Technical Assistance to the Government
of Jharkhand to Operationalize
First Referral Units (FRUs)
Background:
Under
the provisions of National Rural Health Mission
and as a signatory to achieve Millennium Development
Goals, India is committed to improving its maternal
and child health. An analysis of the current maternal
and child health situation in India shows that the
country needs to make strategic investments before
it can achieve the Millennium Development Goals.
The indicators of maternal and child health in Jharkhand
are among the poorest in India as evidenced by several
data sources, including the findings from the recent
National Family Health Survey 3. Against the national
average of 41% institutional deliveries, Jharkhand
reported only 19% institutional deliveries. As a
result of the Janani Suraksha Yojana (JSY) scheme,
an increasing number of women are delivering their
babies in institutions. This increased demand has
put a great deal of pressure on the health system
to improve its maternal and newborn care services.
To reduce maternal and neonatal mortality, the national
government has placed strategic importance on operationalizing
First Referral Units (FRUs) to provide basic emergency
obstetric care and newborn services. Improving
the functioning of 24x7 FRUs has been identified
as a priority in the 10th (2002-07) and 11th Five
Year Plans (2008-12). The government of Jharkhand
is focusing its efforts to expand and improve the
quality of services at FRUs for the management of
obstetric and neonatal complications round-the-clock.
Findings from an assessment of all the 27 health
facilities (19 district hospitals and 8 Community
Health Centers) in Jharkhand commissioned by the
USAID shows that a large gap exists in terms of
providing services on a 24X7 basis.
The assessment found inadequate essential newborn
care and few facilities with a blood bank or blood
storage facilities. Though it is now known what
services are missing, there is insufficient direction
on mechanisms to address these gap.
The Public Health Foundation of India proposes to
address this concern and assist the government of
Jharkhand in operationalizing First Referral Units.
Objectives:
To build capacity of government functionaries
to operationalize First Referral Units
To enable government functionaries to identify
gaps in the functioning of FRUs
To facilitate development of action plans to
address the gaps
To enable government functionaries to develop
FRU-specific monitoring plans to track progress
Key
Areas of Investigation:
The project will
build on the findings from the assessment and make
important contributions in improving the functioning
of FRUs by:
Identification of gaps in the current functioning
and development of action plans to overcome them.
Monitor progress using critical service delivery
indicators.
Strengthen and streamline the necessary linkages
between the functionaries at state and district
level to facilitate operationalization of FRUs.
Provide recommendations for improved functioning
of FRUs within the existing resources, re-allocation
of funding and human resources, or increase in
the overall allocation of resources.
As the project will work towards operationalizing
the 12 FRUs in Jharkhand, the findings will have
state-wide applicability. Additionally, FRUs are
nation-wide institutions and improving their functioning
is a national priority. Learning from this project
in Jharkhand should provide valuable insights
for better functioning of FRUs in other states
in the country through improved policies and management
protocols.
Time
Line:
7 months
Geographical
Focus:
Jharkhand
Key
Stakeholders:
Ministry of Health and Family Welfare, Government
of Jharkhand
Expected
Outcome / Output:
FRU specific action plans that elicit short
and long term strategies to improve functioning
of FRUs
Identification and institutionalization of
critical monitoring indicators to track FRU specific
progress
Improved processes and systems for efficient
problem solving
Improved communication between the government
officials at district and state levels for improved
quality of care at FRUs
Documentation and dissemination of lessons learned
at district and state level to inform all stakeholders
of best practices and innovative approaches to
removing bottlenecks in operationalizing FRUs
in resource-constrained settings
Enhanced government capacity through:
FRU management committees: a sustainable
resource to operationalize and maintain optimal
functioning of FRUs
A gap analysis tool and process of developing
action plans for performance improvement
Cross visits to facilitate learning from
well functioning FRUs within Jharkhand and
in other states
Needs-based capacity building, for example,
data management, team building and inter-personal
skills
Public Health Foundation
of India,
PHD House, Second Floor, 4/2 Sirifort Institutional
Area,
August Kranti Marg, New Delhi – 110016
Under
the provisions of National Rural Health Mission
and as a signatory to achieve Millennium Development
Goals, India is committed to improving its maternal
and child health. An analysis of the current maternal
and child health situation in India shows that the
country needs to make strategic investments before
it can achieve the Millennium Development Goals.
The indicators of maternal and child health in Jharkhand
are among the poorest in India as evidenced by several
data sources, including the findings from the recent
National Family Health Survey 3. Against the national
average of 41% institutional deliveries, Jharkhand
reported only 19% institutional deliveries. As a
result of the Janani Suraksha Yojana (JSY) scheme,
an increasing number of women are delivering their
babies in institutions. This increased demand has
put a great deal of pressure on the health system
to improve its maternal and newborn care services.
Improving
the functioning of 24x7 FRUs has been identified
as a priority in the 10th (2002-07) and 11th Five
Year Plans (2008-12). The government of Jharkhand
is focusing its efforts to expand and improve the
quality of services at FRUs for the management of
obstetric and neonatal complications round-the-clock.
