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Reproductive and Child Health Programme (Phase-II)

2006-12
GUJARAT

Goals

Reduce MMR from 389 (in 1998) to 100 per 100,000 live births by 2010 Reduce IMR from 60 to 30 by 2010 Stabilize population by reducing TFR from 3.0 to 2.1 by 2010

FW & RCH Components

Maternal health Child health Family Planning Immunisation Demography & Evaluation Logistics IEC/BCC

Adolescent Health Quality assurance Partnership with NGO PCPNDT RTI/STI Nutrition

Health Service Infrastructure: Gujarat


Service SC PHC CHC Existing 7274 1066 277 Required 7236 1166 317 Difference +38 -100 -40

SDH
DH

23
23
GMC 6

DH - 23

CHC- 277 PHC - 1066

Sub centers - 7274

Resource Mapping Basic Health Statistics: Health and Medical Institutions Para Medical Training Medical Manpower Nursing Staff Various Health programmes in the State Workloads of FP activities

This provides availability of human resources and health infrastructure.

EVIDENCE BASED MANAGEMENT

Internal System
CRS Routine MIS Reports

External data sources

NFHS SRS DLHS NSSO Latest research as presented in journals like The Lancet, the Bulletin of WHO

Independent Evaluation
UNICEF: MICS (IMNCI-Child Health) UNFPA & Evaluation cell (GoG) (Chiranjeevi) CARE (FW programme)

New Approaches
Result based approach Need based inputs Decentralization Quality of services Reducing health disparity by addressing Equity/ Access issues: inclusive planning Public private partnership Integrated Approach (Health, FW, urban, Tribal, AIDS, NGOs, Private, ISM, ME, etc)

Approach of GoG

Addressing Equity Concerns


Chiranjivi, Bal Sakha & JSY- to increase access of BPL expectant mothers for safe delivery Increased allocation and convergent action to tribal and urban slum areas (50 Blocks)

Reaching out the disadvantaged/ remote, unreachable population- 112 Mobile Health Services in tribal, salt pan area, border area, peri- urban areas and partnership with SNGOs, FNGOs, Private providers, tribal and ISM

Equity..

Bal Sakha

Chiranjivi

The Gujarat Government initiative is a departure from previous practice in that it took sole responsibility for the reimbursement of private health care providers, rather than relying on intermediary parties such as insurers. The state government is working with professional agencies such as associations, obstetricians and academic organizations to plan and implement the new arrangements. Showing remarkable success, the programme has been expanded from five to all 25 districts of Gujarat. Between January 2006 and January 2009, 869 doctors were enlisted. Nearly 2,79,236 deliveries were performed, with each doctor performing an average of 322 deliveries.
WHO conference Nominated for PMs award Asian Innovation award Published in The Lancet

GENDER ISSUES
Gender issues integrated into trainings

Declining sex atio- advocacy and social mobilization, Welfare scheme, encouraging girls education
r

Convergent action with professional bodies, NGOs, PRIs PCPNDT Act

Interventions identified for Different Levels


Clinical level Quality improvements Operationalise FRUs for Comprehensive EmOC Availing BEmOC at CHCs and PHCs Skill based trainings for health providers Public Private Partnership: Need based out sourcing

Interventions identified for Different Levels Outreach Field Visit RCH Camps Immunisation Sessions on fix days: mamata days Mobile Health Units for inaccessible areas

Interventions identified for Different Levels

Community level
Awareness

Generation Trainings & Skill Development Strengthening CBWs including link couples and CBOs Involving PRIs for a meaningful role

Broad Strategies to reduce IMR

Facts:
Total IMR is less than national average Rural IMR is less than national average Urban IMR is more than national average FOCUS ON URBAN SLUMS Critical Situations: Neonatal period Low Birth Weight children FOCUS ON NEWBORN CARE.

Strategic Interventions:
Neonatal Care: At community, household level as well

as hospital i.e. prevent hypothermia, prevent infection & exclusive breast-feeding. Immunization, Diarrhea, Treatment of ARI Dealing with Malnutrition Community Campaigns for nutritional goals including change in dietary behavior of community Birth spacing as a IMR reducing strategy Inter-sectoral coordination: Nirogi Bal Varsh Monitoring and supervision

Broad Strategies to reduce MMR Identifying Risk Causing Complications (like Bleeding, Eclampsia, Obstructed labour, Anemia, Sepsis): Delay 1: Community identifies complications- family decides for Emergency Obstetric Care- IEC Issues Delay 2: Availability of emergency transport -mobilization of community resources Delay 3: Starting the Emergency care at hospital level - Make all FRUs functional - Public Private Partnership

Essential Obstetric Care


Comprehensive Antenatal

care with regular check ups, TT injections, Iron tablets and Supplementary feeding for specific groups Replacing Trained Birth Attendance by Skilled Birth Attendance Quality obstetric services at primary Health Center Effective Supply management of DDKs Creating the right Infrastructure Training for early recognition of bleeding /prolonged labor / Infection /Abnormal presentation/Convulsions Incentive based approach for trained TBAs and early referral for EmOC Mobility support- Interest free moped loans to ANMs

Emergency Obstetric Care


Effective Emergency Obstetric care management Strengthening

FRUs for effective service delivery with Blood transfusion facilities BEmOC to be made available at CHCs and PHCs. Skill development at all required stages Promoting timely referral by TBAs through training Expertise of Gynec and Anesthetists to be made available on panel and promote telemedicine for emergency. Emergency transport for cases with complications and needing referral.

Broad strategy for population stabilization


Volunteerism

policy. Community Needs Assessment approach and focusing on unmet needs Community behavioral change through IEC activities, increase coverage of spacing and permanent FP methods Community based contraceptive availability Skill based training for doctors will be undertaken for tubectomy operations, laperoscopy operations and MTP and training of nursing personnel in IUD insertion technique. Monitoring and supervision: Ensuring filling up all posts of ADHOs, DIECOs and making provision of reporting formats and registers for MIS

and informed choices as basis of population

Overarching Issues

Emphasizing Adolescent Health Harnessing technology Increasing the Involvement of Stakeholders Mainstreaming Gender Meaningful role of PRIs Enhancing Performance of Health Delivery Systems Promoting Indian Systems of Medicine & Homeopathy Qualitative Improvements in Family Planning Establishing Effective Monitoring Mechanisms Increasing Awareness among Women

Harnessing Technology
Harnessing opportunities created by IT revolution for health services The establishment of GIS Management Information Systems through networking of district health offices with the health directorate Implementation of the telemedicine application

Social mobilisation for health


Dai Sangathan by 13 leading NGOs and a strategic road map for Dais involvement. Mother NGOs, Field NGOs in RCH services and service support Jan Swasthya Abhiyan for communitising health programmes Involvement of Elected Representatives

Involvement of Women's Organisations, CBOs, etc

Increasing the Involvement of Stakeholders

Academic Institutions NGOs Professional Bodies (e.g. IMA, Nurses Associations) Womens organizations Youth organizations (e.g. NSS, NCC NYK etc.) Community based organization Religious organizations Press and Media Voluntary and philanthropic organizations Services Clubs (e.g. Rotary, Lions, JC) Corporate, Judiciary, Consumer organizations

Vaccine Preventable Diseases

VPDs

Immunization

Diphtheria

Polio

Whooping cough

Meningitis TB

Tetanus

Measles

NATIONAL IMMUNIZATION PROGRAMME

1978-79 EPI 5 Vaccines (TT, DPT, Polio, BCG, Measles) 1985 UIP Coverage, quality 1995 PPI NID, < 5 yrs, Booth 1999 IPPI NID, < 5 yrs, Booth, HtoH Social mobilization, AFP surveillance Simultaneous RI

Strategies
Coverage > 90 % for 9 12 months age Strengthen surveillance Coverage during epidemic Treatment of measles complications IEC activities Urban measles 5 yrs; school children 10 yrs

Maintenance of cold chain


Storage and transportation of vaccine at the recommended temperature from point of manufacture till given in the body of beneficiaries. Sensitivity to heat

BCG (reconstituted) measles Hep B TT


Least sensitive TT

OPV DPT DT

Sensitivity to freezing
DPT DT TT Hep - B

Vaccine Vial Monitor


Inner square white If the expiry date has not been passed USE the vaccine
Inner square lighter than the outer circle If the expiry date has not been passed USE the vaccine Discard point:

Inner square matches colour of the outer circle


DO NOT use the vaccine, Inform your supervisor Beyond Discard point: Inner square darker than outer circle DO NOT use the vaccine, Inform your supervisor

Equipment for vaccine storage


WIF - 200 C WIC + 20 to 80C DF - 200 C ILR + 20 to 80C Cold boxes 90 hours Vaccine carrier 6 hours Ice packs