Reproductive and child health phase II

1. NEW INITIATIVES & Quality indicators REPRODUCTIVE AND CHILD HEALTH PHASE-ii MANOJ K. VAIDYA

2. New initiatives under rch -ii Making the First Referral units functional. Training of MBBS doctors . Blood storage facilities JANANI SURAKSHA YOJANA

3. 24 Hrs. Functioning of PHCs RCH II • It is planned to establish 2000 FRUs in phases in RCH-II • 50% PHCs and all CHCs to be operationalised in phases • Availability of Services such as - 24 Hrs. Delivery services - New Born care - Family Planning, Counselling and services - Availability of RTI, STI services - Safe abortion services (MVA etc.)

4. Training in Anaesthesia (LSASEMOC) RCH II • Training of MBBS Doctors in Life Saving Anaesthetic Skills for Emergency Obstetric Care . • 18 weeks training course • The First Training Programme Conducted at AIIMS for Chhattisgarh • Training to be conducted in phases and limited to the requirement at FRUs .

5. Training In Obstetric Management RCH II • Training of MBBS doctors in obstetric management and skills including C.S. in RCH-II • Training to be conducted in collaboration with FOGSI • Duration of training to be 16 weeks • Expert Group is considering other details

6. Blood storage facility Management of obstetric emergencies is sometimes not possible due to non-availability of blood. The Drugs and Cosmetics Act was therefore modified to facilitate establishment of blood storage centres at FRU’s.

7. JANANI SURAKSHA YOJANA, RCH II OBJECTIVES • REDUCTION IN MMR & IMR • PREVENTING FEMALE FOETICIDE FOCUS: INSTITUTIONAL DELIVERY GRADED BENEFITS - HPS & LPS BASED ON RATE OF INSTITUTIONAL DELIVERY - RURAL & URBAN DIVIDE - MALE/FEMALE CHILD CATEGORY RURAL URBAN LPS RS 2000 RS 1200 HPS RS 700 RS 600

8. JANANI SURAKSHA YOJANA

9. Vandemataram scheme It is a voluntary scheme wherein any obstetric and gynaec specialist, maternity home can volunteer Enrolled doctors will display ‘ vandemataram logo’ at their clinics. Iron and folic acid tablets, oral pills, TT injections, etc will be provided for free distribution. Of late it has been withdrawn.

10. 0THER INITIATIVES Proposed : Rural Health Care Mission . Referral transport ASHA (Accredited Social Health Activist ) Adolescent Reproductive and Sexual Health A comprehensive infection management and environment plan for RCH-II has been prepared for implementation at CHC, PHC, SC’s.

11. Rural Health Care Mission • The scheme is under consideration . • A comprehensive scale for uplifting primary health infrastructure and services . • To be implemented initially in 8 EAG States, all NE States and J&K.

12. Referral Transport RCH II Key issues: Roads, transportation, RCH I funds poorly Utilized, Community participation lacking Under Consideration – Place funds with AWW /ANM ; [ JSY] – Develop community mechanisms – Provide out source ambulances at PHCs CHCs , and FRUs Easy access to ambulance & assistance from AWW

13. ROLE OF ASHA • A village level link worker attached to AWW/ANM • Motivator for ANC, PNC, Institutional Delivery, Immunization and Family Planning Services • Provide Escort to beneficiary for above services. • Adolescents Health Counsellor .

14. Strategy for addressing Adolescent Reproductive and Sexual Health (ARSH) in RCH Phase II A two-pronged strategy will be supported: Incorporation of adolescent issues in all the RCH training programs and all RCH materials developed for communication and behaviour change . dedicated days and dedicated timings for adolescents at PHC’s.

15. INFECTION MANAGEMENT AND ENVIRONMENT PLAN IMEP which is being extended to health care facilities includes: Treatment and disposal of biomedical wastes Disposal of syringe waste Provision of water, sanitation and good hygiene conditions OBJECTIVE: to ensure managing health and environment risks effeciently end effectively

16. SAFE ABORTION PRACTICES MEDICAL METHOD MANUAL VACCUM ASPIRATION

17. MEDICAL METHOD OF ABORTION Termination of early pregnancy (49days) using 2 drugs - mifeprestone followed by mesoprostol

18. MANUAL VACuUM ASPIRATION Safe and simple technique for termination of pregnancy . Can be used at PHC or comparable facility FOGSI, WHO & state govt are coordinating the project.

19. Some Innovative State Initiatives Gujarat increase access to safe delivery services. It is in partnership with private providers ( Chiranjivi Yojana ) A Dai Sangathan has been formed by 10 leading NGOs of the state to facilitate interface between the health system and the community Punjab Proposed to pay an incentive of Rs . 500/- to BPL SCs belonging to urban areas Purchase and supply of nutrients like iron, calcium, D-worming tablets for pregnant mothers belonging to SC classes.

20. Continued…. screening code for Ca Cervix – Tamil Nadu Subsidized Medical Practitioner (SMP) scheme- assam , bihar Nurse Practitioners Scheme Laproscopic Training -- maharashtra Implementation of Health Insurance scheme on pilot basis.

21. As of now…….. Cabinet/Planning Commission approval: The Cabinet has approved RCH II as a component of the National Rural Health Mission (NRHM) on 4th January 2005. Negotiations initiated with the World Bank and the DFID for funding. Development Partners support: B oth the World Bank and the DFID have agreed with the National PIP and will soon convey their respective Boards approval.

22. Quality indicators Following are the quality indicators used to monitor and evaluate RCH programme through monthly reports: Number of antenatal cases registered Number of pregnant women who had 3 antenatal checkups Number of high risk pregnant women referred Number of pregnant women who had 2 doses of TT Number of pregnant women under prophylaxis and treatment of anaemia Number of deliveries by trained and untrained a ttendants Number of cases with complications referred to PHC/FRU Number of newborn with birth weight recorded

23. Continued……. No. of women given 3 post natal check-ups No. of RTI/STD cases detected, treated and referred No. of children fully immunised No. of adverse reactions reported after immunisation No. of cases of ARI and diarrhoea under 5yrs No. of cases motivated and followed for contraception .

24. references: Parks textbook of preventive and social medicine Fundamentals of community medicine by G M Dhar MoHFW govt of india website Wikipedia WHO official web site