NRHM in context with MCH


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This presentation deals with advent of NRHM, backdrop of public health scenario prior to NRHM & discusses in details vision & core strategy of NRHM. It focuses on different schemes related to maternal & child health under NRHM with special reference to Maharashtra.

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NRHM in context with MCH

  2. 2. National Health Mission (NHM) NRHM NUHM From 1 May 2013
  3. 3. Scheme of Presentation • Backdrop of NRHM • Advent of NRHM – Why & What for ? • Vision of NRHM • Core Strategies • Plan of Action • MCH Services • Achievements • Way ahead …!
  4. 4. Public Health Status 1. Poor Public health expenditure in India - Public health expenditure has declined from 1.3% of GDP in 1990 to 0.9% of GDP in 1999. 2. Vertical Health and Family Welfare Programmes have limited synergisation at operational levels. 3. Lack of community ownership of public health programmes impacts levels of efficiency, accountability and effectiveness. 4. Lack of integration of sanitation, hygiene, nutrition and drinking water issues.
  5. 5. 5. There are striking regional inequalities. 6. Population Stabilization 7. Curative services favor the non-poor: for every Re.1 spent on the poorest 20% population, Rs.3 is spent on the richest quintile. 8. Only 10% Indians have some form of health insurance, mostly inadequate 9. Out of Pocket Expenses -Hospitalized Indians spend on an average 58% of their total annual expenditure Over 40% of hospitalized Indians borrow heavily or sell assets to cover expenses. Over 25% of hospitalized Indians fall below poverty line because of hospital expenses
  6. 6. Vision Of NRHM 1 1. To provide effective health care to rural health population. (Special focus on 18 states) 2. To raise public spending on Health from 0.9% of GDP to 2-3% of GDP. 3. To undertake architectural correction of the health system to strengthen public health management and service delivery in the country.
  7. 7. Vision Of NRHM 2 4. Female health activist (ASHA)in every village. 5. A village health plan prepared through a local team headed by the Health & Sanitation Committee of the Panchayat. 6. Strengthening of the rural hospital for effective curative care and made measurable and accountable to the community through Indian Public Health Standards(IPHS)
  8. 8. Vision Of NRHM 3 7. Integration of vertical Health & Family Welfare Programmes. 8. It seeks to revitalize local health traditions and mainstream AYUSH into the public health system. 9. effective integration of health concerns with determinants of health like sanitation & hygiene, nutrition, and safe drinking water through a District Plan for Health.
  9. 9. Vision Of NRHM 4 10. Address inter state , inter district disparities. 11.Define time-bound goals and report publicly on their progress. 12.To improve access of rural people, especially poor women and children, to equitable, affordable, accountable and effective primary healthcare.
  10. 10. NRHM - GOALS 1. Reduction in Infant Mortality Rate (IMR) and Maternal Mortality Ratio (MMR) 2. Universal access to public health services such as Women’s health, child health, water, sanitation & hygiene, immunization, and Nutrition. 3. Prevention and control of communicable and non- communicable diseases, including locally endemic diseases. 4. Access to integrated comprehensive primary healthcare 5. Population stabilization, gender and demographic balance. 6. Revitalize local health traditions and mainstream AYUSH 7. Promotion of healthy life styles
  11. 11. Core Strategies 1. Train and enhance capacity of Panchayati Raj Institutions (PRIs) to own, control and manage public health services. 2. Promote access to improved healthcare at household level through the female health activist (ASHA). 3. Health Plan for each village through Village Health Committee 4. Strengthening sub-centre through an untied fund to enable local planning and action and more Multi Purpose Workers . 5. Strengthening existing PHCs and CHCs, and provision of 30- 50 bedded CHC per lakh population for improved curative care to a normative standard (Indian Public Health Standards defining personnel, equipment and management standards).
  12. 12. Core Strategies 6. Preparation and Implementation of an inter-sectoral District Health Plan prepared by the District Health Mission, including drinking water, sanitation & hygiene and nutrition. 7. Integrating vertical Health and Family Welfare programmes at National, State, Block, and District levels. 8. Technical Support to National, State and District Health Missions, for Public Health Management. 9. Strengthening capacities for data collection, assessment and review for evidence based planning, monitoring and supervision. 10. Formulation of transparent policies for deployment and career development of Human Resources for health. 11. Developing capacities for preventive health care at all levels for promoting healthy life styles, reduction in consumption of tobacco and alcohol etc. 12. Promoting non-profit sector particularly in under served areas.
  13. 13. Supplementary Strategies 1. Regulation of Private Sector including the informal rural practitioners to ensure availability of quality service to citizens at reasonable cost. 2. Promotion of Public Private Partnerships for achieving public health goals. 3. Mainstreaming AYUSH – revitalizing local health traditions. 4. Reorienting medical education to support rural health issues including regulation of Medical care and Medical Ethics. 5. Effective and viable risk pooling and social health insurance to provide health security to the poor by ensuring accessible, affordable, accountable and good quality hospital care.
  14. 14. Plan Of Action A] ASHA – • Honorary volunteer • Chosen by & accountable to Panchayat. • Bridge between ANM & Village. • Will be imparted necessary training. • Provision of Medicine kit • Will facilitate preparation of Village Health Plan
  15. 15. B] Sub center Strengthening • Each sub-centre will have an Untied Fund for local action @ Rs. 10,000 per annum. This Fund will be deposited in a joint Bank Account of the ANM & Sarpanch and operated by the ANM, in consultation with the Village Health Committee. • Supply of essential drugs, both allopathic and AYUSH, to the Sub-centres. • In case of additional Outlays, Multipurpose Workers (Male)/Additional ANMs wherever needed, sanction of new Sub-centres as per 2001 population norm, and • Upgrading existing Sub-centres, including buildings for Sub- centres functioning in rented premises will be considered.
  16. 16. C] STRENGTHENING PRIMARY HEALTH CENTRES • Adequate and regular supply of essential quality drugs and equipment (including Supply of Auto Disabled Syringes for immunization) to PHCs • Provision of 24 hour service in 50% PHCs by addressing shortage of doctors, especially in high focus States, through mainstreaming AYUSH manpower. • Observance of Standard treatment guidelines & protocols. • In case of additional Outlays, intensification of ongoing communicable disease control programmes, new programmes for control of non communicable diseases, • up gradation of 100% PHCs for 24 hours referral service, and provision of 2nd doctor at PHC level (I male, 1 female) would be undertaken on the basis of felt need.
  17. 17. D] STRENGTHENING CHCs FOR FIRST REFERRAL CARE • Operationalizing 3222 existing Community Health Centres (30-50 beds) as 24 Hour First Referral Units, including posting of anaesthetists. • Codification of new Indian Public Health Standards, setting norms for infrastructure, staff, equipment, management etc. for CHCs. • Promotion of Stakeholder Committees (Rogi Kalyan Samitis) for hospital • management. • Developing standards of services and costs in hospital care. • Develop, display and ensure compliance to Citizen’s Charter at CHC/PHC level. • Creation of new Community Health Centres (30-50 beds) to meet the population norm.
  18. 18. Other Aspects • District Health Plan• District Health Plan • Converging sanitation & hygiene • Strengthening of Disease Control Programmes • PPP & Pvt Sector Regulation • New Health Financing• New Health Financing  Flexibility  Money follows the patient  Standardization of services • Program Management Support  Non lapsable health Pool ( Management System )  Developing Manpower  Improved Governance – o E banking o Social audit
  19. 19. Communitize Flexible Financing Monitor Progress against standards Improved Management Through Capacity Innovations in HR Management
  20. 20. •Reproductive • Maternal •Newborn • Child Health And •Adolescent RMNCH+A Services
  21. 21. Maternal Health Services • Janani Suraksha Yojana • Janani Shishu Suraksha Karyakram - In this programme following free entitlements are provided to pregnant mothers and sick infants. I. Free transport services from home to institute, institute to other institute & institute to home. II. Free diet services to mothers (3 days for normal deliveries and 7 days for C section) III. Zero user fees. IV. Free deliveries and C section. V. Free diagnostics, medicines, Blood Transfusion. • Maternal Death Review • Performance based incentive to LSCS & EmOC trained Medical Officers
  22. 22. Janani Suraksha Yojana (JSY) To reduce Maternal and Neonatal Mortality by promoting institutional delivery among beneficiaries from BPL, SC and ST family in rural and urban area. Incentives for Institutional Delivery Area Beneficiary ASHA Rural Rs 700/- Rs 600/- Urban Rs.600/- Rs 400/- The eligible beneficiary is from Below Poverty Line and if she delivered at home in this case Rs. 500/- is paid . In case of L.S.C.S, Rs 1500/- is to be given to beneficiary.
  23. 23. Janani Shishu Suraksha Karyakaram (JSSK) Janani Shishu Suraksha Karyakaram (JSSK) Under this scheme services are provided to pregnant and deliverd mothers and infants up to 1 year are getting benefitted in all government health facilities by all free health services irrespective of poverty level, caste and parity. 1. Free drugs & Consumables 2. Free Referral Transport 3. Free Diagnostics 4. Free Diet To Delivered Mothers 5. Provision of Free Blood 6. Exemption from User Charges
  24. 24. Fully Protected Mother & Maternal Death Review Fully Protected Mother & Maternal Death Review 1. These include mapping of all health facilities.1. These include mapping of all health facilities. 2. Strengthening Sub-Centres, Primary Health Centres as per IPHS norms, strengthening of First Referral Units. 3. Providing blood transfusion facilities, Caesarean Section services at Government facilities. 4. For enhancing quality and access of services through public health sector, regular provision of services is planned and implemented. Strategy of fully protected mother which include 3 ANC check up, IFA tablet consumption, injection TT second/booster are ensured. Free referral transport services, free diagnostics and medicines, free diet during stay, and adequate PNC care is being implemented across the state. 5. Facility Based MDR and Community Based MDR is taken and reviewed by a committee under the chairmanship of Civil Surgeon/ MOH of Corporations.
  25. 25. Navsanjivani Yojana (Tribal ) • Matrutva Anudan Yojana • Mobile Medical Squad • Dai Meetings • Water Quality Monitoring • Pre Monsoon Activities • Provision of food and loss of wages to relatives accompanying SAM/MAM children.
  26. 26. Child Health Services • Special New Born Care Unit. • Village Child Development Center in Anganwadi for SAM & MAM Children. • Child Treatment Center at PHC/RH for SAM & MAM Children. • Nutritional Rehabilitation Centre in tribal districts. • Organization of Bi Annual Rounds of De-worming and Vitamin A supplementation. • Routine Immunization Programme • Infant Death Audit in one High IMR Block in all districts.
  27. 27. Rashtriya Bal Swasthya Karykram (RBSK) Rashtriya Bal Swasthya Karykram (RBSK) • RBSK aims at early detection and management of the '4Ds' 1. Defects at birth, 2. Diseases in children, 3. Deficiency conditions and 4. Developmental delays including disabilities) prevalent in children.
  28. 28. Implementation Strategy RBSK aims to cover children of 0-18 years of age in• RBSK aims to cover children of 0-18 years of age in Maharashtra. • Biannual Regular health screening of pre-school children up to 6 years of age using Aganwadis as a platform is a essential component. • Moreover, children from 6 to 18 years of age studying in Government and Government aided schools would also receive regular health check-ups. • follow-up referral support and treatment including surgical interventions at tertiary level free of cost
  29. 29. Special Newborn Care Unit (SNCU) • In SNCUs severely sick children born in hospital are admitted and also children referred from outside. • These are specialized new born and sick child care units at district hospitals with specialised equipments, which include 1. phototherapy unit, 2. oxygen hoods, infusion pumps, 3. radiant warmer, 4. Laryngoscope and ET tubes,nasal cannulas etc. • These units have a minimum of 12 to 16 beds with a staff of 3 physicians, 10 nurses, and 4 support staff to provide round the clock services for a new born or child requiring special care such as managing newborn with neonatal sepsis and child with pneumonia, dehydration etc, prevention of hypothermia, prevention of infection, early initiation and exclusive breast feeding, post natal care, immunization and referral services.
  30. 30. Village Child Development Center (VCDC) • The SAM/MAM Children who do not have medical problem are admitted in Village child development Center for 30 days. • The treatment is given by Medical Officer of Primary Health Center and • Nutritious diet is provided by Anganwadi. • For each Child the budget of Rs. 1000/- is allocated for 30 days.
  31. 31. Child Treatment Center (CTC) • Moderately Malnourished children (MAM) and Severely Malnourished children (SAM) having medical complications are admitted in selected Primary Health Centers, Rural Hospitals and Sub District Hospitals for 21 days. • Admitted Malnourished children are examined and treated by Medical officer. • Nutritious diet is given to the children and mother/caretaker. • Loss of Daily wages is given to the mother. • Budget allocatted is Rs. 5,250/- for each child for 21 days.
  32. 32. Nutrition Rehabilitation Center (NRC) • NRCs are established in 15 tribal districts at district hospital/sub district hospital level. • Severely sick malourished children (SAM) are admitted in Nutrition Rehabilitation Centers. • At NRC treatment and nutritious diet for 14 days is given to the children. • Also the mother of the child is given nutritious diet and is taught recipes for preparation of Nutritious diet at home.
  33. 33. De worming & Vitamin A Drive • Bi-annual drive is implemented in Rural and Urban areas of district in Maharashtra. • In this round Vitamin A is given to all children between 9 months to 5 years and • de worming medicine is given to children of age group 1-6 yrs .
  34. 34. Infant & Young Child Feeding (IYCF) • Infant and young child feeding (IYCF) activities are important to reduce malnutrition. • In this activity the mother is educated regarding 1. early breast feeding, 2. exclusive breast feeding for first six months and 3. initiation of complementary feeding.
  35. 35. Integrated Management of New Born & Childhood Illnesses (IMNCI) • In this activity, IMNCI training is given to the staff working in health and ICDS department. • IMNCI training regarding home visit is given to ANM, AWW and MPW. • The programme is implemented in all districts. IMNCI kits are provided to all IMNCI trained Anganwadi workers. • The medicines are provided to AWW for their home visit with IMNCI kit.
  36. 36. MCTS • Mother & Child Tracking System (MCTS), web based• Mother & Child Tracking System (MCTS), web based reporting software, under RCH-II programme for tracking of health services delivered to pregnant mothers and children. • Objectives:- • Name Based Tracking of: 1. Pregnant women - for ANC, Delivery & PNC health services 2. Children - for immunization • To Facilitate: 1. Close monitoring of regular Checkups & service delivery to pregnant mothers with minimum essentials services 2. Full Immunization of Mother & Children 3. To follow up dropouts and track service delivery 4. To promote complete immunization and safe institutional deliveries
  37. 37. Tracking System • New registration – 18 digit UNIQUE ID • Service delivery record update • Allotment of health provider – • Overdue services for same beneficiary for every month are generated in health provider’s work plan. • In rural area two health providers (one ANM & one ASHA) are allotted to each beneficiary. • SMS alerts to beneficiary & health provider – For the information of registration status and services falling due on the mobile number registered in MCTS.
  38. 38. Adolescents’ Health Services • ARSH Clinics along with support for outreach activities • Appointment of counselors at DH. • Weekly Iorn Folic Acid supplementation Scheme • Promotion of Menstrual Hygiene in Adolescents Girls . Under this Programme sanitary napkins are provided at Low cost. • Mobility Support for AH/ICTC counselors
  39. 39. Vulnerable Group Vulnerable Group means vulnerable communities such as SC/ST and BPL populations living in targeted Rural areas and not covered by Urban RCH programmes and Tribal RCH Programmes. Mainly these are Migratory populations of Labours, not living in slums. 1. RCH outreach camps for migratory sugarcane cutters in 25 districts having Co-Operative Sugar Factories. 2. Creation of Health Post for MIHAN SEZ, Wadi, Narsala Industrial zone in peri Urban area of Nagpur having huge population of labours working in Industries, Construction sites. 3. Health Check up of Migrant brick workers
  40. 40. Achievements
  41. 41. IMR 66 64 60 58 58 57 55 53 50 47 44 42 45 45 42 36 36 35 34 33 31 28 25 25 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 India Maharashtra
  42. 42. MMR 301 254 212 178 149 130 104 87 0 50 100 150 200 250 300 350 2001-03 2004-06 2007-09 2010-12 India Maharashtra
  43. 43. Sr. Year India Maharashtra 1 1992-93 3.39 2.86 2 1998-99 2.85 2.52 3 2005-06 2.68 2.11 4 2008-09 2.60 1.90 5 2012 2.40 1.80 Total Fertility Rate
  44. 44. Thanks