NATIONAL HEALTH AND FAMILY WELFARE PROGRAMS RELATED TO MCH INTRODUCTION: Deep rooted customs, traditions and socio-cultural

beliefs favor large family size in many parts of the country and impede the process of change which would accelerate the willing adoption of the small family norm socio-economic factors such as female literacy, age at marriage of girls, status of women, strong son preference, and status of employment of women have a crucial bearing on the fertility behavior of the people. Definition According to wordiq.com Welfare is defined as in general terms, the term welfare refers simply to well being, the human condition whereby people are faring well that is prosperous, in good health and at peace. Family: A group of individuals living under one roof and usually under one head. Program: A listing of the order of events and other pertinent information for a public presentation. OR A system of services, opportunities or projects usually designed to meet a social need. ACCORDING TO WHO Family planning refers to practices that help individuals or couples to attain certain aims and objectives. Aims: Promote the adoption of small family size, norm. Encourage use of spacing methods. Ensure adequate supply of contraceptives to all eligible couples. To arrange facilities for to achieve the set targets.

Objectives: To avoid unwanted births. Bring about unwanted births.

EVOLUATION OF FAMILY PLANNING In order to control the rapid growth of population the policy of family planning was adopted by the Government of India in 1952.

India is the first country to adopt a deliberate policy measure to control the high birth rate. Through the program initially was taken up in a modest way, it gathered momentum after the 1961 census. The late 1960s saw the emergence of a time bound target oriented approach with a massive effort to promote the use of IUDs and condoms. 1970 emphasized on male sterilization. 1976, the Government of India announced the National Population Policy. The objective was to reduce the fertility period of reproductive couples. The policy discouraged the child marriages and increased the minimum age of marriage to 18 for girl and 21 for boys. The family planning program was started on a war footing during the emergency period (1975-1977). Compulsory sterilization was introduced and nearly 10 million people were sterilized. Financial initiatives were given to the people to be attracted for sterilization. However, the program was virtually rejected by the people and its progress received a serious set back during two years after 1976. The Janata Government in 1977 renamed the program as Family Welfare Program and put emphasis on the welfare of the family as a whole. From the sixth plan onwards, long term strategy of limiting population growth started in the country. Seventh plan adopted a practical target for the purpose. During eighth plan, emphasis was given on decentralization planning to check population growth. The ninth plan aimed at controlling the population growth by 16% by 2001 and 1.5 by 2011. MILESTONES OF FAMILY WELFARE PROGRAM 1951-56 First Plan 1961-1966 Third Plan Family planning program adopted by Government of India first of its kind in the world. Extension education approach. Department of Family Planning created in Ministry of Health. Created Target oriented approach. Lippies loop introduced & massive effort to promote IUDs & condoms.

1969-74 Fourth Plan

Family planning services. Primary health center. All India Hospital postpartum programs. Medical termination of pregnancy (MTP) Act 1971. Campaign for male sterilization Renaming Family planning to Family Welfare. Community Involvement. Child Marriage Restraint Act 1978. National Health Policy. Strengthening of maternal and child health. Strengthening Family Welfare. Further inclusion of various programs under MCH. Child survival and safe mother hood program (CSSM). National Development committee report. International conference on population and development (ICPP) Cairo 1994. Target free approach. Review of safe motherhood component of CSSM. Reproductive and child health, (CSSM plus STI & RTI components). National Population policy. National health policy. Planning for RCH-II RCH-II and NRHM. NATIONAL POPULATION POLICY 2000

1974-79 Fifth plan 1983 1980-1985 1985-90 Seventh Plan 1992-97 Eighth Plan 1993-94 1996 1997-2002 Ninth Plan. 2000 2002 2002-07 Tenth plan 2005

Historical Development: Population policy in general refers to policies intended to decrease the birth rate or growth rate. In April 1976, India formed its first National Population Policy it called for an increase in the legal minimum age of marriage from 15 to 18 for females and from 1821 years for males. Statement because irrelevant and the policy was modified in 1977. New policy statement given the importance of the small family norm without compulsion and changed the program title to Family Welfare Program. The national health policy approved by the parliament in 1983 had set the long term demographic goals of achieving a net reproductive rate (NRR) of one by the year 2000. National Population Policy 2000 is the latest in this series. ASPECTS OF NPP: It deals with women education, empowering women for improved health and nutrition. o Child survival and health.

o o o o

The unmet needs for family welfare services. Health care for the under served population groups like urban slums, tribal community. Making school compulsory. Promoting delayed marriage for girls.

OBJECTIVES OF NPP 2000 (i) The Immediate Objectives of The NPP 2000 Are: To address the unmet needs for contraception health care infrastructure and health personnel. To provide integrated service delivery for basic reproductive and child health care. (ii) The Medium Term Objective is: To bring the TFR to replacement levels by 2010, through vigorous implementation of intersectoral operational strategies. (iii) The Long Term Objective is To achieve a stable population by 2045, at a level consistent with the requirements of sustainable socio-economic growth and developments and environmental protection. NATIONAL SOCIO-DEMOGRAPHIC GOALS FOR 2010 Address the unmet needs for basic reproductive and child health services, supplies and infrastructure. Make school education up to the age of 14 free and compulsory and reduce drop outs at primary and secondary school levels to below 20% 1000 live births. Reduce maternal mortality ratio to below 100 per 100,000 live births. Achieve universal immunization of children against all vaccine preventable diseases. Promote delayed marriage for girls, not earlier than age 18 and preferably after 20 years of age. Achieve 80% intuitional deliveries and 100% deliveries by trained persons. Achieve 100% registration of births, deaths, marriages and pregnancies. Prevent and control communicable diseases. Promote vigorously the small family norm to achieve replacement levels of TFR.

STRATEGIC THEMES: Decentralized planning and program implementation. Convergence of service delivery at village levels. Empowering women for improved health and nutrition. Child survival and child health. Meeting the unmet needs for family welfare services. Collaboration with and commitments from non-Government organizations and the private sector. Main streaming Indian system of medicine and homeopathy. Contraceptive technology and research on reproductive and child health. Information, education, and communications. PROMOTIONAL AND MOTIVATIONAL MEASURES:

Providing fertility regulating information/services. Furnishing family life/sex education, information. Improving the status of women. Improving the health and nutritional status. Strict enforcement of child Marriage Restraint Act 1976. Strict enforcement of the Prenatal Diagnostic Techniques Act 1994. Soft loans to ensure mobility to the ANMs will be increased. Providing incentives by Maternity Benefit Schemes NATIONAL FAMILY WELFARE PROGRAM - (RCH)

To achieve population stabilization in 1994, the international conference of population and development (ICPD) was established. Fertility reduction should be addressed at the level of broad social policy including reduction of gender discrimination in education, health care and income generation. Reproductive health programs should focus the needs of actual and potential clients, not only for limiting births, but also for healthy sexuality and child bearing. In India, Reproductive Health approach should shift the focus from the use of family planning as a tool intended essentially for population stabilization. In 1997, the Government of India followed up the international recommendation on reproductive and child health (RCH) as a national program. Definition: World Health Organization (WHO) has defined reproductive health as follows: Reproductive health addresses the reproductive processes, functions, functions, and systems at all stages of life. Reproductive health therefore implies that people are able to have a responsible satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if when and how often to do so. This definition focuses on right of men and women to be informed of and to have access to safe, effective, affordable and acceptable methods of fertility regulation of their choice, and the right to access to appropriate health care services that will enable women to go safely through pregnancy and child birth and provide couples with the best chance of having a healthy infant. OBJECTIVES OF THE PROGRAM: The main objective of RCH is to provide quality integrated and sustainable primary health care services to the women in the reproductive age group and young children and special focus on family planning and immunization. ESSENTIAL COMPONENTS OF RCH PROGRAM: Prevention and management of unwanted pregnancy. Maternal care that includes antenatal delivery and postpartum services. Child survival services for newborns and infants. Management of Reproductive tract infection (TRIs) and sexually transmitted infections (STIs).

Establishment of an effective referral system. Reproductive services for adolescent health. Sexuality, gender information, education and counseling.

MAJOR ELEMENTS OF RCH PROGRAM A. Reproductive health elements. B. Child Survival Element. REPRODUCTIVE HEALTH ELEMENTS: Prevention of unwanted pregnancies. Increase access to contraceptives. Emergency contraceptives. Safe abortion. First Referral Units (FRUs) for emergency obstetric care. Management of RTIs/STDs. Infertility and gynecological disorders. Reproductive health services for adolescent health. Global reproductive health strategy. Pregnancy and delivery services. Referral facilities by Government/Private sector for pregnant woman at risk. Responsible and healthy sexual behavior. Interventions to promote safe motherhood. Essential obstetric care for all. B. CHILD SURVIVAL ELEMENT: Cold chain system. Polio eradication: Pulse polio programs. Essential newborn care. Prevention and management of vaccine preventable disease. Urban measles campaign. Elimination of neonatal tetanus. Global alliance for vaccine and immunization (GAUI). Diarrhea control program and Ors program. Hepatitis B vaccine. MMR vaccine. Prevention and control of vitamin A deficiency among children. INTERVENTIONS IN ALL DISTRICTS Child survival interventions, i.e. immunization vitamin A (to prevent blindness) oral rehydration therapy and prevention of deaths due to pneumonia. Safe motherhood interventions, example: antenatal checkup, immunization for tetanus, safe delivery, and anemia control program. Implementation of target free approach. High quality training at all levels. IEC activities. Specially designed RCH package for urban slums and tribal areas. District subprojects under local capacity enhancement.

INTERVENTIONS IN SELECTED STATES/DISTRICTS Screening and treatment of RTI/STD at sub-divisional level. Emergency obstetric care at selected FRUs by providing drugs. Essential obstetric care by providing drugs and PHNI staff nurse at PHCs. Additional ANM at sub-centers in the weak districts for ensuring MCH care. Improved delivery services and emergency care by providing equipment kits, IUD insertions and ANM kits at sub-centers. Facility of referral transport for pregnant women during emergency to the nearest referral center through panchayat in weak districts. RCH- PHASE II 1. RCH-Phase II began from first April 2005. 2. The focus of the program is to reduce maternal and child morbidity and mortality with emphasis on rural health care. STRATEGIES: Essential obstetric care. (a) Institutional delivery. (b) Skilled attendance at delivery. Emergency Obstetric Care (a) Operationalising first referral units. (b) Operationalising PHC and CHCs for round the clock delivery services. Strengthening Referral System: (a) Institutional delivery: To promote institutional delivery in RCH Phase II. It is envisaged that fifty percent of the PHCs and all the CHCs wound be made operational as 24-hour delivery centers, in a phased manner by the year 2010. These centers wound be responsible for providing basic emergency obstetric care and essential newborn care and basic newborn resuscitation services round the clock. (b) Skilled attendance at delivery. It is now recognized globally that the countries which have been successful in bringing down maternal mortality are the ones where the provision of skilled attendance at every birth and its linkage with appropriate referral services for complicated case have been ensured. (c) The policy decisions: ANMs/LHVs/SNs have now been permitted to use drugs in specific emergency situations to reduce maternal mortality. Emergency Obstetric Care: It has been decided that all the first referral units be made operational for providing emergency and essential obstetric care during the second phase of RCH. The minimum services to be provided by a fully functional FRU are.

1. 24-hour delivery services including normal and assisted deliveries. 2. Emergency obstetric care including surgical interventions like Caesarean section. 3. Newborn care. 4. Emergency care of sick children. 5. Full range of family planning service including laparoscopic services. 6. Safe abortion services. 7. Treatment of STI/RTI. 8. Blood storage facility. 9. Essential laboratory services. 10. Referral services. STRENGTHENING REFERRAL SYSTEM During RCH phase-I, funds were given to the panchayat for providing assistance to poor people in the case of obstetric emergencies, feedback from the states indicate that there was no active involvement of panchayat in running the scheme. Based on these experiences different states have proposed different modes of referral linkage in RCH phase II. Some of them have indicated to involve local self groups, NGOs, and women groups whereas few others have indicated to outsource it. New Initiatives:Training of MBBS doctors in life saving anesthetic skills for emergency obstetric care provision of adequate and timely emergency obstetric care (EMOC) has been recognized as the most important intervention for saving lives of pregnant women who may develop complications during pregnancy of child birth. It is not the replacement of the specialist anesthetist. Government of India is also introducing training of MBBS doctors in obstetric management skills. Setting up of blood storage centers at FRUs according to Government of Indian guidelines. 3. JANANI SURAKSHA YOJANA: The national maternity benefit scheme has been modified into a new scheme called Janani Suraksha Yojana (JSY). It was launched on 12th April 2005. Objectives:Reducing maternal mortality and infant mortality through encouraging delivery at health institutions and focusing at institutional care among women in below poverty line families. FEATURES OF JANANI SURAKSHA YOJANA: (a) It is a 100% centrally sponsored scheme. (b) Under National Rural Health Mission: It integrates the benefit of cash assistance with institutional care during antenatal delivery and immediate postpartum care.

This benefit will be given to all women, both rural and urban, belonging to below poverty live household and aged 19 years or above up to first two live births.
CATEGORY RURAL AREA URBAN AREA Mother's ASHA's Mother's ASHA's Total Rs. Total Rs. Package Package Package Package 1400 600 2000 1000 200 1200 700 700 600 600

LPS HPS

The accredited social health activist would work as a link health worker between the poor pregnant women and public sector health institution. The eligibility of case assistance is as follows: 1) In low performing states (LPs): All women including those from SC and ST families, delivering in government health centers like sub-center, PHC, CHC, first referral unit, general wards, of district hospitals. 2) In high performing states (HPs): Below poverty line women age 19 years and above and the SC and ST pregnant women. VANDEMATARAM SCHEME: This is a voluntary scheme wherein any obstetric and gynae specialist, maternity home, nursing home, lady doctor/MBBS doctor, can volunteer themselves for providing safe motherhood services. The enrolled doctors will display Vandemataram logo at their clinic. Iron and folic acid tablets, oral pills, TT injections etc. will be provided by the respective district medical officers to the Vandemataram doctors/clinics for free distribution to beneficiaries. The cases needing special care and treatment can be referred to the government hospitals, who have been advised to take due care of the patients coming with Vandemataram cards. Safe abortion services: In India, abortion is a major cause of maternal mortality and morbidity and accounts for nearly 8.9% maternal deaths. Under RCH Phase II, following facilities are provided. a) Medical method of abortion. b) Manual vacuum aspiration. Medical Method of Abortion:- Termination of early pregnancy with two drugs. 1. Mifepristone. 2. Misoprostol. Manual Vacuum Aspiration (MVA):-

MUA is a safe and simple technique for termination of early pregnancy, The quality indicators used to monitor and evaluate RCH program through monthly reports are: 1. Number of antenatal cases registered total and at less than 12 weeks. 2. Number of pregnant women who had 3 antenatal check-ups. 3. Number of high risk pregnant women referred. 4. Number of pregnant women who had two doses of tetanus toxoid injection. 5. Number of pregnant women under prophylaxis and treatment for anemia. 6. Number of deliveries by trained and untrained birth attendant. 7. Number of cases with complications referred to PHC/FRUs. 8. Number of newborn with birth weight recorded. 9. Number of RTI/STI cases detected, treated and referred. 10. Number of women given 3 postnatal checkups. 11. Number of children fully immunized. 12. Number of adverse reactions reported after immunization. 13. Number cases motivated and followed up for contraception. INTEGRATED CHILD DEVELOPEMENT SERVICES ICDs scheme is one of the worlds largest and most unique programs for early childhood development, which was launched on 2nd October 1975 (5th five year plan) in pursuance of the National Policy for children. BENEFICIARIES: 1) Children below 6 years. 2) Pregnant and lactating women. 3) Women in the age group of 15-45 years. 4) Adolescent girls in selected blocks [Kishori Shakti Yojana]. OBJECTIVES: (a) To improve the nutritional and health status of children in the age group 0-6 years. (b) To lay the foundations for proper psychological, physical and social development of the child. (c) To reduce mortality and morbidity, malnutrition, and school dropout. (d) To achieve an effective coordination of policy and implementation among the various departments working for the promotion of child development. (e) To enhance the capability of the mother and nutritional needs of the child through proper nutrition and health education. SERVICES: Supplementary nutrition. Immunization. Health checkups. Referral services. Pre-school non-formal education. Nutrition and education. BENEFICIARY:

10

Pregnant women. Services: Health checkup. Immunization against tetanus. Supplementary nutrition. Nutrition and health education. Beneficiary Nursing Mothers Other women 15-45 years Children less than 3 years Services Health Checkups Supplementary nutrition. Nutrition and health education. Nutrition and health education Supplementary nutrition. Immunization. Health checkup. Referral services. Non-formal education. Supplementary nutrition. Immunization. Health checkup. Referral services. Nonformal education. Supplementary nutrition. Nutrition and health education.

Children in age group 3-6 years

Adolescent girls 11-18 years 1. SUPPLEMENTARY NUTRITION:

Supplementary nutrition is given to children below 6 years, and nursing and expectant mothers from low income group. Aim: Each child up to 6 years of age to get 300 calories and 8-10 grams of protein. Each adolescent girl to get 500 calories and 20-25 grams of protein. Each pregnant women and nursing mother to get 500 calories and 20-25 grams of protein. Each malnourished child to get 600 calories and 16-20 grams of protein. Supplementary nutrition is given 300 days in a year under minimum need program. 2. NUTRITION AND HEALTH EDUCATION: Nutrition education and health education is given to all women in the age group of 15-45 years giving priority to nursing and expectant mothers. 3. IMMUNIZATION: immunization of children against 6 vaccine preventable diseases is being done for expectant mothers. 4. HEALTH CHECKUP: This includes

11

(a) Antenatal care of expectant mothers. (b) Postnatal care of nursing mother and care of newborn. (c) Care of children under 6 years of age. 5. NON-FORMAL PRE-SCHOOL EDUCATION: The objective is to provide opportunities to develop desirable altitude, values and behavioral pattern among children. The administrative unit of an ICDs project is the Community Development Block in rural areas. The tribal development block in tribal areas and a group of slums in urban areas. 6. MEDICAL REFERRAL SERVICES: During health checkups and growth monitoring sick or malnourished children in need of prompt medical attention are referred to the PHC or its sub-center. ICDs Team: Anganwadi workers, Anganwadi helpers, supervisor child development project officers and district program officers. Anganwadi worker, a lady selected from the local community. Besides the medical officers, Auxillary nurse midwife (ANM) AND Accredited social health activist from a team with the ICDs. CHILD SURVIVAL AND SAFE MOTHERHOOD PROGRAM In 1992, the child survival and safe motherhood program integrated all the schemes for better compliance. This program had the following components. a) Early registration of pregnancy. b) To provide minimum three antenatal checkups. c) Universal coverage of all pregnant women with TT immunization. d) Active on Food, nutrition and rest. e) Detection of high risk pregnancies and prompt referral. f) Clean deliveries by trained personnel. g) Birth spacing. h) Promotion of institutional deliveries.

12

ORGANIZATION AND ADMINISTRATION OF FAMILY WELFARE PROGRAMS AT VARIOUS LEVELS ORGANIZATION AT THE NATIONAL LEVEL

CABINET COMMITTEE FAMILYPLANNING

CENTRAL FAMILY PLANNING COUNCIL

Ministry of Health & Family Planning

Advisory council's board committee

Department of Family Planning Secretary

Executive Board

Additional Secretary International Finance Advisor

Assistant Commissioner

Marketing Executives

Joint Secretary and Commissioner

13

ORGANIZATION STRUCTURE AT STATE LEVEL FAMILY PROGRAMMING State Cabinet Committee

State Family Planning/Council Board

State Department of Health

Action or Implementation committee

State Family Planning Bureau

Operation Planning and Training Division

Education & Information Division

Administrative & State Division

Statistics Demography & Evaluation Division

ORGANIZATION AT DISTRICT LEVEL District Health Officer

District Family Planning Bureau

Administrative Division

Education & Implementation Division

Field Operation & Evaluation Division

14

AT THE PRIMARY HEALTH CENTER When fully staffed (by 3 medical officers including one lady doctor and supporting personnel). The PHC is expected to provide fairly comprehensive essential health care. AT A VILLAGE LEVEL: Two schemes are being implemented at the village level to improve the outreach of services and increase local participation. (a) The village health guides. (b) Trained dais. The national target is provide one trained dai per 1000 population. COUNSELING FOR FAMILY WELFARE Counseling is a process through which one person helps another by a purposeful conversation in an understanding atmosphere enabling him/her to cope more effectively with life problems. The role of counselor in family planning is of at most importance. The effectiveness of counseling depend on - Professional skills of counselor. - Ability to communicate to client. Counseling in Family Planning:- is a way to help people to overcome obstacles to personality growth and development that are reflected in difficulties in dealing with specific problems or situations. Goals of Counseling: 1. To facilitate behavior change among client. 2. To improve the clients ability to establish and maintain relationship. 3. To enhance the clients ability to cope with problem. 4. To promote decision making process. 5. To facilitate clients potential & development. ELEMENTS OF COUNSELING: Family planning counseling has six elements. 1. G:- Greet the client. 2. A:- Ask client about themselves. 3. T:- Tell client about family planning method. 4. H:- Help client to choose a method. 5. E:- Explain how to use methods. 6. R:- Return for follow-up.

15

NATIONAL RURAL HEALTH MISSION INTRODUCTION:- The method rural health mission (NRHM) is a response to the verdict of the May 2004 general elections which led to the conceptualization of a set of proper policies under the common minimum program. Recognizing the importance of health in the process of economic and social development & to improve the quality of life of its citizens, the government of India launched National Rural Health Mission on 5th April 2005 for a period of 7 years (2005-2012). Aim: NRHM is to provide accessible, affordable, accountable, effective and reliable primary health care and bridging the gap in rural health care through creation of a cadre of accredited social health activist. CHALLENGES: 1. Integration of sanitation, hygiene, nutrition, and drinking water issues in the overall sectoral approach for health. 2. Striking regional inequalities. 3. The challenge of population stabilization. 4. About 10% Indians have some form of health insurance, mostly inadequate. OBJECTIVES: 1. Provision of trained and supported village health activist in under served areas as per need. 2. Preparation of health plans by panchayat as mechanism for involving community in health. 3. Strengthening SC/PHC/CHC by developing Indian public health standards. 4. Increase utilization of first referral units from less than 20% (2002) to more than 75% by 2010. PRINCIPLES: Promote equity, efficiency, quality and accountability in public health systems. Enhance people orientation and community-based approaches. Ensure public health focus. Recognize value of traditional knowledge base of communities. Promote new innovations, method and process development. Decentralize and involve local bodies. GOALS OF NRHM: o Reduction in Infant Mortality Rate and Maternal Mortality Ratio by 50% from existing levels in next 7 years. o Universalize access to public health services such as womens health, child health, water sanitation, immunization, nutrition etc. o Prevention and control of communicable and non-communicable diseases including locally endemic diseases. o Access to Integrated comprehensive primary health care. o Assuring population stabilization, gender, and demographic balance.

16

o Promotion of healthy lifestyles. COMPONENTS: The programs to be integrated are existing programs of health and family welfare including RCH-II, national vector borne diseases control program against malaria, filarial, kala-azar, dengue fever, IDHF and Japanese encephalitis, national leprosy eradication program, national program for control of blindness, iodine deficiency disorder control program, and integrated disease surveillance project. TARGETS: IMR reduced to 30/1000 live births by 2012. MMR reduced to 100/100,000 live births by 2012. TFR reduced to 2.1 by 2012. Malaria Mortality reduction rate 100% by 2010 and sustaining elimination thereafter. Filaria reduction rate 70% by 2010, 80% by 2012, and elimination of 2015. CORE STRATEGIES: Train and enhance capacity of PRIS Panchayat Raj Institutions to own control and manage public health services. Promote access to healthcare to household through the female health activist (Accredited Social Activist, ASHA). Health plan for each village through village health samiti of the panchayat. Strengthening existing PHCs an CHCs and provision of 30-50 bedded CHC per the population for improved curative care to a normative standard. Preparation and implementation of an intersectoral district health plan prepared by the district health mission. Technical support to national state and district health missions for public health management. SUPPLEMENTARY STRATEGIES: Regulation of private sector, including the informal rural practitioners to ensure availability of quality service to citizens at reasonable cost. PLAN OF ACTION: Components: Component 1: Creation of a cadre of Accredited Social Health Activist (ASHA). Selection: Every village/large habitat (1000 population) will have a female community health activist chosen by and accountable to the panchayat to act as the interface between the community and the public healthcare system. o ASHA must be primarily a woman resident of the village married/widow/divorced/and preferably in the age group of 24-45 years. o She should be a literate woman with formal education up to 8th class. o ASHA would act as a bridge between the ANM and the village and be accountable to the panchayat. Component 2: Strengthening Sub-Centers o Each sub-center will have a united fund for local action @ Rs. 10,000 per annum. o Supply of essential drugs both allopathic and AYUSH.

17

Component 3: Strengthening primary health centers. Strengthening PHC for quality preventative, promotive, curative, supervisory, and outreach services. Adequate and regular supply of essential quality drugs and equipments to PHCs. Provision of 24-hour services in 50% PHCs by addressing shortage of doctors especially in high focus states, through mainstreaming AYUSH manpower. Standard treatment guidelines & protocols. Component 4: Strength CHCs for first referred care. Operating all 3222 existing CHCs (30-50 beds as 24 hours first referral units including posting of an anesthetist). Promotion of Rogi Kalyan Samiti for hospital management. Developing standards of services and costs in hospital care. Component 5: District Health Plan: 1. Health plans would form the core unit of action proposed in areas like water supply. 2. District becomes core unit of planning, budgeting and implementation. 3. Project management unit for all districts run through contractual engagement of MBA chartered and data entry operator for improved program management. Component 6: Converging Sanitation And Hygiene Under NRHM (I) 1. The total sanitation campaign is presently implemented in 350 districts and is proposed to cover all 578 districts in 10th plan. 2. The TSC is implemented through PRIs. Component 7: Strengthening Disease Control Programs: Strengthening Ongoing National Disease control programs for malaria, TB, kala-Azar, filarial, blindness & Iodine deficiency shall be horizontally integrated under the mission for improved program delivery. Component 8: Public Private Partnership (PPP) for public health goals including regulation of private sector. 1. Since 75% of health services are being currently provided by the private sector, there is a need to refine regulation. 2. Regulation to be transparent and accountable. 3. Reform of regulatory bodies/creation where necessary. Component 9: New Health Financing Mechanisms 1. Progressively the District Health Mission to move towards paying hospitals for services by way of reimbursement on the principle of money follows the patient. 2. A national expert group to monitor these standards and give suitable advice and guidance on protocols and cost comparisons. Component 10: Reorienting Health/Medical Education to support Rural Health issues. 1. While district and tertiary hospitals are necessarily located in urban centers, they form an integral part of the referral care chain serving the needs of the rural people.

18

2. Need for mainstreaming AYUSH. INSTITUTIONAL MECHANISM I: 1. Formation of following institutions for implementation. 2. Village health & sanitation samiti. 3. Rogi Kalyan Samiti. 4. District Health Mission. 5. State Health Mission. INSTITUTIONAL MECHANISM II: Integration of Departments of Health and Family Welfare and development of national mission steering group consisting planning commission, ministry of Panchayat Raj, Rural Development and Human Resource Development. HEALTH TRUST OF INDIA: 1. For development of knowledge systems research and documentation, health information system, planning, monitoring and evaluation etc. 2. Reviewing health legislation networking and developing of think tank. ROLE OF STATE GOVERNMENT UNDER NRHM: NRHM provides broad conceptual framework states would project operational modalities in there state action plans to be decided in consultation with the national mission steering group. ROLE OF PRIs: The mission envisages the following roles for PRIs. PRI involvement in Rogi Kalyan Samiti for good hospital management. Training to members of PRIs. ROLE OF NGOs FOR THE MISSION: Role of the NGOs for the mission is as envisaged as follows: o In institutional arrangements. o Standing monitoring group for ASHA. o Member for task forces. o Provision of training, BCC and technical support for ASHAs IDHM. o Health resource organization. o Service delivery for identified population groups on select themes. o For monitoring, evaluation and social audit. Role of NGOs The national population policy 2000 envisages increasing role of NGOs/voluntary organizations in building up awareness about & advocacy for RCH interventions and also in improving community participation. In an attempt to increase NGOs participation, the department involved several well-established NGOs such as the Family Planning Association of India and Voluntary Health Association of India in selecting, training, assisting & monitoring of smaller, field level NGOs for carrying out the following functions:

19

Advocacy for maternal child health interventions. Promotion of small healthy family. Improving community participation. Counseling & motivating adolescents to Delay the age at marriage.

During the Tenth Plan, NGOs should have a major role in promoting community participation in: Gender sensitivity and advocacy regarding providing adequate care for the girl child. Baby friendly hospital initiatives and promotion of exclusive breast feeding for six months, advocacy for the introduction of semisolids at the right time. Social marketing of contraceptives ensuring easy availability of ORS/social marketing of ORS. Sensitizing the community regarding adverse consequences of sex determination and sex selective abortions. ROLE OF NATIONAL ORGANIZATIONS IN FAMILY WELFARE PROGRAM o Improving the quality as well as outreach of family welfare services. o Making available funds to the states and UTs for family planning in order to reduce birth rate. o Strengthening family welfare services in areas rural, urban and slums. o Revitalizing training activities of medical & paramedical personnel with emphases on motivational & counseling aspects. HEALTHCARE DELIVERY SYSTEMS: The healthcare systems are intended to deliver the healthcare services. 1. PUBLIC HEALTH SECTOR (a) Primary Health Care 1) Primary Health centers. 2) Sub-centers. (b) Hospitals/Health Centers. 1) Community Health Centers. 2) Rural Hospitals. 3) District Hospital/Health Center. 4) Specialist Hospitals. 5) Teaching Hospitals. (c) Health Insurance Schemes. 1) Employees State Insurance. 2) Central Government Health Scheme. (d) Other Agencies. 1) Defense services. 2) Railways. 2. PRIVATE SECTOR (a) Private Hospitals, Polyclinics, Nursing Homes, and Dispensaries. (b) General practitioners and clinics.

20

3. INDIGENOUS SYSTEM OF MEDICINE (a) Ayurveda and Siddha. (b) Unani and Tibbi. (c) Homeopathy. (d) Unregistered practitioners. 4. VOLUNTARY HEALTH AGENCIES (a) Indian Red Cross Society. (b) Hindu Kusht Nivaran Sangh. (c) Indian Council for Child Welfare. (d) Tuberculosis Association of India. (e) Bharat Sevak Samaj. (f) Central Social Welfare Board. (g) The Kasturba Memorial Fund. (h) Family Planning Association of India. (i) All India Womens Conference. (j) All India Blind Relief Society. (k) Professional Bodies. (l) International Agencies. 5. NATIONAL HEALTH PROGRAMS (a) National Cancer Control Program. (b) National Mental Health Program. (c) National Malaria Program. (d) National Program for Prevention & Control of Diabetes, Cardiovascular Diseases, & Stroke. (e) National Program for Control and Treatment of Occupational Diseases. (f) National Family Welfare Program. (g) National Water Supply & Sanitation Program. (h) Minimum Needs Program. (i) 20-Point Program.

SEMINAR ON
NATIONAL FAMILY WELFARE PROGRAMMES
21

NATIONAL RURAL HEALTH MISSION ROLE OF NGOS

SUBMITTED ON 01-12-2011

SUBMITTED TO MRS.M..JAYA LAKSHMI Assistant professor Dept.obsteric&Gynaecological nursing Yashoda MASTER PLAN SUBJECT :OBSTERIC AND GYNAECOLOGICAL NSG

SUBMITTED BY MISS.S. ASHWINI M.Sc(N) 1ST Year Yashoda college nursing

TOPIC: NATIONAL FAMILY WELFARE PROGRAMMES DATE:01-12-2011 GROUP MSc NURSING 1ST Yr STUDENTS NO OF STUDENTS: 4 METHOD OF TEACHING: LECTURE CUM DISCUSSION AV AIDS OHP CHART BLACK BOARD,HANDOUTS,LCD PROJECTOR GUIDED BY: MRS.M..JAYA LAKSHMI Assistant professor Dept of obsteric&Gynaecological nsg Yashoda college of nursing

22

Saroornagar

PRESENTED BY S.ASHWINI MSc(N) 1ST Year YCON

General objectives:At the end of the seminar the students will be able to gain in depth knowledge regarding national health and family welfare programme related to MCH,National Rural Health Mission,Role of Ngos,Health Care Delivery system.,they will apply this knowledge in their practice Specific objectives :- The students will be able to o Define family welfare programme o Evalution of family welfare programme o o Explain Listout milestones of family welfare programme o o Describe various family welfare programs o o Enumerate historical develop;ment of national population policy o o Objectives of NPP o o Define RCH o o Objectives of RCH PROGRAMME

OBJECTIVES

23

o o o o o o o o o o o o o o o o o o o o o o

To listout essential components of RCH Describe Janani suraksha Yojana scheme Explain Vandemataram scheme Discuss ICDS Explain child survival and safe motherhood programme Listout organizations and administration of family welfare programmes at various levels Introduce National Rural Health Mission Listout objectives of NRHM Enumerate components of NRHM Role of NGOS in family welfare programme Listout various Health Care Delivery Systems CONTENT

Objectives Introduction Definition Evolution of family welfare programme Milestones of family welfare programme National population policy 2000 Aspects of Npp Reproductive&child health programme Janani suraksha yojana scheme Vandemataram scheme

24

Integrated child development services Child survival&safe motherhood programme Organization of family welfare programmes Counseling for family welfare National rural health mission Role of Ngos Health care delivery systems

Definition According to wordiq.com Welfare is defined as in general terms, the term welfare refers simply to well being, the human condition whereby people are faring well that is prosperous, in good health and at peace. Family: A group of individuals living under one roof and usually under one head. Program: A listing of the order of events and other pertinent information for a public presentation. OR A system of services, opportunities or projects usually designed to meet a social need. EVOLUATION OF FAMILY PLANNING In order to control the rapid growth of population the policy of family planning was adopted by the Government of India in 1952. NATIONAL POPULATION POLICY 2000 Historical Development: Population policy in general refers to policies intended to decrease the birth rate or growth rate.

25

 In April 1976, India formed its first National Population Policy it called for an increase in the legal minimum age of marriage from 15 to 18 for females and from 1821 years for males. Statement because irrelevant and the policy was modified in 1977. New policy statement given the importance of the small family norm without compulsion and changed the program title to Family Welfare Program. NATIONAL FAMILY WELFARE PROGRAM - (RCH) Definition: World Health Organization (WHO) has defined reproductive health as follows: Reproductive health addresses the reproductive processes, functions, functions, and systems at all stages of life. Reproductive health therefore implies that people are able to have a responsible satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if when and how often to do so. This definition focuses on right of men and women to be informed of and to have access to safe, effective, affordable and acceptable methods of fertility regulation of their choice, and the right to access to appropriate health care services that will enable women to go safely through pregnancy and child birth and provide couples with the best chance of having a healthy infant. MAJOR ELEMENTS OF RCH PROGRAM A. Reproductive health elements. B. Child Survival Element. 3. JANANI SURAKSHA YOJANA: The national maternity benefit scheme has been modified into a new scheme called Janani Suraksha Yojana (JSY). It was launched on 12th April 2005. Objectives:Reducing maternal mortality and infant mortality through encouraging delivery at health institutions and focusing at institutional care among women in below poverty line families. VANDEMATARAM SCHEME: This is a voluntary scheme wherein any obstetric and gynae specialist, maternity home, nursing home, lady doctor/MBBS doctor, can volunteer themselves for providing safe motherhood services. INTEGRATED CHILD DEVELOPEMENT SERVICES ICDs scheme is one of the worlds largest and most unique programs for early childhood development, which was launched on 2nd October 1975 (5th five year plan) in pursuance of the National Policy for children. BENEFICIARIES: 5) Children below 6 years. 6) Pregnant and lactating women. 7) Women in the age group of 15-45 years. Adolescent girls CHILD SURVIVAL AND SAFE MOTHERHOOD PROGRAM In 1992, the child survival and safe motherhood program integrated all the schemes for better compliance.

26

This program had the following components. i) Early registration of pregnancy. j) To provide minimum three antenatal checkups. NATIONAL RURAL HEALTH MISSION INTRODUCTION:- The method rural health mission (NRHM) is a response to the verdict of the May 2004 general elections which led to the conceptualization of a set of proper policies under the common minimum program. NRHM is to provide accessible, affordable, accountable, effective and reliable primary health care and bridging the gap in rural health care through creation of a cadre of accredited social health activist. OBJECTIVES: 5. Provision of trained and supported village health activist in under served areas as per need. PRINCIPLES: Promote equity, efficiency, quality and accountability in public health systems. Enhance people orientation and community-based approaches. GOALS OF NRHM: Reduction in Infant Mortality Rate and Maternal Mortality Ratio by 50% from existing levels in next 7 years Role of NGOs The national population policy 2000 envisages increasing role of NGOs/voluntary organizations in building up awareness about & advocacy for RCH interventions and also in improving community participation HEALTHCARE DELIVERY SYSTEMS: The healthcare systems are intended to deliver the healthcare services. 1. PUBLIC HEALTH SECTOR (a) Primary Health Care 3) Primary Health centers. 4) Sub-centers. (b) Hospitals/Health Centers. 6) Community Health Centers. 7) Rural Hospitals. 8) District Hospital/Health Center. 9) Specialist Hospitals. 10) Teaching Hospitals. (c) Health Insurance Schemes. 3) Employees State Insurance. 4) Central Government Health Scheme. (d) Other Agencies. 3) Defense services. 4) Railways. 2. PRIVATE SECTOR

27

(a) Private Hospitals, Polyclinics, Nursing Homes, and Dispensaries. (b) General practitioners and clinics. 3. INDIGENOUS SYSTEM OF MEDICINE (a) Ayurveda and Siddha. (b) Unani and Tibbi. (c) Homeopathy. (d) Unregistered practitioners. 4. VOLUNTARY HEALTH AGENCIES (a) Indian Red Cross Society. (b) Hindu Kusht Nivaran Sangh. (c) Indian Council for Child Welfare. (d) Tuberculosis Association of India. (e) Bharat Sevak Samaj. (f) Central Social Welfare Board. (g) The Kasturba Memorial Fund. (h) Family Planning Association of India. (i) All India Womens Conference. (j) All India Blind Relief Society. (k) Professional Bodies. (l) International Agencies. 5. NATIONAL HEALTH PROGRAMS (a) National Cancer Control Program. (b) National Mental Health Program. (c) National Malaria Program. (d) National Program for Prevention & Control of Diabetes, Cardiovascular Diseases, & Stroke. (e) National Program for Control and Treatment of Occupational Diseases. (f) National Family Welfare Program. (g) National Water Supply & Sanitation Program. (h) Minimum Needs Program. (i) 20-Point Program.

28

BIBLIOGRAPHY

BOOK REFERENCE 1)PARKSTEXT BOOK OF PREVENTIVE AND SOCIAL MEDICINE20TH EDITION,BANARSIDAS BHANOT PUBLISHERS,PAGE NO 382-384,411423.509,574,796,802. 2)K K GULANICOMMUNITY HEALTH NURSINGPUBLISHED BY NEELAM KUMAR PUBLISHING HOUSE,PAGE NO 298-336 3)PEE VEEMIDWIFERY&GYNECOLOGICAL NURSING,PUBLISHED BY S.VIKAS&COMPANY INDIA PAGE NO709-791 4)J.KISHORESNATIONAL HEALTH PROGRAMS OF INDIA.7TH EDITION PUBLISHED BY CENTURY PUBLICATIONS,NEWDELHI PAGE NO 78-95,489 5)KAMALA.GCOMMUNITY HEALTH NURSING-1 PUBLISHED BY FLORENCE PUBLISHERS,PAGE NO 583-603 PAGE NO 673-692 7)D C DUTTATEXTBOOK OF GYNAECOLOGY4TH EDITION PUBLISHED BY NEW CENTRAL BOOK AGENCY PAGE NO 438 8)LOWDER MILKMATERNITY NURSING7TH EDITION,PUBLISHED BY ELSEVIER PAGE NO 142-146,488 9)ANNAMMA JACOBA COMPREHENSIVE TEXTBOOK OF MIDWIFERY PUBLISHED BY JATPEE BROTHERS .PAGE NO .225-226,581-585 10)C.S.DAWNTEXTBOOK OF OBSTETRICS,NEONATOLOGY&REPRODUCTIVE&CHILD HEALTH EDUCATION,16TH EDITION.PUBLISHED BY DAWN BOOKS PAGE NO 293-304 11)S.KAMALAM. ESSENTIALS INCOMMUNITY HEALTH NURSING PRACTICE IST EDITION,PUBLISHED BY JATPEE BROTHERS PAGE NO 329-335

29

12)KASTURI SUNDAR RAO COMMUNITY HEALTH NURSING 4TH EDITION PUBLISHED BY BI PUBLICATIONS PVT LTD PAGE NO 363-381 JOURNALS 1)RUKIYE TURK RN MSC ,FUSION TERZIGLU RN,MSC PHD &KAFIYE EROGLU RN MSC PHD.JOURNAL OF MIDWIFERY AND WOMENS HEALTHMJUNE 2010,VOLUME 55 2)SHARON BON.JOURNAL OF MIDWIFERY AND WOMENS HEALTH ,VOLUME55,NO 2,MARCH 2010 WEBSITES: WWW.WORDIQ.COM WWW.ASKGUIDE.COM WWW.FAMILYPLANNING.COM WWW.VIRGINIAUNIVERSITY.COM WWW.NURSINGPLANET.COM WWW.WIKIPEDIA.COM WWW.RESEARCHGATE.COM WWW.LITERATURE.COM

30

SUMMARY Till now I have discussed about family welfare programmes related to MCH which includes National Population Policy,Reproductive&Child Health.Icds. Cssm Janani Suraksha jojana scheme ,Vandemataram scheme role of ngos in family welfare programme.National Rural Health Mission

31