Uttar Pradesh (UP) is the most populous state in India, with over 200 million inhabitants, 42% of whom are under the age of 15. UP scores low on the human development index (in 2005 it was ranked 16 of the 17 states measured) with approximately 30% of the population living below the poverty line. In spite of a well-established health infrastructure and substantial state resources, UP also lags behind other states on mortality reduction and on almost all other indicators of basic health services. According to the 2012 Annual Health Survey, UP had the highest neonatal, infant, and child mortality rates and the second highest maternal mortality ratio of the nine states surveyed.
UP’s public health system suffers from a wide equity gap. Delayed and uneven budget allocations, poor quality of services, limited technical capacity, and weak systems for monitoring, logistics, and human resource management all contribute poor quality services. Uptake of services by the state’s most vulnerable populations is also low due to both access and demand issues.
JSI Research & Training Institute, Inc. (JSI) is partnering with the University of Manitoba under the Uttar Pradesh (UP) Technical Support Unit (TSU) project, which is funded by The Bill & Melinda Gates Foundation. The UPTSU provides techno-managerial support to the GoUP for the implementation of the Government of India’s (GoI) RMNCH+A strategy at scale and otherwise enhance ‘implementation capacity’ at the block, district, divisional and state levels, particularly in high priority districts.
JSI’s technical support contributes to improving the reach, coverage, and quality of essential primary health, family planning, immunization, and nutrition interventions, with a focus on women of reproductive age—especially adolescents and pregnant women–and newborns and children under two years of age. Through an assessment and response approach, JSI is strengthening the critical systems required to ensure quality RMNCH+A services, and documenting and disseminating results and lessons learned to influence public health programs in India and other countries.
The TSU works with the GoUP in planning, leveraging, coordinating, and monitoring the roll out of the programs and services that are at the core of the new RMNCH+A strategy. JSI’s role includes leading the project’s Strategic Planning Team and contributing to its M&E, documentation, immunization and child health functions. The TSU is staffed to provide expert opinion and to put proven implementation strategies and tools into the hands of GoUP counterparts.
The project introduces innovations and proven approaches to build the capacity of the GoUP to implement the RMNCH+A strategy. It builds service delivery and management capacity and strengthens critical elements of the health system. Moreover, it helps the state track progress at all levels and motivate health staff and partners by using district and block scorecards, dashboards, assessment results, supportive supervision checklists and performance based incentives to incentivize behavior change. It also provides opportunities to share project results and learn throughout the process.
It is expected that the project’s assessment and targeted response approach will be adopted statewide and that UP will move up in the state rankings as it rolls out the new national RMNCH+A strategy.