Child and maternal health is still a major problem in India despite strong economic growth over the past 20 years. Many children under five continue to die from vaccine-preventable diseases, malnutrition and diarrhoea caused by inadequate sanitation.
Against this backdrop the Governments of India and Norway launched the Norway India Partnership Initiative (NIPI) in September 2006 to support an existing Indian health programme - the National Rural Health Mission. The initiative runs until 2011 and is focused on five states that account for 40 per cent of India’s population and almost 60 per cent of child deaths: Bihar, Madhya Pradesh, Orissa, Rajasthan and Uttar Pradesh.
NIPI is run by a partnership between the focus states, the government, UNICEF, WHO and UNOPS. The focus states are the key stakeholders in the partnership and NIPI works as a catalyst to help them innovate and pilot new ways of delivering health services.
NIPI funds are not part of the formal state health budget, giving the states the freedom to experiment and test potential interventions on a small and manageable scale before rolling them out as official policy.
Around two million Indian children die before they reach the age of five, as many as half of those die within the first month of life. NIPI has therefore selected the newborn period as its main focus, while recognizing immunization and nutrition as important elements in a holistic approach.
As there can be no safe newborn period without a safe pregnancy and delivery, maternal health is also an integral element. Gender equity is a cross-cutting concern in the project, but also a concrete focus area as both the under-utilization of female health services and the lack of empowerment of mothers impact directly on maternal and child mortality.
UNOPS serves as secretariat for NIPI, runs the 'Child Health Resource Network' and acts as Local Fund Agent for the focus states.
By the end of 2009, using funding channelled through UNOPS, the five states have:
- Increased awareness at state level for child and maternal health issues
- Trained 10,300 ASHAs (Accredited Social Health Activist, a female village-level worker). ASHAs have already visited about 20,000 newborns and their mothers at least four times each - for 2010 that figure is expected to reach 350,000 - against a cash incentive of 4 USD per family visited.
- Placed, trained and financially supported around 75 child and maternal health managers at district and ‘block’ level.
- Opened two Sick Newborn Care Units, with 10 more under construction.
- Trained doctors and nurses for the two units.
- Trained and financially supported 643 Yashodas, local women who give support to nurses, midwives and mothers in maternity wards.
- Supported the establishment and running of the National Child Health Resource Centre in the National Institute of Health and Family Welfare in New Delhi.
- Helped the focus states develop their administrative and financial processes to support the increase in services created by the National Rural Health Mission.
With UNOPS support, the five states are now scaling up several of the interventions, using mainly their own funds. The states have implemented the interventions throughout the process, and so have developed the capacity to take full control at the end of an implementation cycle.