Reproductive and Child Health Program

Reproductive & Child Health Program: 

Reproductive & Child Health Program State Institute of Health & Family Welfare, Jaipur

What is RCH….?: 

What is RCH….? Reproductive & Child Health program is a model developed through experiments in paradigm shifts, Clinic approach Extension & Education “Cafeteria”/ “Targets” “Comprehensive” service delivery approach Primary health care (1983) Targeted interventions-Target couples & EC TFA (1996) Quality services & Policy reforms CNAA(1997-98) Capacity enhancement, 2 SIHFW: an ISO 9001: 2008 certified Institution

Chronological Events : 

Chronological Events NFPP-1951 NFWP-1977 Alma Ata-1978 EPI-1978 NHP-1983 UIP-1985 (unified approach and micro planning) CSSM-1992 (the 1st program officially launched by President of India) ICPD-1994 RCH-I (1997, October) RCH-II (2005-06 -2009-10) 3 SIHFW: an ISO 9001: 2008 certified Institution

Why RCH………?: 

Why RCH………? Unified approach Convergence for integration Performance in relation to Goals & Timeframe Shuffling priorities-Paradigm shift Fertility regulation & Replacement goals High Unmet needs High Morbidity/Mortality in women & children 4 SIHFW: an ISO 9001: 2008 certified Institution

Objectives of RCH: 

Objectives of RCH Reduction in Birth Rate & Empowering women Integration of related programs for meaningful Meeting unmet needs through institutional strengthening & Quality of Care routed by- Choice of methods Information provided to clients 5 SIHFW: an ISO 9001: 2008 certified Institution

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Technical competence of 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

Components of RCH 1: 

Components of RCH 1 Family Planning Child Survival & Safe Motherhood 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) 7 SIHFW: an ISO 9001: 2008 certified Institution

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High Quality training at all levels District sub projects under Local Capacity Enhancement Enhanced community participation through Panchayats , Women groups & NGOs Implementation of Target free approach Referral System 8 SIHFW: an ISO 9001: 2008 certified Institution

Activities : 

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

Differential Strategy based on : 

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) 10 SIHFW: an ISO 9001: 2008 certified Institution

Additional Activities in selected districts: 

Additional Activities in selected districts Screening & Treatment of RTI/STI in- 3 FRUs - “A” Category (FRU=First Referral Unit) 2 FRUs - “B” 1 FRU of “C” Emergency Obstetric Care – 2 FRUs of “B” Category 3 FRUs of “C” 11 SIHFW: an ISO 9001: 2008 certified Institution

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Essential Obstetric. Care- Drugs & PHCs in “B” & “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- 25%S/C of “C” Districts of all States SIHFW: an ISO 9001: 2008 certified Institution 12

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Service strengthening-inputs for- Mobility, Supervision, Micro-planning (50 Districts in 8 States) Dai training-142 Districts with < 30% safe delivery RCH Camps in remote/under-utilized PHCs Border Cluster project-46 Districts in 16 States to have addl. Inputs 13 SIHFW: an ISO 9001: 2008 certified Institution

Child Survival Activities: 

Child Survival Activities Care of New borne Eye, Cord, Bath & Feed Special care & Referral conditions Immunization Vitamin-A (9 dose prophylaxis) Diarrhea-ORT & ARI Standard case definition & management Support Activities- Cold chain Supplies Surveillance SIHFW: an ISO 9001 : 2008 certified Institution 14

Safe Motherhood Interventions: 

Safe Motherhood Interventions Essential Obstetric care- Early registration of pregnancy (12-16 weeks) ANC (3 visits) TT (2 or Booster) IFA (100 Tab.) Delivery by Trained/Skilled Birth attendants observing 5Cs Referral for emergencies-conditions, time-frame & place 15 SIHFW: an ISO 9001: 2008 certified Institution

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PNC (3 visits) Spacing 3 yrs STI/RTI Management Adolescent Reproductive health- Counseling/IEC based on Life cycle approach Emergency Obstetric care Strengthening Referrals Training of TBA/SBA SIHFW: an ISO 9001: 2008 certified Institution 16

CNAA : 

CNAA The Committee on Population in National Development Council (NDC) in 1993 Recommended- Decentralized area specific planning based on Local Needs Creation of a District level Data base on: Quality, Coverage, Impact indicators; for monitoring & Evaluation. 17 SIHFW: an ISO 9001: 2008 certified Institution

Purpose & Key Issues of CNAA: 

Purpose & Key Issues of CNAA Purpose Setting Priorities Identify Target and High Risk groups Estimation of Service needs and matching it with Resources Develop a realistic action Plan Key issues Micro-planning Community involvement Client’s perspective Quality of Care 18 SIHFW: an ISO 9001: 2008 certified Institution

Process of CNAA: 

Process of CNAA Focus on Participatory Planning based on: Felt Needs Actual workload assessment Assess Capacity of Providers Involve people for better Utilization “Speak” to People, “Get through” Records and “Take up” surveys 19 SIHFW: an ISO 9001: 2008 certified Institution

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Develop teams involving local people Organize meetings for decision on service delivery Evaluate need for each Health & Family Welfare service-Share it with people Develop an Action Plan Sub-Center Action plan 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 2000: 

Initiatives after National Population Policy 2000 RCH Camps RCH Out Reach Schemes Home based Neonatal Care Border District Cluster Strategy Hepatitis B Vaccination Project Training of Dais Empowered Action Group District Surveys 21 SIHFW: an ISO 9001: 2008 certified Institution

Lessons from RCH-I: 

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 program objectives Frequent turnover Result/outcome orientation missing Human Resource planning neglected Financial/accounting/disbursement and utilization bottlenecks SIHFW: an ISO 9001: 2008 certified Institution 22

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Generic 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 Loss of opportunities to achieve effectiveness SIHFW: an ISO 9001: 2008 certified Institution 23

RCH Phase II: 

RCH Phase II Major Focus on…… Reducing Maternal & Child Mortality and Morbidity Emphasis on Rural Health Care 24 SIHFW: an ISO 9001: 2008 certified Institution

Key Issues: 

Key Issues Flexibility: States’ needs and capacities Strengthening management capacity Integrated Behavior Change Communication (BCC) strategies Improved client responsiveness to public health facilities Convergence with other critical sectors 25 SIHFW: an ISO 9001: 2008 certified Institution

Activities under RCH-II: 

Activities under RCH-II 1. Strengthening Project Management Structure Re-organizing of Medical Directorate. Renovation of Medical Directorate and NRHM/RCH-II cell. Setting up, of the PMU at state & district levels. Induction of newly appointed professionals Support for communication, equipments and mobility to DPMUs. 26 SIHFW: an ISO 9001: 2008 certified Institution

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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. 27 SIHFW: an ISO 9001: 2008 certified Institution

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3. HRD and capacity building Development of annual training calendar. Strengthening of ANMTCs. Support medical colleges for Anesthesia trainings. Library at SIHFW & Medical Directorate. Orientation of AYUSH Doctors on National Programs. 28 SIHFW: an ISO 9001: 2008 certified Institution

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4 . Improving quality of care and Strengthening Referral System Study on referral system by RHSDP 7 days Mobility support to PHC MOs Installation of new telephone connection at all PHC/CHCs. Work shops for developing standards and protocols for quality of care. SIHFW: an ISO 9001: 2008 certified Institution 29

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5. Strengthening and improvement of logistics and supply systems Feasibility study to setting up of the drugs and logistics warehousing Support for the repair of workshop for cold chain equipment Support for hiring 12 new refrigerators 30 SIHFW: an ISO 9001: 2008 certified Institution

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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. 31 SIHFW: an ISO 9001: 2008 certified Institution

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7. BCC for increasing demand for RCH and contraceptive services Intensive IEC for RCH-II and NRHM interventions. Provision for hiring of IEC van in all districts. Implementation of Integrated Media Plan. IEC for “ Panchamrit program” done by printing of booklet, Banners, cards. 32 SIHFW: an ISO 9001: 2008 certified Institution

8. Specific Interventions: 

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

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Child Health IMNCI launched in 9 districts. Mal nutrition corner at all 237 blocks. Purchase of ORS packets. Family Planning Improving quality of fix camps. Compensation scheme for sterilization. Blood donation camps. NSV mega camps AFHS Training SIHFW: an ISO 9001: 2008 certified Institution 34

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9. Strengthening Networking and Partnership with the civil society Collaboration with IMA & FOGSI Accreditation of Private nursing home for JSY. MNGO scheme in all districts. Annual consultation with stakeholders on NRHM. Social marketing of contraceptives and other health services. 35 SIHFW: an ISO 9001: 2008 certified Institution

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10. Innovative schemes and pilot projects Pilot Project on Population stabilization initiated at Jhalawar & Tonk . PARINCHE project for five districts. Help line at medical directorate for improving communication Campaign on Age at Marriage. Medical Mobile unit for all districts. VCTC at 16 CHCs. 36 SIHFW: an ISO 9001: 2008 certified Institution

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11. Improving and strengthening 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. 37 SIHFW: an ISO 9001: 2008 certified Institution

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12. Establishing and strengthening 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: 

Goals of RCH II Indicator X Plan Goals (2002-07) RCH –II Goals(2005-10 ) NPP 2000 (By 2010) MDG IMR < 45 < 30 < 30 - U-5 MR - - - Reduce by 2/3 from 1990 levels MMR 200 < 100 < 100 Reduce by ¾ by 2015 TFR 2.3 2.1 2.1 - 39 SIHFW: an ISO 9001: 2008 certified Institution

Goals for Rajasthan: 

Goals for Rajasthan Outcomes Goal of Rajasthan up to 2011-12 Infant Mortality Rate (IMR) 32 Maternal Mortality Ratio (MMR) 148 Total Fertility Rate (TFR) 2.1 Crude Birth Rate (CBR) 21 Crude Death Rate (CDR) 7 40 SIHFW: an ISO 9001: 2008 certified Institution

Performance Indicators for RCH [Ante Natal]: 

Performance Indicators for RCH [Ante Natal] Number of Ante Natal cases registration Number of Pregnant women who Had 3 ANCs Had 2 doses of TT Were Under prophylaxis & treatment of anemia Number of high risk pregnant referred Number of deliveries by trained & Untrained birth attendants Number of cases with complications referred to PHC/FRU 41 SIHFW: an ISO 9001: 2008 certified Institution

Performance Indicators (Post natal & New born): 

Performance Indicators (Post natal & New born) 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 42 SIHFW: an ISO 9001: 2008 certified Institution

Institutional Deliveries (Source: DLHS 2 &3): 

Institutional Deliveries (Source: DLHS 2 &3) 43 SIHFW: an ISO 9001: 2008 certified Institution

Ante natal cases Registration (Source :DLHS 2 & 3): 

Ante natal cases Registration (Source :DLHS 2 & 3) 44 SIHFW: an ISO 9001: 2008 certified Institution

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

Number of Pregnant in relation to ANC (Source: DLHS 2 & 3) 45 SIHFW: an ISO 9001: 2008 certified Institution

(Source: DLHS 2 & 3): 

(Source: DLHS 2 & 3) 46 SIHFW: an ISO 9001: 2008 certified Institution

Status of Recording of Birth Weight (Source :NFHS 3): 

Status of Recording of Birth Weight (Source :NFHS 3) 47 SIHFW: an ISO 9001: 2008 certified Institution

Status of 3 Post natal check ups (Source DLHS 3): 

Status of 3 Post natal check ups (Source DLHS 3) 48 SIHFW: an ISO 9001: 2008 certified Institution

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Thank You For more details log on to www. sihfwrajasthan.com or contact : Director-SIHFW on sihfwraj@yahoo.co.in