Presentation for IMA National Convention

Department of Family Welfare

Government of India

NCMP Mandate• Healthcare is one of the 7 Sutras of NCMP.• Investment in health to grow 2-3% of GDP over

next 5 years.• Focus on primary healthcare.• National Scheme for Health Insurance for poor

families.• Special care to the girl child.• Public investment in programmes to control all

communicable diseases to grow.• Special attention to poorer sections for healthcare.• Focused Programme on 150 high fertility districts.

PM’s Vision for Health• A healthy child makes a healthy nation.

• Improved delivery of basic healthcare services by involving Panchayati Raj.

• Real challenge is implementation of stated policies and programmes of the Government by working with States.

• Increased investment in health and education for creation of capabilities that make India globally competitive

• Mission on Urban Slum Renewal contemplated.

• Mission on Rural Healthcare Delivery on the anvil.

• Comprehensive National Scheme for Health Insurance is a priority item.

Population Stabilisation Paradigm

• Aim is population stabilisation, Not population control.

• Family Planning Programme is voluntary and non coercive.

• Government promotes small family and not a 2 child norm.

• Approach to population stabilisation through addressing issues of contraception, maternal and child health.

• Challenge before the Government is improving access to family welfare services to address “unmet needs”

X Plan and NPP 2000 Goals

Indicator Current Level

10th Plan 2007

2010 goals as per NPP

Infant Mortality Rate/1000

64

(2002)

45 <30

Full Immunization of Children

54.2%

(98-99)

100% 100%

Maternal Mortality Rate/1,00,000

400

(1999)

200 <100

Safe Delivery 42.3%

(98-99)

80% 100%

Total Fertility Rate 3.2

(1999)

2.3 2.1

Population Growth Trends

• The growth rate is declining but not fast enough.• National Population Policy 2000 aims at

attainment of Total Fertility Rate (TFR) of 2.1 by 2010 to stabilize population by 2045, at 160 crores.

• Planning Commission estimates attainment of TFR of 2.1 by 2016, implying additional 10 crore population, and cumulative impact peaking at 2050 around 180 crores.

• Hope is to stabilize this population at 135 cr. and below.

• The challenge of population stability is mainly in Empowered Action Group (EAG) States,Assam, Jammu & Kashmir, Haryana.

6

A v e r a g e E x p o n e n t i a l G r o w t h R a t e ( i n % )

0 . 8 4

2 . 2 22 . 2 02 . 1 4

1 . 9 31 . 9 6

0 . 5

0 . 7

0 . 9

1 . 1

1 . 3

1 . 5

1 . 7

1 . 9

2 . 1

2 . 3

2 . 5

1 9 5 1 - 6 1 1 9 6 1 - 7 1 1 9 7 1 - 8 1 1 9 8 1 - 9 1 1 9 9 1 - 0 1 2 0 1 0 ( P r o j )

( - 0 . 0 8 )

( - 0 . 2 1 )

S o u r c e : R e g is t r a r G e n e r a l, In d ia

( - 1 . 0 9 )

0.86 (2021-31)

Family Planning – The Challenge (I)

To reach the target of TFR 2.1 at national level, the need is:

Methods Current acceptors 2003-04*

(in 000’s)

Required by 2007

(in 000’s)

Sterilizations 4873 8234*

IUD Users 6078 17232*

Eq. Condom Users 17831 30013

Eq. Oral Pill Users 8753 15006

•Provisional

•There can be interchange between the two

Methods Current Acceptors (2003-04)

(in 000’s)

Bihar U.P. M.P. Orissa Rajasthan

Sterilizations 109

(467)

487

(954)

352

(785)

89

(314)

300

(425)

IUD Users 122

(984)

2082

(3649)

455

(1555)

142

(471)

265

(937)

Eq. Condom Users

34

(1713)

1760

(6355)

1423

(2709)

284

(821)

1422

(1632)

Eq. Oral Pill Users

41

(857)

852

(3178)

564

(1354)

137

(410)

711

(816)

Family Planning – The Challenge (II)

Figure in bracket is level required by 2007

Family Planning – The Challenge (III)

• Of 48 lakh sterilisations /annum, only 13 lakh (27%) are in CMP States(40% population)

• Of 250 lakh births/annum, 170 lakh are high order(more than 2 children) births

• High order births in CMP States=93lakh• Growth rate for sterilization to be increased

from current level of 4%p.a. to 40% p.a. Private sector to contribute 38% and public sector 2%

• Raise level of sterilisations in CMP States to 50 lakh / annum from present 13 lakh / annum

Family Planning – The Strategy

• Aims at attainment of 10th Plan Goals for sterilization by 2010

• Enhanced package of Compensation in public and private facilities to cover quality transaction costs

• Emphasis on quality protocols for institutions and procedures

• Imprest Fund of Rs.10 lakhs/District Collector for family planning for local planning and timely fund flow

• Increase access to contraceptives through Social Marketing-condom vending machines, local depot holders, FW clinics

Family Planning – Strategy (Contd.)

• Increased access to sterilization/IUD insertion through accrediting private/NGO health facilities

• Insurance cover for acceptors of sterilisation• Professional Indemnity Insurance cover for Govt. &

accredited Private/NGO doctors providing sterilisation

• Raise level of vasectomies from present level of 2% to 20% by 2006-07

• Promote vasectomies by increasing trained service providers, both public and private, higher compensation package and IEC support

Infrastructure Strengthening• Operationalisation of at least 2 FRUs/ Distt.

• Performance benchmarking of public health facilities and providers

• Development of quality protocols and mechanisms for public/ accredited private/ NGO health facilities

• Mapping public and private health facilities at district level

• Holding RCH camps at PHC level

• Engaging private Doctors for fixed day services• Organising short term courses for anesthetists

Infrastructure Strengthening (cont.)

• Accrediting Private/ NGO/Corporate Sector health facilities for Family Welfare services

• Arranging soft loans from banks for private Doctors to open/ upgrade Family Welfare clinics

• Initiating Urban Slums Health Projects in 118 towns/ municipalities with population above one lakh, in CMP states

• Expanding the FW package to health facilities of PSUs, Central Ministries (Railway, Mines, ESI) and Corporate Sector

• Make income from family planning services tax free

Partnership with Private Sector

• Engaging Anaesthetists, Lady Medical Officer @ Rs.800/day

• Engaging doctors @ Rs.1000/day or Rs.100/sterilization

• Vande Mataram Clinics

• Payment of compensation packages for sterilisation in private facilities

The Vision

Launching network of accredited private/NGO health clinics to provide family welfare services:

• Sterilization @ Rs.1200/procedure• IUD insertion @ Rs.75, inclusive of IUD• Immunization services (vaccine – government

supply)• Institutional delivery under Janani Suraksha

Yojana

Sterilization

• The package of Rs.1200 involves payment of Rs.400-450 to Dai/Client

• Rate being revised from Rs.300, and Rs.200 to Rs.1200

• Transaction cost of client, motivation and service provider covered

• The package for public health facilities – Rs.600

• Aim is to ‘market’ a ‘business proposition’.

IUD Insertion

• IUD being marketed by SMOs.• Hope is to market ‘service’ rather than

‘product’ through SMOs.• 15 SMOs registered with GoI.• SMOs to set up network of Clinics offering

subsidized service for IUD insertion• Training, quality control, data fidelity and

capturing larger market segment key concerns

Accrediting Private/ NGO Facilities

• Checklist for tubectomy/ vasectomy clinics finalized• Quality protocol for sterilisation / IUD insertion exist• IMA/ FOGSI have volunteered to accredit Family

Welfare Clinics for the interim period• Hope is to get 10 – 20 clinics per district in smaller District

and 20-30 clinics in larger Districts• Clinics could be ‘graded’ depending on the bouquet of

services provided• Subsidized/ free services to clients in FW clinic on

submission of voucher issued by ANM for eligible couple with register no. of CNAA register.Village women SHG to countersign to show community involvement

Accrediting Private/ NGO Facilities (Cont.)

• Brand positioning of the Network • Option with the State Government to route

payment to clinics through IMA/ district Administration/ Bank

• Verification of claims through Population Research Centres, Regional Evaluation Team, District Administration, MNGOs, Retired Defence Officers.

Immunization

• Government proposes Legislation on mandatory immunization service by private Clinics

• Supply of vaccine by Government

• Aim is to provide RCH services analogous to fully funded National Disease Programmes

Maternal Care

• Ante/post natal check ups to BPL women through Vande Mataram Clinics

• Janani Suraksha Yojana aims at payment of Rs.1000 and Rs.400 for birth of girl/male child to BPL mother, for institutional delivery

• Rs.150 for referral transport, Rs.50-150 to Dai• Accredited private clinics also covered under

the scheme

Proposed Partnerships with IMA

• Aao Gaon Chalen : Adopt a Sub-centre for MCH services

• Operate Family Welfare Clinics : Both as franchiser and the franchisee

• Contractual services at Government facilities on fixed days

• Absenteeism of government Doctors

Thank You