Reproductive and Child Health in India

1. Reproductive and Child Health in India Shiv Chandra Mathur Professor of Preventive and Social Medicine and Director, State Institute of Health and Family Welfare, Rajasthan, Jaipur, India. Shiv Chandra Mathur

2. Description of RCH Project in India • RCH is a five year project launched within the framework of fifty year old nationwide National Family Planning Program in India. • It’s a new approach of managing Population Growth by eliciting more community participation and empowering people to take care of their reproductive health. Shiv Chandra Mathur

3. Goal of RCH Project in India • In a large, diverse federal set-up, people may acquire the ability to regulate their fertility, women are able to go through pregnancy and childbirth safely, the outcome of pregnancy is successful in terms of maternal and infant survivaland well being and couples are able to have sexual relations free of fear of pregnancy and of contracting disease. Shiv Chandra Mathur

4. High-level timing goals • Post - Alma-Ata, Government of India in its National Health Policy, envisaged Health for All by 2000. Mid-decade evaluation of NHP revealed the need to re-strategize to achieve certain reproductive health indicators. Post-ICPD phenomena gave a boost to this change. • Development Program in India are being implemented on a five-year plan model and it was thought of that the goals envisaged in the new RCH approach may coincide with ninth five-year plan of the country. Shiv Chandra Mathur

5. Objectives of RCH Project in India • Introduce a new system of service delivery through decentralized planning and broadening the menu of services delivered under the banner of Family Planning Program in India. • Maneuvering the health care services in a way that it may induce a desired change in specific community health indicators like IMR, TFR, MMR, CBR, effective CPR, Immunization Coverage and delivery by trained hands. Shiv Chandra Mathur

6. Relationship to other projects • Transition from Expanded Program of Immunization - Universal Immunization Program - Child Survival and Safe Motherhood on one hand and striking balance between related projects like Reproductive/Sexual Tract Infection prevention in HIV/AIDS Control Program on the other hand. • Attempts to institutionalize the project based activities in the long term National Family Planning Program in India. • Setting up a public sector - private sector partnership in delivery of health care services by eliciting NGO support. Shiv Chandra Mathur

7. Components of RCH Project in India • Essential Obstetric Care • Emergency Obstetric Care • Essential New Born Care • Medical Termination of Pregnancy • Contraceptives Delivery • RTI/STI Care • Empowering Adolescents • Strengthening Immunization Shiv Chandra Mathur

8. Project Intervention • Based on the status of crude birth rate and female literacy status more than 500 districts of the country were divided in three categories. • Weaker districts were given additional inputs like more trained manpower at the periphery and facilities for referral transport. Shiv Chandra Mathur

9. Logistics • Peripheral facilities were stratified in three categories: • Each subcenter managed by an Auxiliary Nurse Midwife catering to the population of 3000-5000 persons was equipped with Kit A(prophylactics), Kit B (Essential Drugs) and Kit C (bare minimum equipment). • Each Primary Health Center managed by a Medical Officer catering to a population of 25000 to 30000 persons was equipped with Kit D with a wider set of equipment Shiv Chandra Mathur

10. Training/Manpower Development • Awareness Generation Training • for people’s representatives and professionals from other development sectors. • Integrated Skill Training • for health professionals in the field like Auxiliary Nurse Midwives, Lady Health Visitors, Sector Supervisors and Medical Officers working at Primary Heath Centers. • Specialized Skill Training • for specialist performing contraception operations and Medical Termination of Pregnancies and for nurses conducting IUD insertions. Shiv Chandra Mathur

11. IEC Procedures • Extensive use of following communication methods in persuading people to cultivate rational reproductive health practices: • Television-spots; films; interactive panel and live phone-in discussions. • Radio-talks; panel discussions and counseling sessions. • Field Publicity through Songs and Drama. Shiv Chandra Mathur

12. Community Need Assessment • Health Management Information System is being introduced where demographic and reproductive health information of every family is updated periodically through contact drive survey to elicit the hidden demand for obstetric-child health services on one hand and unmet demand for contraception on the other. Such a procedure strengthens the management through de-centralized planning which in spirit fulfills the guidelines of ICPD Cairo. Shiv Chandra Mathur

13. Monitoring - Performance Indicators • Following indicators were used to assess the implementation progress of the RCH Project at the central level: • Decentralized Planning: District Action Plan on fiscal year basis were to be prepared and implemented by district level Managers. • Health Facilities identified and developed as First Referral Units for Emergency Obstetric Care. Shiv Chandra Mathur

14. Monitoring - Performance Indicators (2) • Increase in thePercentage of children seeking care for common disorders like ARI and Diarrhea. • Increase in the current contraceptive prevalence and reduction in the unmet demand of contraception. • Completion of In-service orientation/skill-impartation training. Shiv Chandra Mathur

15. Evaluation - Impact Indicators • Maternal Mortality Rate. • Total Fertility Rate. • Institutional Delivery. • Reduction in the prevalence of RTI/STI. • Infant Mortality Rate. • Underfive Mortality Rate. • Effective Couple Protection Rate. Shiv Chandra Mathur

16. Observations in implementing RCH Project in India (1) • Implementing RCH Project from April1998 to March 2003 in a country like India has provided following experience: • Inadequacy of decentralization form Center to the Districts in management of finance, procurement and related issues. • Weak Management capacity especially in Monitoring and Evaluation, Budgeting, Communication and Extension and delivery of Quality services. Shiv Chandra Mathur

17. Observations in implementing RCH Project in India (2) • Weakness of outreach services in holding the subjects for completing the cycle of reproductive health care. • Lack of one unified concept/system and one unified nomenclature. • Multiplicity of Funding Agencies. • Lack of an effective referral back-up. • RCH and AIDS being implemented in two distinct compartments with some of the activities being unduly duplicated. Shiv Chandra Mathur

18. Future of RCH in India • ICPD Cairo has disseminated very strong signals throughout the world and Government of India very enthusiastically initiated the paradigm shift by launching a nationwide RCH Project for five years at the turn of second millenium. It has a huge input in the shape of soft loan from World Bank and grants from agencies varying from UNFPA and Unicef to SIDA and DFID. • Implementing the project for five years, a consensus has evolved to carry on the for yet another five years with mid-course improvement. Thus the project implemented so far is designated as RCH-1 and the one yet to be launched as RCH-2. Shiv Chandra Mathur