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Decentralised planning for RCH services, Uttar Pradesh
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Subject Area="Management structures and systems." Objective="Decentralisation."
Details for Reform Option "Decentralised planning for RCH services, Uttar Pradesh"
Summary

Background: The centralised blanket strategy used in UP for the last 50 years in family planning was failing because the use of contraception is an extremely personal issue, interwoven with religion, tradition and societal values. For the strategies to be successful they need to be tailor-made for each district. Action: In March 1998, after four years of planning, SIFPSA (funded by USAID) launched 6 District Action Plans (DAPs) which would involve all stakeholders from the public and private sectors in decentralised participatory planning using an integrated approach (ie using all resources available in the district). They conducted baseline surveys, workshops and a census of facilities in the districts. The districts set their own objectives and evolved strategies. Each plan was implemented by a district level registered society chaired by the district magistrate and called the District Innovations in Family Planning Services Project Agency (DIFPSA). DIFPSA included representatives from the public and private sectors and is supported by the Project Management Unit (PMU) which monitors the programme and reports back to SIFPSA. The objectives were to: •Facilitate access to reproductive health services (through RCH camps). •Improve quality of reproductive health services (through skill development programmes for health workers). •Generate demand for reproductive health services (through communication campaigns). Strategies also included: •Gaining the support of religious leaders and village heads. •Involving the non-governmental sector including Private Voluntary Organisations (PVOs) and cooperatives, identifying potential partners for project implementation, assisting in formulating projects and monitoring of project implementation on a regular basis. Results: After the first year an assessment was carried out by an external agency POLICY Project. USAID has also carried out an evaluation. They found: •Average increase in Contraceptive Prevalence Rate (CPR) of 1.2% per year in DAP districts. •Increase in sterilization (per 1000 population) from 19.8 (1997-98) to 30.3 (2002-03) – compared to 23.5 in non-SIFPSA districts. •Decrease in population growth by 3.33 % compared to an increase in 0.25 % in non-SIFPSA districts (from 2001 Census conducted February 2001).

Cost Total costs for Varanasi district ranged from INR 26,189,886 (€464,000) in 1998-99 to INR 10,288,900 in 2000-01. Total costs of Mirzapur district ranged from INR 10,266,850 in 2001-02 to INR 7,945,950 in 2003-4.
Place Thirty eight districts in Uttar Pradesh, from 1998. Six were added 1998-99, 9 between 2001 and 2002, 18 between 2002 and 2003 and 5 in 2003 and 2004.
Time Frame Four years from programme conception to implementation of DAPs. It took almost one year to develop the DAPs through the participatory process. One year to implement the DAP model.
Advantages

Participation: DAPs help reverse the management process from a ‘top-down’ approach to a truly participatory one. Responsive: Local needs are identified and ‘fed forward’ to project management at the central level, making the system more responsive to local priorities and concerns. Increased sense of ownership: By the community and by stakeholders who are involved at all stages of the planning and implementation bringing a greater level of commitment to the programme.

Challanges

Time consuming: It took four years to develop and implement the DAP model. Management intensive. Government cooperation needed: Greater integration with government public health system is required.

Prerequisites

Cooperation of state government. Readiness of NGOs, PVOs, private sector and public sector to work together.

Who needs to be consulted

State government; public health facilities; private sector; NGOs; PVOs; local community.

Risks

Sustainability

Sustainable, provided the funding is there. The development of the DAPs and the creation of the PMUs under the IFPS project has, in effect, resulted in the strengthening of the health and family welfare sector at the district level. It has brought in non-health resources for promotion of family welfare and lays the foundations of a robust management system. As the PMU is a unit outside the health department, it retains flexibility of operation but at the same time is accountable to DIFPSA, thereby ensuring that it does not operate in isolation of the public sector. Such a mechanism makes for long-term sustainability.

Chances of Replication

Good. After the initial pilot in six districts (1998-99), the DAP model of SIFPSA has now been implemented in all 38 districts (where SIFPSA is operating). In addition, seven more DAPs (also known as Decentralised Participatory Plans(DPP)) were set up under the Empowered Action Group Scheme of Government of India between 2004 and 2005.

Comments

SIFPSA found that systems improvement was a more successful way of tackling the problem than by grafting a completely new structure and that participatory planning created ownership. However there needs to be good quality data to highlight client needs and infrastructure gaps and a strong monitoring mechanism in place.

Contact

Submitted By

Clare Kitchen, Research Consultant, ECTA, New Delhi. June 2005.

Status Active
Reference Files
Extract from GP report.doc Extract from Report on Good Practices and their Cost Effectiveness (Reproductive and Child Health) Volume III (GOI, Department of Family Welfare; European Commission) March 2004
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