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AYUSHMATIAYUSHMATI

INTRODUCTION

The survival and well being of

mothers and children is central to

family and community life. Reduction

of Maternal Mortality and Infant

Mortality by 2015 is one of theimportant Millennium Development

Goals (MDGs)

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AYUSHMATIAYUSHMATI

The recent SRS Data reveals that the State ofWest Bengal has MMR of 194/100,000 LB.

Although there has been a substantial reduction in

maternal mortality from the earlier figure of 266/100,000 LB., It still remains very high. The

percentage of Institutional Delivery in the state is

only 41%. A majority of the maternal deaths canbe avoided if Emergency Obstetric Care is made

available near the place of residence of the

women.

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AYUSHMATIAYUSHMATI

AYUSHMATI SCHEMEThe scheme propose to reduce maternal

mortality and morbidity by increasing Institutional

Delivery covering the pregnant woman from BPL

and all SC,ST families. West Bengal happens to be astate, where the load on public sector impatient care

is very high, bearing 786/1000 hospitalised cases in

rural area and 654/1000 hospitalised cases in urbavareas. This indicated the public health facilities are

functioning above the critical level of bed

occupancy, which affects quality of services offered.

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AYUSHMATI SCHEMEThe Scheme aims to provide Choice to

the pregnant women in terms of the service

provider by empanelling Private

Hospitals/Nursing Home/facilities run by

NGO / CBO for providing delivery service,

normal as well as complicated, including

Caesarian Section. The Comprehensive

Emergency Obstetric Care will be provided by

the empanelled private health facility.

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Under the scheme, The Health &

Family Welfare Department, Government of

West Bengal would enter into a service

agreement with the empanelled private

facilities to cover these services. The

Empanelled facility will be reimbursed on

Capitation Payment basis according to which

they got fixed rate for the deliveries

conducted by them. The payments are to be

made for a batch of 100 deliveries, including

caesarean section.

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Investigation Prevailing GovernmentsRates (In Rs.)

Blood for routine examination,

including Hb%

15

Urine for routine examination 10

Blood for PPBS 15

VDRL Test 15

Blood for grouping and typing 20

Pregnancy profile USG 200

Total275

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The facilities will be

reimbursed on the basis of fixed

rate (Rs. 1515/-) for each deliveryconducted by them. The

reimbursement has has to be madefor batch 100 deliveries on a

monthly basis.

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OBJECTIVE OF THE SCHEMEThe objective of the scheme is to increase the number of

institutional deliveries by partnering with private sector

facilities empanelled against certain pre-determined

criteria and also to ensure quality of service delivery inthe empanelled private sector facilities by stringent

monitoring supervision. It would make use of network of

private health facilities to provide institutional delivery

services at affordable prices. This scheme intends toimprove access to services, generate demand and provide

choice to the beneficiaries, particularly for those from low

socio-economic groups. For whom the cost acts as a major

barrier to services.

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BENEFICIARIES OF THE SCHEME

The beneficiaries will be pregnant women from BPL and

all SC, ST families, having registered with the ANMs and

having received at least three antenatal checkups at any of

the sub-centre nearby public facilities. It will be a cashless

service, that is the beneficiaries of the scheme will not

have to make payment for the institutional delivery

services availed at the empanelled private facilities. TheBPL cards, Gram Panchayat certificates, JSY card, MCH

card, SC or ST certificate, SC or ST certification by the

Gram Panchayat will be used for the purpose of availing

benefit under the scheme.

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AYUSHMATIAYUSHMATI

CHOSEN DISTRICT FOR

IMPLEMENTATION OF SCHEME

UTTAR DINAJPUR

MALDA

MURSHIDABAD

BANKURA

NADIA

PURULIA

PASCHIM MEDINIPUR

COOCHBEHAR

BIRBHUM

DAKSHIN DINAJPUR

JALPAIGURI

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PROPOSED ACTIVITIES UNDER THE

SCHEMEa. Orientation Training workshops for District Health

Officials

b. Empanelment of private health facilities will be carriedout by the authorized District Health Team, subject to

fulfillment of quality requirement (Annexure - I)

c. Singing of Service Agreement with Empanelled

Private NGO hospital

d. Orientation of the administrative team and the

empanelled private providers by CMOH and other

District Hospital.

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AYUSHMATIAYUSHMATIROLE & RESPOSIBILITIES OF PRIVATE PARTNER

a. Shall provide proper infrastructure includingmanpower, space & equipment for delivery, as

specified in Annexure - I

b. Shall provide BCG & Polio O to the new born (BCG& Polio vaccine shall be made available to them from

the district level)

c. The private partner shall not refuse any pregnant

woman registered under the scheme

d. In the event of a pregnant woman registered under the

scheme being referred, such a referral must be to a

public hospital under the State Health Department

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AYUSHMATIAYUSHMATIROLE & RESPOSIBILITIES OF

PRIVATE PARTNER

e. The private partner shall adhere to the Standard

Operating Procedure (Ensure quality of service,

Employing personnel with proper qualification,

Ensure cleanliness etc.)

f. Shall cooperating with the monitoring team.g. Shall comply with the reporting requirements as

per the reporting format provided in Annexure -

II

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PROCEDURE FOR CLAIM SUBMISSION

a. The private partner shall submit Re-imbursement

Claim Form provided Annexure III at the end of

every month in the prescribed format. For the sake

of convenience, The period will be consideredfrom the first day of the first calendar month to

the last of the same calendar month

b. In case more than 100 deliveries take place in ayear, the private partner shall be reimbursed for

the additional number of deliveries on a pro-rata

basis.

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PROCEDURE FOR CLAIM SUBMISSION

a. Re-imbursement Claim Form should be submitted

within seven calendar days from the last day of

respective month.b. Re-imbursement Claim Form shall be

accompanied with the copies of the monthly

report for the corresponding period.

c. Release of funds would be conditional to regular

submission of the Re-imbursement Claim Form.

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AYUSHMATIAYUSHMATIAnnexure - 1

EMPANELMENT NORM FOR SELECTING THE

PRIVATE PARTNER CHECK LISTPrerequisites :

1. No. of beds :

2. Providers :Sl. No. Provider Name/(S) Qualification

1. Obstetrician*

2. Anaesthetist*

3. Paediatrician*

4. RMO*

5. Staff Nurse

6. Paramedical Staff

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AYUSHMATIAYUSHMATI Annexure - 1EMPANELMENT NORM FOR SELECTING THE

PRIVATE PARTNER CHECK LIST

3. SERVICE OFFERED AND LOGISTIC SUPPORT

I. Necessary Medicines:

Antibiotics

Sedative, Anticonvulsants

Anti hypertensives

Plasma expander

Instrumental delivery facilities (forceps)

Manual removal of placenta

C / S

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AYUSHMATIAYUSHMATIAnnexure - 1

EMPANELMENT NORM FOR SELECTING THE

PRIVATE PARTNER CHECK LISTII Blood Transfusion

III Infrastructure

Labour Room

Operating room

OR Light

DR Light

Functioning Steriliser

Functioning Suction in OR

Functioning Sucker in DR

Sterile Pack

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AYUSHMATIAYUSHMATIAnnexure - 1

EMPANELMENT NORM FOR SELECTING THE

PRIVATE PARTNER CHECK LIST

IV Compliance with the Statutory Norms

Screen (Present / Absent)

Female attendant during

delivery (Present / Absent)

Care Neonate (Yes / No)

Care of Women with C / NS-like

Pre-ecclampsia, Obstructed labour,

Incomplete abortion, PPH (Yes /No)

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AYUSHMATIAYUSHMATIAnnexure - 1

EMPANELMENT NORM FOR SELECTING THE

PRIVATE PARTNER CHECK LIST

4. TECHNICAL COMPONENT

YES / NO Normal Care during labour

Care of normal neonate

Care of Women with C / NS-like

Pre-ecclampsia, Obstructed labour,

Incomplete abortion, PPH

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AYUSHMATIAYUSHMATIAnnexure - 1

5. ROLES, RESPONSIBILITIES, OBLIGATIONSOF THE PRIVATE PARTNER

Explain procedure to the pregnant woman & her

guardian (Yes / No)

Take informed consent (Yes / No)

To conduct IEC activities to create awareness on

the warning signs (Yes / No)

Provide BCG and Polio O vaccination at birth (Yes / No)

Provide PNC services (Yes / No) Advice parents regarding childhood immunisation (Yes / No)

Promote breastfeeding (Yes / No)

Organise training programme for the RMOs & Nurses(Yes/No)

Orient community, Panchayat, & Health workers (Yes / No)

Properly maintain the accessories & equipments (Yes / No)

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Annexure II

Annexure III

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JSY (Related to

DH/SDH/BPHC/PHC/SC)

AYUSHMATI SCHEME (Related

to NURSING HOME)

Maternal Mortality, Infant

MortalitySAME

ANC / SC Registration ANC / SC Registration

Rs. 500/- (ANC) Rs. 500/- (ANC)Rs. 200 / 100 (Inst. Delivery) SAME

Rs. 150 / 250 / 350 (Ref. Transport) SAME

Upto 2 Living Child 1 / 2 - JSY Facility +1525+275 (NursingHome) 3 1575+275+Nursing Home`

BPL + SC + ST BPL + SC + ST

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AYUSHMATIAYUSHMATI

WE CANT SPELL

A

S CCESS

WITHOUT

U

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Implementation of

Hepatitis B

as part of UIP in

11 States

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Hepatitis BHepatitis B A Public Health Problem?A Public Health Problem?

Acute & Chronic Infection

Silent killer A symptomatic sub clinical

infections

Liver cirrhosis / failure, Liver Cancer may

cause death

Unable to correlate between infection andmortality / morbidity because of long gap

of 20 50 years.

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Hepatitis B

Appx. 30% of world population or 2 billionshave serological evidence of infection

(+ antibody in blood)

Of these 350 millions are chronicallyinfected i.e carriers

of the above 1 million die each year dueto Liver cirrhosis / cancer.

HBV is second only to Tobacco in causing

cancer.

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WHO Policy

In 1994 World Health Assembly addeddisease reduction target for Hepatitis B,calling for an 80% reduction in the incidence

of new HBV carriers in children by 2001.

WHO recommended introduction of HBvaccine in countries

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Hepatitis B

Hepatitis means infection of Liver

Infection with 5 types of viruses (A, B, C, D, E, F, G)

is the most common cause ofHepatitis

All the above viruses can cause on Acute illnesslasting for several weeks.

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Hepatitis B

1. Acute Infection

- Mostly mild like flu

- 1 in 4 get worse with jaundice

- 1 in 200 die fulminant Hepatitis

2. Chronic Infection

- 1 in 10 acute infection leads to chronic Infection

- Chronic carriers may have no symptoms but can

infect others

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Hepatitis B

HBV infection can be symptomatic or asymptotic (young

children) & can cause chronic infection, where patient

NEVER gets rid of the virus & some of the carriers (25%)

develop cirrhosis of Liver and Liver Cancer

HBV infection will lead to following out comes

- Patient dies of fulminant Hepatitis

- May recover after illness and develop life long immunity

- May develop chronic carrier stage

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Transmission of Hepatitis B

Mother to Baby at the time of birth

Child to child (cuts, bites & scratches)

Unprotected sexual intercourse

Blood transfusion of infected blood

Unsterillzed needles

Same mode of transmission as HIV (AIDS)From body fluids Blood, semen,

vaginal secretions mainly

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Hepatitis B

HBV virus is NOTspread by

Contaminated food or water and

Can not be spread casually in the

work place

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Remember

Chances of Hepatitis BDisease transmission is100 times more than HIV /AIDS with same exposure

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Age of infection Vs Carrier status

Most people become infected during childhood

90% of infants.

30 40 % of children (1 to 7 years) &

5- 10% of Adults and children above 7 years

will become carriers after infection withHepatitis B virus.

25% of the children infected will die of liver

cancer / cirrhosis

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Hepatitis B

Younger the child more chances of

becoming carriers

latency period for disease to

manifest in carriers could be 20 60

years peak at 25 40 year

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Hepatitis B

The disease burden is significant andwith high morbidity.

The chronic disease manifests duringmid life which are the most.

Productive years of life (25 - 45)

The financial burden and productivity

losses are very significant

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Hepatitis B Vaccine

OBJECTIVE

The primary of routine infant hepatitis B

Immunisation is to prevent the earlychildhood infection which result in chronic

liver disease later in life.

By preventing chronic HBV infection, thisstrategy also serves to reduce the major

reservoir for transmission of new infection.

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Hepatitis B Vaccine schedule

GOI recommendation

Birth, 6, 14 weeks (for Institutional

deliveries)

6, 10, 14 weeks (with DPT)

Both the schedule provide effective

protection

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Hepatitis B Vaccine

HB vaccine can prevent disease and thus the carrier

status in almost all individuals.

Available since 1982 Using DNA recombinant

technology

Contains only outer protein of HBV

Does not contain any live components

Its given in a series of 3 intra muscular doses. The most effective way of using it is in the routine

immunization programme

Gives 95% protection

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Proposed Childhood Vaccination

Schedule with HBV, India

Vaccine Schedule

BCG Birth

OPV6 weeks, 10 weeks, 14 weeks

DPT 6 weeks, 10 weeks, 14 weeks

Hepatitis-B (Institutional

deliveries)

Hepatitis-B (Non-

Institutional deliveries)

Birth, 6 weeks, 14 weeks

6 weeks, 10 weeks, 14 weeks

MEASLES 9 months

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Hepatitis B Vaccine

Vaccine administration Dose 0.5 ml containing 10 ug of the vaccine

Route intra muscular

Site Antero-lateral aspect of thigh in infants

Can be safely given with other vaccines DPT,

OPV, BCG, Measles, Hib (at different sites)

Available as 10-dose vial of liquid vaccine in

the programme

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Vaccine Safety

Its the safest vaccine

Most common side effects are :

Soreness at injection site (3-9%)

Fatigue, headache, irritability (8-18%)

Fever higher than 37.7 degree C (0-8%)

Allergic reactions rare (1 in 6,00,000)

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Hepatitis B Vaccine

COLD CHAIN

The vaccine is to be stored and

transported at +2 to +8 C

It freezes at Minus 0.5 C hence extra

caution to be taken to avoid freezing

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Sensitization Meetings / Trainings

Mos sensitization on hepatitis Bvaccine introduction with monthly

review meetings at District level

ANMs sensitization during weekly /

monthly meetings at PHCs

ANMs training Hepatitis B as part of

the immunization training of health

worker

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