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India’s RMNCH+A Strategy: approach, learnings and limitations
  1. Gunjan Taneja1,
  2. Vegamadagu Suryanarayana-Rao Sridhar2,
  3. Jaya Swarup Mohanty3,
  4. Anurag Joshi4,
  5. Pranav Bhushan5,
  6. Manish Jain6,
  7. Sachin Gupta7,
  8. Ajay Khera8,
  9. Rakesh Kumar9,
  10. Rajeev Gera10
  1. 1USAID-VRIDDHI (Scaling up RMNCH+A Interventions Project), IPE Global, New Delhi, India
  2. 2USAID-VRIDDHI (Scaling up RMNCH+A Interventions Project), IPE Global, New Delhi, India
  3. 3USAID-VRIDDHI (Scaling up RMNCH+A Interventions Project), IPE Global, Ranchi, India
  4. 4USAID-VRIDDHI (Scaling up RMNCH+A Interventions Project), IPE Global, Chandigarh, India
  5. 5National Aspirational Districts PMU, Ministry of Health and Family Welfare, New Delhi, India
  6. 6Public Health Consultant, Lucknow, Uttar Pradesh, India
  7. 7Maternal and Child Health Division, USAID India, New Delhi, India
  8. 8Child and Adolescent Health Division, India Ministry of Health and Family Welfare, New Delhi, India
  9. 9Policy Planning & SDG Integration, United Nations Development Program India, New Delhi, India
  10. 10USAID-VRIDDHI (Scaling up RMNCH+A Interventions Project), IPE Global, New Delhi, India
  1. Correspondence to Dr Rajeev Gera; gerarajeev{at}gmail.com

Abstract

Building on the gains of the National Health Mission, India’s Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCH+A) Strategy, launched in 2013, was a milestone in the country’s health planning. The strategy recognised the interdependence of RMNCH+A Interventions across the life stages and adopted a comprehensive approach to address inequitable distribution of healthcare services for the vulnerable population groups and in poor-performing geographies of the country. Based on innovative approaches and management reforms, like selection of poor-performing districts, prioritisation of high-impact RMNCH+A healthcare interventions, engagement of development partners and institutionalising a concurrent monitoring system the strategy strived to improve efficiency and effectiveness within the public healthcare delivery system of the country. 184 High Priority Districts were identified across the country on a defined set of indicators for implementation of critical RMNCH+A Interventions and a dedicated institutional framework comprising National and State RMNCH+A Units and District Level Monitors supported by the development partners was established to provide technical support to the state and district health departments. Health facilities based on case load and available services across the High Priority Districts were prioritised for strengthening and were monitored by an RMNCH+A Supportive Supervision mechanism to track progress and generate evidence to facilitate actions for strengthening ongoing interventions. The strategy helped develop an integrated systems-based approach to address public health challenges through a comprehensive framework, defined priorities and robust partnerships with the partner agencies. However, lack of a robust monitoring and evaluation framework and sub-optimal focus on social determinants of health possibly limited its overall impact and ability to sustain improvements. Guided by the learnings and limitations, the Government of India has now designed the ‘Aspirational Districts Program’ to holistically address health challenges in poor-performing districts within the overall sociocultural domain to ensure inclusive and sustained improvements.

  • healthcare service delivery
  • RMNCH+A
  • supportive supervision
  • development partners
  • high priority districts

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Handling editor Soumyadeep Bhaumik

  • Contributors GT contributed towards designing the Supportive Supervision intervention, tested the implementation of the mechanism, drafted, reviewed and finalised the manuscript. He advised data analysis and coordinated the inputs from all the authors. VSS conceptualised the Supportive Supervision data analysis tool, coordinated its development and undertook data analysis and interpretation. JSM facilitated the intervention on ground, supported the development of the resource package for the intervention and drafting of the introduction and discussion sections. AJ facilitated the intervention on ground and supported the drafting of the methodology and results sections. PB cleaned, managed and analysed the data and coordinated with the various stakeholders involved in the implementation of the mechanism. MJ drafted and edited the manuscript and undertook data analysis and interpretation. SG reviewed and edited the manuscript and supported the development of the technical package for the intervention. AK conceptualised the scope of the strategy and the Supportive Supervision intervention and contributed to critically reviewing the manuscript. RK was associated with the conceptualisation of the RMNCH+A strategy and approach, providedoversight and guidance during implementation and reviewed the manuscript. RG contributed to design and development of the intervention, provided inputs into the data management and analysis sections and also critically reviewed the manuscript.

  • Funding This work was made possible by the support of the American people through the US Agency for International Development (USAID) and its VRIDDHI–Scaling Up RMNCH+A Interventions Project, implemented by IPE Global under the terms of Cooperative Agreement No AID-386-A-14-00001.

  • Disclaimer The contents of this paper are the responsibility of IPE Global and do not necessarily reflect the views of USAID.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The authors state that the current article describes a programmatic intervention: the RMNCH+A Strategy across the 184 High Priority Districts (HPD) of the country after approval from the Ministry of Health and Family Welfare, Government of India. As this strategy was limited to improving service delivery mechanisms and was a national government-led initiative no ethical clearance was sought before implementation of the intervention.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data generated or analysed during this study are included in this published article (and its supplementary information files: online supplementary file 1–RMNCH+A Supportive Supervision Checklist and online supplementary file 2–Supportive Supervision data set).

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