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

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Presentation on theme: "A postulate of Proposed Gujarat State Plan ofOperation RCH Phase - II A postulate of Proposed Gujarat State Plan of Operation RCH Phase - II By Project."— Presentation transcript:

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

9 Sr. No.IndicatorCurrent20052010 Health 1Total Fertility Rate 2Life Expectan cy at Birth (Male) 61.56571 3Life Expectan cy at Birth (Female) 62.86875 4Maternal Mortality Rate (1992-93) 3.891.5Below 1

10 Sr. No.IndicatorCurrent20052010 Health 5Infant Mortality Rate 604016 6Under 5 Mortality Rate (1996) 20.415Below 10 7Children Immuniza tion Rate 5480100 8Couple Protection Rate 54.56570 9% Institution al Deliveries 557080

11 Sr. No.IndicatorCurrent20052010 Health Infrastructure 1Sub – Centers 7274 7490 (Rural) 1200 (Urban) 2Primary Health Centers 105411001229 3Community Health Centers 254260307 4Functional FRUs 44100307

12 Marginal Budgeting for Bottlenecks 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 findings of Marginal Budgeting for Bottlenecks











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.


44 Goal/ Outcome/ Output/ Activities Strategic Intervention 1.2 Basic EmOC facilities are operational during programme period on 24x7 with trained medical officer and 2 staff nurses OUTPUT 2: INSTITUTIONAL DELIVERIES RATE IS INCREASED Strategic Intervention 2.1: Essential Obstetric Care facilities are made available Strategic Intervention 2.2: Referral Transport for routine deliveries and for Referral of obstetric emergencies by planned transport options Strategic Intervention 2.3: Community support system is developed by community Strategic Intervention 2.4: As per Janani Suraksha Scheme, provide monetary incentive to families and TBAs for accompanying pregnant women for deliveries at institutions

45 Goal/ Outcome/ Output/ Activities OUTPUT 3: UNIVERSALISE ANTENATAL COVERAGE FOR PREGNANT WOMEN Strategic Intervention 3.1: Ensure minimum 3 antenatal check ups of all pregnant women Involve ANM, TBAs, link couples and AWWs OUTPUT: 4 HOME DELIVERIES ARE SAFE AND CLEAN (WHEREVER INSTITUTIONAL DELIVERIES ARE NOT FEASIBLE) Strategic Intervention 4.1: Remaining untrained TBAs are trained and skill attendance is encouraged for home delivered Strategic Intervention 4.2: TBA kits are periodically replenished OUTPUT: 5 WOMEN RECEIVEIVING POST-PARTUM CARE ARE INCREASED Strategic Intervention 5.1: Contact on day 1, 2 and 7 and then at 6 th week and link with visits for neonates care for integrated mother-child care

46 Goal/ Outcome/ Output/ Activities Strategic Intervention 5.1: Conduct audit of maternal deaths in the community in transit or in the hospital OUTCOME: 2 REDUCED NUMBER OF INFANT DEATHS Goal/ Outcome/ Output/ Activities OUTPUT: 1 IMPROVE CARE SEEKING AND REFERRAL OF SICK NEONATES WHO CANNOT BE MANAGED AT HOME Strategic Intervention 1.1: Improve facility-based care for complex newborn care with visiting specialist doctors, strengthen facilities and increase their utilization Strategic Intervention 1.2: Basic newborn care facilities are operational during programme period with trained medical officer and 2 staff nurses Strategic Intervention 1.3: Normal new born care is strengthened at all health care facilities through supply of essential life saving drugs, gloves etc. Strategic Intervention 1.4: Educate families, improve skills of AWWs, link couples and ANMs in diagnosing newborn sickness facilitate transport Community support system for referral of sick neonates is developed by village community

47 Goal/ Outcome/ Output/ Activities OUTPUT: 3 ROUTINE IMMUNIZATION AND OUTREACH SERVICES STRENGTHENED Strategic Intervention 3.1: Reaching out to every child through mobility support for ANM, strengthened cold chain and sterilisation facilities, and series needles through support fund Strategic Intervention 3.4: Strengthen Delivery System through refurbishing cold chain and sterilization equipment Strategic Intervention 3.3: Contracting ANMs on need base for outreach sessions and on specific vaccine days Strategic Intervention 3.4: Conduct social research/ participatory research with community and ANMs for increased efficiency of ANMs and immunisation Goal/ Outcome/ Output/ Activities OUTPUT: 6 REDUCING THE GAP IN HEALTH SYSTEMS OF TRIBAL VS GENERAL PEOPLE Strategic Intervention 6.1: Orientation of Tribal Healers for childhood illnesses and their management through improved treatment seeking behaviours Strategic Intervention 6.2: Local folk artists of tribal areas are made capable of mobilising people to seek for treatment and understand childhood illnesses

48 Goal/ Outcome/ Output/ Activities OUTCOME 3: COUPLES HELPED IN ACHIEVING THEIR REPRODUCTIVE INTENTIONS OUTPUT 1: REDUCED CURRENT UNMET NEED FOR FP METHODS BY 75 % OF EXISTING LEVELS BY 2007 Strategic Intervention 1.1: Comprehensive FP services with permanent methods of Sterilisation, NSV and spacing methods and safe MTP services are strengthened under one roof Strategic Intervention 1.2: Increased access to basic FP services of abdominal TL, safe MTP and IUD and other spacing methods Strategic Intervention 1.3: Access to IUD insertion services improved at the sub centers and access to safe MTP services are increased Strategic Intervention 1.4: Access to non-clinical contraceptives increased through depot holders/link couples Strategic Intervention 1.4: Improved quality of care for client satisfaction

49 Goal/ Outcome/ Output/ Activities OUTPUT: 2 INCIDENT OF HIGH RISK SEXUAL BEHAVIOUR IN 15-49 YEARS REDUCED Strategic Intervention 2.1: Develop 250 health facilities (PHCs/CHCs) to provide quality RTI/STI case management Strategic Intervention 2.2: Awareness generated on RTI/STI/HIV-AIDS among adolescent and CBO members OUTCOME: 4 URBAN POOR AND SLUM DWELLERS RECEIVE BASIC HEALTH FACILITIES FOR BETTER LIVING Strategic Interventions: Establish urban health centres in the towns not having any hospital, CHCs or PHC facilities Ensure staff, equipment and medicines are available at Urban Health Centres according to specifications Create community based female health volunteer to provide basic health services for minor illness and vaccinations

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

51 Areas of concern Rural Health Low utilisation Lack of maintenance Rural poor unable to afford Medical expenses Lack of education/ awareness

52 Areas of concern Inadequate blood banks Paucity of well organised referral system Urban Health Convergence of Health and Urban Dept. Poor Health Status of slum dwellers

53 Areas of concern BPLs unable to secure basic necessity and medical facilities Lack of planned efforts Over crowding of secondary and tertiary care In adequate infrastructure Environmental Health

54 Areas of concern Difficulty in quality and quantity of ground water supply Excessive salinity, fluorides, nitrites in water Concentration of chemical industries Improper treatment of biomedical wastes

55 Areas of concern Natural and man made disasters Irrigations Nutritional Health % relying on exclusive breast feeding is less

56 Areas of concern Disparity in Nutritional status in various income levels Poor awareness of healthy/ nutritious food More focus still requires in under 2 years and the lactating ones

57 Method Adopted to Analyse Priorities Literature Review Prepared by various field organisations and institutions to reveal critical issues

58 Method Adopted to Analyse Priorities Carrying out practical studies in form of: Rapid Household Survey Monitoring and Validation Survey Facility Survey

59 Other Data Sources Data Sources by GoI Rapid Household Survey by GOI NFHS Survey SRS Other State Specific information

60 Action Plan Thrust Areas for Human Development Index are reduction in: IMR MMR TFR

61 Different Levels of Interventions Community level Awareness Generation Trainings & Skill Development Strengthening CBWs including link couples and CBOs Involving PRIs for a meaningful role

62 Different Levels of Interventions Clinical level Quality improvements Operationalising FRUs for Comprehensive EmOC

63 Different Levels of Interventions Availing Basic EmOC at CHCs and PHCs Skill based trainings for health providers Public Private Partnership: Need based out sourcing

64 Different Levels of Interventions Outreach Field Visit RCH Camps Immunisation Sessions on fix days Mobile Health Units for inaccessible areas

65 Broad Strategies to reduce IMR FOCUS is on URBAN SLUMS and NEWBORN CARE.

66 Strategic Interventions Neonatal Care: At community, household level as well as hospital for prevention of hypothermia and infection & to go for breast-feeding exclusively. Immunization, Diarrhoea, Treatment of ARI Dealing with Malnutrition

67 Strategic Interventions Community Campaigns for nutritional goals including change in dietary behavior of community Birth spacing as an IMR reducing strategy Intersectoral coordination Monitoring and supervision

68 Broad Strategies to reduce MMR Identifying Risk Causing Complications (like Bleeding, Eclampsia, Obstructed labour, Anemia, Sepsis): Delay level 1: Community identifies complications- family decides for Emergency Obstetric Care- IEC Issues

69 Broad Strategies to reduce MMR Delay level 2: Availability of emergency transport-mobilization of community resources Delay level 3: Starting the Emergency care at hospital level and make all FRUs functional

70 Areas of Strategic Intervention Two Major thrust areas: Essential Obstetric Care Emergency Obstetric care

71 Essential Obstetric Care Comprehensive Antenatal care Replacing Trained Birth Attendance by Skilled Birth Attendance Quality obstetric services at primary Health Center Effective Supply management of DDKs

72 Essential Obstetric Care Creating the right Infrastructure Training for early recognition of bleeding /prolonged labor / Infection /Abnormal presentation/Convulsions Incentive based approach for trained TBAs and early referral for EmOC Mobility support- Interest free moped loans to ANMs

73 Emergency Obstetric Care Effective Emergency Obstetric care management Strengthening FRUs for effective service delivery with Blood transfusion facilities BEmOC to be made available at CHCs and PHCs. Skill development at all required stages

74 Emergency Obstetric Care Promoting timely referral by TBAs through training Expertise of Gynae and Anesthetists to be made available on panel and promote telemedicine for emergency. Emergency transport for cases with complications and needing referral.

75 Broad strategy for population stabilization CNA approach and focusing on unmet needs Volunteerism and informed choices as basis of population policy Community behavioral change through IEC

76 Broad strategy for population stabilization Community based contraceptive availability Skill based training for doctors and paramedics Monitoring and supervision: Ensuring filling up all posts of ADHOs, DIECOs and strengthening MIS

77 Overarching Issues Emphasizing Adolescent Health Harnessing Technology Increasing the Involvement of Stakeholders Mainstreaming Gender Meaningful role of PRIs

78 Overarching Issues Enhancing Performance of Health Delivery Systems Promoting Indian Systems of Medicine & Homeopathy Qualitative Improvements in Family Planning Establishing Effective Monitoring Mechanisms Increasing Awareness among Women

79 Harnessing Technology Harnessing opportunities created by IT revolution for health services through networking of district health offices with the health directorate The establishment of GIS Implementation of the telemedicine application

80 Increasing the Involvement of Stakeholders

81 Type of OrganizationRole in Health Activities Academic InstitutionsBasic and applied research Operations Training Monitoring and evaluation Policy guidance/advice NGOsProviding services IEC and Community mobilisation Providing community inputs in planning Providing feedback of government services Training Professional Bodies (e.g. IMA, Nurses Associations) Providing support to national health programmes Giving input in planning and policy making Helping in staff recruitment Putting forward view of the professionals Women s organizationsSupporting the programme Putting forward women s issues and gender issues Helping monitor programme Help in IEC and services delivery Youth organizations (e.g. NSS, NCC NYK etc.) Support programme implementation IEC and community mobilization Youth involvement Community based organizationIEC and mobilizing community Helping in service delivery Advice and referral Transport

82 Religious organizationsHelping in promoting healthy lifestyle Promoting health by inculcating religious and cultural values Helping in services delivery and community mobilisation Press and MediaProjecting the correct and balance image of the health services Providing feedback on health service functioning Giving voice to people s needs and feelings IEC and mass mobilisation Voluntary and philanthropic organizations Providing volunteer time and money for health work Services Clubs (e.g. Rotary, Lions, JC) Supporting health awareness and services by volunteer time and money CorporateSupport health activities for employees and families and neighboring villages and help IEC Provide funds and help in management development in health department JudiciaryProvide balanced judgments where public interest is developed with individual interests Provide effective and quick resolution of public grievances Consumer organizationsProtect consumer interests in health with long term view

83 Enhancing Performance of Health Delivery Systems Enhancing productivity and accountability within the department through training programme and systemic changes Developing capacity among senior personnel for strategic planning and health systems management

84 Enhancing Performance of Health Delivery Systems Improving logistics and supplies including improvements in the Central Medical Stores Organization Optimum utilization of equipments and maintenance of infrastructure

85 Budget for Human Resource Specialists at 100 Comprehensive BEmOC centers (Obstetrician/Pediatrician/Anestheti st on contractual basis) Contractual Staff Nurse at All PHCs State and district level consultants and support staff Village level link couples Community based health volunteers in urban areas

86 Budget for facility improvement Civil works Repair/renovation at CHCs / PHCs / SCs Equipment / Instrument based on facility survey for Comprehensive and basic BEmOC Capacity building

87 Budget for Service provision Drugs/ Consumables for EmOC/STI/RTI Iron supplement for Adolescent population Institutional deliveries

88 Budget for IEC activities Mass Media Family and self care- Educational material Mahila Swasthya Sangh Print media

89 Budget for Human Resource Specialists at 100 Comprehensive BEmOC centers (Obstetrician/Pediatrician/Anesthetist on contractual basis) Contractual Staff Nurse at All PHCs State and district level consultants and support staff Village level link couples Community based health volunteers in urban areas

90 Budget for facility improvement Civil works repair/renovation at CHCs /PHCs / SCs Equipment/Instrument based on facility survey for Comprehensive and basic BEmOC Capacity building

91 Budget for Service provision Drugs/ Consumables for EmOC/STI/RTI Iron supplement for Adolescent population Institutional deliveries

92 Budget for IEC activities Mass Media Family and self care- Educational material Mahila Swasrthya Sangh Print media

93 Thanks

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