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Photograph of Mother and Child
Title of Women Development, Child Welfare and Disabled Welfare Department
 You are here: Home >  Maarpu - A Convergence Initiative
 

1.Overview
MAARPU (change) signifies the convergence efforts by the Health, Women Development & Child Welfare, Panchayati Raj and Rural Development Departments, working along with the Self Help Groups (SHGs) and their federations, to bring about a quick decline in the Infant Mortality Rate (IMR), Maternal Mortality Ratio (MMR) and Malnutrition in the State of Telangana
Maarpu involves focus on the 20 identified key interventions which include Early Registration of Pregnancy; Ante Natal Checkups; Maternal Nutrition; Identification of high-risk pregnancies; Birth Planning; Institutional Delivery; Early initiation of breast feeding; Exclusive breast feeding for six months; Post Natal Care and Newborn Care; Immunization; Growth Monitoring; Complementary feeding & Child Nutrition; Management of ARI & Diarrhoea; Strengthening of referral system; Family Planning; Maternal & Infant Death Reviews; Sanitation & Hygiene; Age at Marriage; Adolescent Girls and Gender Sensitization
Led directly by the District Collector in each district, Maarpu takes shape through a combination of improved service delivery, convergence across departments, community-led demand stimulation and behavioural change. The concerned departments are expected to ensure universal availability of quality services and to improve the design of their respective programmes, while active community participation anchored in meetings of the village level convergence committees helps in the identification of service delivery gaps for timely corrective action.
The implementation of Maarpu has given valuable insights into key problems and bottlenecks as well as innovative strategies and solutions. At present, a cascading training programme has been rolled out for Maarpu. As part of this initiative 6 Community Resource Persons (CRPs) have been identified for each mandal and are being trained. Teams of CRPs are expected to visit the villages (“Maarpu Darshini”) to bring about behavioural change in the community and to stimulate demand for health and nutrition services
2.Focus on 20 key interventions to reduce MMR, IMR& Malnutrition
The 20 key interventions are as follows

1Early Registration of Pregnancy. Registration to be done immediately on confirmation but definitely before 12 weeks of pregnancy and has the following components:

a.A confirmatory pregnancy test
b. Registration
c. Issuance of Mother and Child Protection (MCP) card both in public & private sector

2Ante Natal Checkups (ANCs). Every pregnant women to have minimum four ANCs of which, one between 16-20 weeks and the other between 32-34 weeks to be attended by the Medical Officer at the Primary Health Centers(PHCs) or as part of Fixed Day Health Services (FDHS). The components of the ANC are:

a.Haemoglobin estimation (Sahli’s method)
b. B.P. measurement
c. Urine testing
d. Weight monitoring
e. Tetanus Toxoid
f. Distribution and ensuring consumption of Iron Folic Acid (IFA) tablets
g. Updating the MCP card after each service delivery
h. Health counseling, which includes awareness generation regarding general hygiene, exercise, diet, rest, breast care and danger signs during pregnancy.

3Maternal Nutrition. Every pregnant women to have minimum four ANCs of which, one between 16-20 weeks and the other between 32-34 weeks to be attended by the Medical Officer at the Primary Health Centers(PHCs) or as part of Fixed Day Health Services (FDHS). The components of the ANC are:

a.Nutrition counseling be anchored by AWW with support of members of Village Health, Sanitation and Nutrition Committee (VHSNC) and particularly with help of ANM/ ASHA/SHGs/VOs. Focus will be on diet intake in terms of quantity and quality food with proteins and iron rich foods, and on consumption of IFA tablets
b. Diet supplementation at Anganwadi Center (AWC)

4Identification of high-risk pregnancies &ensuring appropriate referral
5Birth Planning. Advanced birth planning for the pregnant woman is to be done with four components:

a.Identification of the Institution where delivery is planned and to promote institutional deliveries at Public Health facilities (even if the delivery is planned in another village/town)
b. Transport arrangements with 108 or any other alternative method
c. Identifying the person(s) accompanying the pregnant woman for delivery
d. Arrangements required for 48 hours stay at the hospital after delivery

6Institutional delivery.  Basic Services to be delivered for Intranatal care In Public & Private sector are:

a.Quality of Intra natal care (Partogragh to be plotted for every delivery to know the course of parturition)
b. APGAR score of newborn and birth weight to be recorded in MCP card
c. “Zero” doses of BCG, OPV and Hepatitis B and recorded in MCP card
d. Issue of Birth certificate from MCP card
In addition to the above services, Public Health facilities to
e.Make JSY payments before discharge
f.Ensure safe drop back after 48-hour stay at the hospital

7Early initiation of breastfeeding.(within an hour of birth). Counseling by Medical Officer or Health staff in case of institutional delivery and by AWW/ASHA/ANM during Home visits
8Exclusive breastfeeding for six months.Counseling of mothers at AWCs and during Home visits of AWW/ASHA/ANM
9Post Natal Care and Newborn Care.  The Medical Officer to do the first postnatal visit at the hospital. The remaining six postnatal visits for the care of the mother & the newborn will to be done primarily by ASHA with support of AWW. ANM/Lady health supervisor/Medical officer shall be doing prioritized postnatal visits to high-risk cases, those that require special care, verify a sample of postnatal visits done by ASHA and provide on job training on post natal visits to ASHA. Apart from the examination the ASHA/AWW are required to:

a.Identify signs of sickness in both mother and the newborn
b.Ensure appropriate, timely referral and inform the Medical Officer of the PHC to ensure that the Specialist/First Referral Unit (FRU) is ready to receive the patient

9Immunization.  The infant gets zero dose of BCG, OPV and Hepatitis B at time of delivery; three doses each of DPT, OPV, Hepatitis B vaccines in sixth,tenth and fourteenth weeks after birth; Measles vaccine and Vit A after completion of nine months of age; DPT booster doses at 18 months and 60 months with biannual doses of Vit. A solution upto 60 months
11Growth Monitoring.

a.Regular growth monitoring by weighing all children below 5 years and plotting in MCP cards and growth registers of AWC through AWW/ANM
b.Immediate counseling of mothers & family members in case of faltering or decrease in weight of children using ready reckoner by AWW/ANM
c.Identify moderate & severe malnutrition and ensure nutritional counseling, supplementation and referral
d.Identification of Severe Acute Malnutrition (SAM), referral to Nutritional Rehabilitation Centers (NRCs) and follow-up

12Complementary feeding & Child Nutrition.

a.Counseling and Home visits for introducing complementary feeding at 7th month and continued breast-feeding up to 2 years
b.Counseling on age specific quantity, quality and frequency of dietary intake for children (from 7th month to 5 years) during NHDs, Home visits and Awareness Programmes
c.Supplementary nutrition at AWC

13Management of ARI & Diarrhoea.

a.Early identification of ARI & Diarrhoea
b.Use of ORS & Zn for Diarrhoea
c.Continued feeding during episodes of illness
d.Appropriate referral & follow up

14Strengthening of referral system.Establishing a referral linkage between community to health facilities and among health facilities. This will particularly include referrals for ARI, Diarhoea and other severe illnesses among infants and referrals for high-risk pregnancies
15Family Planning.

a.Delay in first pregnancy
b.Spacing methods after first delivery
c.Permanent methods with focus on Male sterilizations

16Family Planning.

a.Delay in first pregnancy
b.Spacing methods after first delivery
c.Permanent methods with focus on Male sterilizations

17Sanitation & Hygiene.

a.Counseling on Sanitation & Hygiene (Environmental & Personal)
b.Hand washing practices
c.Ensuring Cleaning of village water tanks & Chlorination of Water(Wells/Bore wells/Potable water)
d.Use of Indian Sanitary Latrines (ISL) by households

18Age at Marriage.

a.Implementation of Prohibition of Child Marriage Act, 2006
b.Awareness creation regarding the ill-effects of child marriage and legal provisions

19Adolescent Girls.

a.Weekly Iron Folic Acid Tablet supplementation at schools and AWC
b.Nutrition and health education on lifecycle approach
c.Focus on school dropout’s and vocational training

20Gender Sensitization. Focus on

a.Implementation of PC & PNDT act
b.Sex Ratio
c.Girl child education, trafficking and domestic violence

Administrative Structures for Convergence
The following Committees are set up at various levels for monitoring and implementing the convergence efforts
  • State Level Convergence Committee: This will have Chief Secretary as Chairperson; Principal Secretaries / Secretaries of Health, Medical and Family Welfare, Women Children, Disabled & Senior Citizens, Rural Development, Panchayati Raj, Rural Water Supply and Sanitation, School Education and Planning as Members; Commissioner (Health & Family Welfare) as Member-Convener; Commissioner (Women Development & Child Welfare), CEO (SERP) and Mission Director (NRHM) as Members & Co-conveners

  • 2. District Level Convergence Committee: This will have District Collector as Chairperson; Joint Collector, Cluster Convergence Officers (they will be District Officers identified by District Collectors), DCHS, Medical superintendent of teaching hospitals, PO (RVM), CEO (ZP), SE (PR), SE (RWS) and representatives of Zilla Mahila Samakhyaas (ZMS) as Members; DM&HO as Member-Convener; PD (ICDS) and PD (DRDA)as Members & Coconveners.

  • 3. Cluster Level Convergence Committee: This will be constituted at the level of the Community Health & Nutrition Cluster level and will have Cluster Convergence Officer (CCO) as Chairperson; Medical Officers (PHCs), Supervisors (ICDS), Cluster Co-coordinators (SERP) and representatives of Mandal Mahila Samakhyas (MSS) as Members; SPHO as Member-Convener; CDPO and Area Coordinators (SERP) as Members & Coconveners

  • 4. Village Level Convergence Committee: This will be the Village Health, Sanitation & Nutrition Committee (VHSNC) as prescribed by GOI. This will have Sarpanch as Chairperson; all SC/ST/women ward members, any women MPTC member/ZPTC member/MPP President living in the village, president of village education committee, ANM, AWW, ASHA as Members and VOs as Member Conveners
Conduct of Village level Convergence Committee
The agenda for the VLCC meeting will be as follows
  • Action Taken Report of previous meeting
  • Review of Health and Nutrition Services availed by women and children with a focus on registration of all ANCs, ensuring full ANC check-ups and services, tackling anemia among pregnant women, follow-up of each high risk case, birth plans for deliveries due, children born with low birth weight, full immunization of children, follow up of children with Severe Acute Malnutrition (SAM)/ Moderate Acute Malnutrition (MAM) and underweight children, maternal or infant death, if any
  • Plan to ensure that services that are due or overdue get delivered fully
  • Review of Nutrition & Health Days (NHDs 1 and 2), Fixed Day Health Services (FDHS) and home visits by ASHAs, Anganwadi Workers and ANM, along with members of VLCC, VOs and SHGs
  • Discussion on the Health and Nutrition behaviour of the community with focus on preventing child marriage and gender-selective abortions, encouraging deliveries in government institutions and spreading awareness about JSSK benefits, opting for normal delivery and avoiding unnecessary C-Sections, early initiation of breast feeding, exclusive breast feeding for 6 months and complementary feeding from 6 months to 3 years
  • Discussion on social and other issues like gender sensitization, etc.
  • Action plan for the next month
• Format No. 1 meant as a tool for preparing action plan on health and nutrition concerns; for discussing the agenda of VLCC; for monitoring of service delivery and implementation of plan; and for reporting to the MO (PHC) and CDPO is as given at Format-I
7.Maarpu Darshini
In order to bring about behavioural change in the community with regard to health and nutrition issues identified as the 20 key interventions of “Maarpu” and to create demand for health and nutrition services, a unique “Maarpu Darshini” campaign has been undertaken with the help of Community Resource Persons(CRPs)
SERP has identified 6 CRPs for each Mandal in the State. These 6 CRPs are constituted into two teams. Each Gram Panchayat visited by a CRP team for a 4-day “Maarpu Darshini” campaign. During the 4-day visit, the CRP teams will mainly conduct Group Meetings with various clusters of households of the Gram Panchayat. In the Group meetings, Inter Personal Sessions (IPCs) is conducted with the target groups and family members on the 20 key indicators of “Maarpu” with the help of a “Flip book” known as Maarpu karadeepika that has been prepared specifically for this purpose
Apart from Group Meetings, the 4-day visit also includes Maarpu meetings, home visits, rally, Grama Sabha etc. It is expected that all the functionaries particularly the ANM, ASHA, AWW, and Panchayat Secretary help the CRP Team to conduct the “MAARPU DARSHINI” successfully
In order to roll out the “Maarpu Darshini” campaign, trainings were conducted at the State level and are being conducted at the District and Mandal level. The flow chart at Table-I indicates the 3 day training of the District Resource Persons at State level, 6- day training of CRPs at the District level, 1-day orientation of various functionaries at the Mandal level, as well as the 4- day Maarpu Darshini visit of the CRP team to each Grampanchayat. Details of the day-wise activity for Maarpu Darshini are at Table-II.
8.References
G.O.Ms.No.249,Dept of HM&FW dt.24.09.2012
Convergence to improve Health and Nutrition Status of Women and Children - Interdepartmental Coordination for Effective Convergence – Launch of Maarpu Programme – Orders – Issued
G.O.Ms.No.57,Dept of HM&FW dt.30.04.2013
Convergence to improve Health and Nutrition Status of Women and Children - Interdepartmental Coordination for Effective Convergence – Maarpu Programme – Operational Guidelines – Issued
Karadeepika
A training Manual for 20 key interventions of Maarpu