Reproductive & Child Health Program
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Transcript of Reproductive & Child Health Program
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1SIHFW: an ISO 9001: 2008 certified Institution
Reproductive & Child Health
Program
State Institute of Health and Family Welfare, Jaipur
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What is RCH.?Reproductive & Child Health program is a model
developed through experiments in paradigm shifts, Clinic approach
Extension & Education Cafeteria/ Targets Comprehensive service delivery approach Primary health care (1983) Targeted interventions-Target couples &
EC TFA (1996) Quality services & Policy reforms CNAA(1997-98)
Capacity enhancement,
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Chronological Events
NFPP-1951NFWP-1977
Alma Ata-1978EPI-1978
NHP-1983UIP-1985 (unified approach and microplanning)
CSSM-1992 (the 1st program officially
launched by President of India) ICPD-1994
RCH-I (1997, October)RCH-II (2005-06 -2009-10)SIHFW: An ISO:9001:2008 certified Institution 3
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Why RCH?
Program was conceived in view of the need of
Unified approach
Convergence for integration
Performance in relation to Goals & TimeframeShuffling priorities-Paradigm shift
Fertility regulation & Replacement goals
High Unmet needsHigh Morbidity/Mortality in women & children
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Objectives of RCH
Reduction in Birth Rate & Empowering women
Integration of related programs for meaningful
Meeting unmet needs through institutionalstrengthening & Quality of Care routed by-
Choice of methodsInformation provided to clients
Technical competence of providers
Interpersonal relationship between
Clients & service providersMechanism to ensure continuity of Care
Constellation of service appropriate toneed of users
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Approach
Clinic approach
Extension & Education
Cafeteria/ Targets
Comprehensive service delivery approach
Primary health care (1983)Targeted interventions-Target couples and
Eligible couples
Target free approach (1996)
Quality services & Policy reformsCommunity Needs Assessment Approach
(1997-98)
Capacity enhancement
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Approach
Targets April 1996 Goals National
State District PHC Sub-Center
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Phases of RCH Program
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Components of RCH1
Family Planning
Child Survival & Safe Motherhood
Client approach to health care
Prevention/Management of RTI/STD/AIDSAdolescent Reproductive Health
Modified Management Information Sub-System
IEC & CounselingCommunity Needs Assessment Approach
(CNNA)
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High Quality training at all levels
District sub projects under Local CapacityEnhancement
Enhanced community participation throughPanchayats, Women groups & NGOs
Implementation of Target free approach
Referral System
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Activities
Universal interventions without anydifferentiation
CS & SM interventions
Operationalization of CNAA Institutional development
Modified Management Information sub-system
IEC & CounselingUrban & Tribal area RCH package
District sub-projects for capacity enhancement
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Differential Strategy based on
Crude Birth Rate & Female Literacy Rate
Category-A (Low CBR, High Literacy)
(58)
Category-B (Moderate CBR, Moderateliteracy) (184)
Category-C (High CBR, Low literacy)
(265)
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Additional Activities in SelectedDistricts
Screening & Treatment of RTI/STI in-
3 FRUs - A Category (FRU=FirstReferral Unit)
2 FRUs - B1 FRU of C
Emergency Obstetric Care-
2 FRUs of B Category3 FRUs of C
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Essential Obstetric. Care-
Drugs & PHCs in B & Ccategory
Contractual PHN/Staff nurse inC category
Additional HWF in 30% S/C of C of 8States
Contractual PHNs/Staff NurseReferral Transport facility- 25%S/C of C
Districts of all States
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Service strengthening- inputs for-
MobilitySupervision
Micro-planning (50 Districts in 8States)
Dai training-142 Districts with < 30% safedelivery
RCH Camps in remote/under-utilized PHCs
Border Cluster project-46 Districts in 16 States tohave addl. Inputs
[Total Reported FRUs in India are 1724] 1992-97
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Child Survival ActivitiesCare of New borne
Eye, Cord, Bath & FeedSpecial care & Referral
conditions
Immunization
Vitamin-A (5 dose prophylaxis)
Diarrhea-ORT & ARI
Standard case definition &
managementSupport Activities-
Cold chain
SuppliesSIHFW: An ISO:9001:2008 certified Institution 16
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Safe Motherhood Interventions
Essential Obstetric care-Early registration of
pregnancy (12-16 weeks)
ANC (3 visits)
TT (2 or Booster)
IFA (100 Tab.)
Delivery by Trained/Skilled
Birth attendants (TBA)observing 5C
Referral for emergencies-conditions, time-frame &
placeSIHFW: An ISO:9001:2008 certified Institution 17
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PNC (3 visits)Spacing 3 yrs
STI/RTI Management
Adolescent Reproductivehealth-
Counseling/IEC based onLife cycle approach
Emergency Obstetric care
Strengthening Referrals
Training of TBA/SBA
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CNAA
[Community Need Assessment Approach]
The Committee on Population in NationalDevelopment Council (NDC) in 1993
recommended
Decentralized area specific planningbased on Local Needs
Creation of a District level Data base on:
Quality
CoverageImpact indicators; for monitoring &
Evaluation
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Purpose & Key Issues of CNAA
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Purpose
Setting Priorities
Identify Target andHigh Risk groups
Estimation of Serviceneeds andmatching it withResources
Develop a realisticaction Plan
Key Issues
Micro-planningCommunityinvolvementClients perspectiveQuality of Care
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Process of CNAA
Focus on Participatory Planning basedon:
Felt Needs
Actual workload assessmentAssess Capacity of Providers
Involve people for better Utilization
Speak to People, Get throughRecords and Take up surveys
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Develop teams involving local people
Organize meetings for decision on servicedelivery
Evaluate need for each Health & FamilyWelfare service-Share it with people
Develop an Action PlanSub-Center Action plan
PHC Action plan
CHC Action planDistrict Action plan: Consolidation
State Action plan: Compilation
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Initiatives after National PopulationPolicy 2000
RCH Camps
RCH Out Reach Schemes
Home based Neonatal Care
Border District Cluster Strategy
Hepatitis B Vaccination Project
Training of Dias
Empowered Action GroupDistrict Surveys
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Lessons from RCH-I
One size fits all approachState/District level requirements not accounted
Adequate program mgt. skills missing
Planning, monitoring, budgeting and resourceallocation did not match program objectives
Frequent turnover
Result/outcome orientation missing
Human Resource planning neglectedFinancial/accounting/disbursement and
utilization bottlenecks
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Generic BCCFocused and thematic approach missing
Low utilization of public health facilities
Complaints against insensitive providers
Hidden cost incurred by users Limited choices for clients
No convergence between related sectors
Fragmented approach
Duplication
Loss of opportunities to achieve effectiveness
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RCH Phase II
Major Focus on
Reducing Maternal & Child Mortality andMorbidity
Emphasis on Rural Health Care
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Key Issues
Flexibility: States needs and capacities
Strengthening management capacity
Integrated Behavior Change
Communication (BCC) strategies
Improved client responsiveness topublic health facilities
Convergence with other critical sectors
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Activities under RCH II
1. Strengthening Project ManagementStructure
Re-organizing of Medical Directorate
Renovation of Medical Directorate andNRHM/RCH-II cell
Setting up, of the PMU at state & districtlevels
Induction of newly appointedprofessionals
Support for communication, equipmentsand mobility to DPMUs
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2. Strengthening Infrastructure
Upgrading of PHCs as BEmOcs
Provision of blood storage at 26 identifiedCEmOcs
Support for equipment and labor tables at 25%PHCs (10000.00 Rs. Per Institution)
Support for minor repair and renovation of publicfacilities at 50% PHCs (25000.00 Rs. Per
Institution)Facility survey of all PHC and CHCs
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3. HRD and capacity buildingDevelopment of annual training calendar
Strengthening of ANMTCs
Support medical colleges for Anesthesiatrainings
Library at SIHFW & Medical Directorate
Orientation of AYUSH Doctors on National
Programs
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5. Strengthening and improvement oflogistics and supply systems
Feasibility study to setting up of the drugs
and logistics warehousingSupport for the repair of workshop for cold
chain equipment
Support for hiring 12 new refrigerators
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6. Strengthening HMIS, M&E
Support for CNNA format, ECS has beenprovided from state level
Integration of RCH-II/NRHM reportingformat in existing HMIS software
Baseline and concurrent evaluation
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7. BCC for increasing demand for RCHand contraceptive services
Intensive IEC for RCH-II and NRHMinterventions
Provision for hiring of IEC van in all districts Implementation of Integrated Media Plan
IEC for Panchamrit program done byprinting of booklet, Banners, cards
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8. Specific Interventions
Maternal Health
RCH camps target
Dai training target
Night delivery facility at all PHCs and CHCsHiring of contractual staff (PHN & LT)
Provision of 1321 additional ANMS at 10
desert and tribal districtsSTD/RTI drugs for PHCs
Jannani Suraksha Yojna
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Family Planning
Improving quality of fixcamps
Compensation schemefor sterilization
Blood donation camps
NSV mega camps
AFHS Training
Child Health
IMNCI launchedin 9 districts
Mal nutritioncorner at all
237 blocks
Purchase of
ORS packets
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9. Strengthening Networking and
Partnership with the civil society
Collaboration with IMA & FOGSI
Accreditation of Private nursing home
for JSYMNGO scheme in all districts
Annual consultation with stakeholderson NRHM
Social marketing of contraceptives andother health services
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10. Innovative schemes and pilotprojects
Pilot Project on Population stabilizationinitiated at Jhalawar & Tonk.
PARINCHE project for five districts.Help line at medical directorate for
improving communication
Campaign on Age at Marriage.
Medical Mobile unit for all districts.
VCTC at 16 CHCs.
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11. Improving and strengthening RCHServices in Tribal population
Six districts, namely, Baran, Banswara,Chittorgarh Dungarpur, Sirohi andUdaipur
Process for developing PIP for six urbandistricts is under process
12. Establishing and strengthening RCHservices in Urban Area
Urban slum population in Jaipur, Jodhpur,Kota, Bikaner, Pali, Udaipur,Ganganagar, Hanumangarh, Bhilwaraand Tonk
PIP for 8 urban slums is under process.SIHFW: An ISO:9001:2008 certified Institution 39
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Goals of RCH II
Indicator X Plan Goals(2002-07)
RCH IIGoals(2005-10)
NPP 2000(By 2010)
MDG
IMR
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Goals for Rajasthan
Outcomes Goal of Rajasthan up to2011-12
Infant Mortality Rate (IMR) 32
Maternal Mortality Ratio(MMR) 148
Total Fertility Rate (TFR) 2.1
Crude Birth Rate (CBR) 21
Crude Death Rate (CDR) 7
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Performance Indicators for RCH[Ante Natal]
Number of Ante Natal cases registration
Number of Pregnant women who
Had 3 ANCs
Had 2 doses of TTWere Under prophylaxis & treatment of anemia
Number of high risk pregnant referred
Number of deliveries by trained & Untrainedbirth attendants
Number of cases with complications referred toPHC/FRU
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Performance Indicators[Post natal & New born]
Number of New born with Birth weight recorde
Number of woman given 3 post natal checkups
Number of Fully Immunized children
Number of Adverse reactions reported afterImmunization
Number of cases motivated & followed up forcontraception
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Institutional Deliveries (Source DLHS 2 &3)
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Number of Ante Natal CasesRegistration (Source DLHS 2 & 3)
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Number of Pregnant in Relation toANC
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(Source DLHS 2 & 3)
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Status of Full Immunization ofChildren
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(Source DLHS 2 & 3)
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Status of Recording of Birth Weight
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(Source NFHS 3)
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Status of 3 Post Natal Check Ups
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(Source DLHS 3)
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THANK YOU