SEMINAR ON ASPIRATIONAL DISTRICTS PROGRAMS.pptx

Aspirational district program is a new initiative by NITI AYOG which was started in 2018

1. ASPIRATIONAL DISTRICTS PROGRAMME Presenter : Dr. Manisha, JR-1 Mentor: Dr. Sudha Bala, Associate professor 1

2. OUTLINE: Introduction Need For the program Selection of districts Critical Components of the program Key focus areas of ADP Stewardship structure Planning for Aspirational districts Best practices SWOC Analysis 2

3. LEARNING OBJECTIVES Framework and Implementation Strategies of ADP Impact and Outcome by Key performing Indicators Best Practices and Challenges 3

4. INTRODUCTION I ndia has achieved the MDG target MMR and recorded 77% reduction from 1990 (556) to 2015 (130). Under-five mortality fell by 66% in the same period. Life expectancy has increased from 33 years in 1947 to 68.7 years in 2015. The country eliminated guinea worm (2000), became polio free in 2014, eliminated yaws, maternal and neonatal tetanus in 2016. Leprosy stands eliminated at the national level moving ahead to eliminate kala-azar, lymphatic filariasis, leprosy and malaria. 4

5. However, inequities in health outcomes continue to persist across states and districts. Though there have been such achievements for about 3 decades, the country lags behind on the HDI. Contributing factors for this includes poor physical resources, lack of infrastructure networks, poor co-ordination between various sectors, low standards of health, nutrition, education and skill and above all years of Poverty. To address this problem district of least progress have been identified. 5

6. The Prime Minister emphasized that instead of stamping these districts as backward districts hence forth they would be called “ASPIRATIONAL DISTRICTS”. T he GOI has launched the ‘Transformation of Aspirational Districts’ initiative in January 2018 in 115 districts with a vision of a New India by 2022 by improving India’s ranking under HDI , raising living standards and ensuring inclusive growth of all its citizens. 6

7. NEED FOR THE PROGRAM 7

8. C ountries have relied heavily on traditional measures of economic development like the GDP to define success. However, India has not been able to fully transform its remarkable economic success into social development. According to Social Progress Imperative, India’s rank on Social Progress Index remained constant from 2014 to 2018 at 103rd position with a marginal increase of 2.1 in its score. 1. Moving beyond economic measures of success The Transformation of ASPIRATIONAL DISTRICTS PROGRAMME makes an attempt to address this short Coming by Monitoring performance on the essential elements that define a Good Society like Health, Education, and basic Infrastructure. 8

9. 2. Enabling Equitable Regional Development M aternal mortality ratio is 19 per 1,00,000 live births in Kerala vs 195 per 1,00,00 live births in Assam. The district level social progress index (presented in Figure) that measures the performance of districts across 12 facets of social progress including healthcare, education, personal rights etc. clearly highlights this disparity that exists within Indian districts 9

10. THE TRANSFORMATION OF ASPIRATIONAL DISTRICTS PROGRAMME IS A SIGNIFICANT STEP TOWARDS ADDRESSING THE REGIONAL DISPARITIES ACROSS THE INDIAN LANDSCAPE. Even states with high per capita GDP such as Maharashtra have some districts in the bottom tier, implying that having a high GDP doesn’t translate into high social progress. 10

11. 3. Driving Change through Cooperative and Competitive Federalism The districts are encouraged to strive for excellence by catching up with the best district within their state and then aspiring to become one of the top-performing districts in the country. This is fostered through a spirit of competitive and cooperative federalism, where districts learn from and compete with each other. THE TRANSFORMATION OF ASPIRATIONAL DISTRICTS PROGRAMME IS DRIVEN BY A SPIRIT OF COMPETITIVE FEDERALISM TO ENCOURAGE DIFFERENT GEOGRAPHIES TO WORK TOWARDS A COMMON GOAL OF DEVELOPMENT 11

12. Objectives of Aspirational Districts Programme To identify  A spirational district , identifying  easily achieving targets  for immediate improvement and measuring progress by ranking districts on a monthly basis. Improve the  living standards of the citizens  living in aspirational districts and ensuring inclusive growth for all through the motto “ Sabka Saath Sabka Vikas aur Sabka Vishwas”. To make aspirational districts  compete with the best district  within their state, and subsequently aspire to become  one of the best in the country  by following the spirit of  competitive & cooperative federalism . 12

13. SELECTION OF DISTRICTS The initial 115 districts were identified from 28 states Ministry of Home affairs – 35 districts ( LWE affected areas) Central ministries of GOI – 55 districts ( Severe deficiency in areas) NITI Aayog – 25 districts Districts were ranked based on the composite Index derived from Indicators of Core sectors like poverty, health and nutrition, education, and basic infrastructure 13

14. Sl No. Indicator Source Sector Weightage 1 Landless household dependent on Manual Labour SECC D7 Deprivation 25% 2. Ante Natal Care     NFHS - IV Health and Nutrition 7.50% 3. Institutional Deliveries 7.50% 4. Stunting of children below 5 years 7.50% 5. Wasting of children below 5 years 7.50% 6. Elementary Drop-out Rate U-DISE 2015-16 Education 7.50% 7. Adverse pupil teacher ratio 7.50% 8. Unelectrified household       Ministry data     Infrastructure 7.50% 9. Household without individual toilet 7.50% 10. Un-connected villages under PMGSY 7.50% 11. Rural Household without access to water 7.50% 14

15. STATE DISTRICT Andhra Pradesh Alluri Sitharamaraju , Parvathipuram Manyam , Y.S.R. Arunachal Pradesh Namsai Assam Baksa, Barpeta, Darrang, Dhubri, Goalpara, Hailakandi, Udalguri Bihar Araria, Aurangabad, Banka, Begusarai, Gaya, Jamui, Katihar, Khagaria, Muzaffarpur, Nawada, Purnia, Sheikhpura, Sitamarhi Chhattisgarh Bastar, Bijapur, Dakshin Bastar Dantewada, Kondagaon, Korba, Mahasamund, Narayanpur, Rajnandgaon, Sukma, Uttar Bastar Kanker Gujarat Dohad, Narmada Haryana Mewat Himachal pradesh Chamba Jammu & Kashmir Baramula, Kupwara Jharkhand Bokaro, Chatra, Dumka, Garhwa, Giridih, Godda, Gumla, Hazaribagh, Khunti, Latehar, Lohardaga, Pakur, Palamu, Pashchimi Singhbhum, Purbi Singhbhum, Ramgarh, Ranchi, Sahibganj, Simdega, Karnataka Raichur, Yadgir LIST OF ASPIRATIONAL DISTRICTS 15

16. STATE DISTRICT Kerala Wayanad Madhya Pradesh Barwani, Chhatarpur, Damoh, Guna, Khandwa, Rajgarh, Singrauli, Vidisha Maharashtra Gadchiroli, Nandurbar, Washim, Osmanabad Manipur Chandel Meghalaya Ribhoi MIZORAM Mamit Nagaland Kiphire Odisha Balangir , Dhenkanal, Gajapati , Kalahandi, Kandhamal, Koraput, Malkangiri, Nabarangapur , Nuapada , Rayagada   Punjab Firozpur, Moga Rajasthan Baran, Dhaulpur, Jaisalmer, Karauli, Sirohi Sikkim Soreng Tamil Nadu Ramanathapuram, Virudhunagar Telangana Asifabad (Adilabad), Bhoopalapalli (Warangal), Khammam Tripura Dhalai Uttarakhand Hardwar, Udham Singh Nagar Uttar Pradesh Bahraich , Balrampur , Chandauli , Chitrakoot , Fatehpur, Shrawasti , Siddharthnagar , Sonbhadra 16

17. CRITICAL COMPONENTS OF THE PROGRAM (THE 3C APPROACH) CONVERGENCE COLLABORATION COMPETITION 17

18. Key Focus Areas of ADP ADP MONITORS 81 DATA POINTS FOR 49 INDICATORS 18

19. Thematic Area Weightage Indicators Health & Nutrition 30% 13 indicators covering ANC, PNC, health of new – borns , growth of children, contagious diseases, and health infrastructure. Education 30% 8 indicators covering learning outcomes, infrastructure (toilet access for girls, drinking water, electricity supply) and institutional indicators (Pupil-teacher ratio, timely delivery of textbooks). Agriculture & Water Resources 20% 10 indicators , covering outputs (yield, price realisation etc.), inputs (quality seed distribution, soil health cards), and institutional support (crop insurance, artificial insemination, animal vaccination etc.) Financial Inclusion & Skill Development 10% 6 indicators such as central government schemes (Atal Pension Yojana, Pradhan Mantri Jeevan Jyoti Bima Yojana etc.), reach of institutional banking (Jan Dhan Yojana), and institutional financing for small businesses (Mudra loans). Skill development has 5 indicators tracking the skilling of youth, employment, and the skilling of vulnerable/marginalized groups. Infrastructure 10% Infrastructure has 7 indicators that include household toilets, drinking water, electricity, and road connectivity. 19

20. S. NO. INDICATORS WEIGHTAGE 1.1 Percentage of pregnant women (PW) receiving four or more antenatal care (ANC) check-ups against total ANC registrations 0.6 1.2 Percentage of ANC registered within first trimester against the total ANC registrations 0.9 1.3 Percentage of PW receiving four or more ANC check-ups against total ANC registrations 0.9 2 Percentage of PW taking supplementary nutrition under the ICDS program regularly 0.9 3.1 Percentage of PW having severe anaemia treated against PW having severe anaemia tested cases 1.5 3.2 Percentage of PW tested for Haemoglobin 4 or more than 4 times for respective ANCs against total ANC registration 1.2 4.1 Sex ratio at birth 0.9 4.2 Percentage of Institutional Deliveries out of total estimated deliveries 1.2 5 Percentage of home deliveries attended by an SBA trained health worker out of total home deliveries 0.9 6.1 Percentage of new borns breast fed within one hour of birth 1.2 6.2 Percentage of low-birth-weight babies (Less than 2500 gms ) 0.9 6.3 Proportion of live babies weighed at birth 0.9 7 Percentage of underweight children under 5 years 2.1 8.1 Percentage of stunted children under 5 years 0.6 8.2 Percentage of children with Diarrhoea treated with ORS 0.6 20

21. 8.3 Percentage of children with Diarrhoea treated with Zinc 0.6 8.4 Percentage of children with ARI in the last 2 weeks taken to a health facility 0.6 9.1 Percentage of Severe Acute Malnutrition (SAM) 1 9.2 Percentage of Moderate Acute Malnutrition (MAM) 0.5 10.1 Breastfed children receiving adequate diet (6-23 months) 1 10.2 Non-Breastfed children receiving adequate diet (6-23 months) 0.5 11 Percentage of children fully immunized (9-11 months) (BCG+ DPT3 + OPV3 +Measles1) 3 12.1 Tuberculosis (TB) case notification rate (Public and Private Institutions) against estimated cases 0.75 12.2 TB Treatment success rate among notified TB patients (public and private) 0.75 13.1 Proportion of Sub centres/PHCs converted into Health & Wellness Centres (HWCs) 1.8 13.2 Proportion of Primary Health Centres compliant with Indian Public Health Standards 1.5 13.3 Proportion of functional FRUs (First referral units) against the norm of 1 per 5,00,000 population (1 per 3,00,000 for hilly terrain) 0.45 13.4 Proportion of specialist services available in District hospitals against 10* core specialist services 0.6 13.5 Percentage of Anganwadi’s centres/Urban PHCs reported to have conducted at least one Village Health Sanitation & Nutrition Day/Urban Health Sanitation & Nutrition day/respectively in the last one month 0.6 13.6 Proportion of Anganwadis with own buildings 0.6 13.7 Percentage of First referral units (FRU) having labour room and obstetrics OT NQAS certified ( ie meet LaQShya quidelines ) 0.45 21

22. NITI Aayog in collaboration with the Planning Department, Government of Andhra Pradesh has created a dashboard “Champions of Change”, where 81 data-points are tracked regularly. Based upon their entry, they are ranked based on progress made on a real-time basis. There are two types of ranking that emerge from this database: Delta Ranking – Which captures the change in districts ranking over time and are shown on the dashboard and are published as Regular reports by NITI AAYOG. Baseline Ranking – Which captures the district performance compared to the baseline year and was published as a comprehensive report by NITI AAYOG. RANKING 22

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25. District Performance (Overall) Since Inception (Apr 2018) 25

26. District Overall Performance Based on Monthly Delta Ranking 26

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28. STEWARDSHIP STRUCTURE 28

29. PLANNING FOR ASPIRATIONAL DISTRICTS Situational analysis Health action plan Monitoring and sustenance Implementation of Strategies 29

30. Health situation needs to be analysed totality in terms of h ealth systems approach as follows: Health services Accessibility to Health Services Quality of Services (Means of verification) Essential Medicines and Logistics Health Workforce Health Information Systems Health Finance Leadership and Governance Situational analysis 30

31. 1. Health services A. Accessibility to Health Services Institutional delivery rate and immunization coverage - to identify blocks with poor reach of health services. Average trips per day and distance covered - for efficient functioning of the referral transport system. 31

32. B. Quality of Services Rapid assessment of quality of services in key areas of RMNCH+A, NCDs, and CDs including TB etc. KAYAKALP and NQAS assessment - to identify the service delivery related gaps. LaQShya assessment for all high case load facilities. Patient feedback - Mera Aspatal, MCTFC reports and Grievance redressal desks etc . 32

33. 2. Essential Medicines and Logistics Current status in implementation of free drugs and diagnostics initiative. Assessment of District Drug store for infrastructure and HR related gaps. 33

34. 3. Health Workforce Human resource availability v/s requirement Assessment of vacancy status of ASHA and ANM Health facilities assessment - IPHS checklists Key areas of capacity building - SBA, NSSK, PPIUCD, Injectable Contraceptive, BEmOc, EmOC, Dakshata, SNCU staff, RNTCP, CPHC, NCD screening, ASHA etc. as per guidelines. 34

35. 4. Health Information Systems Status of roll out and issues IT platforms like RCH portal, HMIS, DVDMS, FP-LMIS, E-Vin, Nikshay , etc. Gaps in HMIS, RCH and other data systems Availability of data entry operators and their continuous capacity building in line with the programmatic changes. 35

36. 5. Health Finance Assessing whether adequate finances have been provisioned to ensure quality health services in the first place. Exploring the scope of funding and rational use of finances for cost effective interventions. Status of utilization of NHM funds under various budget head and reasons for low utilization, if any. Implementation status of PFMS and DBT under various national health schemes . 36

37. 6. Leadership and Governance Frequency of review meetings at state, district and block levels. Status of inter-departmental meeting and joint action plan with line departments. 37

38. Health action plan The main aim of planning is to prepare a District Health Action Plan. Planning with respect to health system blocks can be done as follows A. Service Delivery Various strategies to strengthen the health service delivery are: • Mapping the available facilities (both public and private). • Mapping the available services within the facilities. • Strengthening the existing services. • Increasing access to widened scope of special services. 38

39. B. Human Resource A few strategies to achieve optimal human resource at facilities and at community level : • Rational and need based deployment. • Training of MBBS doctors on Multitasking such as EmOC, LSAS, IUCD/PPIUCD. • Bridge course for midlevel service providers. • Use of NHM flexibility norms to hire specialists. • Incentives for difficult and hard to reach area 39

40. C. Information Systems It is important to ensure the timeliness, completeness and correctness of information systems like HMIS and MCTS/RCH Portal. Review and Monitoring of programmes should be conducted by the districts strictly on HMIS data Filling of vacant positions of data entry operators with regular capacity building. 40

41. D. Finance Resources In addition to the funds allocated through the NHM PIP, other sources of funding can also be utilized, i.e. State budget. DM Flexipool. District Mineral fund. District Tribal fund. Minorities development funds. CSR funds etc. 41

42. Implementation for improving Indicators Maternal health Anemia Newborn health Child health and Nutrition Immunization 6. Family Planning 7. Adolescent health 8. RNTCP 9. HWCs 10. VHSND H igh impact interventions have been identified to all the important NITI Aayog indicators pertaining to health sector in the following areas: 42

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44. Sustainability To maintain the effectiveness of interventions in Aspirational Districts, it is crucial to continuously monitor key indicators and provide ongoing guidance and support to field staff through regular supervision. Key action points • Monthly review meetings - under the Chairmanship of DM. • Fortnightly review meetings - at the level of respective CMHOs. • Weekly review - at the block level by Block Medical officer. • Documentation of all the review meetings with action taken report and strategy plan should be maintained. 44

45. ROLE OF DEVELOPMENT PARTNERS Key Action points : Conduct rapid gap analysis of health facilities based on health system building blocks. Provide support in preparation of District Health action plan. Provide monitoring support to district, participate in monthly meetings and share the progress and issues related to NITI Aayog indicators with CMHOs and DM. Support District CMHO in implementation of all key NHM interventions to improve the overall health services in the district. 45

46. Impact of ADP attaining the SDGs The NITI Aayog's SDG India Index report 2019 highlighted that several ADP indicators closely align with the SDG goals: Goal 3 (Good Health and Well-being), Goal 4 (Quality Education), Goal 8 (Decent Work and Economic Growth), Goal 9 (Industry, Innovation, and Infrastructure), Goal 10 (Reduce Inequalities) 46

47. BEST PRACTICES ENGAGEMENT OF BIKE AMBULANCE, AUTO AMBULANCE AND DELIVERY VAN TO PROMOTE INSTITUTIONAL DELIVERIES. District: Kandhamal in Odisha HEALTH AND NUTRITION HOSTELS FOR PREGNANT TRIBAL WOMEN District: Vizianagaram in Andhra Pradesh CENTRALISED KITCHENS FOR BETTER NUTRITION District: Nandurbar in Maharashtra KALPANA PROGRAMME FOR BETTER HEALTH District: Dhenkanal in Odisha 47

48. S TRENGTH Focusing on Deserving Regions Cooperative Federalism Competitive Federalism Resource Efficiency Real–time Data Tracking W EAKNESS Coordination Issue Delta Ranking Public Involvement O PPOURTUNITY Independent Studies  Motivation Realignment   C HALLENGES Insufficient Focus  Lack of human resource SWOC ANALYSIS 48

49. ASPIRATIONAL BLOCKS PROGRAMME T o improve the  performance of blocks  that are lagging on various development parameters. C overs  500 districts across 31 states and Union Territories , M ajority of them in the states of Uttar Pradesh, Bihar, Madhya Pradesh, Jharkhand, Odisha and West Bengal. Aspirational blocks are  geographically remote and backward and receive poor rainfall. They are drought-prone and susceptible to many uncertainties. The Aspirational Blocks Programme is similar to the  Aspirational District Programme , except that it is implemented at block level .  49

50. REFERENCES DK Taneja’s Health Policies and Programmes in INDIA SPI: An assessment of Aspirational District Program Operational Guidelines For Improving Health and Nutrition Status in ASPIRATI ONAL DISTRICTS ASPIRATIONAL DISTRICTS PROGRAMME: AN APPRAISAL www.iasbook.com/social-progress-index-spi/ Social Progress Index (SPI) - IAS Book https://pwonlyias.com/aspirational-districts-programme-niti-aayog/ BEST PRACTICES (ASPIRATIONAL DISTRICTS) AN ASSESSMENT OF THE ASPIRATIONAL DISTRICTSPROGRAMME 2.O Transformation of aspiration district: Baseline ranking and real time monitoring Dash board 2018 50

51. THANK YOU 51