Reproductive and Child Health Project (RCH-I) 1997-2005

Dr. K. N. Patel Former Additional Director (FW) & Project Director RCH, IPD and Sector Reforms

TFA:95-96; CNAA:97-98

RCH

1997-98

IPPI 1999

ICPD-1994
FP FW 1977
Integration with PH care 1972 AIHPPP 1969 Targeted prog 1967

CSSM 1985 UIP

1992

EPI

1978

Extension Education approach 1962

NSEP

MCH,

NTCP

NFPP

What is RCH
People have the ability to reproduce and regulate their fertility, women are able to go through pregnancy and child birth safely, the outcome of pregnancies is successful in terms of maternal and child survival and well being and couples are able to have sexual relations free of fear of pregnancy and of contracting diseases.

Strategy

Decentralized, Need Based, Participatory Planning : RCH Committees, CNAA, Financial mechanism-SCOVA Focus on quality and Clients right: Quality cell, upgraded facilities and Improved Training, informed choice Making Services Gender Sensitive Absence of Contraceptive Targets and Incentives Multi-Sectoral Approach, GO-NGO partnership

Approach

Bottom up approach Community Need based approach Life cycle approach Client centered approach Cafeteria approach Faily centered approach

Paradigm shift: change in approach

Action Earlier approach New approach

Decisions Components

Centrally MCH & FP

Focus Needs satisfaction Approach

Mother, child Demographic Top down

Decentralized MCH, FP, Adolescent health, Reproductive health-RTI/STI, HIV, BCC Health management Mother, child, young people, families Individual
Bottom up, client centered, need based

Client choice

Very limited

Informed choice

Sterilization Targets, focus on sterilization, client no much say for FP method Camp Oriented Approach Targets, Cash Incentives for Sterilization Cases, Burden on Health Workers Neglect of Quality, clients rights ignored Inflation of Target Statistics

Set Targets GoI, decision centra

Accept Targets States

Break Down Targets: Districts

Distribute Targets PHCs

Implement Targets: Workers

Key aspects of participatory planning Need Based Participatory Planning

Community Involvement in Planning & Monitoring Self Estimated Goals by Health Workers Dist Integrated Package of Services Multi-sectoral participation Good Quality of Care PHC Educating Community to adopt Correct Health Practices

Report Results State Strategies & Computations Support & Monitor Facilitate Implementation

Sub Center
CNAA, Participatory Planning, Set Goals

RCH package of services

FOR MOTHERS

Early Registration Inj. Tetanus Toxoid - 2 doses Tab. Iron Folic acid 4 Antenatal & 4 Post natal check-ups Deliveries by skilled persons Encourage Institutional deliveries Emergency Obstetric Care-Early identification of complications- good referral transport- FRUs

RCH package of services

FOR Children: Built on UIP and CSSM Essential Newborn Care: warmth, wt, clean mouth cavity, asepsis Early, Exclusive breast feeding and Weaning Growth monitoring Immunization Vitamin-A Prophylaxis Oral Rehydration Therapy Management of diarrhoea and Acute Respiratory Tract infection Treatment of Anaemia

RCH package of services

FOR Eligible Couples Making quality Contraceptive methods available at appropriate distance Informed choice- cafeteria approach through counseling Spacing of at-least 3 years between children Safe MTP services

RCH package of services

OTHER NEW SERVICES Management of RTIs & STIs Adolescent health Womens empowerment Gender equality/equity Male participation

Life Cycle Approach

Healthy pregnancy and child birth gives Healthy Child that grows into--Healthy Adolescent which leads to --Healthy Reproductive Years Healthy Pregnancy Healthy Child Birth The cycle continues in to next generation Healthy Elderly woman

Achieving a healthy child

Knowledgeable Well fed Mature

Adolescent Health

HEALTHY MOTHER
HEALTHY BIRTH

Ante Natal

HEALTHY Health Education DEVELOPMENT

IMCI

Trained Attendant Referral System

HEALTHY CHILD
Hygiene

Breast Feeding

Sanitation

HEALTHY ENVIRONMENT

HEALTHY DIET

Balanced Diet

Water

Supplements

Inputs by Various Donor Agencies

World Bank- RCH-National component World Bank RCH -Sub-Project, Vadodara. UNFPA Supported IPD Project European Commission Supported Sector Investment Program UNICEF supported Border Cluster District Project

UNFPA Supported IPD Project

Surendranagar, Banaskantha, Dahod, Sabarkantha, Kutch. Constituted the Committees PMU established Actions initiated for Development of State Population Policy Mobility support Support to NGOs

World Bank Inputs

Contractual Staff Staff Nurse at PHC Safe Motherhood Consultants Anesthetist at CHC Laboratory Technician at CHC Sate Level Consultants

World Bank Inputs

Major Civil Works in Hospital / CHC Minor Civil Works at PHC / Subcenter Moped Loan For ANMs Strengthening MIS Records / Reports at Facility Drugs / Instrument Kits (In Kind)

EC supported Sector Investment Program

Narmada & Rajkot Districts State Sector Reform Cell District Sector Reform Agency formed State & Dist. Workshops Decentralization mechanisms Action plan 2001 Earthquake related reconstruction of health facilities. State PIU.

UNICEF Supported Border Cluster Districts project

Valsad & Dang Districts Project launched Mobility support to Female Health Workers Capacity building of health providers MIS support Civil works for sub center repairs Drugs & equipment to SC/PHC Strengthening FRUs

THANK YOU