Health Promotion

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Health Promotion:

Health Promotion State Institute of Health & Family Welfare Rajasthan

What is health promotion?:

What is health promotion? “process of enabling people to increase control over, and to improve their health”. WHO (1990), Health Promotion Glossary 2 SIHFW: an ISO 9001:2008 certified Institution 2

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Health promotion is defined as “behavior motivated by the desire to increase wellbeing and actualize human health potential.” (Pander, Murdaugh and Parsons – 2002) “Health promotion is the process of enabling people to increase control over and to improve their health.” (WHO) SIHFW: an ISO 9001:2008 certified Institution 3

Health Promotion?:

Health promotion is any combination of health, education, economic, political, spiritual or organizational initiative designed to bring about positive attitudinal, behavioral, social or environmental changes conducive to improving the health of populations. Health Promotion? SIHFW: an ISO 9001:2008 certified Institution 4

Health Promotion?:

Directed towards action on the determinants or causes of health Requires a close co-operation of sectors beyond health services, reflecting the diversity of conditions which influence health. Health Promotion? SIHFW: an ISO 9001:2008 certified Institution 5

The context of Health:

The context of Health SIHFW: an ISO 9001:2008 certified Institution 6

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SIHFW: an ISO 9001:2008 certified Institution 7

A Framework For Health Promotion Activities:

A Framework For Health Promotion Activities Class Gender Age Ethnicity Housing Environment Regional Location Access to health services Access to leisure facilities Nutrition Smoking Physical activity Psychosocial factors, e.g. stress Cholesterol Blood pressure Obesity C H D Key Social Stratification Factors Environment Factors Lifestyle Factors Physiological Factors 8 SIHFW: an ISO 9001:2008 certified Institution

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9 Early Pathogenesis- Tissue changes Tissue changes Pre-Pathogenesis-A, H, E interaction Pathogenesis Levels of Prevention Primary Secondary Tertiary Health. Promotion Specific Protection Susceptibility Pre-symptomatic stage Clinical disease Early diagnosis Treatment Disability Limitation/ Rehabilitation Death Recovery Disability Chronic state Convalescence Preven-tion . Modes Immunity & Resistance SIHFW: an ISO 9001:2008 certified Institution

Evolution Of Health Promotion:

Evolution Of Health Promotion Alma-Ata (1978) "Alma-Ata Declaration“ International Conferences on health promotion:- Ottawa 1986 Adelaide 1988 Jakarta 1997 Sundsvall 1991 Mexico 2000 Bangkok 2005 10 SIHFW: an ISO 9001:2008 certified Institution

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Health Promotion Emblem adopted at Ottawa 11 SIHFW: an ISO 9001:2008 certified Institution

Important Areas For Consideration In Health Promotion (Ottawa Charter, 1986) :

Building a healthy public policy Creating supportive environments Developing personal skills Strengthening community action Reorienting health services Important Areas For Consideration In Health Promotion (Ottawa Charter, 1986) 12 SIHFW: an ISO 9001:2008 certified Institution

Key stakeholders in HP:

Key stakeholders in HP Government departments Health authorities Primary Health care team Local bodies CBOs/ NGOs Corporate houses Mass media 13 SIHFW: an ISO 9001:2008 certified Institution

The Basic Principles Of Health Promotion: Ottawa 1986 :

The Basic Principles Of Health Promotion: Ottawa 1986 Build healthy public policy Prerequisites for health Advocate Enable 14 SIHFW: an ISO 9001:2008 certified Institution

The Basic Principles Of Health Promotion: Ottawa 1986 :

The Basic Principles Of Health Promotion: Ottawa 1986 Mediate Create supportive environments Strengthen community action Develop personal skills Reorient health services 15 SIHFW: an ISO 9001:2008 certified Institution

WHO key principles:

WHO key principles Involves whole population in context of daily life rather than focusing on people at risk of disease Directed at the determinants of health Combines diverse approaches Aims at effective public participation Health professionals have an important role in enabling health promotion 16 SIHFW: an ISO 9001:2008 certified Institution

Why do we need health promotion?:

Why do we need health promotion? Promotes quality of life Reduces inequalities in health Reduces pressure on services “Adds life to years Adds years to life” “Health Promotion is concerned with making healthier choices easier choices” 17 SIHFW: an ISO 9001:2008 certified Institution

Health Promotion Strategy 2004 – 2007:

Health Promotion Strategy 2004 – 2007 Vision Statement To improve the health of the population by focusing on healthier lifestyles and to meet the needs of the local community by promoting inclusive and sustainable initiatives, thereby enabling people to increase control over and improve their health and well-being 18 SIHFW: an ISO 9001:2008 certified Institution

Key Aims :

Key Aims To meet national and local targets in relation to health promotion and to address recommendations made by the Audit Commission in February 2004 To develop health promotion elements of agreed local health and community strategies To engage and work in partnership with other local agencies and disciplines…working in a variety of settings SIHFW: an ISO 9001:2008 certified Institution 19

Action Planning:

Action Planning Key areas : Healthier Eating Physical Activity Smoking Cessation Tobacco Control SIHFW: an ISO 9001:2008 certified Institution 20

The Process Of Health Promotion:

The Process Of Health Promotion Focus Strategies Impact Outcomes Individuals Groups Population Education counseling Economic change Legislative change Policy or organization change Behavioral educational change Social, economic and environment change Better Health Quality of life SIHFW: an ISO 9001:2008 certified Institution 21

A Framework for Health Promotion Activities:

A Framework for Health Promotion Activities Areas Of Health Promotion Activity Preventive health services(Primary, secondary, tertiary Community-based work Organization development Healthy Public Policy Environmental health measures Economic and regulatory activities Health education programs SIHFW: an ISO 9001:2008 certified Institution 22

Approaches To Health Promotion :

Approaches To Health Promotion Medical Behavior change Educational Empowerment Social change SIHFW: an ISO 9001:2008 certified Institution 23

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Diverse yet complimentary approaches Communication Education Legislations Fiscal Organizational changes Community development SIHFW: an ISO 9001:2008 certified Institution 24

Medical Approach :

Medical Approach Aim To reduce morbidity and premature mortality. To ensure freedom from disease and disability. Activity Uses medical intervention to prevent ill-health or premature death. Eg . - Immunization, screening, fluoridation. Based on scientific methods. 25 SIHFW: an ISO 9001:2008 certified Institution

Medical Approach :

Medical Approach Expert-led, top down Emphasizes compliance Does not focus on positive health Ignores social and environmental dimensions Evaluation: Reduction in disease rates & associated mortality. 26 SIHFW: an ISO 9001:2008 certified Institution

Behavior Change Approach :

Behavior Change Approach Aim To encourage individuals to adopt healthy behaviors Views health as the responsibility of individuals Methods: Communication Education Persuasion, motivation Expert-led, top down. “Victim-blaming” Behavior is very complex & Multi-factorial 27 SIHFW: an ISO 9001:2008 certified Institution

Behavior Change Approach :

Behavior Change Approach Evaluation: Behavior change after the intervention The behavior change is only apparent after a long time Difficult to isolate any behavior change as attributable to a health promotion intervention 28 SIHFW: an ISO 9001:2008 certified Institution

Educational Approach :

Educational Approach Aim To provide knowledge and information. To develop the necessary skills for informed choice. The outcome is client’s voluntary choice. 29 SIHFW: an ISO 9001:2008 certified Institution

Educational Approach :

Educational Approach Methods Information-giving through interpersonal channels, small groups and mass media, Group discussion for sharing and exploring health attitudes Role play for decision-making and negotiating skills 30 SIHFW: an ISO 9001:2008 certified Institution

Educational Approach :

Educational Approach Weakness Assumes that by increasing knowledge, there will be an attitudinal change, which leads to behavioral change. Ignores the constraints that social, economic and environmental factors place on voluntary change. Evaluation Knowledge, attitude and practice 31 SIHFW: an ISO 9001:2008 certified Institution

Client-centered Approach: empowerment approach :

Client-centered Approach: empowerment approach Aim Helps people to identify their own needs and concerns, and gain the necessary skills and confidence to act upon them Role of health promoter: facilitator and catalyst 32 SIHFW: an ISO 9001:2008 certified Institution

Client-centered Approach :

Client-centered Approach Two types of empowerment: Self-empowerment – based on counseling and aimed at increasing people’s control over their own lives. Community empowerment – related to community development to create active, participating communities which are able to change the world about them through a program of action. 33 SIHFW: an ISO 9001:2008 certified Institution

Client-centered Approach :

Client-centered Approach Methods Counseling, community development and advocacy Health advocacy by professionals Promoting public involvement and participation in decision-making on health-related issues Evaluation Difficult because empowerment is long term Results are hard to specify and quantify 34 SIHFW: an ISO 9001:2008 certified Institution

Client-centered Approach :

Client-centered Approach Evaluation includes Outcome evaluation - the extent to which specific aims have been met. Process evaluation - the degree to which the individual and community have been empowered as a result of the intervention. 35 SIHFW: an ISO 9001:2008 certified Institution

Social Change Approach :

Social Change Approach Aim To bring about changes in physical, social, and economic environment which enables people to enjoy better health. Make the environment supportive of health To promote the healthy choice the easier choice The focus is on changing society, not on changing the behavior of individuals 36 SIHFW: an ISO 9001:2008 certified Institution

Social Change Approach :

Social Change Approach Methods Focus on shaping the health environment lobbying/advocacy development of healthy public policies and legislation fiscal measures creating supportive social and physical environments 37 SIHFW: an ISO 9001:2008 certified Institution

Approaches in Health Promotion: the example of healthy eating:

Approaches in Health Promotion: the example of healthy eating Approaches Intervention Medical Diagnosis of need for reduction in Saturated fat, sugar or salt intake e.g. Obesity, hypertension, diabetes - BMI Index etc. Behavior Change Encouragement of healthier eating Health Education Information given regarding healthier Foods-via health promotion arrangements; leaflets, posters, media Client centered (empowerment) ‘self help’ weight control groups, food Co-operatives, grow your own schemes Social Change Public health legislation (e.g. Food Labeling); policy development in workplace; lobbying for cheaper foodstuffs e.g. lean meat 38 SIHFW: an ISO 9001:2008 certified Institution

Nursing Strategies for Health Promotion :

Nursing Strategies for Health Promotion Role modeling Acting as a change agent Health education Setting priorities Using principles of behavior modification Promoting holistic health Collaborating with other health care providers 39 SIHFW: an ISO 9001:2008 certified Institution

The Nurses Role In Health Promotion :

The Nurses Role In Health Promotion Model lifestyle behaviors and attitudes. Facilitate client involvement Teach self care strategies Assist individuals, families and communities Educate clients to choose activities conducive to health promotion Promote problem solving skills. Advocate for promoting a healthy environment. 40 SIHFW: an ISO 9001:2008 certified Institution

Health Maintenance :

Health Maintenance Prevention Exercise Smoking cessation Healthy diet Alcohol Multiple vitamins Calcium Eye examination Dental examination 41 SIHFW: an ISO 9001:2008 certified Institution

Safety:

Safety Seat belts Smoke detectors Helmets 42 SIHFW: an ISO 9001:2008 certified Institution

Effective Strategies for Health Promotion:

Effective Strategies for Health Promotion Putting health knowledge to practice Role of science in health Public health Workplace wellness programs Health care Stress management Hygiene Exercise Sports nutrition 43 SIHFW: an ISO 9001:2008 certified Institution

Approaches in Health Promotion: the example of healthy eating:

Approaches in Health Promotion: the example of healthy eating Medical Approach To identify those at risk from disease Aims Primary health care consultation e.g. measure body mass. Methods Expert-led. Passive, conforming client. Worker/client relationship 44 SIHFW: an ISO 9001:2008 certified Institution

Approaches in Health Promotion: the example of healthy eating:

Approaches in Health Promotion: the example of healthy eating Behavior change Approach To encourage individuals to take responsibility for their own health and choose healthier lifestyles. Aims Persuasion through one-to-one advice, information, mass campaigns, e.g. ‘Look After Your Heart’ dietary messages. Methods Expert-led. Dependent client. Victim blaming ideology. Worker/client relationship 45 SIHFW: an ISO 9001:2008 certified Institution

Approaches in Health Promotion: the example of healthy eating:

Approaches in Health Promotion: the example of healthy eating Educational Approach To increase knowledge and skills about healthy lifestyles. Aims Information. Exploration of attitudes through small group work. Development of skills, e.g. women’s health group. Methods May be expert led. May also involve client negotiation of issues for discussion. Worker/client relationship 46 SIHFW: an ISO 9001:2008 certified Institution

Approaches in Health Promotion: the example of healthy eating:

Approaches in Health Promotion: the example of healthy eating Empowerment Approach To work with client or communities to meet their perceived needs. Aims Advocacy Negotiation Networking Facilitation e.g. food co-op, fat women’s group. Methods Health promoter is facilitator, client becomes empowered. Worker/client relationship 47 SIHFW: an ISO 9001:2008 certified Institution

Approaches in Health Promotion: the example of healthy eating:

Approaches in Health Promotion: the example of healthy eating Social change Approach To address inequalities in health based on class, race, gender, geography. Aims Organizational policy , e.g. hospital catering policy Public health legislation, e.g. food labeling. Fiscal controls, e.g. subsidy to farmers to produce lean meat. Methods Entails social regulation and is top-down. Worker/client relationship 48 SIHFW: an ISO 9001:2008 certified Institution

Evaluation in Health Promotion:

Evaluation in Health Promotion Does Health Promotion work? Can we demonstrate the success of Health Promotion? How can do we measure success in Health Promotion? What is evaluation in Health Promotion? 49 SIHFW: an ISO 9001:2008 certified Institution

Evaluation:

Evaluation Making a value judgment about something A critical assessment of the good and bad points of an intervention, and how it can be improved. Answers the question: “Have the program objectives been achieved?” 50 SIHFW: an ISO 9001:2008 certified Institution

Why Evaluate?:

Why Evaluate? To assess results and to determine if objectives have been met To justify the use of resources To demonstrate success in order to compete for scarce resources To assist future planning by providing a knowledge base To improve practice by building on success and learning from mistakes 51 SIHFW: an ISO 9001:2008 certified Institution

Why Evaluate?:

Why Evaluate? To determine the effectiveness and efficiency of different methods of Health Promotion. To win credibility and support for Health Promotion. To inform other so that they don’t have to reinvent the wheel. 52 SIHFW: an ISO 9001:2008 certified Institution

What to Evaluate?:

What to Evaluate? 1. WHAT has been achieved - the outcome 2. HOW it has been achieved - the process 53 SIHFW: an ISO 9001:2008 certified Institution

Types of Evaluation:

Types of Evaluation 1. Process evaluation 2. Impact evaluation 3. Outcome evaluation 54 SIHFW: an ISO 9001:2008 certified Institution

Process Evaluation:

Process Evaluation Refers to what happens between the input and the outcome. Assessing the process of program implementation Ongoing, a method of quality control. Monitors progress of the program (in terms of efficiency, cost effectiveness and timeliness) 55 SIHFW: an ISO 9001:2008 certified Institution

Impact Evaluation:

Impact Evaluation Impact refers to immediate effects of the intervention or short-term outcome. It is carried out at the end of the program 56 SIHFW: an ISO 9001:2008 certified Institution

Outcome Evaluation:

Outcome Evaluation Outcome are the long-term consequences; they are usually the ultimate goals of a program Outcome evaluation involves an assessment of long-term effects of a program More difficult & time-consuming to implement. 57 SIHFW: an ISO 9001:2008 certified Institution

How to Evaluate?:

How to Evaluate? 58 SIHFW: an ISO 9001:2008 certified Institution

Process Evaluation:

Measuring the program inputs 2. Using performance indicators to measure activity. PI provide a quantifiable measure activity. Examples are: Number of health educational materials produced and distributed. Process Evaluation 59 SIHFW: an ISO 9001:2008 certified Institution

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3. Obtaining feedback from other people e.g. colleagues and other staff. 4. Obtaining feedback from the clients or participants of HP program their reactions, perceptions and suggestions methods include observation, interview or questionnaires 5. Documentation e.g. reports, checklist, diaries, video-taping, slides etc. 60 SIHFW: an ISO 9001:2008 certified Institution

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Number of health educational materials produced and distributed. Number of people attending educational activities. Screening uptake rates. Uptake of physical activities formed and number of people involved. PIs need to be identified at the planning stage. Monitoring PIs helps you to determine how well your program is progressing. 61 SIHFW: an ISO 9001:2008 certified Institution

Impact Evaluation:

Measure changes in health awareness, knowledge and attitudes. Measure interest shown by target groups e.g. uptake of health education materials, phone-ins, participation in activities etc. Observation, questionnaires, Interviews, discussions etc. Use of attitude scales. Impact Evaluation 62 SIHFW: an ISO 9001:2008 certified Institution

2. Evaluate behavior change - Observing what clients do. - Recording behavior e.g. number of people attending exercise sessions, health screening, stop smoking etc. - Interview or questionnaire. :

2. Evaluate behavior change - Observing what clients do. - Recording behavior e.g. number of people attending exercise sessions, health screening, stop smoking etc. - Interview or questionnaire. 63 SIHFW: an ISO 9001:2008 certified Institution

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Evaluate policy changes in relation to Safety Food Exercise Smoking SIHFW: an ISO 9001:2008 certified Institution 64

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4. Changes in the environment Cleaner air. Provision of public toilets. Provision of safe water supply and better housing. Food hygienic Reduction in mosquito breeding sites 65 SIHFW: an ISO 9001:2008 certified Institution

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Changes in health status Improvements in BMI, blood pressure, fitness levels, blood cholesterol levels etc. 66 SIHFW: an ISO 9001:2008 certified Institution

Outcome Evaluation:

Outcome Evaluation This is the preferred evaluation method because it measures sustained and significant changes which have stood the test of time. Uses hard evidence and quantitative methods. 67 SIHFW: an ISO 9001:2008 certified Institution

Behavior:

1.Behavior change e.g. safe sexual practices, 2. Policy and legislation changes e.g. lead-free petrol, ban on indirect tobacco advertising, No Smoking Areas, establishment of Safety and Health Committees in all work places etc. Behavior 68 SIHFW: an ISO 9001:2008 certified Institution

Environmental changes:

3. Environmental changes e.g. jogging tracks and playgrounds improved public transportation system, better housing facilities, clean air and water, 4. Changes in health status reduction in morbidity, disability and mortality rate improve life expectancy reduced prevalence of risk factors Environmental changes 69 SIHFW: an ISO 9001:2008 certified Institution

Measuring Behavior Change Attribution To Intervention:

Measuring Behavior Change Attribution To Intervention 1. To compare the target group’s health-related behavior before and after the intervention. change will occur with time confounding factors difficult to eliminate To compare the target group’s behavior to control group 70 SIHFW: an ISO 9001:2008 certified Institution

Challenges In Evaluation:

Challenges In Evaluation 1. Deciding what to measure Some objectives are difficult to measure e.g. attitudes and behaviors. Need to select appropriate evaluation criteria and performance indicators (specific, sensitive, relevant etc. 71 SIHFW: an ISO 9001:2008 certified Institution

When to evaluate? :

2. When to evaluate? The timing of evaluation affects the assessment of the overall success or failure of a program due to time effects. Delay of impact The effects of a program may not be immediate e.g. behavior change. Immediate evaluation might not yield positive results. When to evaluate? 72 SIHFW: an ISO 9001:2008 certified Institution

Loss of impact :

Decay of impact Non sustainable intervention Adjusting for secular trends Factors other than HP interventions Only those changes over and above the general trend may be attributed to the program Loss of impact 73 SIHFW: an ISO 9001:2008 certified Institution

Health promotion Initiatives:

Health promotion Initiatives 74 SIHFW: an ISO 9001:2008 certified Institution

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The ‘ Condom Bindass Bol ’ (Say Condom Freely) campaign created by Lowe, Mumbai, has been awarded in 2011 year’s UN Grand Award. This award is given by the UN Department of Public Information (DPI) in association with the International Public Relations Association (IPRA). 75 SIHFW: an ISO 9001:2008 certified Institution

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The campaign was created by Anand Suspi , creative director, Lowe. The operation is a joint effort between the Indian ministry of health and family welfare, ICICI Bank and Private Sector Partnership-One (PSP-One) of the US Agency for International Development (USAID). 76 SIHFW: an ISO 9001:2008 certified Institution

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The objective of the campaign was to address the decline in condom use and sales in eight states of North India, which together comprise 45 per cent of the condom market in the country. The states included Delhi, Rajasthan , Uttar Pradesh, Uttaranchal, Madhya Pradesh, Chattisgarh , Bihar and Jharkhand. 77 SIHFW: an ISO 9001:2008 certified Institution

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The campaign communicated the fact that uttering the word ‘condom’ in public should not be embarrassing, it should be used without hesitation. 78 SIHFW: an ISO 9001:2008 certified Institution

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Babli Boli Production & Management of a Radio Programme for Rural Women & Related Community-based Activities 79 SIHFW: an ISO 9001:2008 certified Institution

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Period One year: June 1, 2009 to  August 31, 2010 Goal To raise awareness on HIV modes of transmission and antenatal/postnatal care among rural women by integrating messages on RCH/FP and HIV/AIDS issues in a specially developed radio programme. 80 SIHFW: an ISO 9001:2008 certified Institution

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Donors National AIDS Control Organization(NACO) United Nations Development Programme(UNDP) Partner/Implementing Organizations Bihar – 2 districts - Jan Nirman , Sitamarhi - Shaktivardhini , East Champaran . 81 SIHFW: an ISO 9001:2008 certified Institution

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Rajasthan – 5 districts - Bal Sansar Sanstha (BSS), Ajmer - Humana People to People India (HPPI), Alwar - Centre for Community Economics and Development Economics Consultants Society (CECOEDECON), Jaipur - Gramin Vikas Vigyan Samiti (GRAVIS), Jodhpur - Society for Upliftment of Rural Economy (SURE), Barmer 82 SIHFW: an ISO 9001:2008 certified Institution

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Objectives: Increase consistent condom use among sexually active young people and the general public Increase use of service centres like PHCs and CHCs for reproductive health services Promote use of Integrated Counseling & Testing Centres services Increase public knowledge and discourse on reproductive health, family planning and HIV/AIDS Increase self-efficacy among rural women 83 SIHFW: an ISO 9001:2008 certified Institution

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Babli Boli –a 52 episode radio drama series, was primarily targeted towards rural women (15 to 29 year-olds).The secondary audience was service providers, influencers, opinion shapers and leaders, media personnel and faith-based leaders. 84 SIHFW: an ISO 9001:2008 certified Institution

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Formative research was undertaken to further refine the audience segment and understand their attitudes and perceptions. Scripts were finalized on the basis of a design document prepared in a workshop with technical inputs from the John Hopkins University, Centre for Communication Programmes, Mumbai 85 SIHFW: an ISO 9001:2008 certified Institution

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The radio programme was broadcast on the All India Radio network over northern India. Community mobilization activities focused in 700 villages across seven selected districts of Rajasthan and Bihar. 86 SIHFW: an ISO 9001:2008 certified Institution

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It has been observed that, people’s perception of issues related to HIV/AIDS and PLHA are changing in the villages. Women associated with the Listeners’ Clubs have started talking about the issues. 87 SIHFW: an ISO 9001:2008 certified Institution

Toll Free ‘104’Medical Advice Service:

Toll Free ‘104’Medical Advice Service This service is Launched on January 2012 in State. A toll-free helpline to provide 24-hour medical counseling and health-related information. The helpline is staffed by specially trained counselors, para -medics and doctors. 88 SIHFW: an ISO 9001:2008 certified Institution

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Following services are included under the scheme- 1.Information directory for tracking health services providers/institutions 2.Complaint registration about person/institution 3.Advice on long term ill conditions like diabetes, heart issues etc 89 SIHFW: an ISO 9001:2008 certified Institution

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4.Health and symptoms checker (initial assessment, flu advice, pregnancy related information , family planning etc) 5. First aid information 6. Any other health related services 7.The services must be available in three language, viz. Rajasthani , Hindi and English. 90 SIHFW: an ISO 9001:2008 certified Institution

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8.Response to health scares and other localized epidemics 9.Counselling and advice (stress, depression, anxiety, post-trauma recovery, HIV/AIDS/RTI, STI) 10. Get information about various health schemes run by the Centre and the state government 91 SIHFW: an ISO 9001:2008 certified Institution

Swasthya Chetna Yatra (Last 2 Yatras) :

Swasthya Chetna Yatra (Last 2 Yatras ) Health Camps Organized 17,548 Total Patients Treated 53,09,120 Allopathy 31,19,444 Ayurved , Unaani , Homeopathy 13,78,295 Free Medicine 30,02,052 Patients 92 SIHFW: an ISO 9001:2008 certified Institution

Health Camps during Swasthya Chetna Yatra:

Health Camps during Swasthya Chetna Yatra 93 SIHFW: an ISO 9001:2008 certified Institution

Right Age of Marriage:

Right Age of Marriage 94 SIHFW: an ISO 9001:2008 certified Institution

Family Planning:

Family Planning 95 SIHFW: an ISO 9001:2008 certified Institution

Safe Motherhood:

Safe Motherhood 96 SIHFW: an ISO 9001:2008 certified Institution

Institutional Deliveries:

Institutional Deliveries 97 SIHFW: an ISO 9001:2008 certified Institution

3 ANC Checkup:

3 ANC Checkup 98 SIHFW: an ISO 9001:2008 certified Institution

IEC on Wheels:

IEC on Wheels 99 SIHFW: an ISO 9001:2008 certified Institution

Campaign on 108 Ambulances:

Campaign on 108 Ambulances 100 SIHFW: an ISO 9001:2008 certified Institution

Hoardings:

Hoardings 101 SIHFW: an ISO 9001:2008 certified Institution

Thank You :

Thank You For more details log on to www. Sihfwrajasthan.com or contact : Director-SIHFW on sihfwraj@yahoo.co.in 102 SIHFW: an ISO 9001:2008 certified Institution

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