Presentation on theme: "Reproductive & Child Health interventions:"— Presentation transcript:
1 Reproductive & Child Health interventions: Status and issues at a glance….Dr. Rakesh Kumar, Joint Secretary (RCH), Ministry of Health & Family WelfareGovernment of India
2 Current Status (All India) RCH-II GOAL INDICATORSALL INDIA STATUS(Source of data)RCH Goals (2012)MMR301 (SRS )254 (SRS )212 (SRS 07-09)<100IMR60 (SRS 2003)53 (SRS 2008)47 (SRS 2010)<30TFR3.0 (SRS 2003)2.6 (SRS 2008)2.5 (SRS 2010)2.112 States and UTs have achieved the national target for IMR21 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-upSignificant Rural –Urban Variation across 9 states; Orissa & Chhattisgarh and UP & Bihar reflect the two extremesMothers who had full antenatal check-up (%)StateState valueMinimumMaximumRangeAssam11.9Dhubri (2.1)Jorhat (18.2)16.1Bihar5.9Madhepura (2.4)Patna (16.4)14.0Jharkhand13.1Garhwa (3.6)Purbi Singhbhum (31.6)28.1Madhya Pradesh13.3Sheopur (1.8)Balaghat (30.8)28.9Chhattisgarh19.5Korba (10.9)Dhamtari (34.5)23.6Odisha18.6Jajpur (5.4)Jagatsinghpur (36.0)30.6Rajasthan8.5Karauli (1.7)Jaipur (19.5)17.8Uttar Pradesh3.9Balrampur (0.6)Kanpur Nagar (14.8)14.3Uttarakhand11.1Rudra Prayag (3.7)Dehradun (22.7)19.0With 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.IssuesIrregular & Incomplete reporting on DPsLess than 50% FRUs conducting C- section with low numbersOnly about 50% of 24X7 PHCs have a delivery load of 10 or more per monthUnderutilized DPsKey actionable pointsRegular performance monitoring of DPsPrioritization of resources including rational deployment of manpowerRegular reporting by States like Rajasthan, MP, Haryana, OrissaLess than 40% FRUs conduct C sections in AP, Bihar, Chhattisgarh, Jharkhand, MP, Odisha, Rajasthan, Uttarakhand
5 Safe DeliverySignificant Rural –Urban Variation across 9 states; Jharkhand & Chhattisgarh and Rajasthan & MP reflect the two extremesSafe delivery (%)StateState valueMinimumMaximumRangeAssam70.1Karimganj, Hailakandi (34.8)Sibsagar (88.2)53.4Bihar53.5Sheohar (30.2)Munger (80.4)50.2Jharkhand47.1Pakaur (24.8)Purbi Singhbhum (69.0)44.2Madhya Pradesh82.2Dindori (45.5)Indore (96.3)50.9Chhattisgarh49.5Surguja (32.6)Kanker (69.4)36.8Odisha75.2Nabarangpur (35.6)Puri (92.7)57.1Rajasthan76.2Jaisalmer (48.6)Jaipur (92.2)43.6Uttar Pradesh51.3Balrampur (22.0)Jhansi (89.4)67.4Uttarakhand56.9Tehri Garhwal (43.1)Nainital (79.5)36.4With 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 (%)StateState valueMinimumMaximumRangeAssam57.7Hailakandi(28.9%)Nalbari(77.6%)48.7Bihar47.7Sheohar(24.2%)J Munger(75%)50.8Jharkhand37.6Dumka(19.4%)Purbi Singhbhum(63.0%)43.6Madhya Pradesh76.1Indore(92.5%)Dindori(44.5%)48.0Chhattisgarh34.9Bilaspur(21.9%)Bastar(59.3%)37.4Odisha71.3Nabarangapur(31.8%)Puri (91.6%)59.8Rajasthan70.2Barmer(34.5%)Jaipur(90.9%)56.4Uttar Pradesh45.6Balrampur (16.8%)Jhansi(75.2%)58.4Uttarakhand50.5Bageshwar(33.9%)Dehradun(70.2%)36.3With 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 HealthTracking of Severe AnemiaIssuesPoor tracking of severe anemia cases by majority of the states due to lack of orientation of frontline workers, coordinated IFA supply and Hb testing equipmentsKey actionable pointsOrient 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 HealthMaternal Death Review (MDR)IssuesIrregular and under reportingBoth FBMDR and CBMDR are in place in very few statesPoor quality review confining to medical causes rather than identifying sytemic gapsKey actionable pointsState level team to orient, train and mentor the service providers & field functionariesDissemination of findings of analysis of maternal deaths to all stakeholdersPrioritize 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 HealthSafe Abortion ServicesIssuesPoor reporting by the states, only 12 states have reported on 6 monthly formatsStatus of deployment & utilisation of skills of the already trained providers is not reportedAbsence or lack of functionality of District level MTP CommitteesKey actionable pointsNeed 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 clinicsTesting of PW for HIV not done on regular basisNo focus on elimination of congenital syphilisKey actionable pointsConvergence with SACSProcurement 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 beneficiariesDelays 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 establishedDelays in JSY reporting to GOI (almost all States)Key actionable pointsMonitoring and random verification of JSY beneficiaries to be initiated.Payment of incentive before women being dischargedJSY admin expenses to be used only for JSY activities such as monitoring and IECEligible BPL pregnant women need to be paid home delivery assistanceGrievance redressal cells to be establishedJSY 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 CareIssuesSlow progress in the setting up of sick newborn care units in HFDPaucity of trained manpower; 53% of the units have adequate MOs and 40% adequate NursesEquipment lying unutilized in many units especially in NBSUsSlow 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 attentionMentoring & supervision by state level institutions missingKey actionable pointsSaturation of all delivery points with Newborn Care Corners;Facility Based Newborn Care trainings to be linked with posting to specified unitsDeveloping at least one State level Resource Center to support trainings, observership and mentoring processConvergence of newborn care facilities with the HBNCEstablish effective referral linkages( district specific) between newborn care facilities (NBCC, NBSU and SNCU).
14 State specific issues in Neo-natal care States/UTsSlow 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, LakshadweepTraining of NSSK (< 75%)All State’/UTs except Arunachal Pradesh, Goa, Madhya Pradesh, Nagaland and OdishaUtilization of services in SNCUs (< 100 admissions/month)D & N Haveli, Goa, Himachal Pradesh, Jharkhand, Kerala, Mizoram and Nagaland11 States/UTs either don’t have SNCU or not reportedOut born admissions(< 30 % )J & K, Kerala, Uttar Pradesh, Delhi, Mizoram, Bihar, Uttarakhand, Assam, Maharashtra, Chandigarh, Karnataka, GoaTraining of ASHA in module 6 & 7 (< 50% )Andhra Pradesh, Assam, Bihar, HP, J & K, Jharkhand, Maharashtra, Madhya Pradesh, Punjab, Rajasthan, Uttar Pradesh, West BengalASHA kit (not available)Andhra Pradesh, Assam, Bihar, J & K , Jharkhand, Maharashtra, Odisha, Punjab, Uttar Pradesh, West BengalHBNC 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 careIssuesLow awareness among providers regarding iron supplementation guidelines resulting in very low coverageLow use of Zinc with ORS in cases of diarrhoeaUnderutilisation of Nutrition Rehabilitation centres , outcomes not monitored and national treatment protocols not being followed by many statesLimited focus on IYCF in State PIPsSlow pace of child health trainings especially F-IMNCIKey actionable pointsReinforce anaemia and diarrhoea management guidelines; stock management of ORS, Zinc and iron syrup/tabletsEstablish State level Resource Centres to guide IYCF and Nutrition interventionsActive promotion of IYCF practices in health facilities through all MCH contactsReview and strengthen linkages of community based program and AWC to NRCs
16 Child Nutrition, ARI and Diarrhoea IssuesStates/UTsVitamin 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, DelhiLBW babies (> 21%)Andhra Pradesh, Chandigarh, Dadra & Nagar Haveli, UP , MP, Jharkhand, Rajasthan, Uttarakhand, Assam, Bihar, OdishaBreastfeeding 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 NaduIFA received by under 3 children (< 40%)UP, Rajasthan, Jharkhand, Uttarakhand, Odisha, MP, Assam, Bihar, ChatisgarhNRC establishment(< 50%)AP, Delhi, Rajasthan, Uttrakhand , WBNRC Utilisation (< 50%)UP Assam Karnataka Bihar Jharkhand MaharashtraORT /ORS use (< 50%)Uttarakhand , Uttar Pradesh, Jharkhand , Bihar, Madhya Pradesh , Rajasthan , West Bengal , Punjab
17 Fully Immunized Children (AHS-2011) Full ImmunizationStateState ValueMinimumMaximumUttrakhand75.4Haridwar (55.3%)Pithoragarh (87.5%)Chattisgarh74.1Surguja (55.5%)Kanker ( 93.2%)Rajasthan70.8Dhaulpur (37.4%)Hanumangarh (91.4%)Bihar64.5Kishanganj (26.6%)Samastipur ( 83.9%)Jharkhand63.7Giridih (28%)Purbi Singhbhum (82.7%)Assam59Dhubri (29.9%)Dibrugarh (83.8%)Odisha55.0Rayagada (11.9%)Kendrapara (82.9%)MP54.9Jhabua ( 23.8%)Indore (77.6%)UP45.3Etah (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 ImmunizationYear 2012 declared as Year of Intensification of Routine ImmunizationImmunization weeks being conducted across the countryHepatitis B vaccine universalizedIssuesMissed out/hard to reach/ high risk area with low immunization coverageAreas missed due to vacant sub-centersPoor cold chain maintenanceInadequately trained human resourceLow coverage of Hepatitis B, especially the birth dosePoor demand generation and awareness activity at field levelKey actionable pointsMapping of such areas, updating microplan to incorporate them, covering these areas on highest priorityEnsuring Alternative vaccinators until vacancy filledEnsure trained refrigerator mechanics for each district and training of all health workersImplement Hep B-birth dose at all health institutions conducting delivery. Improve coverage of Hep BDesign 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, UttarakhandHepatitis -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, UttarakhandDPT1- DPT 3 drop out (>10% children )Puducherry, Lakshadweep, Meghalaya, Daman & Diu, UttarakhandPlanned sessions missed (>20%)Meghalaya, Uttar Pradesh, Uttarakhand, MaharashtraMeasles 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 transmissionMeasles Catch-up campaign completed in 9 states vaccinating 4.8 crore children62 new JE endemic districts identified and will be covered under campaign in phased manner.IssuesRisk of importation of Polio virus still persistsIntroduction of Measles 2nd dose under RI after 6 months of campaign pending in many districtsPhase III of Measles campaign targeting 167 districts in 5 states starting September 2012Poor coverage of JE vaccine under RI in 113 JE endemic districtsKey actionable pointsMaintain high coverage during pulse polio roundStates to issue orders for incorporation of Measles 2nd dose under RIUP, Bihar, Gujarat, MP and Rajasthan to ensure >90% coverageIncrease 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)StateState valueMinimumMaximumRangeAssam2.6Kamrup (2)Hailakandi (4.2)2.2Bihar3.7Patna (2.8)Sheohar (4.7)1.9Jharkhand3.1Purbi Singhbhum (2.4)Lohardagga (4)1.6Madhya PradeshIndore (2.2)Shivpuri (4.5)2.3Chhattisgarh2.9Koriya (2.4)Kawardha (3.7)1.3OdishaJharsuguda (2)Boudh (3.7)1.7Rajasthan3.2Kota (2.6)Barmer (4.7)2.1Uttar Pradesh3.6Kanpur Nagar (2.3)Shrawasti (5.9)UttarakhandPithoragarh (1.7)Haridwar (3.1)1.4Within a State, the maximum variability of 3.6 reported in Uttar PradeshAcross 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 InterventionBetter performing StatesPoor performing StatesPPIUCD TRAINING – 6 high focus states:Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Rajasthan and Uttar PradeshBihar, Rajasthan and Jharkhand are progressing wellMadhya Pradesh, Chhattisgarh and JharkhandINTERVAL IUCD TRAINING in 11 states; 8 EAG states, Assam, Haryana and J&KAssam and Haryana have started the project, Bihar, Chhattisgarh, J&K and Uttarakhand are likely to start soonMadhya Pradesh, Uttar Pradesh, Odisha and RajasthanAPPOINTMENT OF RMNCH COUNSELLORS – 18 statesBihar and Madhya PradeshNone 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 PlanningDelivery of contraceptives by ASHAs at doorstep (launched in July 2011)ASHA are delivering contraceptives at the doorsteps in 233 districts of 17 States231 districts have implemented except East & South Garo Hills of Meghalaya7 of these 231 districts are yet to send utilization reports:Bihar (Sheikhpura)Uttar Pradesh (Lakhimpur Kheri, Bhadohi, Barabanki, Kannauj) - 4Manipur (Ukhrul, Tamenglong),Response from NE states (except Assam), Himachal Pradesh and Uttar Pradesh is very poorAlthough Chhattisgarh and Jharkhand have reported utilisation of contraceptives, filed visits suggest that the scheme has not taken off at the field level
24 Family PlanningEnsuring spacing after marriage and between 1st and 2nd child (launched in May 2012) through incentivisation of ASHAsServices 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 childRs. 1000/- in case the couple opts for a permanent limiting method up to 2 children only
25 Adolescent Health - ARSH IssuesSlow pace of ARSH Programme implementation in Uttar Pradesh, Bihar, Chhattisgarh and Himachal PradeshIrregular clinics with poor turn outHardly any referralsPoor community mobilisationInadequate convergence with other departmentsInadequate reportingKey actionable pointsSetting up of services (clinics) for adolescentsEnsure deployment of trained staff at ARSH clinicsTraining of Human ResourceCommunity mobilisation and out-reach services to be strengthenedRegular reporting of activitiesFormulation of State specific IEC strategy for AdolescentsBest 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 servicesNational Strategy for Adolescent Health in India is under construction
26 School Health Programme IssuesBiannual screening for Disease, Deficiency and Disability yet to emerge across States in the countryDedicated school health teams not proposed by the statesMicro-planning not availablePoor mentoring, monitoring, and reportingPoor utilization of resources approved in stateKey actionable pointsCloser coordination with Department of Education.Linkages with other NRHM – components like Adolescent HealthPooling of resource – financial, IEC and Human, National Disease control programmesBest Practices:Dedicated team for screening in MaharashtraImplementation 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 IssuesSlow uptake of sanitary napkinsIncomplete re-conciliation of records across various levelsHardly any counseling of AGsIrregular reporting to MoHFW, especially by Chhattisgarh and Uttar PradeshConvergence required with Total Sanitation Campaign / for effecting disposal mechanismsKey actionable pointsRe-orientation / re-training of ASHAs regarding promotion of sanitary napkins.Monitoring to be strengthenedFocus 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 matchUse of incinerators and their construction through Total Sanitation Campaign / SSA fundsStatus of ImplementationTotal supply by HLL to States = 322 lakh packs2nd 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) IssuesNo plan for WIFS submitted by Chhattisgarh, Himachal Pradesh, Lakshadweep and Daman and DiuThey also did not participate in the National Level TOTs.Difficulties in IFA procurement for NE states and UTsState level WIFS Advisory committees yet to be activatedKey actionable pointsStates (UP, Chhattisgarh, Himachal Pradesh, Lakshadweep and Daman and Diu) to submit plansDifficulties 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 upConvergence with Education and ICDS/SABLA departmentsFormation of State level WIFS Advisory CommitteeTrainingsDevelopment of media planRegular reporting, monitoring and review of implementationReadiness Status: PAN INDIA ROLL OUTAs 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 practicesRoutine Immunisation plus Hepatitis B, H influenza ,Pulse polioVitamin A & Iron Folic Acid supplementationUse of ORS and Zinc for diarrheaIntegrated Case management of neonatal and childhood illnessesManagement of children with severe acute malnutritionChildhoodWeekly Iron Folic Acid Supplementation, Preventive health check-ups; Screening for disease, deficiency and disability & referralProvision of reproductive & sexual health services Promotion of menstrual hygieneAdolescentsFamily planning advice and counseling ,Provision of a range of family planning methodsScreening for STIs and its managementAccess to Safe abortion & Post abortion careReproductive age groupNeonatal resuscitation with bag and maskEssential new-born care at birth and up to 6 weeksManagement of sick newbornsNeonatal periodEssential care during pregnancyTracking of pregnant women with severe anemia and case managementAccess to safe abortion and post abortion FP counseling and servicesTreatment of complications of s/unsafe abortionsManagement of STI/RTIPPTCTPregnancyDetection and management of postpartum sepsis & other complications in postnatal periodHome based postnatal care & support for breastfeedingPost-partum family planning advice and provision of contraceptivesPostpartumCare during labour and delivery (at the health facility)Skilled birth attendance for home deliveriesEmergency Obstetric careBirth
30 Summary of Key ActionsImperative to closely monitor the State specific targets under RCHDefine District specific targets and review accordinglyStrengthen monitoring of key interventions at all levels (use Dashboard indicators); timely reporting (HMIS, MCTS) and feedback for midcourse correctionSpecial attention to High Focus Districts; 9 states should use AHS data for District specific planningDistrict specific strategies to be adopted to reach the ‘Unreached’ population including urban poorStrengthen referrals and linkages between various levels of health facilities to ensure Continuum of CareEmphasize on quality of care: national guidelines and protocols for management should be followed