A postulate of Proposed Gujarat State Plan of Operation RCH Phase - II

1. A postulate of Proposed Gujarat State Plan ofOperation RCH Phase - II By Project Director RCH

2. The Process • Constituting the State Design Team • Adapting Successful Practices • Using Marginal Budgeting for Bottlenecks (MBB) tool for Resource Allocation • Resource Mapping • Exclusive Method to analyse priorities

3. The State Design Team • The design team consists of • Experts within Govt. set up & SIHFW • NGO representatives • UN agencies’ representatives • Experts from IIM Ahmedabad as invitees

4. Approach of GoG • Addressing specific needs in concern areas of: • Rural, Urban and Tribal Health • Environmental Health as a vital issue • Role of adequate nutrition

5. Approach of GoG • Focused Strategies: • Analysing components of IMR, MMR and TFR dealing with bottlenecks.

6. Approach of GoG • Holistic Approach: • Balanced integration with inputs received in IPD, BDCS, EC Sector Reform

7. Approach of GoG • Health and Human Development: • Thrust for Human Development to maximise reproductive health and not just adopting target-oriented approach. • Gujarat Vision 2010 • Strong commitment

8. Our Vision 2010 Health Indicators

12. Marginal Budgeting forBottlenecks • An effort to identify the strengths and weaknesses of implementation of RCH program by means of HH study, Monitoring and validation study and Facility study in 5 districts • All 3 studies in 40 clusters in each district

13. Marginal Budgeting for Bottlenecks • HH study: identified 6 families with infant in a cluster • MV study:15 PHC, 30 SC (1village in each SC) in 40 cluster area • Facility study: BEmOC, BEmPaedC and FW at PHC, CHC, DH

14. HH study • 40 Clusters by standard cluster sampling tech • Proportional allocation for Urban and Rural • Municipal Corporation not included

15. HH study • Information for ANC, INC, PNC, Breast Feeding practices, Weaning, FW, Awareness for hygiene, nutrition, Home based management for fever and Diarrhea.

16. HH study • A teams of 2 FHW, 2 MPHS (M/F) and 1 MO for each cluster • 8 teams in each district x 5 days ( 1 for each cluster) = 40 • Orientation of all teams at SIHFW

17. HH study • Pre-tested in field • Participatory planning by District teams • Data of about 7000 families entered and results are awaited [some results are available but yet to be validated]

18. Monitoring and Validation Study (MV study) • Team of 2 PG of Public Health/ Community Medicine • 3 Teams in each district x 5 days (1 PHC/ day) = 15 PHC • Orientation at SIHFW with faculties of Medical Colleges • Questions related to PHC infrastructure, FHW and TBA skills and availability, accessibility and use of services.

19. Monitoring and Validation Study (MV study) • Observations and suggestions by teams are included • Field tested and includes validation for records and beneficiary • Overview indicates good skills but need for refreshing

20. Facility Study • Initial plans for CHC and DH, PHC included later • Information specifically for BEmOC and BEmPaedC, scope for assessing skills of personnel • Could be done in one pilot district

21. Facility Study • Planned for other districts also • Overview indicates need for filling up the posts and updating the skills • Field work: 16 –26 January 2004

22. Some findingsofMarginal BudgetingforBottlenecks

33. Other information made available under MBB study • PROVIDER OF INC • PLACE OF BIRTH • Cleanliness of Place of delivery, environment offered to the new born • PNC Provision, number of visits and their timeliness

34. Other information made available under MBB study • BREAST FEEDING AND TIMING • Breast Feeding and use of Colostrums • Period of Breast Feedin • Method of Washing Hands • Use of Mosquito Net

35. Other information made available under MBB study • Amount of Food and Liquid Given to Child and Knowledge Quotient • Diarrhea episodes • Source of ORS Pack • Place of Purchase of Medicine • H/O fever episode and Blood Smear Taken • Vit A instituted and its frequency

36. Priority fixing • Diligent use of community based link couple for family and community level care in rural areas and for family and community level care in urban areas. • Promotion institutional deliveries by providing incentive to TBAs.

37. Priority fixing • Increase in institutional deliveries. Staff nurses would be engaged on contractual basis in all PHCs for round the clock services.

38. Priority fixing • 100 facilities will be identified (from among District Hospital, Sub district hospital, community health centers and labeled as FRUs) and upgraded for provision of comprehensive emergency obstetric care, New born care, laparoscopic sterilization operation and MTP service

39. Priority fixing • Up gradation of 250 facilities (from among CHCs/PHCs) for provision of basic emergency obstetric care, new born care, abdominal TL, MTP and STI/RTI services

40. Priority fixing • Up gradation of 1500 facilities (from among PHCs/SCs) for institutional deliveries, FP services, NSV and basic newborn care. • 250 centers to be developed to provide STI/RTI diagnostic and treatment facilities

41. Priority fixing • Strengthening State Project Management Unit and District RCH society thorough employing resource persons, consultants and other necessary human resources.

42. Priority fixing • Advocacy for issues of PNDT act, NSV, adverse sex ratio and gender mainstreaming through creating state level forum with active participation of NGOs and other institutions.

50. Resource Mapping • Besides health statistics, it reveals: • Health and Medical Institutions • Para Medical Training • Medical Manpower • Nursing Staff • Various Health programmes in the State • Workloads of FP activities • Ongoing surveys of monitoring and validation and facility surveys will provide the latest information