Effectiveness of district health promotion model (Hoshiarpur Ambala model): An implementation experience from two districts from Northern part of India

Abstract

Introduction: In India, implementation of Health Promotion activities follows a vertical approach at district level. A Health Promotion project was therefore implemented for 3 years in Hoshiarpur and Ambala districts of Northern India, with objectives to develop, implement, and assess the effectiveness of integrated health promotion model. Materials and Methods: Situation analysis in two districts was followed by a state level stakeholders workshop in which detailed layout of model and a health promotion manual (Hindi, English, and Punjabi) was developed for capacity building of workforce. The effectiveness of model was assessed using mix of quantitative as well as qualitative methods. Results: The key features of model included integration and convergence within National Health Programs, multitasking, multisectoral involvement, and community empowerment, using digital media and advocacy tools. The facility assessment survey revealed improvements in implementation of activities as per annual activity calendar of IEC/BCC activities, better display of IEC material, with improved reporting, monitoring, and supervision. At community level, the awareness levels of the community members regarding communicable/noncommunicable diseases and key Reproductive and Child Health issues improved significantly (P < 0.05). Similarly, the client exit survey showed that dissemination of health information by MO/ANM increased in 3 years from 8% to 80% and 7.3% to 75% in districts Hoshiarpur and Ambala, respectively (P < 0.05). In-depth interview with key stakeholders and focused group discussion with Village Health and Sanitation Committee/Village Level Core Committee has shown their active involvement and improvements in their functioning. Based on indicative costing, per capita costs of National Health Mission for IEC/BCC/Health promotion activities need to be increased from INR 0.7 (USD 0.01) to INR 4 (USD 0.06), which requires increase in budget allocation from 1% to minimum of 4%. Conclusion: Model was found to be effective and feasible on pilot implementation. District level human and financial resources, however, must be augmented to implement health promotion activities effectively.