DFID Department forInternationalDevelopment

Reproductive & Child Health 2 - India

Infection management & environment

Sean Doolan, DFID India

S-Doolan@dfid.gov.uk

Ruma Tavorath, World Bank South Asia

RTavorath@worldbank.org

November 2004

DFID Department forInternationalDevelopment Outline

National context

RCH2 outline

Para-SEA

Scoping volumes, activities & phasing

WHO & SWAPs frameworks

Integration into outputs & outcomes

Focusing on most vulnerable

Establishing process

DFID Department forInternationalDevelopment Government of India

“Sustainability is not an option but an imperative. … the environment is not to be seen as a stand-alone concern. It cuts across all sectors of development” (Three environmental targets)

GoI Tenth Plan

National Environmental Policy (in prep.)

Constitution of India: Articles 21 (right to life –food, water, environment), 47 (food & health), 48A (protection of environment), 51A (fundamental duties)

Variable capacity, MoEF, CPCB, SPCBs

DFID Department forInternationalDevelopment

Environment MDG -

challenged in India

Ranks 116th of 149 countries in 2002 Environmental Sustainability Index (WEF)

120th of 122 countries for water quality (2003 World Water Assessment)

Environmental degradation costs 4.5-8% GDP (in line with growth)

Natural disasters - 50 million people a year

185 million people living in slums

300 million below $1 a day

Waste management weak

DFID Department forInternationalDevelopment Why environment screening?

Identify and exploit environmental

opportunities e.g. synergies & savings

Identify and manage environmental risks

e.g. historical problems, reputational risks

Ensure that activities are consistent with

policy & international best practice

Bank procedures – do no harm to do good

DFID Department forInternationalDevelopment RCH 2

Sector Wide Approach (SWAp)

Many development partners – DFID,

World Bank, EC, GTZ, USAID, UNICEF,

UNFPA, WHO …

Government of India, Ministry of Health

& Family Welfare (2 departments)

State governments

DFID Department forInternationalDevelopment Why strategic?

Scale - £4.5 billion, 5 years

Like-minded partners? – harmonisation, SWAp

Political will - injection safety, GAVI, AD syringes

Health systems development projects

National Rural Health Mission – new govt

Merging H & FW – single Secretary

Alignment vertical health programmes

Inter-sectoral convergence

DFID Department forInternationalDevelopment Objectives?

Communities utilize and benefit from

responsive, equity-sensitive and quality-

based Reproductive- and Child/Newborn

Health Care services

IMEP underpins RCH 2 operations to deliver

better health outcomes for most vulnerable

groups – meet national legislative

requirements

DFID Department forInternationalDevelopment Methods

Logframe components

WHO tools - www.healthcarewaste.org

Formal appraisal schedule

Working groups

Special studies – linkages, not integration

Consultancy

MoHFW working group

Backstaging & advocacy

DFID Department forInternationalDevelopment Logframe outputs

1. Decentralised

management

2. Training/HR

3. M&E – barriers to

equitable service &

outcomes

4. Gender-sensitive family

planning

5. Maternal health &

institutional deliveries

6. Adolescents

7. New-born &

child health

8. Urban slums

9. Tribal health

DFID Department forInternationalDevelopment Logframe outputs

Planning guidelines & training

Standards for services

Infrastructure

Asset management

Utilities

Procurement & logistics

Immunisation

Infection management policies & strategies

Institutional mechanisms

Training & BCC / IEC

DFID Department forInternationalDevelopment Issues

Immunisation & institutional deliveries

Behaviour change, sharps safety, training

Infection control & quality of care, provision of services

Construction & asset management

Cold chain, utilities, watsan

Immunisation & injection safety

POPs, incineration, distribution

Public private partnerships

Biomedical waste handling rules, compliance

DFID Department forInternationalDevelopment WHO Rapid Assessment Tool

Health care facilities Storage

Staff Collection &

transport

Waste generation Off-site transport

Segregation &

handling

Waste treatment

Containers Final disposal

DFID Department forInternationalDevelopment WHO Rapid Assessment Tool

Policy & regulations Institutions

Policy & budget

Sanitation &

wastewater

Water – drinking &

other uses

Energy

DFID Department forInternationalDevelopment Scoping

63% injections unsafe in India

69% public hospitals

74% immunisation clinics

60% private sector facilities

2 million new Hepatitis B cases a year

400,000 new Hepatitis C cases

30,000 new HIV-positive cases

1.5 million deliveries PHCs, CHCs

DFID Department forInternationalDevelopment Scoping

280 million AD syringes

550,000 outreach sites

2,150 tonnes plastic

615 tonnes needles

1.25 million sq m construction

62,000 tonnes construction waste

2,700 blood storage facilities

DFID Department forInternationalDevelopment Outputs

Infection Management & Environment

Plan

IMEP cross-referenced in PAD, aide

memoires, indicators, studies

Awareness within MoHFW, States,

development partners

Recognition of infection management

Working group established

Process for operational guidance

DFID Department forInternationalDevelopment Successes

Equity focus – worker, ragpicker & patient safety

EAG & NE states

Allocation for HCWM

Needle-cutters for immunisation

Duty of care – healthcare without harm

Growing awareness in Governments

World Bank & DFID partnership

Technical assistance recognition

DFID Department forInternationalDevelopment Successes

Framing in appropriate language

Backstaging

NGO & practitioner linkages

DFID Department forInternationalDevelopment Barriers

Overlapping institutions

Vertical silos

Crowded space to operate

Access to information

Effective linkages

Champions

Not business as usual

DFID Department forInternationalDevelopment Remaining challenges

Sourcing expertise

Participation

Capacity & capacity building

Scale

Supervision

Behavioural change

Institutional linkages