RMNCAH N 13 th CRM National Briefing Workshop

RMNCAH +N 13 th CRM National Briefing Workshop Dr. S. K Sikdar Additional Commissioner Ministry of Health and Family Welfare Government of India

Reproductive Maternal Newborn Child Adolescent Health + Nutrition Adolescent Reproductive & Child Health Reproductive RMNCAH+N Child Maternal APPROACH Newborn

Reproductive Health

Reproductive Health Contraceptive choices and Schemes under National Family Planning Program Temporary Methods • Condoms (Nirodh) • Oral Contraceptive Pills– Combined Oral Contraceptives (Mala N) – Centchroman (Chhaya) – Emergency Contraceptive Pills (Ezy Pill) • IUCD-380 A, 375 • Injectable MPA Permanent Methods • Male Sterilization (Conventional Vasectomy/NSV) • Female Sterilization (Minilap/Laparoscopic) Schemes: • Sterilization Compensation Scheme- Enhanced in 11 high focus high TFR states. Higher Package for PPS and Male Sterilization • Clinical Outreach Teams (COT) for quality sterilization services • Drop back scheme- for Sterilization clients • PPIUCD/ PAIUCD Incentive Scheme- for Provider, Acceptor and ASHA • Mission Parivar Vikas- in 146 high TFR districts • ASHA schemes: • Home delivery of Contraceptives by ASHA • Ensuring spacing at Birth Scheme • Pregnancy Testing Kit (with ASHA/ at SC)

Generating mass awareness on contraceptives and healthy reproductive practices WPD, Vasectomy fortnight Category revival campaign Streamlining Contraceptive Supplies Unified Software for FP logistics • Web based, App based and SMS based application • Instant access to stock information from National level to ASHA level • Auto forecasting of contraceptives 360 degree media campaign • SMS alerts for key indicators • Auto generated reports for program review

What to look for in CRM: Reproductive Health Review delivery and quality of Family Planning services (including PPIUCD, Sterilization services, Injectable contraceptives etc) Review the status of State Quality Assurance Committees (SQAC/SISC), District Quality Assurance Committees (DQAC/DISC) etc Review of ASHA schemes (Home Delivery of Contraceptives, ensuring spacing at birth scheme, pregnancy testing kits) etc In Mission Parivar Vikas (MPV) States check for implementation of initiatives such as Nayi Pahel Kit, Saas Bahu Samellan etc Review the availability and utilization of FP commodities & implementation of Family Planning Logistics information System (FPLMIS). Assess the quality of counseling services by RMNCH+A counsellors/ home based distribution of contraceptives

Maternal Health

Maternal Health Janani Shishu Suraksha Karyakram Capacity Building of HR: Dakshata, LSAS, SBA, Safe Delivery Application Janani Surksha Yojana Strengthening FRUs Delivery Points Universal screening for HIV and Syphilis Comprehensive Abortion Care Services MCH Wings Obs HDUs/ ICUs MCH Wing Pradhan Mantri Surakshit Matritva Abhiyan Maternal Death Surveillance & Response

La. Qshya| लकषय (Labour Room & Maternity OT Quality Improvement Initiative) Key Components • Organization and standardization of Labour rooms, OTs and Obstetric HDUs/ ICUs as per national guidelines and standards • Structured Quality Improvement efforts/processes to improve adherence to critical practices around childbirth • Improved client satisfaction “Respectful Maternity Care” (RMC). Expected Outcomes Labour Room Certification 75% achievement of targets for quality 80% satisfaction of beneficiaries La. Qshya Badges – Platinum/ Gold/ Silver Facility level Incentives 9

Midwifery Initiative Lancet Series on Midwifery (2014): Safe and effective midwifery care can avert 83% of all maternal deaths, stillbirths and newborn deaths Midwifery Initiative launched during Partners Forum - 2018 To be skilled as per competencies prescribed by International Confederation of Midwives- training curriculum being designed To provide access to quality maternal and newborn health services: • Promote natural birthing by promoting positive child birthing experience • Ensure respectful care • Reduce over medicalization

What to look for in CRM: Maternal Health Impact of JSSK on OOPE for maternal and newborn health – availability of JSSK entitlements and grievance redressal mechanisms Availability and impact of JSY incentives Issues in updation of the JSY beneficiaries details into the PMMVY-CAS (Software of PMMVY, Mo. WCD) Impact of PMSMA on Coverage and Quality of ANC Services Availability of comprehensive ANC services including HIV/ Syphilis testin, high risk pregnancy tracking mechanisms Use of MCP Card Quality of Intrapartum and immediate postpartum care services – progress under La. Qshya Initiative and certification of facilities Plan for Roll out of Midwifery Initiative and introduction of Midwifery Cadre Progress in operationalizing FRUs and emergency obstetric care services Focus on availability of respectful maternity care and positive pregnancy experience for women

What to look for in CRM: Maternal Health Status of Community engagement for maternal health Focus and impact of trainings such as Dakshata, LSAS, CEm. OC, SBA etc Systems for Maternal Death Surveillance and Response & Maternal Near Miss Reviews Availability of Comprehensive Abortion Care Services Progress under MCH wings, Obstetric HDUs/ ICUs etc Innovations for Maternal Health

Child Health

Strategic Interventions under Child Health Programme Newborn Heath Essential Newborn care Facility Based Newborn care Home based Newborn Care and Young Child Care Other Interventions: KMC, Use of Gentamycin Nutrition related interventions Nutrition Rehab centres Pneumonia & diarrhoea related interventions IMNCI and F-IMNCI IYCF promotion / MAA Program IDCF/ Defeat Diarrhoea Campaign Anaemia Mukt Bharat (AMB) and Vitamin A suppl. Promotion of ORS and Zinc use by ASHA Deworming Child Death Review RBSK Screening at delivery points for birth defects Screening at AWC and Schools for 4 Ds DEIC Establishment

Focus on Early Childhood Development • 1000 day released Booklet • Messages integrated in MCP Card • HBYC Platform to be leveraged • Ayushman Bhava app developed • Call Centre approach 15

Anemia Mukt Bharat Estimated 450 million beneficiaries Reaching nearly 50% of the country’s population

What to look for in CRM: Child Health • Uptake of services in SNCUs, NBSUs and NBCCs (referal management, Outpatient clinical services for common childhood illnesses etc) • Establishment of MNCU in high Case Load and better performing units • Status of progress on implementation of Home Based Newborn Care / Home based care of Young Children interventions – Training of ASHA in Module 6&7 – Home visits by ASHA during first 42 days of life – Status of Follow up of SNCU discharges and LBW babies • Implementation status of Defeat Diarrhoea Campaign • Status of Community based management of common neonatal and childhood illnesses (status of Zn- ORS distribution , identification of sick newborns by ASHAs etc)

What to look for in CRM: Child Health • Issues of Malnutrition, Convergence with AWW under POSHAN Abhiyaan – IFA Supplementation under Anaemia Mukt Bharat – Status of activities carried out to improve child nutrition such as MAA programme, IYCF, Micronutrient supplementation and deworming, Management of children with severe acute malnutrition (SAM) • Implementation of Rashtriya Bal Swasthaya Karyakram (RBSK) Screening of Children – 0 -3 years of age group – Operational status of DEICs, Mobile health teams, screening and management 4 Ds. • Whether adequate IEC, IPC, BCC Activity at the community level initiated to generate community awareness on interventions such as breast feeding practices, vaccine preventable diseases etc.

Immunization

Revised National Immunization Schedule Age Birth 6 Weeks 10 weeks 14 weeks 9 -12 months 16 -24 months 5 -6 years 10 years 16 years Pregnant Woman Vaccines given BCG, OPV-0, Hepatitis B Birth dose OPV-1, Pentavalent-1, f. IPV-1, Rota-1 & PCV-1* OPV-2, Pentavalent-2 & Rota-2 OPV-3, Pentavalent-3, f. IPV-2, Rota- 3 & PCV-2* MR 1, JE 1*, PCV-B* MR 2, JE 2*, DPT-B, OPV –B DPT-B 2 Td Td Td 1, 2 or Td Booster** *in select states and districts ** one dose if previously vaccinated within 3 years

New vaccines Rotavirus Vaccine: • Recently expanded to the entire country PCV Vaccine: • PCV vaccine introduced in routine immunization in entire Bihar, Himachal Pradesh, Madhya Pradesh, 19 districts of Uttar Pradesh and 18 districts of Rajasthan. Measles-Rubella Vaccine: • MR vaccination campaign has been completed in 32 states/UTs – now part of RI as two doses at 9 -12 months and 16 -24 months and ongoing in 2 states (Sikkim & Rajasthan) • MR campaign not conducted in Delhi & West Bengal yet

Mission Indradhanush & Intensified Mission Indradhanush • • Aims at increasing full immunization coverage to 90%. Focus on underserved populations/areas 554 districts across country covered. Also implemented under Gram Swaraj & Extended Gram Swaraj Abhiyan IMI 2. 0 • Intensified Mission Indradhanush planned to be implemented from December 2019 to March 2020 • 271 districts across 27 States /UTs and 652 Blocks in 109 districts of 2 states (UP & Bihar) have been selected for IMI 2. 0

What to look for in CRM: Immunization Status of coverage of all vaccines in routine immunization(RI). Implementation of State Task Force/District Task Force meeting for Immunization. Status of AEFI management system Availability of communication plan at district level Alternate Vaccine delivery arrangements Maintenance of Cold chain. Awareness of ASHAs regarding incentives in RI & also review the status of payment of incentives. • Availability and use of due list, MCP cards, counterfoils • Updation & compliance of micro-plans and • Document the constraints for 100% immunization & Plans for improving RI Coverage. • •

Adolescent Health

Rashtriya Kishor Swasthya Karyakram (RKSK) Healthy Lifestyle Mental and Emotional Well Being Violence free living RKSK Objectives Reproductive and Sexual Health Improved nutritional status Substance misuse prevention Being implemented to reach 253 millions adolescents (aged 10 -19 years) across the country

RKSK : Key Implementation Approaches COMMUNITY BASED APPROACH FACILITY BASED APPROACH SCHOOL BASED APPROACH Weekly Iron Folic Acid Supplementation (WIFS) Program � Screening of Adolescents for 4 Ds (RBSK) � Deworming during National � Weekly Iron Folic Acid Deworming Day (NDD) Supplementation (WIFS) � Provision of sanitary napkins Program � Peer Educator (Saathiya) � Deworming during National program for out of Deworming Day (NDD) school/vulnerable adolescent � Provision of sanitary napkins groups � � Adolescent Friendly Health Clinics (AFHCs) providing counselling and clinical services � Adolescent Health Resource Centre at District Hospital � � Quarterly Adolescent Health Day (AHD) Adolescent Friendly Clubs (AFCs) � Health promotion and prevention activities

What to look for in CRM: Adolescent Health o Knowledge and Information about adolescent Health issues and awareness about available adolescent health services. o Sensitization of frontline workers-ANMs, ASHA and AWWs on adolescent health issues. o Administration of Blue IFA tablets in schools and Aanganwadi Centres o Peer Education Program (Applicable for PE districts)

Decline in Sex Ratio and PC&PNDT Act • The Pre-conception and Pre-natal Diagnostic techniques (Prohibition of Sex Selection) Act, 1994 (PC& PNDT Act) was enacted in 1996 and further amended in 2003 • Prohibits sex selection before and after conception and imposes penalty. • Policy making bodies both at national and state levels-(Central/ State Supervisory Boards) • Implementation lies with the States though State and District Appropriate Authorities assisted by Advisory Committees Review Steps taken by the State for Implementation of the PC & PNDT Act

ANMOL Kilkar i& Mobil e Acade my RCH Portal MCTFC Mission Mode Project

Review Agenda Points for RCH Portal/ANMOL • • Frequency of meeting conducted to review RCH Portal/ ANMOL Adequacy of HR, and IT infrastructure at facilities reporting on RCH Portal Availability and utilization of RCH register at field level. Timely updation of RCH services (including ANC, Delivery, PNC, Routine Immunization data) on RCH Portal Monitoring and validation of data quality on RCH Portal Performance review of ANMs regards to ANMOL tablet application usage for data entry Review on trainings and refresher trainings on ANMOL for ANMs Management and maintenance of tablets for increasing the life of the tablets. 30

Review Agenda Points Kilkari/ Mobile Academy/ MCTFC Kilkari and Mobile Academy is currently functional in 13 States – Assam, Bihar, Chhattisgarh, Delhi, Haryana, Himachal Pradesh, Jharkhand, Madhya Pradesh, Odisha, Rajasthan, Uttarakhand, Uttar Pradesh and West Bengal. • Kilkari and Mobile Academy: ü 100% registration of all Pregnant Women and parents of children upto 1 year of age and ASHAs with validated contact detail in RCH Portal ü Have awareness/ IEC activities been taken up at field level? ü Have Trainings at districts/blocks been conducted? ü Timely distribution of Mobile Academy course completion certificate ü Mobile Number data accuracy in MCTS/RCH Portal. • MCTFC ü Have correct mobile numbers of PW/ASHAs and ANMs been provided in RCH Portal?

National Iodine Deficiency Disorders Control Programme (NIDDCP) • Have sanctioned posts of Technical Officer, Statistical Assistant, LDC, Lab Technician and Lab Assistant under NIDDCP been filled? • Whether District IDD survey/resurvey has been conducted in the State/UT in the specific District being visited by the CRM Team? • Whether the State IDD monitoring laboratory has been carrying out salt & urine analysis for iodine content and urinary iodine excretion (UIE)? • Status of procurement of Salt Testing Kits (STKs) for conducting salt testing by ASHA in IDD endemic District at community/household level • Status of IEC activities required for creating awareness about IDD

Basic Infrastructure (10%) Agenda Points CRM Teams: Review Impact of Aspirational District Approach on RMNCAH+N Services in these areas Agriculture & Water Resources (20%) Financial Inclusion (10%) RMNCAH+N coalition working towards improvement of indicators in these districts Aspirational Districts: Addressing the health and well being of 117 districts across 28 States for transformation by the year 2022 Education (30%) • Aspirational districts identified by NITI Ayog Health & nutrition (30%) Aspirational Districts A set of 13 core and 31 sub-core indicators identified for demonstrating the progress on health & 33 nutrition in these districts

Remember!!! As part of CRM teams your responsibility is enormous and your feedback critical! You have the opportunity to influence the future of women & children in India!