Transcript Slide 1

Reproductive & Child Health interventions:
Status and issues at a glance….
Dr. Rakesh Kumar, Joint Secretary (RCH), Ministry of Health & Family Welfare
Government of India
Current Status (All India)
RCH-II GOAL
INDICATORS
MMR
IMR
TFR
ALL INDIA STATUS
(Source of data)
301 (SRS 2001-03)
254 (SRS 2004-06)
60 (SRS 2003)
53 (SRS 2008)
3.0 (SRS 2003)
2.6 (SRS 2008)
RCH Goals
(2012)
212 (SRS 07-09)
47 (SRS 2010)
2.5 (SRS 2010)
<100
<30
2.1
 12 States and UTs have achieved the national target for IMR
 21 States and UTs have achieved national target for TFR.
 Only Kerala and Tamil Nadu have achieved all 3 RCH goals.
2
Reproductive & Child Health interventions:
Status and issues at a glance….
Maternal Health - Full Antenatal Check-up
26.5
18.0
19.5
16.9
18.6
20.0
10.9
13.3
22.3
10.4
13.1
18.5
10.5
11.9
19.0
8.3
11.1
6.1
8.5
4.7
5.9
9.1
2.8
3.9
20
10
Urban
17.2
30
Rural
17.4
Total
28.9
Full Antenatal Check-up (%)
40
0
Uttar Pradesh
Bihar
Rajasthan
Uttarakhand
Assam
Jharkhand
Madhya Pradesh
Odisha
Chhattisgarh
Significant Rural –Urban Variation across 9 states; Orissa & Chhattisgarh and UP & Bihar reflect the two
extremes
State
Assam
Bihar
Jharkhand
Madhya Pradesh
Chhattisgarh
Odisha
Rajasthan
Uttar Pradesh
Uttarakhand
State value
11.9
5.9
13.1
13.3
19.5
18.6
8.5
3.9
11.1
Mothers who had full antenatal check-up (%)
Minimum
Maximum
Dhubri (2.1)
Jorhat (18.2)
Madhepura (2.4)
Patna (16.4)
Garhwa (3.6)
Purbi Singhbhum (31.6)
Sheopur (1.8)
Balaghat (30.8)
Korba (10.9)
Dhamtari (34.5)
Jajpur (5.4)
Jagatsinghpur (36.0)
Karauli (1.7)
Jaipur (19.5)
Balrampur (0.6)
Kanpur Nagar (14.8)
Rudra Prayag (3.7)
Dehradun (22.7)
Range
16.1
14.0
28.1
28.9
23.6
30.6
17.8
14.3
19.0
With in a State, the maximum variability of 28.0 reported in Jharkhand. Across 284 districts, Full ANC ranges
from 0.6% in Balrampur (UP) to 30.6% in Jagatsinghpur ( Odisha)- a variability of more than 28.9% points.
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Reproductive & Child Health interventions:
Status and issues at a glance….
Maternal Health
Delivery Points aim to provide comprehensive care at the 17,000 health facilities that are
performing above a certain benchmark.
Issues
Key actionable points
•
•
•
•
•
•
•
•
Irregular & Incomplete reporting on DPs
Less than 50% FRUs conducting Csection with low numbers
Only about 50% of 24X7 PHCs have a
delivery load of 10 or more per month
Underutilized DPs
Regular performance monitoring of DPs
Prioritization of resources including
rational deployment of manpower
Regular reporting by States like Rajasthan, MP, Haryana, Orissa
Less than 40% FRUs conduct C sections in AP, Bihar, Chhattisgarh, Jharkhand, MP,
Odisha, Rajasthan, Uttarakhand
4
Reproductive & Child Health interventions:
Status and issues at a glance….
Safe Delivery
100
90
80
70
60
50
40
30
Safe Delivery (%)
75.1
73.4
70.1 67.7
64.7
49.5
47.1
39.0
Jharkhand
53.5 51.4
51.3 48.4
44.3
Chhattisgarh
Uttar Pradesh
Bihar
81.9
77.6
73.0
88.6
86.9
76.2 72.8
75.2 73.3
92.8
82.2
78.4
56.9
49.4
Uttarakhand
Assam
Odisha
Rajasthan
Madhya Pradesh
Significant Rural –Urban Variation across 9 states; Jharkhand & Chhattisgarh and Rajasthan & MP reflect the
two extremes
State
Assam
Bihar
Jharkhand
Madhya Pradesh
Chhattisgarh
Odisha
Rajasthan
Uttar Pradesh
Uttarakhand
State value
70.1
53.5
47.1
82.2
49.5
75.2
76.2
51.3
56.9
Safe delivery (%)
Minimum
Karimganj, Hailakandi (34.8)
Sheohar (30.2)
Pakaur (24.8)
Dindori (45.5)
Surguja (32.6)
Nabarangpur (35.6)
Jaisalmer (48.6)
Balrampur (22.0)
Tehri Garhwal (43.1)
Maximum
Sibsagar (88.2)
Munger (80.4)
Purbi Singhbhum (69.0)
Indore (96.3)
Kanker (69.4)
Puri (92.7)
Jaipur (92.2)
Jhansi (89.4)
Nainital (79.5)
Range
53.4
50.2
44.2
50.9
36.8
57.1
43.6
67.4
36.4
With in a State, the maximum variability of 67.0% points reported in UP. Across 284 districts, Safe Delivery
ranges from 22.0% in Balrampur(UP) to 96.3% in Indore ( MP)- a variability of more than 74.3 % points.
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Reproductive & Child Health interventions:
Status and issues at a glance….
Institutional Delivery
Institutional Delivery(%)
100
Total
50
Urban
Rural
0
Significant Inter-State variation across 9 states; Institutional Delivery: Ranges from 34.9% in Chhattisgarh to
76.1% in MP.
State
Assam
Bihar
Jharkhand
Madhya Pradesh
Chhattisgarh
Odisha
Rajasthan
Uttar Pradesh
Uttarakhand
State value
57.7
47.7
37.6
76.1
34.9
71.3
70.2
45.6
50.5
Institutional Delivery (%)
Minimum
Hailakandi(28.9%)
Sheohar(24.2%)
Dumka(19.4%)
Indore(92.5%)
Bilaspur(21.9%)
Nabarangapur(31.8%)
Barmer(34.5%)
Balrampur (16.8%)
Bageshwar(33.9%)
Maximum
Nalbari(77.6%)
J Munger(75%)
Purbi Singhbhum(63.0%)
Dindori(44.5%)
Bastar(59.3%)
Puri (91.6%)
Jaipur(90.9%)
Jhansi(75.2%)
Dehradun(70.2%)
Range
48.7
50.8
43.6
48.0
37.4
59.8
56.4
58.4
36.3
With in a State, the maximum variability of 59.8 reported in Odisha. Across 284 districts, Institutional Delivery
ranges from 16.8% in Balrampur(UP) to 91.6% (Odisha)- a variability of more than 62.7% points.
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Reproductive & Child Health interventions:
Status and issues at a glance….
Maternal Health
Tracking of Severe Anemia
Issues
• Poor tracking of severe anemia cases by
majority of the states due to lack of
orientation of frontline workers,
coordinated IFA supply and Hb testing
equipments
Key actionable points
• Orient all frontline workers on diagnosis
and line listing of pregnant women with
severe anaemia.
• Coordination between supply of IFA
tablets, availability of trained laboratory
technicians & testing equipments,
referral linkages for treatment.
Odisha, J&K and M.P have started tracking and reporting on severely anemic women at
Delivery Points
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Reproductive & Child Health interventions:
Status and issues at a glance….
Maternal Health
Maternal Death Review (MDR)
Issues
• Irregular and under reporting
• Both FBMDR and CBMDR are in place in
very few states
• Poor quality review confining to medical
causes rather than identifying sytemic
gaps
Key actionable points
•
•
•
State level team to orient, train and
mentor the service providers & field
functionaries
Dissemination of findings of analysis of
maternal deaths to all stakeholders
Prioritize constitution of FBMDR
committees at DPs (FRUs and above)
•No. of States reporting regularly has increased from 9 to 20 in a period of 6 months (Sept
2011 to March, 2012)
•States of MP, Assam, Odisha & Punjab have taken a no. of initiatives to improve MDR
process
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Reproductive & Child Health interventions:
Status and issues at a glance….
Maternal Health
Safe Abortion Services
Issues
• Poor reporting by the states, only 12
states have reported on 6 monthly
formats
• Status of deployment & utilisation of
skills of the already trained providers is
not reported
• Absence or lack of functionality of
District level MTP Committees
Key actionable points
•
•
•
•
Need to
prioritize on expanding
availability and access to quality services
in public sector (particularly “Delivery
Points”
Link CAC training to posting at specified
“Delivery Points”.
Activate DLCs to optimally utilise and
regulate private sector providers.
Strategise to disseminate visible IEC/BCC
messages on safe abortion services.
MP & Maharashtra have reported more than 50% trained providers providing MTP
services.
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Reproductive & Child Health interventions:
Status and issues at a glance….
Maternal Health
RTI/STI Services
Issues
Key actionable points
•
•
•
•
•
•
•
Lack of convergence with SACS at the
state level.
Irregular availability of drugs in the
field.
Poor Linkage with the adolescent
friendly clinics
Testing of PW for HIV not done on
regular basis
No focus on elimination of congenital
syphilis
•
•
•
10
Convergence with SACS
Procurement of Syndromic drug kit and
RPR Testing kits.
Linkages with AFHS.
Ensuring testing of HIV in PW at delivery
points.
Testing of all PW at the DPs for syphilis.
Reproductive & Child Health interventions:
Status and issues at a glance….
Janani Suraksha Yojana (JSY)
JSY PERFORMANCE 2012-13 (I qtr)
JSY PERFORMANCE: 2005-12
• All India achievement for the I
qtr is 82%.
• Majority of States have
reported more than 70%
achievement .
• Low performing states are: JH
& Manipur (41%), Haryana
(44%), Himachal (50%)
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Reproductive & Child Health interventions:
Status and issues at a glance….
Maternal Health
JSY
Issues
Key actionable points
•
•
•
•
•
•
•
Poor
monitoring
and
random
verification of JSY beneficiaries
Delays in payments in most of the
States (Jharkhand, Bihar, MP, UP,
Manipur, Andhra Pradesh)
JSY admin expenses used for non-JSY
activities (Uttarakhand, Bihar)
Less no. of mothers getting JSY benefit
for home delivery (esp. Bihar, Assam,
UP, Rajasthan)
Grievance redressal cells yet to be
established
Delays in JSY reporting to GOI (almost
all States)
•
•
•
•
•
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Monitoring and random verification of
JSY beneficiaries to be initiated.
Payment of incentive before women
being discharged
JSY admin expenses to be used only for
JSY activities such as monitoring and IEC
Eligible BPL pregnant women need to be
paid home delivery assistance
Grievance redressal cells to be
established
JSY reports need to be sent timely to GOI
Reproductive & Child Health interventions:
Status and issues at a glance….
Child Health-Neonatal period
Aim is to operationalise Newborn care corner at each delivery point and make one special newborn
care unit functional in each district ; Cover all newborns for first 6 weeks of life through Home Based
newborn Care
Issues
•
•
•
•
•
•
•
Key actionable points
Slow progress in the setting up of sick
newborn care units in HFD
Paucity of trained manpower; 53% of the
units have adequate MOs and 40% adequate
Nurses
Equipment lying unutilized in many units
especially in NBSUs
Slow pace of trainings resulting in incorrect
clinical practices.
Disconnect between different level of
newborn care facilities; weak linkages with
the community based programme (HBNC)
Record keeping and timely reporting requires
attention
Mentoring & supervision by state level
institutions missing
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•
•
•
•
•
Saturation of all delivery points with
Newborn Care Corners;
Facility Based Newborn Care trainings to be
linked with posting to specified units
Developing at least one State level Resource
Center to support trainings, observership
and mentoring process
Convergence of newborn care facilities with
the HBNC
Establish effective referral linkages( district
specific) between newborn care facilities
(NBCC, NBSU and SNCU).
Reproductive & Child Health interventions:
Status and issues at a glance….
State specific issues in Neo-natal care
Issues
States/UTs
Slow progress in establishment Manipur, Tripura, Sikkim, West Bengal, Bihar, Chhattisgarh, Uttar Pradesh, J &
K, Himachal Pradesh, Punjab, Haryana, Andhra Pradesh, Lakshadweep
of SNCUs (< 50% against
target)
Training of NSSK (< 75%)
All State’/UTs except Arunachal Pradesh, Goa, Madhya Pradesh, Nagaland and
Odisha
Utilization of services in SNCUs D & N Haveli, Goa, Himachal Pradesh, Jharkhand, Kerala, Mizoram and
Nagaland
(< 100 admissions/month)
11 States/UTs either don’t have SNCU or not reported
Out born admissions
(< 30 % )
J & K, Kerala, Uttar Pradesh, Delhi, Mizoram, Bihar, Uttarakhand, Assam,
Maharashtra, Chandigarh, Karnataka, Goa
11 States/UTs either don’t have SNCU or not reported
Training of ASHA in module 6
& 7 (< 50% )
Andhra Pradesh, Assam, Bihar, HP, J & K, Jharkhand, Maharashtra, Madhya
Pradesh, Punjab, Rajasthan, Uttar Pradesh, West Bengal
ASHA kit (not available)
Andhra Pradesh, Assam, Bihar, J & K , Jharkhand, Maharashtra, Odisha,
Punjab, Uttar Pradesh, West Bengal
HBNC roll out (Home visit
started)
Chhattisgarh, Haryana, Gujarat, Karnataka, Maharashtra, Uttarakhand,
Mizoram, Meghalaya, Sikkim , Tripura, Daman & Diu
14
Reproductive & Child Health interventions:
Status and issues at a glance….
Nutrition, ARI, Diarrhea
Community and facility based management of Diarrhoea and Pneumonia is a priority,
promote infant and young child feeding practices through the health system and home based
newborn care
Issues
Key actionable points
• Low awareness among providers regarding
iron supplementation guidelines resulting in
very low coverage
• Low use of Zinc with ORS in cases of diarrhoea
• Underutilisation of Nutrition Rehabilitation
centres , outcomes not monitored and national
treatment protocols not being followed by
many states
• Limited focus on IYCF in State PIPs
• Slow pace of child health trainings especially FIMNCI
•
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•
•
•
Reinforce anaemia and diarrhoea
management guidelines; stock management
of ORS, Zinc and iron syrup/tablets
Establish State level Resource Centres to
guide IYCF and Nutrition interventions
Active promotion of IYCF practices in health
facilities through all MCH contacts
Review and strengthen linkages of
community based program and AWC to NRCs
Reproductive & Child Health interventions:
Status and issues at a glance….
Child Nutrition, ARI and Diarrhoea
Issues
States/UTs
Vitamin A 1st Dose
administration (<60%)
Nagaland, Arunachal Pradesh, Madhya Pradesh, Bihar , Manipur, Uttar
Pradesh, Haryana, Tamil Nadu, Meghalaya, Jammu & Kashmir, Gujarat,
Rajasthan, Chhattisgarh, Sikkim, UTs combined, Uttarakhand, Jharkhand,
Orissa, Delhi
LBW babies (> 21%)
Andhra Pradesh, Chandigarh, Dadra & Nagar Haveli, UP , MP, Jharkhand,
Rajasthan, Uttarakhand, Assam, Bihar, Odisha
Breastfeeding with in 1 hr
(< 40% )
Tripura , Jharkhand, Uttar Pradesh, Punjab , Bihar, Jammu & Kashmir,
Uttarakhand, Andhra Pradesh, Rajasthan, Delhi , West Bengal, Madhya
Pradesh, Karnataka , Himachal Pradesh, Tamil Nadu
IFA received by under 3
children (< 40%)
UP, Rajasthan, Jharkhand, Uttarakhand, Odisha, MP, Assam, Bihar,
Chatisgarh
NRC establishment
(< 50%)
AP, Delhi, Rajasthan, Uttrakhand , WB
NRC Utilisation (< 50%)
UP Assam Karnataka Bihar Jharkhand Maharashtra
ORT /ORS use (< 50%)
Uttarakhand , Uttar Pradesh, Jharkhand , Bihar, Madhya Pradesh , Rajasthan ,
West Bengal , Punjab
16
Reproductive & Child Health interventions:
Status and issues at a glance….
Fully Immunized Children (AHS-2011)
100
80
48.1
44.7
45.3
51.1
64.9
54.9
54.3
59.5
55.0
63.7
59
58.2
20
61.1
71.4
63.7
64.3
66.1
64.5
69
77.3
70.8
73
78.7
74.1
73.8
79.9
40
75.4
60
0
Uttrakhand
Chattisgarh
Rajasthan
Bihar
Jharkhand
Total
Urban
Assam
Odisha
MP
UP
Rural
Full Immunization
State
Uttrakhand
Chattisgarh
Rajasthan
Bihar
Jharkhand
Assam
Odisha
MP
UP
State Value
75.4
74.1
70.8
64.5
63.7
59
55.0
54.9
45.3
Minimum
Haridwar (55.3%)
Surguja (55.5%)
Dhaulpur (37.4%)
Kishanganj (26.6%)
Giridih (28%)
Dhubri (29.9%)
Rayagada (11.9%)
Jhabua ( 23.8%)
Etah (13.5%)
Maximum
Pithoragarh (87.5%)
Kanker ( 93.2%)
Hanumangarh (91.4%)
Samastipur ( 83.9%)
Purbi Singhbhum (82.7%)
Dibrugarh (83.8%)
Kendrapara (82.9%)
Indore (77.6%)
Basti (73.8%)
State of Odisha has the maximum variation among the districts min 11.9 to max 82.9 and next is UP
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Reproductive & Child Health interventions:
Status and issues at a glance….
Routine Immunization
• Year 2012 declared as Year of Intensification of Routine Immunization
• Immunization weeks being conducted across the country
• Hepatitis B vaccine universalized
Issues
Key actionable points
• Missed out/hard to reach/ high risk
area with low immunization coverage
• Areas missed due to vacant subcenters
• Poor cold chain maintenance
• Inadequately trained human
resource
• Low coverage of Hepatitis B,
especially the birth dose
• Poor demand generation and
awareness activity at field level
•
- 18 -
•
•
•
•
Mapping of such areas, updating microplan
to incorporate them, covering these areas on
highest priority
Ensuring Alternative vaccinators until
vacancy filled
Ensure trained refrigerator mechanics for
each district and training of all health
workers
Implement Hep B-birth dose at all health
institutions conducting delivery. Improve
coverage of Hep B
Design BCC plan at community/district and
state level
Reproductive & Child Health interventions:
Status and issues at a glance….
Routine Immunization
States with Low Performance
DPT3 Coverage
(<50% coverage)
Uttar Pradesh, Assam, Puducherry, West Bengal, Karnataka,
Chhattisgarh, Arunachal Pradesh, Kerala, Tamil Nadu, Sikkim,
Uttarakhand
Hepatitis -B birth dose
(<15% coverage)
Meghalaya, Rajasthan, Karnataka, Lakshadweep, Himachal
Pradesh, Manipur, Maharashtra, Jharkhand, Chhattisgarh,
Assam, Haryana, Uttar Pradesh, West Bengal, Gujarat,
Arunachal Pradesh, Mizoram, Tamil Nadu, Sikkim,
Uttarakhand
DPT1- DPT 3 drop out
(>10% children )
Puducherry, Lakshadweep, Meghalaya, Daman & Diu,
Uttarakhand
Planned sessions missed
(>20%)
Meghalaya, Uttar Pradesh, Uttarakhand, Maharashtra
Measles 2nd Dose (<15%
coverage Non-SIA states)
Karnataka, Andhra Pradesh, Delhi, Tamil Nadu, Uttarakhand
19
Reproductive & Child Health interventions:
Status and issues at a glance….
Immunization Campaigns
(Polio, Measles, JE)
• WHO removed India from the list of countries with active endemic wild polio virus
transmission
• Measles Catch-up campaign completed in 9 states vaccinating 4.8 crore children
• 62 new JE endemic districts identified and will be covered under campaign in phased manner.
Key actionable points
• Maintain high coverage during pulse
polio round
• States to issue orders for incorporation
of Measles 2nd dose under RI
• UP, Bihar, Gujarat, MP and Rajasthan to
ensure >90% coverage
• Increase JE vaccination coverage under
RI in endemic districts
Issues
• Risk of importation of Polio virus still persists
• Introduction of Measles 2nd dose under RI
after 6 months of campaign pending in many
districts
• Phase III of Measles campaign targeting 167
districts in 5 states starting September 2012
• Poor coverage of JE vaccine under RI in 113 JE
endemic districts
20
Reproductive & Child Health interventions:
Status and issues at a glance….
Family Planning-Total Fertility Rate
Total Fertility Rate
Uttarakhand
Odisha
Assam
Chhattisgarh
Jharkhand
Madhya Pradesh
Rajasthan
Uttar Pradesh
2.8
3.9
3.7
2.7
3.9
3.6
2.5
3.4
3.2
2.4
3.5
3.1
2.4
3.3
3.1
2.3
3.1
2.9
1.9
2.7
2.6
1.9
Urban
2.4
Rural
2.3
2.0
2.4
2.3
4.0
3.5
3.0
2.5
2.0
1.5
1.0
Total
Bihar
Significant Rural-Urban variation across 9 large States ; Uttarakhand & Odisha and UP & Bihar reflect the two extremes.
State
Assam
Bihar
Jharkhand
Madhya Pradesh
Chhattisgarh
Odisha
Rajasthan
Uttar Pradesh
Uttarakhand
State value
2.6
3.7
3.1
3.1
2.9
2.3
3.2
3.6
2.3
Total Fertility Rate (TFR)
Minimum
Maximum
Kamrup (2)
Patna (2.8)
Purbi Singhbhum (2.4)
Indore (2.2)
Koriya (2.4)
Jharsuguda (2)
Kota (2.6)
Kanpur Nagar (2.3)
Pithoragarh (1.7)
Hailakandi (4.2)
Sheohar (4.7)
Lohardagga (4)
Shivpuri (4.5)
Kawardha (3.7)
Boudh (3.7)
Barmer (4.7)
Shrawasti (5.9)
Haridwar (3.1)
Range
2.2
1.9
1.6
2.3
1.3
1.7
2.1
3.6
1.4
Within a State, the maximum variability of 3.6 reported in Uttar Pradesh
Across 284 districts, TFR ranges from 1.7 in Pithoragarh (Uttarakhand) to 5.9 in Shrawasti (UP)- a
variability of more than 4 children!
21
Reproductive & Child Health interventions:
Status and issues at a glance….
Family Planning
Status of Key Activities
Intervention
Better performing States
Poor performing States
PPIUCD TRAINING – 6 high
focus states:
Bihar, Chhattisgarh, Jharkhand,
Madhya Pradesh, Rajasthan
and Uttar Pradesh
Bihar, Rajasthan and Jharkhand
are progressing well
Madhya Pradesh,
Chhattisgarh and
Jharkhand
INTERVAL IUCD TRAINING in 11
states; 8 EAG states, Assam,
Haryana and J&K
Assam and Haryana have started
the project, Bihar, Chhattisgarh,
J&K and Uttarakhand are likely
to start soon
Madhya Pradesh, Uttar
Pradesh, Odisha and
Rajasthan
APPOINTMENT OF RMNCH
COUNSELLORS – 18 states
Bihar and Madhya Pradesh
None of the other states
have reported any
progress.
POST PARTUM STERILISATION
(PPS):
(as % of total sterilisation)
Tamil Nadu, Goa, Kerala, Andhra
Pradesh, Puducherry (more than
50%)
All EAG states have less
than 10% PPS
22
Reproductive & Child Health interventions:
Status and issues at a glance….
Family Planning
Delivery of contraceptives by ASHAs at doorstep (launched in July 2011)
•
•
•
•
•
ASHA are delivering contraceptives at the doorsteps in 233 districts of 17 States
231 districts have implemented except East & South Garo Hills of Meghalaya
7 of these 231 districts are yet to send utilization reports:
– Bihar
(Sheikhpura)
- 1
– Uttar Pradesh
(Lakhimpur Kheri, Bhadohi, Barabanki, Kannauj)
- 4
– Manipur
(Ukhrul, Tamenglong),
- 2
Response from NE states (except Assam), Himachal Pradesh and Uttar Pradesh is
very poor
Although Chhattisgarh and Jharkhand have reported utilisation of contraceptives,
filed visits suggest that the scheme has not taken off at the field level
23
Reproductive & Child Health interventions:
Status and issues at a glance….
Family Planning
Ensuring spacing after marriage and between 1st and 2nd child (launched in
May 2012) through incentivisation of ASHAs
• Services of ASHAs for counselling newly married couples to ensure
spacing of 2 years after marriage and spacing of 3 years after the birth of
1st child.
• The scheme is operational in 18 states (EAG, NE and Gujarat and
Haryana)
• ASHA would be paid following incentives under the scheme:
– Rs. 500/- to ASHA for ensuring spacing of 2 years after marriage.
– Rs. 500/- to ASHA for ensuring spacing of 3 years after the birth of
1st child
– Rs. 1000/- in case the couple opts for a permanent limiting method
up to 2 children only
24
Reproductive & Child Health interventions:
Status and issues at a glance….
Adolescent Health - ARSH
Issues
Key actionable points
•
•
•
•
•
•
•
Slow pace of ARSH Programme
implementation in Uttar Pradesh, Bihar,
Chhattisgarh and Himachal Pradesh
Irregular clinics with poor turn out
Hardly any referrals
Poor community mobilisation
Inadequate convergence with other
departments
Inadequate reporting
•
•
•
•
•
Setting up of services (clinics) for
adolescents
Ensure deployment of trained staff at
ARSH clinics
Training of Human Resource
Community mobilisation and out-reach
services to be strengthened
Regular reporting of activities
Formulation of State specific IEC
strategy for Adolescents
Best Practices:
• Implementation models by States like ‘Udaan’ of Uttarakhand, ‘Maitreyi’ Clinics of Maharashtra,
Sneha Clinics of West Bengal & Yuva Clinics of AP.
• Peer Educator model of Assam, Haryana can be replicated.
• Working on outreach strengthening and comprehensive package of services
• National Strategy for Adolescent Health in India is under construction
25
Reproductive & Child Health interventions:
Status and issues at a glance….
School Health Programme
Issues
Key actionable points
•
•
•
•
•
•
Biannual screening for Disease,
Deficiency and Disability yet to emerge
across States in the country
Dedicated school health teams not
proposed by the states
Micro-planning not available
Poor mentoring, monitoring, and
reporting
Poor utilization of resources approved
in state
•
•
Closer coordination with Department
of Education.
Linkages with other NRHM –
components like Adolescent Health
Pooling of resource – financial, IEC and
Human, National Disease control
programmes
Best Practices:
• Dedicated team for screening in Maharashtra
• Implementation through exclusive teams – Maharashtra, Kerala (JPHN at schools),
Uttarakhand, A&N island (outsourced) and in campaign mode in Gujarat, Bihar &
Himachal Pradesh, with involvement of public health infrastructure in other states,
Public and PPP– Rajasthan
26
Reproductive & Child Health interventions:
Status and issues at a glance….
Menstrual Hygiene Scheme
Key actionable points
Issues
•
•
•
•
•
•
Slow uptake of sanitary napkins
Incomplete re-conciliation of records
across various levels
Hardly any counseling of AGs
Irregular reporting to MoHFW,
especially by Chhattisgarh and Uttar
Pradesh
Convergence required with Total
Sanitation Campaign / for effecting
disposal mechanisms
•
•
•
•
Re-orientation / re-training of ASHAs
regarding promotion of sanitary napkins.
Monitoring to be strengthened
Focus more on new users i.e. Girls who
have not had access to any such product
prior to launch of scheme.
Proper record maintenance i.e.
reconciliation of delivery by HLL / receipt
by State and sale of packs vis-à-vis
amount of incentive paid to ASHA, as
they should match
Use of incinerators and their construction
through Total Sanitation Campaign / SSA
funds
Status of Implementation
•
•
•
•
Total supply by HLL to States = 322 lakh packs
2nd and 3rd quarter supplies (> 600 lakhs packs) also in place
% of consumption till 31st July 2012 = 26.3 %
States performing well (good uptake) in HP, Kerala, MP, Orissa (Out of 17 implementing
States through Central Supply)
27
Reproductive & Child Health interventions:
Status and issues at a glance….
Weekly Iron Folic Acid Supplementation (WIFS)
Issues
Key actionable points
• No plan for WIFS submitted by
Chhattisgarh, Himachal Pradesh,
Lakshadweep and Daman and Diu
• They also did not participate in the
National Level TOTs.
• Difficulties in IFA procurement for
NE states and UTs
• State level WIFS Advisory
committees yet to be activated
•
•
•
•
•
States (UP, Chhattisgarh, Himachal Pradesh,
Lakshadweep and Daman and Diu) to submit plans
Difficulties in procurement for NE states and UTs
being addressed through GO on procurement of
IFA and Albendazole tablets from CPSE. States
need to proactively take it up
Convergence with Education and ICDS/SABLA
departments
Formation of State level WIFS Advisory Committee
– Trainings
– Development of media plan
Regular reporting, monitoring and review of
implementation
Readiness Status: PAN INDIA ROLL OUT
• As per State plans, 23 states to complete procurement process by end September, 2012-13,
Rajasthan, Karnataka, Chandigarh, Jharkhand, Mizoram and Puducherry by October 2012.
• Supply of IFA and Albendazole tablets to reach schools & Aganwadi centres by end November in
22 States / UTs except Manipur, Meghalaya, Karnataka (end December 2012) and Rajasthan
(February 2013)
• Training of all field functionaries to be complete by November, 2012 barring Meghalaya (in Dec
2012)
28
Reproductive & Child Health interventions:
Status and issues at a glance….
Birth
Adolescents
Reproductive
age group
• Detection and management of postpartum
sepsis & other complications in postnatal
period
• Home based postnatal care & support for
breastfeeding
• Post-partum family planning advice and
provision of contraceptives
• Care during labour and delivery (at the health
facility)
• Skilled birth attendance for home deliveries
• Emergency Obstetric care
29
Postpartum
• Essential care during pregnancy
• Tracking of pregnant women with severe anemia
and case management
• Access to safe abortion and post abortion FP
counseling and services
• Treatment of complications of s/unsafe abortions
• Management of STI/RTI
• PPTCT
• Neonatal resuscitation with bag and mask
• Essential new-born care at birth and up to 6
weeks
• Management of sick newborns
Neonatal
period
• Family planning advice and counseling ,Provision
of a range of family planning methods
• Screening for STIs and its management
• Access to Safe abortion & Post abortion care
• Promotion of IYCF practices
• Routine Immunisation plus Hepatitis B, H
influenza ,Pulse polio
• Vitamin A & Iron Folic Acid supplementation
• Use of ORS and Zinc for diarrhea
• Integrated Case management of neonatal
and childhood illnesses
• Management of children with severe acute
malnutrition
Childhood
• Weekly Iron Folic Acid Supplementation,
Preventive health check-ups; Screening for
disease, deficiency and disability & referral
• Provision of reproductive & sexual health
services Promotion of menstrual hygiene
Pregnancy
Adopting evidence based interventions across Lifecycle
(RMNCH+A Strategy)
Reproductive & Child Health interventions:
Status and issues at a glance….
Summary of Key Actions
Imperative to closely monitor the State specific targets under RCH
Define District specific targets and review accordingly
Strengthen monitoring of key interventions at all levels (use Dashboard indicators);
timely reporting (HMIS, MCTS) and feedback for midcourse correction
Special attention to High Focus Districts; 9 states should use AHS data for District
specific planning
District specific strategies to be adopted to reach the ‘Unreached’ population
including urban poor
Strengthen referrals and linkages between various levels of health facilities to ensure
Continuum of Care
Emphasize on quality of care: national guidelines and protocols for management
should be followed
30
Reproductive & Child Health interventions:
Status and issues at a glance….
Thank You
31