1、A postulate of Proposed Gujarat State Plan of Operation RCH Phase - II,By Project Director RCH,The Process,Constituting the State Design Team Adapting Successful Practices Using Marginal Budgeting for Bottlenecks (MBB) tool for Resource Allocation Resource Mapping Exclusive Method to analyse priorit
2、ies,The State Design Team,The design team consists of Experts within Govt. set up & SIHFW NGO representatives UN agencies representatives Experts from IIM Ahmedabad as invitees,Approach of GoG,Addressing specific needs in concern areas of: Rural, Urban and Tribal Health Environmental Health as a vit
3、al issue Role of adequate nutrition,Approach of GoG,Focused Strategies: Analysing components of IMR, MMR and TFR dealing with bottlenecks.,Approach of GoG,Holistic Approach: Balanced integration with inputs received in IPD, BDCS, EC Sector Reform,Approach of GoG,Health and Human Development: Thrust
4、for Human Development to maximise reproductive health and not just adopting target-oriented approach. Gujarat Vision 2010 Strong commitment,Our Vision 2010,Health Indicators,Marginal Budgeting for Bottlenecks,An effort to identify the strengths and weaknesses of implementation of RCH program by mean
5、s of HH study, Monitoring and validation study and Facility study in 5 districts All 3 studies in 40 clusters in each district,Marginal Budgeting for Bottlenecks,HH study: identified 6 families with infant in a cluster MV study:15 PHC, 30 SC (1village in each SC) in 40 cluster area Facility study: B
6、EmOC, BEmPaedC and FW at PHC, CHC, DH,HH study,40 Clusters by standard cluster sampling tech Proportional allocation for Urban and Rural Municipal Corporation not included,HH study,Information for ANC, INC, PNC, Breast Feeding practices, Weaning, FW, Awareness for hygiene, nutrition, Home based mana
7、gement for fever and Diarrhea.,HH study,A teams of 2 FHW, 2 MPHS (M/F) and 1 MO for each cluster 8 teams in each district x 5 days ( 1 for each cluster) = 40 Orientation of all teams at SIHFW,HH study,Pre-tested in field Participatory planning by District teams Data of about 7000 families entered an
8、d results are awaited some results are available but yet to be validated,Monitoring and Validation Study (MV study),Team of 2 PG of Public Health/ Community Medicine 3 Teams in each district x 5 days (1 PHC/ day) = 15 PHC Orientation at SIHFW with faculties of Medical Colleges Questions related to P
9、HC infrastructure, FHW and TBA skills and availability, accessibility and use of services.,Monitoring and Validation Study (MV study),Observations and suggestions by teams are included Field tested and includes validation for records and beneficiary Overview indicates good skills but need for refres
10、hing,Facility Study,Initial plans for CHC and DH, PHC included later Information specifically for BEmOC and BEmPaedC, scope for assessing skills of personnel Could be done in one pilot district,Facility Study,Planned for other districts also Overview indicates need for filling up the posts and updat
11、ing the skills Field work: 16 26 January 2004,Some findings of Marginal Budgeting for Bottlenecks,Other information made available under MBB study,PROVIDER OF INC PLACE OF BIRTH Cleanliness of Place of delivery, environment offered to the new born PNC Provision, number of visits and their timeliness
12、,Other information made available under MBB study,BREAST FEEDING AND TIMING Breast Feeding and use of Colostrums Period of Breast Feedin Method of Washing Hands Use of Mosquito Net,Other information made available under MBB study,Amount of Food and Liquid Given to Child and Knowledge Quotient Diarrh
13、ea episodes Source of ORS Pack Place of Purchase of Medicine H/O fever episode and Blood Smear Taken Vit A instituted and its frequency,Priority fixing,Diligent use of community based link couple for family and community level care in rural areas and for family and community level care in urban area
14、s. Promotion institutional deliveries by providing incentive to TBAs.,Priority fixing,Increase in institutional deliveries. Staff nurses would be engaged on contractual basis in all PHCs for round the clock services.,Priority fixing,100 facilities will be identified (from among District Hospital, Su
15、b district hospital, community health centers and labeled as FRUs) and upgraded for provision of comprehensive emergency obstetric care, New born care, laparoscopic sterilization operation and MTP service,Priority fixing,Up gradation of 250 facilities (from among CHCs/PHCs) for provision of basic em
16、ergency obstetric care, new born care, abdominal TL, MTP and STI/RTI services,Priority fixing,Up gradation of 1500 facilities (from among PHCs/SCs) for institutional deliveries, FP services, NSV and basic newborn care. 250 centers to be developed to provide STI/RTI diagnostic and treatment facilitie
17、s,Priority fixing,Strengthening State Project Management Unit and District RCH society thorough employing resource persons, consultants and other necessary human resources.,Priority fixing,Advocacy for issues of PNDT act, NSV, adverse sex ratio and gender mainstreaming through creating state level f
18、orum with active participation of NGOs and other institutions.,Resource Mapping,Besides health statistics, it reveals: Health and Medical Institutions Para Medical Training Medical Manpower Nursing Staff Various Health programmes in the State Workloads of FP activities Ongoing surveys of monitoring
19、and validation and facility surveys will provide the latest information,Areas of concern,Rural Health Low utilisation Lack of maintenance Rural poor unable to afford Medical expenses Lack of education/ awareness,Areas of concern,Inadequate blood banks Paucity of well organised referral system Urban
20、Health Convergence of Health and Urban Dept. Poor Health Status of slum dwellers,Areas of concern,BPLs unable to secure basic necessity and medical facilities Lack of planned efforts Over crowding of secondary and tertiary care In adequate infrastructure Environmental Health,Areas of concern,Difficu
21、lty in quality and quantity of ground water supply Excessive salinity, fluorides, nitrites in water Concentration of chemical industries Improper treatment of biomedical wastes,Areas of concern,Natural and man made disasters Irrigations Nutritional Health % relying on exclusive breast feeding is les
22、s,Areas of concern,Disparity in Nutritional status in various income levels Poor awareness of healthy/ nutritious food More focus still requires in under 2 years and the lactating ones,Method Adopted to Analyse Priorities,Literature Review Prepared by various field organisations and institutions to
23、reveal critical issues,Method Adopted to Analyse Priorities,Carrying out practical studies in form of: Rapid Household Survey Monitoring and Validation Survey Facility Survey,Other Data Sources,Data Sources by GoI Rapid Household Survey by GOI NFHS Survey SRS Other State Specific information,Action
24、Plan,Thrust Areas for Human Development Index are reduction in: IMR MMR TFR,Different Levels of Interventions,Community level Awareness Generation Trainings & Skill Development Strengthening CBWs including link couples and CBOs Involving PRIs for a meaningful role,Different Levels of Interventions,C
25、linical level Quality improvements Operationalising FRUs for Comprehensive EmOC,Different Levels of Interventions,Availing Basic EmOC at CHCs and PHCs Skill based trainings for health providers Public Private Partnership: Need based out sourcing,Different Levels of Interventions,Outreach Field Visit
26、 RCH Camps Immunisation Sessions on fix days Mobile Health Units for inaccessible areas,Broad Strategies to reduce IMR,FOCUS is on URBAN SLUMS and NEWBORN CARE.,Strategic Interventions,Neonatal Care: At community, household level as well as hospital for prevention of hypothermia and infection & to g
27、o for breast-feeding exclusively. Immunization, Diarrhoea, Treatment of ARI Dealing with Malnutrition,Strategic Interventions,Community Campaigns for nutritional goals including change in dietary behavior of community Birth spacing as an IMR reducing strategy Intersectoral coordination Monitoring an
28、d supervision,Broad Strategies to reduce MMR,Identifying Risk Causing Complications (like Bleeding, Eclampsia, Obstructed labour, Anemia, Sepsis): Delay level 1: Community identifies complications- family decides for Emergency Obstetric Care- IEC Issues,Broad Strategies to reduce MMR,Delay level 2:
29、Availability of emergency transport-mobilization of community resources Delay level 3: Starting the Emergency care at hospital level and make all FRUs functional,Areas of Strategic Intervention,Two Major thrust areas:Essential Obstetric CareEmergency Obstetric care,Essential Obstetric Care,Comprehen
30、sive Antenatal care Replacing Trained Birth Attendance by Skilled Birth Attendance Quality obstetric services at primary Health Center Effective Supply management of DDKs,Essential Obstetric Care,Creating the right Infrastructure Training for early recognition of bleeding /prolonged labor / Infectio
31、n /Abnormal presentation/Convulsions Incentive based approach for trained TBAs and early referral for EmOC Mobility support- Interest free moped loans to ANMs,Emergency Obstetric Care,Effective Emergency Obstetric care management Strengthening FRUs for effective service delivery with Blood transfusi
32、on facilities BEmOC to be made available at CHCs and PHCs. Skill development at all required stages,Emergency Obstetric Care,Promoting timely referral by TBAs through training Expertise of Gynae and Anesthetists to be made available on panel and promote telemedicine for emergency. Emergency transpor
33、t for cases with complications and needing referral.,Broad strategy for population stabilization,CNA approach and focusing on unmet needs Volunteerism and informed choices as basis of population policy Community behavioral change through IEC,Broad strategy for population stabilization,Community base
34、d contraceptive availability Skill based training for doctors and paramedics Monitoring and supervision: Ensuring filling up all posts of ADHOs, DIECOs and strengthening MIS,Overarching Issues,Emphasizing Adolescent Health Harnessing Technology Increasing the Involvement of Stakeholders Mainstreamin
35、g Gender Meaningful role of PRIs,Overarching Issues,Enhancing Performance of Health Delivery Systems Promoting Indian Systems of Medicine & Homeopathy Qualitative Improvements in Family Planning Establishing Effective Monitoring Mechanisms Increasing Awareness among Women,Harnessing Technology,Harne
36、ssing opportunities created by IT revolution for health services through networking of district health offices with the health directorate The establishment of GIS Implementation of the telemedicine application,Increasing the Involvement of Stakeholders,Enhancing Performance of Health Delivery Syste
37、ms,Enhancing productivity and accountability within the department through training programme and systemic changes Developing capacity among senior personnel for strategic planning and health systems management,Enhancing Performance of Health Delivery Systems,Improving logistics and supplies includi
38、ng improvements in the Central Medical Stores Organization Optimum utilization of equipments and maintenance of infrastructure,Budget for Human Resource,Specialists at 100 Comprehensive BEmOC centers (Obstetrician/Pediatrician/Anesthetist on contractual basis) Contractual Staff Nurse at All PHCs Sta
39、te and district level consultants and support staff Village level link couples Community based health volunteers in urban areas,Budget for facility improvement,Civil works Repair/renovation at CHCs / PHCs / SCs Equipment / Instrument based on facility survey for Comprehensive and basic BEmOC Capacit
40、y building,Budget for Service provision,Drugs/ Consumables for EmOC/STI/RTI Iron supplement for Adolescent population Institutional deliveries,Budget for IEC activities,Mass Media Family and self care-Educational material Mahila Swasthya Sangh Print media,Budget for Human Resource,Specialists at 100
41、 Comprehensive BEmOC centers (Obstetrician/Pediatrician/Anesthetist on contractual basis) Contractual Staff Nurse at All PHCs State and district level consultants and support staff Village level link couples Community based health volunteers in urban areas,Budget for facility improvement,Civil works
42、repair/renovation at CHCs /PHCs / SCs Equipment/Instrument based on facility survey for Comprehensive and basic BEmOC Capacity building,Budget for Service provision,Drugs/ Consumables for EmOC/STI/RTI Iron supplement for Adolescent population Institutional deliveries,Budget for IEC activities,Mass Media Family and self care-Educational material Mahila Swasrthya Sangh Print media,Thanks,
