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REPRODUCTIVE AND CHILD HEALTH
        PROGRAMME




           Dr. Bhuwan Sharma
           Assistant Professor
              Dept. of PSM
       Grant Govt. Medical College
MILES STONE IN MCH CARE IN INDIA
•   1880 – ESTABLISHMENT OF TRAINING OF DAIS IN AMRITSTAR
•   1902 - 1st MIDWIFERY ACT TO PROMOTE SAFE DELIVERY
•   1930 - SETTING UP OF ADVISORY COMMITTEE ON MATERNAL
    MORTALITY.
•   1946 - BHORE COMMITTEE RECOMMENDATION ON
    COMPREHENSIVE & INTEGRATED HEALTH CARE
•   1952 – PRIMARY HEALTH CENTER NET WORK & FAMILY PLANNING
    PROGRAMME
•   1956 – MCH CENTERS BECOME INTEGRAL PART OF PHCS
•   1961 - DEPARTMENT OF FAMILY PLANNING CREATED
•   1971 – MTP ACT
•   1974 – FAMILY PLANNING SERVICES INCORPORATED IN MCH CARE
•   1977 – RENAMING FAMILY PLANNING TO FAMILY WELFARE
•   1978 – EXPANDED PROGRAMME ON IMMUNIZATION
•   1985 – UNIVERSAL IMMUNIZATION PROGRAMME
•   1992 – CHILD SURVIVAL& SAFE MOTHERHOOD PROGRAMME
•   1996 – TARGET FREE APPROACH
•   1997 – RCH PROGRAMME PHASE-1
•   2005 – RCH PROGRAMME PHASE-2
Dr. bhuwan rch
RCH – Ι PROGRAMME

     15.10. 1997
Objectives
•Reduction of Maternal Morbidity and
Mortality (MMR)
•Reduction of Infant Morbidity and Mortality
(IMR)
•Reduction of Under 5 Morbidity and
Mortality (U5MR)
•Promotion of adolescent health
•Control of reproductive tract infections and
sexually transmitted infections.
• The first phase of the programme had
  started from 1997
• To bring down the birth rate below 21
  per 1000 population
• To reduce the infant mortality rate
  below 60 per 1000 life born
• To bring down the maternal mortality
  rate below 400 per one lakh.
• Eighty per cent institutional delivery,
• 100 per cent antenatal care
• and 100 per cent immunization of
children
Vertical Programmes   Integrated Service Delivery

  Camp Oriented       Client Oriented

  Target Oriented     Goal Oriented


  Quantity Oriented   Quality Oriented
Camp Oriented   .      Client Oriented


• Sterilization
  Camps                 • Full Range of RCH
                          Services
•    IUD Camps
                        • Need Based
• Immunisation
  Camps
Target Oriented       Goal Oriented

   Performance by        Performance by
      Numbers            Quality

• Top Down              • Bottom up
                        • Client Need Based
• Target Driven
                        • Community
                          Participation
• To the Govt. System   • To the Clients,
                          Community
Safe Motherhood Services
- Essential Care for All                        Child Survival
- Early Identification of Complications         Services
- Emergency Services those who are in need


  Family Welfare
- Increased access to       Healthy      Prevention and
  Contraceptives            Mother       Management of
                              &
- Safe Abortion              Child          RTI /STI
  Services

                   Adolescent Health Care and
                     Family Life Education
COMPONENTS OF RCH
 PROGRAMME

Prevention and management of unwanted pregnancy
Maternal care that includes antenatal, delivery, and
 postpartum services
Child survival services for newborns and infants
Management of reproductive tract infections and
 sexually transmitted infections
REPRODUCTIVE HEALTH ELEMENTS
 Responsible and healthy sexual behaviour
 Intervention to promote safe motherhood
 Prevention of unwanted pregnancy
 To increase accessibility of contraceptives
 Safe abortions
 Pregnancy and delivery services
 Management of RTI/STD
 Referral facility by government/private
  sector for pregnant women at risk
 Reproductive health services for
  adolescents
 Screening and treatment of infertility,
  cancer & other gynecological disorders
CHILD SURVIVAL ELEMENTS
 Essential New Born Care
 Prevention and management of vaccine
  preventable disease
 Urban measles campaign
 Neonatal tetanus elimination
 Surveillance of vaccine preventable diseases
 Cold chain system
 Polio eradication : pulse polio programme
 ARI control programme
 Diarrhea control programme and ORS programme
 Prevention and control of Vitamin A deficiency
  among children
 Baby Friendly Hospital Initiative (BFHI)
STRATEGY
 BOTTOM-UP PLANNING
 COMMUNITY NEED ASSESSMENT
  APPROACH
 DECENTRALISED PARTICIPATORY
  PLANNING & IMPLEMENTATION
 STRENGTHENING INFRASTUCTURE
 INTEGRATED TRAINING PACKAGE
 IMPROVED MANAGEMENT SYSTEM
 INTERVENTIONS
 MONITORING & EVALUATION
ANTE NATAL CARE
 Early registration of pregnancies (12 – 16 weeks)
 Minimum 3 antenatal visits (20,32,36 weeks) check-
  ups
 Anaemia prophylaxis ( Iron and Folic acid tablets)
 Two doses of TT
 Minimum investigations( Weight, B.P,Blood group, Rh
  typing, Urine examination,VDRL,HIV (TRIDOT TEST)
 Identification of high risk group, Early detection of
  complication of pregnancy & timely , safely referral to
  FRU
 Treatment of worm infestation with Mebendazole
 Health education on diet, breast feeding, care of
  breast, personnel hygiene during pregnancy,& family
  planning
REFERAL

1. BLEEDING            1.FIRST LEVEL
                       REFERRAL CENTER
2. OBSTRUTED LABOUR
                       2.COMMUNITY
                       HEALTH
                       CENTER/DISTRIC
                       HOSPITAL
1. SEPSIS
2. TOXAEMIA           PRIMARY HEALTH
3. ABORTION           CENTER

1.ANAEMIA
                       SUB CENTER
2.FAMILY PLANNING
PACKAGES OF SERVICES AT FRU
 •VACCUM EXTRACTIONS
 •ADMINISTRATION OF ANAESTHESIA
 •BLOOD TRANSFUSION
 •CASEAREAN SECTION
 •MANUAL REMOVAL OF PLACENTA
 •CARRY OUT SUCTION CURETTAGE FOR INCOMPLETE
 ABORTION
 •INSERTION OF INTRAUTERINE DEVICES
 •STERILIZATION OPERATION
TYPES OF KIT for FRU
•Kit-E – Laparotomy set
•Kit-F - Mini– Laparotomy set
•Kit-G – IUD insertion set
•Kit-H – Vasectomy set
•Kit- I – Normal delivery set
•Kit- J – Vacuum extraction set
•Kit- k – Embryotomy set
•Kit- L – Uterine evacuation set
•Kit-M – Equipment for anesthesia
•Kit-N- Neonatal resuscitation set
•Kit-O- Equipment and reagent for blood test
•Kit-P – Donor blood transfusion set
INTRANATAL CARE


Delivery by trained personnel (100%)
Institutional delivery (80%)
Care at birth ( Five cleans: Clean Birth
 Canal,Clean surface for delivery,Clean
 Hands,Clean Cutting, & Clean Cord)
POST NATAL CARE

 3 post natal check-ups of mothers after
 delivery
 Breast feeding – early & exclusive breast
 feeding
 Spacing – minimum 3 years between two
 pregnancies
NEW STRATEGY
 Empowered action group has been consituted on 20.03.2001


 Training of dais in 156 districts 18 states/uts 2001-2002


 RCH camps & RCH out reach scheme


 Gadchiroli model to take care of home based neonatel care in 2002


 Kangaroo mother care to take care of low birth weight infants


 Border district cluster strategy – 49 districts/17 states


 Integrated management of childhood illness (IMNCI) strategy to take care
of sick newborns
STEPS TO REDUCE MATERNAL
             MORTALITY
• HEALTH SECTOR ACTIONS
 Basic antenatal , intra natal &post natal care.
 skilled attendants @ every birth.
 EOC & Comprehensive obstetric care.
 Prevention of unwanted pregnancy &unsafe
  abortions.
 Joint consultations -medical disorders.
 Maternal mortality audit .
STEPS TO REDUCE
• COMMUNITY , SOCIETY & FAMILY ACTIONS .

• HEALTH PLANNERS /POLICY MAKERS ACTIONS
 community education ,motivation.
 Strengthen referral system.
 management protocols for obstetric
  emergencies.
 CME – Improve quality & standard of care.
 Maternal mortality audit .
STEPS TO REDUCE
• LEGISLATIVE & POLICY ACTIONS

 Girl children & adolescents :
  nutrition , education ,economic opportunities.
 Remove barriers to access health care.
 Cost
 Socio cultural factors
 Safe abortions & post abortion care -MVA
 Remove social inequalities- gender , age
  marital status.
Dr. bhuwan rch
World Health Day 2005 Slogan
 Make Every Mother And Child Count
Reflects that health of women
 and children should be given
 higher priority at all levels of
 health care system.

Every one is accountable for
 health of mothers & children
RCH - II PROGRAMME



     01-04-2005
THE 5 YEAR PHASE OF RCH II

VISION To bring about outcomes as
          envisioned in the
 1. Millennium Development Goals
 2. The National Population Policy 2000
     (NPP 2000)Goals
 3. The Tenth Plan Goals
 4. The National Health Policy 2002
 5. and Vision 2020 India
Dr. bhuwan rch
1728 - FRU




  PHC-22928



SUB CENTER-
38044
1. MATERNAL HEALTH
a) 260 Primary Health Centres are proposed to be taken up for
   improving access to Essential Obstetric and New Born Care
   services round the clock in TN. All CHC, & 50% PHCs to be
   made functional for 24 hrs delivery services,& 2000 FRU are
   proposed
b) Improving quality of antenatal, neonatal and postnatal care
    by providing increased number of antenatal checkups, fixed
    day antenatal clinics, linking visits of neonates with
    postnatal care, empowering the VHNs in performing
    obstetric first aid and newborn care.
c) Improvement of the referral networking systems by
    establishing emergency help line.
d) Regular conduct of blood donation camps for the continued
    availability of blood in the blood banks.
e) Universalizing the concept of birth companionship during the
    process of labour in all health facilities conducting deliveries.
f) Operationalisation of maternal death audit to address the
    issues that have led to maternal deaths.
Dr. bhuwan rch
2. INFANT AND CHILD HEALTH


a.Reduction of new-born deaths, infant deaths and child deaths
by providing continuous health care and strengthening of new-
born care infrastructure facilities.


b. Organizing counseling sessions for the mothers.


c. Implementing integrated management of neonatal and
childhood illness.


d. Operationalization infant death/stillbirth verbal autopsy.


e. Addressing the issue of female infanticide and foeticide.
Integrated Management of Neonatal
& childhood Illnesses (IMNCI)


IMNCI is a strategy for an integrated
 approach to the management of childhood
 illness as it is important for child health
 programmes to look beyond the treatment
 of single disease.
Major highlights

 Inclusion of 0-7 days in the programme


 Incorporation of national guidelines


 Training of health personnel


 Proportion of training time devoted to sick young infant and
  sick child is equal

 Skill based
3. ADOLESCENT HEALTH.


a)Focusing adolescents as receivers and providers of
knowledge and function as link volunteers in the community.


b) Utilising the services of trained adolescents for
propagating Indian System of Medicines.


c) Broadcasting and Telecasting of programme by AIR/TV
focusing adolescent, gender and health related subjects.


d) Formation of co-ordination committee at the district level
and monitoring committee at the State level for overseeing
the AIR/TV programme.
4. FAMILY WELFARE


a)While sustaining the ongoing family welfare
interventions in all districts, 19 districts with Higher
order births will be targeted for intensified
interventions.
b) Social marketing programme for condom and other
health commodities, promotion of IUD insertions,
familiarizing the concept of one-stop Family Welfare
Centre.
c) Increasing access to safe abortion services by
popularising manual vacuum aspiration (MVA)
technique.
d) Establishment of one-stop family welfare services at
Comprehensive Emergency Obstetric and New Born
Care (CEMONC) Centres.
e) Popularizing No Scalpel Vasectomy.
5. Reproductive tract infections / Sexually transmitted
infections / Cancer control.




a)Establishment of Reproductive Tract Infection /
Sexually Transmitted Infection, early Cancer detection
clinics .


b) Strengthening RCH outreach services.


c) RTI/STD clinic in selected 70 primary health centers
6. Infrastructure strengthening for service delivery


a) Construction of HSC buildings where HSCs are
currently functioning in rented premises
b) Rebuilding HSCs which are unfit for occupation.
c) Taking up of repairs/renovation and provision of
water supply/electrical works to PHCs/HSCs.
d) Need-based supply of equipment/furniture to the
HSCs and PHCs as per the standard list including gas
connections.
e) Provision of Cell phones to HSCs where large
number of deliveries take place.
f) Provision of telephones to PHCs
7. TRAINING


a)Skill upgradation training with focus on
improving/upgrading the skills of health care
providers.


b) Integrated skill training for peripheral health
functionaries such as VHNs, SHNs, medical officers and
health inspectors.


c) Improving managerial and communication skills of
health staff.
8. BEHAVIOURAL CHANGE COMMUNICATION (BCC)




a) Social mobilisation activity against female infanticide and
foeticide by preventive counselling.
b) Formation of HSC, Block, District level committees for saving
female babies.
c) Conducting of Kalaipayanam (travelling street theatre) to
promote social mobilization and to improve health care among
the target population
d) Telecasting of TV serials, Radio broadcasts, wall paintings,
hoardings and glow signs for popularizing health and
reproductive health messages in important places.
9. HEALTH MANAGEMENT INFORMATION SYSTEMS
Introduction of IT-enabled HMIS for planning and monitoring health
services at the State/District /Block levels


10. STRENGTHENING OF TEACHING INSTITUTIONS
Strengthening the facilities at teaching institutions for providing
optimum obstetric, family welfare, neonatal child health services.


11. ESTABLISHING URBAN HEALTH POSTS
To provide an integrated and sustainable system for primary health
care service delivery catering to the requirements of urban slum
population and other vulnerable groups
12. HEALTH FINANCING




The health care expenditure in India currently
stands at 6.1% of GDP. The private out of pocket
expenditure being 4.7% of Gross Domestic
Product (GDP). The total government expenditure
on family welfare has shown an increasing trend
from 4.9 billion in fifth plan (1974-79) to Rs.
271.25 billion in the tenth plan (2002-07)
ACCESSIBILITY
    INDICATOR
•No. of eligible couples registered/ANM
•No. of Antenatal Care sessions held as planned
•% of sub Centers with no ANM
•% of sub Centers with working equipment of ANC
•% ANM/TBA without requisite skill
•% sub centers with DDKs
•% of sub centers with infant weighing machine
•% subcenters with vaccine supplies
•% sub centers with ORS packets
•% sub centers with FP supplies
QUALITY INDICATOR
•% Pregnancy Registered before 12 weeks
•% ANC with 5 visits
•% ANC receiving all RCH services
•% High risk cases referred
•% High risk cases followed up
•% deliveries by ANM/TBA
•%PNC with 3 PNC visits
•% PNC receiving all counselling
•% PNC complications referred
•% Eligible couple offered FP choices
•% women screened for RTI/STDs
•% Eligible couple counselled for prevention of RTI/STDs
•% ADD given ORS
•% ARI treated
•% children fully immunized
IMPACT INDICATOR
•% DEATHS FROM MATERNAL CAUSES
•MATERNAL MORTALITY RATIO
•PREVALENCE OF MATERNAL MORBIDITY
•% LOW BIRTH WEIGHT
•NEO-NATAL MORTALITY RATIO
•PREVALENCE OF POST NATAL MATERNAL MORBIDITY
•% BABY BREAST FEED WITHIN 6 HRS OF DELIVERY
•COUPLE PROTECTION RATE
•PREVALENCE OF TERMINAL METHOD OF
STERILIZATION
•PREVALENCE OF SPACING METHOD
•% ABORTION RELATED MORBIDITY
•PREVALENCE OF ADD
•PREVALENCE OF ARI
•PREVALENCE OF RTI/STDs
THANK YOU

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Dr. bhuwan rch

  • 1. REPRODUCTIVE AND CHILD HEALTH PROGRAMME Dr. Bhuwan Sharma Assistant Professor Dept. of PSM Grant Govt. Medical College
  • 2. MILES STONE IN MCH CARE IN INDIA • 1880 – ESTABLISHMENT OF TRAINING OF DAIS IN AMRITSTAR • 1902 - 1st MIDWIFERY ACT TO PROMOTE SAFE DELIVERY • 1930 - SETTING UP OF ADVISORY COMMITTEE ON MATERNAL MORTALITY. • 1946 - BHORE COMMITTEE RECOMMENDATION ON COMPREHENSIVE & INTEGRATED HEALTH CARE • 1952 – PRIMARY HEALTH CENTER NET WORK & FAMILY PLANNING PROGRAMME • 1956 – MCH CENTERS BECOME INTEGRAL PART OF PHCS • 1961 - DEPARTMENT OF FAMILY PLANNING CREATED • 1971 – MTP ACT • 1974 – FAMILY PLANNING SERVICES INCORPORATED IN MCH CARE • 1977 – RENAMING FAMILY PLANNING TO FAMILY WELFARE • 1978 – EXPANDED PROGRAMME ON IMMUNIZATION • 1985 – UNIVERSAL IMMUNIZATION PROGRAMME • 1992 – CHILD SURVIVAL& SAFE MOTHERHOOD PROGRAMME • 1996 – TARGET FREE APPROACH • 1997 – RCH PROGRAMME PHASE-1 • 2005 – RCH PROGRAMME PHASE-2
  • 4. RCH – Ι PROGRAMME 15.10. 1997
  • 5. Objectives •Reduction of Maternal Morbidity and Mortality (MMR) •Reduction of Infant Morbidity and Mortality (IMR) •Reduction of Under 5 Morbidity and Mortality (U5MR) •Promotion of adolescent health •Control of reproductive tract infections and sexually transmitted infections.
  • 6. • The first phase of the programme had started from 1997 • To bring down the birth rate below 21 per 1000 population • To reduce the infant mortality rate below 60 per 1000 life born • To bring down the maternal mortality rate below 400 per one lakh. • Eighty per cent institutional delivery, • 100 per cent antenatal care • and 100 per cent immunization of children
  • 7. Vertical Programmes Integrated Service Delivery Camp Oriented Client Oriented Target Oriented Goal Oriented Quantity Oriented Quality Oriented
  • 8. Camp Oriented . Client Oriented • Sterilization Camps • Full Range of RCH Services • IUD Camps • Need Based • Immunisation Camps
  • 9. Target Oriented Goal Oriented Performance by Performance by Numbers Quality • Top Down • Bottom up • Client Need Based • Target Driven • Community Participation • To the Govt. System • To the Clients, Community
  • 10. Safe Motherhood Services - Essential Care for All Child Survival - Early Identification of Complications Services - Emergency Services those who are in need Family Welfare - Increased access to Healthy Prevention and Contraceptives Mother Management of & - Safe Abortion Child RTI /STI Services Adolescent Health Care and Family Life Education
  • 11. COMPONENTS OF RCH PROGRAMME Prevention and management of unwanted pregnancy Maternal care that includes antenatal, delivery, and postpartum services Child survival services for newborns and infants Management of reproductive tract infections and sexually transmitted infections
  • 12. REPRODUCTIVE HEALTH ELEMENTS  Responsible and healthy sexual behaviour  Intervention to promote safe motherhood  Prevention of unwanted pregnancy  To increase accessibility of contraceptives  Safe abortions  Pregnancy and delivery services  Management of RTI/STD  Referral facility by government/private sector for pregnant women at risk  Reproductive health services for adolescents  Screening and treatment of infertility, cancer & other gynecological disorders
  • 13. CHILD SURVIVAL ELEMENTS  Essential New Born Care  Prevention and management of vaccine preventable disease  Urban measles campaign  Neonatal tetanus elimination  Surveillance of vaccine preventable diseases  Cold chain system  Polio eradication : pulse polio programme  ARI control programme  Diarrhea control programme and ORS programme  Prevention and control of Vitamin A deficiency among children  Baby Friendly Hospital Initiative (BFHI)
  • 14. STRATEGY  BOTTOM-UP PLANNING  COMMUNITY NEED ASSESSMENT APPROACH  DECENTRALISED PARTICIPATORY PLANNING & IMPLEMENTATION  STRENGTHENING INFRASTUCTURE  INTEGRATED TRAINING PACKAGE  IMPROVED MANAGEMENT SYSTEM  INTERVENTIONS  MONITORING & EVALUATION
  • 15. ANTE NATAL CARE  Early registration of pregnancies (12 – 16 weeks)  Minimum 3 antenatal visits (20,32,36 weeks) check- ups  Anaemia prophylaxis ( Iron and Folic acid tablets)  Two doses of TT  Minimum investigations( Weight, B.P,Blood group, Rh typing, Urine examination,VDRL,HIV (TRIDOT TEST)  Identification of high risk group, Early detection of complication of pregnancy & timely , safely referral to FRU  Treatment of worm infestation with Mebendazole  Health education on diet, breast feeding, care of breast, personnel hygiene during pregnancy,& family planning
  • 16. REFERAL 1. BLEEDING 1.FIRST LEVEL REFERRAL CENTER 2. OBSTRUTED LABOUR 2.COMMUNITY HEALTH CENTER/DISTRIC HOSPITAL 1. SEPSIS 2. TOXAEMIA PRIMARY HEALTH 3. ABORTION CENTER 1.ANAEMIA SUB CENTER 2.FAMILY PLANNING
  • 17. PACKAGES OF SERVICES AT FRU •VACCUM EXTRACTIONS •ADMINISTRATION OF ANAESTHESIA •BLOOD TRANSFUSION •CASEAREAN SECTION •MANUAL REMOVAL OF PLACENTA •CARRY OUT SUCTION CURETTAGE FOR INCOMPLETE ABORTION •INSERTION OF INTRAUTERINE DEVICES •STERILIZATION OPERATION
  • 18. TYPES OF KIT for FRU •Kit-E – Laparotomy set •Kit-F - Mini– Laparotomy set •Kit-G – IUD insertion set •Kit-H – Vasectomy set •Kit- I – Normal delivery set •Kit- J – Vacuum extraction set •Kit- k – Embryotomy set •Kit- L – Uterine evacuation set •Kit-M – Equipment for anesthesia •Kit-N- Neonatal resuscitation set •Kit-O- Equipment and reagent for blood test •Kit-P – Donor blood transfusion set
  • 19. INTRANATAL CARE Delivery by trained personnel (100%) Institutional delivery (80%) Care at birth ( Five cleans: Clean Birth Canal,Clean surface for delivery,Clean Hands,Clean Cutting, & Clean Cord)
  • 20. POST NATAL CARE  3 post natal check-ups of mothers after delivery  Breast feeding – early & exclusive breast feeding  Spacing – minimum 3 years between two pregnancies
  • 21. NEW STRATEGY  Empowered action group has been consituted on 20.03.2001  Training of dais in 156 districts 18 states/uts 2001-2002  RCH camps & RCH out reach scheme  Gadchiroli model to take care of home based neonatel care in 2002  Kangaroo mother care to take care of low birth weight infants  Border district cluster strategy – 49 districts/17 states  Integrated management of childhood illness (IMNCI) strategy to take care of sick newborns
  • 22. STEPS TO REDUCE MATERNAL MORTALITY • HEALTH SECTOR ACTIONS  Basic antenatal , intra natal &post natal care.  skilled attendants @ every birth.  EOC & Comprehensive obstetric care.  Prevention of unwanted pregnancy &unsafe abortions.  Joint consultations -medical disorders.  Maternal mortality audit .
  • 23. STEPS TO REDUCE • COMMUNITY , SOCIETY & FAMILY ACTIONS . • HEALTH PLANNERS /POLICY MAKERS ACTIONS  community education ,motivation.  Strengthen referral system.  management protocols for obstetric emergencies.  CME – Improve quality & standard of care.  Maternal mortality audit .
  • 24. STEPS TO REDUCE • LEGISLATIVE & POLICY ACTIONS  Girl children & adolescents : nutrition , education ,economic opportunities.  Remove barriers to access health care.  Cost  Socio cultural factors  Safe abortions & post abortion care -MVA  Remove social inequalities- gender , age marital status.
  • 26. World Health Day 2005 Slogan Make Every Mother And Child Count Reflects that health of women and children should be given higher priority at all levels of health care system. Every one is accountable for health of mothers & children
  • 27. RCH - II PROGRAMME 01-04-2005
  • 28. THE 5 YEAR PHASE OF RCH II VISION To bring about outcomes as envisioned in the 1. Millennium Development Goals 2. The National Population Policy 2000 (NPP 2000)Goals 3. The Tenth Plan Goals 4. The National Health Policy 2002 5. and Vision 2020 India
  • 30. 1728 - FRU PHC-22928 SUB CENTER- 38044
  • 31. 1. MATERNAL HEALTH a) 260 Primary Health Centres are proposed to be taken up for improving access to Essential Obstetric and New Born Care services round the clock in TN. All CHC, & 50% PHCs to be made functional for 24 hrs delivery services,& 2000 FRU are proposed b) Improving quality of antenatal, neonatal and postnatal care by providing increased number of antenatal checkups, fixed day antenatal clinics, linking visits of neonates with postnatal care, empowering the VHNs in performing obstetric first aid and newborn care. c) Improvement of the referral networking systems by establishing emergency help line. d) Regular conduct of blood donation camps for the continued availability of blood in the blood banks. e) Universalizing the concept of birth companionship during the process of labour in all health facilities conducting deliveries. f) Operationalisation of maternal death audit to address the issues that have led to maternal deaths.
  • 33. 2. INFANT AND CHILD HEALTH a.Reduction of new-born deaths, infant deaths and child deaths by providing continuous health care and strengthening of new- born care infrastructure facilities. b. Organizing counseling sessions for the mothers. c. Implementing integrated management of neonatal and childhood illness. d. Operationalization infant death/stillbirth verbal autopsy. e. Addressing the issue of female infanticide and foeticide.
  • 34. Integrated Management of Neonatal & childhood Illnesses (IMNCI) IMNCI is a strategy for an integrated approach to the management of childhood illness as it is important for child health programmes to look beyond the treatment of single disease.
  • 35. Major highlights  Inclusion of 0-7 days in the programme  Incorporation of national guidelines  Training of health personnel  Proportion of training time devoted to sick young infant and sick child is equal  Skill based
  • 36. 3. ADOLESCENT HEALTH. a)Focusing adolescents as receivers and providers of knowledge and function as link volunteers in the community. b) Utilising the services of trained adolescents for propagating Indian System of Medicines. c) Broadcasting and Telecasting of programme by AIR/TV focusing adolescent, gender and health related subjects. d) Formation of co-ordination committee at the district level and monitoring committee at the State level for overseeing the AIR/TV programme.
  • 37. 4. FAMILY WELFARE a)While sustaining the ongoing family welfare interventions in all districts, 19 districts with Higher order births will be targeted for intensified interventions. b) Social marketing programme for condom and other health commodities, promotion of IUD insertions, familiarizing the concept of one-stop Family Welfare Centre. c) Increasing access to safe abortion services by popularising manual vacuum aspiration (MVA) technique. d) Establishment of one-stop family welfare services at Comprehensive Emergency Obstetric and New Born Care (CEMONC) Centres. e) Popularizing No Scalpel Vasectomy.
  • 38. 5. Reproductive tract infections / Sexually transmitted infections / Cancer control. a)Establishment of Reproductive Tract Infection / Sexually Transmitted Infection, early Cancer detection clinics . b) Strengthening RCH outreach services. c) RTI/STD clinic in selected 70 primary health centers
  • 39. 6. Infrastructure strengthening for service delivery a) Construction of HSC buildings where HSCs are currently functioning in rented premises b) Rebuilding HSCs which are unfit for occupation. c) Taking up of repairs/renovation and provision of water supply/electrical works to PHCs/HSCs. d) Need-based supply of equipment/furniture to the HSCs and PHCs as per the standard list including gas connections. e) Provision of Cell phones to HSCs where large number of deliveries take place. f) Provision of telephones to PHCs
  • 40. 7. TRAINING a)Skill upgradation training with focus on improving/upgrading the skills of health care providers. b) Integrated skill training for peripheral health functionaries such as VHNs, SHNs, medical officers and health inspectors. c) Improving managerial and communication skills of health staff.
  • 41. 8. BEHAVIOURAL CHANGE COMMUNICATION (BCC) a) Social mobilisation activity against female infanticide and foeticide by preventive counselling. b) Formation of HSC, Block, District level committees for saving female babies. c) Conducting of Kalaipayanam (travelling street theatre) to promote social mobilization and to improve health care among the target population d) Telecasting of TV serials, Radio broadcasts, wall paintings, hoardings and glow signs for popularizing health and reproductive health messages in important places.
  • 42. 9. HEALTH MANAGEMENT INFORMATION SYSTEMS Introduction of IT-enabled HMIS for planning and monitoring health services at the State/District /Block levels 10. STRENGTHENING OF TEACHING INSTITUTIONS Strengthening the facilities at teaching institutions for providing optimum obstetric, family welfare, neonatal child health services. 11. ESTABLISHING URBAN HEALTH POSTS To provide an integrated and sustainable system for primary health care service delivery catering to the requirements of urban slum population and other vulnerable groups
  • 43. 12. HEALTH FINANCING The health care expenditure in India currently stands at 6.1% of GDP. The private out of pocket expenditure being 4.7% of Gross Domestic Product (GDP). The total government expenditure on family welfare has shown an increasing trend from 4.9 billion in fifth plan (1974-79) to Rs. 271.25 billion in the tenth plan (2002-07)
  • 44. ACCESSIBILITY INDICATOR •No. of eligible couples registered/ANM •No. of Antenatal Care sessions held as planned •% of sub Centers with no ANM •% of sub Centers with working equipment of ANC •% ANM/TBA without requisite skill •% sub centers with DDKs •% of sub centers with infant weighing machine •% subcenters with vaccine supplies •% sub centers with ORS packets •% sub centers with FP supplies
  • 45. QUALITY INDICATOR •% Pregnancy Registered before 12 weeks •% ANC with 5 visits •% ANC receiving all RCH services •% High risk cases referred •% High risk cases followed up •% deliveries by ANM/TBA •%PNC with 3 PNC visits •% PNC receiving all counselling •% PNC complications referred •% Eligible couple offered FP choices •% women screened for RTI/STDs •% Eligible couple counselled for prevention of RTI/STDs •% ADD given ORS •% ARI treated •% children fully immunized
  • 46. IMPACT INDICATOR •% DEATHS FROM MATERNAL CAUSES •MATERNAL MORTALITY RATIO •PREVALENCE OF MATERNAL MORBIDITY •% LOW BIRTH WEIGHT •NEO-NATAL MORTALITY RATIO •PREVALENCE OF POST NATAL MATERNAL MORBIDITY •% BABY BREAST FEED WITHIN 6 HRS OF DELIVERY •COUPLE PROTECTION RATE •PREVALENCE OF TERMINAL METHOD OF STERILIZATION •PREVALENCE OF SPACING METHOD •% ABORTION RELATED MORBIDITY •PREVALENCE OF ADD •PREVALENCE OF ARI •PREVALENCE OF RTI/STDs