MID TERM REVIEW OF REPRODUCTIVE AND CHILD HEALTH PROGRAMME II NGO Consultation

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MID TERM REVIEW OF REPRODUCTIVE AND CHILD HEALTH
PROGRAMME IINGO Consultation

• 17 December 2008

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Overview of the Presentation

• RCH II / NRHM Programme Goals
• Strategies
• Progress of Interventions

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CURRENT STATUS VIS-A-VIS RCH II/NRHM GOALS
Note 1. Census 2001 2. Current MMR and TFR
data pre-dates RCH II, while IMR data is for
first year of RCH II. 3. Union territories
(except Delhi) have been excluded in the findings
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RCH II STRATEGIES
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MATERNAL HEALTH STRATEGIES

• Demand Promotion Janani Suraksha Yojana.
• Services Public sector
• Early detection of pregnancy through rapid
  detection kits.
• Quality ANC, PNC, Institutional and Safe Delivery
  
• Skilled Attendance at birth (domiciliary health
  facilities).
• Essential and Emergency Obstetric Care
• Operationalise facilities- FRUs, CHCs, 24 Hrs
  PHCs.
• Multi-skilling of doctors to overcome shortage of
  critical specialities (training on Life saving
  Anaesthesia Skills and Emergency Obstetric Care)
• Strengthen Referral Systems including transport.
• Management of RTIs STIs at PHCs CHCs/FRUs.
• Safe Abortion Services PHC/ FRU level
• Services Private sector
• Accrediting private health institutions under JSY
• Fixed package for contracting out services (e.g.
  Chiranjeevi scheme in Gujarat)
• Supporting Private Gynaecologist to establish
  their nursing homes in Tribal area where
  Chiranjeevi scheme is not working (in Gujarat)

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JANANI SURAKSHA YOJANA (JSY)

• Key Features
• Early Registration
• Referral Transport (Home to Health Institution)
• Promoting Institutional birth
• Post delivery visit and reporting
• Family Planning and Counseling

• Supported by
• ASHA/ any Link worker
• Cash Assistance

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CHILD HEALTH STRATEGIES

• Integrated Management of Neonatal and Childhood
  Illnesses
• Pre-service and In-service training of providers
  
• Improving health systems (e.g. facility
  upgradation, availability of logistics, referral
  systems)
• Community and Family level care
• Home Based Newborn and Child Care/
• Facility Based Newborn Care
• Infant and Young Child Feeding
• including Improving Early and Exclusive
  Breastfeeding and Complementary Feeding
• Nutritional Rehabilitation Centre for Management
  of Acute Malnutrition
• Reduction in morbidity and mortality due to Acute
  Respiratory Infections (ARI) and Diarrhoeal
  Diseases
• Supplementation with micronutrients Vitamin A
  iron
• School Health Program

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IMMUNISATION INTERVENTIONS

• Introduction of new vaccines based on disease
  specific mortality and morbidity indicators
  Hepatitis B
• System Strengthening
• Activity based funding to strengthen service
  delivery
• Alternate vaccine delivery to ensure reach into
  villages
• Alternate Vaccinators to ensure sessions are held
  
• ASHA/Link workers used for Social Mobilization to
  ensure demand creation in community.
• Strengthening Supportive supervision
• Half yearly meeting at State with districts to
  ensure monitoring.
• Support for POL to assist active supervision
• Capacity Building Trainings at all levels for
  all aspects of immunization service delivery
• Monitoring and supervision of the programme at
  service delivery level
• Demand generation Social Mobilization

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FAMILY PLANNING STRATEGIES

• Reduce unmet need for spacing methods
• Reduce unmet need for terminal methods
• Increasing male participation
• Expanding contraceptive choices
• Ensuring quality care in Family Planning
• Introducing indemnity insurance
• Revision of compensation to acceptors of
  sterilization
• Social marketing of Family Planning products
• Strengthening contraceptive logistics
• Emphasis on promotion of IUD 380 and Emergency
  Contraception

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PROGRESS OF RCH II
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INSTITUTIONAL DELIVERIES
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JSY PERFORMANCE

• Allocation for 2008-09 is Rs. 1281.47 crores

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MATERNAL HEALTH PROGRESS
Achievements in Facility Operationalisation
NRHM data, Aug 2008

• Training of MOs in anaesthesia and EmOC and
  ANMs/SNs in SBA has gained considerable momentum.
  
• Achievements in MH trainings (cumulative)

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VILLAGE HEALTH AND NUTRITION DAYS

• KEY COMPONENTS
• Registration of pregnancy
• ANC
• PNC
• Birth planning
• Immunization
• Counselling on nutrition
• Counselling on family planning
• Services for sick children

Based on data from NRHM
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PROGRESS 2005-08

• Maternal health
• Institutional deliveries have increased in most
  of the states in the country. High focus states
  have shown tremendous growth. Maximum increases
  in MP, Orissa, Rajasthan, Assam, and Bihar.
• Ten fold increase in JSY beneficiaries to 73.29
  lakhs in 3 years. Greater transparency in JSY
  implementation seen during state visits.
• JSY has led to huge increases in institutional
  delivery MP (21.9 points) Rajasthan (12.2
  points) Bihar (11 points) Orissa (10.2
  points).

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PROGRESS 2005-08

• Maternal health (contd.)
• Facility operationalisation 49 and 46 of FRU
  and 24x7 PHC targets achieved.
• Multi skill training of doctors in EmOC and LSAS
  and task shifting to ANMs and SNs gaining
  momentum.
• Referral transport systems, in general have been
  given emphasis across states visits to MP and
  Gujarat indicated wide use of the Janani Express
  Yojana and EMRI 108 service respectively.
• Field visits indicate availability of NISHCHAY
  (Rapid pregnancy testing kit) with peripheral
  health functionaries. A rapid assessment
  conducted recently indicates over 82 of ASHAs
  themselves performed tests. Need to ensure
  subsequent counselling/ follow up.

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Coverage in Child Immunization
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PROGRESS 2005-08

• Child Health
• Full immunisation has improved across states
  particularly in Assam, Jharkhand, Rajasthan,
  Bihar, Uttarakhand and Sikkim.
• Drop outs between BCG and measles, and within
  doses, have declined.
• The negative trend seen in full immunisation
  coverage between CES 20052006 has been reversed
  in DLHS III in Rajasthan, Punjab and Karnataka.
• Improvements in early initiation of breastfeeding
  and exclusive breastfeeding.
• IMNCI implementation has accelerated 193
  districts with 71,355 personnel trained
  pre-service IMNCI underway in 62 medical colleges.

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Programmatic interventions in Family Planning

• Addressing the unmet need in terminal methods
• Fixed Day Static services
• Developing Skilled manpower for the same
• Increasing Male participation through
  intensive promotion of NSV
• Promotion of IUDs as a short long term
  spacing method
• Promotion of Emergency Contraceptive Pills
• Increasing Basket of choices for Contraceptives

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Promotional Interventions in FP

• Revised COMPENSATION scheme
• Family planning INSURANCE scheme
• Ensuring Contraceptive supply
• Promoting PPP/ Social Marketing
• Promoting contraception through increased
  ADVOCACY

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FP Systems Mechanisms for monitoring for quality

• Quality Assurance Committees
• Monitoring all aspects of RCH
• Technical manuals updated
• Standards and QA in Sterilization services
• IUD for MOs and Nursing Personnel
• Standard Operating Procedures for sterilisation
  camps
• Emergency Contraceptive pills
• Fixed Day Strategy in sterilisation services

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Progress of FP Indicators

• TFR
• CPR
• Contraceptive use

• reduced from 3.3
• to 2.9 (SRS 05)
• increased
• to 45.7 (NFHS 3)
• increased from 48.2 to 56.3 (NFHS 3)

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Indicators
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PROGRESS 2005-08

• Behaviour change communication
• Strong NRHM brand.
• State-specific BCC strategies have been developed
  in Chhattisgarh, Jharkhand and Uttar Pradesh,
  while district specific BCC strategies are
  underway in MP.
• Other key state level initiatives include
  innovative IPC tools in Uttarakhand, BCC kit and
  training module developed by Chhattisgarh and IPC
  tools such as flip book for ASHAs in UP, BCC
  corners at the PHC level in Gujarat, pilot to
  involve tribal community healers and utilizing
  Kalyani clubs in Orissa.

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PROGRESS 2005-08

• Monitoring and evaluation
• Overall, monitoring of the RCH II program has
  strengthened since its inception.
• NFHS III 2005/6 released in 2007 DLHS III
  results released.
• MoHFW has rationalised the indicator set for the
  national MIS a web based system for reporting
  has been launched.
• Capacity of the ME division strengthened. Data
  Triangulation Cell set up.
• Several examples of states which have developed
  better ME tools GIS mapping in Gujarat and
  Orissa pregnancy cohorts in TN.

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INNOVATIONS

• Range and spread of innovations is impressive,
  and over 200 have been identified so far. These
  cover
• Promotion of safe motherhood and institutional
  deliveries (24)
• Innovations have been piloted within the NRHM/RCH
  II parameters of decentralization, flexibility,
  and results based performance
• Equity is a central theme in a large number of
  innovations.
• Several are state specific but some span several
  states, or are similar across states (e.g. EMRI,
  Chiranjeevi-like schemes to promote safe
  motherhood/ institutional deliveries)
• Several states have undertaken evaluation of
  their innovations, while some innovations have
  been evaluated nationally.

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INNOVATIONS

• Referral transport (17)
• Immunisation and IYCF (27)
• IEC/ BCC (18)
• ARSH (5)
• Health insurance (8)
• Contracting out management of health facilities
  (14)
• Social franchising (4)
• Inceentivising human resources to improve access,
  performance and range of services (8)
• Mobile Health clinics (11)
• Community involvement (28)
• Programme Monitoring and Management Information
  Systems (13)
• Incentives to improve mobility, availability and
  attendance of staff (22)

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• Paradigm shift envisaged under RCH II is well
  underway

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THANK YOU