mh and rch plan merged

8/9/2019 MH and RCH Plan Merged

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MATERNAL HEALTHReview Meeting

Bhopal

July 2, 2010


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ACTION TAKEN REPORT

S. No. Decision taken in the last meeting of

Secretaries & Mission Directors

Action Taken Report

1 Comprehensive Plan for a district withfocus on supervision, monitoring and dataanalysis

District Plan for RCH initiated insample districts

2

Defining protocols for institutional delivery,SBA and home delivery

An Operational Guideline forMaternal and New Born Care hasbeen developed and disseminated.

3 Adequate amount of resources for management and supervision

National level: SupportiveSupervision structure finalised.State level: Consultation held withStates for State / District / Statelevel Supportive Supervisionstructure.

4 Quality of services not matching thedemand in the service

With the establishment of Centraland State level supervisorystructures, the quality of servicedelivery will improve.


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1. Delivery Statistics


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Delivery Statistics All India Expected deliveries 266.05 lakhs

Reported deliveries 196.08 lakhs Institutional deliveries 142.86 lakhs 54%Source: HMIS


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Institutional Deliveries: 2009-10

Source: HMIS; % against expected deliveries


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Institutional Deliveries: 2009-10 NE States



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Institutional Deliveries:Non HF states 2009-10



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Home Deliveries by Non-SBA: 2009-10

Source: HMIS


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2. Facility Operationalisation


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FRUs: Operationalisation till 2009-10

Source: ROPs


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24x7 Facilities: Operationalisation till 2009-10

Source: ROPs


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Observations and Issues

Data from states shows that not all FRUs fulfil the critical criteria offunctionality

Similar observations are made during various state visits/ JRMs/CRMs. Facilities usually designated and reported as FRU/ 24x7without the required inputs/ complement of services in place

Further, variations seen in the figures of operational facilities inpresentations/ different reports (e.g. HMIS, NRHM bulletin, etc.)

State No. of FRUsreported functional

No. of FRUs fulfillingALL 3 critical criteria offunctionality

Assam 60 55

Punjab 168 79Orissa 78 45


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3. Training


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Training Progress till 2009-10: LSAS


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Training Progress till 2009-10: EmOC


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Training Progress till 2009-10: SBA


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Capacity Utilisation of Training Centres EAGStates and Assam


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Capacity Utilisation of Training Centres Non-HF States


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Posting of LSAS & EMOC trained doctors at FRUs EAG States


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Posting of LSAS & EMOC trained doctors at FRUs NE States


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Posting of LSAS & EMOC trained doctors at FRUs Non-HF States


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MH Training Expenditure 2009-10

Source: ROP 2009-10 and FMRs


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Issues All States

Quality of training needs improvement Doctors trained in LSAS and EmOC need to be posted at FRUs on priority.

Posting order for the doctors should come along with the nominations

LSAS and EmOC trained doctors should be issued a G.O. for practicingspecialised skills, since there are several instances of them being usedagain as GDMOs

Bihar and Uttar Pradesh QACs not operational; no alternative monitoring mechanism

No planned monitoring visits by state/ district program officers for monitoringquality of training and implementation of technical protocols

Rajasthan

TIER 1 & TIER 2 examinations for LSAS not conducted in most centers Number of cases that each candidate anaesthetized is below the minimum

criteria set in GOI guidelines; No candidate has undergone CPR training

Gujarat Monitoring of training quality through SIHFW to be revitalised


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Issues J & K

EmOC trainees unable to practice skills at the dist. training centre, sincetrainers are posted to sites other than training centre; quality of training ofconcern; exams postponed no action to resolve the issue

SBA and BEmOC ToT conducted however training not conducted as perprotocols

West Bengal

Monitoring of training quality through SIHFW to be activated SBA training quality needs special attention

Assam, Meghalaya, Sikkim & Tripura QACs functional, but monitoring activities need further strengthening

Manipur QACs in place, but not fully operational

Mizoram QACs in place, but not fully operational

All 8 MOs trained in LSAS yet to undergo 3rd tier exam


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4. Janani SurakshaYojana


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JSY Expenditure 2009-10


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Expenditure 2009-10 JSY vs. RCH II SupplySide : JSY Focus States


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Expenditure 2009-10 JSY vs. RCH II SupplySide: Non-Focus States


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Quality of Care focus states


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JSY Focus States

Penetration of JSY = proportion of JSY beneficiaries out of deliveries at public institutions

Reach of ASHAs = proportion of ASHAs receiving JSY benefits out of JSY deliveries at publicinstitutions


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5. Maternal Death Review


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Status of implementation of MDR

S.

No.

Activity No. of

States

Implemented by

1 Issue Govt. of orderby the States

14 AP, Assam, DNH, Goa, Jharkhand, Karnataka,Kerala, MP, Meghalaya, Mizoram, Rajasthan,

Uttarakhand, TN, Delhi

2 Issue of Guidelines

to the district /facilities

15 AP, Chhattisgarh, DNH, Delhi, Haryana,

Jharkhand, Karnataka, Kerala, MP,Meghalaya, Rajasthan, Sikkim, TN, UP and

Uttarakhand3 Constitution of State Committees

11 AP, Assam, Chhattisgarh, DNH, Delhi,Jharkhand, Kerala, MP, Manipur, Rajasthan,

UP4 Constitution of

DistrictCommittees

9 AP, Assam, Jharkhand, Chhattisgarh, Kerala,MP, Manipur, Rajasthan, UP

5 Orientationprogramme

8 Assam, Jharkhand, Karnataka, Kerala, MP,Rajasthan, TN, Delhi

Based on information received from 30 States/ UTs


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Nearly 12,500 maternal deaths reported

3 out of 5 maternal deaths classified as Other Need for greater orientation of service providers on correct classification

and entry of maternal mortality data.

States to fast track setting up of MDR mechanisms

Source; HMIS


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APPROACH to RCH PLANNING FOR HIGH

FOCUS DISTRICTS


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Identified High Focus Districts represent approximately 35%of population but account for over 41% of births and closeto 50% of IMR and 60% of MMR.

MOHFW identified 264 backward districts based on health

and socio-demographic parameters for focussed attentionto:

Reduce regional disparities

For faster attainment of health goals

MOHFW constituted 8 teams of officers to visit a sample of

districts in the high focus states to prepare RCH sub-plans

Background for District Planning


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Assam Dhubri GoalparaBihar Muzzafarpur SamastipurChhattisgarh Bilaspur Kawardha

Jharkhand Deogarh DumkaM.P Umaria Annupur Orissa Kandmal NayagarhRajasthan PaliU.P. Kanpur Dehat Unnao

Sample Plans


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ight Principles of the district:lan1. Invest resources in strengthening those facilities which are functional and

managing case load.

2. Also identify areas where access is the issue and develop/strengthenfacilities there.

3. Estimate precise training load: ExternalTrainers/Training.

4. Prioritise those providers for training who are providing the bulk of theservices and where access has to increase.

5. Work out the facilities where human resource gaps must be closed as apriority.

6. Strengthen home based care- for deliveries in select sites and for neonates

everywhere.7. Differential financing- more funds to those facilities which require more.

8. Provider incentives- both for volume of work and for those in inaccessibleareas.


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District Planning :BilaspurChhattisgarh


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PLANNING PROCESS

Participatory planning with district and state officials

Analysis of block-wise data to identify service delivery and

utilisation

Field visit observations, data analysis, projected service demand.

Identification of facilities for upgradation

Delivery points at all levels of care identified for

strengthening, including clustering of sub-centres in

under-served areas, based on spatial distribution and

delivery load

Facility-wise gaps identified at all levels

Private facilities roped in wherever available


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DELIVERY STATISTICS: 2009-10

Total Population 22,95,243

CBR 26.1

Expected pregnanicies per year 65897

Total reported deliveries in nos (from HMIS) 64839

Reported deliveries as % of expected pregnancies 98.4%

Actual Delivery as numbers and as % of expectedpregnancies:

Institutional 28398 (43.1%)

Home 36441 (55.3%)

Home deliveries by SBA (assisted by health personnel) 12090 (18.3%)

Home deliveries by non-SBA (not assisted by healthpersonnel/ unassisted)

24351 (37%)

Total Unreported deliveries 1058 (1.6%)


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Delivery Points

FACILITY TOTAL NO.INDISTRICT

CURRENTDELIVERYPOINTS(2009-10)

PROPOSEDDELIVERYPOINTS 2010-11


Med College Hosp 1 1 1 1

DH 1 1 1 1

CHC 11 11 11 11

PHC 75 51 55 70

Sub-centre 357 80 80 80

Private provider* 35 + 35 38 43

TOTAL 480 + 179 186 206

Focus is on strengthening existing delivery points

since utilisation is low


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Delivery Points

FACILITY TOTAL NO.INDISTRICT

CURRENTDELIVERYPOINTS(2009-10)



Med College Hosp 1 1 1 1

DH 1 1 1 1

CHC 11 11 11 11

PHC 75 51 55 70

Sub-centre 357 80 80 80

Private provider* 35 + 35 38 43

TOTAL 480 + 179 186 206

Focus is on strengthening existing delivery points

since utilisation is low


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( - )nnual Budget Summary 2010 2011udget Head ( )mount Rs in LakhsHuman resource .100 32

Infrastructure .260 55Training .139 29

Referral .0 00

PPP .0 00Others .62 53

rand Total .62 68

Budget


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Need Assessment in the 15 districts in 8 states

visited by central team

(analysis done of RCH sub-plans for 15 districts)


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Large HR gaps are seen across allthe districts.

Major requirement is for ANMs and

staff nurses

Several districts have proposed aSupervisory cadre for enhanced

supportive supervision.

Other paramedical staff, e.g. X-Ray,

OT, and ECG technicians, etc.

have also been proposed.

Account for 1/3rd of the budget

required per district.

S.No. Category ofStaff AdditionalRequirement1 Specialists 154

2 MedicalOfficers

289

3 Staff Nurses 7074 ANMs 588

5 Labtechnicians

111

6 ForSupportiveSupervision

66

7 Rural HealthPractitioners

29

8 AYUSHpractitioners

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HR Gaps

T i i G


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In light of the focus on increasingcoverage of safe delivery servicesby skilled providers, the largestrequirement is for SBA training ofstaff nurses and ANMs.

Additional training sites areproposed to be strengthened tocater to the increased load.

Districts have also proposed multi-skilling of medical officers to fillgaps in critical specialties.

The other major training proposed isfor IUD insertion.

Training accounts for 11.5% of thebudget required per district.

Training Gaps

S.No.

Training Load for 2010-11

1 SBA 1674

2 BEmOC 308

3 LSAS 22

4 EmOC 51

5 MTP 105

6 F-IMNCI 620

7 IUCD 5938 NSV 10

9 Mini Lap 23

10 Lap Sterilisation 3


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INFRASTRUCTURE Includes

Repair/ renovation of existing structures (OTs, labour rooms, boundarywall, water supply, etc.)

Construction of new health facilities (predictably, gaps are large inthese backward districts and states)

Blood storage centres, sick newborn care units (SNCU), newbornstabilisation units (NBSU), ASHA waiting halls in high volumefacilities, etc.

EQUIPMENT

Additional beds, MVA kits (for safe abortion services), generators,equipment for blood storage units, newborn baby corners, NBSUs,SNCUs, etc.

Account for 40% of the budget required per district

Infrastructure Gaps


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Likely Additional


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Budget Head Total for 13districts

Unit cost/district

Projected costfor 235 districts

Human resource 16.68 1.85 435.60

Infrastructure 29.11 2.24 526.15

Training 5.16 0.64 151.48

Referral Transport 0.95 0.12 28.00

PPP 0.73 0.37 85.78

Others 2.83 0.36 83.09

Grand Total 55.46 5.57 1310.10

Amount in Rs. Crore

Likely Additional

Requirement for 235 Districts


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Preparation of similar sub-plans for other backward districts

Steps already underway to involve development partnersand other agencies to provide support to states instrengthening planning and monitoring

Increasing training capacity to handle increased load

States to prioritise interventions in these districts:Ensure strengthening of facilitiesRationalise staff to ensure these facilities have fewer

gapsProvide incentives to staff to work in these facilitiesPrioritise trainingSet up/ strengthen supportive supervision systems

WAY FORWARD


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Thank You

mh and rch plan merged

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