REPRODUCTIVE CHILD HEALTH PROGRAMME PHASE II RCH II

REPRODUCTIVE & CHILD HEALTH PROGRAMME, PHASE II (RCH- II) Commemoration of 5 years of NRHM Amit Mohan Prasad, JS 13 th April 2010

CURRENT STATUS VIS-À-VIS RCH II/ NRHM GOALS RCH II Goal Indicator All India Trends (Source of Data) Targets for the year 2012 No. of states having achieved the targets MMR (per lakh live births) 301 254 (SRS 2001 - (SRS 200403) 06) <100 1 IMR (per 1000 live births) 58 53 (SRS 2004) (SRS 2008) <30 6 TFR 2. 9 2. 6 (SRS 2004) (SRS 2008) 2. 1 14

MMR…we need to accelerate pace of decline

Maternal Mortality-Magnitude and Causes About 28 million pregnancies and 67, 000 maternal deaths per year in India * Other Conditions includes Anemia. Source: RGI-SRS 2001 -03

MATERNAL HEALTH STRATEGIES Multi-Pronged Approach… n Maternal death caused due to three delays: Delay-1: Delay in decision-making n Delay-2: Delay in reaching the hospital n Delay-3: Delay in initiating appropriate care n

MATERNAL HEALTH STRATEGIES Multi-Pronged Approach… Delay in Decision making n n Issues: Lack of awareness, financial constraints, etc. Intervention: n Awareness and counselling through ASHA, ANM, and AWW n Availability of finance through JSY for institutional delivery n Availability of services at the village through Village Health & Nutrition Days (VHNDs) – 58. 17 lakh VHNDs held during 2008 -09; and 44. 33 lakh during 2009 -10 (till January 2010). n Skilled providers for domiciliary birth

MATERNAL HEALTH STRATEGIES Multi-Pronged Approach… Delay in reaching the hospital n n Issues: Lack of knowledge about danger signs, and availability of transport facilities Intervention: n Orientation and counselling on danger signs through ASHA, ANM, and AWW n Availability of finance for hiring vehicle through JSY n Availability of referral services through EMRI, government ambulances, and other PPP arrangements

MATERNAL HEALTH STRATEGIES Multi-Pronged Approach… Delay in initiating appropriate services n n Issues: Availability of operational facilities for tracking pregnancy and its complications Intervention: n Upgradation of infrastructure at the district level and conversion of nearly 2500 CHCs to FRUs n Multi-skilling of doctors to overcome shortage of critical specialties n n 1024 doctors trained in anaesthesia skills and 543 doctors trained in obstetric skills for handling pregnancies and their complications 37162 staff nurses/ LHVs/ ANMs trained as skilled birth attendants

MATERNAL HEALTH n n n MMR seen as the indicator of health of the health system Emphasis on early registration Full complement of Ante natal check up can help in identifying high risk pregnancies in time Operationalize VHND for ANC, PNC and Nutritional supplementation Some states trying Iron Sucrose injection this year

MATERNAL HEALTH n n JSY reached the 1 crore (provisional) mark during 2009 -10 Pregnant woman and child tracking system rolled out Common MCH card for MOHFW and MWCD designed and rolled out for the first time AMTSL being tried out in the high burden districts

MATERNAL HEALTH STRATEGIES (contd. . ) n Comprehensive safe abortion services n n n Guidelines released on April 12, 2010 by Hon’ble Vice President of India May be taken up by States on priority to ensure training of personnel, and provision of services at health facilties Maternal Death Review n n Guidelines for facility based maternal death review and community based verbal autopsy, already shared with the States last year May be taken up on priority (several states have proposed in current PIP may ensure adherence to Go. I protocols)

CHILD HEALTH & IMMUNISATION

IMR Need to accelerate IMR reduction

Uttar Pradesh Bihar Gujarat Maharashtra Tamil Nadu Kerala 14

Need to accelerate NMR reduction

INTERVENTIONS FOR ADDRESSING CAUSES OF CHILD DEATHS Neonatal Deaths CAUSES INTERVENTIONS Severe infections (36% deaths) IMNCI / F-IMNCI, Basic new born care (NSSK), Early initiation of breast feeding Preterm birth (25% deaths) NSSK Birth asphyxia (23% deaths) NSSK Neonatal tetanus (4% deaths) TT (mother) Under-5 Child deaths CAUSES INTERVENTIONS Acute respiratory infections (19% deaths) Antibiotics, IMNCI Diarrhoeal diseases (17% deaths) ORS, Zinc Measles (4%) Immunization

CHILD HEALTH n n Need to focus on neonatal and early neonatal mortality To. T of NSSK has been rolled out very fast. States need to plan and set up SNCUs, Child Stabilization units and Newborn corners Time to look at Birth Defects like cretinism, neural tube defects, cleft lip/palate etc.

CHILD HEALTH n n 3 Delays are important in this context also Part of VHSC money can be effectively utilised for arranging referral transport for sick child Block PHC level supervisors and ANMs to monitor the implementation of IMNCI Central hand holding teams prepared 18

Other key child health interventions n School Health Programme running across all States / UTs; nearly 45% of all school-going children (9. 5 crores out of 22 crores) covered during Apr-Nov 2009. n n n A national workshop on School Health is being organised on May 6 -7, 2010 638 Nutrition Rehabilitation Centres established so far, to handle severe acute malnutrition among children. A session on NRCs also will be there on 6 th May

Sick Newborn Care Units (SNCUs)

Initiatives for improving RI service delivery § One of the key components of VHND § § All vaccines are provided through AD Syringes All vaccines vials have Vaccine Vial Monitors § § § Provide easy sign of a break in the cold chain loss of potency Alternate vaccine delivery § § Role of ASHA is critical – maintaining immunisation due list; informing beneficiaries in advance; mobilising beneficiaries on VHND; track drop outs Name based tracking of children for immunisation initiated – joint MCH card developed with Mo. WCD; States may coordinate with their WCD depts. to ensure that a uniform card is used Rs 50/- per session in all States for alternate vaccine delivery For NE states and Hard-to reach areas in other states - Rs 100/-per session is being provided Alternate vaccinators for urban slums & underserved areas Capacity building of all immunization staff Improve supervision through mobility support and regular review meetings

Fully Immunized Children (12 -23 mo) India: DLHS-II (2002 -04) 45. 9 Source: http: //www. mohfw. nic. in/dlhs 08_release_1. htm DLHS-III (2007 -08) 54. 1%

Coverage of Universal Immunization Program DLHS 3(2007 -08) Fully Immunized Partially Immunized No Immunization 11. 3 % 34. 6 % 54. 1 % Source: District Level House hold Survey 2008

Reaching the Last Mile Govt. of India State/ UT Flow of Funds, Vaccines & Logistics from Go. I to PHC/CHC Divisions /Districts CHC/PHC s Vaccines by Alternat e Vaccine Delivery Subcentre Vaccinati on by ANM Sessio n Community Mobilizatio n by ASHA Village

Status of AEFI Committees State Level District Level N=35 N=494 ~80% district in India have constituted District AEFI committee State No. of Districts Manipur Meghalaya West Bengal 9 7 19 (as on 15 th Mar 2010) No. of Districts with AEFI Committee Source : As per available records with MOHFW, Go. I

Second Opportunity for Measles Immunisation National Technical Advisory Group on Immunization (NTAGI) recommended for 2 nd Opportunity for Measles vaccination through n Supplementary Immunization Activities of Measles where measles coverage <80% n n 14 States identified for SIA (NE State except Mizoram, UP, Bihar, MP, Rajasthan, Chhattisgarh, Gujarat, Haryana, Jharkhand) 2 nd dose of Measles where measles coverage >80% n n 21 states identified for 2 nd dose of Measles (Rest of the states)

Vaccine & Logistics flow in the country Manufacturer State cold chain store 35 nos WIF 19 nos(7 NCFC) in 13 states WIC 37 nos (11 NCFC) in 28 states Beneficiaries Sub-centers/ sessions sites Identified Regional Store 20 Nos WIF 10 (3 NCFC) WIC 20 (5 NCFC) CHC/PHC 26439 nos ILR (S) 35713 (20229 NCFC) DF (S) 25063 (12491 NCFC) GMSDs 4 nos (Only buffer Stock & imported Vaccines) WIFs 9 nos (9 NCFC) WICs 8 nos (2 NCFC) Divisional cold Chain stores 96 nos WIC 96 nos Districts stores (618 nos) DF (L) 3221 (2223 NCFC) ILR (L) 2680 (1999 NCFC)

Cold Chain Monitoring n By MOHFW: n n n All CC Equipments procured and supplied to the states. Cold Chain maintenance fund to the states @ 500/- per PHC & 1000 per district. All imported spares are being provided. On the job training for the repairs of cold chain equipments to the refrigerator mechanics of the states, out of 405 Ref. Mechanics, 393 RMs trained since 2007 Technical support for maintenance of cold chain. By states: n n Cold chain officers at state head quarters. Total 22 nos CCO posted. SEPIO working as CCO in 13 states 405 refrigerator mechanics posted in the states to maintain the cold chain equipments. Indigenous spares being procured by the states. Periodical cold chain handlers training.

Cold Chain: Key issues 1. Most cold chain rooms are old & substantial up gradation is required. n 2. 3. 4. 5. 6. 7. Installation of new WIC/WIFs – space allocation. Total 91 WICs and 25 WIFs have already been send to the states. The installation team will be visiting states after 15 th April 2010 but in many states the site of installation is not ready. The delay in installation will leads to deterioration of new equipments. A large part of the cold chain equipment (45%) in the country is currently operating on obsolete CFC refrigerant. High sickness rate, response time and break down period of cold chain equipments. Temperature monitoring of cold chain equipments requires strengthening Cold chain management is poor in some places (including private practitioner), particularly for temperature recording and risk of freezing the freeze-sensitive vaccines. There is need to assess adequacy of trained manpower with essential qualifications at every level. Disposal of condemned equipments – occupying un-necessary space. Needs to be dispose off on priority basis

Estimated Polio Cases/year, India PPIs OPV introduced started in 1995 in RI in 1978 PPIs strengthened

FAMILY PLANNING

Family Planning Services n Improved sterilization performance – 50 lakh plus cases n Increasing service provider base n NSV trained – 4562 n IUCD insertion trained – 19021 n Compensation package for NSV revised to Rs. 1500 n Family Planning Insurance operationalised. n ASHAs as depot holders of contraceptives. n n Focus on spacing methods and Post Partum Family Planning services Improving quality of services through Quality Assurance Committees at state and district level

Family Planning Services (contd. . ) n n n A National Workshop is being organised on May 5, 2010, bringing together key stake holders and reknowned persons A list of MLAs, MPs and Zilla Parishad CEOs was requested from the States, for targeted action for FP advocacy Incentive being considered for ASHA for follow up of IUD insertion to ensure retention n Rs. 50 at the end of 3 months if client retains the IUD n Rs. 50 at the end of 6 months if client retains the IUD n Payment linked to confirmation of the retention of the IUD by the client, by the sub-centre ANM or the MO I/c (PHC)

FAMILY PLANNING n n n Need to bring it back into focus Family Planning for Maternal and Child health also in addition to Population Stabilization JSY+ initiative: post partum counseling TOT on Zoe model National Workshop on the 5 th of May

TO SUM UP n n Continuous focus on the reduction of IMR, MMR, TFR Neonatal mortality, Immunisation coverage, Anemia and malnutrition require focus Numbers achieved, quality of care remains Infrastructure --- SNCU, Blood Storage Unit, Maternity Wards, ASHA rooms 35

We are committed to achieve the MDGs Countdown to 2015 begins……. .