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Reproductive and ChildHealth Programme

Phase-II)2006-12

GUJARAT

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Reduce MMR from 389 (in 1998) to100 per 100,000 live births by 2010

Reduce IMR from 60 to 30 by 2010

Stabilize population by reducing TFRfrom 3.0 to 2.1 by 2010

Goals

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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

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Health Service Infrastructure: Gujarat

Service Existing Required Difference

SC 7274 7236 +38

PHC 1066 1166 -100

CHC 277 317 -40

SDH 23

DH 23

GMC

6

DH - 23

CHC- 277

PHC - 1066

Sub centers - 7274

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EVIDENCE BASED MANAGEMENT

Internal System

CRSRoutine MIS Reports External data sources

NFHS

SRSDLHSNSSO

Latest research as presented in journals like TheLancet, the Bulletin of WHO

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

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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)

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Approach of GoG

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Addressing Equity Concerns

Chiranjivi, Bal Sakha & JSY- to increaseaccess of BPL expectant mothers for safedelivery

Increased allocation and convergent action totribal and urban slum areas (50 Blocks)

Reaching out the disadvantaged/ remote,

unreachable population- 112 Mobile HealthServices in tribal, salt pan area, border area,peri- urban areas and partnership withSNGOs, FNGOs, Private providers, tribal and

ISM

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Equity..

Chiranjivi

Bal Sakha

http://images.google.co.in/imgres?imgurl=http://www.edcourtenay.co.uk/content/binary/India.jpg&imgrefurl=http://www.edcourtenay.co.uk/CategoryView,category,Personal.aspx&h=288&w=352&sz=34&tbnid=J5l0kzIgymioQM:&tbnh=94&tbnw=116&hl=en&start=211&prev=/images%3Fq%3Dindian%2Bmother%2Band%2Bchild%26start%3D200%26svnum%3D10%26hl%3Den%26lr%3D%26sa%3DNhttp://images.google.co.in/imgres?imgurl=http://www.refocus-now.com/Stock/Babies%2520baby%2520boy%2520girl%2520child%2520children/thumbnails/tnBaby,%2520child,%2520infant,%2520new%2520born,%2520M.Spencer.jpg&imgrefurl=http://www.refocus-now.com/Stock/Babies%2520baby%2520boy%2520girl%2520child%2520children/index2.htm&h=200&w=166&sz=13&tbnid=RGkKpag4p4lCfM:&tbnh=99&tbnw=82&hl=en&start=39&prev=/images%3Fq%3Dnew%2Bborn%2Bchild%2B%26start%3D20%26svnum%3D10%26hl%3Den%26lr%3D%26sa%3DNhttp://images.google.co.in/imgres?imgurl=http://www.ivcs.org.uk/apk_clinic_new_baby.jpg&imgrefurl=http://www.ivcs.org.uk/apk_health_clinic.htm&h=207&w=200&sz=34&tbnid=BCWxVDWOuMY7OM:&tbnh=100&tbnw=96&hl=en&start=30&prev=/images%3Fq%3Dindian%2Bmother%2Band%2Bchild%26start%3D20%26svnum%3D10%26hl%3Den%26lr%3D%26sa%3DN

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The Gujarat Government initiative is adeparture from previous practice in thatit took sole responsibility for thereimbursement of private health care

providers, rather than relying onintermediary parties such as insurers.The state government is working withprofessional agencies such asassociations, obstetricians andacademic organizations to plan andimplement the new arrangements.

Showing remarkable success, theprogramme has been expanded fromfive to all 25 districts of Gujarat.Between January 2006 and January2009, 869 doctors were enlisted. Nearly

2,79,236 deliveries were performed,with each doctor performing an averageof 322 deliveries.

WHO conferenceNominated for PMs award

Asian Innovation awardPublished in The Lancet

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GENDER ISSUES

Gender issues integrated into trainings

Declining sex ratio- advocacy and socialmobilization, Welfare scheme, encouraging

girls education

Convergent action with professionalbodies, NGOs, PRIs

PCPNDT Act

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Interventions identified for Different LevelsClinical level

Quality improvements

Operationalise FRUs for ComprehensiveEmOC

Availing BEmOC at CHCs and PHCs

Skill based trainings for health providers Public Private Partnership: Need based out

sourcing

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Interventions identified for Different Levels

Outreach

Field Visit

RCH Camps

Immunisation Sessions on fix days:

mamata days

Mobile Health Units for inaccessibleareas

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Interventions identified for Different Levels

Community level

Awareness Generation

Trainings & Skill DevelopmentStrengthening CBWs including link

couples and CBOs

Involving PRIs for a meaningful role

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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 averageFOCUS ON URBAN SLUMS

Critical Situations:

Neonatal periodLow Birth Weight children

FOCUS ON NEWBORN CARE.

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Strategic Interventions:

Neonatal Care: At community, household level as wellas hospital i.e. prevent hypothermia, prevent infection &exclusive breast-feeding.

Immunization, Diarrhea, Treatment of ARIDealing with Malnutrition

Community Campaigns for nutritional goals includingchange in dietary behavior of community

Birth spacing as a IMR reducing strategy Inter-sectoral coordination: Nirogi Bal Varsh

Monitoring and supervision

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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 allFRUs functional

- Public Private Partnership

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Essential Obstetric CareComprehensive Antenatal care with regular check ups,

TT injections, Iron tablets and Supplementary feeding forspecific groups

Replacing Trained Birth Attendance by Skilled BirthAttendance

Quality obstetric services at primary Health Center

Effective Supply management of DDKs

Creating the right Infrastructure

Training for early recognition of bleeding /prolongedlabor / Infection /Abnormal presentation/Convulsions

Incentive based approach for trained TBAs and earlyreferral for EmOC

Mobility support- Interest free moped loans to ANMs

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Emergency Obstetric CareEffective Emergency Obstetric care management

Strengthening FRUs for effective service deliverywith Blood transfusion facilities

BEmOC to be made available at CHCs and PHCs.

Skill development at all required stagesPromoting timely referral by TBAs through training

Expertise of Gynec and Anesthetists to be made

available on panel and promote telemedicine foremergency.

Emergency transport for cases with complicationsand needing referral.

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Broad strategy for population stabilization

Volunteerism and informed choices as basis of population

policy.Community Needs Assessment approach and focusing on

unmet needs

Community behavioral change through IEC activities, increase

coverage of spacing and permanent FP methodsCommunity based contraceptive availability

Skill based training for doctors will be undertaken fortubectomy operations, laperoscopy operations and MTP andtraining of nursing personnel in IUD insertion technique.

Monitoring and supervision: Ensuring filling up all posts ofADHOs, DIECOs and making provision of reporting formatsand registers for MIS

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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

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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

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Social mobilisation for health

Dai Sangathan by 13 leading NGOs and astrategic 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

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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)

Cor orate Judiciar Consumer or anizations

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Vaccine Preventable

Diseases

VPDs

Immunization

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Polio Whooping cough

Diphtheria

Tetanus

Meningitis TB

Measles

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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,

HtoHSocial mobilization, AFP

surveillance

Simultaneous RI

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Strategies

Coverage > 90 % for 912 months age

Strengthen surveillance

Coverage during epidemic

Treatment of measles complications

IEC activities

Urban measles 5 yrs; school children 10

yrs

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Maintenance of cold chain

Storage and transportation of vaccineat the recommended temperature from

point of manufacture till given in the

body of beneficiaries. Sensitivity to heat

BCG (reconstituted) OPV

measles HepB DPT DT TT

Least sensitive TT

Sensitivity to freezing

DPT DT TT Hep - B

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Vaccine Vial Monitor

Inner square white

If the expiry date has not been passed

USE the vaccine

Inner square lighter than the outer circleIf 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

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