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FAMILY PLANNING PROGRAM FAMILY PLANNING DIVISION Ministry of Health & Family Welfare Government of India.

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Presentation on theme: "FAMILY PLANNING PROGRAM FAMILY PLANNING DIVISION Ministry of Health & Family Welfare Government of India."— Presentation transcript:

1 FAMILY PLANNING PROGRAM FAMILY PLANNING DIVISION Ministry of Health & Family Welfare Government of India

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3 3 DEMOGRAPHIC SCENARIO 1.India is the second most populous country in the world. 2.India has 17 % of world’s population and has less than 3% of earth’s land area. 3.While the global population has increased 3 times, India has increased its population 5 times during the last century. 4.India’s population is expected to exceed that of China before 2030 to become the most populous country in the world.

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6 6 WHAT IS TFR The total fertility rate is the average number of children a woman would have if she were to pass through her reproductive years bearing children at the same rates as the women now in each age group. The total fertility rate is the average number of children a woman would have if she were to pass through her reproductive years bearing children at the same rates as the women now in each age group. It is computed by summing the age specific fertility rates for all ages. It is computed by summing the age specific fertility rates for all ages. It gives a magnitude of completed family size It gives a magnitude of completed family size In simple terms TFR denotes the average number of children borne per woman

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8 8 Benefits of family planning Stabilises population Stabilises population Reduces maternal mortality Reduces maternal mortality Reduces infant and child mortality Reduces infant and child mortality

9 9 Slower rates of population growth benefit all aspects of development Population Agriculture Health Education Economy Urbanisation Environment

10 10 National Population Policy, 2000  IMMEDIATE OBJECTIVE Address the unmet needs of contraception, Reproductive and Child Health care  MEDIUM TERM OBJECTIVE Achieve Replacement Level Fertility by 2010 Achieve Replacement Level Fertility by 2010  LONG TERM OBJECTIVE Bring about population stabilisation by 2045

11 11 Situation analysis NPP 2000 and the present scenario: NPP 2000 and the present scenario: 1. 2010 Population replacement (put back now to 2021) 2. 2045 Population Stabilization (put back now to 2060 (1.53 billion in 2060). 3. EAG states constitute 42% of the population (TFR between 3.4 and 4.3)

12 12 GOI POLICY (Servicing the unmet need) Based on felt needs of the community Based on felt needs of the community TARGET FREE TARGET FREE Children by choice & not chance Children by choice & not chance Equal emphasis on both limiting and spacing methods Equal emphasis on both limiting and spacing methods ELA :Scientific and statistically significant way being formulated for calculating state wise performance level based on unmet need ELA :Scientific and statistically significant way being formulated for calculating state wise performance level based on unmet need Population stabilization is a priority area of the GOI

13 13 MEETING UNMET NEEDS MEETING UNMET NEEDS 1Two third Indians want to use contraception 2There is no scope for coercion 3Ensure availability of quality RH services 4Meet the felt needs of couple 5Enable couple to achieve their RH goals 

14 14 Programatic interventions in Family Planning (GOI) 1. Addressing the unmet need in contraception through Assured delivery of family planning services Assured delivery of family planning services Developing skilled manpower for the same Developing skilled manpower for the same 2. Increasing male participation through intensive promotion of NSV 3. Promotion of IUDs as a short & long term spacing method 4. Promotion of Emergency Contraceptive Pills 5. Increasing basket of choices

15 15 Promotional Interventions in Family Planning (GOI) 1. Ensuring quality care in FP services 2. Revised compensation scheme 3. Family planning insurance scheme 4. Promoting Public Private Partnerships 5. Promoting contraception through increased advocacy

16 16 Temporary (Spacing) Methods IUD 380 A IUD 380 A EC Pills EC Pills OC Pills OC Pills CC ( dual purpose condoms) CC ( dual purpose condoms)

17 17 Reduce unmet need in Spacing (advantages of IUD 380 A) 10 years’ duration & not 3 years 10 years’ duration & not 3 years Can cover reproductive life span in 2 insertions only (25- 45 yrs.) Can cover reproductive life span in 2 insertions only (25- 45 yrs.) Can potentially replace the sterilization procedures Can potentially replace the sterilization procedures Can be inserted at subcentre level Can be inserted at subcentre level ANM/ MOs could be given refresher training ANM/ MOs could be given refresher training

18 18 Promotion of EC Pills 2 tabs of 0.75mg or 1 tab of 1.5mg within 72 hrs of intercourse in the following situations: 2 tabs of 0.75mg or 1 tab of 1.5mg within 72 hrs of intercourse in the following situations: Unprotected intercourse Unprotected intercourse Unplanned intercourse Unplanned intercourse Failed CC (Nirodh- torn) Failed CC (Nirodh- torn) Assault/ rape Assault/ rape Levonorgesterol only Levonorgesterol only No side effect No side effect One time activity to replace MTP One time activity to replace MTP Reduces Maternal Mortality by 10-15% Reduces Maternal Mortality by 10-15%

19 19 Reducing unmet need in Terminal method Assuring service provision through Assuring service provision through Fixed day service round the year Periodic camps Augmenting trained manpower in Augmenting trained manpower in NSV Minilap Lap. Ster.

20 20 Male participation (Why No Scalpel Vasectomy- NSV ?) 1. Attain population stabilization in a short period 2. Shifting responsibility of family planning from females to males

21 21 Why NSV ? 6 Ss:- (advantages) Scalpel less Scalpel less Stitch less Stitch less Safe Safe Sound Sound Simple Simple Short Short

22 22 Tubectomy (If client chooses it after all options have been explained) Offer minilap because Offer minilap because No postgraduate surgeon/ gynaecologist required No postgraduate surgeon/ gynaecologist required No anesthetist required normally No anesthetist required normally No pneumoperitoneum (inflating with gas) No pneumoperitoneum (inflating with gas) Less post operative distress Less post operative distress If client still demands Laparoscopic Tubectomy If client still demands Laparoscopic Tubectomy Offer services routinely at DH, FRU, CHC, BLOCK PHC (wherever OT is available)

23 23 Camps in tubectomy Should preferably start by 9 AM Should preferably start by 9 AM As the client is fasting since the previous evening As the client is fasting since the previous evening Has travelled long distances to reach the camp site and Has travelled long distances to reach the camp site and Is dehydrated Is dehydrated Has to have 4 hrs post operative observation before being discharged after being rehydrated Has to have 4 hrs post operative observation before being discharged after being rehydrated

24 24 Ensuring quality care in FP The manual on Standards in sterilization has been updated, printed & uploaded on the website. The manual on Standards in sterilization has been updated, printed & uploaded on the website. The manual on Quality assurance in sterilization has been updated, printed & uploaded on the website. The manual on Quality assurance in sterilization has been updated, printed & uploaded on the website. Six Regional Dissemination Workshops on the revised Standards and QA manuals held countrywide in 06-07. Six Regional Dissemination Workshops on the revised Standards and QA manuals held countrywide in 06-07.

25 25 Ensuring quality care in FP All states reported to have set up the QACs at state and district levels as per affidavit filed by them in the supreme court All states reported to have set up the QACs at state and district levels as per affidavit filed by them in the supreme court Revised extended QAC as per the updated manuals are in place in most of the states. Revised extended QAC as per the updated manuals are in place in most of the states. Most states have completed their orientation of the districts for QA Most states have completed their orientation of the districts for QA

26 26 COMPENSATION A.For Public (Govt.) facilities Breakage of the Compensati on package Acce ptor Motiva tor Drugs and dressin g Surgeo n charges Anest hetist Staff nurse OT techni cian/h elper Refresh ment Camp managem ent Total High focus states VAS.(ALL)TUB.(ALL)11006002001505010010075-25151515151010101015001000 Non High focus states VAS.(ALL)TUB (BPL + SC/ST only)) 11006002001505010010075--25151515151010101015001000 Non High focus states TUB(APL)250150100752515151010650

27 27 COMPENSATION B For Private Facilities: Category Type of operation FacilityMotivatorTotal High focus states Vasectomy (ALL) Tubectomy (ALL) 1300135020015015001500 Non High focus states Vasectomy (ALL) Tubectomy (BPL + SC/ST) 1300135020015015001500

28 28 Family Planning Insurance Scheme ( limit of indemnity) Claims arising out of Sterilization Operation Amount ADeath at hospital/ within seven days of discharge Rs. 2,00,000/- BDeath due to sterilization (8 th – 30 th day from the date of discharge ) Rs. 50,000/- CExpenses for treatment of Medical Complications Rs. 25,000/- DFailure of Sterilization Rs. 30,000/- EDoctors/ Facilities covered for litigations up to 4 cases per year including defence cost Rs. 2,00,000/- Dissemination meetings conducted for all state officials Dissemination meetings conducted for all state officials Public institutions to display boards on the scheme Public institutions to display boards on the scheme _________________________

29 29 9. Strengthening contraceptive supply NSV instruments NSV instruments Revised Specifications prepared in 2006 (on website) Revised Specifications prepared in 2006 (on website) States asked to procure as per their requirements through PIPStates asked to procure as per their requirements through PIP Laparoscopes Laparoscopes Revised Specifications prepared in 2006 (on website) Revised Specifications prepared in 2006 (on website) States asked to procure as per their requirements from central funds as per approved specifications (can place indents with the TNMSC ) States asked to procure as per their requirements from central funds as per approved specifications (can place indents with the TNMSC ) ECP supply ECP supply Procurement has restarted recently Procurement has restarted recently Requirements from states received and being supplied Requirements from states received and being supplied

30 30 10. Promotion of contraception through intensive advocacy Advocacy kit on contraceptives Expert committee and core committee set up Expert committee and core committee set up All existing material reviewed and updated New materials developed for NSV, IUD380A, ECP, OCP All prototypes for audio, video and print (leaflets, flip charts, posters) finalised and passed on to the IEC division for production and distribution to the states (Jan, 08) Dissemination of FP capsule through regional workshops (WHO biennium 08-09) Dissemination of FP capsule through regional workshops (WHO biennium 08-09) Approval obtained Funding awaited

31 31 Family Planning Components (What the SFT should look for) Components (What the SFT should look for) Contraception Contraception Conception (infertility management) Conception (infertility management) Quality Assurance Quality Assurance Accreditation of facilities Accreditation of facilities Empanelment of providers Empanelment of providers Compensation Compensation Insurance Insurance

32 32 Responsibilities of the states/ districts Increase number of services centres Increase number of services centres Availability of services Availability of services Accessibility of services Accessibility of services Affordability of services Affordability of services (Upgradaiton of DHs, FRUs, CHCs, PHCs & SCs under NRHM) Accreditation of private providers (PPP) Accreditation of private providers (PPP)

33 33 Responsibilities of the states/ districts Regular fixed day services round the year a) DH- on demand (daily/ weekly) b) FRU/CHC- weekly/fortnightly/monthly c) PHC- monthly/ bimonthly - (Tubectomy only if OT available) d) SC- IUD/ ECP (on demand) Tubectomy:Wednesday (optional) Vasectomy:Saturday (optional)

34 34 Responsibilities of the states/ districts 1.Ensure at least One NSV Surgeon per PHC (ultimate aim) One NSV Surgeon per PHC (ultimate aim) One Tubectomy Surgeon per PHC (ultimate aim) One Tubectomy Surgeon per PHC (ultimate aim) One IUDProvider per SC (ultimate aim) One IUDProvider per SC (ultimate aim) 2.Effect Manpower Rationalization Manpower Planning (based on ELA) Manpower Planning (based on ELA) Manpower Training Manpower Training Manpower Placement Manpower Placement 3.Develop Comprehensive Training Plan for NSV NSV Minilap Minilap LTT LTT IUD IUD ECP ECP

35 35 Action at State/Dist. level Appoint Nodal officer for Family Planning Appoint Nodal officer for Family Planning (for Planning, Implementing, Monitoring, Supervising & Evaluation) Constitute QAC at state level (10 members) & notify Constitute QAC at state level (10 members) & notify Constitute DQAC at dist. level (9 members) & notify Constitute DQAC at dist. level (9 members) & notify Accredit facilities (Public/Private/NGO) Accredit facilities (Public/Private/NGO) Empanel doctors (Public/Private/NGO) Empanel doctors (Public/Private/NGO) Conduct Conduct Half yearly meetings of state QAC (to be minuted) Half yearly meetings of state QAC (to be minuted) Quarterly meetings of Dist. QAC (to be minuted) Quarterly meetings of Dist. QAC (to be minuted)

36 36 Action at State/Dist. level Orientation of CMOs on NFPIS (National Family Planning Insurance Scheme) NFPIS (National Family Planning Insurance Scheme) Compensation Scheme (Revised) Compensation Scheme (Revised) ELA district wise for limiting & spacing methods (based on dist. Unmet Need) ELA district wise for limiting & spacing methods (based on dist. Unmet Need) Manpower development (district action plan) Manpower development (district action plan) NSV (MOs) NSV (MOs) Minilap/ LTT (MOs) Minilap/ LTT (MOs) IUD (MOs/ SNs/ LHVs/ ANMs) IUD (MOs/ SNs/ LHVs/ ANMs) ECPs (MOs/ SNs/ LHVs/ ANMs/ ASHAs) ECPs (MOs/ SNs/ LHVs/ ANMs/ ASHAs) Contraceptive updates Contraceptive updates District budget allocation and disbursement District budget allocation and disbursement Monthly Review of FP performance with CMOs

37 37 Action at State/Dist. level Display prominently (facility wise) Revised compensation scheme Revised compensation scheme Family planning insurance scheme Family planning insurance scheme Service availability (district action plan) Service availability (district action plan) Fixed day service calendar Fixed day service calendar NSV NSV Minilap/ LTT Minilap/ LTT IUD IUD Camp calendar for above Camp calendar for above IEC materials on IEC materials on NSV NSV IUD IUD ECPs ECPs Budget may be provided accordingly Budget may be provided accordingly

38 38 Action at State/Dist. level Lay down benchmarks (performance indicators) and Rank Districts Rank Districts Reward districts Reward districts Reward CMOs (state award) Reward CMOs (state award) Recommend for national recognition Recommend for national recognition

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