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Maharashtra State - Health Status

Home > India > Maharashtra > Health Status 

REPRODUCTIVE HEALTH AND CHILD HEALTH PROGRAMME

The Reproductive Health & Child Health Programme is implemented in the state since 1997. The programme is monitored by the State Family Welfare Bureau which is located at Pune.


Organizational structure:


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In the year 1994, the International Conference on Population & Development (ICPD) held the discussions at Cairo. The reasons for not reaching the goals set for Population Control were analyzed. Subsequent sample studies indicated that there are some areas where the earlier programme has not reached. Therefore, the entire strategy was changed and the following issues were given priority.

• Women's empowerment
• Adolescent Health
• Reproductive rights
• Reproductive Health
• Quality of Care

• People have the ability to reproduce and regulate their fertility.
• Women are able to go through pregnancy and child birth safely.
• The outcome of pregnancy is successful in terms of maternal and infant well being.
• Couples are able to have sexual relations free of fear of unwanted pregnancy and of contracting sexually transmitted diseases.
• After forty care.

• Women's health, safe motherhood (including safe management of unwanted pregnancy and abortion women's development
• Child health (child survival and child development)
• Adolescent Health (sexuality development, adolescence education and vocational component)
• Effective family planning( Ensuring Informed choice, Counseling, gender equality and greater male participation)
• Prevention, detection and management of Reproductive Tract Infections, Sexually Transmitted Infections, HIV/ AIDS and cancer of the reproductive system
• Prevention and management of infertility and other reproductive disorders
• Prevention, detection and management of genetic. and environmental disorders
• Reproductive health care of elderly persons

1. To improve Reproductive and Child Health Programme management by strengthening, monitoring and supervision.
2. To enhance Accessibility, Availability and Acceptability of quality services to meet the Unmet Needs.
3. To ensure better utilization of the services by increasing awareness among the community about the available facilities and also about the factors affecting demographic processes like age at marriage, son preference, safe motherhood practices and new born care.
4. To organize special health service camps and Adolescent Clinics
5. To involve related Departments and Non-Government Organizations (NGO) Community Based Organizations (CBO) and Local Self Governments in the programme

1. Establishment of First Referral Units. (F. R. U.)
   
   There are 350 Rural Hospitals in the State. Out of these, 123 have been considered for establishing as First Referral Units (F.R.U.) All the F.R.U.'s have been supplied with Kits E to P. To operationalise the F.R.U.'s - Posts of Specialists (Gynecologist/Surgeon, "Paediatritian or Physician" & Anaesthetist) have been created at every FRU. All F.R.U's have been provided with Rs. 10.00 Lakh for repairs & renovation of Labor Room & Operation Theatre, upgrading water supply and electrification, Provision for using services of Gynecologist & Anaesthetist on contract basis.
    
2. 24-hour delivery scheme
    
   The scheme is implemented in following four districts in the State.

Sr. No.	District	No. of PHCs
1	Nanded	53
2	Parbhani	47
3	Jalna	28
4	Yavatmal	57
	TOTAL:	185

The scheme is implemented to encourage institutional deliveries in order to reduce maternal and infant mortality. There is good response and increase in the number of institutional deliveries is observed. The Medical Officers, Nurse and Attendant are given incentive under this scheme.

The scheme is implemented to encourage institutional deliveries in order to reduce maternal and infant mortality. There is good response and increase in the number of institutional deliveries is observed. The Medical Officers, Nurse and Attendant are given incentive under this scheme.

3. Appointment of Consultants
    
   It is proposed to appoint Consultants in following areas on contractual basis, at state level.

1. Finance
2. Cold chain
3. Monitoring and evaluation
4. Promotion of contraceptive use.
5. IEC

4. RCH Camps
    
   In order to have an easy access for the treatment of ATI/STI, Disease Diagnostic Camps are proposed under the scheme. Following type of services are provided in the Camp. Information counseling and services.

• Contraceptive methods.
• Menstrual regulation.
• MTP services
• Gynaecological problems (ATI/STI)
• Adolescent problems.

5. Establishment of Neonatal Care Unit:
   
   In order to bring down the Infant Mortality Rate from 48 / 1000 live births to 25 by 2004, It is essential to improve the Neonatal Care. It is, therefore, proposed to establish Neonatal Care Units in following districts.

1. Ratnagiri	7. Osmanabad
2. Sangli	8. Wardha
3. Sindhudurg	9. Buldhana
4. Solapur	10. Raigad
5. Satara	11. Ahmednagar
6. Beed	12. Bhandara

The State Government has already sanctioned Neonatal Intensive Care Units at Jalgon, Parbhani, Kolhapur, Akola and Latur.


Supply of essential equipments in the Delivery Room. Ambulance facility to transport low birth weight babies and supply of instruments for ICU.

6. Referral Transport
    
   It is observed that for maternal death, the unavailability of transport is one reason. Therefore, under the scheme, it is proposed to place Rs. 5,000/ - with the local gram panchayat for first year and Rs. 4,000/ - / Rs. 3,000/- / Rs 2000/ - / Rs. 1000/- subsequently. The scheme is to be implemented in selected 50 villages of 10 districts viz. Nanded, Nandurbar, Dhule, Solapur, Parbhani, Bhandara, Gadchiroli, Aurangabad, Jalna and Osmanabad. Beneficiary will get Rs. 300/- for transport
    
7. Utilization of Services of Private Gynecologist and Anaesthetist on contract basis
   
   In order to provide emergency obstetric services, the Specialists are required. They are not available at many of the First Referral Units. Therefore, a provision has been made to utilize the services of private Gynecologists and Anaesthetist by paying them consultation charges.
    
8. Training of Dais
   
   In number of villages, the delivery is conducted by the Traditional birth attendants. In order to reduce Maternal Mortality and Infant Mortality safe delivery practices are essential. Under the scheme, the Dais, who are conducting the deliveries will be trained at selected FRUs and also required Orientation Training will be given.
    
9. NGO involvement
   
   The Government of India has selected four Mother NGOs in the State. These NGOs are working since 1998-99. They have so far registered 110 Field NGOs from the districts assigned to them.

Mother NGO	No. of Field NGOs	Districts allotted
Society of Services to Voluntary Agencies (SOSVA)	37	Pune, Nagpur, Ahmednagar, Raigad, Mumbai, Amravati, Latur, Nanded, Wardha, Gadchiroli, Chandrapur, Yavatmal, Buldhana, Akola, Washim, Osmanabad, Satara, Bhandara, Gondia.
Sevadham Trust, Pune	30	Sindhudurga, Solapur, Thane, Kolhapur, Ratnagiri, Parbhani, Sangli, Hingoli.
Pravara Medical Trust, Loni, Dist. Ahmednagar	26	Beed, Aurangabad, Jalna
Godavari Foundation, Jalgaon	17	Nasik, Dhule, Nandurbar, Jalgaon, Buldhana, Yavatmal.

1. Sterilization
   
   The sterilization programme is well established in the State. There are Operating facilities available for sustained programme. In the year 2000-2001, 109% sterilizations were performed against the Expected level of achievement. The high light of the performance is that 40% sterilizations were performed on two issues. This indicates quality of the programme and the acceptability by the Community.
   
   The performance is mainly through Female sterilization operations. The Population Policy is now giving stress on Male sterilizations. Therefore, a special scheme promoting No Scalpel Vasectomy (NSV) is being implemented. Under the scheme, the Medical Officers have been trained and NSV camps are organized.
    
2. Urban Family Welfare Programme
   
   The 2001 Census has registered the urban population of 42%. To implement the Health Programmes in the urban area, proper Health Infrastructure. is not available. The Urban Family Welfare Centres and Urban Health Posts have been established as follows: 

Sr. No.	Type of Institutions	Govt.	Local Bodiestal	Vol. Organs.	To
URBAN FAMILY WELFARE CENTRES
1	Type - I	10	12	0	22
	Type-II	0	9	1	10
	Type-III	10	15	17	42
	TOTAL:	20	36	18	74
URBAN HEALTH POSTS
2	Type - A	3	9	0	12
	Type - B	2	14	0	16
	Type - C	9	31	2	42
	Type - D	25	15	30	210
	TOTAL:	39	209	32	280

The above centres and the staff receive 100% grants from Govt. of India through State Government. The targets are allotted to the institution for sterilization performance. The performance is monitored and the work of the Centre is evaluated.

The above centres and the staff receive 100% grants from Govt. of India through State Government. The targets are allotted to the institution for sterilization performance. The performance is monitored and the work of the Centre is evaluated.

Government has already sanctioned Neonatal Intensive Care Units at Jalgon, Parbhani, Kolhapur, Akola Latur. scheme implemented encourage institutional deliveries in order reduce maternal infant mortality. There good response increase number observed. Medical Officers, Nurse Attendant given incentive under this scheme.

3. Post Partum Programme
   
   The Post Partum Programme is Maternity centre based Family Welfare Programme. There are 5 type of centres recognized on the basis of the workload of obstetric cases, abortion and MTP cases. The acceptors of performance are direct and indirect. The institutions are expected to complete the target of sterilization, Cu-T. On the basis of this, the grants are released. In the State, following Post Partum Centres are sanctioned.

Sr. No.	Agency	No. of Post Partum Centres
		A Teach	A Non-Teach	B Type	C Type	Sub District	Total
1	Govt.	8	7	7	14	47	83
2	Local Body	3	2	3	1	12	21
3	Vol. Orgn.	1	2	1	3	10	17
	TOTAL:	12	11	11	18	69	121

3. Award Scheme
   
   In order to motivate the Health staff, an Award Scheme offering Cash incentive has been started from August 2000. The Award scheme is for Medical Officers, ANMs and also for Panchayat Samitis. The Selection Committee of District Collector, CEO, ZP, DHO and District RCH Officer will select the Health Staff for the Award.
    
4. Revised Savitribai Phule Kanya Kalyan Yojana
   
   The scheme is revised from 1st May 2000 and is applicable for -

1. Couples below poverty line.
2. Couples accepting sterilization with only one daughter and no son will receive Rs. 10,000/- as Fixed Deposit, and the daughter will receive it after completing 18 years. An additional amount of Rs. 5,000/- will be awarded as a Five Year Fixed Deposit for the girl completing 10th Standard, provided she does not get marry before the age of 20 years.
3. Similar scheme is applicable for couple with two daughters and no son, the amount is Rs. 5,000/ - per daughter.

3. Monitoring of Age at Marriage

1. Anti-Early Marriage Fort Night.
2. Gathering of Newly married couples.
3. Reporting of marriages before the age of 18.
4. Monthly Early Marriage (EM) reports.

3. Prevention of misuse of ore-natal Sex Determination Act (PNDT Act)
   
   The Act came in to force on 1st January 1996. The objective is to regulate the activity of the Genetic Counselling Centres, Genetic Laboratories and Genetic Clinics. The facility is expected to be used for detecting Genetic Disorders. However, it was observed that the facility has been misutilized by getting the Fetus aborted after it is diagnosed as a female, This has resulted in to the imbalance between Sex Ratio. The 2001 Census reveals that sex ratio for male / female in Maharashtra State has come down to 922 compared to 934 in the 1991 census. 
   
   The Supreme Court has already directed all the States to take stringent measures against the misutilization of the act. In view of this, the State has already taken following actions.

• State Appropriate Authority is the Additional Director of Health Services. (FW) Pune
• Advisory Committee appointed.
• District Appropriate Authorities appointed
• Registration of the equipment has been made compulsory for all the centers.
• Information, Education & Communication Campaign for community awareness regarding the provisions of the Act and punishment for violation of rule has been undertaken on large scale. A regular review is taken at the Govt. level.

3. School Health
   
   The Health check up of the School going children will timely correct the defects in the early stages and will result in proper physical and mental development of the child. In order that this is done in the primary stage, School Health Check-ups are organised since last five years on campaign basis.
   
   The examination of the students in Class I to IVth standard takes place in October, November every year. The data collected indicate that the activity is useful. The cases identified are referred to the Health Institutions where proper treatment, surgical intervention is carried out.
    
4. Immunization Proaramme
   
   The Universal Immunization against vaccine preventable diseases such as Tuberculosis, Polio, Diphtheria, Pertusis, Tetanus and Measles is routinely carried out. The Routine Immunization Programme has received very good response from the community.

Polio Eradication:
 
The success of the Immunization against Polio has laid to the strategy of Polio Eradication. The Govt. of India undertook the activity of Pulse Polio Immunization since last five years.

The IEC activities and excellent implementation plan has resulted into 98 to 99% coverage and reduction in the polio cases. Through the support from WHO for AFP Surveillance, the programme is being monitored efficiently.

The Community response as well as NGO involvement and the commitment of the State Government has resulted in nearing the Polio eradication final stage.


Strategy:
1. Strengthening routine immunization programme.
2. Organization of National Immunization Days.
3. Organization if intensive Pulse Polio Immunization
4. Effective AFP Surveillance

Yearwise No. of Polio cases reported

Sr. No.	Year	No. of Polio cases
1	1997	62
2	1998	124
3	1999	19
4	2000	7
5	2001	4
6	2002 (till Sept.)	4

5. Training under RCH Programme
   
   The Government of India has identified National Institute of Health & Family Welfare (NIHFW) as the Nodal Agency for Training activities under the RCH Programme.
   
   The State has formed the "State Level RCH Training Co-ordination Committee". According to the guidelines of NIHFW and in consultation with the Collaborating Training Institute (CTI) i.e. KEM Hospital & Research Centre, Pune, the Comprehensive Training Action Plan (CTP) has been prepared. Following type of training activities are under progress.
6.  
   1. Integrated Skill Development Training (ISDT) for M.D., LHV, ANM (12 days).
      The Training is Hospital based. The objective is to improve the skills of the workers for improv- ing the quality of Service delivery.
       
   2. Integrated Skill Development Training (ISDT)
      for Male Health Supervisors and Workers (6 days). The objective is to involve the Male Health Supervisor and Workers in the RCH Programme activities.
       
   3. Specialized Skill Development Training (SST) (12 days):
      The Medical Officers are sent for Training in Mini lap, Laparoscopic sterilization, Medical Termination of Pregnancy (MTP) and No Scalpel Vasectomy (NSV). The ANMs and LHVs are trained in Intra Uterine Device (Cu-T) insertion Technique.
      
      The objective is to increase the trained and skilled manpower, so that, the performance will improve in quantity as well as in quality.
       
   4. Management Training (1 week):
      The Institute of Health Management, Pachod, District Aurangabad has been identified for the training of State / Regional and district level Officers.
       
   5. Communication (11 days):
      Public Health Institute, Nagpur and HFWTC, Pune have been identified for training of Health supervisors.
7. Nav Sanjeevani Yojana:
   
   The State Government has selected the districts having tribal population for the implementation of special Programmes. In following districts, Nav SannjeevaniYojana has been introduced.
8. Districts covered
    

9. 1. Thane	2. Raigad	3. Nasik
   4. Dhule	5. Jalgaon	6 Ahmednagar
   7. Nandurbar	8. Amravati	9. Yavatmal
   10. Nanded	11. Nagpur	12. Pune
   13. Gondia	14. Chandrapur	15. Gadchiroli


Following activities are implemented:

1. Pre monsoon Health check up of Tribal mothers and children and treatment.
2. Regular water quality monitoring.
3. Filling of vacancies.
4. Monthly Examination of Grade III & Grade IV children.
5. Facility of diet to patient and one relative at PHC and RH.
6. Maintaining the mobility of the vehicles.
7. Ensuring availability of Drugs for epidemic control at the Health Institutions.
    
12. Integrated Tribal Develol2ment Project (ITDP)
    
    Following tribal districts are covered: 

1. Thane	2. Nasik	3. Nandurbar
4. Amravati	5. Gadchiroli

The schemes implemented are -

Matrutwa Anudan Yojana:

The schemes are implemented through out the year. The beneficiary is pregnant mother. Rs. 400/- in cash and drugs worth Rs. 400/- are given to the beneficiary. The objective is to support the diet and encouraging the beneficiary to accept safe motherhood concept.

• Dai Training:
   
  The Dais conducting the delivery are called for quarterly one day orientation training. They are paid Rs. 40/- as honorarium and Rs. 10/- as meeting expenses. The Dais are oriented about safe delivery practices and new born care.
   
• Pada Swayamsevak:
  
  The scheme is implemented from May to December every years. The Pada worker is paid Rs. 300/- per month. 5530 posts of Pada Workers have been sanctioned. They are expected to perform following activities:

1. Water disinfection.
2. Tablet Chloroquin distribution to fever patients.
3. ORS packets to diarrhoea patients.
4. Information of epidemic outbreak to PHC.
5. Assistance in the distribution of supplementary diet.

• Appointment of Honorary Doctors:
  The scheme is implemented from June to December. The appointed Doctor is paid Rs..6,000/ - per month. 132 posts have been sanctioned. The Doctor is expected to carry out:

1. Health check up of mother and child in every pada / village in the area.
2. Treatment of mothers and children having health problems.
3. Examination of children in Anganwadi.

 


Honorary Doctors & Pada Swavansevak

 

District	Honorary Doctors		Pada Swayansevak
	Sanctioned	Filled in	Sanctioned	Filled in
Thane	35	35	1872	1872
Nasik	25	25	968	968
Nandurbar	265	25	1312	1279
Gadchiroli	22	25	239	239
Amravati	25	25	1139	1139
TOTAL	132	132	5530	5497

The above centres and the staff receive 100% grants from Govt. of India through State Government. The targets are allotted to the institution for sterilization performance. The performance is monitored and the work of the Centre is evaluated.

Government has already sanctioned Neonatal Intensive Care Units at Jalgon, Parbhani, Kolhapur, Akola Latur.
scheme implemented encourage institutional deliveries in order reduce maternal infant mortality. There good response increase number observed. Medical Officers, Nurse Attendant given incentive under this scheme.

1. Five posts of Staff Nurses sanctioned.
2. One room of the R.H converted in to Warm Room.
3. Care of Low Birth Weight Babies
4. Use of Thermocole Box

1. 26 Talukas of 5 districts have been included.
2. Rs. 14/- per day per child can be spent on the treatment.
3. Arrangement for residence of the parents.