JRM

JRM Gujarat State 6th JRM PRESENTATION ON FACILITY OPERATIONALISATION AND VHNDS : CURRENT STATUS , KEY ISSUES ANDWAY FORWARD Structure of the Presentation 1. Good / innovative practices adopted by the state (facility Operationalization and VHNDs) Facility Operationalization 2. Current status of FRUs, 24/7 PHCs 3. Key issues 4. Way forward Village health and nutrition days 5. Current status 6. Key issues 7. Way forward Good / Innovative practices adopted by the State PPP: • • • Chiranjeevi Scheme and Extended Chiranjeevi Scheme. Bal-Sakha: PPP with private pediatricians for providing Essential and emergency new born care PPP with CBOs for CHCs and PHCs Institutions strengthening: • • • Strengthening of Community Health Centers. Initiation of NABH/NABL Establishment of PIU for Improved Infrastructure. • • Scaling up the Mobile Health Comprehensive Units. Establishment and Operationalization of EMRI-108 Maternal health: • • • • • • • Implementation of Janani Suraksha Yojana. Maternal and infant death audits Incentives to Health Service Providers. Specialist on Call basis. Birth micro plans follow up as per EDD by EMRI 108 Improved Blood availability Insecticide treated bed nets for the prevention against malaria for children & lactating mothers Child health: • • • • Immunization with focused attention on Low performing blocks. Implementation of IMNCI School health program Beti vadhavo (Bachao) Abhiyan Adolescent health: • • • 53 Adolescent health center functional 8 members trained in Adolescent health (MAMTA) Planning universal AFHS centers in 3 districts Out reach service: • • Mamta Abhiyan Induction of Mamta Taruni Abhiyan. Trainings: • Capacity Building of Health Service Providers. Training for CEmOC, BEmOC, Anesthesia, SBA to staff. A supplementation to ANC and PNC Family planning program: • • • Scaling up the Family Planning service coverage Quality training for IUD -StatewidwTraining of surgeons for NSV/Laproscopic TL: – – Additional: • • • Web based programme to monitor Civil Registration System. Iodised salt and Vit. IMNCI training pre and post service training of Health.• • • • • Increasing FHWs training centers and seats EmNBC training ( two batch. 8 candidates) Initiating specialized mid-wifery courses in 6 nursing colleges. Fluorosis control (Health component) Covering the Urban Poor through urban health service network 125 surgeons trained in NSV and within 2007-08 state is going to have 250 trained surgeons 770 surgeons trained and certified for laproscopic TL surgery . ICDS functionaries Introducing FIMNCI in the state Malnutrition • • • • • • Nirogi bal varsh integrated approach State Nutrition cell and network functional Child Development and Nutrition Centers (CDNC) 11 CDNC centers functional State specific Anemia protocol and integrated initiatives to reduce anemia in pregnant women and children Adolescent Anemia control program Calcium. of Planned FRUs District hospitals 23 Other than District hospitals 101 Sub total 124 PPP (Chiranjivi) 850 Grand total 974 No.Current Status FRUs-1 No. C/S facility 24/7 77 2. Blood facility (Total) Blood bank Blood storage facility PPP (Private 129 blood bank tie up ) 119 16 11 92 . of Operational Government FRUs with 1. with Normal deliveries conducted 24X7 230 79 Essential newborn care services available . of facilities) 331 No.MTP 36 2. Newborn care Government facility 30 Balsakha/ CY combination 220 All the above three criteria 28 + 220= 248 No.*Current Status FRUs-2 3. of planned 24x7 PHCs … contd Status on 1st April. Current status: 24/7 PHCs No. of operational 24X7 PHCs. of Operational FRUS with Male Sterilization Services (Not Camp Based) 29 Female Sterilization Services (Not Camp based) 33 Safe Abortion Services . 2009 (No. with IUCD services Early and safe abortion services (including MVA) RTI / STI treatment or counseling 105 331 37 FRUs & 24/7 PHCs : Existing Staff position in facilities (Nos) Facility OBG specialis t Anaesthe tist Paediatrici MOs MOs an trained trained in in LSAS CEm OC R 46* A 14 A 3 A 5 MOs trained in blood storage MOs Staff trained nurses in BEm OC R DH 48 * 0* A 20 R 52* A 32 A 56 A 54 R 847 A 83 0 33 1 FRUs (other than DH) Facilities other than FRUs (above PHC level) 10 0* 2 0* 0 47 75 0 96 349 0* 0 0* 0 0* 0 0 0 0 450 1911 18 80 . of operational 24X7 PHCs.Availability of Referral transport 24X7 All the above 3 criteria 331 79 No. A Total 302 A 52 A 34 A 607 A 65 A 65 A 807 A 0 A 5775 . A: Available. LSAS refers to training in Life Saving Anaesthesia Skills FRUs & 24/7 PHCs : Existing Staff position in facilities (…contd. both regular and contractualEmOC refers to the Comprehensive EmOC training (including C-section).24x7 PHC 0 0 0 0 0 0 0 0 0 0 993 23 0 Private Facilities Total N A 48 85 0 88 0 NA NA NA NA NA NA NA 52 35 46 14 50 80 56 600 32 71 R: Required as per GoI guidelines/ norms of respective facility irrespective of number of positions sanctioned. RTI/ diagnosis storage SBA STI mgmt. BEmOC refers to Management of common obstetric complications.) Facility MOs Staff LTs MOs LTs Doctors Doctors Staff ANMs/ trained nurses trained trained trained trained trained nurses LHVs in RTI/ trained in RTI/ in in in NSV in Lap trained trained STI in STI MTP blood Ligation in in SBA mgmt. ) % of BPL cases .) ^ Referral transport provided / arranged Average/ month/ facility (in No.29 24/7 PHCs Deliveries (Normal & Assisted) Referral to higher institution for complications Cases referred out Average / month / facility (in No.) Highe st Lowes t % of BPL * Average/ month/ facility (in No.) Aver age/ mont h/ facilit y (in No.) High est Lowe st % of BPL * Ave rag e/ mo nth / faci lity (in No.) ^ Range (in a month/ facility) (in No.) ^ 13 Range (in a month/ facility) (in No.Utilization Level for operational facilities FRUs & 24/7 PHCs FRUs Deliveries (Normal & Assisted) Caesarian sections Blood Trans fusion s % of BPL * Avera ge/ month (in No.) High est Lowe st 2008 -09 53 450 20 85 0 14.) ^ Range (in a month/ facility) (in No. review of findings in regional workshops of BHOs to identify the gaps in the services ARSH SERVICES: CURRENT STATUS AFHS centers Details Type of Facility Medical Collage District Hospitals No 06 23 . and Anesthesia (80) BEmOC training to MO (600) and staff Nurses (1200) EMRI 108 transport services EmNBC training (Multi skilling) PPP Chiranjivi and Bal sakha yojana Motivation charges to Dai/ ASHA for accompanying mother to institutions for delivery Verbal Autopsy of maternal deaths and infant deaths.2008 -09 18 67 0 3. Key Issues in existing facilities (FRUs & 24/7 PHCs) • • • Shortage of Specialists (ObGyn and Anesthesia) Shortage of MBBS doctors Shortage of Staff Nurses – – – Contractual appointment uncertainity Do not want to go in far away areas Difficult terrain and socio-cultural barriers in Dang (a hilly tribal district) 4. STEPS TO ADDRESS KEY ISSUES • • • • • • • Short Term training to Medical Officers for C-Section (50). 7 66.6 60 50 40 30 20 10 0 % males attending the AFHS Centres % Females attending the AFHS Centres 45.4 2.4 .9 40 30 20 5.AFHS Monthly Report March Progressive) 64.9 10 26.9 33.CHCs PHCs Total Centers Training Details Category Medical Officers 12 12 53 No 271 FHWs Officers (MAMTA international training) 2537 8 Utilization of ARHS Centers Marital Status wise AFHS Centre Attendes (Source:-.AFHS Monthly Report-March Progressive) 70 60 50 Purpose of Visit (Source:-.AFHS Monthly Reports March Progressive) 54.1 0 Curative Preventive Councelling Information seeking Married adolescent Unmarried adolescents Sex wise AFHS Centre Attendes (Source:-. Key Issues : VHNDs • • • • • • Growth Monitoring followed by counseling Community participation Tracking of beneficiaries Logistics Capacity of Supportive supervision Decentralised Monitoring and intervention .Constraints and steps to address the same • • • • • Prioritisation in district program Skill to develop and manage centers Convergence with school health and GSACS activity Initiating MAMTA Taruni program from 1st July to develop a base for referrals Planning universal coverage in three districts as pilot 5. of VHNDs planned in 2008-09 % of planned VHNDs held   Average No.74%)   No. 2009 317496 310336 (97. of beneficiaries per VHND Average % of BPL beneficiaries per VHND 15573893 (50. Current status: VHNDs Status Health and ICDS convergence st on 1 April.18) 6. VHNDS : Steps to address key issues • • • • • • Active participation of VHSC Better Communication through BCC planning Developing a protocol for decentralised monitoring Supportive supervision trainings Effective Referral systems to CDNCs.Gujarat 17th June 2009 Healthcare Facilities . Action plan for tracking of mother and children including migrated in and out State .7. No. of Rogi Kalyan Samitis formed (PHCs) No. 7. 6. 5. of Village Health Committee ASHAs 2 5 7 6 23 273 1056 16860 25861 Present Status of ASHA ASHA Criteria Status(2008-09) No of ASHA Sanctioned 31436 . 9. of Governing body meetings held No. 8. 3. 2. of executive committee meetings held No. No. of State health Mission meetings held No.Governance of NRHM S. of Rogi Kalyan Samitis formed (CHCs) No. Activity Number 1. of Rogi Kalyan Samitis formed (Medical Colleges) No. of Rogi Kalyan Samitis formed (District hospitals) No. 4. 8 95 97. of ASHA trained in Module I 21227 No. of ASHA trained in Module IV 12431 Trend of Civil Registration CRS Registration Trend Birth (%) Registration Trend Death (%) 85. of ASHA selected 25861 No.No.3 75.2 01 02 03 04 05 06 07 . of ASHA trained in Module II 15619 No.4 58.1 74.9 84. of ASHA trained in Module III 13563 No.6 84.1 64 74 66.6 90.7 62.2 94. 04 135706 Institutional… 55 46 37 NFHS-I NFHS-II NFHS-III State MIS 2008-09 140000 135000 130000 125000 120000 115000 110000 105000 100000 121043 2007-08 2008-09 .Maternal Health Maternal Mortality (per lakh live births) in Gujarat 450 400 389 Maternal Dealth 350 300 250 200 150 100 50 0 1989 1999-01 2001-03 2005-07 2010 100 202 172 160 Trend of Institutional Deliveries 90 80 70 60 50 40 30 20 10 0 82. 57%) 820/2000 Total Deliveries under Chiranjeevi scheme Estimated Maternal Death Maternal death reported under Chiranjeevi scheme Mothers saved under Chiranjeevi scheme Estimated Early NeoNatal death Early NeoNatal death reported under Chiranjeevi scheme Early Neonates saved 321302 514 62 452 7390 1246 6144 Trend of Deliveries at CHCs 90000 80000 70000 60000 50000 40000 30000 20000 10000 0 80539 42171 43704 2006-07 2007-08 Deliveries… 2008-09 .Outcome of Chiranjeevi Scheme: ( Up to April-09 • • • • Normal Deliveries: C-Section: Complicated Deliveries: Private specialist enrolled: 284049 19345 (6.02%) 17908 (5. Jun09. Apr09. 229 42 Nov. 09. Dec09.Usage of EMRI 108 80000 Pregnancy releted Emergencies 70000 Total Medical Emergencies 62015 59134 70019 60291 Medical EM & Pregnancy Cases 60000 50869 49888 50000 40602 40000 34490 28095 20396 20000 10075 10000 948 1445 1846 0 9 Sep08.1191 Level of Delay Year 2008-09 Receiving Year 2007-08 care 12% Treatment 25% Transport 26% Decision making 62% Transport 11% Decision Making 64% . Jan09. 08. Aug09. Oct09. 30000 16780 11656 13403 16191 16974 2881 4683 8085 11274 13363 19256 20897 20697 24435 7027 3476 733 1304 1656 1964 Feb09. Mar09.Dec. Deliveries conducted in Ambulance – 4069 Deliveries conducted at Place . Feb09. 18 Oct08. Nov09.Jan08. Sep09. Jul09. May09. Mar09. of trained personnel MO-600 Staff Nurse200 1 Basic Emergency Obstetric Care (BEmOC) MO.Staff Nurse Promoting institutional delivery Medical Colleges. BEmOC. Community Health Centers Medical Colleges. District Hospitals 2 Comprehensive Emergency Obstetric Care (CEmOC) MO Providing EMOC Services Medical Colleges. District Hospitals. Community Health Centers 50 3 Life Saving and Aneasthetic skill in Emergency Obstetric Care (LAS) MO Providing EMOC Services 80 4 Skilled birth attendant training (SBA) FHW and ANM Promoting institutional delivery at sub centers by ANMs District hospitals and selected FRUs 5775 .No. CEmOC. LAS) Sr. Type of Training Cader Objective Place No. District Hospitals.Capacity Building (Training of SBA. 258 19.294 12.Pre and post CEmOC and LSA training performance (24 centers) ’06-’07 ’07-’08 ‘8-’09 Deliveries 10.699 LSCS 186 282 524 . 05 points reduction in TFR per year between 2003 to 2007 TREND IN IMR (SRS): 2003-2007 58 57 57 56 55 54 IMR 54 53 53 52 52 51 50 49 2003 2004 2005 SRS (Year) 2006 2007 53 .7 (SRS 2007) IMR TFR <30 2. 2009 GUJARAT Date: 15.RCH II: SIXTH JOINT REVIEW MISSION May-June.06.1 • • • 4 points reduction in MMR per year between 2001-03 to 2004-06 1.25 points reduction in IMR per year between 2003 to 2007 0.2009 PROGRESS: RCH GOALS GUJARAT INDIC ATOR INDIA RCHII/NR HM (2012) goal <100 Trend (year & source) Current status MMR 172 (SRS 0103) 57 (SRS 2003) 2.6 (SRS 2007) 254 (SRS 0406) 55 (SRS 2007) 2.8 (SRS 2003) 160 (SRS 0406) 52 (SRS 2007) 2. 8 2.9 36.3 54.8 2.7 2.2 19.0 30.0 0.0 Total unmet need (%) Full ANC (%) Institutional delivery (%) Full Immunisation Children breastfed ORS received Advise / Treatment (%) within one hour of during diarrhoea during ARI (%) birth (%) (%) DLHS-2 DLHS-3 16.3 54.6 2.5 74.3 24.5 56.8 2.6 2.2 50.0 10.7 25.9 24.6 2.0 60.0 70.TREND IN TFR (SRS): 2003-2006 2.8 2.8 2.3 16.5 2003 2004 2005 SRS (Year) 2006 2007 PROGRESS: OUTCOME INDICATORS DLHS 2 – 3 80.0 40.4 .0 52.9 48.9 2.0 54.0 20.7 TFR 2.7 2. 1 254 46.8 212 . 1 Indicators PHCs Surveyed PHCs functioning on 24 hours basis PHCs having new born care services* PHCs having referral services for pregnancies/delivery* PHCs conducted at least 10 deliveries during last one month* CHCs Surveyed Number 542 % 1.1 93 36.12 45.TREND IN EXPENDITURE: 05-09 140 120 116.21 40 20 2.64 08-09 RCH II Reported Expenditure RCH II Audited Expenditure JSY Reported Expenditure DLHS-3 RESULTS FORFACILITY OPERATIONALISATION Sn.12 7.42 0 05-06 8.3 2 152 59.6 1.9 1.55 06-07 07-08 13.1.1.1.67 46.64 45. in crores 80 60 51.94 22.2 163 64 1.92 9.60 100 Rs. 1 2.6 157 74.1 2.2 2.3 14 8.9 .3.3.3.1 CHCs having Obstetrician/Gynecologist CHCs having 24 hours normal delivery services CHCs designated as FRUs CHCs designated as FRUs offering caesarean section** FRUs having new born care services on 24 hour basis** FRUs having blood storage facility** 24 11.3 2.3 207 97.2 135 86 2.2.1 38 24.