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1. National Programs 1. Universal Immunisation program(UIP) 2. Janani Suraksha Yojana(JSY) 3.Pradhan Mantri Surakshit Matritya Abhiyan(PMSMA) 4.National Program for Family planning Presentor : Dr Jason Dsouza Moderator: Dr Mario Bukelo

2. UNIVERSAL IMMUNIzATION PROGRAM(UIP)

3. UNIVERSAL IMMUNIzATION PROGRAM(cont.) B ecame a part of Child Survival and Safe motherhood Programme in 1992 and is currently one of the key areas under National Rural Health Mission(NRHM) since 2005

4. UNIVERSAL IMMUNIzATION PROGRAM(cont.) KEY ROLES: ROUTINE IMMUNISATION CAMPAIGNS(POLIO,MEASLES & JAPANESE ENCAPHALITIS) MONITORING ADVERSE EVENTS FOLLOWING IMMUNISATION VACCINE AND COLD STORAGE LOGISTICS IMMUNISATION TRAININGS

5. Roadmap of vaccine Introduction 2010 2015 2011 2013 2017 2016 Since 2010 several new vaccines introduced in Country’s UIP 5 2002 1985 2006 JE vaccine introduced

6. UNIVERSAL IMMUNIzATION PROGRAM(cont.) Under UIP, following vaccines are provided: 1. BCG (Bacillus Calmette Guerin) 2. DPT (Diphtheria, Pertussis and Tetanus Toxoid) 3. OPV (Oral Polio Vaccine) 4. Measles & Rubella 5. Hepatitis B 6. TT (Tetanus Toxoid) 7. JE vaccination (in selected high disease burden districts) 8. Hib containing Pentavalent vaccine ( DPT+HepB+Hib ) 9. RotaVirus Vaccine

7. Universal Immunization Programme (Scope and Scale) Make in India : Largest vaccine manufacturing capacity in the world

8. Immunization Coverage (FIC) > = 80% 70% to 80% 60% to 70% 50% to 60% < 50% India: 43.5% ranging from 21% to 81%, NFHS-3, 2005-06 India: 62% ranging from 36% to 91%, NFHS-4, 2015-16

9. Two milestones achieved On 27 th March 2014, South-East Asia Region of WHO, including India, certified POLIO-FREE On 14 th July 2016, WHO certified India for eliminating maternal and neonatal tetanus

10. Rapidly changing landscape of Universal Immunization Programme

11. UNIVERSAL IMMUNIzATION PROGRAM(cont.) To create evidence base to enable planning and deployment of effective interventions. Integrated disease surveillance projects-for dectection of early warning signals of outbreaks(for control, elimination & eradication) . Another source is the National Polio Surveillance Project (NPSP), which has done extremely well in acute flaccid paralysis (AFP) and measles surveillance in India. WHO/NPSP provides needed technical and training support for AFP and measles surveillance VPD Surveillance

12. UNIVERSAL IMMUNIzATION PROGRAM(cont.)

13. UNIVERSAL IMMUNIzATION PROGRAM(cont.)

14. FAQ’s: 1) Which vaccines can be given to a child between 1-5 years of age, who has never been vaccinated? DPT 1, OPV-1, measles and 2 ml of vitamin A solution. Followed by second and third doses of DPT and OPV at one month intervals. Measles second dose is also to be given as per the schedule. Booster dose of OPV/DPT given at a minimum of 6 months after administering OPV3/DPT3. 2)Which vaccines can be given to a child between 5-7 years of age, who has never been vaccinated ? First, second and third doses of DPT at one month intervals. The booster dose of DPT ,6 months after administering DPT3 (minimum) upto 7 years of age. UNIVERSAL IMMUNIzATION PROGRAM(cont.)

15. UNIVERSAL IMMUNIzATION PROGRAM(cont.) 3) Should one re-start with the first dose of a vaccine if a child is brought late for a dose ? To pick up from where the schedule was left off. 4) Why is it not adviced to clean the injection site with spirit swab before vaccination? Some of the live components of vaccines are killed when comes in contact with spirit 5) Why should there be a minimum gap of 4 weeks between two doses of DPT? Decreasing the interval between two doses may not obtain optimal antibody production for protection.

16. UNIVERSAL IMMUNIzATION PROGRAM(cont.) 6)Why give the DPT vaccine in the antero-lateral mid thigh and not the gluteal region ? To prevent damage to the sciatic nerve and moreover vaccine deposited fat of gluteal region does not invoke the appropriate immune response. 7)What should one do if the child is found allergic to DPT or develops encephalopathy after DPT ? Should be given the DTaP/DT vaccine instead of DPT for the remaining doses.

17. UNIVERSAL IMMUNIzATION PROGRAM(cont.) 8) If a child has received the measles vaccine before 9 months of age, is it necessary to repeat the vaccine later? Yes, i.e. after the completion of 9 months until 12 months of age and at 16-24 months. Can be administered upto 5 years of age. 9) What is measles catch-up campaign ? To vaccinate all children between 9m to 10 years of age with one dose of measles vaccine.

18. UNIVERSAL IMMUNIzATION PROGRAM(cont.) 10)Why give BCG vaccine only on the left upper arm ? To maintain uniformity and for helping surveyors in verifying the receipt of the vaccine. 11)Why do we give 0.05 ml dose of BCG to newborns(below 1 month of age) ? Skin of newborns is thin and an intradermal injection of 0.1 ml may break the skin or penetrate into the deeper tissue causing local abscess and enlarged axillary lymph nodes. Dose of 0.05ml is sufficient to elicit adequate protection. 12)If no scar appears after administering BCG, should one re-vaccinate the child ? No need to re-vaccinate the child.

19. UNIVERSAL IMMUNIzATION PROGRAM(cont.) 13) If a girl has received all doses of DPT and TT as per the NIS till 16 years of age and she gets pregnant at 20 years, should she get one dose of TT during pregnancy ? Give 2 doses of TT during the pregnancy as per the schedule. 14) Can TT be given in the first trimester of pregnancy ? Yes, it should be given as soon as pregnancy is diagnosed. 15)Why give the birth dose of hepatitis B vaccine only within 24 hours of birth ? Effective in preventing perinatal transmission of Hepatitis B if given within the first 24 hours.

20. UNIVERSAL IMMUNIzATION PROGRAM(cont.) BCG vaccine given till 1 year of age Pentavalent vaccine till 1 year of age OPV vaccine can be given till 5 years of age Measles vaccine can be given till 5 years of age DPT vaccine can be given upto 7 years of age JE vaccine can be given upto 15 years of age

21. UNIVERSAL Immunization PROGRAM(cont.) Cold Chain: If vaccines are exposed to excessive Heat ,Cold, Light they may lose their potency or effectiveness; hence Cold chain must be maintained .

22. UNIVERSAL IMMUNIzATION PROGRAM(cont.) • BCG (after reconstitution) MOST SENSITIVE • OPV • Measles (before and after reconstitution) • DPT • BCG (before reconstitution) • DT • TT • HepB LEAST SENSITIVE Heat Sensitivity Sensitivity from Freezing : HepB >>>DPT >>> DT >>>> TT MOST SENSITIVE LEAST SENSITIVE

23. eVIN : Mobile application which gives real time information about vaccine stocks and Temperature monitoring of cold chain system .Launched in 2015

24. Janani Suraksha Yojana(JSY)

25. Janani Suraksha Yojana National Maternity Benefit scheme; Launched on 12th April 2005 Objective: Reducing maternal and neonatal mortality by promoting institutional delivery among women in BPL families Salient Features : -100 % centrally sponsored scheme -Being implemented under NRHM (all states & UTs; it integrates cash assistance with institutional care during antenatal delivery and immediate post partum care) -Benefit will be extended upto the third child if mother chooses to undergo sterilization immediately after delivery(HPS). In LPS all births are given cash assisatnce . -Health activist involved: ASHA,AWW,TBA

26. Janani Suraksha Yojana(Cont.) Important Features of JSY: - Low Performing States :Uttar Pradesh, Uttaranchal, Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh, Assam, Rajasthan, Orissa and Jammu and Kashmir(Main focus of JSY). - Tracking Each Pregnancy : JSY card along with a MCH card. Health worker assigned under supervision of ANM and MO, will prepare a micro-birth plan which will effectively help in monitoring Antenatal Check-up, and post delivery care. - Eligibility for Cash Assistance: BPL Certification – in all HPS states. If No BPL card, depending on the family status gram panchayath would issue a certificate. - Disbursement of Cash Assistance : To meet the cost of delivery; Done at the hospital level cash given at one go to mother while ASHA would get her money once Child is immunized with BCG or after her postnatal visit.

27. Janani Suraksha Yojana(Cont.) Eligibility for Cash Assistance: LPS: All pregnant women delivering in government health centres HPS: All BPL/Scheduled Caste/Scheduled Tribe (SC/ST) women delivering in a government health centre , such as SC/PHC/CHC/FRU/general wards of district or state hospital BPL/SC/ST women in accredited private institutions Cash Assistance for Institutional Delivery (in Rs) Category Rural area Mother ASHA Total Urban Area Mother ASHA Total LPS 600* 2000 1000 400** 1400 HPS 700 600* 1300 600 400** 1000

28. Janani Suraksha Yojana(Cont.) Subsidized caesarean section, up to Rs. 1500/delivery All BPL pregnant women(LPS & HPS) preferring to deliver at home, are entitled to cash assistance of Rs. 500 per delivery, regardless of age and birth order. Vandemataram scheme : Voluntary scheme for doctors and health institutions to volunteer in providing safe motherhood services. Vandemataram Logo in Institution, Iron,Folic Acid,oral pills, TT injections etc. will be provided by DHO for free distribution to beneficiaries

29. Janani Suraksha Yojana(Cont.) As Part of RCH-phase 2: Safe abortion Services are also provided (Medical and MVA) Village Health and Nutrition Day: Once a month at Anganwadi center Maternal death review Pregnancy tracking

30. Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) Launched in the year 2016 under National Health Mission Aims: Providing assured, comprehensive and quality antenatal care, free of cost, universally to all pregnant women on the 9th of every month. If its a Sunday/ a holiday, then the Clinic organized on the next working day. This service is in addition to the routine ANC at the health facility. Goal: To improve the quality and coverage of Antenatal Care (ANC) including diagnostics and counselling services as part of the Reproductive Maternal Neonatal Child and Adolescent Health (RMNCH+A) Strategy   Target Beneficiaries: The program aims to reach out to all Pregnant Women who are in the 2nd & 3rd Trimesters of pregnancy .

31. Package of services under PMSMA 1. Routine antenatal check up 2. Diagnostic services 3. Identification and management of high risk pregnancy 4. Counselling on Nutrition, Family Planning, Birth Preparedness, New born and Post Natal care. Other components of PMSMA are: 1. Communication for behavioural change 2. Health system strengthening for providing quality services 3. Referral transport Pradhan Mantri Surakshit Matritva Abhiyan ( Cont )

32. Essential pre-requisites for Facilities organizing PMSMA Human resources: ANM/GNM T rained Medical Officer Lab Technician Pharmacist ANM/SN/ trained in counselling USG: Sonologist/Radiologist for USG Lab Investigations: • Hemoglobin • Urine Albumin and Sugar • Blood Sugar (Dipstick) • Malaria • VDRL, HIV,Blood Sugar • Blood Grouping Pradhan Mantri Surakshit Matritva Abhiyan ( Cont )

33. Pradhan Mantri Surakshit Matritva Abhiyan ( Cont ) All identified high risk pregnancies should be referred to higher facilities and JSSK help desks that have been set up at these facilities. Before leaving the facility every pregnant women to be counselled, may be individually or in groups, on nutrition ,rest, safe sex, safety, birth preparedness, identification of danger signs, institutional delivery and Post- partum Family Planning (PPFP). • Filling out the MCP cards at these clinics is mandatory and a sticker indicating the condition and risk factor of the pregnant women should be added onto MCP card for each visit: Green Sticker : For women with no risk factor detected Red Sticker: For women with high risk pregnancy Blue Sticker : For women with Pregnancy Induced Hypertension Yellow Sticker: Pregnancy with co-morbid conditions such as diabetes, hypothyroidism, STIs etc.

34. National Programme for Family Planning Matritya Abhiyan(PMSMA) First country in the world to have launched a National Programme for Family Planning in 1952 Goal : -To reduce India's overall fertility rate to 2.1 by the year 2025 -In addition to population stabilization goals also promotes reproductive health and reduce maternal, infant & child mortality and morbidity 52.5% of country’s fertility is contributed by age group 15-24 years 15-24 years women contribute 46% of the maternal mortality

35. India’s Contribution to World Population

36. Source: Census 2011

37. MoHFW launched “Mission Pariwar Vikas” in 2016 ,with an aim to improve access to contraceptives and family planning services at all levels of health system in high fertility districts(146) spreading over seven high focus states Bihar, Uttar Pradesh, Assam, Chhattisgarh, Madhya Pradesh, Rajasthan & Jharkhand. Objective: To accelerate access to high quality Family Planning choices based on information, reliable services and supplies within the rights framework. Hum DO : NFPP through Hum Do aims to provide eligible couples with information and guidance on family planning methods and services available, to ensure individuals and couples lead a healthy, happy and prosperous life Mission Parivar Vikas

38. Key highlights of FP programmes

39. Expansion of the basket of FP Choices Augmenting the demand through ASHA Schemes for Family Planning Promoting quality sterilization services Promoting quality IUCD services Generating demand and awareness for FP services Addressing global Commitments (Family Planning 2020) Key FP Initiatives/Schemes

40. New Initiatives under Family Planning Mission Parivar Vikas Unified Software for FP logistics Expansion of Contraceptive basket of choices New Contraceptive Packaging New FP media campaign

41. Temporary Methods Condoms ( Nirodh ) Oral Contraceptive Pills- Combined Oral Contraceptives (Mala N) Centchroman ( Chhaya ) Emergency Contraceptive Pills ( Ezy Pill) IUCD-380A, 375 Injectable MPA Permanent Methods Male Sterilization (Conventional Vasectomy/NSV) Female Sterilization ( Minilap /Laparoscopic) IUCD 375 IUCD 380 A

42. Promoting quality IUCD services Interval IUCD: Can be provided in all public health facilities by a trained provider in OPD PPIUCD (Post partum IUCD): Inserted within 48 hours after delivery in facilities conducting deliveries PAIUCD (Post abortion IUCD): Inserted within 12 days of abortion in PHC and above facilities PPIUCD and PAIUCD incentive scheme : Trained/Skilled empanelled provider inserting PPIUCD/PAIUCD- Rs 150 per insertion. ASHA accompanying Client- Rs 150/insertion Beneficiary- Rs . 300

43. Expansion of the basket of FP Choices Introduction of new contraceptive choices- Injectable Contraceptive (Antara Program) Centchroman ( Chhaya ) Progesterone only Pills- under pilot Introduction of new device - Cu IUCD 375 (effective for five years) was introduced in program in 2012-13. Introduction of new method - Post partum IUCD was introduced in the program in 2010-11 and has provided post partum women an effective spacing option. Augmenting the demand through ASHA Schemes for Family Planning : Home Delivery of Contraceptives Ensuring Spacing at Birth Pregnancy Testing Kits : are now a part of ASHA kits so as to ensure early management of pregnancy

44. Promoting quality sterilization services Sterilization Compensation Scheme- The compensation package has been enhanced in 2014 for 11 high focus high TFR states Higher package for post partum sterilization and male sterilization Higher package for MPV districts

45. Sterilization Compensation Scheme States Acceptor ASHA/ Health Worker Others Total 11 High focus states (UP, BH, MP, RJ, CG, JH, OD, UK, AS, HR, GJ) VAS. 2000 300 400 2700 TUB. 1400 200 400 2000 TUB. (PPS) 2200 300 500 3000 Mission Parivar Vikas Districts VAS. 3000 400 600 4000 TUB. 2000 300 500 2800 TUB. (PPS) 3000 400 600 4000 Other High focus states (NE states, J&K, HP) VAS. 1100 200 200 1500 TUB. 600 150 250 1000 Non High focus states VAS. 1100 200 200 1500 TUB. (BPL + SC/ ST only) 600 150 250 1000 TUB. (APL) 250 150 250 650

46. National Family Planning Indemnity Scheme- Clients are indemnified in the unlikely events of deaths, complications and failures following sterilization The providers/ accredited institutions are indemnified against litigations The scheme was revised in 2013 and is now being operated by the state governments directly with NHM funding. Claims arising out of Sterilization Operation Amount (Rs.) Additional as per Hon’ble SC Directives A Death at hospital/ within seven days of discharge 2,00,000 2,00,000 B Death following Sterilization (8 th – 30 th day from discharge) 50,000 50,000 C Expenses for treatment of Medical Complications 25,000 25,000 D Failure of Sterilization 30,000 30,000 E Doctors/facilities covered for litigations up to 4 cases per year including defense cost 2,00,000 (per case)

47. KARNATAKA

48. References K.Park Textbook of PSM,25 th edition Ministry of Health and family welfare www.nhm.gov.in/immunisation www.nhp.gov.in NFHS-5 and DLHS -4 details