REPRODUCTIVE & CHILD HEALTH PROGRAMME, PHASE II (RCH II) CRM Briefing November 25, 2008 1

STRUCTURE OF THE PRESENTATION Current status vis-à-vis NRHM/RCH II goals Strategies and progress Maternal health Child health Immunisation Financial expenditure Innovations

CURRENT STATUS VIS-A-VIS RCH II/NRHM GOALS  RCH II Goal Indicator All India Status (Source of Data)  Targets for No. of states having achieved % of total population (for states having achieved) 10th Plan (2007) RCH II /NRHM (2012) 10th Plan targets RCH II /NRHM targets 10th Plan targets # RCH II /NRHM targets # MMR (per lakh live births) 398 (SRS 1997-98) 301 (SRS 2001-03) <200 <100 8 Nil 43.1% IMR (per 1000 live births) 71 (SRS 1997) 55 (SRS 2007) <45 <30 13 5 31.1% 3.7% TFR 3.3 2.8 (SRS 2006) 2.3 2.1 10 44.3% 25.0% Note: 1. # Census 2001 2. Current MMR and TFR data pre-dates RCH II, while IMR data is for first year of RCH II. 3. Union territories (except Delhi) have been excluded in the findings 3

JANANI SURAKSHA YOJANA (JSY) Key Features Early Registration Delivery care through micro-birth plan Referral Transport (Home to Health Institution) Promoting Institutional birth Post delivery visit and reporting Family Planning and Counseling Supported by ASHA/ any Link worker Cash Assistance

Mother’s/ ASHA Package JANANI SURAKSHA YOJANA- ELIGIBILITY LPS States (8 EAG, Assam, J&K) All pregnant women, delivering in Government or Accredited Private institutions HPS States (Remaining States & UTs) All BPL pregnant, SC and ST women, delivering in Government or Accredited Private institutions, aged 19 years, cash benefit restricted to two live births CASH ASSISTANCE (Rs.) Category Mother’s/ ASHA Package Rural Areas Urban Areas In LP States 1400/ 600 1000/ 200 In HP States 700 600

Allocation for 2008-09 is Rs. 1281.47 crores JSY PERFORMANCE 35% increase in reported beneficiaries in April – June quarter between 2007-08 and 2008-09. Some state examples on next slide. Allocation for 2008-09 is Rs. 1281.47 crores

JSY PERFORMANCE (contd..)

7.8 12.2 7.2 18.8 15.2 13.5 8.9

JSY EVALUATION STUDIES IN 6 STATES Evaluation of JSY scheme carried out in 2007 in 6 states : - UP, Rajasthan, MP, Orissa, Assam and West Bengal Major Highlights Increased utilization of ANC services. Institutional deliveries have substantially increased Positive shift to Institutional Delivery compared to previous birth. Social Equity issues being addressed. ANMs/ASHAs/AWWs – main source of information about JSY. Areas for strengthening Timely payments to beneficiaries and ASHAs. Costs incurred by BPL families on institutional delivery, including on transportation, accommodation and ANC checks.

JSY: STRATEGIES Steps to strengthen JSY Payment prior to discharge through bearer cheque Monitoring of JSY at all levels (including verification of specified proportion of beneficiaries by each level of officers) Grievance redressal mechanism for JSY set up at the local level; listing of beneficiaries outside the health facility to be instituted for ensuring transparency and for facilitating grievance redressal. Quality of deliveries at public health facilities to be monitored; private sector facilities accredited and monitored. Two days stay after delivery to be promoted, and newborn care essentials (counselling and basic equipment) are focused upon in the facilities MTR visits/ meetings have shown that: States are paying beneficiaries through bearer cheques Grievance redressal mechanisms have been set up at state levels Beneficiary lists are posted outside health facilities, and updated regularly 2-day stay post delivery is being promoted

3. INNOVATIONS

INNOVATIONS NRHM/ RCH II has fostered innovations due to the inherent flexibility provided for local need-based approaches for gaps in service delivery. A directory is currently being prepared after a desk review of innovative schemes/ approaches implemented by states. Innovations have been piloted within the NRHM/RCH II parameters of decentralization, flexibility, and results based performance Many innovations are targeted at BPL, and seeking to improve equity of access to health services Several are state specific but some span several states, or are similar across states (e.g. EMRI, Chiranjeevi-like schemes to promote safe motherhood/ institutional deliveries) RCH II has provided a platform for sharing of innovations across states. Several states have undertaken evaluation of their innovations, while some innovations have been evaluated nationally. Range and spread of innovations is impressive, and over 200 have been identified so far.

INNOVATIONS (CONTD..) Innovative schemes/ activities address “needs/ gaps” The Innovation document has been made according to the core areas which the innovations propose to address. For example the various sections are, referral transport, contracting out management of public health facilities, Safe Motherhood, etc. Out of the 208 innovations compiled, around 50 have been taken up for desk review and 19 for field study Innovations underway in states to be visited during CRM

MONITORING: WAY FORWARD Strengthening of system of Quarterly variance analysis reports (physical and financial) against approved state PIP Review meetings for monitoring and handholding DLHS-3 is currently underway; will provide inputs for mid course corrections. Joint Mid-Term Review (MTR) currently underway. The program will also be reviewed against specified Indicators to measure outcome of the interventions in last 3 years of RCH II.

Thank You