REPODUCTIVE AND CHILD HEALTH SERVICES.pdf
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REPRODUCTIVE
AND
CHILD HEALTH SERVICES
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DR. G.V. NAGARAJ
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PROJECT DIRECTOR, (RCH)
STATE FAMILY WELFARE BUREAU
DH&FWS, BANGALORE - 560 009
JULY 1998
KEPKODUe^VE
AMD
QH9£D HEACTH SERVICES
------------------ - ----- --------------------------- - --------- ------------- Dr, G.V. Nagaraj*
THE PAST:
For over 30 years Family Welfare Programme was known for its
rigid, target based approach in contraceptives. The performance
was measured by the reported numbers of the four contraceptive
methods-Sterilisaticn, Intrauterine device, Oral pills and Conaoms.
This was widely criticised for being a coercive approach.
The 1994 Cairo International Conference on Population and
Development (ICPD) formulated a growing International consensus
that improving reproductive health and family planning is essential
to human welfare and development.
A growing body of evidence and the Cairo consensus suggest
"Numerical method specific contraceptive target and
monetary incentives" for providers to be replaced by a broader
system of "programme performance goals" and measures
focussed on a range of reproductive health services.
The World Bank report-1995 concludes that, the current
contraceptive "Target and Incentive" system gives a demographic
planning emphasis to family welfare programme (FWP) which is
antithetical to the reproductive and child health (RCH) client
centered approach advocated in the GOI-ICPD country statement
for the Cairo conference. In particular emphasis on numerical
targets is a major reason for the lack of attention to the individual
client needs and is detrimental to the quality of services provided.
MBBS, DPH (Cal), PGDHM, MD, Ml PHA
Project Director (RCH),
State FW Bureau, Ananda Rao Circle, Bangalore 0 560 009.
I
i
-2-
Family Welfare Programme to Reproductive Child Health
-The paradigm shift:
To date the impact of Family Welfare Programme has been
measured in terms of their contribution to increase contraceptive
prevalence and to decrease fertility. These indicators are
inadequate for measuring the impact of reproductive Health
Programme and therefore, new indicators for monitoring
reproductive health services and "Service Quality" from the
perspective of the client are urgently needed.
Over the past decade there has been a clearer articulation and
definition of reproductive health as a concept and some thinking on
the ways in which reproductive health problems should be
addressed.
Against this background the main recommendations of the World
Bank report on the Indian Family Welfare Programme (FWP) is that
the programme is to be re-oriented expeditiously to a Reproductive
and Child Health approach (RCH). The main objective of which
would be to meet individual client health and family planning needs
and to provide high quality services.
The principle goal of a reproductive health programme is to
" Reduce unwanted fertility " safely there by responding to the
needs of the individuals for "High quality health services" as well
as to the demographic objectives.
The report recommends that the targets be replaced by a broad set
of performance goals and greater emphasis on "male
contraceptive methods" especially vasectomy and condoms
and greater choice of methods.
_________________________
" Government goals for family planning should be defined in
terms of unmet needs for information and services.
Demographic goals should not be imposed in family planning
providers in the form of targets or quotas1'
-World Bank -1995
-3-
The trend of health programme should change from a "Population
Control Approach" of reducing number to an approach that is
"Gender Sensitive and Responsive" client based approach of
addressing the reproductive health needs of individuals, couples
and families.
Reproductive Health Programmes should aim to reduce the
burden of unplanned and unwanted child bearing and related
morbidity and mortality.__________________________________
What is reproductive Health ?
The 1994 International Conference on Population and Development
at Cairo (ICPD) has indicated a consensus definition as a "State of
complete physical, mental and social well being and not merely the
absence of disease or infirmity in all matters relating to reproductive
system and its function and processes"
Reproductive health approach means that
*
People have ability to reproduce and regulate their
fertility.
Women are able to go through pregnancy and child birth
safely.
*
The outcome of pregnancy is successful in terms of
maternal and infant survival and well being and
Couples are able to have sexual relation free of the fear of
pregnancy and of contracting diseases.
(Fathallah-1988)
The reproductive health approach believe that it is linked to the
subject of reproductive rights and freedom and to women status and
empowerment. Thus it extends beyond the narrow confines of family
planning to encompass all aspects of human sexuality and
reproductive health needs during the various stages of life cycle.
-4-
Reproductive health programme is concerned with a set of
Specific Health Problems
*
Identifiable cluster of client groups
*
Distrinctive goals and strategies
The programme enable clients:
To make informed choices
*
Receive screening
Counseling services
*
Education for responsible and healthy sexuality
*
Access services for prevention of unwanted pregnancy
Safe abortion
Maternity care and child survival
*
Prevention and management of reproductive morbidity.
Implementing reproductive health services means a change in
the existing culture of the programme from one that focuses on
achieving targets to one that aim at providing a range of quality
services.
-5-
Objective of RCH packages are :
1. Meet individual client health and family planning needs.
2. Provide high quality services.
3. Ensure greater service coverage
RCH Policy :
The fundamentai policy change is that Instead of remaining
responsible for reducing rate of population growth, reproductive
health programme would become responsible for reducing burden
of unplanned and unwanted child bearing and related morbidity and
mortality.
Further the basic assumption is that improvement in service quality
will result in client satisfaction and will over long term translate into
higher contraceptive prevalence and ultimately fertility regulation. By
providing good quality services the programme will be able to
achieve the objective of not only reducing fertility but also reducing
reproductive morbidity and mortality.
New Signals :
Shifting to reproductive health approach implies changing the
implementation signals. :
* Client satisfaction becomes the primary programme goal
with demographic impact a secondary though important
concern.
* Broadening the service package is necessary
* Improving service quality becomes the top priority.
-6-
The new signals for a quiet revolution in the way the programme is
planned and managed are :
Primary goal
: While still encouraging smaller families
help Client meet their own health and
F.P. needs.
Priority services : Full range of family planning services
Performance measures
Management approach
Attitude to client
Accountability
: Quality of care, client
satisfaction, coverage
measures.
: Decentralised, client-needs
driven, gender sensitive
: Listen, assess needs, inform.
: To the client and community
plus health and F.W. staff.
Reproductive Morbidity and Mortality :
*
*
1/3 of the total disease burden in the developing country of
women 15-44 years of age is linked to health
problems related to pregnancy, child birth, abortion,
HIV and Reproductive tract infections (RTI’s).
The heavy load of reproductive morbidity among Indian
women is an outcome of their:
1. Poverty
2. Powerlessness 3. Low social status
4. Malnutrition 5. Infection 6. High fertility
7. Lack of access to health care
India's maternal mortality ratio, usually estimated at 400500 per 1,00,000 live birth is fifty times higher than that in
the developed countries.
In India a small study has revealed that for every women
who dies, an estimated 16 others develop various risks.
Chronic and debilitating conditions such as vaginal
fistulas and uterine prolapse cause terrible suffering.
-7-
CHILD SURVIVAL AND SAFE MOTHERHOOD PROGRAMME
TO
REPRODUCTIVE AND CHILD HEALTH SERVICES
Implementation of a very important, massive and highly credible
UIP programme from 1985 to 1991 throughout the country has
made a break-through in the improvement of mother and child
health services. In spite of this, compared to developed countries,
our country is still lagging behind in respect of sensitive indicators
such as infant mortality rate and maternal mortality rate.
Looking at the perinatal mortality which contributes 50% of the
infant mortality rate and also one mother dying out of 250
pregnancies, it can be concluded that immunization alone is not
adeguate and will not be able to bring down these death rates.
Hence along with the immunization programme, a package of
services named "CHILD SURVIVAL AND SAFE MOTHERHOOD"
was implemented with the World Bank assistance from April-1992
to September-1996 in all the states.
i
The main objectives of CSSM programme are
Improvement in mother and child health
Lowering the infant deaths (0 to 1 year) child mortality
(1 to 4 years) and maternal deaths.
The package of services under this programme are :
CHILDREN :
1. Essential new born care
2. Immunization (BCG, DPT, Polio and Measles)
3. Appropriate management of diarrhoea cases
4. Appropriate management of ARI
5. Vitamin 'A' prophylaxis
-8-
MOTHERS:
1. Ante-natal care and identification of maternal
complications
2. Immunization (against Tetanus)
3. Deliveries by trained personnel
4. Prevention and treatment of anaemia
5. Promotion of Institutional deliveries
6. Management of Emergency Obstetric Care (EmOC)
7. Birth spacing
THE RCH PACKAGE :
..
During 1995-96, Mandya was identified as Target Free District and
the performance was measured by certain quality indicators. Based
on the experience, from April 1996 all the districts in Karnataka
have adopted "Target Free Approach" and from Sept. 1997 onwards
as Community Needs Assessment Approach. The implementation
of earlier isolated programmes concentrating on Family Welfare
and Mother and Child Health under National Family Welfare
Programme will now be implemented as an Integrated
Reproductive and Child Health Services which is equivalent to
*
1
2
1
Family Planning, to focus on fertility regulation
and
Child Survival and Safe Motherhood Programme
and
Treatment of Reproductive Tract Infections and
Sexually Transmitted Infections and prevention
of AIDS
Through
Client Oriented/Mother-FriendlyZ user - specific,
Family Welfare Services
High quality services
-9-
The specific programmes under Reproductive and Child
Health services are
1. Prevention and management of unwanted pregnancies
2. Maternal care
a) Ante-natal services
b) Natal services
c) Post-natal services
3. Child Survival
4. Treatment of Reproductive Tract Infections (RTI) and
Sexually Transmitted Infections (STI).
Reducing the 'unmet need' increasing 'service coverage' and
ensuring 'quality of care1 will be the focus of implementation.
The implementation guidelines of these health interventions at
various levels are detailed in the annexure.
1
-10ESSENTIAL REPRODUCTIVE AND CHILD HEALTH SERVICES
AT DIFFERENT LEVELS OF THE HEALTH SERVICES SYSTEM
Health
Intervention
Community Level
Subcenter Level
Primary Health
Centre Level
1. Prevention and
management of
unwanted
pregnancy
1. Sexuality and
gender information
education and
counseling
No.1 as in
community level
Nos. 1-6 and
2. Community
mobilization and
education for
adolescents, newly
married youth, men
and women.*
3. Community
based
contraceptive
distribution **
(through
panchayats, village
Health Guides,
Mahila Swathya
Sanghas, etc., with
follow-up)
4. Motivating
referral for
sterilization
5. Social marketing
of condoms and
oral pills through
community sources
and G.P. (Oral pills
to be distributed
through health
personnel including
GPS towomen
who are starting
pills for the first
time).
6. Free supplies to
health services
* to be piloted
** Panchayats to
distribute only
condoms
2. providing * oral
contraceptives
(OCS) and
condoms.
3. Providing IUD
after screening for
contraindications.
4. Conseling and
eariy referral for
medical termination
of pregnancy.
S.Counseling/
management/
referral for side,
effects, method
related problems,
change of method
where indicated.
7. performing tubal
ligation by minilap
on fixed dates*
8. Performing
vasectomy.
9. Providing first
trimester medical
termination of
pregnancy upto 8
weeks (includes
MR)
10. Facilities for
Copper T insertion
to post natal cases
11. Treatment
facilities for all
types of referrals.
6. Add other
methods to expand
choice.
7. Providing
treatment for minor
aliments and
referral for
problems.
* Social marketing
of pills and
condoms through
HW (M&F) may be
explored by
permitting her to
retain the money.
* PHC s should
have facilities for
tubal ligation and
minit lap including
OTs and
equipments.
First referral
Unit/District
Hospital Level
Nos. 1-11 and
12. Providing
services for
medical
termination of
pregnancy in the
first and second
trimester (upto-20
weeks) where
indicated.
-11-
ESSENTIAL REPRODUCTIVE AND CHILD HEALTH SERVICES
AT DIFFERENT LEVELS OF THE HEALTH SERVICES SYSTEM
Health
Intervention
Community Level
Subcenter Level
Primary Health
Centre Level
First referral
Unit/District
Hospital Level
2.Maternity care
1. Early registration
of all Pregnant
Women
2. Awareness
raising for
importance of
appropriate care
during pregnancy &
identification of
danger signs
No.1-4 and
Nos.1-10 and
Nos. 1-12 and
5. Three antenatal
contacts with
women either at
the sub-centre or at
the outreach village
sites during
immunisation/MCH
sessions.
11. Treatment of
T.B.
13. Diagnosis and
treatment of
RTIs/STIs.
14. Weakly
clincnics for High
risk pregnancies.
3. To mobilise
community support
for transport,
referral and blood
donation
6. Early detection
of high risk factors
& maternal
complications and
prompt referral
4. Counseling
education for
breast feeding
nutrition, family
planning, rest,
exercise & personal
hygiene etc.,
7. Referral of high
risk women for
institutional
delivery.
Prenatal Services
5. Early detection
and referral of high
risk pregnancies
6. Observing five
cleans or through
Social marketing of
disposable delivery
kits, Delivery
planning as to
where? when and
from whom?
I
12. Testing of
syphilis for high risk
group and
treatment where
necessary including
for RTI’s.
8. Treatment of
malaria (facilities
including drugs to
be made available
at subcentres)
9. Treatment for TB
and folloup.
10. Preventive
measure against all
comtnunicable
disease
* training of
laboratory
technicians,
equipment and
reagents required
* The need for IEC
support and
establishment of
first Referral
facilities
M10
J I
-12Health
Intervention
Community Level
Subcenter Level
Primary Health
Centre Level
First referral
Unit/District
Hospital Level
Delivery Services
1. Early
Recognition of
pregnancy and its
danger signals (
rupture of
membranes of
more than 12 hours
duration, prolapse
of the cord,
hemorrhage)
Nos.1-4 and
Nos. 1-7 and
Nos. 1-9 and
5. Supervising
home delivery
8. Modified
partograph
10. Treatment of
severe sepsis
6. Prophylaxis and
treatment for
infection (except
sepsis)
9. Delivery services
11. Delivery of
referred cases
2. Conducting
clean deliveries
with delivery kits by
trained personnel.
3. Detection of
complications
referral for hospital
delivery.
4. Providing
transport for
referral
7.Routine
prophylaxis for
gonococci eye
infection.
10. Repair of
episiotomy and
perennial tears
12. Treatment of
high risk cases
13. Services for
obstetrical
emergencies
anesthesia,
cesarean section,
blood transfusion
through close
relatives linkages
with blood banks
and mobile
services.
5. Referral of New
bom having
difficulty in
respiration
6. Management of
Neonatal
hypothermia
j
-13-
Health
Intervention
Community Level
Subcenter Level
Primary Health
Centre Level
First referral
Unit/District
Hospital Level
Postpartum
services
1. Breast -feeding
support.
Nos. 1-6 and
Nos. 1-8 and
Nos.1-10 and
7. Referral for
complications
9. Referral to
FRUs for
complications after
starting an I.V. line
and giving initial
does of antibiotics
and oxytocin when
indicated.
11. Management of
referred cases.
2. Family Planning
counseling
3. Nutrition
counseling
4. Resuscitation for
asphyxia of the
newborn
5. Management of
neonatal
hypothermia
6. Early recognition
of post partum
sepsis & referral
8. Giving inj.
Ergometrine after
delivery of placenta
10 . Management
of asphyxiated new
bom (equipment to
be provided)
PHCs and FRUs
would require
additional
equipment and
training for
management of
asphyxiated new
boms and
hypothermia.
These include a
resuscitation bag
and mask and
radiant warmers.
-14-
Health
Intervention
Community Level
Subcenter Level
Primary Health
Centre Level
First referral
Unit/District
Hospital Level
Child survival
1. Health education
for breast feeding
nutrition
immunization,
utilisation of
services, etc.,
Nos 1-6 and
Nos.1-9and
Nos. 1-10 and
7. Treatment of
dehydration and
pneumonia and
referral of severe
cases.
10. Management of
referred cases.
11. Handling of all
paediatric cases
including
encephalopathy.
12. Identification of
certain FRU's to
provide specialist
services and
training
2. Detection and
referral of high risk
cases, such as low
birth weight,
premature babies,
babies with
asphyxis,
infections, severe
dehydration acute
respiratory
infections
(ARI).etc.,
3. Help during
Immunization by
ANM.
4. Help during
Vitamin 'A'
supplementation by
ANM.
5. Detection of
pneumonia and
seeking, early
medical care by
community and
treatment by ANM.
L
6. Treatment of
diarrhoea cases
and ARI cases
8. First aid for
injuries etc.,
9. Closing watching
on the
development of
child and creating
awareness of
cheap and
nutritious food.
-15-
Health
Intervention
Community Level
Subcenter Level
Primary Health
Centre Level
First referral
Unit/District
Hospital Level
Management of
RTIs/STIs
1. IEC. counseling
for awareness and
prevention
No.1 and 4
Nos 1-8 and
Nos. 1-9 and
5. Identification and
referral for vaginal
discharge, lower
abdominal pain,
genital ulcers in
women, and
urethra discharge,
genital ulcers,
swelling in scrotum
or groin in men.
9. Treatment of
RTIs/STIs
10. Laboratory
diagnosis and
treatment of
RTIs/STIs
2. Condom
distribution
3. Creating
awareness about
usage of sanitary
pads by women of
reproductive period
4. Creating
awareness of about
RTI's and Personal
hygiene
6. Diagnosis of
RTI/s and STI’s by
Syndrome
approach.
7. Referral of
Cases not
responding to
useval treatment.
8. Partner
notification/referra I
10. Syphilis testing
in antenatal women
11.Syndromic
approach to detect
arid treat STD in
Antenatal post
natal and at risk
groups
-16-
THE PACKAGE OF
REPRODUCTIVE AND CHILD HEALTH SERVICES
Reproductive Child Health (RCH) can be defined as a state in which "People
have the ability to reproduce and regulate their fertility: women are able to go
through pregnancy and child birth safely, the outcome of pregnancy is
successful in terms of maternal and infant survival and well being; and couples
are able to have sexual relations free of the fear of pregnancy and contracting
disease". This means that every couple should be able to have child when they
want and, that the pregnancy is uneventful and see, that the, safe delivery
services are available, that at the end of the pregnancy the mother and the
child are safe and well and the contraceptives by choice are available to
prevent pregnancy and of contracting disease.
The essential elements of reproductive and child health services at the
community and sub-centre level are given below which will help you to
understand how the reproductive and child health services are to be provided
at the community level. The different services provided under RCH programme
ar©.
I. FOR THE MOTHERS :
* TT Immunization
* Prevention and treatment of anaemia
Antenatal care and early identification of maternal complications
★
* Deliveries by trained personnel
*
Promotion of institutional deliveries
*
Management of Obstetric emergencies
Birth spacing
II. FOR THE CHILDREN
“
“
★
Essential newborn care
Exclusive breast feeding and weaning
★
Immunization
Appropriate management of diarrhoea
*
Appropriate management of ARI
★
Vitamin A prophylaxis * Treatment of Anaemia
III. FOR ELIGIBLE COUPLES
---------* Prevention of pregnancy * Safe abortion
IV. RTI/STD
---------------Prevention and treatment of reproductive tract and sexually
transmitted diseases
-17-
IMPLEMENTATION OF RCH PROGRAMME
IN
KARNATAKA STATE
I) POLICY ISSUES :
X
Reproductive & Child Health Programme will be implemented in the State as a
100% Centrally Sponsored Family Welfare Programme during the Ninth Five Year
Plan ending by 2000-2002 A.D.
*
.State Government has principally agreed to implement and a Government Order
has been issued to this effect (No.HFW 96 FPR 95 dated 17-6-1998).
According to this
*
The funds will flow from Government of India through 'State Finance Department'
*
The programme will be implemented as a National component and Sub Project -
(Bellary Dist.)
*
Posts created under CSSM Programme will be continued under RCH budget.
*
The Empowered Committee & a Steering Committee will monitor, guide and solve
the problems of implementation of RCH Programme.
*
The following posts have been redesignated :
Additional Director (FW&MCH): Project Director (RCH
*
Joint Director (FW)
Joint Project Director (RCH)
District MCH Officer
:Dist. RCH Officer
Procurement will be done through Karnataka Health Systems Development
Project.
*
Minor Civil Works to subcentres, Primary Health Centres, Community Health
Centres will be done through IPP-IX.
-18II) FUNDING : A sum of Rs. 190.10 crores will be available to Karnataka State during the
Ninth Plan as cash and kind assistance. This includes cash assistance of Rs. 15.05 crores
exclusively to Bellary Sub-Project.
III) CATEGORY OF DISTRICTS : The RCH Programme will be implemented in the State
based on differential approach. Inputs in all the districts have not been kept uniform
because efficient delivery will depend on the capability of the health system in the district.
Therefore basic facilities are proposed to be strengthened and streamlined specially in the
weaker districts as the better-off districts already have such facilities and the more
sophisticated, facilities are proposed for the relatively advanced districts which have
acquired capability to make use of them effectively. All the districts have been categorised
into : Category 'A'-3 districts, Category ’B'-11 districts, Category '0-6 districts.
On the basis of crude birth rate and female literacy rate which reasonably reflect the RCH
status of the State the districts will be covered in a phased manner over three years.
Category wise phasing of the districts and the facilities to be provided are as follows:
RCH PROJECT - PHASING OF DISTRICTS
YEAR1
CAT 'A' (2)
(A1) Dakshina
Kannada
(A3) Mandya
CAT 'B' (4)
(B2) Uttara
Kannada
(B10) Belgaum
(B5)
Chikkamagalur
(Bl 1) Dharwad
CAT ’C (3)
(C1) Bijapur
(C3 Bidar)
(C4) Gulbarga
CAT’A' (1)
(A2) Kodagu
CAT 'B' (4)
(B1)Hassan
(B7) Mysore
(B3) Bangalore
(R)
(B4) Tumkur
CAT 'C (3)
(C2) Bellary
(C5) Raichur
(C6) Bangalore
(B8) Kolar
(B9)
Chitradurga
O)
YEAR 2
(8)
(sub-project)
CAT 'A1 (0)
YEARS
CAT 'B' (3)
(3)
<
I
CAT 'C (0)
(B6) Shimoga
-19IV) PROGRAMME INPUTS :
I] NATIONAL COMPONENT :
Annual Action Plan For 1998-99 has been prepared
1
CONSULTANTS : Five consultants will be hired one each for IEC, MCH,
Administration & Training, Monitoring and Evaluation and Procurement and
Finance.
2.
COLD CHAIN MAINTENANCE : Budget for minor repairs both by State level and
also by District level will be available.
3
CONTRACTUAL STAFF : Staff Nurse will be hired in category 'C & 'B' districts to
the extent of 25% of PHCs in the first year.
4
EMERGENCY OBSTETRIC CARE DRUGS (EmOC): To bring down the maternal
deatlhs, emergency obstetric Care Drugs will be supplied to FRUs wherever
cesarean section and other emergency surgical procedures are being conducted.
5
ESSJENTIAL OBSTETRIC CARE DRUGS: These drugs will be supplied in the
form of kits by Govt, of India during the first year.
6
KITS 'E' TO 'P' : These kits were supplied to 68 FRUs under CSSM programme.
Still there are large number of FRUs which are to be equipped during the first
year. 2 districts in 'A' category, 4 districts in 'B' category and 3 districts in 'C
category will be supplied with 'E' to 'P' kits.
7
24 HOURS DELIVERY SERVICES AT PHCs : To enhance the institutional
deliveries, a scheme will be taken up on a pilot basis in Kolar district wherein an
incentive of Rs.200/- to Medical Officer and Rs. 150/- to Staff Nurse will be given
who attends night deliveries between 7.00 pm to 8.00 a.m.
8
ESSENTIAL NEW BORN CARE EQUIPMENTS : Essential New Bern Care
Equipments were supplied by Govt, of India through National Neonatology Forum
under CSSM programme for few PHCs in Chikkamagalur, Chitradurga and Kolar
districts. Realising that the peri-natal mortality rate is responsible for more than
50% of infant deaths, new Born Care Equipments will be supplied to 10 bedded
maternity hospitals, FRUs/CHCs and Block Level PHCs where there are facilities
such as wards, staff nurse and labour room.
9
ACTIVITIES : A sum of Rs. 15.00 lakhs is available for taking up innovative
IEC activities focusing on behavioural changes in addition to enhancing
awareness regarding interventions under RCH programme.
-2010
VEHICLE : Field staff particularly Junior Health Assistant (F) will be supplied two
wheelers to improve her mobility, accessibility for service to attend emergency
services and also to Improve her Status in public. This facility will be taken up in 7
Non-IPP-IX districts (Tumkur, Kolar, Bangalore (U), Bangalore (R), Dharwad,
Raichur & Bidar).
11
MINOR CIVIL WORKS : An amount of Rs. 190.00 lakhs has been made available
to take up minor civil works particularly in the institutions such as Subcentres,
PHCs, FRUs and also training centres.
12
Government of India will be directly releasing the funds to the Deputy
Commissioners of the districts to support IEC activities through Zilla Saksharatha
Samithis (ZSS). Each proposal costing about Rs.3.00 to Rs.5.00 lakhs will have
to be formulated by the ZSS and directly sent to Govt, of India for funding.
13
TRAINING UNDER RCH : The State Institute of Health & FW will be dovetailing
the RCH component in the regular IPP-IX
training programme. Awareness
programme for the State Level Officers as well as District Level Officer will be
initiated . Manuals have already been
made available at all the districts for
undertaking six days RCH training programme for ANM's.
14
IMPROVED MANAGEMENT: Preparation of district plans under Community
Needs Assessment Approach as a Decentralized Participatory planning is under
way. Training programme has been completed in most of the districts.
II. SUB PROJECT : BELLARY :
Annual Action Plan for 1998-99 has been prepared.
A sum of Rs. 15.05 crores exclusively for Sub Project Bellary has been approved by Gol.
Civil Works
: 5 Sub centres, 5 PHCs & 5 Maternity Hospitals
Equipments
: 174 Subcentres, 10 PHCs, 50 PHUs, 4 maternity Hospitals
Furniture
: 76 Subcentres, 10 PHCs, 11 PHUs
Vehicles
: 15 Ambulance & 2 Jeeps
I EC activities
:CNA: Video-films, flip charts, hand books & hand outs
Baseline Survey:
NGO involvement:
Own Your Telephone
Contractual staff : Staff Nurses & Laboratory Technicians.
rchs18]
i
PEKFORMAKCE IHDICATORS IN RCH PROGRAMME
OBJECTIVE
INDICATORS
(%)
1997
1998
1999
2000
2001
2002
BASE
LINE
LIMPROVED
MANAGEMENT
II. IMPROVED
QUALITY,
COVERAGE AND
EFFECTIVENES
-T
s
cc
' I r •., -> III. ENAHANCED
; c % S
)
; 5
* POPULATION
STABILISATION
bdl]
1.DISTRICT
PLANS
CNA APPROACH
DATA SOURCE
(%)
20
50
100
100
100
100
RECORDS (D&E CELL)
2. SC.,PHC*s, FRU's,
EQUIPPED WITH
(%)
0
25
50
60
75
100
FACILITY
SURVEY/RECORDS
3. INSTITUTIONAL
DEVELOPMENT
(PLACEMENT OF
STAFF)
(%)
0
10
25
50
75
100
FACILITY SURVEY
1. SAFE DELIVERIES
(%)
43
50
52
54
56
60
SERVICES STATISTICS
2. COUPLE
PROTECTION RATE
(%)
58
59
60
62
63
65
SURVEY/RECORDS
3. I NFANT
MORTALITY RATE
PER 1000
Lbs
52
50
45
42
40
38
SRS
4. MATERNAL
MORTALITY RATE
PER 1000
Lbs
4.5
4
3.5
30
2.5
2.0
SERVICE STATISTICS
5. STAFF TRAINED
%
2
10
30
60
75
100
RECORDS
6. REACHED
WITH RTI,
HIV/AIDS MESSAGE
%
20
30
60
75
80
85
CLIENT SURVEY
7. UNMET NEED
%
18
16
14
12
10
8
HOUSE HOLD SURVEY
PER 1000
POPULA
TION
22
21.5
21
18
15
12
SRS
8. CRUDE BIRTH RATE
Position: 1757 (3 views)