IMNCI Training under RCH – II
Integrated Management of Neonatal Childhood Illness is the centerpiece of the Newborn and Child Health Strategy in RCH Phase –II. It includes the home and community based component (through ANM and AWWs) and the facility based out patient care component, as is being piloted in UNCEF's Border District Projects. In addition the component on Management of Sick Neonates and Children in the inpatient setting at PHC/ R.H./ FRUs. Health system strengthening and community participation components have been addressed effectively to ensure effective implementation.
IMNCI is the central pillar of Child Health Strategy that include three components
1) Improvement in case management skills of health staff.
2) Improvement in health systems for effective managements.
3) Improvement in Family & Community practices.
As per Govt. of India guidelines a new initiative under Integrated Management of Neonatal & Childhood Illness (IMNCI) initiatives is being implemented in State as a major step towards reduction of Infant Morbidity and IMR in selected 9 districts. And 11 more districts also being covered for training by July 2007 onwards.
Maharashtra State has decided to take up IMNCI initiative in 9 districts – From RCH flexi pool funds – Thane, Nashik, Amaravati and Gadchiroli.
UNICEF assistance – Osmanabad, Latur, Chandrapur, Nanded & Nandurbar.
In IInd Phase IMNCI strategy is introduced in Raigad, Beed, Ahemadnagar, Jalgaon, Dhule, Pune, Gondia, Yavatmal. Nagpur, Wardha. Districts. Dist Buldhana has been added recently.
This initiative mainly involved is training doctors and Para medical staff in early diagnosis and proper management of common illnesses in infants and children below 5 years of age.
MOs, Supervisors (H.A. male / female, Mukhya Sevikas), Health Functionaries.
(ANMs/ MPW/ AWW) are to be trained under this project in 5 tribal districts and 4 other districts mentioned above. ToT for these 8 tribal districts is arranged with the help of UNICEF, Mumbai from March–April, 2007 in Nashik and Nagpur.
Important activities under IMNCI
Nodal Officer for IMNCI
Implementation of IMNCI needs to have co–ordination with other department of the state Government like ICDS, RDD, and Medical Education etc. State RCH Officer/Additional Director (FW) has taken this responsibility.
Establishment of a Co–ordination Group
As per guidelines received by GOI that the coordination group has to be formed including donor agencies like UNICEF, other departments like ICDS / WCD, Rural Development, Department of Medical Education. Vide G R No. RCH/1005/CR13/05/FW–1 dated 1st April 05 the working group has been formed as follows
|1.||Director of Health Services,Mumbai||Chairman|
|2.||Additional Director of Health Services,(Fw,MCH,&SH),Pune||Member|
|3.||Joint Director of Health Services,(German Project), Pune||Member|
|4.||Deputy Director (FW)||Member|
|5.||Deputy Director (WCD)/RCH Co–ordinator||Member|
|6.||Deputy Director (RRD)||Member|
|7.||Representative from UNCIEF||Member|
|8.||Representative from UNFPA||Member|
|9.||Representative of LAP/NNF(One member from each organization)||Member|
|10.||Deputy Director of Health Sevices (RCH),SFWB,Pune||Member Secretary|
This group is responsible for monitoring, follow up and review up implementation of IMNCI in the state.
Formation of District Level Co–ordination Group
District level Co–ordination group has been formed on similar lines that of state level co–ordination group. Vide G R No. RCH/1005/CR13/05/FW–1 dated 1st April o5 the working group has been formed as follows
|1.||CEO ZP||Chair Person|
|2.||Deputy CEO (ICDS)||Member|
|4.||Pediatrician Dist. Hospital||Member|
|5.||Representative of INF/NNF/IMA||Member|
|7.||Dist. RCH Officer||Member|
|9.||DHO, Z.P.||Member Secretary|
Dean, of nearby Govt. Medical College is being included in the District Coordination working group as we are involving Medical Colleges in IMNCI training in No. of districts.This group is responsible for monitoring, follow up and review of implementation of IMNC in the district.
Arrange translation, Printing and supply of Training Material
This activity has been already completed. The training material has been sent to Nashik, Thane, Amravati and Gadchiroli Districts. UNICEF has already supplied the training material in 5 districts assisted by them.
Create pool of State level Trainers
GOI has expressed the opinion that about 40 to 50 trainers in a district are required for undertaking training of Health Staff on a continuous basis. It has been decided to conduct at least two TOT at HFWTC Aurangabad with clinical assistance from Government Medical College Aurangabad, UNICEF Mumbai has shown willingness to arrange national trainers during this TOT. We can further train Additional District Trainer from the trained MODTT, Medical Officers, LHV, PHN, Nursing Officer/ Tutor etc. by giving them an additional training of two days for supportive supervision and facilitation. It is under consideration to outsource this training activity to some NGO / Group of Experts like Retired Pediatrition, Public Health Specialist, Medical Officer, PHN / Nursing Officer, wherever feasible.
Identify the State Nodal Institute for IMNCI Training
It is under consideration to develop HFWTC Aurangabad as State Nodal Institute for IMNCI Training. We have held two TOTs at Aurangabad. Government Medical College Aurangabad has an adequate caseload, excellent facilities for hands on training, HFWTC Aurangabad has adequate facilities for class room training.
Improvement of Health System
GOI has directed to make available essential drugs with workers and at facilities covered under IMNCI. IMNCI kit is being issued to PHC, Subcenter & AWW. GOI has stressed to reinforce referral institutions like RH/FRUs or Private/ Public partnerships to be established. Action is under way to develop FRUs as per Indian Public Health Standards. Medicine kits are being provided to the trained ANM, AWW after completion of the training. Funds have been already allocated to the 9 IMNCI implemented districts & also in more districts where also training has been started total 23 districts are under IMNCI Programme.
Improvement of Family and Community Practices
IEC campaign for awareness generation regarding breast–feeding practices, illness recognition, early case seeking etc. is being launched. Counseling of caregivers and families is being undertaken as part of management of sick child when they are brought health worker / health facility. BCC has to be focused on improving new born and childcare practices. IEC Bureau Pune has been entrusted to undertake this responsibility.
|Status of IMNCI training (MOs & Paramedicals)|
|Sr.No.||District||Total Trg. Load||Trained|
Essential New Born Care Training
With the help of National Neonatal Forum we have Started Essential New Born Care Training of 2 days for MO PHCs and we have covered 7 districts of Vidarbha under EC–SIP funding and till last year we have trained 413 MBBS MOs in Essential New Born Care. This year we are covering districts of Thane Nasik Nandurbar Chandrapur and Gadchiroli. for this component.
The main goals under the Reproductive and child Health Programme are to reduce MMR, IMR and TFR. In tribal area due to geographical hurdles, customs and taboos as well as health seeking behaviour the rate of MMR and IMR and Pregnancy wastage is very high. Thane, Nandurbar, Nasik, Amaravati and Gadchiroli are very sensitive which need attention on priority basis. Hence it is proposed to implement Arogya Sakhi Yojana, which will aims towards improving Maternal Health especially focusing on reducing Maternal Morbidity and Morality related to Obstetric causes mainly by ANC, conducting Delivery and PNC.
Arogya Sakhi Yojana is being implemented in 150 villages in 5 tribal districts where there is no public health facility like Sub–center, PHC, PHU and MHU available. Preferably a village having population about 1,000 is selected. The eligibility criteria for 'Arogya Sakhi' is she should be married, age about 35 years, resident from same village, she should be literate and willing to undergo training for 6 months at District Hospital/ Sub–District/ Woman Hospital.
After training each Arogya Sakhi will function as Trained Birth Attendant by providing ANC, conducting normal deliveries, PNC, treatment for minor ailment as well as referral of the cases. After completion of the training, she will be issued delivery kit and honorarium and rent for room for clinic/ delivery room for 4 years.
The expenditure for Arogya Sakhi training has been made available from the European Commission Supported Sector Investment Programme till March 2007 and next subsequent years the expenditure will be incurred under RCH – II Programme.
|Status of Arogya Sakhi training|
|SR. No.||District||Total Trg. Load||Trained (I st batch)||Trained (IInd batch)||Total Trained under EC–SIP|
Maternal Health is major issue especially in tribal area. It is necessary to address this under tribal RCH on priority basis. In order to reduce Maternal Mortality, it is very essential to promote the institutional delivery or delivery by SBA. Considering the vast difficult terrains, geographical and inaccessible health services and as well as population of villages. It will be difficult in the near future to achieve 100% institutional deliveries. Hence it is proposed to ensure the safe delivery by trained personal at village level. There are about 6,000 TBA available in Thane, Nandurbar, Nasik, Amaravati and Gadchiroli. There are still 489 villages remaining in these 5 tribal districts.
To impart the training it is essential to identify a woman from these villages. It is proposed to adopt the following eligibility for selection of such woman.
1. She should be married and resident of same village.
2. She should be a middle age.
3. She should be literate.
The training center will be near by RH/ SDH for 3 weeks and one–week hands on training will be given at District Hospital. The duration for training is 30 days. After the training each Dai will be provided Dai Kit. The expenditure for this training will be paid through RCH –II funds.
|Status of Dai Training|
|SR. No.||District||Total Trg. Load||No.Trained||Remaining Load|
There has been some difficulty noted in finding suitable candidates willing to under go Dai training course in Thane and Nashik districts.Now thsi Trainnig is going ononly in Gadchiroli district.
Life Saving Skills in Anesthesia for EmOC
As per GOI guidelines 18 weeks certificate course for M.B.B.S. Doctors who has completed 5 years services will be undertaken in State, as there is acute shortage of Anaesthetist in state. The EmOC services cannot be given at FRU. 12 weeks training will be given at Medical Collage and 6 weeks at District Hospitals. 6 centers in the state are recognized for the training. The centers are: – Amaravati, Dhule, Kolhapur, Nanded and KEM Hospital, Mumbai and Sion Hospital, Mumbai. TOT was arranged at KEM Hospital Mumbai on 29th June 2006 conducted by Faculty members of AIIMS, New Delhi. A batch of 4 doctors will be sent to each Medical College. After completion of training the doctors will be posted at FRU and will work for at least 3 years. The Mannequin is received from UNICEF; hence training is started in 3 Medical Colleges, i.e. at KEM Hospital Mumbai, GMC Kolhapur and GMC Nanded. Total 15 Doctors were trained last Year. This year we have started ths training in 7 more Medical College, 4o more Doctores are under training at present.
Adolescent health component activity will be undertaken under RCH–II in 33 District Hospitals and 7 Woman Hospitals. The Gynecologists of these hospitals were trained w.e.f. 20–23rd June 2006. Instruction have been issued to start Adolescent Health Clinic at District Hospital and selected Sub–district Hospitals on fixed day of the week.
During RCH–II the State decided to impart Managerial Training of health programmes to THOs of all districts. This training was conducted by PHCMRC – NGO. The duration of the training is 5 days. Training status is as follows. This training is over. Status of THO training
|SR. No.||District||Total Trg. Load||No.Trained||Remaining Load|
BEmOC & SAB Training
Basic Emergency Obstetric Care Training has been decided to be given to Medical Officers of 24 X 7 days PHCs and MOs from R.H. Skilled attendance at Birth training will be imparted to ANM/LHV/Staff Nurse. The duration of the training is 15 days for both these trainings. It has been decided to conduct ToT for Gynaecologist, OT Nurse, Labour room Nurse, MODTT/ ADHO at divisional level. ToT workshops were conducted at PHI, Nagpur, HFWTC, Pune & Nashik. A batch comprising of 3 Medical Officers is to deputed for BEmOC training and 3 ANM/LHV/Staff Nurse will be deputed for SBA training to district hospital and women hospital. Every month one batch will be conducted at District Hospital and Women Hospital alternatively of BEmOC followed by SBA. Rs. 50.000/– have been already issued for purchase of essential injections, drugs during training and after training for SBA training.
|Status of BEmOC & SBA training|
|SR. No.||Name of Training||Total Trg. Load 2006–07||Trained Since inception||Remaining Load|
Both BEmOC and SAB training are going on in above 45 selected training sites in full swing in the state.
Under Unicef EC – SIP funding we have trained 7 teams Gynecologists & Nurses at CMC Vellore during 2004 to 2006. Presently we have started EMoC Training at Daga Hospital Nagpur & 2 Sr MBBS doctors for tribal district of Chandrapur are attending the training.
There is increased trained of Laproscopic Sterilization. Laproscopic Sterilization is on going activity. To train eligible candidates (Gynaecologist & General Surgeon) in Laproscopic sterilization, the following institutes are identified
- Sasoon Hospital, Pune
- YCM Hospital, Pimpari Chinchwad.
- Shri Sali Hospital, Manchar,Dist. Pune
- Women Hospital – Jalna.
- District Hospital – Alibag.
- Govt. Medical College,Dhule.
Contribution from Private Sector is there in the form of performance as well as training to Surgeons. The training of Laproscopic Sterilization is to be imparted to team comprising of Gynaecologist / General Surgeon Private Practitioners who are eligible for training and has desired to under go training Family Planning Association of India and Sangamnerkar Dwarika Foundation Hospital are exclusively identified for private Gynaecologists and Surgeons for Laproscopic Ligation Training. We have trained 10 doctors in laproscopy during last year.
This of ISDT has not been paid adequate attention by any Dist Health officers. As per recent guidelines received from Ministry of Health and Family Welfare the State has recognized Cama and albless Hospital Mumbai as nodal Training Training Centre on IUD Insertion for ANMs /LHVs and training of first batch has been started from 28th June 2007. at Cama and albless Hospital Mumbai.
NSV training is imparted during camps of a period of 5 days. 2–4 Surgeons are trained in one batch. MBBS doctors with 5 years of experience are eligible for the training. Rs. 1.96 crores has been distributed to all the districts for undertaking this training. The norm of Rs. 53,000/– for organizing a 5–day camp for training of 4 Medical Officers has been already communicated.
No. of MOs trained: Up till now 223 (Year 2006–07)
Availability of Trainers
- No. of state Trainers available: 3.
- No. of District Trainers available: 76.
- No. of Service Providers/ MO's trained: 292.
- No. of District Hospitals provding NSV Services:33.
As per GoI guidelines Tubectomy training was being conducted for a period of 12 working days. However in view of the feedback received from various sources, the hands on training experience obtained in 12 days were not found adequate. It has been decided to fix the duration of tubectomy training of 6 weeks. This training is being conducted in all district hospitals & women hospitals.
|Training Load||Trained||To be Trained|
This training load will be completed in next 3 years.
Integrated ISDT under NRHM for newly recruited ANMs/LHVs on contract basis
Under NRHM the state has recruited about 3500 ANMs/LHVs In 24hrsx7days PHCs/Sub–centers to strengthen RCH Services to community. It has been decided to train all these nursing candidates on RCH/NRHM issues by conducting training of 12 days at District Training Team level A ToT of Principal HFWTCs &MO DTTs has been finished at Nagpur recently. It is proposed to start actual training from 2nd July 2007 onwards for these ANMs/ LHVs in the state. Funds also have been released to Principal HFWTCs . Now GOI has instructed to stop this training ISDT.