N E W I N I T I A T I V E S &Q U A L I T Y I N D I C A T O R S

REPRODUCTIVE AND CHILD HEALTH PHASE-II

MANOJ K. VAIDYA

NEW INITIATIVES UNDER RCH-II

1. Making the First Referral units functional.

2. Training of MBBS doctors.

3. Blood storage facilities

4. JANANI SURAKSHA YOJANA

24 HRS. FUNCTIONING OF PHCSRCH 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.)

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.

TRAINING IN OBSTETRIC MANAGEMENTRCH 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

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.

JANANI SURAKSHA YOJANA, RCH II

OBJECTIVES • REDUCTION IN MMR & IMR • PREVENTING FEMALE FOETICIDEFOCUS:• 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

JANANI SURAKSHA YOJANA

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• Of late it has been withdrawn.

0THER INITIATIVES

Proposed :

1. Rural Health Care Mission.

2. Referral transport

3. ASHA (Accredited Social Health Activist)

4. Adolescent Reproductive and Sexual Health

5. A comprehensive infection management and environment plan

for RCH-II has been prepared for implementation at CHC, PHC,

SC’s.

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.

REFERRAL TRANSPORTRCH 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

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.

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.

INFECTION MANAGEMENT AND ENVIRONMENT PLAN

IMEP which is being extended to health care facilities includes:

a) Treatment and disposal of biomedical wastesb) Disposal of syringe wastec) Provision of water, sanitation and good hygiene conditions

OBJECTIVE: to ensure managing health and environment risks effeciently end effectively

SAFE ABORTION PRACTICES

• MEDICAL METHOD• MANUAL VACCUM ASPIRATION

MEDICAL METHOD OF ABORTION

Termination of early pregnancy (49days) using 2 drugs - mifeprestone followed by mesoprostol

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.

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

PunjabProposed 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.

CONTINUED….

screening code for Ca Cervix – Tamil NaduSubsidized Medical Practitioner (SMP) scheme-

assam, bihar

Nurse Practitioners Scheme

Laproscopic Training -- maharashtra

Implementation of Health Insurance scheme on

pilot basis.

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: Both the World Bank and the DFID have agreed with the National PIP and will soon convey their respective Boards approval.

QUALITY INDICATORS

Following are the quality indicators used to monitor and evaluate RCH programme through monthly reports:

1. Number of antenatal cases registered2. Number of pregnant women who had 3 antenatal checkups3. Number of high risk pregnant women referred4. Number of pregnant women who had 2 doses of TT5. Number of pregnant women under prophylaxis and treatment

of anaemia

6. Number of deliveries by trained and untrained attendants7. Number of cases with complications referred to

PHC/FRU8. Number of newborn with birth weight recorded

CONTINUED…….

9. No. of women given 3 post natal check-ups10. No. of RTI/STD cases detected, treated and referred11. No. of children fully immunised 12. No. of adverse reactions reported after immunisation13. No. of cases of ARI and diarrhoea under 5yrs

14. No. of cases motivated and followed for contraception.

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