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Border District Cluster Strategy: accelerating the reduction of maternal and child mortality, Gujarat
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Subject Area="Inter-sectoral links." Objective="Improved outreach services."
Details for Reform Option "Border District Cluster Strategy: accelerating the reduction of maternal and child mortality, Gujarat"

Background: Government of India (GOI) has a Border District Cluster Strategy (BDCS) for accelerated implementation of the RCH programme. With the support of UNCEF, BDCS is developing new models and tools to achieve these goals in the poorest districts of the country - two of them are in Gujarat. The purpose of developing such tools is to measure 5 key determinants of the basic services: availability; access; utilisation; effectiveness; adequate coverage. The programme has the following key components: (i) a Minimum Intervention Package including immunisation, Vitamin A supplementation, Ante-Natal Care (ANC), safe delivery, Post-Natal Care (PNC), prevention against nutritional anaemia, newborn care, management of diarrhoea and pneumonia. (ii) The expanded intervention package including Integrated Management of Neonatal and Childhood Illnesses and Safe Motherhood interventions through emergency obstetric care. Action: The BDCS aims to improve general access to quality services by: (i) Increasing human resource capacities to provide preventive and curative primary health care. (ii) Strengthening the role of the supervisors to effectively monitor and manage health workers. (iii) Improving the sub-centres. (iv) Reinforcing the availability and accessibility of essential drugs by improving logistics system. The key approach to greater success is to achieve greater inter-sectoral collaboration between Auxiliary Nurse Midwives (ANMs), Anganwadi Workers (AWWs) and the Male Health Worker (MHW) in the form of a Health and Nutrition Team (HNT). At the same time, micro-planning exercises ensure that sub-centre clinics remain open regularly and their outreach activity to the distant hamlets is improved through mobility support. Key activities included: (i) Information, Education and Communication (IEC) for Healthy Babies: Traditional healers were trained in newborn care at home and timely referral of high-risk pregnant women. In the remote, inaccessible areas, key messages were communicated through folk performances. (ii) Micro-planning for ANC with mobility support from UNICEF ensured better demand for ANCs. (iii) Adolescent Girls Anaemia Control Programme with weekly in-school Iron Folic Acid (IFA) tablets distribution. (iv) Skilled delivery and PNC by ensuring the presence of ANMs at the sub-centres. (v) Formation of a HNT made up of ANM, AWWs and MHW. The HNT ensured necessary ANC and PNC to lactating mother. The ANMs visited the Anganwadi Centres (AWCs) to verify ANC registration. (vi) Formation of Village Health Committees (VHCs) and Self Help Groups (SHGs) to support community mobilisation for routine activities including immunisation and ANC. (vii) Immunisation and Vitamin A supplement. (viii) Collaboration with the forest department for the use of wireless sets and vehicles for maternal and newborn emergencies. Results: (Baseline data is monitored quarterly. The data is collected and validated from sub-centres and the PHCs.) 87 out of 145 sub-centres refurbished. Outreach proportion increased from 75% to 86%. 86% children received BCG and 59% fully immunised in earthquake affected area as compared to 77% and 41% respectively in rural Gujarat Demand of ANC increased in Dangs from 60% in 2001 to 90% in 2002. 50% increase in the number of timely complicated maternity cases admitted as compared to the baseline data. 70% of targeted villages have VHCs formed with 87% have quarterly meetings. 75% of the 377 sub-centres offer daily curative services with three-fold increase in 2002 in number of children treated. Vaccines and Vitamin A supplements availability was 90 % in Valsad district. Improvement in measles vaccines from 73% to 85%.

Cost The budgeted amount for reaching out to two districts in Gujarat for two years is INR 448,550 . Additional funds for the expenditure of existing programmes would be met through funds from the state budget.
Place Dangs and Valsad districts, Gujarat. From 2003 - ongoing.
Time Frame Information not available.

Comprehensive: Sound design of a service package combining reduction of infectious diseases through immunisation with reduction of maternal and infant deaths. Inclusive: Integrated process including national and international financial and technical resources so that advocacy reaches out to the vulnerable groups.


Training needed: Data collection and analysis by the Medical Officers (MOs) needs to be strengthened so that they are able to use it as a supervisory tool. Acceptance essential: Institutionalising the monitoring and evaluation process is an immediate need.


The IEC design tool has to be developed to ensure community empowerment and health awareness.

Who needs to be consulted

State government; PHCs; ANMs; AWCs; the community.



It can be sustained if the supportive supervisory tools are institutionalised and the MOs are able to use its analysis as a supervisory tool.

Chances of Replication

It is being replicated in 19 districts in 7 states. It shows different but, effective, results in all the states.


Sub-centres can provide more effective clinical services with the help of one of the HNT members. Validation of data collected through a peer group increases their understanding of supportive supervision so that mid-course correction can take place.


Submitted By

Sara Joseph, Researcher, ECTA, New Delhi. September 2004.

Status Active
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