Thematic Sessions

Chair: Mr C K Mishra, Addl. Secretary & MD (NHM)

Speakers:

Mr Manoj Jhalani, Joint Secretary (NHM)
India National Health Mission – Pioneer of an Integrated Approach for Health Care Delivery

Mr Anshu Prakash, Joint Secretary
Non-Communicable Diseases – Determinants and at risk approach for prevention and management

Dr Sanjeev Kumar, ED, NHSRC
Innovations in health System

Dr A C Dhariwal, Director, NVBDCP
JE/AES Prevention and Control – Inter-sectoral Approach

Dr S Venkatesh, Director, NCDC
Integrated Disease Surveillance

India has over two million community health workers (CHWs) in the key national health and nutrition programs. Are they on the critical path to delivering health outcomes? What does it look like on the ground?

In this session we will hear from five people about the experiences, evidence and implications to improve the performance of CHWs in diverse contexts in India. The session will bring together innovative ways improving the performance of CHWs in delivering key maternal neonatal child health and nutrition interventions. Through this mix of speakers we will learn different approaches to improve the last mile delivery of interventions through CHWs within Health and ICDS programs in India.

Mr. Alkesh Wadhwani will describe Bill & Melinda Gates Foundation’s overall approach to supporting the states of Bihar, UP and Karnataka in improving the performance of CHWs and share the evidence and lessons from the Ananya program in Bihar. Mr. Shamik Trehan will speak to the challenge of enhancing the last mile delivery through creation of platforms for planning, use of data and supportive supervision in the state of Bihar followed by Mr. Siddhartha Swarup, who will describe the use of information, communication technologies for CHWs for improving health communication in Bihar and other states. Dr. Saba Mebrahtu and Gayatri Singh from UNICEF and Ms. Manjula Singh from DFID will share their innovative approaches, experiences and lessons from different states in improving the performance of CHWs in multiple contexts.

The discussion with all speakers will examine the implications of these experiences for the key national programs like NRHM and ICDS programs in India and more broadly for CHW program grams in other countries that seek to improve health outcomes

Speakers:
1. Mr. Alkesh Wadhwani, Head, Integrated Delivery, India Country Office, Bill & Melinda Gates Foundation
2. Mr. Shamik Trehan, Chief of Party, Bihar Technical Support Unit
3. Mr. Siddhartha Swarup, Technical Director, BBC Media Action
4. Dr. Saba Mebrathu, Section Chief, Nutrition, UNICEF
5. Ms. Manjula Singh, Health Advisor, DFID

Moderator: Mr Alkesh Wadhwani

Assumptions: A large audience made up of knowledgeable and motivated public health professionals from all over the world.

Background: Before 2013 five of the six regions of WHO had adopted a measles elimination goal. Only SEAR had not. The Region of the Americas and the European Region had also adopted rubella and congenital rubella syndrome (CRS) elimination goals. By 2009, the Region of the Americas had eliminated both indigenous measles and rubella.

The last case of paralysis due to indigenous wild polio virus in SEAR occurred in January 2011. In September 2013, with more than two and half years being polio-free and anticipating the certification of SEAR as polio-free in March 2014, the Regional Committee of SEAR resolved to build on the success of polio and passed a resolution to eliminate measles and control rubella and congenital rubella syndrome in SEAR by 2020.

The experience of the Region of the Americas proves that the strategies and tools exist to achieve regional measles elimination and rubella and CRS control. The experience of the other four regions highlights the on-going challenges to achieve these goals. The countries of SEAR will have to draw on their experience with making the region polio-free and the experiences of the other regions in measles elimination and rubella and CRS control in order to achieve the 2020 goal.

Objectives of the session:

1. To inform the audience of the regional goal to eliminate measles and control rubella and congenital rubella syndrome CRS)
2. To present the current status and explain the strategies to eliminate measles and control rubella and CRS;
3. To present significant challenges to achieving the goals, and
4. To present experiences from key countries.

There is a growing call for evidence based interventions. But what does this really look like on the ground?

In this session we’ll hear from 4 people who are using data to radically change the way we think about health programs and progress. Through the mix of speakers we will explore how governments, doctors, health workers, and researchers, are pushing boundaries on using data to improve lives. The session will focus on new ways of using measurement, not only to evaluate interventions but also as an intervention in itself.

Two of the speakers, Dr. B.M. Ramesh and Dr. Hemant Shah, will describe their efforts in Uttar Pradesh, and Bihar respectively. Both will describe how their teams are working with State governments to improve outcomes. Dr. Ramesh will describe efforts in Uttar Pradesh to establish a set of tracking tools and performance dashboards. Dr Hemant Shah will speak to the challenge and opportunities of using data to improve clinical outcomes in high-load public facilities. Between them they will discuss lessons generated from direct observations of deliveries, algorithm based simple case sheets and checklists, and the use of dashboards to drive change. Also looking at maternal health, Dr. Aditi Iyer, will describe a set of innovative methods and tools being used to improve maternal safety and rights in Karnataka including: (i) risk assessments during pregnancy and postpartum, (ii) verbal autopsies of maternal deaths and near misses, and (iii) community events to build collective learning and responsibility for maternal safety. Finally we will turn to Dr. Abhijit Chowdhury, who will share his experiences in evaluating a high impact program to improve the quality of rural health care providers in West Bengal. A doctor who is immersed in evaluation, he will provide a unique perspective on how this evaluation is helping him think through and strengthen the program and how the Government of West Bengal has begun to translate findings into policy. The discussion with all speakers will examine how advancements in measurement tools, processes, and data use are creating opportunities and challenges in improving health.

Speakers:
Dr. B.M. Ramesh, Chief of Party, Uttar Pradesh Technical Support Unit
Dr. Hemant Shah, Director, State RMNCH+A Unit, Bihar; Bihar Technical Support Unit
Dr. Aditi Iyer, The Gender and Health Equity (GHE) Project at the Centre for Public Policy, Indian Institute of Management
Dr. Abhijit Chowdhury, Head, Hepatology at P.G. Hospital in Kolkata.

Moderator: Dr Katherine Hay, Deputy Director, Measurement Learning and Evaluation of the Bill and Melinda Gates Foundation.

Concept note

Despite their diversity, the BRICS nations face a number of similar public health challenges, including inequitable access to health services and medicines, growing health costs, infectious diseases such as HIV and tuberculosis, and growing rates of non-communicable diseases. The major challenge is how to provide health care to millions of people, in particular among the most vulnerable segments of their populations.

With this concern in mind, BRICS representatives hosted an event during the 67th World Health Assembly, in May, 19, 2014, in which presented their perspectives on the strategies and iniciatives to overcome bottlenecks to increase access to pharmaceutical technologies with the support of WHO, UNAIDS, UNITAID and UNDP. In that event, the Brazilian Association of Collective Health (ABRASCO) suggested the organization of a new meeting of BRICS countries, during the 14th World Congress of Public Health, in Kolkata, India, in February, 2015, to continue this discussion.

The Brazilian Government, through its Ministry oh Health, has agreed in promoting this new event and, in fact, it became a partner country of the 14th WCPH, supporting its realization. However, it were not able to organize the session, sending a official representative and contacting the BRICS representatives. In consequence, ABRASCO proposes now that the thematic session 5 – Innovation and Equitable Access to Medicines in BRICS be conducted by representatives of the National Public Health Associations of BRICS nations. Each one will present its country policies related to innovation and access to medicines.

As discussed in the previous event, in May, 2014, India is the supplier of around 80% of antiretroviral generic drugs for the developing world, enhancing competition within the pharmaceutical sector and, therefore, reducing prices of medicines. Brazil has been implementing policies on access to HIV medicines and drugs to treat diabetes and hypertension. Both Brazil and South Africa are undertaking reforms in their intellectual property legislations, to facilitate and expand the use of public health related TRIPS flexibilities, while India revised its Patents Act in 2005.

Russia incorporated a number of public health flexibilities in its patent laws afetr joining the World Trade Organization in 2012. China revised its patent laws in recent years, confirming that compulsory licences may be granted for the benefit of public health. China is responsible for 70% of the global supply of active pharmaceutical ingredients for the production of finished medicines. At the same time, BRICS are engaged in many south-to-souht collaboration initiatives to create favourable environment to foster accessibility and affordability of health products in low and middle income countries.

In sum, BRICS have a major role to play in order to advance access to public health services and goods and deliver more cost-effective, equitable and sustainable solutions for common health challenges.

Their National Public Health Associations may advance the debate, in the 14th WCPH, contributing to face challenges as increasing number of people needing access to pharmaceuticals, high prices for certain products, few resources to fund treatment, and increasing interest in developing domestic manufacturing and innovation capacity in the field of medicines.

CHAIR, CO-CHAIR & PANELISTS: Keeping the theme in mind, panelists for the session will be from the fields of Obstetrics, Pediatrics, Public Health, Nursing as well as Policymakers. Experts/Specialists with long standing experience of working with Government, Unicef & Civil Society will be the panelists and speak on different facets of this thematic area.

Chairperson: Mr Malay kumar De, Principal Secretary, Dept of H&FW, Govt of West Bengal (TBC)
Co-Chair: Dr Genevieve Begkoyian, Chief, Health Section, Unicef, India Country Office (TBC)

Speakers:
- Dr Rathna Kumar- Senior Obstetrician and Advisor to Govt of Tamil Nadu for maternal health
- Dr Ashok Deorari- Professor , Department of Pediatrics , WHO Collaborating Centre for Education& Research in Newborn Care , All India Institute of Medical Sciences
- Dr M Prasamma- Senior nursing faculty and Executive Director at ANSWERS (Academy for Nursing Studies and Women’s Empowerment Research Studies)
- Dr Rakesh Kumar- Joint Secretary, MOHFW, Govt of India/any other representative from MOHFW (TBC)
- Dr Kaninika Mitra-Health Specialist, Unicef Office for West Bengal

Background and Aims:

Why the Session is important in the current scenario.

Reducing maternal and child mortality is among the main goals of the National Health Mission (NHM). Huge financial and strategic investments are being made to achieve these goals. Keeping in mind India’s commitment to the Millennium Development Goals 4 and 5, the Call to Action: Child Survival and Development 2013 has been made a top priority. The Government of India along with its Development Partnersis aiming at accelerating child survival and improving maternal health in the near future and beyond 2015 through implementation of RMNCH+A strategy, with focus on the High Priority Districts.

Reducing Neonatal Deaths is one of the key priority areas of Government and Development Partners. Apart from the entire RMNCH+A strategy guiding interventions through a life-cycle based approach, the recently launched India Newborn Action Plan (INAP)—developed in response to the Global Every Newborn Action Plan (ENAP) and launched at the World Health Assembly in June 2014—outlines a targeted strategy for accelerating the reduction of preventable newborn deaths and stillbirths in the country. INAP defines the latest evidence on effective interventions which will not only help in reducing the burden of stillbirths and neonatal mortality, but also maternal deaths. Out of all the interventions which reduce neonatal as well as maternal deaths, contribution of quality of care at birth is the highest.

In last decade, coverage in terms of availability and accessibility of maternal & neonatal health care services has been substantially increased across states, especially with a substantial increase in institutional delivery, but quality of service delivery still remains a challenge and needs to be prioritized for action.

Keeping the above background in mind, the topic of panel discussion has two key areas for discussion- care at birth and quality of care.

What benefit attendees will get, i.e. skills, knowledge or perspective acquired
Participants will learn about:
• The importance of improving quality of care during delivery and childbirth for reduction of maternal & neonatal mortality.
• Government’s policies and programmes for improving quality of maternal and neonatal care.
• The status and challenges in providing good quality care during delivery in different states of India.
• Experiences from different parts of the country on initiatives to improve quality of care at birth.
• Innovative ideas/experiences which can be scaled up or replicated for improving quality of care.

Methods: This Session will operate in a series of stages – as follows
Stage one: 5 minutes introduction by Chair / Moderator
Stage two: 10 minutes presentation per speaker on the subject with or without help of PPT
Stage three: 30 minutes for open discussion
Stage four (etc.): 5 minutes for summing up

Conclusions: The panel discussion with presentation by experts followed by interaction with audience will enrich all participants in learning and deliberating on the status, challenges and action for improving quality of care during birth, which is a very critical intervention contributing to reduction in neonatal and maternal mortality.

Chair: N.K.Ganguly

Speakers:
• S K Bhattacharya: ex-ICMR
• Thomas Wierzba, PATH
• Sushant Sahastrabuddhe, IVI
• Eileen PATH

Background and Aims:
Enteric and diarrhoeal diseases are caused by a multitute of organisms and have several modes of transmission and presentation as well as management. In this session we will hear experts speak on the global burden as well as control of the more important causes of enteric and diarrhoeal diseases including their vaccines.

Methods:
Topic one: Update on Global Burden of diarrhea and enteric diseases
Topic two: Status of Shigella burden and vaccine development.
Topic three: Burden of typhoid and paratyphoid and strategies for control
Topic four: Importance of Communications in prevention and control of these diseases.

Conclusions:
The importance and severity of enteric and diarrhoeal diseases will be highlighted in this session. Since they usually affect those with low hygenic status, interpersonal communications will also go a long way in control of these diseases.

Among the 7.6 million under-five deaths globally each year, approximately 40% occur in the neonatal period and almost 99% occur in low and middle-income countries. Infections are still the leading cause of neonatal death in these countries, where a large proportion of births occur at home in unhygienic conditions. Health facilities in these low resource settings also struggle to achieve hygienic practices during labour, delivery and the immediate postpartum period and babies are often discharged early into same environment that home-born babies experience.

In this panel 4 speakers will summarize the evidence for interventions proven to reduce mortality and share important policy and programmatic experiences for both prevention and treatment of neonatal infections.

The panel will begin with an overview of the current global burden of newborn infections and their contribution to under-five mortality. The first speaker will summarize the pooled analyses of 3 RCTs (Nepal, Bangladesh, Pakistan) which showed that immediate application of 7.1% chlorhexidine digluconate to the freshly-cut umbilical cord reduces neonatal mortality by 23%.

Programmatic experiences from Nepal and Nigeria will be presented to highlight approaches utilized for successful advocacy, policy development, program implementation plus strategies to address challenges for the scale up of chlorhexidine nationwide in both countries.

The final speaker will present the results from the COMBINE trial in Ethiopia which evaluated the impact on neonatal mortality of management of possible severe bacterial infection by government Health Extension Workers, when referral to a health center was not possible or accepted by families. The antibiotic regimen was intramuscular gentamicin plus oral amoxicillin for 7 days. The evaluation found that the intervention reduced neonatal mortality after the first day of life. Final data will be shared during the presentation (pending publication).

Speakers:

1. Dr. Luke Mullany, Associate Professor, Department of International Health, Johns Hopkins University
2. Ms. Leela Khanal, Project Manager, Chlorhexidine Navi Care Program/Nepal
3. Dr. Nosa Orobaton, Chief of Party, TSHIP/JSI/Nigeria
4. Dr. Steve Wall, Newborn Health Technical Lead, Saving Newborn Lives, Save the Children
5. Dr. Penny Dawson, Sr. Technical Advisor/JSI. MODERATOR

Programme

10:30 – 10:35: Introductory remarks – Dr Nata Menabde, WHO Representative to India
10:35 – 10:45: Preventing impoverishment through Financial protection – Dr Pascal Zurn, WHO India
11:45- 10:55: Ensuring overall health gains through provisioning quality services – Dr Chandrakant Lahariya WHO India
10:55 – 11:05: Ensuring equitable health gains through access to services – Mr Daniel Albrecht, WHO India
11:05- 11:15: Moderated open discussion on presentations

11: 15– 11:40: Panel Discussion
Moderator: Dr Reuben Samuel, WHO India

Panelists:
Dr Nata Menabde (WHO India)
Mr CK Mishra (MoHFW, Govt of India) (TBC)
Dr T Sundararaman (JNU, New Delhi) (TBC)
Dr Gita Sen/Dr Indrani Gupta (TBC)
11:40- 12:00: Moderated open discussion