Reproductive and Child Health Project (RCH-I) 1997-2005

1. Reproductive and Child Health Project (RCH-I) 1997-2005 Dr. K. N. Patel Former Additional Director (FW) & Project Director – RCH, IPD and Sector Reforms

2. Background IPPI 1999 1997-98 TFA:95-96; CNAA:97-98 RCH ICPD-1994 FP FW 1977 CSSM 1992 Integration with PH care1972 1985 UIP AIHPPP 1969 1978 Targeted prog 1967 EPI Extension Education approach 1962 NSEP MCH, NTCP NFPP

3. What is RCH People have the ability to reproduce and regulate their fertility, women are able to go through pregnancy and child birth safely, the outcome of pregnancies is successful in terms of maternal and child survival and well being and couples are able to have sexual relations free of fear of pregnancy and of contracting diseases.

4. Strategy • Decentralized, Need Based, Participatory Planning : RCH Committees, CNAA, Financial mechanism-SCOVA • Focus on quality and Client’s right: Quality cell, upgraded facilities and Improved Training, informed choice • Making Services Gender Sensitive • Absence of Contraceptive Targets and Incentives • Multi-Sectoral Approach, GO-NGO partnership

5. Approach • Bottom up approach • Community Need based approach • Life cycle approach • Client centered approach • Cafeteria approach • Faily centered approach

6. Paradigm shift: change in approach

7. Previous Approach Top Down Sterilization Targets, focus on sterilization, client no much say for FP method Set Targets GoI, decision centrally Camp Oriented Approach Accept Targets States Targets, Cash Incentives for Sterilization Cases, Break Down Targets: Districts Burden on Health Workers Neglect of Quality, clients rights ignored Distribute Targets PHCs Inflation of Target Statistics Implement Targets: Workers

8. New Approach Bottom Up Key aspects of participatory planning Need Based Participatory Planning Report Results Strategies & Computations State • Community Involvement in • Planning & Monitoring • Self Estimated Goals by Health Workers • Integrated Package of Services • Multi-sectoral participation • Good Quality of Care • Educating Community to adopt • Correct Health Practices Support & Monitor Dist Facilitate Implementation PHC Sub Center CNAA, Participatory Planning, Set Goals

9. RCH package of services FOR MOTHERS • Early Registration • Inj. Tetanus Toxoid - 2 doses • Tab. Iron Folic acid • 4 Antenatal & 4 Post natal check-ups • Deliveries by skilled persons • Encourage Institutional deliveries • Emergency Obstetric Care-Early identification of complications- good referral transport- FRUs

10. RCH package of services FOR Children: Built on UIP and CSSM • Essential Newborn Care: warmth, wt, clean mouth cavity, asepsis • Early, Exclusive breast feeding and Weaning • Growth monitoring • Immunization • Vitamin-A Prophylaxis • Oral Rehydration Therapy • Management of diarrhoea and Acute Respiratory Tract infection • Treatment of Anaemia

11. RCH package of services FOR Eligible Couples • Making quality Contraceptive methods available at appropriate distance • Informed choice- cafeteria approach through counseling • Spacing of at-least 3 years between children • Safe MTP services

12. RCH package of services OTHER NEW SERVICES • Management of RTIs & STIs • Adolescent health • Women’s empowerment • Gender equality/equity • Male participation

13. Life Cycle Approach • Healthy pregnancy and child birth gives Healthy Child that grows into--- • Healthy Adolescent which leads to --- • Healthy Reproductive Years • Healthy Pregnancy • Healthy Child Birth • The cycle continues in to next generation • Healthy Elderly woman

14. Knowledgeable Well fed Mature HEALTHY MOTHER Adolescent Health Ante Natal HEALTHY DEVELOPMENT HEALTHY BIRTH Health Education Trained Attendant IMCI Referral System Hygiene Breast Feeding HEALTHY ENVIRONMENT HEALTHY DIET Sanitation Balanced Diet Water Supplements Achieving a healthy child HEALTHY CHILD

15. Inputs by Various Donor Agencies • World Bank- RCH-National component • World Bank RCH -Sub-Project, Vadodara. • UNFPA Supported IPD Project • European Commission Supported Sector Investment Program • UNICEF supported Border Cluster District Project

16. UNFPA Supported IPD Project • Surendranagar, Banaskantha, Dahod, Sabarkantha, Kutch. • Constituted the Committees • PMU established • Actions initiated for Development of State Population Policy • Mobility support • Support to NGOs

17. World Bank Inputs • Contractual Staff Staff Nurse at PHC Safe Motherhood Consultants Anesthetist at CHC Laboratory Technician at CHC Sate Level Consultants

18. World Bank Inputs • Major Civil Works in Hospital / CHC • Minor Civil Works at PHC / Subcenter • Moped Loan For ANMs • Strengthening MIS • Records / Reports at Facility • Drugs / Instrument Kits (In Kind)

19. EC supported Sector Investment Program • Narmada & Rajkot Districts • State Sector Reform Cell District Sector Reform Agency formed • State & Dist. Workshops • Decentralization mechanisms • Action plan • 2001 Earthquake related reconstruction of health facilities. State PIU.

20. UNICEF SupportedBorder Cluster Districts project • Valsad & Dang Districts • Project launched • Mobility support to Female Health Workers • Capacity building of health providers • MIS support • Civil works for sub center repairs • Drugs & equipment to SC/PHC • Strengthening FRUs

21. THANK YOU