Reproductive and Child Health Programme -II

1. Reproductive and Child Health Programme -II Dr.S.P.Yadav Director, Family Welfare Government of Rajasthan

2. RCH- II Vision To bring about outcomes as envisaged in the State Population Policy, minimizing regional variations in areas of RCH and population stabilization through an integrated, focused, participatory program, meeting unmet demands of the target population and provision of assured, equitable, responsive quality services.

3. Rajasthan Population Policy Goals 2001 2008 2011 TFR 3.78* 2.6 2.1 Birth Rate 31.1 24 21 Death Rate 8.0 7.0 7.0 IMR 80.0 62 56 Source: State Population Policy, 2000

4. RCH-II Key Strategies • Strengthening Project Management Structure at state and district • Strengthening Infrastructure at various levels of service delivery • Human resource development and capacity building • Improving quality of services through setting standards, indicators and process protocols • Strengthening Referral System • Strengthen and improve logistics and supply systems • Strengthening information system, monitoring and evaluation • BCC for increasing demand for RCH and contraceptive services • Technical interventions under MH,CH, FP, ASRH and Gender • Separate Tribal and urban slum components • Strengthening Networking and Partnership with the civil society

5. Strategy & Progress so far: Strategy:1 Strengthening project management structure • State Health Society – constituted • District Health Society – constituted in 32 districts • RMRS in 298 CHCs and 358 PHCs registered. Other under process • SPMU – established • DPM DAM & DA posted in almost all 32 districts • Reorganization of Directorate and thematic division set-up • Key positions in each thematic division filled

6. Strategy:2 Strengthening Infrastructure • Development of 800 model Sub-centre with labour room (200 developed 2005-06) • Revolving funds to all 1488 PHC @Rs.25000/- for maintenance • Strengthening of 43 BEmOC @ Rs.4.9 lac/ each • Facility survey planned for 228 PHCs ** A rationalization exercise undertaken to avoid duplicacy 128 CHCs under IPHS and 197 CHCs covered under RHSDP

7. Strategy:3 Strengthening Human Resources • Orientation of District teams for operationalisation of RCH II and NRHM interventions completed. • Specialized skilled trainings – master trainers for anesthesia, BEmOC and blood storage unit, SBA and IMNCI developed. • District level training for BEmOC, BSU, SBA, IMNCI initiated. • Midwifery Resource Centre for SBA TOT established. • ASHA Resource Centre established.

8. Strategy:4 Improving QOC and Referral Services • Referral protocols developed by RHSDP • 7 days mobility support to each PHC/CHC and Dy.CM&HO office • Money for referral transport at each SC/PHC/CHC given under untied fund. • Referral transport under JSY scheme. Strategy:5 Drug Logistics and warehousing • Establishment of corporation for procurement logistics and warehouse on the line of TNDMC • Cold chain equipment maintenance.

9. Strategy:6 -Strengthening HMIS • Eligible Couple Survey for CNAA completed. • HMIS formats revised. • Gram Set: The studio established and installation of equipment in progress. • Initiate concurrent evaluation and service statistics validation exercise in 3 districts. Strategy:7-Behaviour Change Communication (BCC) • State Plan for BCC under finalization. • Four thematic areas identified for intensive communication campaign. • Age at Marriage • Sex Selection • Institutional Delivery • Small Family-Happy Family

10. Thematic Area Interventions A. Maternal Health Antenatal Care • To improve the coverage of full ANC (three check-ups + 2 TT + 100 IFA) from the current level 14.7 percent (DLHS-RCH 1998-99) to 60 percent by 2010 Intranatal Care • To increase delivery by skilled birth attendant (doctor, ANM, Nurse) from 15.5 percent (DLHS-RCH 1998-99) to 35 percent by 2007 and 60 percent by 2010. • Increase the met need of EmOC by women manifesting with obstetrics complications Post natal care • Increase the post natal care services (including 3 follow ups) from current level to 50 percent by 2010. Promotion of Safe Abortion Practices • To increase the safe abortion services from current level to 50 percent by 2010 RTI/STD Management • To reduce the prevalence rate of RTI/STI among women from 37 percent (DLHS-RCH 1998-99) to 22 percent by 2007 and 5 percent by 2010.

11. 24 hours delivery: 931 PHCs covered and 13274 deliveries conducted up to July 2006. RCH camps: 20 camps per district per month. 583 RCH camps held between April to July 2006. Dai trainings: 10000 TBA training per year planned & 1191 dais trained up to July 2006. Hiring of Additional ANMs: 648 ANM hired against plan for 1321 ANMs Planned for hiring of additional 50 PHNs & Lab Technician for 2005-06 and 100 for 2006-07. (Contd….) B. Maternal Health Progress

12. C. Maternal Health Progress • Operationalization of 360 institutions initiated (172 BEmOC + 60 CEmOC + 128 IPHS) for EmOC services. • Provision of safe abortion services at Govt. and private institutions • RTI/STD services available at all institutions

13. D. Child Health Objectives • Increase coverage of complete immunization of children in12 -23 months from 37.1 percent (DLHS –RCH 1998-99) to 50 % by 2007 and 85 % by 2010 • Increase in proportion of newborn children provided newborn care at the time of delivery and first week of postnatal period • Increase in proportion of sick children having access to clinical care ,especially diarrhea ,ARI and child hood illness

14. E. Child Health Strategies • Strengthen routine immunization • Improve outreach services through MCHN days.-169095 days observed at AWW. • Strengthening cold chain and Logistics • Integrated Management of Neo-natal & Childhood Illness. • Continuation of Vitamin A Bi-annual drives • Progress • Task Force constituted for Child Health. • IMNCI intervention initiated 9 districts • MCHN days: 169095 sessions observed at MCHN day sites (89.6%) • Immunization: 26.51% children were fully immunized up to July 06 against the yearly target.

15. F. ASRH Services • State level planning workshops held • Master Trainers training planned September, 2006 • LSE training of Teachers under progress

16. Achievement of Various FP Methods

17. Strategy:9 Strengthening Networking and Partnerships • Selection of 19 MNGO & 1 Service NGO completed. • FCC through NGOs in 8 districts • Up scaling of JSY helpline in 32 blocks through NGOs

18. Strategy:10 Innovative Schemes and Pilot Programmes • Connectivity of district hospitals with medical colleges proposed under Tele-medicine. • Pilot project in Tonk and Jhalawar for population stabilization. • Establishment of PCPNDT Cell at SIHFW • SHRC establishment under process

19. Strategy:11 (a) Tribal RCH • Proposed to cover 6 districts. • To ensure availability of skill service providers by hiring Additional ANMs & Specialists. • To ensure reach of the services by organizing outreach camps.

20. Strategy:11 (b) Urban RCH • Proposed to cover 8 big cities. • Provision of basic primary health care in urban slums. • Strengthening of referral network for sub-population. • Strengthen monitoring of services in urban areas. • Establishment of tier-I institutions on the population of 50 thousand in urban slums.

21. To Sum-up • Increase absorption capacity of health system. • Implementation of complete range of interventions. • Monitoring quality of interventions for RCH-II.

22. Financial Progress under RCH-II for the Yr 06-07SPIP Approved by NPIP= Rs. 107.99 Crores

23. Thanks