Programme |
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The
overall goal of RCH programme is to reduce infant and maternal
morbidity and mortality in the state. These goals will be achieved
through improvement in quality, enhancing accessibility and availability,
and coverage with the reproductive and child health services,
including family welfare. The programme emphasizes empowerment
of women and communities for enhancing health service utilization
to achieve reproductive goals and population stabilization.
There are twelve key strategies identify for RCH II 1. Strengthening Project Management Structure at state and district levels
2. Strengthening Infrastructure at various levels of health service delivery
3. Human resource development and capacity building
4. Improving quality of care and Strengthening Referral System
5. Strengthening and improvement of logistics and supply systems
6. Strengthening Health Management information system (HMIS), monitoring and evaluation
7. Behaviour Change Communication for increasing demand for RCH and contraceptive services
8. Specific Interventions Maternal Health:
Child Health:
Adolescent Health
Family Planning
9. Strengthening Networking and Partnership with the civil society
10. Innovative schemes and pilot projects
12. Establishing and strengthening RCH services in Urban Area
The programme will address the urban slum population in Jaipur,
Jodhpur, Kota, Bikaner, Pali, Udaipur, Ganganagar, Hanumangarh,
Bhilwara and Tonk cities. |
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| Immunization | |||||||||||||||||||||||||||||||||||
| Complete immunization of a child is an important step towards the good health status of the child, hence Immunization has been kept as a major strategy. The complete Immunization in Rajasthan is poor as reported from independent surveys. Comparison of Reported and Evaluated Coverage 2005-06 (%)
Summary of Recent Initiatives 1. Service
delivery improvements 2.Financial Support for Social Mobilizers 3.
Partnerships with other agencies / organizations (e.g. ICDS, IAP,
PP etc.) Bottlenecks for full Coverage
Accessibility A
State Task Force has been formed which will review the
immunization programme six monthly chaired by Principal Health
Secretary.A State Immunization cell has been formed which will
review the activities on a weekly basis.District Task forces have
been formed to review the Immunization activities in the districts. 3. Improved Vaccine / Supply Logistics : Expanding the Cold Chain Reach and Improved Performance throughAlternative vaccine delivery system (mobility support to PHCs for vaccine delivery) and Polythene bags to keep Vaccine in good condition 4. Ensuring that all children in all villages/towns covered with regular (monthly/quarterly) immunization sessions according to village size through mobilization of children by ASHA for which a sum of Rs.150 per month has been kept for mobilization of children to the immunization session site. For Immunization in the Urban area/slums provision of hiring ANMs for each session, and provision of social mobilizers to mobilize the children to the session site 5. Improved injection safety by introducing AD Syringes 6. Ensuring accurate record keeping / monitoring with improved supervision and Availability of various Formats
7. Trained Immunization Staff – ANMs, Mid level Managers training for RCHOs, Cold chain handlers, statistical assistants 8. Strengthening Immunization and Cold chain through Major & Minor Repair, Provision for the running costs of WICs & WIF, ILRs & Deep Freezers and POL & maintenance of vaccine delivery van. 9. Review Meetings Two days six monthly review meetings will be conducted at state for district wise review of immunization programme.Monthly meetings of State Steering committee will also be held. State task force meeting will be organized to review the immunization status.Six monthly meetings of State Task Force will be conducted under the chairmanship of Principal Health Secretary to overall review the situation of Routine Immunization in the stateZonal level review meetings will be organized at seven zones of state to review the immunization activities in the districts. 10.Contingency fund at district levelRs. 40/ month per district has been budgeted as contingency fund for communication cost (sending reports through internet and for buying floppy disks) if needed from Districts to State. 11.Disposal of AD SyringesFor proper disposal of AD syringes after vaccination, hub cutters will be provided to cut out the needles (hub) from the syringes. Plastic syringes will be separated out and will be treated as plastic waste. For the disposal of needles, pits will be formed at PHCs as per CPCB guideline. 12.VPDSurveillanceSentinel Surveillance Units: Hospitals and some other major Govt. and private hospitals will be taken up for VPD surveillance:
13.Hepatities B/Never vaccine will be introduced 14. IEC & Social Mobilization plans |
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| Disease Control Programmes | |||||||||||||||||||||||||||||||||||
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| The
National Disease Control Programmes are being implemented in state
under NRHM with a view to achieve the MDG goals to halt the spread
of major diseases and reverse the trend by 2015 so as to reduce
the mortality and morbidity and increase life expectancy and quality
of life. The NDCP encompasses: Revised National TB Control Programme
(RNTCP), National Vector Borne Disease Control Programme (NVBDCP),
and National Programme for control of Blindness (NPCB), The National
Leprosy Eradication Programme (NLEP), Integrated Disease Surveillance
Programme (IDSP), and Iodine Deficiency Disorder Control Programme
(IDDCP). The National Vector Borne Disease Control Programme (NVBDCP) NVBDCP include major vector borne diseases of public Health importance, such as Malaria, Filariasis, Japanese Encephalitis, Dengue, and Kala azar. As per the National Health Policy 2002 the goal is to reduce morbidity and mortality by 50% by 2010. In Rajasthan only Malaria and Dengue are prevalent the strategy for control of vector borne diseases includes: · Enhanced Surveillance with support of community based volunteers (ASHA) and grass root level workers. · Early diagnosis and proper case management through strengthening Primary and Secondary Health institutions. · Integrated vector management using bio-friendly methods and limiting use of insecticides. · Epidemic preparedness and rapid response. · Institutional strengthening and Capacity building of Health personnel. · Behavior change communication · Intersectoral Collaboration · Computerized Management information system. The National Leprosy Eradication Programme Leprosy is a disease of public health concern in India. It is a disease of medico-social concern .Current prevalence is 1.8/10000. Rajasthan has achieved prevalence elimination level (prevalence below 1/10000) in 2000. Current prevalence Rate is 0.24/10000. Under the NRHM the strategies drawn under the National Leprosy Eradication Project to be continued. The fie component include Decentralization and institutional development , strengthening and integration of service delivery, disability care and prevention , IEC and training. Services will be continued to be provided at CHC, PHC, Additional PHC, and hospitals with support from the district nucleus. The sub-centers will be involved in delivery of second and subsequent doses of MDT. NGO will continue to be involved in reconstructive surgery, disability care and prevention and IEC. Village and district Health plans will enable identification and ensure referral of cases requiring disability treatment to the appropriate facility. CMHOs and medical officers will continue to be trained on Leprosy Programme management. Integrated Disease Surveillance Programme (IDSP) Objective of IDSP is to establish a state based system of surveillance through Information and communication technology (ICT) for communicable and non-communicable diseases so that a timely and effective public health action can be initiated in response to the health challenges. IDSP will also improve the efficiency of the existing surveillance activities of the different disease control Programs. Surveillance system will be strengthened through Capacity building of medical officers and health workers and technicians, strengthening of laboratory network and reporting system through ICT. This would p[provide a string foundation to the disease control Programmes under NRHM. ASHA being the link between community and public health system will strengthen the community based surveillance system. Revised National Tuberculosis Control Programme (RNTCP) The RNTCP is the vehicle through which through which the WHO recommended DOTS (Directly Observed Therapy Short course) is implemented in India. All the districts of Rajasthan are being covered. As part of the Programme Designated Microscopy centers (DMCs) have been established at PHC, CHC and district hospitals. RNTPC supports the salary of laboratory technicians, laboratory supplies and consumables. All medical officers are trained under RNTCP for diagnosis management and referral. All SCs, PHCs, CHCs and district hospitals function as DOTS centres. Community level DOTS providers are also trained in delivery of drugs. Para medical staff is trained in monitoring consumption of ant TB drugs. The RNTCP also involves the civil society organizations in its outreach of communication efforts. Under NRHM the ASHA will be the facilitator for early access to the diagnosis, referral and follow-up as a community DOTS provider. National Blindness Control Programme (NPCB) The National Blindness Control Programme aims at reducing prevalence of blindness from the current level of 1.5% to 0.34% by the 2010. Rajasthan state has set a target of about 3 lac cataract operations every year to achieve the goal. Under NPCB apart from providing surgical treatment through IOL (Intraocular lens) implant for cataract, which is major cause of blindness, the other causes of blindness such as childhood blindness, glaucoma and retinal disorders are also dealt. School health check up is also one of the major components of the Programme. ASHA would play an important role in creating awareness of the Programme and motivate people to seek treatment. NRHM would also seek to create synergy between the NPCB and Vitamin A supplementation Programme. |
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| Accredited Social Health Activits The Government of India and Government of Rajasthan have launched a National Rural Health Mission to address the health needs of rural population, especially the vulnerable sections of the society. The sub center is the most peripheral level of contact with the community under the public health infrastructure. This caters to the population norm of 3000 - 5000. The worker in sub center is an ANM who is directly involved in all the health issues of this population, which is spreaded over the wide area of many kilometers and covering 5 to 8 villages. Many a times the villages are not connected by public or private transport system making her more difficult to achieve the objectives and goals of providing quality health care for the poor and oppressed sections of the society. So the new band of community based functionaries, named as Accredited Social Health Activist (ASHA) is proposed in the NRHM who will serve the population of 1000 and 500 in hilly and desert terrene. ASHA
is the first port of call for any health related demands of deprived
sections of the population, especially women, children, old aged,
sick and disabled people. She is the link between the community
and the health care provider. Department
of Medical and Health at State and at Center is looking at ASHA
as a change agent who will bring the reforms in improving the
health status of oppressed community of India. The investment
on ASHA will definitely result in to better health indicators
of state and at large the country.
ASHA Sahayogini Convergence
of DWCD and NRHM Criteria for selection
Roles and Responsibilities of ASHA Sahayogini
Health, Nutrition, basic sanitation, hygienic practices, healthy living and working conditions, information on existing health services and need for timely utilization of health, nutrition and family welfare services.
Birth preparedness, importance of safe and institutional delivery, breast-feeding, immunization, contraception, prevention of RTI/STI. Nutrition and other health issues.
Facilitate to access and avail the health services available in the public health system at Anganwadi Centers, Sub Center, PHC , CHC and district hospitals.
Work with the village Health and sanitation Committee to develop the village health plan
Escorts the needy patients to the institution for care and treatment. She will accompany the woman in labor to the institution and promote institutional delivery
Minor ailments such as fever, first aid for minor injuries, diarrhea. A drug kit will be provided to ASHA
Training Capacity
building of ASHA is critical in enhancing her effectiveness. It
has been envisaged that training will help to equip her with necessary
knowledge and skills. Training of ASHA Sahyogini is a continuous
process. Considering her range of functions and task to be performed,
her induction training is planned for 23 days in 4 rounds (10+4+4+5
days). The trainings are planned in cascade model. The non governmental
organizations are involved in the training of ASHA Sahyoginis
at grass root level. Under NRHM ASHA Sahyogini is a voluntary worker who will get performance linked incentives. The honorarium is linked with the performance indicators of ASHA Sahyogini. The generic Compensation package made for ASHA Sahyogini by linking her with different health programmes. The
detailed compensation package is worked out at state level. If
she works as per the expected standards she would earn approximate
Rs. 1067 per month. ASHA will get the package on Drug Kit for ASHA Sahyogini - The drug Kit is provided to ASHA Sahyogini to provide primary Health Care to the community like minor elements like fever, pain, First Aid etc. The replenishment of medicines is made from PHC /Subcenter stocks. Monthly Meetings - The joint monthly meetings are conducted at PHCs by DWCD and DMHS. ASHA Sahyoginis are interacting with service providers in this monthly meeting. The replenishment of Medicines and payment of incentives are ensured during these meetings. ASHA Mentoring Group For strengthening ASHA- Sayogini Programme in the State a State Level Mentoring Group is constituted under the Chairpersonship of Mission Director, NRHM. This group will oversee the implementation of the scheme and facilitate in developing the policy guidelines. Mentoring Group will act as a think - tank for the programme. The mentoring group will provide technical inputs and support mechanism. The members of ASHA Mentoring Group are Director DWCD, PHED, RD,PRI, IEC, RCH, PH, AIDs, representatives from development partners and NGOs. The Mentoring Group will meet once in three months to review and to provide inputs for the ASHA- Sahyogini Intervention. ASHA Resource Center is the Nodal Agency to organize the meetings and do the follow ups with the support of SPMU- NRHM. ASHA Resource Center for providing support to ASHA Programme at State level Need for ASHA Resource Center - ASHA is at the base of NRHM pyramid and National Rural Health Mission is looking at ASHA as a change agent in Health Sector Reform. She will play a vital role in improving the health indicators of the State especially IMR and MMR. She will also facilitate the improvement in service off take of the healthcare institutions. The State of Rajasthan is spread over a large geographic area with religious, social, cultural, economic variations, so implementation of ASHA component in the state is a challenging task. In this context it is very important to provide technical inputs and strong supportive mechanism to the programme so that expected results can be achieved. State Project Management Unit is established at state level under Director NRHM. SPMU is working as a technical and administrative body to implement the activities of NRHM in the State. ASHA Resource Center (ARC) is conceptualized to improve the quality of the programme. This Center will be established at state level and will work under direction of Mission Director of NRHM Functions of the ASHA Resource Center-
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Janani
Surakha Yojana(JSY) is a centrally sponsored scheme under NRHM
umbrella to benefit pregnant women & certified poor families.
Objective
Beneficiary
Eligibility Criteria (New Guidelines) OFFICE ORDER Duties of ASHA - Sahyogini:
A Nodal officer has been appointed in each district to implement this scheme effectively. |
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| Untied Funds | |||||||||||||||||||||||||||||||||||
There
was an urgent need to strengthen the Subcentres and to also decentralize
its functioning to improve the quality of services and make it
community friendly. For the first time in the history of the FW
programme it was proposed to provide untied funds.
6. Untied funds shall
not be used for any salaries, vehicle purchase, and recurring
expenditures or to meet the expenses of the Gram Panchayat. |
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| IPHS | |||||||||||||||||||||||||||||||||||
| Under National Rural Health Mission Strengthening of CHCs as per the norms of Indian Public Health Standards (IPHS) is an important component. Under this component all the CHCs of the State will be up graded in phases. Under this component 64 CHCs have been selected for up gradation in the year 2005-6. In the year 2006-07 64 more CHCs has been seleceted for up gradation. Now total number of CHCs selected for upgradation to IPHS is 325.
Building plan for the quarters has been approved. Actual construction
work is started. RHSDP will work on 193 CHCs and PWD will work
on 132 CHCs. |
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| Health Facilities | |||||||||||||||||||||||||||||||||||
| Strengthening
of Public Institutions for health Delivery
The Rural Health Care System forms an integral part of the National Health Care System. Provision of Primary Health Care is the foundation of the rural health care system. For developing vast public health infrastructure and human resources of the country, accelerating the socio-economic development and attaining improved quality of life, the Primary health care is accepted as one of the main instrument of action. Primary health care is the essential health care made universally available and accessible to individuals and acceptable to them through their full participation and at a cost the community and the country can afford. Although vast network of this infrastructure looks impressive, accessibility, availability of manpower and quality of services, and their utilization have been major issues in the Public health care delivery system. Adequacy of coverage is an important issue. The number of facilities is not adequate when we consider the current population. The primary Health Care structure in the country
has been established as Sub-Centre Primary
Health Centre (PHC) Community
Health Centres (CHCs) Activities to be taken up for strengthening the facilies: I. Strengthening of the Physical Infrastructure of the existing facilities:
II. Manpower The vacancies need to be filled up. In Rajasthan a decentralized mechanism exists for the appointment of Contractual appointments of MO. ANM, Lab Technician. III Equipments, Drugs and other supplies: A list of essential drugs, equipments and other supplies have been prepared by GOI. An Essential Drug list exists for Rajasthan. Streamlining of the Logistics and Warehousing systems needs tro be done for timely supply of quality drugs IV. Training NRHM envisages an accountable system for delivery of quality services. For quality services, the skill of the health personnel needs to be improved. The attitudinal changes in the health personnel to be responsive to the health needs of the community will require orientation of health personnel. In this context, the induction training, in-service skill development training, and management training of the health personnel are being planned in.
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| Emergency
obstetric care services
Rajasthan is the state with second
highest mother in maternal mortality in India. Approximately total
number of deaths of pregnant ladies in Rajasthan in one year is
equivalent to total number of deaths of pregnant mothers in five
years in Kerala.
Comprehensive and Basic Emergency Obstetric Care Services (CEmOC/BEmOC) United
Nation has developed certain criteria for labeling any institution
as either Basic Emergency Obstetric Care Center (BEmOC) BEmOC is a center which should cover a population of 1.25 lakhs (four centers for a population of five lakhs) and should provide the following services.
CEmOC is a center to cater the needs of population of around five lakhs and should provide all the above six services along with the following services round the clock through out the year. As per the UN process indicators a total number of 128 CEmOCs and 459 BEmOC are required to provide emergency obstetric care services to all the pregnant ladies, of the state. In the regard a total number of 187 institutions have been identified to provide comprehensive emergency obstetric care services in the state keeping in view the geographical conditions and population of the state. These institutions will be strengthened in a phased manner, in the first phase 137 institutions will be strengthened and remaining 50 institutions will be strengthened in the second phase. Similarly a total of 173 institutions are identified to provide basic emergency obstetric care services by the end of this year. |