Bihar with a population of 104 million is the second most populous state in India, next only to Uttar Pradesh. The state is densely populated with 880 persons per square kilometer as against the country average of 324. The sex ratio of the state at 916 females per 1000 males is also less favorable than the national average of 940 females per 1000 males. The state has 9 divisions, 38 districts, 101 sub divisions, 533 blocks and 45,098 villages. All key health indicators in Bihar are below the national average. Increasing fertility, lack of improvement in antenatal care and worsening of under-nourishment amongst children are key areas of concern. In other areas there is improvement, albeit very minimal.
Despite efforts in the last few decades to stabilize population growth, the state’s population continues to grow at a much faster rate than the national population.
Status of Family Planning & Public Health System in Bihar
Using data from all three rounds of the National Family Health Survey, a study examined the trends and determinants of unmet need for family planning in the state of Bihar. It found about 25% of the currently married women, aged 15 - 49 years, have an unmet need for family planning services, 11% for spacing and 12% for limiting. Only 18% of total demand for spacing methods is met compared to about 72% of total demand for limiting methods. The unmet need for family planning among Muslim (32%), rural (24%) and adolescent (36%) and poor women (26%) is relatively higher than other groups.
To address these two major areas of concern - huge unmet need for family planning especially in rural areas and inadequate service provision at government health facilities - Janani decided to extend its Outreach Family Planning Services to some of the high priority districts in Bihar.
To address these issues and bridge the gap Gates Foundation in collaboration with MSI and Janani started an Innovative Model to provide outreach FP services in the Public sector facility. This program is totally handholding the Public sector service delivery facility in terms of quality of care services, to provide additional support in form of Human resource, Equipments and other logistic needs to conduct quality outreach FP services. The Bihar Outreach Project in district of Katihar, Samastipur and Siwan kicked off on 26th November 2014.
The Janani Model of Bihar Outreach FP Services Janani Outreach services are conducted on the request of the DHS. The Outreach team which comprises of one doctor, one anesthetist, two nurses, two female attendants, two male attendants, one counselor, one OT assistant, one lab technician, is based at the Janani – Owned (Surya) Clinic (JOC) of the respective district.
Each district where Janani operates a Surya Clinic, we have an Outreach team which has a medical and equipment kit that it carries to every camp site. The kit includes all the necessary equipment, supplies, medicines, etc to provide ligation, NSV and IUD services. Apart from this other items like tents, beds, blankets, fans; generator, etc are hired locally. The team uses a hired vehicle to travel and carry all the equipment to the site.
The Outreach Coordinator is entrusted with the responsibility of ensuring the smooth organization of these outreach services. Either he visits or assigns someone to visit the camp site a day before to make necessary arrangements, like cleaning, fumigation, etc. The Field Officers are given the responsibility to inform the communities about the outreach dates through Surya Health Promoters (SHPs), RMPs, retailers, shop keepers, chemists, etc during sales trips.
Janani has been providing sterilization services at government health facilities in select districts of Bihar under the PPP model of NRHM since 2004. In the last nine years Janani has organized nearly 2,500 outreach and has conducted 128,000 ligations and 8,400 NSVs. This figure represents 38% of Janani’s total sterilization performance of 356,660 during this same period.
Intervention Area& FP Indicators of the selected districts
Janani has set up four outreach teams, each looking after two districts, to provide the entire range of family planning services, like Ligation, IUCD & NSV, at government health facilities in districts namely Samastipur, Katihar, Siwan .
With these two teams, we are planning to organize 180 outreach services in 2015 by December, providing ligation services to about 3500 women. And at Health Sub Centre(HSC) in two districts, Katihar and Siwan , we are planning to provide IUCD services to around 600 women by year end.
source: AHS 2013-14
The Outreach FP Service Delivery Process
Services Offered at outreach
During the outreach FP services the team provides Tubectomy (ligation), Intrauterine contraceptive device (IUCD), and we intend to provide basket of choice so the outreach team carries with them emergency contraceptive pills (ECP); oral contraceptive pills (OCP) and condoms according to the assessed needs of the client.
Janani does not charge any fees for the provision of these services but gets partial reimbursement by the government for all the ligations and NSVs it performs. The motivator incentive is paid by the government as per the applicable rates. During the procedures and at the time of discharge, all the consumables used and medication given to the client is taken care of by Janani.
Janani intends to conduct most of the procedures under local anesthesia, but in cases where it becomes necessary to perform under general anesthesia, some team members stay back during the night at the site to ensure proper recovery of the clients. Generally a nurse and two attendants stay back. Rarely, if there has been any complication, the doctor also stays back. In order to ensure follow up and increase accountability of the government health system, the client is discharged through the health facility.
IEC/ Communication activity in project area
To promote outreach and increase awareness on family planning basket of choice, Janani is organizing special awareness drives intermittently and also do focused activities to promote modern contraceptive methods in outreach through mikeing, handouts, banners, display panels (on rickshaws, autos, buses, etc) and wall writing.
ASHA Meeting :
From time to time District coordinator and counselors in Siwan, Samastipur and Katihar attend ASHA monthly meeting at Block PHC and they discuss the project, its plans and benefits of the program which Janani is conducting in coordination’s with District Health Society.
Every Thursday ASHA Facilitators meeting is attended by our outreach staff, and they in coordination with ASHA, BHM and MOIC decided the dates for next outreach and accordingly the date for every month is prepared and approval is taken from the District Health Society office.
Bihar Outreach FP Service Delivery Report since Inception (Dec2014 to 31st Aug 2015
In Bihar the outreach services under Bihar Outreach Project started in the month of December 2014, in Katihar district, and in Samastipur the services started from April’2015.
|# ||District Name ||Nos. of outreach done ||Total Registration done ||Total Ligation(Minilap) done ||Total IUCD Inserted ||Total CYP |
|1 ||Katihar ||51 ||1014 ||825 ||90 ||10708.5 |
|2 ||Samastipur ||25 ||434 ||391 ||0 ||4887.5 |
|3 ||Siwan* || || || || || |
Bihar Outreach FP Project – Lens View