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levels; activities not sufficiently influenced by causal thinking and strategic planning;
competing, sometimes chaotic priorities; bureaucratic and political impatience; and
most failures relating to professional leadership at middle levels where supervision
was poorly informed, focused, organised and supported. Based on these findings, a
programme strategy was developed through INHP.
Title of project: Integrated Nutrition and Health Project (INHP)
Duration:1996-2010
Implementing Agencies: USAID, BMGF
Coverage: 8 states, 100-250 million population, mainly ICDS (outreach preventive
services); Bihar, 30-100 million population, both Health and ICDS (outreach and facility)
Objectives
To provide catalytic technical support at operational levelscovering MMR, NMR,
malnutrition, TFR, FIC
Programme Implementation
The two arms of the programme were:
i. Outreach services strengthening (RMNCHN) through behaviour change and
service coverage.
ii. Strengthening access and QoC in facilities for maternal, newborn and FP.
The programme demonstrated simple, doable solutions which included incremental
hands-on learning, improved supervisory interactions, tools, generation and use of
relevant data, quality improvement; better interpersonal communication by ASHA, AWW
using existing supervisory interactions between ANM-ASHA at VHSND; LS-AWW at
sector meetings and field visits; MoIC/BHM-ANM in weekly (Tuesday) meetings; Block
officials-FLWs at monthly meetings. All activities were marked by ad hoc priorities with
short-term activity focus; were limited to FP-immunization-SNP; marked by lack of
strategic vision or plan, poor coordination, low self-esteem and low respect for each
other. There was no focus on behaviour change, making it difficult for the programme
to show results.
Results
• y Seven monthly rounds completed since April involving 2500 sub-centres across
137 blocks in 8 districts.
• y 60-70% participation of ASHA and AWW in sub-centre meetings.
• y 20% ANM ‘taking over’; 50% actively participating; ANM present in over 90% SC
meetings.
• y High level of acceptance at all levels in both programmes; state interested in
using same approach for content beyond RMNCHN.
• y Expecting early results on home visits, behaviour change by Jan 2013.
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Consultation on Supportive Supervision to Strengthen
Capacity of Frontline Workers and Service Providers