Our newest Model District (in a state of 199 million people)

On 11 April 2011, the Model Districts project launched its second district in Unnao, Uttar Pradesh.

The Model District in Unnao will serve as a pilot for the North region for scaling-up quality improvements focused on health systems management, health worker performance, effective delivery of a critical intervention mix, use of real-time data and health technologies, and supply chain management towards improved maternal and child health outcomes.

The Model Districts team will be working with District Magistrate Aneeta Meshram (IAS) and her teams within the health, education, and rural development departments.  During the team’s visit to Unnao for the launch, several critical issues in the district have already been established, including a critical lack of emergency transport, a severe shortage of auxiliary nurse midwives serving in sub-health centres, lack of capacity for safe deliveries, lack of equipment in anganwadi nutrition and preschool centres, and the great need for management and supervision structures for ASHA community health workers.

Uttar Pradesh has a staggering state population of 199 million.  If it was a single country, it would be in the fifth largest in the world after China, India, US, and Indonesia.   According to the 2001 Census UP’s sex ratio is 898 females per every 1,000 males, considerably lower than India’s ratio of 933; 42.4% of women in UP are literate.  Unnao district’s population is over 3.1 million.  Over 80 percent of its population lives in villages and are dependent on agriculture.  Over 38% of Unnao’s population held below poverty line (BPL) cards in 2005-06.

Uttar Pradesh compares poorly to the rest of India in terms of health outcomes and health spending. Unnao has some of the country’s worst health indicators.  Uttar Pradesh’s maternal mortality rates of 440 far exceed India’s national rate of 254.  The under-5 mortality rate (U5MR) is 169 per 1000 live births while the infant mortality rate (IMR) is 86 per 1000 live births.  Immunization rates stand at 26%. Only 17% of pregnant women in Unnao avail of institutional deliveries, while 81.9% women deliver at home. Of these, only 7% women have skilled birth attendants at the time of birth.  Only 60.6% of pregnant women receive antenatal check-ups during their pregnancies.  Unnao’s water supplies have critically high fluoride content.

The Model Districts team looks forward to working with Unnao district officials and collaborative partners on mobilizing resources, capacity building, and management tools for Unnao’s health services.

The first Model District was launched in Morigaon, Assam in October 2010.  To get regular updates about the project from India, follow us on Twitter @modeldistricts.