25 Feb 2014

Healthcare for Women and Children

National Health Mission (NHM)
The details of current schemes being implemented for Maternal Health, Adolescent Health and Child Health (including immunization) are as follows:

Maternal Health:
Under the National Health Mission (NHM), the key steps taken by the Government of India to accelerate the pace of decline in maternal & infant mortality are:
·        Providing resources for operationalization of sub-centers, Primary Health Centers, Community Health Centers and District Hospitals for providing 24x7 basic and comprehensive obstetric care, neonatal, infant and child care services
·        Strengthening of Facility based newborn care by setting up Newborn Care Corners (NBCC) in all health facilities where deliveries take place; Special New Born Care Units (SNCUs) at District Hospitals and New Born Stabilization Units (NBSUs) at First Referral Units for the care of sick newborn.
·        Capacity building of health care providers through training programmes in basic and comprehensive obstetric care, skilled attendance at birth, Integrated Management of Neo-natal and Childhood Illness (IMNCI) and Navjaat Shishu Suraksha Karyakaram (NSSK), facility & home based newborn care, etc.
·        Name Based web enabled tracking of pregnant women & children to ensure optimal antenatal, intranatal and postnatal care to pregnant women and care to new-borns, infants and children.
·        Under the National Iron+ Initiative, Iron and Folic Acid supplementation to pregnant, lactating women and to children and adolescents for prevention and treatment of anaemia
·        Identifying the severely anaemic cases in pregnant women and children at sub centres and PHCs for their timely management
·        To tackle the problem of anaemia due to malaria particularly in pregnant women and children, Long Lasting Insecticide Nets (LLINs) and Insecticide Treated Bed Nets (ITBNs) are being distributed in endemic areas.
·        Exclusive breastfeeding for first six months and promotion of appropriate infant and young child feeding practices
·        Engagement of more than 8.8 lakhs Accredited Social Health Activists (ASHAs) to generate demand and facilitate accessing of health care services by the community.
·        Home Based Newborn Care (HBNC) has been initiated through ASHA to improve new born care practices at the community level and for early detection and referral of sick new born babies.
·        Village Health and Nutrition Days in rural areas as an outreach activity, for provision of maternal and child health services and creating awareness on maternal and child care including health and nutrition education.
·        Universal Immunization Program (UIP) against seven diseases for all children.
·        Vitamin A supplementation for children aged 6 months to 5 years.
·        Janani Shishu Suraksha Karyakaram (JSSK) has been launched in 2011, which entitles all pregnant women delivering in public health institutions to absolutely free and no expense delivery including Caesarean section.  The initiative stipulates free drugs, diagnostics, blood and diet, besides free transport from home to institution, between facilities in case of a referral and drop back home. Similar entitlements are available for sick newborns and infants accessing public health institutions for treatment.
·        To sharpen the focus on vulnerable and marginalized populations in underserved areas, 184 High Priority Districts have been identified for implementation of Reproductive Maternal Newborn Child Health+ Adolescent (RMNCH+A) interventions for achieving improved maternal and child health outcomes.  
·        Demand promotion through Janani Suraksha Yojana (JSY), a conditional cash transfer scheme to promote institutional deliveries. The details of funds allocated for the last three years is as under:

     Child Health:
·        The following interventions under Reproductive and Child Health programme of National Rural Health Mission are being implemented to reducing Infant and child mortality:
·        Operationalizing Community Health Centers as First Referral Units (FRUs) and Primary Health Centers (24X7) for round the clock maternal care services. )
·        Promotion of Institutional Delivery through Janani Suraksha Yojana (JSY) and Janani Shishu Suraksha Karyakram (JSSK): Promoting Institutional delivery to ensure skilled birth attendance for reducing both maternal and neo-natal mortality.
·        Strengthening Facility based newborn care: Newborn care corners (NBCC) are being set up at all delivery points. Special Newborn Care Units (SNCUs) and Newborn Stabilization Units (NBSUs) are also being set up at district hospitals and CHCs respectively for the care of sick newborn including preterm babies.
·        Home Based Newborn Care (HBNC):  Home based newborn care through ASHAs has been initiated to improve new born practices at the community level and early detection and referral of sick newborn babies
·        Capacity building of health care providers: Various trainings are being conducted under National Rural Health Mission (NRHM) to build and upgrade the skills of health care providers in basic and comprehensive obstetric care of mother during pregnancy, delivery and essential newborn care.
·        Name Based Tracking of Pregnant Women to ensure complete antenatal, intranatal and postnatal care
·        Adolescent Reproductive Sexual Health Programme (ARSH) – for adolescents to have better access to family planning, prevention of sexually transmitted Infections, counselling and peer education. 
·        A new initiative Rashtriya Bal Swasthya Karyakram (RBSK) has been launched on 6th February, 2013 for Child health screening and early intervention services to provide comprehensive care to all the children in the community. The purpose of these services is to improve the overall quality of life of children through early detection of birth defects, diseases, deficiencies, development delays including disability.
·        Promotion of appropriate infant and young child feeding practices that include early initiation of breastfeeding and exclusive breastfeeding till 6 months of age.
·        Treatment of children with severe acute malnutrition at special units called the Nutrition Rehabilitation Centres (NRCs), set up at public health facilities. Presently 763 such centres are functional all over the country.
·        National Iron Plus Initiative has been launched for improved thrust on anemia prevention in various age groups including children aged 6 month to 5 years, school going & out of school children, Adolescents, Pregnant and lactating women and women in reproductive age groups.
·        Village Health and Nutrition Days and Mother and Child Protection Card are the joint initiative of the Ministries of Health & Family welfare and the Ministry of Woman and Child for addressing the nutrition concerns in children, pregnant women and lactating mothers.
Ensuring complete immunization of Children.
Funds for Child health programme are components of RCH and NRHM flexipools.

Adolescent Health:

Programme and schemes under Adolescent Health are summarised below:
1.  Weekly Iron and Folic Acid Supplementation (WIFS) Programme

The Ministry of Health and Family Welfare has rolled out the Weekly Iron and Folic Acid Supplementation (WIFS) Programme in 2012-13 to meet the challenge of high prevalence and incidence of anaemia amongst adolescent girls and boys. The long term goal is to break the intergenerational cycle of anaemia, the short term benefit is of a nutritionally improved human capital.
Salient features of WIFS programme:
Administration of supervised Weekly Iron-folic Acid Supplements
Screening of target groups for moderate/severe anaemia and referring these cases  to an appropriate health facility.
Biannual de-worming (Albendazole 400mg), six months apart, for control of helminthes infestation.
Information and counselling for improving dietary intake and for taking actions for prevention of intestinal worm infestation.

2.    Scheme for Promotion of Menstrual Hygiene

The Ministry of Health and Family Welfare has launched a new Scheme for Promotion of Menstrual Hygiene in rural adolescent girls. This programme aims at providing adequate knowledge and information about menstrual hygiene to rural girls and improving access to high quality sanitary napkins along with ensuring  safe disposal mechanisms.

The scheme aims to cover 1.5 crore girls in the age group of 10-19 years in 152 districts of 20 states. The scheme includes providing a pack of 6 sanitary napkins under the NRHM’s brand ‘Freedays’

3. Rashtriya Kishor Swasthya Karyakram

The Ministry of Health and Family welfare has recently launched Rashtriya Kishor Swasthya Karyakram (RKSK) on 7th January 2014 to respond to health and development needs of adolescents in India. This programme envisions that all adolescents in India are able to realise their full potential by making informed and responsible decisions relating to their health and well-being.

Rashtriya Kishor Swasthya Karyakram, as a programme, is underpinned by evidence that adolescence is the most important stage of the life cycle for health interventions. Addressing adolescent health needs would obviate several reproductive, maternal and child health challenges.  For example, age at marriage, birth preparedness, appropriate spacing, teenage pregnancy and mortality and morbidity associated with it can be addressed only when we start to work with adolescents, both boys and girls, and their caregivers. 

To address these health challenges, and based on a national analysis, Rashtriya Kishor Swasthya Karyakram focuses on six areas of health: sexual and reproductive health, nutrition, injuries and violence (including gender based violence), non-communicable diseases, mental health and substance misuse.
The key strength of the program is its health promotion approach. It is a paradigm shift from the existing clinic-based services to promotion and prevention and reaching adolescents in their own environment, such as in schools and communities. Key drivers of the program are peer educators, counsellors, parents and the community; communication for social and behaviour change communication; and Adolescent Friendly Health Clinics across levels of care.

Budgetary details- The funds for roll out of RKSK will be provided to states as a part of National Health Mission Programme Implementation Plan (PIP) 2014-15 and implementation will begin in the states after April 2014-15.

World Health Organization (WHO) provides only technical support for various activities connected with the health programmes like research, workshop, meetings and dissemination of information as well as offering fellowships through the Govt. of India which is aimed at strengthening the infrastructure and improving the quality of public health programmes. 

Also the financial and technical support is received from the various International agencies such as World Bank, Department for International Development (DFID), United Nations Population Fund (UNFPA), European Union (EU), United States Agency for International Development (USAID) and ENTWICKLUNGSBANK (KFW) for implementation of Reproductive and Child Health Programme II and for Pulse Polio Immunization Programme.

This was stated by Shri Ghulam Nabi Azad, Union Minister for Health and Family Welfare in a written reply to the Rajya Sabha today.

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