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Reproductive & Child Health interventions:

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1 Reproductive & Child Health interventions:
Status and issues at a glance…. Dr. Rakesh Kumar, Joint Secretary (RCH), Ministry of Health & Family Welfare Government of India

2 Current Status (All India)
RCH-II GOAL INDICATORS ALL INDIA STATUS (Source of data) RCH Goals (2012) MMR 301 (SRS ) 254 (SRS ) 212 (SRS 07-09) <100 IMR 60 (SRS 2003) 53 (SRS 2008) 47 (SRS 2010) <30 TFR 3.0 (SRS 2003) 2.6 (SRS 2008) 2.5 (SRS 2010) 2.1 12 States and UTs have achieved the national target for IMR 21 States and UTs have achieved national target for TFR. Only Kerala and Tamil Nadu have achieved all 3 RCH goals.

3 Mothers who had full antenatal check-up (%)
Maternal Health - Full Antenatal Check-up Significant Rural –Urban Variation across 9 states; Orissa & Chhattisgarh and UP & Bihar reflect the two extremes Mothers who had full antenatal check-up (%) State State value Minimum Maximum Range Assam 11.9 Dhubri (2.1) Jorhat (18.2) 16.1 Bihar 5.9 Madhepura (2.4) Patna (16.4) 14.0 Jharkhand 13.1 Garhwa (3.6) Purbi Singhbhum (31.6) 28.1 Madhya Pradesh 13.3 Sheopur (1.8) Balaghat (30.8) 28.9 Chhattisgarh 19.5 Korba (10.9) Dhamtari (34.5) 23.6 Odisha 18.6 Jajpur (5.4) Jagatsinghpur (36.0) 30.6 Rajasthan 8.5 Karauli (1.7) Jaipur (19.5) 17.8 Uttar Pradesh 3.9 Balrampur (0.6) Kanpur Nagar (14.8) 14.3 Uttarakhand 11.1 Rudra Prayag (3.7) Dehradun (22.7) 19.0 With in a State, the maximum variability of 28.0 reported in Jharkhand. Across 284 districts, Full ANC ranges from 0.6% in Balrampur (UP) to 30.6% in Jagatsinghpur ( Odisha)- a variability of more than 28.9% points.

4 Maternal Health Issues Key actionable points
Delivery Points aim to provide comprehensive care at the 17,000 health facilities that are performing above a certain benchmark. Issues Irregular & Incomplete reporting on DPs Less than 50% FRUs conducting C- section with low numbers Only about 50% of 24X7 PHCs have a delivery load of 10 or more per month Underutilized DPs Key actionable points Regular performance monitoring of DPs Prioritization of resources including rational deployment of manpower Regular reporting by States like Rajasthan, MP, Haryana, Orissa Less than 40% FRUs conduct C sections in AP, Bihar, Chhattisgarh, Jharkhand, MP, Odisha, Rajasthan, Uttarakhand

5 Safe Delivery Significant Rural –Urban Variation across 9 states; Jharkhand & Chhattisgarh and Rajasthan & MP reflect the two extremes Safe delivery (%) State State value Minimum Maximum Range Assam 70.1 Karimganj, Hailakandi (34.8) Sibsagar (88.2) 53.4 Bihar 53.5 Sheohar (30.2) Munger (80.4) 50.2 Jharkhand 47.1 Pakaur (24.8) Purbi Singhbhum (69.0) 44.2 Madhya Pradesh 82.2 Dindori (45.5) Indore (96.3) 50.9 Chhattisgarh 49.5 Surguja (32.6) Kanker (69.4) 36.8 Odisha 75.2 Nabarangpur (35.6) Puri (92.7) 57.1 Rajasthan 76.2 Jaisalmer (48.6) Jaipur (92.2) 43.6 Uttar Pradesh 51.3 Balrampur (22.0) Jhansi (89.4) 67.4 Uttarakhand 56.9 Tehri Garhwal (43.1) Nainital (79.5) 36.4 With in a State, the maximum variability of 67.0% points reported in UP. Across 284 districts, Safe Delivery ranges from 22.0% in Balrampur(UP) to 96.3% in Indore ( MP)- a variability of more than 74.3 % points.

6 Institutional Delivery (%)
Significant Inter-State variation across 9 states; Institutional Delivery: Ranges from 34.9% in Chhattisgarh to 76.1% in MP. Institutional Delivery (%) State State value Minimum Maximum Range Assam 57.7 Hailakandi(28.9%) Nalbari(77.6%) 48.7 Bihar 47.7 Sheohar(24.2%) J Munger(75%) 50.8 Jharkhand 37.6 Dumka(19.4%) Purbi Singhbhum(63.0%) 43.6 Madhya Pradesh 76.1 Indore(92.5%) Dindori(44.5%) 48.0 Chhattisgarh 34.9 Bilaspur(21.9%) Bastar(59.3%) 37.4 Odisha 71.3 Nabarangapur(31.8%) Puri (91.6%) 59.8 Rajasthan 70.2 Barmer(34.5%) Jaipur(90.9%) 56.4 Uttar Pradesh 45.6 Balrampur (16.8%) Jhansi(75.2%) 58.4 Uttarakhand 50.5 Bageshwar(33.9%) Dehradun(70.2%) 36.3 With in a State, the maximum variability of 59.8 reported in Odisha. Across 284 districts, Institutional Delivery ranges from 16.8% in Balrampur(UP) to 91.6% (Odisha)- a variability of more than 62.7% points.

7 Tracking of Severe Anemia
Maternal Health Tracking of Severe Anemia Issues Poor tracking of severe anemia cases by majority of the states due to lack of orientation of frontline workers, coordinated IFA supply and Hb testing equipments Key actionable points Orient all frontline workers on diagnosis and line listing of pregnant women with severe anaemia. Coordination between supply of IFA tablets, availability of trained laboratory technicians & testing equipments, referral linkages for treatment. Odisha, J&K and M.P have started tracking and reporting on severely anemic women at Delivery Points

8 Maternal Death Review (MDR)
Maternal Health Maternal Death Review (MDR) Issues Irregular and under reporting Both FBMDR and CBMDR are in place in very few states Poor quality review confining to medical causes rather than identifying sytemic gaps Key actionable points State level team to orient, train and mentor the service providers & field functionaries Dissemination of findings of analysis of maternal deaths to all stakeholders Prioritize constitution of FBMDR committees at DPs (FRUs and above) No. of States reporting regularly has increased from 9 to 20 in a period of 6 months (Sept 2011 to March, 2012) States of MP, Assam, Odisha & Punjab have taken a no. of initiatives to improve MDR process

9 Safe Abortion Services
Maternal Health Safe Abortion Services Issues Poor reporting by the states, only 12 states have reported on 6 monthly formats Status of deployment & utilisation of skills of the already trained providers is not reported Absence or lack of functionality of District level MTP Committees Key actionable points Need to prioritize on expanding availability and access to quality services in public sector (particularly “Delivery Points” Link CAC training to posting at specified “Delivery Points”. Activate DLCs to optimally utilise and regulate private sector providers. Strategise to disseminate visible IEC/BCC messages on safe abortion services. MP & Maharashtra have reported more than 50% trained providers providing MTP services.

10 Maternal Health RTI/STI Services Issues Key actionable points
Lack of convergence with SACS at the state level. Irregular availability of drugs in the field. Poor Linkage with the adolescent friendly clinics Testing of PW for HIV not done on regular basis No focus on elimination of congenital syphilis Key actionable points Convergence with SACS Procurement of Syndromic drug kit and RPR Testing kits. Linkages with AFHS. Ensuring testing of HIV in PW at delivery points. Testing of all PW at the DPs for syphilis.

11 Janani Suraksha Yojana (JSY)
JSY PERFORMANCE: JSY PERFORMANCE (I qtr) All India achievement for the I qtr is 82%. Majority of States have reported more than 70% achievement . Low performing states are: JH & Manipur (41%), Haryana (44%), Himachal (50%)

12 Maternal Health JSY Issues Key actionable points
Poor monitoring and random verification of JSY beneficiaries Delays in payments in most of the States (Jharkhand, Bihar, MP, UP, Manipur, Andhra Pradesh) JSY admin expenses used for non-JSY activities (Uttarakhand, Bihar) Less no. of mothers getting JSY benefit for home delivery (esp. Bihar, Assam, UP, Rajasthan) Grievance redressal cells yet to be established Delays in JSY reporting to GOI (almost all States) Key actionable points Monitoring and random verification of JSY beneficiaries to be initiated. Payment of incentive before women being discharged JSY admin expenses to be used only for JSY activities such as monitoring and IEC Eligible BPL pregnant women need to be paid home delivery assistance Grievance redressal cells to be established JSY reports need to be sent timely to GOI

13 Child Health-Neonatal period
Aim is to operationalise Newborn care corner at each delivery point and make one special newborn care unit functional in each district ; Cover all newborns for first 6 weeks of life through Home Based newborn Care Issues Slow progress in the setting up of sick newborn care units in HFD Paucity of trained manpower; 53% of the units have adequate MOs and 40% adequate Nurses Equipment lying unutilized in many units especially in NBSUs Slow pace of trainings resulting in incorrect clinical practices. Disconnect between different level of newborn care facilities; weak linkages with the community based programme (HBNC) Record keeping and timely reporting requires attention Mentoring & supervision by state level institutions missing Key actionable points Saturation of all delivery points with Newborn Care Corners; Facility Based Newborn Care trainings to be linked with posting to specified units Developing at least one State level Resource Center to support trainings, observership and mentoring process Convergence of newborn care facilities with the HBNC Establish effective referral linkages( district specific) between newborn care facilities (NBCC, NBSU and SNCU).

14 State specific issues in Neo-natal care
States/UTs Slow progress in establishment of SNCUs (< 50% against target) Manipur, Tripura, Sikkim, West Bengal, Bihar, Chhattisgarh, Uttar Pradesh, J & K, Himachal Pradesh, Punjab, Haryana, Andhra Pradesh, Lakshadweep Training of NSSK (< 75%) All State’/UTs except Arunachal Pradesh, Goa, Madhya Pradesh, Nagaland and Odisha Utilization of services in SNCUs (< 100 admissions/month) D & N Haveli, Goa, Himachal Pradesh, Jharkhand, Kerala, Mizoram and Nagaland 11 States/UTs either don’t have SNCU or not reported Out born admissions (< 30 % ) J & K, Kerala, Uttar Pradesh, Delhi, Mizoram, Bihar, Uttarakhand, Assam, Maharashtra, Chandigarh, Karnataka, Goa Training of ASHA in module 6 & 7 (< 50% ) Andhra Pradesh, Assam, Bihar, HP, J & K, Jharkhand, Maharashtra, Madhya Pradesh, Punjab, Rajasthan, Uttar Pradesh, West Bengal ASHA kit (not available) Andhra Pradesh, Assam, Bihar, J & K , Jharkhand, Maharashtra, Odisha, Punjab, Uttar Pradesh, West Bengal HBNC roll out (Home visit started) Chhattisgarh, Haryana, Gujarat, Karnataka, Maharashtra, Uttarakhand, Mizoram, Meghalaya, Sikkim , Tripura, Daman & Diu

15 Nutrition, ARI, Diarrhea
Community and facility based management of Diarrhoea and Pneumonia is a priority, promote infant and young child feeding practices through the health system and home based newborn care Issues Low awareness among providers regarding iron supplementation guidelines resulting in very low coverage Low use of Zinc with ORS in cases of diarrhoea Underutilisation of Nutrition Rehabilitation centres , outcomes not monitored and national treatment protocols not being followed by many states Limited focus on IYCF in State PIPs Slow pace of child health trainings especially F-IMNCI Key actionable points Reinforce anaemia and diarrhoea management guidelines; stock management of ORS, Zinc and iron syrup/tablets Establish State level Resource Centres to guide IYCF and Nutrition interventions Active promotion of IYCF practices in health facilities through all MCH contacts Review and strengthen linkages of community based program and AWC to NRCs

16 Child Nutrition, ARI and Diarrhoea
Issues States/UTs Vitamin A 1st Dose administration (<60%) Nagaland, Arunachal Pradesh, Madhya Pradesh, Bihar , Manipur, Uttar Pradesh, Haryana, Tamil Nadu, Meghalaya, Jammu & Kashmir, Gujarat, Rajasthan, Chhattisgarh, Sikkim, UTs combined, Uttarakhand, Jharkhand, Orissa, Delhi LBW babies (> 21%) Andhra Pradesh, Chandigarh, Dadra & Nagar Haveli, UP , MP, Jharkhand, Rajasthan, Uttarakhand, Assam, Bihar, Odisha Breastfeeding with in 1 hr (< 40% ) Tripura , Jharkhand, Uttar Pradesh, Punjab , Bihar, Jammu & Kashmir, Uttarakhand, Andhra Pradesh, Rajasthan, Delhi , West Bengal, Madhya Pradesh, Karnataka , Himachal Pradesh, Tamil Nadu IFA received by under 3 children (< 40%) UP, Rajasthan, Jharkhand, Uttarakhand, Odisha, MP, Assam, Bihar, Chatisgarh NRC establishment (< 50%) AP, Delhi, Rajasthan, Uttrakhand , WB NRC Utilisation (< 50%) UP Assam Karnataka Bihar Jharkhand Maharashtra ORT /ORS use (< 50%) Uttarakhand , Uttar Pradesh, Jharkhand , Bihar, Madhya Pradesh , Rajasthan , West Bengal , Punjab

17 Fully Immunized Children (AHS-2011)
Full Immunization State State Value Minimum Maximum Uttrakhand 75.4 Haridwar (55.3%) Pithoragarh (87.5%) Chattisgarh 74.1 Surguja (55.5%) Kanker ( 93.2%) Rajasthan 70.8 Dhaulpur (37.4%) Hanumangarh (91.4%) Bihar 64.5 Kishanganj (26.6%) Samastipur ( 83.9%) Jharkhand 63.7 Giridih (28%) Purbi Singhbhum (82.7%) Assam 59 Dhubri (29.9%) Dibrugarh (83.8%) Odisha 55.0 Rayagada (11.9%) Kendrapara (82.9%) MP 54.9 Jhabua ( 23.8%) Indore (77.6%) UP 45.3 Etah (13.5%) Basti (73.8%) State of Odisha has the maximum variation among the districts min 11.9 to max and next is UP

18 Routine Immunization Year 2012 declared as Year of Intensification of Routine Immunization Immunization weeks being conducted across the country Hepatitis B vaccine universalized Issues Missed out/hard to reach/ high risk area with low immunization coverage Areas missed due to vacant sub-centers Poor cold chain maintenance Inadequately trained human resource Low coverage of Hepatitis B, especially the birth dose Poor demand generation and awareness activity at field level Key actionable points Mapping of such areas, updating microplan to incorporate them, covering these areas on highest priority Ensuring Alternative vaccinators until vacancy filled Ensure trained refrigerator mechanics for each district and training of all health workers Implement Hep B-birth dose at all health institutions conducting delivery. Improve coverage of Hep B Design BCC plan at community/district and state level

19 Routine Immunization States with Low Performance
DPT3 Coverage (<50% coverage) Uttar Pradesh, Assam, Puducherry, West Bengal, Karnataka, Chhattisgarh, Arunachal Pradesh, Kerala, Tamil Nadu, Sikkim, Uttarakhand Hepatitis -B birth dose (<15% coverage) Meghalaya, Rajasthan, Karnataka, Lakshadweep, Himachal Pradesh, Manipur, Maharashtra, Jharkhand, Chhattisgarh, Assam, Haryana, Uttar Pradesh, West Bengal, Gujarat, Arunachal Pradesh, Mizoram, Tamil Nadu, Sikkim, Uttarakhand DPT1- DPT 3 drop out (>10% children ) Puducherry, Lakshadweep, Meghalaya, Daman & Diu, Uttarakhand Planned sessions missed (>20%) Meghalaya, Uttar Pradesh, Uttarakhand, Maharashtra Measles 2nd Dose (<15% coverage Non-SIA states) Karnataka, Andhra Pradesh, Delhi, Tamil Nadu, Uttarakhand

20 Immunization Campaigns (Polio, Measles, JE)
WHO removed India from the list of countries with active endemic wild polio virus transmission Measles Catch-up campaign completed in 9 states vaccinating 4.8 crore children 62 new JE endemic districts identified and will be covered under campaign in phased manner. Issues Risk of importation of Polio virus still persists Introduction of Measles 2nd dose under RI after 6 months of campaign pending in many districts Phase III of Measles campaign targeting 167 districts in 5 states starting September 2012 Poor coverage of JE vaccine under RI in 113 JE endemic districts Key actionable points Maintain high coverage during pulse polio round States to issue orders for incorporation of Measles 2nd dose under RI UP, Bihar, Gujarat, MP and Rajasthan to ensure >90% coverage Increase JE vaccination coverage under RI in endemic districts

21 Family Planning-Total Fertility Rate
Significant Rural-Urban variation across 9 large States ; Uttarakhand & Odisha and UP & Bihar reflect the two extremes. Total Fertility Rate (TFR) State State value Minimum Maximum Range Assam 2.6 Kamrup (2) Hailakandi (4.2) 2.2 Bihar 3.7 Patna (2.8) Sheohar (4.7) 1.9 Jharkhand 3.1 Purbi Singhbhum (2.4) Lohardagga (4) 1.6 Madhya Pradesh Indore (2.2) Shivpuri (4.5) 2.3 Chhattisgarh 2.9 Koriya (2.4) Kawardha (3.7) 1.3 Odisha Jharsuguda (2) Boudh (3.7) 1.7 Rajasthan 3.2 Kota (2.6) Barmer (4.7) 2.1 Uttar Pradesh 3.6 Kanpur Nagar (2.3) Shrawasti (5.9) Uttarakhand Pithoragarh (1.7) Haridwar (3.1) 1.4 Within a State, the maximum variability of 3.6 reported in Uttar Pradesh Across 284 districts, TFR ranges from 1.7 in Pithoragarh (Uttarakhand) to 5.9 in Shrawasti (UP)- a variability of more than 4 children!

22 Family Planning Status of Key Activities
Intervention Better performing States Poor performing States PPIUCD TRAINING – 6 high focus states: Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Rajasthan and Uttar Pradesh Bihar, Rajasthan and Jharkhand are progressing well Madhya Pradesh, Chhattisgarh and Jharkhand INTERVAL IUCD TRAINING in 11 states; 8 EAG states, Assam, Haryana and J&K Assam and Haryana have started the project, Bihar, Chhattisgarh, J&K and Uttarakhand are likely to start soon Madhya Pradesh, Uttar Pradesh, Odisha and Rajasthan APPOINTMENT OF RMNCH COUNSELLORS – 18 states Bihar and Madhya Pradesh None of the other states have reported any progress. POST PARTUM STERILISATION (PPS): (as % of total sterilisation) Tamil Nadu, Goa, Kerala, Andhra Pradesh, Puducherry (more than 50%) All EAG states have less than 10% PPS

23 Family Planning Delivery of contraceptives by ASHAs at doorstep (launched in July 2011) ASHA are delivering contraceptives at the doorsteps in 233 districts of 17 States 231 districts have implemented except East & South Garo Hills of Meghalaya 7 of these 231 districts are yet to send utilization reports: Bihar (Sheikhpura) Uttar Pradesh (Lakhimpur Kheri, Bhadohi, Barabanki, Kannauj) - 4 Manipur (Ukhrul, Tamenglong), Response from NE states (except Assam), Himachal Pradesh and Uttar Pradesh is very poor Although Chhattisgarh and Jharkhand have reported utilisation of contraceptives, filed visits suggest that the scheme has not taken off at the field level

24 Family Planning Ensuring spacing after marriage and between 1st and 2nd child (launched in May 2012) through incentivisation of ASHAs Services of ASHAs for counselling newly married couples to ensure spacing of 2 years after marriage and spacing of 3 years after the birth of 1st child. The scheme is operational in 18 states (EAG, NE and Gujarat and Haryana) ASHA would be paid following incentives under the scheme: Rs. 500/- to ASHA for ensuring spacing of 2 years after marriage. Rs. 500/- to ASHA for ensuring spacing of 3 years after the birth of 1st child Rs. 1000/- in case the couple opts for a permanent limiting method up to 2 children only

25 Adolescent Health - ARSH
Issues Slow pace of ARSH Programme implementation in Uttar Pradesh, Bihar, Chhattisgarh and Himachal Pradesh Irregular clinics with poor turn out Hardly any referrals Poor community mobilisation Inadequate convergence with other departments Inadequate reporting Key actionable points Setting up of services (clinics) for adolescents Ensure deployment of trained staff at ARSH clinics Training of Human Resource Community mobilisation and out-reach services to be strengthened Regular reporting of activities Formulation of State specific IEC strategy for Adolescents Best Practices: Implementation models by States like ‘Udaan’ of Uttarakhand, ‘Maitreyi’ Clinics of Maharashtra, Sneha Clinics of West Bengal & Yuva Clinics of AP. Peer Educator model of Assam, Haryana can be replicated. Working on outreach strengthening and comprehensive package of services National Strategy for Adolescent Health in India is under construction

26 School Health Programme
Issues Biannual screening for Disease, Deficiency and Disability yet to emerge across States in the country Dedicated school health teams not proposed by the states Micro-planning not available Poor mentoring, monitoring, and reporting Poor utilization of resources approved in state Key actionable points Closer coordination with Department of Education. Linkages with other NRHM – components like Adolescent Health Pooling of resource – financial, IEC and Human, National Disease control programmes Best Practices: Dedicated team for screening in Maharashtra Implementation through exclusive teams – Maharashtra, Kerala (JPHN at schools), Uttarakhand, A&N island (outsourced) and in campaign mode in Gujarat, Bihar & Himachal Pradesh, with involvement of public health infrastructure in other states, Public and PPP– Rajasthan

27 Menstrual Hygiene Scheme
Issues Slow uptake of sanitary napkins Incomplete re-conciliation of records across various levels Hardly any counseling of AGs Irregular reporting to MoHFW, especially by Chhattisgarh and Uttar Pradesh Convergence required with Total Sanitation Campaign / for effecting disposal mechanisms Key actionable points Re-orientation / re-training of ASHAs regarding promotion of sanitary napkins. Monitoring to be strengthened Focus more on new users i.e. Girls who have not had access to any such product prior to launch of scheme. Proper record maintenance i.e. reconciliation of delivery by HLL / receipt by State and sale of packs vis-à-vis amount of incentive paid to ASHA, as they should match Use of incinerators and their construction through Total Sanitation Campaign / SSA funds Status of Implementation Total supply by HLL to States = 322 lakh packs 2nd and 3rd quarter supplies (> 600 lakhs packs) also in place % of consumption till 31st July 2012 = 26.3 % States performing well (good uptake) in HP, Kerala, MP, Orissa (Out of 17 implementing States through Central Supply)

28 Weekly Iron Folic Acid Supplementation (WIFS)
Issues No plan for WIFS submitted by Chhattisgarh, Himachal Pradesh, Lakshadweep and Daman and Diu They also did not participate in the National Level TOTs. Difficulties in IFA procurement for NE states and UTs State level WIFS Advisory committees yet to be activated Key actionable points States (UP, Chhattisgarh, Himachal Pradesh, Lakshadweep and Daman and Diu) to submit plans Difficulties in procurement for NE states and UTs being addressed through GO on procurement of IFA and Albendazole tablets from CPSE. States need to proactively take it up Convergence with Education and ICDS/SABLA departments Formation of State level WIFS Advisory Committee Trainings Development of media plan Regular reporting, monitoring and review of implementation Readiness Status: PAN INDIA ROLL OUT As per State plans, 23 states to complete procurement process by end September, , Rajasthan, Karnataka, Chandigarh, Jharkhand, Mizoram and Puducherry by October 2012. Supply of IFA and Albendazole tablets to reach schools & Aganwadi centres by end November in 22 States / UTs except Manipur, Meghalaya, Karnataka (end December 2012) and Rajasthan (February 2013) Training of all field functionaries to be complete by November, 2012 barring Meghalaya (in Dec 2012)

29 Reproductive age group
Adopting evidence based interventions across Lifecycle (RMNCH+A Strategy) Promotion of IYCF practices Routine Immunisation plus Hepatitis B, H influenza ,Pulse polio Vitamin A & Iron Folic Acid supplementation Use of ORS and Zinc for diarrhea Integrated Case management of neonatal and childhood illnesses Management of children with severe acute malnutrition Childhood Weekly Iron Folic Acid Supplementation, Preventive health check-ups; Screening for disease, deficiency and disability & referral Provision of reproductive & sexual health services Promotion of menstrual hygiene Adolescents Family planning advice and counseling ,Provision of a range of family planning methods Screening for STIs and its management Access to Safe abortion & Post abortion care Reproductive age group Neonatal resuscitation with bag and mask Essential new-born care at birth and up to 6 weeks Management of sick newborns Neonatal period Essential care during pregnancy Tracking of pregnant women with severe anemia and case management Access to safe abortion and post abortion FP counseling and services Treatment of complications of s/unsafe abortions Management of STI/RTI PPTCT Pregnancy Detection and management of postpartum sepsis & other complications in postnatal period Home based postnatal care & support for breastfeeding Post-partum family planning advice and provision of contraceptives Postpartum Care during labour and delivery (at the health facility) Skilled birth attendance for home deliveries Emergency Obstetric care Birth

30 Summary of Key Actions Imperative to closely monitor the State specific targets under RCH Define District specific targets and review accordingly Strengthen monitoring of key interventions at all levels (use Dashboard indicators); timely reporting (HMIS, MCTS) and feedback for midcourse correction Special attention to High Focus Districts; 9 states should use AHS data for District specific planning District specific strategies to be adopted to reach the ‘Unreached’ population including urban poor Strengthen referrals and linkages between various levels of health facilities to ensure Continuum of Care Emphasize on quality of care: national guidelines and protocols for management should be followed

31 Thank You

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