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National health mission

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National Health Mission - By Dr.Sujatha Sathananthan

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National health mission

  1. 1. National Health Mission Dr.S.Sujatha M.D.,D.P.H., Assistant Professor Department Of Community Medicine Chengalpattu Medical College.
  2. 2. Milestones 1992 – Child Survival and Safe Motherhood (CSSM) 1997- RCH I phase 2005 – RCH II phase (2005-2012) - National Rural Health Mission  Feb 2013 – RMNCH+ A Strategy May 2013 – National Health Mission June 2014 – India Newborn Action Plan (INAP) 4/29/2018 2Chengalpattu Medical College
  4. 4. NRHM National Rural Health Mission (NRHM) was launched at the National Level in April 2005 for a period of seven years (2005- 2012) . 4/29/2018 4Chengalpattu Medical College
  5. 5. Plan of Action-Components  1)ASHA  2)Strengthening of Sub-Centers  3)Strengthening of PHCs  4)Strengthening of CHCs for First referral  5)District Health Plan  6)Converging Sanitation & Hygiene under NRHM  7)Strengthening Disease control program  8)Public-private partnership for public Health goals, including regulation of private sector  9)New health financing mechanisms  10)Reorienting health/medical education to support rural health issues 4/29/2018 5Chengalpattu Medical College
  6. 6. Component A: ASHA • Accredited social health activists 4/29/2018 6Chengalpattu Medical College
  7. 7. Component A: ASHA Accredited social health activists  Every village will have a female ASHA  Chosen by and accountable to the panchayat 4/29/2018 7Chengalpattu Medical College
  8. 8. ASHA – Accredited Social Health Activist  ASHA must be primarily a woman resident of the village ‘Married/ Widow/ Divorced” and preferably in the age group of 25 to 45 yrs.  ASHA should have effective communication skills, leadership qualities and be able to reach out to the community.  She should be a woman with formal education up to Eighth Class.  Adequate representation from disadvantaged population groups should be ensured to serve such groups better. 4/29/2018 8Chengalpattu Medical College
  9. 9. Training Prototype training material for ASHA to be developed at National level subject to State level modifications. 4/29/2018 9Chengalpattu Medical College
  10. 10. ROLE AND RESPONSIBILITY OF ASHA  ASHA will be the health activist in the community who will create awareness on health  She will take steps to create awareness and provide information to the community  She will counsel women on birth preparedness, importance of safe delivery, breast feeding and complementary feeding, immunization, contraception and prevention of common infections including reproductive tract infection / sexually transmitted infection and care of the young child. 4/29/2018 10Chengalpattu Medical College
  11. 11. Role of ASHA  She will mobilize the community and facilitate them in accessing health and health related services available at the anganwadi / sub centre / primary health centres  She will work with the village health and sanitation committee of the gram Panchayat to develop a comprehensive village health plan  She will arrange escort/ accompany pregnant women and children requiring treatment/ admission to the nearest pre-identified health facility i.e., primary health centre / community health centre/ first referral unit. 4/29/2018 11Chengalpattu Medical College
  12. 12. Role of ASHA  She will provide primary medical care for minor ailments such as diarrhoea, fevers, and first aid for minor injuries.  She will be a provider of directly observed treatment short – course (DOTS) under revised national tuberculosis control programme.  She will also act as a depot holder for essential provisions being made available to every habitation.  A drug kit will be provided to each ASHA. 4/29/2018 12Chengalpattu Medical College
  13. 13. Role of ASHA  Her role as a provider can be enhanced subsequently.  She will inform about the births and deaths in her village and any unusual health problems/disease outbreaks in the community to the Sub-centres/ Primary Health Centre.  She will promote construction of household toilets under Total Sanitation Campaign. 4/29/2018 13Chengalpattu Medical College
  14. 14. Role of ASHA and integration with Anganwadi  Organizing Health Day once/twice a month.  On health day, the women, adolescent girls and children from the village will be mobilized for orientation on health related issues  AWW to participate and guide organizing the Health Days at Anganwadi Centre (AWC).  AWW and ANMs will act as resource persons for the training of ASHA. 4/29/2018 14Chengalpattu Medical College
  15. 15. Role of ASHA and integration with Anganwadi  IEC activity through display of posters, folk dances etc.  Anganwadi worker will be depot holder for drug kits and will be issuing it to ASHA.  AWW will update the list of eligible couples and also the children less than one year of age in the village with the help of ASHA.  ASHA will support the AWW in mobilizing pregnant and lactating women and infants for nutrition supplement. 4/29/2018 15Chengalpattu Medical College
  16. 16. Role and integration with ANM  She will hold weekly / fortnightly meeting with ASHA and discuss the activities undertaken during the week/ fortnight.  She will guide her in case ASHA had encountered any problem during the performance of her activity.  AWWs and ANMs will act as resource persons for the training of ASHA  ANMs will inform ASHA regarding date and time of the outreach session and will also guide her for bringing the beneficiary to the outreach session.  ANM will participate and guide in organizing the health days at anganwadi centres  She will take help of ASHA in updating eligible couple register of the village concerned. 4/29/2018 16Chengalpattu Medical College
  17. 17. Role and integration with ANM  She will utilize ASHA in motivating the pregnant women for coming to sub centre for initial check-ups.  She will also help ANMs in bringing married couples to sub centres for adopting family planning.  ANM will guide ASHA in motivating pregnant women for taking full course of Iron and folic acid tablets and tetanus toxoid injections etc.  ANMs will orient ASHA on the dose schedule and side effects of oral pills 4/29/2018 Chengalpattu Medical College 17
  18. 18. Role and integration with ANM  ANMs will educate ASHA on danger signs of pregnancy and labour so that she can timely identify and help beneficiary in getting further treatment.  ANMs will inform ASHA on date, time and place for initial and periodic training schedule.  She will also ensure that during the training ASHA gets the compensation for performance and also TA/DA for attending the training 4/29/2018 Chengalpattu Medical College 18
  19. 19. Plan of Action-Components 1)ASHA 2)Strengthening of Sub-Centers 4/29/2018 19Chengalpattu Medical College
  20. 20. STRENGTHENING SUB-CENTRES Each sub-centre will have an Untied Fund for local action @ Rs. 10,000 per annum. 4/29/2018 20Chengalpattu Medical College
  21. 21. Essential drugs to subcentres Supply of essential drugs to the Sub- centres. 4/29/2018 21Chengalpattu Medical College
  22. 22. Plan of Action-Components 1)ASHA 2)Strengthening of Sub-Centers 3)Strengthening of PHCs 4/29/2018 22Chengalpattu Medical College
  23. 23. STRENGTHENING PRIMARY HEALTH CENTRES  Adequate and regular supply of essential quality drugs and equipment to PHCs  Provision of 24 hour service in PHCs  Intensification of ongoing communicable disease control programmes, new programmes for control of non- communicable diseases and provision of 2nd doctor at PHC level (1 male, 1 female) 4/29/2018 23Chengalpattu Medical College
  24. 24. Plan of Action-Components 1)ASHA 2)Strengthening of Sub-Centers 3)Strengthening of PHCs 4)Strengthening of CHCs for First referral 4/29/2018 24Chengalpattu Medical College
  25. 25. STRENGTHENING CHCs FOR FIRST REFERRAL UNITS  Existing CHC (30-50 beds) as 24 Hour FRU, including posting of anaesthetists  Codification of new Indian Public Health Standards, setting norms for  Infrastructure  Staff  Equipment  Management  Promotion of Rogi Kalyan Samitis for hospital management. 4/29/2018 25Chengalpattu Medical College
  26. 26. Plan of Action-Components 1)ASHA 2)Strengthening of Sub-Centers 3)Strengthening of PHCs 4)Strengthening of CHCs for First referral 5)District Health Plan 4/29/2018 26Chengalpattu Medical College
  27. 27. DISTRICT HEALTH PLAN • District becomes core unit of planning, budgeting and implementation 4/29/2018 27Chengalpattu Medical College
  28. 28. At district level: Health Programmes Family Welfare Programmes District Health Mission” 4/29/2018 28Chengalpattu Medical College
  29. 29. Plan of Action-Components 1)ASHA 2)Strengthening of Sub-Centers 3)Strengthening of PHCs 4)Strengthening of CHCs for First referral 5)District Health Plan 6)Converging Sanitation & Hygiene under NRHM 4/29/2018 29Chengalpattu Medical College
  30. 30. CONVERGING SANITATION AND HYGIENE UNDER NRHM Total Sanitation Campaign (TSC) in all districts 4/29/2018 30Chengalpattu Medical College
  31. 31. Sanitary toilet ASHA would be incentivized for promoting household toilets by the Mission. 4/29/2018 31Chengalpattu Medical College
  32. 32. Plan of Action-Components 1)ASHA 2)Strengthening of Sub-Centers 3)Strengthening of PHCs 4)Strengthening of CHCs for First referral 5)District Health Plan 6)Converging Sanitation & Hygiene under NRHM 7)Strengthening Disease control program 4/29/2018 32Chengalpattu Medical College
  33. 33. STRENGTHENING DISEASE CONTROL PROGRAMMES 4/29/2018 33Chengalpattu Medical College
  34. 34. Contd..  Disease surveillance system at village level would be strengthened.  Supply of generic drugs (both AYUSH & Allopathic). Provision of a mobile medical unit at District level for improved Outreach services. 4/29/2018 34Chengalpattu Medical College
  35. 35. Plan of Action-Components 1)ASHA 2)Strengthening of Sub-Centers 3)Strengthening of PHCs 4)Strengthening of CHCs for First referral 5)District Health Plan 6)Converging Sanitation & Hygiene under NRHM 7)Strengthening Disease control program 8)Public-private partnership for public Health goals, including regulation of private sector 4/29/2018 35Chengalpattu Medical College
  36. 36. 9. NEW HEALTH FINANCING MECHANISMS Village - VHWSC- Rs.10,000 per year. HSC - Untied funds – Rs.10,000 per year. AMG – Rs.10,000 per year. PHC - Untied funds – Rs.25,000 per year. - AMG – Rs.50,000 per year - PWS – Rs.1,00,000 per year 4/29/2018 36Chengalpattu Medical College
  37. 37. FLEXIBLE FINANCING LE FINANCING CHC - Untied funds Rs.50,000 per year. AMG – Rs.50,000 per year. RKS (PWS) – Rs.1,00,000 per year. Districts - DH&SDH – RKS – Rs.5,00,000 per year. Medical College – Rs.10,00,000 per year. Health Melas – Rs.8,00,000 per year. per constituency 4/29/2018 Chengalpattu Medical College 37
  38. 38. Plan of Action-Components 1)ASHA 2)Strengthening of Sub-Centers 3)Strengthening of PHCs 4)Strengthening of CHCs for First referral 5)District Health Plan 6)Converging Sanitation & Hygiene under NRHM 7)Strengthening Disease control program 8)Public-private partnership for public Health goals, including regulation of private sector 9)New health financing mechanisms 10)Reorienting health/medical education to support rural health issues4/29/2018 38Chengalpattu Medical College
  39. 39. REORIENTING HEALTH/MEDICAL EDUCATION TO SUPPORT RURAL HEALTH ISSUES  While district and tertiary hospitals they form an integral part of the referral care chain serving the needs of the rural people.  Medical and para-medical education facilities need to be created in states, based on need assessment. 4/29/2018 39Chengalpattu Medical College
  40. 40. NRHM – 5 MAIN APPROACHES COMMUNITIZE Hospital management committees United grants to community Funds, functions to local community organizations Decentralized planning, village health and sanitation committees FLEXIBLE FINANCING Partnership of state and community resources United grants to institutions NGO sector for public health goals More resources for more reforms MONITOR, PROGESS AGAINST STANDARDS Setting IPHS standards Facility surveys Independent monitoring committees at block, district and state levels IMPROVED PROGRAMME MANAGEMENT THROUGH CAPACITY Block and district health office with management skills NGOs in capacity building Continuous skill development support INNOVATION IN HUMAN RESOURCE MANAGEMENT Nurse managers More nurses local resident criteria 24X7 emergency medical services at PHC/CHC Multi skilling 4/29/2018 40Chengalpattu Medical College
  41. 41. NRHM ACHIEVEMENTS IN TAMIL NADU EMRI  Emergency Referral Services (Toll free no 108) introduced in all the districts. Chengalpattu Medical College4/29/2018 41
  42. 42. Chengalpattu Medical College NICU MODEL 4/29/2018 42
  43. 43. Health Mela Health Mela conducted Chengalpattu Medical College4/29/2018 43
  44. 44. INFRASTRUCTURE UPGRADATION • 148 First Referral Units and CEmONC centers provided with essential equipments for maternal and child care including central oxygen supply . • 513 PHCs taken up for Infrastructure upgradation, extensions, renovations and repair works in 2009-10 to cope up with additional service demands. Chengalpattu Medical College4/29/2018 44
  45. 45. Facelift of PHC Omandur PHC, Villupuram Dist. Before After Chengalpattu Medical College4/29/2018 45
  46. 46. Chengalpattu Medical College Mechanized laundry services in all the HUDs 4/29/2018 46
  47. 47. PHC Siruvanthadu AfterBefore Chengalpattu Medical College4/29/2018 47
  48. 48. Healthy Environment Morappur PHC, Dharmapuri Dist. Chengalpattu Medical College4/29/2018 48
  49. 49. Healthy Environment for Patient Kaveripakkam PHC Healthy Environment Kaveripakkam PHC, Vellore Dist. Chengalpattu Medical College4/29/2018 49
  50. 50. Healthy Environment Kaveripakkam PHC, Vellore Dist Chengalpattu Medical College4/29/2018 50
  51. 51. Healthy Environment Ladavaram PHC, Vellore Dist. Chengalpattu Medical College4/29/2018 51
  52. 52. Garden – Nandhivaram PHC, Saidapet HUD Chengalpattu Medical College4/29/2018 52
  53. 53. Waiting Hall for Relatives and Children Chengalpattu Medical College4/29/2018 53
  54. 54. Baby Warmer Chengalpattu Medical College4/29/2018 54
  55. 55. New Born Corner – Radiant warmer, other necessary equipment and trained staff. Thirupoondi PHC, Nagappattinam Dist. New Born Corner Chengalpattu Medical College4/29/2018 55
  56. 56. Solar Water Heater in PHC Chengalpattu Medical College4/29/2018 56
  57. 57. Scan Facility at PHC Chengalpattu Medical College4/29/2018 57
  58. 58. Inverter Facility at PHC Chengalpattu Medical College4/29/2018 58
  59. 59. Safe Drinking Water Chengalpattu Medical College4/29/2018 59
  60. 60. Generator for Operation Theaters Chengalpattu Medical College4/29/2018 60
  61. 61. Blood storage facility Banavaram PHC, Vellore Dist. Chengalpattu Medical College4/29/2018 61
  62. 62. Caesarean operation Banavaram PHC, Vellore Dist. Chengalpattu Medical College4/29/2018 62
  63. 63. Computer Facility in PHC Chengalpattu Medical College4/29/2018 64
  64. 64. VBD - Control Activities Chengalpattu Medical College4/29/2018 65
  65. 65. Integrated vector control measures Chengalpattu Medical College4/29/2018 66
  66. 66. MONITORING AND EVALUATION Process indicators : (a) Numbers of ASHA seleted by due process (b) Number of ASHA trained (c) % of ASHA attending review meeting after one year. Outcome indicators : (a) % of newborn who were weighed and families counselled (b) % of children with diarrhoea who received ORS (c) % of institutional deliveries 4/29/2018 67Chengalpattu Medical College
  67. 67. MONITORING AND EVALUATION (d) % of JSY claims made to ASHA (e) % completely immunized in 12-23 months age group (f) % of unmet need for spacing contraception among BPL (g) % of fever cases who received chloroquine within first week in an malaria endemic area; Impact indicators : (a) IMR (b) child malnutrition (c) number of case of TB/ leprosy cases detected as compared to previous year. 4/29/2018 68Chengalpattu Medical College
  68. 68. 4/29/2018 Chengalpattu Medical College 69
  69. 69. Why NUHM?  Urban population is estimated to increase from 35.7 crores in 2011 to 43.2 crores in 2021  Rapid increase in the urban population can lead to increase in the number of slums  Slum population is growing at the rate of 7% annually  Poor health status of the urban slums  Inadequacy of the health care delivery to the slum population 4/29/2018 70Chengalpattu Medical College
  70. 70. Challenges of urban health care  Poor households not knowing where to go to meet health need  Weak and dysfunctional public system of outreach  Contaminated water, poor sanitation  Poor environmental health, poor housing  Unregistered practitioners first point of contact – use of irrational and unethical medical practice  Community organizations helpless in health matters 4/29/2018 71Chengalpattu Medical College
  71. 71. Challenges of urban health care  Weak public health planning capacity in urban local bodies  Large private sector but poor cannot access them  Problems of targeting the poor on the basis of BPL card  No convergence among wider determinants of health  No system of counselling and care for adolescents  No concerted campaigns for behaviour change  Problems of unauthorized settlements 4/29/2018 72Chengalpattu Medical College
  72. 72. Challenges of urban health care  Over congested secondary and tertiary facilities and underutilized primary care facilities.  Problem of drug abuse and alcoholism  Many slums not having primary health care facility  High incidence of domestic violence  Multiplicity of urban local bodies, State government, etc. management of health needs of urban people  No norms for urban health facilities 4/29/2018 73Chengalpattu Medical College
  73. 73. Access to health care  Inadequate public health care delivery system  Severely restricted health care access (for urban poor)  lack of standards for urban health delivery system makes the urban poor more vulnerable  Poor environmental conditions – overcrowding, poor housing, poor water and electricity availability result in high incidence of communicable diseases, asthma etc.  Higher rates of traffic accidents, domestic violence, mental health cases, drugs, tobacco and alcohol abuse 4/29/2018 74Chengalpattu Medical College
  74. 74. National Urban Health Mission The NUHM would focus on: – Urban Poor living in listed and unlisted slums – Vulnerable population such as homeless, rag-pickers, street children, rickshaw pullers, construction and brick and lime kiln workers, sex workers, and other temporary migrants. – Public health thrust on sanitation, clean drinking water, vector control, etc. – Strengthening public health capacity of urban local bodies. 4/29/2018 75Chengalpattu Medical College
  75. 75. UrbanHealth CareDelivery Model 4/29/2018 76Chengalpattu Medical College
  76. 76. Urban Health Care Facilities 4/29/2018 77Chengalpattu Medical College
  77. 77. Urban Health Care Delivery  Health services delivered under the urban health delivery system through the Urban-PHCs and Urban- CHCs will be universal in nature  Outreach services will be targeted to specific groups (slum dwellers and other vulnerable groups)  1 FHW (ANM) for 10,000 population; Outreach sessions in area of every ANM on weekly basis  FHW to be stationed at PHC; Mobility support for outreach activities  School Health Programmes 4/29/2018 78Chengalpattu Medical College
  78. 78. Urban CHC  For 2,50,000 population (5,00,000 for metros)  Inpatient facility, 30 -50 bedded (100 bedded in metros) Only for cities with a population of above 5 lakhs  Renovation of existing referral facility or up-gradation of facility shall essentially be the first choice  Support for local contractual arrangements for part time Specialist/ Medical Officer. 4/29/2018 79Chengalpattu Medical College
  79. 79. Urban Health Care Delivery  Promote role of urban local bodies in the planning and management of urban health care  One USHA for 1000-2500 population  States to have flexibility of motivating Mahila Arogya Samiti (MAS) for getting the work done  One MAS for 50-100 households  Annual grant of Rs. 5000 to the MAS  NGOs may also be given this responsibility 4/29/2018 80Chengalpattu Medical College
  80. 80. Urban Health Care Delivery  IPHS/ Revised IPHS for Urban areas etc  Quality of the services provided will be constantly monitored for improvement  Strengthen IDSP  Convergence with AYUSH practitioners 4/29/2018 81Chengalpattu Medical College
  81. 81. Roles & responsibilities of ASHA  Identify target beneficiaries and support ANM in conducting outreach sessions  Promote formation of Women’s Health Groups  Provide information to the community  Facilitate access to health and related services  Accompany pregnant women and children requiring treatment/ admission  Facilitate development of a comprehensive health plan  Facilitate construction of community/ household toilets  Act as depot holder  Maintain necessary information and records. 4/29/2018 82Chengalpattu Medical College
  82. 82. Women’s Health Committee • Process of promotion of Women’s Health Committee Women’s Health Committee 15 members for about 250-350 families encouraged to work collectively on community issues potential community leaders and target women 4/29/2018 83Chengalpattu Medical College
  83. 83. Roles of the Mahila Arogya Samiti  Support ASHA in tracking and monitoring coverage of key interventions  Facilitate group counseling sessions  Support outreach camps by ensuring presence of target group  The conveners or other designated representatives of the group along with the respective Link Volunteer will attend meetings held at the UHC and provide feedback on service delivery.  Collect, manage and utilize a Community Health Fund for meeting health emergencies in the slum and for sustaining health promotion efforts.  Maintain BCC and IEC materials at a safe and easily accessible place in the community.4/29/2018 84Chengalpattu Medical College
  84. 84. Functions of UPHC • Medical care – OPD services 4 hours in the morning and 2 hours in the evening • RCH II services • National health programmes • Collection and reporting of vital events • IDSP • Referral services • Basic laboratory services • Counselling services 4/29/2018 85Chengalpattu Medical College
  85. 85. Services provided under NUHM Community / outreach services Services at UPHC Services at UCHC 4/29/2018 86Chengalpattu Medical College
  86. 86. Main services Maternal health  Registration, ANC, identification of danger signs, referral for institutional delivery, follow up counselling and behaviour promotion  ANC, PNC, initial management of complicated delivery cases and referral, management of regular maternal health conditions, referral of complicated cases  Delivery, management of complicated gynae/ maternal health conditions, hospitalization and surgical interventions including blood transfusion. Family welfare  Counselling, distribution of OCP/CC, referral for sterilization, follow up of contraceptive related complications  IUD insertion, management of contraceptive related complications  Sterilization operations, fertility treatment 4/29/2018 87Chengalpattu Medical College
  87. 87. Main services Child health and nutrition immunization, identification of danger signs, referral, follow –up, distribution of ORS, paediatric cotrimoxazole, post natal visits, counselling for new born care diagnosis and treatment of childhood illness, referral of acute/chronic cases, identification and referral of neonatal sickness management of complicated paediatric / neo-natal cases, hospitalization, surgical intervention, blood transfusion 4/29/2018 88Chengalpattu Medical College
  88. 88. Main services Cancer  Symptomatic search and referral, follow up of under treatment patients  Identification and referral, follow up of under treatment patients  Diagnosis, treatment and hospitalization Trauma care (burns and injuries)  First aid and referral  First aid/ emergency resuscitation, documentation for medico-legal case and referral  Case management and hospitalization, physiotherapy and rehabiltiation Other surgical interventions  Identification and referral  Hospitalization and surgical intervnetion Other support services like IEC, BCC, counselling and personal and social hygiene. 4/29/2018 89Chengalpattu Medical College
  89. 89. Essential Health Care Services under NUHM Community Level Primary Health Care Level Referral Centre (U-CHC) Maternal Health • Registration • Ante-natal Care • Identification of danger signs • Referral for institutional delivery • Follow-up • Counseling and Behavior • Ante-natal and Post-natal care • Management of complicated delivery cases and referral • Management of regular maternal conditions • Referral of complicated cases • Delivery (normal and complicated) • Management of complicated Gynae/maternal health condition • Hospitalization and surgical interventions including blood transfusion Child Health and Nutrition • Immunization • Identification of danger signs • Referral services • Follow-up • Distribution of ORS • Post-natal visits/counseling for new-born care • Diagnosis and treatment of childhood illnesses • Referral of acute cases/chronic illness • Identification and referral of neo-natal sickness • Management of complicated pediatric/neonatal cases • Hospitalization • Surgical interventions • Blood transfusion Nutrition Deficiency Disorders • Height/weight measurement • Distribution of IFA tablet • Promotion of iodized salt • Nutrition supplements to identified children and pregnant/lactating mothers • Promotion of breastfeeding • Complementary feeding prevention of under-nutrition • Diagnosis and referral of acute deficiency cases • Management of acute deficiency cases • Hospitalization • Treatment and rehabilitation of sever under-nutrition 4/29/2018 90Chengalpattu Medical College
  90. 90. Monitoring and evaluation City level indicators (process and input indicators of NUHM) Community process  Number of mahila Arogya Samiti (MAS) formed  Number of MAS members trained  Number of ASHA selected and trained Health systems  Number of ANMs recruited  Number of special outreach health camps organized in slum / HFas  Number of UHNDs organized in the slums aand vulnerable areas  Number of UPHCs made operational  Number of UCHCs made operational  Number of RKS created at UPHC and UCHC  OPD attendance in UPHCs  Number of deliveries conducted in public health facilities 4/29/2018 91Chengalpattu Medical College
  91. 91. NATIONAL HEALTH MISSION The National health mission was approved in May 2013. The main programmatic components include health system strengthening in rural and urban areas, reproductive – maternal – new-born – child and adolescent health (RMNCH+A) and control of communicable and non-communicable diseases. 4/29/2018 92Chengalpattu Medical College
  92. 92. Vision of the NHM “Attainment of Universal Access to Equitable, Affordable and Quality health care services, accountable and responsive to people’s needs, with effective inter-sectoral convergent action to address the wider social determinants of health”. 4/29/2018 93Chengalpattu Medical College
  93. 93. SERVICE DELIVERY STRATEGIES  Reproductive, Maternal, Newborn, Child Health and Adolescent (RMNCH+A) Services  Maternal Health – Comprehensive package of RMNCH+A services. – Janani Suraksha Yojana (JSY) – Janani Shishu Suraksha Karyakram (JSSK)  Access to safe abortion services  SNCU(Special Newborn are Units),NBSU(Newborn stabilization Units),NBCC(NewBorn Care Corners),FBNC(Facility Based Newborn Care),IYCF(Infant and Young Child Feeding practices),HBNC(Home Based Newborn Care)  NSSK(Navjaat Sishu Suraksha Karyakram)  NRCs(Nutritional Rehabilitation Centres)  IDCF (Intencified Diarrhoea Control Fortnight) 4/29/2018 94Chengalpattu Medical College
  94. 94. SERVICE DELIVERY STRATEGIES  MCTS (Maternal and Child Tracking System)-PICME  Prevention and Management of Reproductive Tract Infections (RTI) and Sexually Transmitted Infections (STI)  Gender Based Violence  New-born and Child Health  Universal Immunization  Health Screening and Early Intervention Services  Adolescent Health  Iron and Folic Acid (IFA) supplementation  Facility -based adolescent health services 4/29/2018 95Chengalpattu Medical College
  95. 95. SERVICE DELIVERY STRATEGIES  Community based health promotion activities  Information and counseling on sexual and reproductive health (including menstrual hygiene),  Substance abuse  Mental health  Non-communicable diseases, injuries  Adolescent Friendly Health Clinics (AFHC)  Provision of Weekly Iron and Folic acid Supplementation (WIFS)  National Iron Plus Initiative.  Universal use of iodized salt  Family Planning Intra-Uterine Contraceptive Devices (IUCD). 4/29/2018 96Chengalpattu Medical College
  96. 96. Control of Communicable Diseases 1. The National Vector Borne Diseases Control Programme (NVBDCP) is an umbrella programme for prevention and control of vector borne diseases viz. Malaria, Japanese Encephalitis (JE), Dengue, Chikungunya, Kala-Azar and Lymphatic Filariasis. Of these, Kala-Azar and Lymphatic Filariasis have been targeted for elimination by 2015. 2. Revised National Tuberculosis Control Programme (RNTCP) 3. National Leprosy Control Programme (NLEP) 4. Integrated Disease Surveillance Programme (IDSP) 4/29/2018 97Chengalpattu Medical College
  97. 97. Non Communicable Diseases (NCD) 1. National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) 2. National Programme for the Control of Blindness (NPCB) 3. National Mental Health Programme (NMHP) 4. National Programme for the Healthcare of the Elderly (NPHCE) 5. National Programme for the Prevention and Control of Deafness (NPPCD 6. National Tobacco Control Programme (NTCP) 7. National Oral Health Programme (NOHP) 8. National Programme for Palliative Care (NPPC) 9. National Programme for the Prevention and Management of Burn Injuries (NPPMBI) 10. National Programme for Prevention and Control of Fluorosis (NPPCF) 4/29/2018 98Chengalpattu Medical College
  98. 98. MONITORING AND EVALUATION  Use of data from large scale population surveys  Commissioning implementation research or evaluation studies  use of HMIS data and field appraisals and reviews  Health outcomes, output and process indicators  Periodic Population Health Surveys and Demographic Information  The Sample Registration Surveys (SRS)  Death statistics  National Sample Survey Organization (NSSO) data on cost of care and morbidity, DLHS and NFHS. 4/29/2018 99Chengalpattu Medical College
  99. 99. RMNCH+A 4/29/2018 Chengalpattu Medical College 100
  100. 100. What does RMNCH+A stands for 1. Reproductive, 2. Maternal, 3. New-born, 4. Child health 5. Adolescent care Plus denotes • Inclusion of adolescence as a distinct ‘life stage’ in the overall strategy • Links maternal and child survival to other components (family planning , adolescent health, gender & PC & PNDT) • Links home and community based services to facility based care • Ensuring linkages , referrals and counter referrals between various levels of health care system Adolescent Health Package Reproductive Health package Antenatal & Intrapartum care package Newborn care package Post partum family planning,spacin g methods Under five child health pacakge 4/29/2018 101Chengalpattu Medical College
  101. 101. 4/29/2018 102Chengalpattu Medical College
  102. 102. RBSK( Rashtriya Bal Swasthya Karyakram) –Feb 2013 4/29/2018 Chengalpattu Medical College 103
  103. 103. 4/29/2018 Chengalpattu Medical College 104
  104. 104. RKSK (Rashtriya Kishor Swasthiya Karyakram) Jan 2014 4/29/2018 Chengalpattu Medical College 105 Beyond ARSH - focuses on Life skills Nutrition Gender based injuries and violence Non-communicable diseases Mental health Substance misuse
  105. 105. WIFS –Weekly Iron Folic acid Supplementation 4/29/2018 Chengalpattu Medical College 106
  106. 106. WIFS - Advantages  Improved concentration in school, and school performance  Feeling stronger and less tired,  Increased energy levels and output in day to day work,  Increased appetite,  Improved overall capacity to work and earn  Better sleep  Improved skin appearance,  Regularization of menstruation  Building pre-pregnancy health 4/29/2018 Chengalpattu Medical College 107
  107. 107. Key activities  Both boys and girls to be given IFA and Albendazole Tablets  6th to 12th class students to be covered  Weekly Fixed day approach  Supervised consumption of weekly IFA tablet to be ensured  IFA tablet to be given after meals ( Mid-Day Meal or Lunch)  Screen students for pallor and refer  Bi-annual ( six months apart) distribution of Albendazole tablets  HE sessions to be conducted regularly  Filling of Individual compliance cards 4/29/2018 Chengalpattu Medical College 108
  108. 108. 4/29/2018 Chengalpattu Medical College 109
  109. 109. 4/29/2018 Chengalpattu Medical College 110
  110. 110. Iron plus Initiative 4/29/2018 Chengalpattu Medical College 111
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  112. 112. 4/29/2018 Chengalpattu Medical College 113
  113. 113. PUDHU YUGAM SCHEME The programme will be focused in rural areas with the following objectives: To increase awareness among adolescent girls on menstrual hygiene,  build self-esteem, and empower girls for greater socialisation To increase access to and use of high quality sanitary napkins by adolescent girls in rural areas To ensure safe disposal of sanitary napkins in an environment friendly manner 4/29/2018 Chengalpattu Medical College 114 .
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  117. 117. CONCLUSION The NHM envisages achievement of universal access to equitable, affordable & quality health care services that are accountable and responsive to people's needs. 4/29/2018 118Chengalpattu Medical College
  118. 118. Thank You 4/29/2018 119Chengalpattu Medical College