Dr DAREZ AHAMED IAS MISSION DIRECTOR NATIONAL HEALTH

Dr. DAREZ AHAMED, IAS. , MISSION DIRECTOR, NATIONAL HEALTH MISSION, TAMIL NADU.

POPULATION India 1210 Million Tamil Nadu 72. 10 Million 32 Districts in Tamilnadu

ABOUT TAMIL NADU Ø Population- 7. 21 crores. Ø Decadal growth rate 15. 60% (2001 -2011). Ø Seventh most populous state in India. Ø 6% of country’s population. Ø Lowest TFR of 1. 7 in the country. Ø One of the most urbanised states (48. 45%) in India Ø Consists 1. 1 crore Eligible Couples.

% OF HIGER ORDER OF BIRTH (3 & ABOVE)

Current Use of Family Planning Methods in Tamil Nadu (NFHS-IV) - Acceptors 53. 2 %

% OF P. S. IN TOTAL STERILISATION

TRENDS IN PPIUCD PERFORMANCE

METHOD WISE PERMANENT STERILISATION PERFORMANCE 2015 -16

TRENDS IN PPIUCD PERFORMANCE

METHOD-WISE PPIUCD PERFORMANCE

GRAVIDA WISE MATERNAL DEATH ANALYSIS 2015 -2016

Why strategy had to be changed: MMR 25, IMR 10 by 2023 is target set by our vision document. High risk Non acceptors had to be brought in to the system , shift from population stabilization strategy to RMNCH +A strategy. The DFW needs this fundamental reorientation to shift from target based to maternal and child health related interventions. 7. 9 % HOB contributes 25% of MMR Lack of spacing directly contributing to MMR, IMR and other morbidities. The best way to tackle high risk non acceptors is to counsel them when they are in the health facilities. (99. 9% institutional deliveries). The most receptive period in non acceptors is during this period.

Strategy contd. . Imparting tubectomy training and life saving skill in anaesthesia trained MBBS doctors which has been a key strategy in implementation of PPS even at the level of CHC. PPIUCD doesn’t require repeat visit to the facility, and state is looking at strengthening MVA/MMA as a logical corollary to PPIUCD as an RMNCH+A strategy. Over the counter abortifacients has been a signifanct contributor to MMR about 1%. 100 block strategy is being implemented by having specific action plans for blocks. (Reasons were as varied as unmet , religious , etc)

HOB blocks. Sl. Name of the No. District Name of the Blocks No of % of HOB Maternal 2014 Deaths 2014 -15 1 Namakkal Kolli Hills 24. 4 1 2 Tiruvannamalai Jawad Hills 21. 7 0 3 Tiruvannamalai Chengam 21. 5 1 4 Villupuram Kalrayan Hills 19. 6 1 5 Tiruvannamalai Thiruvannamalai 19. 2 4 6 Tiruvannamalai Thandrampattu 19. 2 0 7 Karur Thogamalai 18. 2 2 8 Tiruvannamalai Pudupalayam 17. 9 3 9 Vellore Pernampet 17. 6 2 10 Vellore Alangayam 17. 3 1

Sl. Name of the District No. Name of the Blocks 11 Villupuram Mugaiyur 12 Tiruvannamalai Kalasapakkam 13 Sivagangai V. Pudur 14 Vellore Jolarpet 15 Villupuram Thirukoilur 16 Tiruvallur R. K. Pet 17 Thoothukudi Alwarthirunagari 18 Thoothukudi Udankudi 19 Salem Tharamangalam 20 Dharmapuri Pennagaram % of HOB 2014 17. 3 17. 1 16. 7 16. 6 16. 5 16. 3 16. 2 16. 1 15. 8 No of Maternal Deaths 201415 1 3 0 1 1 0 2 0 0 1

INSTITUTIONS PERFORMING PPIUCD Name of the Institution No. of institution performing PPIUCD 2016 -17 MEDICAL COLLEGE HOSPITALS 21 GOVERNMENT HOSPITALS 214 PRIMARY HEALTH CENTRES 239 URBAN HEALTH POSTS 24 TOTAL 498

POSITIVE ATMOSPHERE FOR POST PARTUM STERILISATION AND PPIUCD Ø Universal awareness of post partum services Ø 99. 6 % of deliveries are institutional Ø All the pregnant mothers are registered for antenatal care and tracked using PICME Ø Easy accessibility of post partum sterilisation and PPIUCD services Ø Motivation by medical and para medical staff during hospitalisation

POSITIVE ATMOSPHERE FOR POST PARTUM STERILISATION AND PPIUCD Ø Follow up visits at Village level by VHN, SHN, AGW etc Ø Confidence on the Survival of the baby – IMR has come down to 20/1000 live births Ø 100% Antenatal, Natal & Postnatal Care resulted in increasing safe delivery practice Ø Reduction in visits to facilities in PPIUCD

POSITIVE ATMOSPHERE FOR POST PARTUM STERILISATION AND PPIUCD Ø Health Education & Behavioural Change Communication have helped in removing the Social Taboos to some extent & creating awareness Ø Constant Post Operative visit, early recognition of complication & Prompt management of complications have resulted in reduction in morbidities & mortalities in Sterilisation Ø Periodic review of failures by the quality assurance committee and updating the knowledge of Service Providers

POSITIVE ATMOSPHERE FOR POST PARTUM STERILISATION AND PPIUCD Ø State Level review on sterilisation deaths by the panel of experts Ø This leads to early redressal of problems associated with such incidence Ø Prompt Payment of all Financial assistance to the acceptors and service providers

n a Th u o y k