Implementation framework for Healthy Ageing in India

Working on Multi-Sectoral Engagement in Healthy Ageing – translating priorities for Decade of Healthy Ageing (2020-2030) into action. The project included designing of implementation framework for multi-sectoral engagement for healthy ageing and that allows all relevant sectors to synergize their roles and contribute in a coordinated manner towards ‘Decade of Healthy Ageing’.

Key Achievements 

  • Gathered inputs on specific needs of various socio-economic-cultural-geographical subgroups of elderly
  • Garnered commitment from different stakeholder groups for mainstream healthy ageing into their mandates
  • Formulated an implementation framework for multi-sectoral engagement of health and non-health sectors.
  • Multi-stakeholder involvement to streamline healthy ageing policies in India. 
  • Mainstream Healthy Ageing into the national development agenda.

National Dissemination of Operational Frameworks of Women’s Children’s, and Adolescent’s Health

The project involved supporting the WHO Country Office (CO) to organize the National Dissemination and Advocacy Workshop and facilitate the process of developing an operational plan/framework for the India Strategy for Women’s Children’s, and Adolescent’s Health (I-WACH) through a consultative process with key stakeholders. 

Key Achievements

  • Carried out a desk review and analysis of policies related to Global Strategy for Women, Children and Adolescents 
  • Developed a plan of action with MOHFW and WHO-CO  
  • Organized expert group meetings and convene consultation 
  • Prepared a draft operational plan/ framework for the I-WACH 
  • Successfully organized the national dissemination meeting
  • Developed an operational plan/framework for I-WACH

Action Plan on implementation of WHO Standards for the Family of International Classification

The project is about the assessment of implementation status of World Health Organisation (WHO) Standards for the Family of International Classification (WHO-FIC) of Mortality, Morbidity, Functionality, Disability, and Clinical Intervention in India. The usage of the WHO-FIC is to enable coding of health data which would allow for advanced epidemiological analysis of country’s health data. 

With better statistics, the health policy and planning for the country can be further improved. The project was awarded to SCHOOL by WHO India Country Office. The project duration is January 2021 to June 2022. The assessment was carried out in two selected districts namely Faridabad in the state of Haryana and Raipur in the state of Chhattisgarh.  The project was also supported by Central Bureau of Health Intelligence (CBHI), who is the collaborating centre from India to support the implementation of WHO-FIC in the country.

Key Achievements:

10 healthcare facilities (2 Primary Health Centres, 2 Community Health Centres, 2 District Hospitals, 2 Private Medical Colleges, and 2 Government Medical Colleges) 5 each from the two district sites were assessed. Assessments were done by observational method within these facilities to understand the implementation status of WHO-FIC coding.

 

  1. A total of 69 in-depth interviews (IDIs) (state and district level officials, head of medical institutions, doctors, nurses, paramedics and other staff) have been conducted across the two states. 
  2. 102 Medical Certification of Cause of Death (MCCD) forms, and 252 discharge summaries have been assessed within the 10 healthcare facilities, to understand the quality of healthcare data, and the utilization of WHO-FIC coding.
  3. A total of 60 clinical staff, of which 30 are doctors and 30 are nurses, were surveyed to know their knowledge/ capacity on WHO-FIC coding, and their current perception and utilization of WHO-FIC codes.
  4. 10 maps have been developed to understand the processes for the healthcare facilities assessed to map the process of data generation, collation, WHO-FIC coding, and reporting.
  5. Currently the Final report for the WHO-FIC and the Strategic action plan for the country to successfully implement and strengthen WHO-FIC coding of health data is under development.

Analysis of Ayushman Bharat-Health & Wellness Centres and Documentation of Essential Health Services COVID-19

The project aimed to assess the operational status of nearly 30,000 HWCs through data analysis at national and state levels of critical indicators related to the delivery of essential services and coverage of the population. During the process, SCHOOL engaged with WHO officials of the Ministry of Health and Family Welfare. The report compiled guided the strategy for operationalizing nearly 1.2 lakh HWCs across 28 stets and 8 union territories of India. 

 

Key Achievements 

 

  • Assessment of 1.2 lakh HWCs across 28 states and 8 union territories of India to understand the quality of healthcare services, and impact of COVID-19 on the services
  • Identification of best practices, and recommendations for improving healthcare services

Comprehensive Health Data Model and its Implementation in Smart Cities

The WHO Country Office for India provided technical support to Smart Cities Mission (SCM) for developing multi stakeholder health data model and a digital platform for Smart Cities that incorporates essential features required to improve the health of urban citizens as part of Smart Solutions. 100 cities have been identified under SCM across the country and the initiative provides an opportunity to create a health-supportive environment that includes clean and safe physical environments of high quality. 

Key Achievements 

  • Landscape analysis of the existing health and health-related data for mapping key urban health indicators at local level
  • Developed and implemented SOPs for data collection and linking datasets with dashboard. 
  • Co-ordinated and provided structured feedback to line ministries/departments for developing a dashboard for SCM.
  • Data model initially entailed conducting landscape analysis of existing data information on health and environmental services being made available by various sectors

Assessment and Advocacy Support for Nurturing Care Framework

The project focused on assessing the Nurturing Care Framework for Early Childhood Development for implementation on a national level. The overall objective of the assignment was to assess the preparedness of the key stakeholders in terms of implementation of the framework and make suitable recommendations for advocacy and action. 

Key Achievements 

  • Mapping of existing national legislation, policies, programmes, national capacity and committed resources (including budget) supporting Nurturing Care for ECD across various sectors
  • Assessed accessibility to intervention for children aged 0-3 years, including caregiver empowerment approaches, delivered by various sectors like health, nutrition, social welfare, education, and others. 
  • Undertook stakeholder analysis and assessed the role played by stakeholders (WHO and partners) in development and implementation of national multi-sector roadmap. 

Documenting the Journey of Maternal Health Services in the Country

he aim of the project was the prepare a report to document the journey of midwifery services so far and develop a technical research paper on the efforts undertaken on promotion of the services and changing policy perspective in the country. A concurrent documentation on the learnings from various quality improvement initiatives undertaken for maternal health in the country which can be scaled up was also included. 

Key Achievements 

  • Documented the pathway of the growth of midwifery services in the country, historical journey of the services in the country and current status
  • Identified key milestones in the development of midwifery services, efforts undertaken for promotion of midwifery cadre and the policy perspectives supporting them.
  • Documented key learnings from various quality improvement initiatives underway in improving maternal health services in the country by partner agencies and ministry of health under LaQshya program).
  • Collated and developed a ready reference on the different quality improvement programs being implemented across the country by the partner agencies from improving quality, equity and dignity for intrapartum care

Documenting the State of Mothers in India

The project focused on preparing a technical report and research paper for peer reviewed publication that would highlight the existing evidence, implementation status of programs, innovation, and best practices through an analysis of health systems and policies from the perspective of maternal care.

The creation of the report aimed to help the country in developing key strategies for improving maternal health and align it with the country objectives as outlined in the Global Strategy for Women, Adolescents and Children. It also aimed to identify roadblocks to reduce maternal mortality in the county and help advocate for stakeholders to mainstream the agenda for Ending Preventable Maternal Mortality (EPMM) and maternal health related SGD targets in to their respective programmes. Key Achievements

Researched and documented the existing evidence on programs, initiatives, policies, and practices undertaken for providing or improving maternal health care services.

Prepared two technical papers highlighting: State of mother in India and providing continuum of care for mother in the country under the perspective of ensuring QED (Quality, Equity, Dignity) Health systems and maternal care in India

Technical Support during the COVID-19 Pandemic

The project focused on providing technical support to WHO India for patient safety, emergency response on COVID-19 and quality of health services for advancing universal health coverage. 

The objective of the project was to support and facilitate WHO in data analysis and to develop an analytical report on evolution of health and wellness centres in the country. The SCHOOL team worked with the Ministry of Health and Family Welfare to prepare policy briefs and speeches as needed, and to draft ready to submit manuscripts, reports, and other related documents on patient safety and quality of care for publications. 

Key Achievements 

  • Provided support for documentation on the progress of HWCs, developing the summary tables for analysis, conducting literature review and draft a report. 
  • Engaged with expert bio-statistician to conduct the analysis of data 
  • Facilitated the visits of identified subject experts to state and field level to conduct assessments at ground level (as visits to validate findings from analysis of data shared by MoHFW) 
  • Coordinated with the support meetings of experts, by supporting their travel and conducting these meetings. 
  • Facilitated the drafting, finalization and copy editing of the report before finalization.

WHO-SEARO Country Survey on Positive Pregnancy Experience

The WHO-SEARO Country Survey reviewed the status and adaptation of “2016 WHO recommendations on antenatal care, intrapartum care, and postnatal care for a positive pregnancy experience”. The project focused on mapping the current status of policies in India against recommendation and understanding the current status of policy implementation and compilation of relevant health data to evaluate performance. 

 

Key Achievements 

  • Desk review on current implementation of WHO recommended policies for positive pregnancy experience in WHO-SEARO country, specific for India
  • Mapping of how key policies/ recommendations have been implemented in India
  • Achievements made under policies/ recommendations adopted through secondary data research
  • Additional stakeholder consultation to understand implementation status and achievement made (health data)

Developing an Urban Health Equity Framework

The project is about developing an Urban Health Equity Framework for action on urban health equity and indicators appropriate for India. The project was awarded to SCHOOL by WHO India Office and implemented between August to November 2021. 

Under this project an Urban Health Equity Framework for action on urban health equity and indicators appropriate for India was developed through desk reviews of existing reports and work; and city stakeholder analysis and shared with WHO India. 

Prepared compendium/scoping report of existing healthy city network(s) and their current functions to promote health and address inequities.

Also prepared and shared protocol and terms of reference to build Healthy City Network based on reports, findings and interactions with stakeholders

National Multisectoral Action Plan (NMAP)

SCHOOL is contributing to the implementation of the WHO’s Country Cooperation Strategy with the Government of India by supporting the work of the WHO Country Office for India in area of NCDs and comorbidities. As a part of National Multi sectoral action plan, SCHOOL organisation has deployed their resource in the role of a Senior Technical Consultant to WHO to provide technical support to WHO India and Government of India for developing next phase of National Multisectoral Action Plan 2023-2030, aligned with implementation road map 2023–2030 for the global action plan. This involves working in close collaboration with Ministry of Health and Family Welfare (MoHFW), partner organizations, CSOs, stakeholders, multiple ministries and departments namely Ministry of Panchayati Raj for Healthy Village, Ministry of Education, UGC for Health promoting universities index, Ministry of Sports and Youth Affairs for implementation of South East Asian Regional action plan for promoting physical activity, providing technical support to implement recommendations of UN High Level meetings for prevention and control of NCDs, strengthen National multisectoral strategies and development of next phase of action plan to achieve the national NCD targets. SCHOOL shall also be facilitating implementation of various frameworks, guidelines developed for promoting healthy setting approaches (educational institutions, workplaces, cities, villages) through their resource deployed to WHO and will assist in various ongoing cost-effective interventions to reduce NCD risk factors and support states in implementing multisectoral actions. 

Key Achievements (Till 31st Mar 2023)

  1. Consensus building workshop with stakeholders to implement Urban Equity Framework addressing determinants of health in Indian cities.
  2. Submission of first draft of the strategy document of NMAP (2023-2030) to WHO India.
  3. Facilitation for organising a round table consultation meeting chaired by Members of NITI Aayog and programme experts, technical advisors from the specialised UN agencies - WHO SEARO, WHO India, UNICEF and UNESCO organisation.
  4. Documentation of the best international practices in school health programme and recommended interventions from the technical experts from all UN agencies documented and submitted to NITI Aayog.
  5. As a part of assistance to the School Health & Wellness Programme of Ayushman Bharat, part of NMAP, supporting Health promoting schools’ initiative of NITI Aayog through close coordination and engagement with all the thematic experts from WHO SEARO, WHO-India, UNESCO and UNICEF to collate, record the discussions and suggestions, submission of all the supporting documents and knowledge materials to NITI Aayog.

Regional Analysis and Assessment of Older People’s situation during COVID-19

The assessment included understanding the impact of COVID-19 on older people through the dimensions of Gender, Equity, and Human Rights in the South-East Asia Region (Bhutan, India, Indonesia, Thailand and Sri Lanka)

 

The objectives of the regional assessment exercise were accomplished through a combination of desk review of important, relevant documents and key informant interviews of stakeholder consultations. The review of the grey and published literature and existing data sets included: distillation, review and comparative synthesis of existing data and evidence from official global databases and available WHO data, repositories, scientific and grey literature and continental reporting mechanisms. 

 

Key Achievements: 

  • Dissemination of available data on older people during the pandemic in give SEAR member states
  • Critical analysis of COVID-19 mitigation measures that have been implemented by countries including essential health services for older people, gaps and needs to be further addressed by all five member states. 
  • Documenting experiences, good practices and lessons learned that can be shared among other countries. 
  • Propose actions that should be prioritized in context of the UN Decade of Healthy Ageing 2021-2030 for WHO SEARO countries.

National Health Profile 2020 in Collaboration with WHO

The project involved providing technical support in revising the National Health Profile 2020 by updating the existing data, addition of new data points and new data visualizations

 

Key achievements:  

  • Preparation of a draft of NHP 2020.
  • Identification of the data points/key health indicators – both existing and new ones.
  • Organization of consultations with the domain experts regarding proposed draft outline and build consensus on the key health indicators to be incorporated in the final version of NHP 2020.
  • Coordination with the multiple stakeholders for the receipt of data. 

Supporting Patient Safety and Health Services-Related Activities

The project involved providing technical support by assisting WHO India and the MoHFW for coordinating the finalization of operational guidelines for NPSIF and assisting in various activities on and around World Patient Safety Day 2019. Activity reports of expert group consultations were organized for the finalization of the operational guideline. The final draft of the operational guideline for execution of national patient safety implementation framework 2018-2025 was created. 

 

Key Achievements

  • Coordination with experts writing various sections of operational guidelines for NPSIF on behalf of WHO and MoHFW
  • Supporting and facilitating working group sessions, as and when planned to finalise operational guidelines
  • Supporting WHO India focal person for various activities around World Patient Safety Day on 17 Sept 2019
  • Finalisation and formatting of document after inputs and review
  • Preparation of presentations and other notes as needed

Planning and Advocacy for Patient Safety Activities during COVID-19

The project involved providing planning and implementation support for COVID-19 related activities under the aegis of Emergency Response Division of WHO CO. 

 

Key Achievements: 

  • Engagement with 20 national-level organizations and bodies including MoHFW, NHSCRC, and NCDC.
  • Development and implementation of training modules on IPC for National level TOT to create a pool of trainers at state level
  • Training of 100 master trainers from various UN agencies for COVID-19 response.
  • Technical support for formulating various guidelines in-consultation with WHO and MoHFW. These include – Rational use of PPE, Utilization of ambulance to transport COVID-19 suspects/confirm cases, sanitization and disinfection of different settings at the time of COVID-19, Triage at facility level, Home quarantine and facility level isolation, dead body management, SOPs for sanitation workers, Continuity of essential services at the time of COVID, Preparedness of COVID-19 dedicated facilities, Biomedical waste management at COVID-19 facilities, cluster containment plan, guidelines to ensure safer workplaces during COVID-19, Preparedness and response of COVID-19 in urban slums, utilization of disinfectants/ sprays on public, FAQs on COVID-19.