Problem

I have been working with fhi360 in assisting the Government of Madhya Pradesh (MP) to implement MPHSRP (Madhya Pradesh Health Sector Reforms Program) for the last one year.

Madhya Pradesh, a state in central India has very high infant and mother mortality rates, compared to the national average. Our programme helps strengthen the system and we work closely with the Health Department, WCD (Women & Child Development) & PHED (Public Health Engineering Department) departments aiming to reduce MMR (Maternal Mortality Ratio), IMR (Infant Mortality Ratio), Malnutrition & TFR (Total Fertility Rate) in the state of Madhya Pradesh in India.

MCTS (Mother & Child Tracking System) is an online monitoring software which has been developed by Government of India with an objective to track the different services being provided/ to be provided to a pregnant mother right from conception until the baby turns a one year old.This tracking of  service delivery plays a vital role and helps in guiding and planning towards the actions to be taken towards MMR & IMR.

The tracking system still needs to be worked upon further before it can be implemented.

 

Why we used the tool

My team mates and I used the Theory of Change and Causes Diagram in one combination, and SWOT Analysis, Question Ladder and the Critical Tasks list in another combination (see page..) Our aim is to strengthen the usage of the MCTS software by re-defining roles, incentives and contingency strategies for all the people and stakeholders responsible for its functioning. We did this by using a set of tools to re-visit and consolidate the challenge we are facing, and then use another set of tools to identify potential team members and create a critical pathway to implement our solution.

 

How we used the tool

We used these tools in Jabalpur District in Madhya Pradesh as a pilot.  First, I explained the purpose of doing the whole exercise to the field team – the District Health Officer, the Auxiliary Nurse Midwife (ANM) and the Accredited Social Health Assistant (ASHA) worker.

We took stock of:

• Why the MCTS system is not being updated at all;
• The people involved and what their roles are, and
• Understanding the bottlenecks that we should address to solve the issue.

We then used a combination of SWOT Analysis, Question Ladder and Critical Tasks list.

 

SWOT Analysis

To understand the team’s strengths & weaknesses that could help us to figure out what they can do to be more efficiency and help people take responsibility for their actions.

 

Question Ladder

To help redefine individual responsibilities for individuals with the entire team’s consensus and input.

 

Critical Tasks list

To help develop timelines to put the new plan into place.

 

Results of using the tool

The SWOT Analysis helped the team to review their strengths and helped us understand how individual contributions affect the team’s work and vice versa. It also helped us to envisage  possible ‘threats’ that could hamper the smooth functioning of the system – something that we had never considered before.

The Question Ladder helped us to identify potential team members that could be re-assigned with new tasks, timelines and accomplishments in the updated system. The process was participatory and had the consensus of all those involved directly and indirectly.

For us, developing or improving programmes and measuring outcomes go hand in hand. We used the Critical Tasks list to create a new schedule for the updating the service system and create markers to receive feedback on how effective the new system is. In every pilot it is critical to measure the ‘perceived and actual’ change before we can even think of scaling up. The task list helped us chart that critical journey and milestones for the pilot.