Child Survival Services
The state IMR and NMR are 45 and 29 (SRS 2002) respectively, which are better than national average. However, it is observed that, these rates have not improved since last 5 to 6 years.
The activities for reduction of IMR, NMR revolve around
- Increasing awareness up to grassroots level for home based care.
- Increasing reach and availability of items for home based care such as ORS and Septran etc.
- Improving nutritional status of pregnant women and children including promotion of early and exclusive breast feeding, weaning, nutrition demonstrations.
- Developing village level referral plans and provisions for referral transport for EmPC.
Establishing Neonatal Intensive Care Unit (NICU), at District Hospitals & selected tribal First Referral Unit (FRU) New born care units and new born care corners at appropriate levels, improving the environment of pediatric wards at district hospitals etc.
Capacity building and trainings are other important action areas covering
- Trainings IMNCI with priority to tribal area.
- MCHN training & New Born Care.
- TBA training.
- Promotion on Early and exclusive breast feeding.
- Orienting community members and CBOs on identification of danger signs for EmPC in diarrhea, Acute Respiratory Tract Infection (ARI), etc.
- Provision of training equipments and models (to be procured under EC component).
Various incentive schemes exist in tribal areas state which promote maternal care, new born care and care of child illness including diet for parent and compensation for loss of wages for parent/guardian are promoted by the state government apart from the national maternity benefit scheme for Below Poverty Line (BPL) families.
Reproductive and Child Health (RCH) II proposes to allocate special resources for the tribal areas like Innovative schemes of Subsidized Medical Practitioners, and Nurse practitioners to give thrust on IMR related activities.In addition to these, major thrust will be given on promoting joint working of ICDS and Health functionaries through better convergence and close monitoring at all levels.
- Promotion of early and exclusive breast–feeding.
- Health checkup of malnourished children by Medical Officer (MO), Primary Health Center (PHC) at Aanganwadi .Though the ICDS functionaries.
- New Born Care (NBC) & Maternal and Child Health Nurse (MCHN) training.
- Integrated Management of Neonatal and Child Illnesses (IMNCI).
High Neo natal, Infant and under % mortality is the most important challenge in child health in tribal and urban areas of the state.Most neo natal deaths occur at home because of home delivery conducted by untrained persons who do not practice aseptic procedures during deliveries. There are difficulties in transporting of sick neonates to hospitals.
- Observing ‘Five cleans’ while conducting home delivery.
- Protecting the new born from hypothermia, infection and starting early and exclusive breast–feeding.
- Insuring all home deliveries are visited within 48 hrs. by Anganwadi Worker (AWW).
- Prevention and management of neo natal sepsis by giving treatment.
- Identification of warning signals and prompt referral of neonate to referral hospital.
- Home based correct case management of diarrhea and Acute respiratory infection with involvement or TBA’s and Aanganwadi workers.
Monitoring of growth records
UNICEF & ICDS along with health department has developed innovative growth and health checkup cards for mothers and under five children. (–9 to 5 years).
Healthy Baby Competition
To create awareness about good nutritional practices and maintaining child in good health, state proposes to take this initiative in selected districts by organizing Healthy Baby Competition on periodic basis after good publicity along with prizes to children.
Providing easy access to contraceptives, ORS Packets etc
Adolescent Health Services
Adolescent issues will be incorporated in all the Reproductive and Child Health (RCH) training programmes and all Reproductive and Child Health (RCH) materials developed for communication and behaviour change. This will entail that interventions for addressing unmet need for contraception and pregnancy care, prevention of STIs including HIV/AIDS Adolescent Health initiative.
The activity will be in two areas. One being through School based activity for student group and will be implemented through the Education department, similar to program run for HIV/AIDS awareness by State AIDS society.
Second approach is through the ICDS/SHG/NGOs for non–school adolescents. UNFPA and UNICEF are piloting in this direction to evolve an agreeable srategy.
Orientation of health staff: It is essential to equip the health staff with knowledge and skills so as to enable them to cater to reproductive and sexual health needs of adolescents are critical.
Adolescent Health Clinics: The controlling/preventing reproductive tract infections in adolescent girls at District Hospital & select Rural Hospitals in phased manner.
Role of SHGs
The State is proposing to undertake an initiative to involve SHGs for local production of low cost sanitary pads which will serve as an economic support to SHG groups.
Family Planning – Reducing Total Fertility Rate
Population stabilization is the mandate of State Family Welfare Bureau. Maharashtra has major regional variation due to socio–cultural groups. Actions are planned to identify need–based districts to focus area specific issues. The broad classification of districts brings forth the division of districts in tribal districts – where age at first pregnancy, ignorance about family planning, traditional beliefs and neonatal mortality are main causes of larger family size.
Further, in Marathwada and Vidarbha region, the problem is more of having a preference to male child. The decreasing sex ratio of 0–6 years age group indicates a need of stringent actions and implementation of PNDT act.
The state is implementing F.W. activities with top priority since last 2–3 decades. Annual eligible couple survey as a process to identify community needs assessment is carried out to know the current status of target couples for spacing and terminal methods of contraception.
State regularly monitors the performance of sterilization on 2 issues and promotion of No Scalpel Vasectomies (NSV) has been given priority in last 5–6 years.
State also implements a incentive scheme from state resopurses for promoting sterilization of BPL couples with only 1–2 females issues and no male issue, under the auspices of ‘Savitribai Phule Kanya Kalyan Yojana’. Such couples are given cash certificates in the name of female issues, which mature at their age of 18 years. State is receiving good response to this scheme.
State will implement following activities in Reproductive and Child Health (RCH) Phase II for reducing TFR
|1.||Yearly expected level of achievements (ELA) to be decided on local situation and CNA approach.|
|2.||Identification and promotion of village level depot holders to provide contraceptives like oral pills and Nirodh at local level.|
|3.||Social franchising with private doctors and other outlets.|
|4.||Social marketing through agencies like Population Services Health Organization (PSHO).|
|5||Promotion of NSV through Behavioural Change Communication (BCC) & training of medical officers to reduce stress on female sterilization.|
|6||Organization of Newly Married Couple Meet at grass root level two times a year|
|7||BCC activities to reduce male preference through Non health intervention.|
|8||Felicitation of couples accepting sterilization on 1–2 female issues fr4om Above BPL group.|
|9||Promotion of spacing method especially emergency contraceptive through FOGSI.|
|10||Revitalization of & establishment of MTP centers to take care of unwanted pregnancies mainly due to failure of contraceptive use with routine monitoring.|
|11||IEC and implementation of activities related PNDT helping to reduce male preference.|
|12||Involvement of private practitioners not only in sterilization programmes but also in spacing especially IUD programme. Under this one would like to improve training if private practitioner desire and also necessary logistic support.|
|13||Plan to have 2–3 Laproscopy surgeons with necessary no. of laproscopes in each district as it is observed that beneficiaries prefer to undergo laproscopic surgery as minimum stay is required.|
|14||State is negotiating with insurance companies for reimbursement claim in case of complication occurring during or post sterilization not only for the beneficiary undergoing sterilization but also for the child of sterilized couple below 3–5 years.|