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PLANNING &ORGANISATION OF RCH SERVICES FOR 1 LAKH POPULATION IN A RURAL AREA. Dr. I.Selvaraj. I am very grateful to The Super course, as my view is disseminated to global audience through my Power point presentations in different topics. I hope you might have enjoyed.
PLANNING &ORGANISATION OF RCH SERVICES FOR 1 LAKH POPULATION IN A RURAL AREA
This power point presentation is prepared based on RCH PHASE-II Programme. Those who have gone through my earlier presentations on RCH-PHASE-I , RCH-PHASE-II &Modified RCH-PHASE-II will be benefited. My aim of this presentation is to help the developing countries to strengthen their activities in their areas so that our ultimate goal of population stabilization will be achieved.
My vision is always to disseminate the knowledge of community medicine to all my public health colleagues without any monetary gain. I hope you will all enjoy & gain a lot. Please send me the feedback.
B.Sc., M.B.B.S., D.I.H.,PGCH&FW(NIHFW)
(M.D Community Medicine, Sree Ramachandra Medical college &RI)
D.P.H., (MADRAS MEDICAL COLLEGE, Recognized by MCI)
Senior Divisional Medical officer (Selection Grade Officer)
On Study Leave
Reproductive health can be defined as a state in which people have the ability to reproduce and regulate their fertility, women are able to go through pregnancy and child birth safely, the outcome of pregnancy is successful in terms of maternal and infant survival and well being, and couples are able to have sexual relations free of the fear of pregnancy and of contracting diseases.
To bring about outcomes as envisioned in the
1. Millennium Development Goals
2. The National Population Policy 2000 Goals
3. The Tenth Plan Goals
4. The National Health Policy 2002
5. and Vision 2020 India
1.To Improve routine immunization coverage
2.To reduce the unmet need for contraception
To bring the Total fertility Rate to replacement level by 2010
Population stabilization by 2045
Program:Comprehensive R.C.H services
Plan :High quality, integrated, decentralized, Need based and holistic approach, CNAMA
Evaluation:R.C.H indicators/Feedback data
There are about 50 comprehensive R.C.H services to be effectively carried out for the entire population:
1.Essential newborn care like keeping the baby warm, checking the baby\'s weight and giving the baby mother\'s first milk is important. The premature babies or low birth weight babies need special care. Babies with any complications should be refereed to the nearest health center.
2. Exclusive breast-feeding must be encouraged for the first three months. Weaning or starting the baby on semisolid food should start in the fourth month.
3. BCG, DPT, Polio and Measles immunizations should be administered to every child meticulously to prevent death and disabilities.
4. Vitamin A prophylactic for children is necessary to prevent blindness.
5. Parents must be informed about oral rehydration therapy and correct management of diarrhea. The availability of ORS packets in the villages should be ensured.
6. Acute respiratory infection in children should be detected early. They can be treated by cotrimoxazole tablets. Acute cases should be refereed to health center.
7. Treatment of Anemia.
1. A large number of people suffer in silence due to reproductive tract infections (RTIs) and sexually transmitted diseases (STDs). RTIs and STDs can make people infertile. If a pregnant woman has RTIs or STDs, it can affect the health of her child. People suffering from such infections should be referred to the health center.
2. Adolescents are parents of tomorrow. It is important to prepare them for the future by counseling them on family life and reproductive health. This can be a sensitive topic, as it has not been addressed before. Therefore, the involvement of parents, Anganwadi workers, and Mahila Swasthya Sanghs should be ensured
1.To constitute empowered action group
2. Training of dais
3. To conduct RCH camps & organizeRCH out reach scheme
4. Training of MBBS doctors in Life saving anesthetic skills for emergency obstetric care at FRUs.
5. Strengthening of core strategy of the existing PHCs and CHCs, and provision of 30-50 bedded CHC (community health centre) per lakh population for improved curative care to a normative standard (Indian Public Health Standards defining personnel, equipment and management standards)
6.All Community health centers & 50% of the Primary health centers are to be made functional for providing 24 Hrs. delivery services
7.Primary Health Centers are proposed to be taken up for improving access to Essential Obstetric and New Born Care services round the clock. Cont……
8.Improving quality of antenatal, neonatal and postnatal care by providing increased number of antenatal checkups, fixed day antenatal clinics, linking visits of neonates with postnatal care, empowering the VHNs in performing obstetric first aid and newborn care.
9.Improvement of the referral networking systems by establishing emergency helpline
10.Regular conduct of blood donation camps for the continued availability of blood in the blood banks.
11.Universalizing the concept of birth companionship during the process of labor in all health facilities conducting deliveries.
12.Operationalisation of maternal death audit to address the issues that have led to maternal deaths
NEW INITIATIVES IN RCH PHASE-II
1. Reduction of Neo-natal deaths, infant deaths and child deaths by providing continuous health care and strengthening of new-born care infrastructure facilities.
2. Organizing counseling sessions for the mothers.
3.Implementing integrated management of neonatal and childhood illness
4. Operational sing infant death/stillbirth verbal autopsy.
5. Addressing the issue of female infanticide and foeticide
6Gadchiroli model to take care of home based neonatal care
7.Kangaroo mother care to take care of low birth weight infants
1. Higher order births will be targeted for intensified intervention
2. Social marketing programme has to be developed for condom and other health commodities, promotion of IUD insertions, familiarizing the concept of one-stop Family Welfare Centre.
3. Increasing access to safe abortion services by popularizing manual vacuum aspiration (MVA) technique.
4. Establishment of one-stop family welfare services at Comprehensive Emergency Obstetric and New Born Care (CEMONC) Centres.
5. Popularizing No Scalpel Vasectomy.
6. Availability of a wide range of contraceptive methods MCH and other services
10. Well-trained service providers with skills in inter-personal communication and counseling
11.Appropriate follow-up care
12. Regular monitoring and evaluation of performance
13.A paradigm shift from individualized vertical interventions to a more holistic and integrated life cycle approach giving more focused attention to the reproductive health care.
1.Improved drug procurement & supply systems to tackle the problem of inadequate and irregular supplies
2. Improved supply of cross-matched blood in first referral units thereby decreasing the inter-institutional transfers for transfusion
3. Regular conduct of blood donation camps for the continued availability of blood in the blood banks.
4. Systematic reporting and auditing of maternal & infant deaths
5. For monitoring purposes, standardized systematic reporting of services rendered at primary care level, using simple, manually completed, computer readable forms
6. Ensuring block and district level inter-sectoral coordination for ICDS
7. Improvement of the referral networking systems by establishing emergency help line
8. Each community health center should have one additional post of public health manager and public health nurse
These activities should cover the following messages:
Factors determining good quality care
Spending time with clients
Caring of clients privacy and dignity
a) Focusing adolescents as receivers and providers of knowledge and function as link volunteers in the community.
b) Utilising the services of trained adolescents for propagating Indian System of Medicines.
c) Broadcasting and Telecasting of programme by AIR/TV focusing adolescent, gender and health related subjects.
d) Formation of co-ordination committee at the district level and monitoring committee at the State level for overseeing the AIR/TV programme.
Reproductive tract infections / Sexually transmitted infections / Cancer control.
a) Establishment of Reproductive Tract Infection / Sexually Transmitted Infection, early Cancer detection clinics .
b) Strengthening RCH outreach services.
c) RTI/STD clinic in selected primary health centers
a) Construction of HSC buildings where HSCs are currently functioning in rented premises
b) Rebuilding HSCs which are unfit for occupation.
c) Taking up of repairs/renovation and provision of water supply/electrical works to PHCs/HSCs.
d) Need-based supply of equipment/furniture to the HSCs and PHCs as per the standard list including gas connections.
e) Provision of Cell phones to HSCs where large number of deliveries take place.
f) Provision of telephones to PHCs
a)Social mobilization activity against female infanticide and foeticide by preventive counselling.
b) Formation of HSC, Block, District level committees for saving female babies.
c) Conducting of Kalaipayanam (traveling street theatre) to promote social mobilization and to improve health care among the target population
d) Telecasting of TV serials, Radio broadcasts, wall paintings, hoardings and glow signs for popularizing health and reproductive health messages in important places.
Immunization, Antenatal, Natal and Postnatal care, prevention of malnutrition and common childhood diseases, family planning services and counselling. They also provide elementary drugs for minor ailments such as ARI, diarrhea, fever, worm infestation etc. and carryout community needs assessment.
•Administration of Anesthesia
•Manual Removal of Placenta
•Carry out Suction Curettage for Incomplete Abortion
•Insert Intrauterine Devices
KIT-D-PHC (PRIMARY HEALTH CENTR)
TYPES OF KIT FOR FIRST REFERAL UNIT
•Kit-E – Laparotomy set
•Kit-F - Mini– Laparotomy set
•Kit-G – IUD insertion set
•Kit-H – Vasectomy set
•Kit- I – Normal delivery set
•Kit- J – Vacuum extraction set
•Kit- k – Embryotomy set
•Kit- L – Uterine evacuation set
•Kit-M – Equipment for anesthesia
•Kit-N- Neonatal resuscitation set
•Kit-O- Equipment and reagent for blood test
•Kit-P – Donor blood transfusion set
Assessment of health need
Establish goals &objectives
Implementation of programme
Assessment of resources
Select the best alternative
Establishment of priorities
Design alternative programme
Medical officers (Surgeon, Gen. Physician, Gynecologist, Anesthetist, Public Health Managers)
Dark Room Assistant
CHN(COMMUNITY HEALTH NURSE0
PHC HI (CHIEF HEALTH INSPECTOR)
VHN (VILLAGE HEALTH NURSE)
Siddha – Assistant
M.O, Staff Nurse, Health assistants (Male, Female), Health Inspectors, Pharmacist, Lab technician, Ambulance driver,& Sanitary cleaners, Block extension educator, UDC,LDC (15-17)
Multi purpose Health worker (Male, Female)
Supporting Health workers (Village Health Guide, Traditional birth attendant, Anganwadi workers, ASHA(NRHM)
•No. of Eligible couples registered/ANM
•No. of Antenatal Care sessions held as planned
•% of Sub Centers with no ANM
•% of Sub Centers with working equipment of ANC
•% ANM/TBA without requisite skill
•% Sub centers with DDKs
•% of Sub centers with infant weighing machine
•% Sub centers with vaccine supplies
•% Sub centers with ORS packets
•% Sub centers with FP supplies
•% Pregnancy registered before 12 weeks
•% ANC with 5 visits
•% ANC receiving all RCH services
•% High-risk cases referred
•% High-risk cases followed up
•% Deliveries by ANM/TBA
•%PNC with 3 PNC visits
•% PNC receiving all counselling
•% PNC complications referred
•% Eligible couple offered FP choices
•% Women screened for RTI/STDs
•% Eligible couple counselled for prevention of RTI/STDs
•% ADD given ORS
•% ARI treated
•% Children fully immunized
•%Deaths from maternal causes
•Maternal mortality ratio
•Prevalence of maternal morbidity
•% Low birth weight
•Neo-natal mortality ratio
•Prevalence of postnatal maternal morbidity
•% Baby breast-feeds within 6 hrs of delivery
•Couple protection rate
•Prevalence of terminal method of sterilization
•Prevalence of spacing method
•% Abortion related morbidity
•Prevalence of ADD
•Prevalence of ARI
•Prevalence of RTI/ST
Introduction of IT-enabled HMIS for planning and monitoring health services at the State/District /Block levels
a) Skill upgradation training with focus on improving/upgrading the skills of health care providers.
b) Integrated skill training for peripheral health functionaries such as VHNs, SHNs, medical officers and health inspectors.
c) Improving managerial and communication skills of health staff.
= 1,00,000 ×16.7 =1670
Antenatal registration = Probable number of pregnancies + 10% (for pregnancy wastage)
= 1670 + 167 = 1837
15% of the antenatal registration are high risk
=1837 × 15 = 276
= 1837 = 978.5 =919
Annual Vaccine Requirement
= No of eligible ×No of doses × Proposed coverage ×Multiplication factor based on VAR
(DPT,DT, TT, OPV ) Multiplication factor=1.33
( BCG,Measles) Multiplication factor =2
= 1837 × 1.33 × 2= 4886 Doses
= 245 vials ( Each Vial = 20 doses)
= 1620 × 1.33 × 3 = 6464 Doses
= 646 vials ( Each vial = 10 Doses)
= 1620 ×2 ×1
= 3240 Doses
= 324 Vials+ Diluents ( Each vial = 10 doses)
= 1620 ×2 ×1
= 3240 Doses
= 324 Vials + Diluents
= 1620 ×1.33 ×4
= 8618 Doses
= 862 vials
Estimation of syringes & Needles
= No of registered pregnant women ×Session planned +No of infants × session planned
= 3674+ 8100 = 11774 AD Syringes &Needles
= 15000 × 10 =1500
= 100 × 1500 = 1,50,000
Total = 1,83,700+1,83,800 =367500 (Large tablets)
= 1,50,000 (small tablets)
= 1,00,000 × 16.7 × 0.97 = 1620
Total doses for infants = 1620
= 1620 × 1,00,000 I.U
Each bottle = 100 ml
= 1 ml = 1,00,000I.U
= 17 Bottles
Total doses for children < 3 years =8000-1620=6380
= 6380 × 4 =25520 doses
= 2ml = 1dose = 510 bottles + 17
Total Vit-A Solutions = 100ml × 527
= Population of the area ×Birth Rate
= 1,00,000 × 16.7 = 1670
= 1670 = 835
= 15000 ×40 =6000
= 835+ 6000 =6835 ×6 =41010
Sphygmomanometer & stethoscope
One for each sub center
One weighing scale for adult & on spring balance for babies in each sub centre
Public health experts should be an essential part of the executive management team and will have to play a key role in our country by identifying the major problems in the RCH programme such as the absence of links between communities, subcentres and referral facilities; shortages of equipment and trained staff at referral facility; and a lack of emergency transport to adequately meet the needs of pregnant women particularly for obstetrical emergencies. Allocation of resources should be linked to states performance as well as to population size. They have to identify the new indicators for performance, and allocation of resources based on the felt need of the on priority.
Active participation of Community with involvement and support of women’s self help groups, village health nurse, anganwadi workers, asha activist etc., will be very effective in improving women accessibility to different components of RCH services and increasing sensitivity to women’s needs. The private sectors role in improving women’s health is very helpful. We have to find out a mechanism to involve them through appropriate rules ®ulations to provide the RCH Phase-II programme to the community.
World Health Day slogan 2005 “Make Every Mother and Child Count”
reflects that health of women and children should be given higher priority at all levels of health care system. Every one is accountable for health of mothers & children. The World Health Day slogan 2006 “Working together for health” reflects the involvement of health care workers to provide quality health care services to the community. The fulfillment objective of Phase-II RCH programme is the joint effort of community and service providers.