Maternal Health Interventions NRHM/RCH-II

1. Maternal Health Interventions NRHM/RCH-II Maternal Health Division Ministry of Health & Family Welfare Government of India

2. GOALS OF NRHM Universal Health Care • access • affordability • equity • quality

3. Maternal Mortality-Magnitude of the Problem About 30 million pregnancies occur every year in India. 27 million deliveries 15% of these are likely to develop complications. Complications cannot be predicted. 77,000 avoidable maternal deaths per year

4. Maternal Mortality Maternal Mortality Ratio “ number of women who die in a year due to causes related to pregnancy and child birth for every 100, 000 live births ” Wide Variations: • India 301/100,000 live births • Tamil Nadu 134/100,000 live births • U.P. 517/100,000 live births • Sweden/USA 8-12/100,000 live births • Sri Lanka 24/100,000 live births • Malaysia 20/100,000 live births

5. Maternal Mortality Ratioover the years NSS(1957-60)* 1321 NSS(1963-64)* 1195 SRS(1972-76) 853 SRS(1977-81) 810 SRS(1982-86) 580 NFHS I (1992-93) 424** NFHS II (1998-99) 540** RGI,SRS (1997-98) 398 RGI,SRS(1999-01) 327 RGI,SRS (2001-03) 301 * Based on indirect time series estimates ** Based on small sample size Declining trend

6. MMR ReductionWe need to accelerate

7. MMR Trends (RGI-SRS-2006)

8. Goals and targets

9. Causes of Maternal Mortality

10. Strategies… over the years

11. ISSUES IN MATERNAL HEALTH • SOCIAL • Age at marriage • Maternal Care • Women’s status • PROGRAMMATIC • Antenatal care • Skilled attendance at birth • Emergency Obstetric care • Adopting a Lifecycle approach to Women’s health

12. MH Indicators- India, NFHS II and III

13. ANC Status, NFHS III

14. INSTITUTIONAL & SAFE DELIVERIES NFHS III

15. Key MH Strategies in RCH-II • Essential and Emergency Obstetric Care • Quality ANC, PNC, Institutional and Safe Delivery. • Skilled Attendance at birth (domiciliary & health facilities). • Operationalise FRUs, CHCs and 24 Hrs PHC. • Strengthen Referral Systems. • Management of RTIs & STIs at PHCs & CHCs/FRUs. • Safe Abortion Services - MVA at PHC level. • Infection Management and Environment Plan (IMEP).

16. NRHM • Accredited Social Health Activist (ASHA) – one per 1000 population • Janani Suraksha Yojana • Inter-sectoral Convergence. Facility Strengthening / Improving Access • Strengthening of Infrastructure- IPHS • Improving availability of Human Resource • Untied funds at sub centres • Rogi Kalyan Samitis (Hosp. Mgmt. committees) • Involvement of Professional associations and medical colleges • Public private partnership

17. Essential Obstetric Care • Early Registration (12-16 wks) • 3 Antenatal Check-ups • Prevention & Treatment of anemia • Institutional /Safe Delivery • Postnatal Check-up

18. Parenteral A/B Parent.Oxytocics Anticonvulsants Digital removal of POC MRP Assisted vaginal delivery All functions of BasicEmOC + Cs sections Blood transfusion BasicEmOC Comp.EmOC

19. MMR in1960s in Thailand, Srilanka &Malaysia

20. Home Deliveries and Neonatal Mortality

21. SKILLED BIRTH ATTENDANCE • Skilled Birth Attendant • Enabling Environment

22. Issues related to Skilled attendance at Birth • Reorienting Medical Officers • Preservice & inservice training for SNs/LHVs/ANMs • Operationalising SCs/ PHCs/CHCs/FRUs for skilled attendance at birth.(Enabling Environment)

23. Skilled Birth Attendance POLICY DECISIONS Empower Health Worker for some Basic Em.O.C.interventions • Permission to use drugs for prevention of PPH. • Permission to use drugs in emergency situations before referral • Permission to perform basic procedures at community level in emergency situations

24. Emergency Obstetric Care • Critical factor- TIME: 3 delay model. • Decision to seek care • Arrival at health facility • Provision of adequate care at health facility • 24 X 7 PHCs First Referral Units (FRUs) at sub-district level.

25. Janani Suraksha Yojana • 100% centrally sponsored scheme • Promotes institutional delivery among poor pregnant women • Cash assistance to eligible women for delivery • Special dispensation for 10 states with low institutional delivery ( LPS) • ASHA- Link between beneficiary & govt.in LPS—other states are HPS

26. Policies and guidelines • Operationalising FRUs. • Setting up Blood Storage Units. • Operationalisation of 24x7 PHCs. • MTP up to 8 weeks pregnancy using MVA technique • Training of MBBS Doctors in Anesthesia skills. • Training of MBBS Doctors in EmOC including C-Section in partnership with FOGSI. • Pregnancy care and Management of Common Obstetric Complications by MOs. • AN Care and SBA for ANMs /LHV/Staff Nurses. • Guidelines for RTIs and STIs including HIV/AIDS

27. Thrust Areas of Maternal Health • Operationalising all FRUs for EmOC • Establishing Blood storage Centers/ Banks • All CHCs and 24 Hrs PHCs for round the clock delivery, newborn services, MTP and RTI/STI services • Expediting the Implementation of • SBA training • Anesthesia training • EmOC training • Regular Quality assurance, implementation review and monitoring

28. MH- FUND ALLOCATION

29. MIES –NRHM : MH Indicators Annual Return-Part C: Annual.xls Quarterly Return : Part Q3, Q4,Q7,Q13,Q14,Q24 Quarterly.xls Monthly Return : Part A:M-100,200, Part B : M1,2,3,5,6,7,8,9 Monthly.xls

30. Operating Manual- State PIPs-RCH-II Flexipool • Annexure 3 b : Indicative format for current status and targets. Annexure 3b.doc • Annexure 3 d: Format for Annual Work Plan Annexure 3d.xls • Annexure 3 e: Detailed Budget Format Anne 3e.xls • Annexure 4a : Format for Quarterly progress Report (QPR)-Physical and Financial Annex 4a.xls

31. Maternal Health Division- Reporting formats • Maternal health activities : Monitoring Format for MH Activities.doc • Anesthesia Training: Reporting Format for States for AnesthesiaTrg. Final.doc • SBA Training : SBAplanmatrix( Final).doc • EmOC Training : Reporting format for FOGSI Training.doc

32. THANK YOU