• Training guidelines giving criteria for certification, selection of trainees & training instt./medical college, minimum procedures etc. finalized
• Link between beneficiaries and ANMs.
40 plus care including screening code for CaCx- in /tnBCC including IEC, counseling, family & community participation.Subsidized Medical Practitioner (SMP) scheme – This scheme is based on success achieved of this scheme in Pune district . Districts will identify remote and hilly areas where medical care is not available . Newly passed out Medical Graduates (Preferably Ayurvedic) will be provided with assistance in the form of honorarium, drugs etc. on a tapering basis for two years so as to settle their private practice.Nurse Practitioners Scheme– Similar to SMP scheme districts will identify villages where nurses can practice Midwifery and other minor ailment treatment on payment basis, they will be provided with honorarium, drugs etc. on a tapering basis for two years so as to settle their private practice.Implementation of Health Insurance scheme on pilot basis.
There is increased trained of Laproscopic Sterilization. Laproscopic Sterilization is on going activity. To train eligible candidates (Gynaecologist & General Surgeon) in Laproscopic sterilization, the following institutes are identified -1) Sasoon Hospital, Pune2)YCM Hospital, PimpariChinchwad3)ShriSali Hospital, Manchar,Dist. Pune4)Women Hospital - Jalna5)District Hospital - Alibag6)Govt. Medical College,DhuleContribution from Private Sector is there in the form of performance as well as training to Surgeons. The training of Laproscopic Sterilization is to be imparted to team comprising of Gynaecologist / General Surgeon Private Practitioners who are eligible for training and has desired to under go training Family Planning Association of India and SangamnerkarDwarikaSubsidized Medical Practitioner (SMP) scheme – This scheme is based on success achieved of this scheme in Pune district . Districts will identify remote and hilly areas where medical care is not available . Newly passed out Medical Graduates (Preferably Ayurvedic) will be provided with assistance in the form of honorarium, drugs etc. on a tapering basis for two years so as to settle their private practice.Nurse Practitioners Scheme– Similar to SMP scheme districts will identify villages where nurses can practice Midwifery and other minor ailment treatment on payment basis, they will be provided with honorarium, drugs etc. on a tapering basis for two years so as to settle their private practice.
SINCE IT IS A TARGET FREE APPROACH MONTHLY MONITORING IS MANDATOTRY.
Reproductive and child health phase II
REPRODUCTIVE AND CHILD HEALTH PHASE-ii<br />NEW INITIATIVES &<br />Quality indicators<br />MANOJ K. VAIDYA<br />
New initiatives under rch-ii<br />Making the First Referral units functional.<br />Training of MBBS doctors.<br />Blood storage facilities<br />JANANI SURAKSHA YOJANA<br />
24 Hrs. Functioning of PHCsRCH II<br />• It is planned to establish 2000 FRUs in phases in<br /> RCH-II<br />• 50% PHCs and all CHCs to be<br />operationalisedin phases<br />• Availability of Services such as<br /> - 24 Hrs. Delivery services<br /> - New Born care<br /> - Family Planning, Counselling and services<br /> - Availability of RTI, STI services<br /> - Safe abortion services (MVA etc.)<br />
Training in Anaesthesia (LSASEMOC)RCH II<br />• Training of MBBS Doctors in Life Saving<br /> Anaesthetic Skills for Emergency Obstetric Care.<br />• 18 weeks training course<br />• The First Training Programme<br />Conducted at AIIMS for Chhattisgarh<br />• Training to be conducted in phases<br /> and limited to the requirement at<br /> FRUs.<br />
Training In Obstetric ManagementRCH II<br />• Training of MBBS doctors in obstetric<br /> management and skills including C.S. in<br /> RCH-II<br />• Training to be conducted in collaboration<br /> with FOGSI<br />• Duration of training to be 16 weeks<br />• Expert Group is considering other details<br />
Blood storage facility<br />Managementof obstetric emergencies is sometimes not possible due to non-availability of blood.<br />The Drugs and Cosmetics Act was therefore<br /> modified to facilitate establishment of blood<br /> storage centres at FRU’s.<br />
Vandemataram scheme<br />It is a voluntary scheme wherein any obstetric and gynaec specialist, maternity home can volunteer<br /> Enrolled doctors will display ‘vandemataram logo’<br /> at their clinics.<br />Iron and folic acid tablets, oral pills, TT injections, etc will be provided for free distribution.<br />Of late it has been withdrawn.<br />
0THER INITIATIVES<br />Proposed :<br />Rural Health Care Mission.<br />Referral transport<br />ASHA (Accredited Social Health Activist)<br />Adolescent Reproductive and Sexual Health<br />A comprehensive infection management and environment plan for RCH-II has been prepared for implementation at CHC, PHC, SC’s.<br />
Rural Health Care Mission<br />• The scheme is under consideration.<br />• A comprehensive scale for uplifting primary health<br /> infrastructure and services.<br />• To be implemented initially in 8 EAG States, all NE<br /> States and J&K.<br />
Referral TransportRCH II<br />Key issues: Roads, transportation, RCH I funds poorly<br /> Utilized, Community participationlacking<br />Under Consideration<br /> – Place funds with AWW /ANM; [ JSY]<br /> – Develop community mechanisms<br /> – Provide out source ambulances at PHCs<br /> CHCs, and FRUs<br />Easy access to ambulance & assistance from AWW <br />
ROLE OF ASHA<br />• A village level link worker attached to<br />AWW/ANM<br />• Motivator for ANC, PNC, Institutional<br /> Delivery, Immunization and <br /> Family Planning Services<br />• Provide Escort to beneficiary for above<br />services.<br />• Adolescents Health Counsellor.<br />
Strategy for addressing Adolescent Reproductive and Sexual Health(ARSH) in RCH Phase II<br />A two-pronged strategy will be supported:<br />Incorporation of adolescent issues in all the RCH training programs and all RCH materials developed for communication and behaviour change.<br />dedicated days and dedicated timings for adolescents at PHC’s.<br />
INFECTION MANAGEMENT AND ENVIRONMENT PLAN<br />IMEP which is being extended to health care facilities includes:<br />Treatment and disposal of<br /> biomedical wastes<br />Disposal of syringe waste<br />Provision of water,<br /> sanitation and good <br /> hygiene conditions<br />OBJECTIVE: to ensure managing health and environment risks effeciently end <br /> effectively<br />
MEDICAL METHOD OF ABORTION<br />Termination of early pregnancy (49days) using 2 drugs<br /> - mifeprestone followed by mesoprostol<br />
MANUAL VACuUMASPIRATION<br />Safe and simple technique<br /> for termination of pregnancy.<br />Can be used at PHC or <br /> comparable facility<br />FOGSI, WHO & state govt<br /> are coordinating the project.<br />
Some Innovative State Initiatives<br />Gujarat<br />increase access to safe delivery services. It is in partnership with private providers (ChiranjiviYojana)<br />A Dai Sangathan has been formed by 10 leading NGOs of the state to facilitate interface between the health system and the community<br />Punjab<br />Proposed to pay an incentive of Rs. 500/- to BPL SCs belonging to urban areas <br /> Purchase and supply of nutrients like iron, calcium, D-worming tablets for pregnant mothers belonging to SC classes.<br />
Continued….<br /><ul><li>screening code for Ca Cervix – Tamil Nadu
Subsidized Medical Practitioner (SMP) scheme- assam, bihar
Implementation of Health Insurance scheme on pilot basis.</li></li></ul><li>As of now……..<br />Cabinet/Planning Commission approval: The Cabinet has approved RCH II as a component of the National Rural Health Mission (NRHM) on 4th January 2005. <br />Negotiations initiated with the World Bank and the DFID for funding. <br />Development Partners support: Both the World Bank and the DFID have agreed with the National PIP and will soon convey their respective Boards approval.<br />
Quality indicators<br />Following are the quality indicators used to monitor and evaluate RCH programme through monthly reports:<br />Number of antenatal cases registered<br />Number of pregnant women who had 3 antenatal checkups<br />Number of high risk pregnant women referred<br />Number of pregnant women who had 2 doses of TT<br />Number of pregnant women under prophylaxis and treatment of anaemia<br />Number of deliveries by trained and untrained attendants<br />Number of cases with complications referred to PHC/FRU<br />Number of newborn with birth weight recorded<br />
Continued…….<br />No. of women given 3 post natal check-ups<br /> No. of RTI/STD cases detected, treated and referred<br />No. of children fully immunised<br />No. of adverse reactions reported after immunisation<br />No. of cases of ARI and diarrhoea under 5yrs<br />No. of cases motivated and followed for contraception.<br />
references:<br />Parks textbook of preventive and social medicine<br />Fundamentals of community medicine by G M Dhar<br />MoHFWgovt of india website<br />Wikipedia<br />WHO official web site<br />