• Panchamrit
• Parinche
• Social Marketing

• Introduction
• Demographic Profile
• Efforts as on today
• Why Panchamrit
• Objective
• Components of Panchamrit
• Activity for each Component
• Targeted Areas
• Scheduled Activities
• Strategy
• Roles and Responsibility

• Antenatal Care – Efforts are being strengthened to increase ANC coverage through MCHN days. CNA have been conducted to identify eligible couples and pregnant women are tracked for ANC through ASHAs and JMC. JSY Scheme has also been included to promote BPL population.
• Delivery by skilled birth attendant –

• PNC- two postnatal checkups is being done to every delivered mother. It is being promoted through JSY scheme and MCHN days.
• 24 hrs delivery scheme- Total 1178 PHCs and 194 CHCs are covered in the scheme. There is provision of Rs 100/- for Doctors, Rs 100/- for ANM. Rs 100/- for motivators (Dai, AWW, JMC, SHG, ASHA and others) and Rs 30/- for sweeper for each night delivery.
• Dai Training scheme- Approx. 50,000 Dais have been identified to be trained for conducting clean and safe deliveries, 20855 Dais have been trained so far.
• Strengthening Institution for providing emergency obstetric care services –150 new BEmOC and 50 CEmOC have been strengthened so far to handle emergency obstetric care.
• Development of Model PHC- To provide 24 hrs emergency medical and obstetric services 97 PHCs have been developed as Model PHC.
  

• Routine Immunization- Routine immunization is being strengthened by increasing access to the un-reached through MCHN days, better monitoring system, safe injection by Auto Disable syringes, effective cold chain system and improved VPD surveillance.
• Pulse Polio drive- No Polio case reported in the State during last three years. More than 95% coverage in NID and SNID is achieved.
• MCHN days session – In the State 49000 MCHN sessions have been planned to be held every month, so as to reach every village on a fixed day at a fixed site.
• IMNCI- More than 50% infant’s death occurs in Neo-natal period. Three home visits by health worker/ANM/Sahyogini for new born during first week after birth is the key strategy for the IMNCI programme. The programme is running in two districts at present and being introduced in another eight districts of the State shortly.

• Promotion of spacing methods- It is being done through health worker and about 40000 JMC. Social Marketing of contraceptive is being implemented.
• Promotion of NSV – State level, District level and Block level workshops have been held for the Promotion of NSV. Two Mega camps in each district are being held to popularize NSV among masses. Doctors are being trained to increase service providers.
• Incentive for sterilization- Incentive and cash award to beneficiaries, Motivators and workers is being provided in the population stabilization programme. Funds have been allotted to improve quality of camps.

1. Elimination of Vaccine Preventable Diseases: through universal (100%) immunization.
   
2. Elimination of Micronutrient Deficiency: through
   · Elimination of Vit. A Deficiency in children less than five years.
   · Elimination of Iodine Deficiency
   · Reduction of Iron Deficiency in children less than five years and mothers.
   · Promotion of Breast Feeding.
   
3. Family Welfare: ensuring · Contraseptive methods
   . Sterilization (Male/Female)
   . Contraseptive (IUD,OP,Condom,E-pils)
   · Safe MTP
   
4. Safe Motherhood: ensuring
   · 100% Registration of pregnancy and provision of at least three Ante Natal check ups.
   · Increase institutional deliveries to at least 50% of all deliveries.
   · Promoting deliveries by Skilled Birth Attendant (ANM/ MO)
   · Ensure provisions by Janani Suraksha Yojana
   · Spacing Births- Three year interval between two births.
   · Right Age at marriage through Promotional Activities.

· Reduce Neonatal Mortality by ensuring 100% registration of new borns and providing check ups.

• Vaccination of All Targeted beneficiary by All antigens (BCG, Polio, DPT, Measles for children and TT for mothers) at Right Age.
• i.e.- BCG & Polio at birth to all institutional deliveries,
• BCG (if not given at birth); Polio and DPT at 6 weeks of age,
• Second and third dose of OPV & DPT at 4 weeks interval and
• Measles vaccination at completion of nine months.
• BCG can be given during any visit, before one year of age, if not given previously.

• Elimination of Vit. A Deficiency in children less than five years: through administration of Vit A solution (1,00,000 IU) with Measles vaccination at 9 completed months of age. This improves measles sero-conversion as well as helps eliminate Vit A deficiency. Vitamin- A deficiency is the main cause of night blindness.
• Second dose of Vit A (2,00,000 IU) should be given with Booster dose of OPV/ DPT at 16-24 months of age and there after three more doses of Vit A (2,00,000 IU) at six moths interval.
• Elimination of Iodine Deficiency: Families are asked to bring sample of salt they are using to the session site, on MCHN day. ANM is supposed to carry iodine-testing kit. She will test salt samples and using the results as reference emphasizes up on the importance of using iodized salt and consequences of iodine deficiency.

• Reduction of Iron Deficiency in children less than five years and mothers: all pregnant and lactating mothers and children below 5 years will be given prophylactic IFA Tab. (100 tablets per beneficiary to be taken one daily after meals). For identification of anemia physical check up (pallor of eyes, tongue and nails) will suffice and therapeutic dose will be given as per norms. Advocacy for balanced diet and right cooking practices will follow.

• Promotion of Breast Feeding: All pregnant mothers, preferably during early pregnancy, will be examined by ANM for retracted nipples and advised exercise for its correction.

• Spacing Births- Three year interval between two births: Distribution condoms and oral pills, advocacy for IUD insertion including and use of E-Pill.
  ANM / AWW/ ASHA will talk with persons present including male members about importance of small family and ways to achieve it. She can use Flip- book, poster or any other IEC tool as per need and availability.
  She will ensure participation of Jan Mangal Couple, AWW and ASHA.
• Right Age at marriage: Since early marriages are common tradition in most of the communities of Rajasthan and early pregnancy i.e. before full development of organs, is the major cause of maternal and child morbidity and mortality.
  She will arrange group meeting after the session, with opinion leaders/ religious leaders/ PRIs/ JMCs/ any social organization working there/mothers and other family members and talk to them about physical, social and mental problems associated with early marriages as well as legal implication associated.
  If any young mother death has occurred in her or neighboring area or any mentally retarded child has born to a young mother, she will use this as evidence to impress up on the gravity of right age at marriage..

• Register all pregnant mothers of her area and provide Ante Natal check up on the spot i.e. she will confirm pregnancy by history taking, take weight; blood pressure and do physical examination for Anemia and edema feet, do per abdominal examination for checking lie and verify gestational age with period of amenorrhoea. and advocate for at least three ANC check ups in pregnancy (preferably one in each trimester)
• Increase institutional deliveries to at least 50% of all deliveries: she will talk with all pregnant mothers and their mother in law, any other member of community about- 1) un-predictability of pregnancy outcome, 2) importance of preparedness (how crucial are first two hour in saving life of mothers), 3) value of institutional delivery, and 4) Institutions in vicinity where round the clock Emergency Obstetric Care services are available, where they should go in case of emergency. 5) She will inform community about availability of funds with her or with medical officer for Referral Transportation for mothers in emergency to higher institutions.
• Promoting deliveries by Skilled Birth Attendant: she will inform community about her availability (where about) so that, people can approach her in case of needs. She will conduct normal deliveries and before referring emergency obstetric cases, will provide first aid services.
• Ensure utilization of provisions by Janani Suraksha Yojana for BPL Families: giving all needed information and informing people of the locality about ASHA and her role.
• 5. Ensuring Healthy New Born:
  
  Reduce Neonatal Mortality by ensuring institutional deliveries and 100% registration of newborn. She will create environment for registry of all births and at least three check-ups within 7 days of birth. She will provide on the spot check-up to all newborn babies of her area during the session and advocate for future check-ups.

· All Urban Slums

· Desert and Tribal Areas

· All C- Category Villages i. e. > ½ hour distance from the nearest sub-center, villages under SC where ANMs are not available (either not posted/ or deputed/ or on leave for three or more months), Villages with no SC or AWC.

· Left out villages/ hamlets during MCHN sessions.

· Reported case of vaccine preventable disease in last 2 years.

· Vaccination coverage less than 30%

· Areas of hard core Non- Acceptors due to religious or any other reasons.

· Areas where activities are either irregular or not provided at all.

• First MCHN week – 26th January to 1st February 2006
• Second MCHN week – 23rd February to 1st March 2006.
• Third MCHN week – 4th April to 10th April 2006.

• MO In-charge PHC shall identify the name of ANM who shall prepare the Sub-center Micro-plan. The ANM shall further identify the un-reached area (name of village/Mohalla) and its population.
• ANM shall decide the fix session site for observing the MCHN day in each targeted village. In case of Dhanis/ pockets of few houses, mobile team consisting ANM & two to three social mobilizer shall be formed to observe the MCHN week house-to-house.
• The ANM shall further identify the name of social mobilizer who shall mobilize the mother and children to the session site for MCHN activities. The mobilizer shall be AWW, Sahyogini, Sahayika, JMC or any other lady who can mobilize the beneficiaries to the session site.
• All the information shall be entered in the appropriate column, for the full week. In case of the villages having population of less than 500, two session sites in a day can be planned but it should not be more than 30 minutes distance by vehicle.
• The Micro-plan shall be submitted to the MO in-charge PHC before 15th Jully 2006, furnishing complete information in the formats.

• MO in-charge PHC shall collect the Micro plan of all the sub-centers and prepare the Micro-plan of PHC.
• Day and sub-center wise information shall be entered in first nine columns with the help of sub-center micro plan. Similarly day and sub-center wise vaccine requirement shall be calculated. Minimum one vial of each antigen shall be calculated and entered in the appropriate column of the micro-plan. In the last total requirement of vaccine shall be calculated and entered.
• The mobility support plan and the route charts shall be prepared by the MO PHC looking to the time required in the travelling. The Vaccine and Logistics should reach at the session site before 10 AM. In case more than one vehicle is required, it should be indicated in the mobility support plan but more than two vehicles in a PHC shall not be allowed.
  The Micro plan shall be submitted to the CMHO/RCHO latest by 21st Jully 2006.

• Detailed Micro-plan for the urban slums is prepared by the RCHO and send to the Directorate latest by 15th Auguest 2006.
• For services in urban slums staff can be mobilized from nearby dispensary/MCWC/UFWC/Hospital or urban revamping scheme. Staff can be mobilize from the area where MCHN week actually is not been carried out during the MCHN week. In case of shortage of staff one ANM per 10000 urban slums population can be hired. Hired ANM will conduct services in the identified uncovered areas and will be paid Rs 350/- per session. One social mobilizer for each session site is also be identified who shall mobilize the beneficiaries to the session site. Rs 150/- per session will be paid to the mobilizer. The ANM will carry vaccine, Kit-A, Medicines and other logistics from the cold chain depot herself at the session site.
• RCHO would be Nodal officer , responsible for preparing Micro-plan and implementation of activities in urban slums at districts.
• Dy. CMHO, MO Subdivision will likewise be responsible for activities and micro-planning of Sub-division level urban slums.
• Doctors monitoring the pulse polo programme at district control room be made responsible to monitor Urban Slums MCHN week activities.

• District Micro Plan of the districts shall be prepared by the CMHO/RCHO after compiling the Micro-plans of the PHC .
• District Micro plan shall be submitted to the State before 1st week of Auguest 2006 through Fax.

• The 32 State Monitors who have been allotted to the Districts shall reach in their districts on first day to start the programme and monitor the activity.
• Seven State Monitors of immunization cell who have been allotted the zone shall visit in their zone and monitor the activity through out the week.
• The orientation and the Check list to the State Monitors shall be given on 23rd January 2006 in the Directorate.
• The Check-list and the report of the Monitor shall be collected by the Dy. Director (Immunization) who shall identify the shortcoming and report shall be submitted to the Director (FW) with in three days of completion of the activity.
• Dy. Director (Immunization) will be the key person of for MIS along with his assistants and persons from NPSP Jaipur Head quarter. NPSP shall support Dy Director Immunization in collecting the reports through net/fax etc.

The concerned Joint Directors of the Zone will co-ordinate the activities and human resources in their respective zones.

CMHO, Additional CMHOs, RCHO, and Dy. CMHOs shall monitor full MCHN week in their area. All the officers shall visit at least three MCHN sessions per day and the report be submitted to the CMHO on same day.

CMHO shall submit his consolidated report to the Directorate control room on same day.

MO in-charge PHC shall Monitor 100% MCHN days of his area and report shall be submitted to the CMHO/RCHO on the same day.

Rajasthan faces a severe challenge in combating health care and its related issues like malnutrition, inadequate sanitation and the growing incidence of communicable diseases. The problems in access to health care are related to the harsh terrain and lack of efficient communication system. Since all these dimensions of human development needs improvement, the pilot project on Empowering Rural Communities through provision of additional health inputs in difficult areas of Rajasthan has been initiated in one sector PHC of five district namely Harsani, Barmer, Manohar Thana – Jhalawar, Losal – Sikar, Ajan – Bhartpur and Kalinjara – Banswara.

Under this project a community health worker/volunteer will be identified. This female volunteer will act as a change agent for overall development of the village. It attributes that they will not restrict their activity to health sector but make efforts for all-round development. These volunteers would regularly visit schools, help solve all veterinary poultry services required by villagers, take villagers in confidence to sustain a cleanliness and sanitary movement in the village. They will educate people to restrain from child marriage and educate them on better nutrition practices and mobilize the community to reach the point of self sufficiency in preventing common diseases.

Capacity building of these volunteers is critical in enhancing her effectiveness. It has been envisaged that training will help to equip her necessary knowledge and skills resulting in achieving of scheme objectives.

After the selection of volunteers, they will undergo nine months training process (2 days in a week i.e. 8 days in a month) to acquire necessary skills and confidence for performing her spelled out roles. A cascade model of training has been proposed where trainers for trainings will be trained at state and thereafter the teams will train volunteers at PHC level of each district, simultaneously. Each district has a training team, which may comprise of officers from various departments including animal husbandry, doctors / health activist of NGOs, officers of medical and health department or other related departments.

• A strong urban bias in the distribution network.
• Low incentives for commercial participants.
• A limited range of products.
• The simultaneous presence of a wasteful, free distribution system.

Strategic Interventions

Social marketing of contraceptives, especially in rural areas will be strengthened. A strategy for Social Marketing is being developed and will include marketing of products and also the processes through social franchising. The creation of service availability through social franchising would enhance the availability in rural areas. The range of methods will be broadened. Community based depot holders and distributors will be part of the social marketing strategy. Social franchising would be the method to franchise the processes by franchising services of acceptable quality at affordable prices to the community. Condom vending machines are being introduced on a pilot basis in 54 HIV high-prevalence districts. The project has been promoted jointly by National AIDS Control Organization (NACO) and Department of family Welfare on a cost-sharing basis.

Involving Panchayati Raj Institutions, Urban local bodies and NGOs:

Establishing depot holders to increase coverage of family planning services, as many women are unable to leave their homes to attend health facilities. This is a major barrier even in life-threatening situations. Involving PRIs, ULBs and NGOs to mobilize the community, sensitizing community members to gender issues and training community members will enable women to access contraceptive services closer to home and support them in increasing their mobility.

Strategic Interventions

One couple (JJan Mangal couple) from each village will be selected by the villagers themselves and will be trained to provide counselling and services for non-clinical FP methods such as pills, condoms and others. They will be supplied with pills and condoms by the ANMs for free distribution and act as depot holders for these supplies. They will also procure pills and condoms from social marketing agencies and provide these contraceptives at the subsidized rate. They will provide referral services for methods available at medical facilities. They will assist in community mobilization and sensitization.