Reproductive & Child Health Program

State Institute of Health and Family Welfare, Jaipur

SIHFW: an ISO 9001: 2008 certified Institution

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What is RCH….?
Reproductive & Child Health program is a model developed through experiments in paradigm shifts,
 

   

EC
   

Clinic approach Extension & Education “Cafeteria”/ “Targets” “Comprehensive” service delivery approach Primary health care (1983) Targeted interventions-Target couples & TFA (1996) Quality services & Policy reforms CNAA(1997-98) Capacity enhancement,
SIHFW: An ISO:9001:2008 certified Institution 2

Chronological Events
Ø NFPP-1951 Ø NFWP-1977 Ø Alma Ata-1978 Ø EPI-1978 Ø NHP-1983 Ø UIP-1985 (unified approach and micro planning) Ø CSSM-1992 (the 1st program officially launched by President of India) Ø ICPD-1994 Ø RCH-I (1997, October) Ø RCH-IIISO:9001:2008 certified -2009-10) SIHFW: An (2005-06 Institution

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Why RCH………?
Program was conceived in view of the need of Ø Unified approach Ø Convergence for integration Ø Performance in relation to Goals & Timeframe Ø Shuffling priorities-Paradigm shift Ø Fertility regulation & Replacement goals Ø High Unmet needs Ø High Morbidity/Mortality in women & children •

SIHFW: An ISO:9001:2008 certified Institution 4

Objectives of RCH
Ø Reduction in Birth Rate & Empowering women Ø Integration of related programs for meaningful Ø Meeting unmet needs through institutional strengthening & Quality of Care routed byØChoice of methods ØInformation provided to clients ØTechnical competence of providers ØInterpersonal relationship between Clients & service providers ØMechanism to ensure continuity of Care ØConstellation of service appropriate to need of users

SIHFW: An ISO:9001:2008 certified Institution

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Approach
Ø Clinic approach Ø Extension & Education Ø “Cafeteria”/ “Targets” Ø “Comprehensive” service delivery approach Ø Primary health care (1983) Ø Targeted interventions-Target couples and Eligible couples Ø Target free approach (1996) Ø Quality services & Policy reforms Ø Community Needs Assessment Approach (1997-98) Ø Capacity enhancement

Ø

SIHFW: An ISO:9001:2008 certified Institution

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Approach

Targets

   

April 1996  National State District PHC Sub-Center

Goals

SIHFW: An ISO:9001:2008 certified Institution

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Phases of RCH Program

SIHFW: An ISO:9001:2008 certified Institution

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Components of RCH1
Ø Family Planning Ø Child Survival & Safe Motherhood Ø Client approach to health care Ø Prevention/Management of RTI/STD/AIDS Ø Adolescent Reproductive Health Ø Modified Management Information Sub-System Ø IEC & Counseling Ø Community Needs Assessment Approach (CNNA)

SIHFW: An ISO:9001:2008 certified Institution

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Ø High Quality training at all levels Ø District sub projects under Local Capacity Enhancement Ø Enhanced community participation through Panchayats, Women groups & NGOs Ø Implementation of Target free approach Ø Referral System Ø Ø

SIHFW: An ISO:9001:2008 certified Institution

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Activities
Universal interventions without any differentiation Ø CS & SM interventions Ø Operationalization of CNAA Ø Institutional development Ø Modified Management Information sub-system Ø IEC & Counseling Ø Urban & Tribal area RCH package Ø District sub-projects for capacity enhancement •

SIHFW: An ISO:9001:2008 certified Institution 11


Differential Strategy based on Crude Birth Rate & Female Literacy Rate
ØCategory-A (Low CBR, High Literacy) (58) ØCategory-B (Moderate CBR, Moderate literacy) (184) ØCategory-C (High CBR, Low literacy) (265)


SIHFW: An ISO:9001:2008 certified Institution

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Additional Activities in Selected Districts
Ø Screening & Treatment of RTI/STI inØ3 FRUs - “A” Category (FRU=First Referral Unit) Ø2 FRUs - “B” Ø1 FRU of “C” Ø Emergency Obstetric CareØ2 FRUs of “B” Category Ø3 FRUs of “C”

SIHFW: An ISO:9001:2008 certified Institution

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Ø Essential Obstetric. CareØDrugs & PHCs in “B” & “C” category ØContractual PHN/Staff nurse in “C” category Ø Additional HWF in – 30% S/C of “C” of 8 States Ø Contractual PHNs/Staff Nurse Ø Referral Transport facility- 25%S/C of “C” Districts of all States Ø
SIHFW: An ISO:9001:2008 certified Institution 14

Ø Service strengthening- inputs forØMobility ØSupervision ØMicro-planning (50 Districts in 8 States) Ø Dai training-142 Districts with < 30% safe delivery Ø RCH Camps in remote/under-utilized PHCs Ø Border Cluster project-46 Districts in 16 States to have addl. Inputs Ø [Total Reported FRUs in India are 1724] 1992-97 Ø
SIHFW: An ISO:9001:2008 certified Institution 15

Child Survival Activities
ØCare of New borne ØEye, Cord, Bath & Feed ØSpecial care & Referral conditions ØImmunization ØVitamin-A (5 dose prophylaxis) ØDiarrhea-ORT & ARI ØStandard case definition & management ØSupport ActivitiesØCold chain ØSupplies
SIHFW: An ISO:9001:2008 certified Institution 16

Safe Motherhood Interventions
ØEssential Obstetric careØEarly registration of pregnancy (12-16 weeks) ØANC (3 visits) ØTT (2 or Booster) ØIFA (100 Tab.) ØDelivery by Trained/Skilled Birth attendants (TBA) observing 5C ØReferral for emergenciesconditions, time-frame & place
SIHFW: An ISO:9001:2008 certified Institution 17

ØPNC (3 visits) ØSpacing 3 yrs ØSTI/RTI Management ØAdolescent Reproductive healthØCounseling/IEC based on Life cycle approach ØEmergency Obstetric care ØStrengthening Referrals ØTraining of TBA/SBA
SIHFW: An ISO:9001:2008 certified Institution 18

CNAA
[Community Need Assessment Approach] The Committee on Population in National Development Council (NDC) in 1993 recommended Ø Decentralized area specific planning based on Local Needs Ø Creation of a District level Data base on: ØQuality ØCoverage ØImpact indicators; for monitoring & Evaluation •

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Purpose & Key Issues of CNAA

Purpose

Ø Setting Priorities Ø Identify Target and High Risk groups Ø Estimation of Service needs and matching it with Resources Ø Develop a realistic action Plan

Key Issues ØMicro-planning ØCommunity involvement ØClient’s perspective ØQuality of Care

SIHFW: An ISO:9001:2008 certified Institution

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

SIHFW: An ISO:9001:2008 certified Institution

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Ø Develop teams involving local people Ø Organize meetings for decision on service delivery Ø Evaluate need for each Health & Family Welfare service-Share it with people Ø Develop an Action Plan ØSub-Center Action plan ØPHC Action plan ØCHC Action plan ØDistrict Action plan: Consolidation ØState Action plan: Compilation •
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Initiatives after National Population Policy 2000
Ø RCH Camps Ø RCH Out Reach Schemes Ø Home based Neonatal Care Ø Border District Cluster Strategy Ø Hepatitis B Vaccination Project Ø Training of Dias Ø Empowered Action Group Ø District Surveys Ø
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Lessons from RCH-I
Ø “One size fits all’ approach Ø State/District level requirements not accounted Ø Adequate program mgt. skills missing Ø Planning, monitoring, budgeting and resource allocation did not match program objectives Ø Frequent turnover Ø Result/outcome orientation missing Ø Human Resource planning neglected Ø Financial/accounting/disbursement and utilization bottlenecks
SIHFW: An ISO:9001:2008 certified Institution 24

Ø Generic BCC Ø Focused and thematic approach missing Ø Low utilization of public health facilities Ø Complaints against insensitive providers Ø Hidden cost incurred by users Ø Limited choices for clients Ø No convergence between related sectors Ø Fragmented approach Ø Duplication Ø Loss of opportunities to achieve effectiveness Ø Ø
SIHFW: An ISO:9001:2008 certified Institution 25

RCH Phase II

Major Focus on……

Ø Reducing Maternal & Child Mortality and Morbidity Ø Emphasis on Rural Health Care

SIHFW: An ISO:9001:2008 certified Institution

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Key Issues
Ø Flexibility: States needs and capacities Ø Strengthening management capacity Ø Integrated Behavior Change Communication (BCC) strategies Ø Improved client responsiveness to public health facilities Ø Convergence with other critical sectors

Ø

SIHFW: An ISO:9001:2008 certified Institution

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Activities under RCH II

1. Strengthening Project Management Structure ØRe-organizing of Medical Directorate ØRenovation of Medical Directorate and NRHM/RCH-II cell ØSetting up, of the PMU at state & district levels ØInduction of newly appointed professionals ØSupport for communication, equipments and mobility to DPMUs
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2. Strengthening Infrastructure Ø Upgrading of PHCs as BEmOcs Ø Provision of blood storage at 26 identified CEmOcs Ø Support for equipment and labor tables at 25% PHCs (10000.00 Rs. Per Institution) Ø Support for minor repair and renovation of public facilities at 50% PHCs (25000.00 Rs. Per Institution) Ø Facility survey of all PHC and CHCs

SIHFW: An ISO:9001:2008 certified Institution

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3. HRD and capacity building Ø Development of annual training calendar Ø Strengthening of ANMTCs Ø Support medical colleges for Anesthesia trainings Ø Library at SIHFW & Medical Directorate Ø Orientation of AYUSH Doctors on National Programs •

SIHFW: An ISO:9001:2008 certified Institution

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4. Improving quality of care and

Strengthening Referral System Ø Study on referral system by RHSDP Ø 7 days Mobility support to PHC MOs Ø Installation of new telephone connection at all PHC/CHCs Ø Work shops for developing standards and protocols for quality of care


SIHFW: An ISO:9001:2008 certified Institution 31

5. Strengthening and improvement of logistics and supply systems

Ø Feasibility study to setting up of the drugs and logistics warehousing Ø Support for the repair of workshop for cold chain equipment Ø Support for hiring 12 new refrigerators

SIHFW: An ISO:9001:2008 certified Institution

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6. Strengthening HMIS, M&E

Ø Support for CNNA format, ECS has been provided from state level Ø Integration of RCH-II/NRHM reporting format in existing HMIS software Ø Baseline and concurrent evaluation

SIHFW: An ISO:9001:2008 certified Institution

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7. BCC for increasing demand for RCH and contraceptive services Ø Intensive IEC for RCH-II and NRHM interventions Ø Provision for hiring of IEC van in all districts Ø Implementation of Integrated Media Plan Ø IEC for “Panchamrit program done by printing of booklet, Banners, cards •

SIHFW: An ISO:9001:2008 certified Institution

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8. Specific Interventions

Maternal Health ØRCH camps target ØDai training target ØNight delivery facility at all PHCs and CHCs ØHiring of contractual staff (PHN & LT) ØProvision of 1321 additional ANMS at 10 desert and tribal districts ØSTD/RTI drugs for PHCs ØJannani Suraksha Yojna
SIHFW: An ISO:9001:2008 certified Institution 35

Ø

Child Health ØIMNCI launched in 9 districts ØMal nutrition corner at all 237 blocks ØPurchase of ORS packets

Family Planning ØImproving quality of fix camps ØCompensation scheme for sterilization ØBlood donation camps ØNSV mega camps ØAFHS Training

SIHFW: An ISO:9001:2008 certified Institution

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9. Strengthening Networking and Partnership with the civil society Ø Collaboration with IMA & FOGSI Ø Accreditation of Private nursing home for JSY Ø MNGO scheme in all districts Ø Annual consultation with stakeholders on NRHM Ø Social marketing of contraceptives and other health services •

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10. Innovative schemes and pilot projects Ø Pilot Project on Population stabilization initiated at Jhalawar & Tonk. Ø PARINCHE project for five districts. Ø Help line at medical directorate for improving communication Ø Campaign on Age at Marriage. Ø Medical Mobile unit for all districts. Ø VCTC at 16 CHCs. •

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11. Improving and strengthening RCH Services in Tribal population Ø Six districts, namely, Baran, Banswara, Chittorgarh Dungarpur, Sirohi and Udaipur Ø Process for developing PIP for six urban districts is under process


12. Establishing and strengthening RCH services in Urban Area Ø Urban slum population in Jaipur, Jodhpur, Kota, Bikaner, Pali, Udaipur, Ganganagar, Hanumangarh, Bhilwara and Tonk Ø PIP for 8 urban slums is under process. 39 SIHFW: An ISO:9001:2008 certified Institution

Goals of RCH II
Indicator X Plan Goals RCH –II NPP 2000 (2002-07) Goals(2005- (By 2010) 10) IMR <45 <30 <30 U-5 MR MDG

Reduce by 2/3 from 1990 levels Reduce by ¾ by 2015 -

MMR

200

<100

<100

TFR

2.3

2.1

2.1

SIHFW: An ISO:9001:2008 certified Institution

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Goals for Rajasthan
Outcomes Infant Mortality Rate (IMR) Maternal Mortality Ratio (MMR) Total Fertility Rate (TFR) Crude Birth Rate (CBR) Crude Death Rate (CDR) Goal of Rajasthan up to 2011-12 32 148 2.1 21 7

SIHFW: An ISO:9001:2008 certified Institution

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Performance Indicators for RCH [Ante Natal]
Ø Number of Ante Natal cases registration Ø Number of Pregnant women who ØHad 3 ANCs ØHad 2 doses of TT Ø Were Under prophylaxis & treatment of anemia Ø Number of high risk pregnant referred Ø Number of deliveries by trained & Untrained birth attendants Ø Number of cases with complications referred to PHC/FRU Ø
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Performance Indicators [Post natal & New born]

Ø Number of New born with Birth weight recorded Ø Number of woman given 3 post natal check ups Ø Number of Fully Immunized children Ø Number of Adverse reactions reported after Immunization Ø Number of cases motivated & followed up for contraception

Ø
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Institutional Deliveries (Source DLHS 2 &3)

SIHFW: An ISO:9001:2008 certified Institution

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Number of Ante Natal Cases Registration (Source DLHS 2 & 3)

SIHFW: An ISO:9001:2008 certified Institution

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Number of Pregnant in Relation to (Source DLHS 2 & 3) ANC

SIHFW: An ISO:9001:2008 certified Institution

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Status of Full Immunization of (Source DLHS 2 & 3) Children

SIHFW: An ISO:9001:2008 certified Institution

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Status of Recording of Birth Weight
(Source NFHS 3)

SIHFW: An ISO:9001:2008 certified Institution

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Status of 3 Post Natal Check Ups
(Source DLHS 3)

SIHFW: An ISO:9001:2008 certified Institution

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