Reproductive & Child Health

Program

State Institute of Health & Family Welfare,

Jaipur
 What is RCH….?
• Reproductive
R d i & Child Health
H l h program isi a model
d l
developed through experiments in paradigm shifts,
Clinic
Cli i approach h
Extension & Education
“Cafeteria”/
Cafeteria / “Targets”
Targets
“Comprehensive” service delivery approach
Primary health care (1983)
Targeted interventions-Target couples & EC
TFA (1996)
Quality services & Policy reforms
CNAA(1997 98)
CNAA(1997-98)
Capacity enhancement, 2
SIHFW: an ISO 9001: 2008 certified Institution
 Chronological
g Events
• NFPP-1951
• NFWP-1977
NFWP 1977
• Alma Ata-1978
• EPI 1978
EPI-1978
• NHP-1983
• UIP-1985 (unified approach and micro
planning)
• CSSM-1992 (the 1st program officially
l
launched
h db by P
President
id t off IIndia)
di )
• ICPD-1994
• RCH-I (1997,
(1997 October)
• RCH-II (2005-06 -2009-10) 3
SIHFW: an ISO 9001: 2008 certified Institution
 y RCH………?
Why
• Unified approach
• Convergence
C ffor integration
i t ti
• Performance in relation to Goals &
Ti f
Timeframe
• Shuffling priorities-Paradigm shift
• Fertility
F tilit regulation
l ti & R Replacement
l t goals
l
• High Unmet needs
• High Morbidity/Mortality in women &
children

SIHFW: an ISO 9001: 2008 certified Institution 4

 Objectives of RCH
• Reduction in Birth Rate & Empowering
women
• Integration
g of related p
programs
g for
meaningful
Meeting unmet needs through institutional
strengthening & Quality of Care routed
by
by-
• Choice of methods
• Information
I f ti provided
id d tto clients
li t
SIHFW: an ISO 9001: 2008 certified Institution 5
• Technical competence
p of p
providers

• Interpersonal relationship between Clients

& service providers

• Mechanism to ensure continuity of Care

• Constellation of services appropriate to

need of users

SIHFW: an ISO 9001: 2008 certified Institution 6

 p
Components of RCH -1
• Family Planning
• Child S
Survival
i l&S Safe
f M
Motherhood
th h d
• Client approach to health care
• Prevention/Management of RTI/STD/AIDS
• Adolescent Reproductive Health
• Modified Management Information Sub-
System
• IEC & Counseling
• Community Needs Assessment Approach
(CNAA)
SIHFW: an ISO 9001: 2008 certified Institution 7
• High Quality training at all levels

• District sub projects under Local

Capacity Enhancement

• Enhanced community participation

through Panchayats,
Panchayats Women groups &
NGOs

• Implementation of Target free approach

• Referral System
SIHFW: an ISO 9001: 2008 certified Institution 8
 Activities
Universal interventions without any
differentiation
• CS & SM interventions
• Operationalization of CNAA
• Institutional development
• Modified Management Information subsub-
system
• IEC & Counseling
• Urban & Tribal area RCH package
• District sub-projects
sub projects for capacity
enhancement 9

SIHFW: an ISO 9001: 2008 certified Institution

Differential Strategy Based on

Crude Birth Rate & Female Literacy Rate

• Category-A (Low CBR, High
Literacy) (58)
• Category-B (Moderate CBR,
Moderate literacy) (184)
• Category-C (High CBR, Low literacy)
(
(265))

SIHFW: an ISO 9001: 2008 certified Institution 10

Additional Activities in Selected
Districts
Di t i t
• Screening & Treatment of RTI/STI in
in-
• 3 FRUs - “A” Category (FRU=First
Referral Unit)
• 2 FRUs - “B”
• 1 FRU of “C”
C
• Emergency Obstetric Care –
• 2 FRUs of “B”
B Category
• 3 FRUs of “C”

SIHFW: an ISO 9001: 2008 certified Institution 11

• Essential Obstetric. Care-
• Drugs & PHCs in “B” B & “C”
C category
• Contractual PHN/Staff nurse in “C”
category
• Additional HWF in – 30% S/C of “C” of 8
States
• Contractual PHNs/Staff Nurse
• Referral Transport facility-
facility 25%S/C of “C”
C
Districts of all States

SIHFW: an ISO 9001: 2008 certified Institution 12

• Service
S i strengthening-inputs
h i i for-
f
• Mobility,
• Supervision,
• Micro-planning (50 Districts in 8
S
States))
• Dai training-142 Districts with < 30% safe
d li
delivery
• RCH Camps in remote/under-utilized PHCs
• Border Cluster project-46 Districts in 16
States to have addl. Inputs

SIHFW: an ISO 9001: 2008 certified Institution 13

 C d Su
Child a Activities
Survival ct t es
• Care of New borne • Diarrhea-ORT & ARI
• Eye, Cord, Bath & • Standard case
Feed definition &
• Special care & management
Referral conditions • Support Activities-
• Immunization • Cold chain
• Vitamin-A (9 dose • Supplies
prophylaxis) • Surveillance

SIHFW: an ISO 9001: 2008 certified Institution 14

Safe Motherhood Interventions
• Essential Obstetric care-
• Early
E l registration
i t ti off pregnancy (12
(12-
16 weeks)
• ANC (3 visits)
i it )
• TT (2 or Booster)
• IFA (100 T Tab.)
b)
• Delivery by Trained/Skilled Birth
attendants
tt d t observing
b i 5Cs
5C
• Referral for emergencies-conditions,
time frame & place
time-frame
SIHFW: an ISO 9001: 2008 certified Institution 15
 • PNC (3 visits)
p
• Spacingg 3 yyrs
• STI/RTI Management
p
• Adolescent Reproductive health-
• Counseling/IEC based on Life
cycle
y approach
pp
• Emergency Obstetric care
g
• Strengtheningg Referrals
• Training of TBA/SBA

SIHFW: an ISO 9001: 2008 certified Institution

16
 CNAA
The Committee on Population in National
Development Council (NDC) in 1993
Recommended-
• Decentralized
D t li d area specificifi planning
l i
based on Local Needs
• Creation of a District level Data base on:
Quality,
Coverage,
• Impact indicators; for monitoring &
Evaluation.
Evaluation
SIHFW: an ISO 9001: 2008 certified Institution 17
Purpose & Key Issues of CNAA
Purpose Key issues
• Setting Priorities • Micro-planning
• Identify Target and • Community
Hi h Risk
High Ri k groups i
involvement
l t
• Estimation of Service • Client’s perspective
needs and matching • Quality of Care
it with Resources
• Develop a realistic
action Plan

SIHFW: an ISO 9001: 2008 certified Institution 18

 Process of CNAA

Focus on Participatory
p y Planning g based
on:
• Felt Needs
• Actual workload assessment
p
• Assess Capacity y of Providers
• Involve people for better Utilization
Speak to People, “Get
• “Speak” Get through
through”
Records and “Take up” surveys

SIHFW: an ISO 9001: 2008 certified Institution 19

• Develop teams involving local people
• Organize meetings for decision on service
delivery
y
• Evaluate need for each Health & Family
Welfare service-Share it with people
p p
• Develop an Action Plan
• Sub-Center Action plan
p
• PHC Action plan
• CHC Action plan
• District Action plan: Consolidation
• State Action plan: Compilation
20
SIHFW: an ISO 9001: 2008 certified Institution
Initiatives after National Population
Policy
P li 2000
• RCH Camps
• RCH Out Reach Schemes
• H
Home b
based
dNNeonatal
t lC
Care
• Border District Cluster Strategy
• Hepatitis B Vaccination Project
• Training of Dais
• Empowered Action Group
• District Surveys
SIHFW: an ISO 9001: 2008 certified Institution 21
 Lessons from RCH-I
• “One size fits all” approach does not work
• State/District level requirements not
accounted
• Adequate program mgt. skills missing
• Planning, monitoring, budgeting and resource
allocation did not match p program g objectives
j
• Frequent turnover
• Result/outcome orientation missing
• Human Resource planning neglected
• Financial/accounting/disbursement and
utilization bottlenecks
SIHFW: an ISO 9001: 2008 certified Institution 22
• Generic
G i BCC
• Focused 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
• pp
Loss of opportunities to achieve
effectiveness
SIHFW: an ISO 9001: 2008 certified Institution 23
 RCH Phase II

Major Focus on……

• Reducing Maternal & Child Mortality

and Morbidity

• Emphasis on Rural Health Care

SIHFW: an ISO 9001: 2008 certified Institution 24

 y Issues
Key
• Flexibility: States’ needs and capacities

• Strengthening management capacity

• Integrated Behavior Change

Communication ((BCC)) strategies
g

• Improved client responsiveness to

public health facilities

• Convergence with other critical sectors

SIHFW: an ISO 9001: 2008 certified Institution 25
 Activities under RCH-II
1. Strengthening Project Management
Structure
• Re-organizing of Medical Directorate.
• R
Renovation
ti off M
Medical
di l Di
Directorate
t t and d
NRHM/RCH-II cell.
• Setting up,
up of the PMU at state & district
levels.
• Induction of newly appointed professionals
• Support for communication, equipments and
mobility to DPMUs
DPMUs.
SIHFW: an ISO 9001: 2008 certified Institution 26
 2. Strengthening Infrastructure
• Upgrading of PHCs as BEmOcs.
• Provision of blood storage at 26 identified
CEmOcs
• Support for equipment and labor tables at
25% PHCs.(10000.00
( Rs. Per Institution))
• Support for minor repair and renovation of
public facilities at 50% PHCs. (25000.00 Rs.
Per Institution)
• Facility survey of all PHC and CHCs.

SIHFW: an ISO 9001: 2008 certified Institution 27

 3. HRD and Capacity Building
• D
Development
l t off annuall ttraining
i i calendar.
l d
• Strengthening of ANMTCs.
• Support medical colleges for Anesthesia
trainings.
• Lib
Library att SIHFW & M Medical
di l DiDirectorate.
t t
• Orientation of AYUSH Doctors on National
Programs.

SIHFW: an ISO 9001: 2008 certified Institution 28

 4. Improving Quality of Care and
Strengthening
St th i Referral
R f l System
S t
• Study on referral system by RHSDP
• 7 days Mobility support to PHC MOs
• Installation of new telephone connection at
allll PHC/CHC
PHC/CHCs.
• Work shops for developing standards and
protocols for quality of care
care.

SIHFW: an ISO 9001: 2008 certified Institution 29

 5. Strengthening and Improvement of
Logistics and Supply Systems

• F
Feasibility
ibilit study
t d to
t setting
tti up off the
th drugs
d
and logistics warehousing
• Support for the repair of workshop for cold
chain equipment
• Support for hiring 12 new refrigerators

SIHFW: an ISO 9001: 2008 certified Institution 30

 6. Strengthening HMIS, M&E

• Support for CNAA format, ECS has been

provided from state level.
• Integration of RCH-II/NRHM reporting
format in existing HMIS software.
• Baseline and concurrent evaluation.

SIHFW: an ISO 9001: 2008 certified Institution 31

 7. BCC For Increasing Demand For RCH
and Contraceptive Services
• Intensive IEC for RCH-II and NRHM
interventions Provision for hiring of IEC van
interventions.
in all districts.
• Implementation
p e e tat o o of Integrated
teg ated Media
ed a Plan.
a
• IEC for “Panchamrit program” done by
printing
p g of booklet,, Banners,, cards.

SIHFW: an ISO 9001: 2008 certified Institution 32

 8. Specific Interventions

Maternal Health
• RCH camps target
• Dai training target
• Night delivery facility at all PHCs and CHCs.
• Hiring of contractual staff (PHN & LT)
• Provision of 1321 additional ANMS at 10
desert and tribal districts.
• STD/RTI drugs for PHCs
• Janani Suraksha Yojna
33
SIHFW: an ISO 9001: 2008 certified Institution
Child Health Family Planning
• IMNCI launched in 9 • Improving quality of fix
districts. camps.
• Mal nutrition corner at • Compensation scheme
all 237 blocks. for sterilization.
• Purchase of ORS • Blood donation camps
camps.
packets. • NSV mega camps
• AFHS Training

SIHFW: an ISO 9001: 2008 certified Institution 34

 9. Strengthening Networking and
Partnership with the Civil Society
• Collaboration with IMA & FOGSI
• A
Accreditation
dit ti off P
Private
i t nursingi h
home ffor
JSY.
• MNGO scheme in all districts.
districts
• Annual consultation with stakeholders on
NRHM.
NRHM
• Social marketing of contraceptives and other
health services.
services
SIHFW: an ISO 9001: 2008 certified Institution 35
 10. Innovative Schemes and Pilot
Projects
• Pilot Project on Population stabilization
initiated at Jhalawar & Tonk.
Tonk
• PARINCHE project for five districts.
• Help line at medical directorate for
improving communication
• Campaign on Age at Marriage.
Marriage
• Medical Mobile unit for all districts.
• VCTC at 16 CHCs
CHCs.
SIHFW: an ISO 9001: 2008 certified Institution 36
 11. Improving
p g and Strengthening
g g RCH
Services in Tribal Population

• Six districts, namely, Baran, Banswara,

Chittorgarh Dungarpur, Sirohi and Udaipur

• Process for developing PIP for six urban

districts is under process.

SIHFW: an ISO 9001: 2008 certified Institution 37

12. Establishing
g and Strengthening
g g RCH
Services in Urban Area

• Urban slum population in Jaipur, Jodhpur,

Kota, Bikaner, Pali, Udaipur, Ganganagar,
Hanumangarh, Bhilwara and Tonk

• PIP for 8 urban slums is under process.

SIHFW: an ISO 9001: 2008 certified Institution 38

 Goals of RCH II
Indicator X Plan RCH –II NPP 2000 MDG
Goals Goals(200 (By 2010)
((2002-07)) 5-10))

IMR <45 <30 <30 -

Reduce by
U-5 MR - - - 2/3 from 1990
levels
Reduce by ¾
MMR 200 <100 <100 by 2015

TFR 2.3 2.1 2.1 - 39

SIHFW: an ISO 9001: 2008 certified Institution
 Goals for Rajasthan

Outcomes 2012-13 2013-14 2014-15

MMR 248 193 150

TFR 2.9 2.8 2.6

Mothers who had

3 or more ANC 1413907 1541369 1671931
check ups
Institutional
Deliveries in
56% 58% 61%
public health
facilities
Source: State NRHM PIP 2012-13 40

SIHFW: an ISO 9001: 2008 certified Institution

 Goals for Rajasthan

Outcomes 2012-13 2013-14 2014-15

Early Neonatal
24 21 18
Mortality

NMR 28 24 20

IMR 37 31 25

U5MR 51 45 39

Full Immunization 80 % 85% 90%

Source: State NRHM PIP 2012-13 41

SIHFW: an ISO 9001: 2008 certified Institution

Performance Indicators for RCH
[Ante-Natal]
[A t N t l]
• Number of Ante Natal cases registration
• Number of Pregnant women who
• Had 3 ANCs
• Had 2 doses of TT
• Were Under p prophylaxis
p y & treatment of anemia
• Number of high risk pregnant referred
• Number of deliveries by trained & Untrained
birth attendants
• Number of cases with complications
p referred to
PHC/FRU 42
SIHFW: an ISO 9001: 2008 certified Institution
 Performance Indicators
(Post
(P t natal
t l & New
N born)
b )

• Number of New born with Birth weight

recorded
• Number of woman given 3 post natal check
ups
• Number of Fully Immunized children
• Number of Adverse reactions reported after
Immunization
• Number of cases motivated & followed up for
contraception
i
43
SIHFW: an ISO 9001: 2008 certified Institution
 Institutional Deliveries
(Source: DLHS 2 &3)

Institutional Delivery%
y

45.5 47
40.9

30.3

2002-04[Raj] 2007-08[Raj] 2002-04[Ind] 2007-08[Ind]

SIHFW: an ISO 9001: 2008 certified Institution 44

 Institutional
st tut o a Deliveries
e e es
India Rajasthan

16804718 17585434
16222201
14823481

1136597 1202596 1207065 1279362

2008-09
008 09 2009-10
009 0 2010-11
0 0 2011-12
0
Source: MoHFW/ www.rajswasthya.nic.in
SIHFW: an ISO 9001: 2008 certified Institution 45
 Ante-natal Cases Registration
(Source :DLHS 2 & 3)

80 73 6
73.6
75.3
70 67.3

60
56 6
56.6
50
Axis Title

40
30
20
10
0
2002-04[Raj] 2007-08[Raj] 2002-04[Ind] 2007-08[Ind]
46
SIHFW: an ISO 9001: 2008 certified Institution
 Number of Pregnant in Relation
to
t ANC

80.2
73.5

Status of 3 or
61.4 55
51 more ANCs %
53.5 50.4
46.8 At least 1 TT
Vaccination

28.8 Mothers who

28.2 consumed
20.5
05 100 IFA
tablets

7.4

2002-04[Raj] 2007-08[Raj] 2002-04[Ind] 2007-08[Ind]

SIHFW: an ISO 9001: 2008 certified Institution 47

(Source: DLHS 2 & 3)
 Full Immunization of children aged
12 23 months
12-23 th (in
(i ‘000
‘000s))

22529 23306 231 1

23141 22332

India
Rajasthan

1596 1540 1368 1336

2008-09
2008 09 2009-10
2009 10 2010
2010-11
11 2011
2011-12
12
Source: MoHFW/ www.rajswasthya.nic.in
SIHFW: an ISO 9001: 2008 certified 48
Institution
Status of Recording of Birth Weight
New Born whose birth weight was recorded

34 1
34.1

20.9

NFHS 3 [2005-06] Raj NFHS 3 [2005-06] Ind

(Source :NFHS 3) 49
SIHFW: an ISO 9001: 2008 certified Institution
 Status of 3 Post Natal Check ups

Mother who received postnatal care within 2

weeks of delivery

50.8

38.2

2007-08[Raj] 2007-08[Ind]

(Source DLHS 3) SIHFW: an ISO 9001: 2008 certified Institution 50

 Thank You

For more details log on to

www. sihfwrajasthan.com
or
contact : Director-SIHFW
on

sihfwraj@yahoo.co.in