1 dr. h. bhushan assistant commissioner maternal health mohfw-goi

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1 Dr. H. Bhushan Assistant Commissioner Maternal Health MoHFW-GOI

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Dr. H. BhushanAssistant Commissioner Maternal Health

MoHFW-GOI

MH Interventions in RCH-II Essential Obstetric Care : Ensuring Quality ANC Care. Institutional and Safe Delivery (promotion by Janani Suraksha Yojana). Prophylaxis and treatment of Nutritional Anemia. Provision of 24 Hrs Delivery Services at PHC. Post natal care for mother and newborn.

Skilled Attendance at Birth (domiciliary & health facilities):• Training of SNs/LHVs/ANMs in SBA.• Orientation of MBBS Doctors in SBA.

Emergency Obstetric and neonatal Care• Operationalization of First Referral Units (FRUs).• Training of MBBS doctors in Life Saving Anaesthetic Skills and

Emergency surgical interventions.

Referral Services at both Community and Institutional level.

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MH Interventions (Contd..)Other MH Interventions:• Expand early Safe Abortion Services- introduce

MVA at PHC level• Strengthening RTI/ STI services at sub-district

level.• Setting up of Blood Storage Centers (BSC) at FRUs• Village Health and Nutrition Day

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RCH-II (2005-2010): Operational Targets

Operationalize 2000+ FRUs in the country;Make at least 50% PHC operational for 24 hoursManagement of common obstetric complications

by MOso Capacity building of MBBS doctors for Anaesthetic Skills at FRUso Training MBBS doctors for Emergency Obstetric Care including

caesarean Section.

Provision of Early and safe abortion; and RTI/STI services at Sub District levelTrain and empower MOs/ ANMs /LHVs as Skilled

birth attendantsDevelop referral linkages

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Issues with Operationalization of facilities Skewed priorities and fragmented efforts by the States. Need

to prioritize strategies/interventions.

State RCH II PIPs do not reflect targets as prescribed in NPIP.

State and District Action Plans (training centres/cells, drugs, equipment, funds etc.) not in place.

Shortfall of specialist Manpower.

Irrational deployment and posting of trainers and trained manpower.

Improper mapping of resources.

Shortage of Blood Storage Centers.

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FRU-Definition

An existing facility (district hospital, sub-divisional hospital, Community Health Centre etc. ) can be declared fully operational First Referral Unit (FRU) only if it is equipped to provide round the clock services for Emergency Obstetric and New Born Care, in addition to all emergencies that any hospital is required to provide.

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Requirements of FRU

§ Critical Requirements :EmOC including surgical interventions like Caesarean

Section and other medical interventions.Blood Storage facilityNew-Born Care.24-hour delivery services including normal and assisted

deliveries.

§ Desirable Requirements :Emergency Care of sick children.Full range of family planning services including

Laparoscopic Services.Safe Abortion ServicesTreatment of STI/RTIEssential Laboratory ServicesReferral (transport) Services

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Selection of a facility as FRU

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Format for Selection of FRUs

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Format 2: Listing of resourcesCategory/Facility 1 2 3

1 Name and Address2 No. of Sanctioned Bed3 No. of Operational Beds

4 Doctors (Total)

5 OBG Specialist

6 Surgeon7 Anesthetists8 Pediatrician9 Staff Nurses10 Lab Technicians

11 Blood Storage Facility12 Utilization levelA Functional delivery room

B No. of deliveries conducted in previous year(Jan-Dec)

C No. of CS conducted in previous year(Jan-Dec)

D Total Surgeries done in previous year(Jan-Dec)

13 Availability of EquipmentsA Anaesthetics

B C-Sections

C New Born care

14 Availability of InfrastructureA Generator

B 24 hr water Supply

15 Availability of Investigational facilityA Functional Laboratory

B Functional Radiology

C Availability of Functional Ambulance

D Staff Quarters 11

Format 3: Human Resource Summary

Level and Category NumberSanctioned In position Recruitment on Contractual basis

A District Hospital or Equivalent1 MBBS Doctor (M) 2 MBBS Doctor (F)3 Surgeons4 OBG Specialist5 Anesthetist6 Pediatrician7 Lab technicians8 Staff NursesB CHC/ Sub DH

1 MBBS Doctor (M) 2 MBBS Doctor (F)3 Surgeons4 OBG Specialist5 Anesthetist6 Pediatrician7 Lab technicians8 Staff Nurses

C Block PHCs, PHCs and Dispensaries etc.1 MBBS Doctor (M)

2 MBBS Doctor (F)

3 Surgeons

4 OBG Specialist

5 Anesthetist

6 Pediatrician

7 Lab technicians

8 Staff Nurses

9 LHVs

10 ANMs

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Monitoring of FRU operationalization

Dissemination findings

FRU ChecklistFRU Critical Services

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Monitoring of Skilled Based Trainings to Augment Availability of Manpower

Anesthesia Training:

EmOC Training:

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Issues in operationalizing FRUs

Infrastructural: o Operation Theatres, o Labour rooms; o water supply

Logistics :o Shortage/lack of Em. Drugs

Lack of Blood transfusion facilitiesLack of skilled manpower, particularly

Anaesthetists and Gynecologists

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Steps taken by GOI :

Civil works for operationalizing OTs and Labour rooms undertaken;

Emergency drugs were supplied to FRUsDifferent Equipments were supplied to FRUDrugs and Cosmetics Act amended to facilitate

establishing blood storage units at FRUs;Guidelines for blood storage units issued to states;Funds for Hiring of private specialists Anesthetists

and Gynecologists were made available

Newer Initiatives :Short training programmes in anesthesia &

Obstetric Training of ANM/ Staff Nurses in Skilled Birth

Attendance and basic obstetric care along with New born care.

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Steps to be taken by the state……Completing facility survey and identifying the gaps

and thereby formulating an operational plan for 2nd Phase of RCH.

Deployment of Skilled manpower and rationalizing HR policies e.g. transfer policies, cadre reviews etc.

Enabling environment especially adequate residential facilities.

Focused strategies for capacity building of identified training institutions for nurses and ANMs.

Orientation of all health personnel including medical and para medical and all programme managers.

Procurement policies and systems in place.Developing an accreditation criteria for regular

monitoring of the facility and coordinating in its smooth co-ordination.

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Guidelines for Setting Up Blood Storage Centres At First Referral Units

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License for approval of Blood Storage Facility :

The Drug and Cosmetics Act, has been amended with the objective of setting up blood storage facilities at the FRUS / CHCs / PHCs.

Approval from the licensed blood bank from which the storage centre will get the supply.

State Licensing Authority will then approve the Blood Storage Centre after inspection of the facility. Approval will be for a period of two years.

Blood Storage centre can be affiliated to more than one Blood Bank.

License of the Blood Storage centre will automatically be cancelled if the license of the issuing blood bank is cancelled.

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Criteria for Approval Of Blood Storage Centre : Following requirements be available : Space : just 10 sq.m., well lighted and clean Manpower : No additional staff. Trained medical Officer or

LT can be made overall incharge. Electricity: 24 hour supply with back up. Equipments :

o Blood Bag Refrigerators having a storage capacity of 50 units of Blood.

o Deep Freezers.o Insulated Carrier Boxes.o Microscope and centrifuge.

Consumables like gloves, glass tubes etc. Reagents Disinfectants.

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Quantities of Blood Units to be available at any time :

5 units each of A,B,O (positive)2 units of AB (positive)1 units each of A,B,O ( negative)

* Medical officer in-charge should ensure that unused blood bags should be returned to the Linked Blood Bank at least 10 days before the expiry of the blood and fresh blood obtained in its place.

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Training :

A Standard Operating Procedure Manual (SOPM) has been developed for a 3 day training of doctors and technicians, which will include :

Pre-transfusion checking i.e. patient identify and grouping Cross- matching Compatibility Problems in grouping and cross matching Troubleshooting Issue of Blood Transfusion Reactions and its management Disposal of Blood Bags. Maintenance of Cold chain.

It would be desirable for the states to follow those guidelines and protocols.

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Guidelines for

Operationalizing a Primary Health Centre for Providing 24-Hour

Delivery and New born care

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Essential service package to be provided by a 24-hour functional PHC

Essential Services :1. 24-hour delivery services, both normal and assisted 2. Essential new born care 3. Referral for emergencies Desirable Services :1. Ante- natal care and routine immunization services for

children and pregnant women ( besides fixed day services).

2. Post-natal care.3. Early and safe abortion services (including MVA)4. Family planning services.5. Prevention and management of RTIs/STIs.6. Essential laboratory services.

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Selection of the PHC as 24 hour Delivery and New Born Care in RCH-IIA scoring system has been developed, which

are being used to prioritize the PHCs.The PHC with maximum scoring is

operationalized first.The criteria for scoring include :

o Location and Accessibilityo Presence of Staff and Staff Quarterso Labour Roomo Number of deliveries conducted in one yearo Referral services.

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Scoring SystemCategory/Facility 1 2 3

1 Name and Address

2 Location and Accessibility

A Road

B Population Size

C Other health Facilities

D Market Place

3 Staff

A Medical Officer

B Staff Nurse/ANMs

C Staff Quarters

4 Labour Room

5 Deliveries

6 Referral Services

7 Total Score

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Scoring Criteria

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24 X 7 PHCs Monitoring

Dissemination findings.24 X 7 Checklist.

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Monitoring of Skilled Based Trainings

Site Assessment Checklist

SBA Training Monitoring Format

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Steps to be taken by the state……Completing facility survey and identifying the gaps

and thereby formulating an operational plan for 2nd Phase of RCH.

Effort for shifting from incentive on per delivery basis to the deployment of personnel

Deployment of Skilled manpower and rationalizing HR policies e.g. transfer policies, cadre reviews etc.

Enabling environment especially adequate residential facilities.

Focused strategies for capacity building of identified training institutions for nurses and ANMs.

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Steps to be taken by the state contd……Orientation of all health personnel including

medical and para medical and all programme managers.

Procurement policies and systems in place.Developing an accreditation criteria, regular

monitoring of services available.Incentive may be given for accomplishing group

work

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