Enhancing Maternal Health Services: Progress & Challenges

1. RCH-IIProgress and Issues 3rd CRM briefing 3rd November 2009

2. Maternal Health Progress and Issues

3. MMR Trends State-wise

4. MATERNAL HEALTH STRATEGIES • Provision of services Services : Public sector • 1. Essential and Emergency Obstetric Care • Quality ANC, INC, Safe and Institutional delivery • Skilled birth attendance • Multi-skilling of human resources • Operationalize FRU s & 24*7 • PHCs • 3. Services for RTIs & STIs • 4. Safe abortion services • 5. Strengthen referral systems • 6. Village Health and Nutrition Days MULTI-PRONGED APPROACH... Demand Promotion ( JananiSurakshaYojana) • Provision of Services : Private sector • Accreditation of Pvt. Health Facilities for RCH services and SBA training • Fixed package for outsourcing services

5. Key Elements for Success…. Access to Quality Maternal Health Services: A/N and Postpartum care Ensure Skilled Care at Birth Improve access to Emergency Obstetric Care services. Encourage community involvement and investment in maternal health care. Available at.... Functional FRU for comprehensive obstetric care services Functional 24x7 PHC for basic obstetric care services Functional Sub Centre-Routine A/N ,I/N Post partum services(ANM) Village Health &Nutrition Day-comprehensive outreach services

6. PROGRESS IN FACILITY OPERATIONALIZATION:FRUs Critical components for functional FRUs • EmOC including surgical interventions such as Caesarean Section . • Blood Storage facility or adequate tie-ups • New-Born Care. • 24-hour delivery services including normal and assisted deliveries. Status August 2009 Based on data from NRHM

7. PROGRESS IN FACILITY OPERATIONALIZATION:24 X 7 PHCs Critical components for functional 24x7 PHCs • 24-hour delivery services, both normal and assisted • Essential new born care • Referral for emergencies Based on data from NRHM Includes PHCs, CHCs, and other such facilities

8. Augmentation of ‘HR’ through Skill Based Training • Emergency Obstetric Care (EmOC): 16 weeks at Medical College and Dist. Hospital • Life Saving Anaesthesia Skills (LSAS): 18 weeks at Medical College and Dist. Hospital • Basic Emergency Obstetric Care (BeMOC): 10 days at Dist. Hospital • Skilled Birth Attendance (SBA): 21 days at Dist. Hospital Other training on Comprehensive safe abortion, RTI/STI management etc.

9. Issues…. • SYSTEMIC (State) • Poor governance & accountability • Lack of effective HR policies like cadre reviews/promotion , rational deployment of trained ,skilled manpower etc. • Shortfall of specialist & paramedical manpower • Lack of inter-departmental convergence and understanding • PROGRAMMATIC • Lack of holistic planning at state and district level • Operationalization of facilities not linked with skill based training • Lack of monitoring and supportive supervision • Lack of adequate technical skills among MO s in Basic Emergency Obstetric Care

10. JSY Progress and Issues

11. JananiSurakshaYojanaPrimary Component Eligibility Early registration Micro Birth Planning Referral transport(Home to health Institutions) Institutional Birth Post delivery visit and reporting Family planning and counseling Supported by • ASHA • JSY assistance

12. Assistance package (Rs.) Provision for caesarean section: Upto Rs. 1500 per case for hiring services of experts from pvt. Sector ASHA package is now available to all states / UTs * W.e.f 1/04/2009

13. JSY PERFORMANCE Allocation for 09-10 : Rs. 1525.40 Crores

14. Aspects to be reviewed Quality aspects: • Check quality of ANC • Check quality of delivery care • Check the period of stay after delivery • Check whether PNC protocols have been followed Administrative aspects: • Timeline for receiving incentives – beneficiary/ ASHA • Whether names of beneficiaries are regularly displayed at a prominent place in the health facility • Whether grievance redressal cell has been formed and activated • Referral transport – Home to Health institution and institutional referrals • IEC / BCC – Wall writing showing entitlements, etc. • Accreditation of Pvt. Hospitals • PPP models for increasing institutional delivery • Infrastructure adequacy vis-à-vis delivery load

15. Child Health Progress and Issues

16. Focus on high Infant Mortality Rates (SRS 2008)

17. Urgent attention: Nutritional Status Source: NFHS-3

18. INTERVENTIONS TO BE MONITORED

19. New GOI Initiative on Child Health NavjaatShishuSurakshaKaryakram • A new programme on Basic Newborn Care and Resuscitation, launched nationally by GoI to address important interventions of care at birth: • Prevention of Hypothermia • Prevention of Infection • Early initiation of Breast feeding and • Basic Newborn Resuscitation. • OBJECTIVE: To have one trained person at institutional facility, where deliveries take place.

20. Issues to be addressed • States with high IMR to focus on home based care supported by facility based care • States with low IMR to focus on facility based care • Slow coverage of training load • Supportive supervision mechanisms missing • Home visits for MCH not taking place • Functionalization of facilities slow

21. School Health Progress and Issues

22. School Health Programme Being implemented in the state run schools Technical and operational guidelines prepared and disseminated to states and available on NRHM website

23. School Health ProgrammeInterventions • Health service provision a. Screening, health care and referral b. Immunisation c. Micronutrient (Vitamin A & IFA) management d. De worming • Midday Meal Scheme • Capacity building • Health Promoting Schools • Monitoring & Evaluation

24. Urban Health Progress and Issues

25. Urban RCH-II • Objective : - To improve the health status of the urban poor community by provision of quality integrated primary health care services. • The component provides for • Strengthening / establishing urban health infrastructure in slum areas • Supports development of referral system for institutional deliveries, emergency obstetrics care and terminal method of family planning. • Major strategies proposed in State PIPs under Urban RCH are: • Identification and mapping of urban slums • Provision of staff, infrastructure repairs/rent and maintenance costs of Urban Health Posts Contd…

26. Urban RCH-II • Equipment and drugs • Recruitment and training of link workers • Setting up of programme management units for support and monitoring of urban health activities. • Examples of States’ pacific initiatives are also there. However, the expenditure reported is very low which shows that greater attention is required to implement urban health activities in the States. • It is desired to seek a information focussing on the following:- • The present status/system of Urban RCH and how the State Govt. is trying to augment/improve it. • The steps taken so far as well as the innovative steps being taken to provide health care services to the poor people residing in urban slums and other colonies.

27. IEC Progress and Issues

28. Indicators for Policy/Framework/Structure • Does the state have an IEC/BCC Bureau in place • Has the state developed an IEC/BCC strategy • Does the state have an approved annual programme • Does the state have an annual IEC/BCC organogram with details of personnel up to the district level • Has the state prepared an IEC budget indicating budget allocations as reflected in the state PIPs • Has the state/districts identified key areas of interventions eg. Institutional delivery, breastfeeding, diarrhoea, anemia etc as per the situational analysis for the current year

29. Indicators… • Has manpower need been identified • What is the media mix in the BCC plan(audio visual, print media, direct media and IPC) • Have any trainings/capacity building workshops been organised for state level and district level IEC personnel • Is there a regular reporting mechanism in place with district and block officials • Have the states/IEC division identified other stake holders including NGOs, media schools, PPP to chalk out IEC activities