jun 24-Jun 25-Jun

Total Screened Pneumonia cases

121

88

54 53 61 5676

62 69 72 65 6649

15 7 6 7 8 9 10 12 6 10 16 9 9

0

50

100

150

27 Mar-2 Apr

3-9 Apr 10-16Apr

17-23Apr

24-30Apr

1-7 May 8-14May

15-21May

22-28May

29 May -4 Jun

5-11 Jun 12-18Jun

19-25Jun

Total Screened Pneumonia cases Severe pneumonia Referred

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Impact on RMNCH services in project states

Services in all states are gradually opening up in areas outside the containment zones.

Feedback obtained from project states on status of RMNCH services-

Outreach services

Antenatal Care

services

PMSMA & VHSND sessions have started in a few states. In Odisha UHND

cancelled only in five Municipalities, except for containment zone and PMSMA was

organized on 9th June.

In Haridwar district ANC Day along with immunization organized at some of the sub

centers on every Wednesday at Sub center, VHND on every Saturday for

Immunization ANC. However, Lack of mobilization of High-risk ANC clients and

reduced load seen on PMSMA Day.

In Haryana, Patient load in ANC clinics is increasing, PMSMA and VHSND started

as per revised guidelines

Home visits In Jharkhand from 22nd to 24th June 2020, ANMs did screening of High-Risk age

group for NCD to prevent Covid-19 morbidity and mortality.

Odisha state too has started integrated surveillance for COVID-19, active case

finding for TB, screening for NCD, surveillance and sensitization for NDD and

IDCM

In Chhattisgarh, ASHA home visitation is ongoing, however, HBNC home visits

have reduced by 13% as compared to last year Apr-May

In Haridwar AD, Home visits by ASHA have declined since ASHA are involved in

doing surveys and monitoring of home quarantined people in their respective villages

Routine

Immunization

RI services have started by maintaining social distancing in facility level (CHCs,

PHCs and HSCs) in Jharkhand and outreach services are being done using staggered

approach*

In Haridwar district Routine Immunization services are function in all 6 blocks,

Organized at Sub center on Wednesday, VHND on every Saturday

In H.P Routine immunization services are on and State has circulated immunization

guidelines for holding outreach sessions

HBYC services ASHAs are making home visits along with COVID screening. Supportive

supervision of Sahiya on hold from March 2020 in all three implementation districts

of Jharkhand has now resumed.

Family Planning Home Delivery of Contraceptives by ASHAs is ongoing in all states and all

temporary methods (Condoms & Pills) are being provided to beneficiaries

Facility services

ANC services continue to be provided on walk in basis using staggered approach* and following

physical distancing norms. OPD footfall has been less. Non-COVID PW being

transferred in non-COVID vehicles only is being ensured

Institutional

deliveries

All states have identified facilities both COVID and Non COVID for provision of

institutional deliveries and services remain uninterrupted. Delivery load has been

less. Volume of overall institutional deliveries has shown a further decline in June

2nd week compare to March & April in state of Chattisgarh. In Jharkhand state

Mamta Vahan is not operational, but 108 is functional

Newborn care Birth doses continue uninterrupted, as does promotion of Breast-feeding practices

with early initiation of breast feeding and Kangaroo Mother Care.

Immunization

services

are being provided at facilities, for walk-in beneficiaries.

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Admission to SNCU SNCU are fully functional and providing services. No disruption of services & FPC

Services are functional in all states.

In Jharkhand SNCU (Rajmahal) remains closed as is converted to ICU, Covid with

SNCU. Staffs deputed in Covid-19 duties. SNCU Hazaribagh has shifted back to

Hazaribagh Medical College & Hospital building and started functioning normally In

Himachal Pradesh too one SNCU at Medical college Nerchowk Mandi, is not

functioning as facility is a dedicated COVID Hospital.

In Chattisgarh , SNCU admissions showed improvement in June 1st week after

declining in April and May. But in June 2nd week it has declined again amid increase

in Covid 19 cases

Family Planning

services

Fixed Day Camps for Sterilization are not being held. PPIUCD Services is

satisfactory but overall coverage of FP Services has declined.

In Jharkhand due to sudden rise in COVID-19 cases at district level throughout state

FP services viz. sterilization and IUCD/PPIUCD not started, even though instructions

have been sent to the district to start the same. Antara supply has now been received

and distribution from state to facility level started and Antara services resumed.

In Chattisgarh , Sterilization has started but progress is slow. In Assam PPIUCD

services started in 4-5 districts.

In MP due to continuous increase in COVID cases, Sterilization services are affected

at all 52 Districts Hospitals as these hospitals are converted to District Covid

Hospitals, But at CHC level sterilization, PPIUCD and Injectables is being given.

Supplies of FP commodities are still affected from divisional stores in MP on

account of focus on COVID related logistics; there is a shortage of Injectables in

Assam.

In Haridwar AD, Uttarakhand, Fixed Day Camps for Sterilization Service have not

been held from March 20. PPIUCD Service provision is satisfactory but overall

coverage of FP Services has declined. FP Commodities are not available in adequate

quantity in block and district as well. FPLMIS not implemented.

*Staggered approach- Where adequate seating for beneficiaries and caregivers with physical

distancing is ensured

Additional visual support:

Figure 8: Chhattisgarh- Mother taught to hold baby for KMC and provided supported in proper positioning the baby is in frog like condition at SNCU Dhamtari. A comfortable positioning improves the length of KMC.

Figure 7: Chhattisgarh -Mother of a LBW baby at SNCU Dhamtari showing Clean Hand. Adequate Hand Hygiene can reduce infection up to 30% and accounted as single most effective measures for Hospital infection prevention and control practices.

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Figure 11: Uttarakhand- Demonstration of RAD-G at PHC Magroobpur – Haridwar

Figure 9: Jharkhand - ARI screening at HWC Partan, Hazaribagh

Figure 10: Jharkhand - ARI screening at HWC Rengalbera

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Figure 12: Haryana - Mothers attending FPC Session in Aspirational District Mewat

Figure 13: ANM during orientation of Infection Prevention and Covid-19 module through SDA App at SDH Barhi, Hazaribagh, Jharkhand (Photo by – Rajesh, DTC, USAID Vriddhi)

Figure 15: COVID FPC Session at Aspirational District Chamba

Figure 14: KMC Session in ZH Mandi, Himachal Pradesh