1. Maternal Health Interventions NRHM/RCH-II
Maternal Health Division
Ministry of Health & Family Welfare
Government of India

2. GOALS OF NRHM Universal Health Care access affordability equity
quality

3. Maternal Mortality-Magnitude of the Problem
About 30 million pregnancies occur every year in India.
27 million deliveries
15% of these are likely to develop complications.
Complications cannot be predicted.
77,000 avoidable maternal deaths per year

4. Maternal Mortality Maternal Mortality Ratio
“ number of women who die in a year due to causes related to pregnancy and child birth for every 100, 000 live births ”
Wide Variations:
India 301/100,000 live births
Tamil Nadu /100,000 live births
U.P /100,000 live births
Sweden/USA 8-12/100,000 live births
Sri Lanka /100,000 live births
Malaysia /100,000 live births

5. Maternal Mortality Ratio over the years
NSS( )*
NSS( )*
SRS( )
SRS( )
SRS( )
NFHS I ( ) **
NFHS II ( ) **
RGI,SRS ( )
RGI,SRS( )
RGI,SRS ( ) 301
* Based on indirect time series estimates
** Based on small sample size
Declining
trend

6. MMR Reduction We need to accelerate

7. MMR Trends (RGI-SRS-2006)

8. Goals and targets S.No Goal Target Indicators 1
MDG-5: To improve Maternal health
Reduce by 3/4ths the MMR,
MMR
Proportion of births attended by SBA
Institutional delivery 2
NPP-2000
Reduce MMR to
< 100/1,00,000 LB by 2010
80% Institutional Delivery
100% Safe delivery 3
NHP-2002
100/1,00,000 LB by 2015

9. Causes of Maternal Mortality

10. Strategies… over the years
Pre-CSSM
CSSM 1992
RCH – I
RCH – II
Care of Pregnant Women (Antenatal Care. Identify Comp. Refer, Safe/Inst Dely, PP Care)
High risk approach
Essn OC
Safe Deliveries/
Institutional Deliveries
TBAs
TBAs/Clean delivery
Instt/Safe delivery TBAs
Instt/Safe delivery Skilled attendance at birth
Emergency Obstetric Care -
Delay model FRUs
Operationali-sation of FRUs

11. ISSUES IN MATERNAL HEALTH
SOCIAL
Age at marriage
Maternal Care
Women’s status
PROGRAMMATIC
Antenatal care
Skilled attendance at birth
Emergency Obstetric care
Adopting a Lifecycle approach to Women’s health

12. MH Indicators- India, NFHS II and III

13. ANC Status, NFHS III

14. INSTITUTIONAL & SAFE DELIVERIES NFHS III

15. Key MH Strategies in RCH-II
Essential and Emergency Obstetric Care
Quality ANC, PNC, Institutional and Safe Delivery.
Skilled Attendance at birth (domiciliary & health facilities).
Operationalise FRUs, CHCs and 24 Hrs PHC.
Strengthen Referral Systems.
Management of RTIs & STIs at PHCs & CHCs/FRUs.
Safe Abortion Services - MVA at PHC level.
Infection Management and Environment Plan (IMEP).

16. NRHM
Accredited Social Health Activist (ASHA) – one per 1000 population
Janani Suraksha Yojana
Inter-sectoral Convergence.
Facility Strengthening / Improving Access
Strengthening of Infrastructure- IPHS
Improving availability of Human Resource
Untied funds at sub centres
Rogi Kalyan Samitis (Hosp. Mgmt. committees)
Involvement of Professional associations and medical colleges
Public private partnership

17. Essential Obstetric Care
Early Registration (12-16 wks)
3 Antenatal Check-ups
Prevention & Treatment of anemia
Institutional /Safe Delivery
Postnatal Check-up

18. BasicEmOC Comp.EmOC Parenteral A/B All functions of Parent.Oxytocics
Anticonvulsants
Digital removal of POC
MRP
Assisted vaginal delivery
All functions of
BasicEmOC +
Cs sections
Blood transfusion

19. MMR in1960s in Thailand, Srilanka &Malaysia

20. Home Deliveries and Neonatal Mortality

21. SKILLED BIRTH ATTENDANCE
Skilled Birth Attendant
Enabling Environment

22. Issues related to Skilled attendance at Birth
Reorienting Medical Officers
Preservice & inservice training for SNs/LHVs/ANMs
Operationalising SCs/ PHCs/CHCs/FRUs for skilled attendance at birth.(Enabling Environment)

23. Skilled Birth Attendance POLICY DECISIONS
Empower Health Worker for some Basic Em.O.C.interventions
Permission to use drugs for prevention of PPH.
Permission to use drugs in emergency situations before referral
Permission to perform basic procedures at community level in emergency situations

24. Emergency Obstetric Care
Critical factor- TIME: 3 delay model.
Decision to seek care
Arrival at health facility
Provision of adequate care at health facility
24 X 7 PHCs First Referral Units (FRUs) at sub-district level.

25. Janani Suraksha Yojana
100% centrally sponsored scheme
Promotes institutional delivery among poor pregnant women
Cash assistance to eligible women for delivery
Special dispensation for 10 states with low institutional delivery ( LPS)
ASHA- Link between beneficiary & govt.in LPS—other states are HPS

26. Policies and guidelines
Operationalising FRUs.
Setting up Blood Storage Units.
Operationalisation of 24x7 PHCs.
MTP up to 8 weeks pregnancy using MVA technique
Training of MBBS Doctors in Anesthesia skills.
Training of MBBS Doctors in EmOC including C-Section in partnership with FOGSI.
Pregnancy care and Management of Common Obstetric Complications by MOs.
AN Care and SBA for ANMs /LHV/Staff Nurses.
Guidelines for RTIs and STIs including HIV/AIDS

27. Thrust Areas of Maternal Health
Operationalising all FRUs for EmOC
Establishing Blood storage Centers/ Banks
All CHCs and 24 Hrs PHCs for round the clock delivery, newborn services, MTP and RTI/STI services
Expediting the Implementation of
SBA training
Anesthesia training
EmOC training
Regular Quality assurance, implementation review and monitoring

28. MH- FUND ALLOCATION A RCH - TECHNICAL STRATEGIES & ACTIVITIES A.1
SNo
Activities
Sum Of SPIP
(CRORES)
Total Expenditure
% Utilization A
RCH - TECHNICAL STRATEGIES & ACTIVITIES
943. 9
51.51%
A.1
MATERNAL HEALTH
513 .8
470 .3
91.54%
A.10
PROGRAMME MANAGEMENT
89 .88
52 .93
58.89%
A.11
Procurement of Pharmaceuticals & Medical Supplies
13. 40
7.14%
A.2
CHILD HEALTH
61. 95
12. 15
19.61%
A.3
FAMILY PLANNING SERVICES
399 .1
160.1
40.13%
A.4
New Initiatives/innovations/ interventions etc., if any
42. 77
34.85%
A.5
URBAN RCH
55. 26
20. 83
37.71%
A.6
TRIBAL RCH
20. 08
4. 62
23.01%
A.7
INSTITUTIONAL STRENGTHENING
95. 59
47.65%
A.8
TRAINING
83. 51
11. 27
13.50%

29. MIES –NRHM : MH Indicators
Annual Return-Part C:
Annual.xls
Quarterly Return : Part Q3, Q4,Q7,Q13,Q14,Q24
Quarterly.xls
Monthly Return : Part A:M-100,200,
Part B : M1,2,3,5,6,7,8,9
Monthly.xls

30. Operating Manual- State PIPs-RCH-II Flexipool
Annexure 3 b : Indicative format for current status and targets.
Annexure 3b.doc
Annexure 3 d: Format for Annual Work Plan
Annexure 3d.xls
Annexure 3 e: Detailed Budget Format
Anne 3e.xls
Annexure 4a : Format for Quarterly progress Report (QPR)-Physical and Financial
Annex 4a.xls

31. Maternal Health Division- Reporting formats
Maternal health activities :
Monitoring Format for MH Activities.doc
Anesthesia Training:
Reporting Format for States for AnesthesiaTrg. Final.doc
SBA Training :
SBAplanmatrix( Final).doc
EmOC Training :
Reporting format for FOGSI Training.doc

32. THANK YOU