UNIT-X MIRCO BIRTH PLANNING B.Sc Nursing IV year CHN.pptx
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The document outlines the National Rural Health Mission (NRHM) and its initiatives aimed at improving maternal and child health in India through programs like the Janani Suraksha Yojana (JSY) and Janani Shishu Suraksha Karyakaram (JSSK). Key strategies include community participation, micro birth planning, and providing cash assistance for institutional deliveries to reduce maternal and infant mortality rates. The NRHM emphasizes the importance of accessible and equitable healthcare services, with special focus on low-performing states.
UNIT-X MIRCO BIRTH PLANNING B.Sc Nursing IV year CHN.pptx
- 1. Unit-X(B.Sc IV) Micro Birth Planning Process Dr.Anjalatchi M.sc(N)MD(AM)MBA(HA) Era University , Lucknow
- 2. NRHM • National Rural Health Mission launched in April, 2005 Rejuvenate the Health delivery System Universal Health Care • - Accessible • - Affordable • -Equitable Care
- 4. GOAL OF NRHM Reduction of Infant Mortality Rate (IMR) Reduction of Maternal Mortality Ratio (MMR) Reduction of Total Fertility Rate (TFR) Universal Access to Public Health service viz. Women’s Health/Child Health, Water Sanitation Hygiene and Nutrition. Prevention and Control of Communicable and Non Communicable Disease, Population Stabilization, Gender & Demographic balance Main Streaming AYUSH Promotion of Healthy Lifestyle.
- 5. Strategies – Improve Infrastructure Augment manpower Improve management Flexibility to states to deploy funds Decentralization Communitization
- 6. The Paradigm Shift – Community Participation Flexible Funding at all levels
- 7. NHM ROLE Governance reform o Manpower Management o Logistics & Procurement processes. o Decision making processes o Institutional design o Accountability framework Convergence Water and sanitation Nutrition Education
- 8. New Paradigms under NRHM – 1. Community Link Worker – ASHA Supervisor /ASHA 2. Involvement of PRIs through Village Health & Sanitation Committee 3. Reforms in Medical Education – Compulsory Rural posting of Doctors 4. Integration of AYUSH 5. Better programme management through recruitment of Management Experts, Accountants, Computer Experts
- 9. • Action Taken to Reduction MMR – • Implementation of JSY & JSSK • Micro Birth Planning:
- 10. JSY Early Registration ANC (1st Check-up) before 12 weeks, *2nd Check-up 16-20 weeks, *3rd check-up 28-32 weeks * 4th Check-up 36 weeks Promoting Institutional Delivery: Identifying the Institution for delivery as per merit. Post Natal Check-up: Within 48 hours/within 1st week/within 6 weeks INVOLVEMENT OF ASHA: Involvement of ASHAs equipped with drug kit and pregnancy kit for maternal and child health care. Support to ASHAs by appointing 18 ASHA Supervisor. Organizing Village Health & Nutrition Day every month. Micro Birth Planning by the ANM for all the pregnant women
- 11. CONTINUED • “Mamoni” Nutritional Support of Rs. 1000/- to pregnant women – an initiative by Govt. of Assam. • *Cash assistance to mothers under JSY scheme. • * Encouraging mothers to stay in the Hospital up to 48 hours after delivery to prevent post partum hemorrhage by providing Baby Kit (Mamata Kit). • * Training of ANMs/Staff Nurse for SBA • * Training of Medical Officers on EmOC/BEmOC and LSAS • * All the SCs have been provided with SC Kit – A and B. • * Up-gradation of Sub Center for Delivery (191 SCs taken up in 14 high focus districts).
- 12. Continued • Rural Health Practitioners have been posted in the Sub- centres • * Compulsory one year Rural Posting for MBBS doctors to get admission in the PG courses. • * Construction of Labour Room/ Ward in PHC/SD/SHC and operationalizing as 24X7. • * Up-gradation of SDCH/ CHC to First Referral (FRU) Unit having specialist doctor with provision of C-section operation and Blood Storage facility. • * Strengthening of referral mechanism from village to Health Institutions through ‘108 Mrityunjoy’ Emergency Referral Transport and by providing ambulances to health institutions.
- 13. Child birth • Childbirth, also known as labour or delivery, is the ending of pregnancy where one or more babies leaves the uterus by passing through the vagina or by Caesarean section.
- 14. Micro birth plan • This is a tool basically to structure the events/actions related with pregnancy and delivery (To be drawn up by ANM/ASHA). • Essentially it consists of – a. Registration and filling up of JSY card b. Calculation of EDD(Expected date of delivery) c. Informing dates of three essential check ups d. Identification of health facility where delivery will take place e. Identification of means of transport
- 15. Why is a birth plan necessary? • A birth plan is a way for you to communicate your wishes to those caring for you during your labor and after the birth of your baby. • Every birth is a unique experience. • Creating a birth plan empowers you to become informed of all your options during labor. • At the same time, it’s a tool to let the team caring for you know about your preferences.
- 16. Introduction (JSY) Janani Suraksha Yojana (JSY) • Janani Suraksha Yojana (JSY) is a safe motherhood intervention under the National Rural Health Mission (NRHM) being implemented with the objective of reducing maternal and neo-natal mortality by promoting institutional delivery among the poor pregnant women. • The Yojana, launched on 12th April 2005, by the Hon’ble Prime Minister, is being implemented in all states and UTs with special focus on low performing states. • JSY is a 100 % centrally sponsored scheme and it integrates cash assistance with delivery and post-delivery care.
- 17. Fact about the Micro birth Plan • The Yojana has identified ASHA, the accredited social health activist as an effective link between the Government and the poor pregnant women in l0 low performing states, namely the 8 EAG states and Assam and J&K and the remaining NE States. • In other eligible states and UTs, wherever, AWW ((Anganwadi workers )and TBAs or ASHA like activist has been engaged in this purpose, she can be associated with this Yojana for providing the services.
- 18. Important Features of JSY: • The scheme focuses on the poor pregnant woman with special dispensation for states having low institutional delivery rates namely the states of Uttar Pradesh, Uttaranchal, Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh, Assam, Rajasthan, Orissa and Jammu and Kashmir. While these states have been named as Low Performing States (LPS), the remaining states have been named as High performing States (HPS). •
- 19. Continued • Tracking Each Pregnancy: Each beneficiary registered under this Yojana should have a JSY card along with a MCH card. • ASHA/AWW/ any other identified link worker under the overall supervision of the ANM and the MO, PHC should mandatorily prepare a micro-birth plan. This will effectively help in monitoring Antenatal Check-up, and the post delivery care. • Eligibility for Cash Assistance: BPL Certification – This is required in all HPS states. However, where BPL cards have not yet been issued or have not been updated, States/UTs would formulate a simple criterion for certification of poor and needy status of the expectant mother’s family by empowering the gram pradhan or ward member.
- 20. JSY ELIGIBILITY
- 21. CASH ASSISTANCE
- 23. Disbursement of Cash Assistance: • As the cash assistance to the mother is mainly to meet the cost of delivery, it should be disbursed effectively at the institution itself. • For pregnant women going to a public health institution for delivery, entire cash entitlement should be disbursed to her in one go, at the health institution. • Considering that some women would access accrediting private institution for antenatal care, • they would require some financial support to get at least 3 ANCs including the TT injections. • In such cases, at least three-fourth (3/4) of the cash assistance under JSY should be paid to the beneficiary in one go, importantly, at the time of delivery.
- 24. MBP ACTIVITIES
- 26. Challenges MH
- 28. JSSK • Government of India has launched the Janani Shishu Suraksha Karyakaram (JSSK) on 1st June, 2011. The scheme is to benefit pregnant women who access Government health facilities for their delivery. Moreover it will motivate those who still choose to deliver at their homes to opt for institutional deliveries.
- 29. Introduction • Government of India has launched the Janani Shishu Suraksha Karyakaram (JSSK) on 1st June, 2011. The scheme is to benefit pregnant women who access Government health facilities for their delivery. Moreover it will motivate those who still choose to deliver at their homes to opt for institutional deliveries. All the States and UTs have initiated implementation of the scheme.
- 30. Situation • High out of pocket expenses being incurred by pregnant women and their families in the case of institutional deliveries in form of drugs, User charges, diagnostic tests, diet, for C – sections. •
- 31. The New Initiative • In view of the difficulty being faced by the pregnant women and parents of sick new- born along-with high out of pocket expenses incurred by them on delivery and treatment of sick- new- born, Ministry of Health and Family Welfare (MoHFW) has taken a major initiative to evolve a consensus on the part of all States to provide completely free and cashless services to pregnant women including normal deliveries and caesarean operations and sick new born (up to 30 days after birth) in Government health institutions in both rural and urban areas.
- 32. FREE ENTITLEMENT FOR ANC • The following are the Free Entitlements for pregnant women:Free and cashless delivery • Free C-Section • Free drugs and consumables • Free diagnostics • Free diet during stay in the health institutions • Free provision of blood • Exemption from user charges • Free transport from home to health institutions • Free transport between facilities in case of referral • Free drop back from Institutions to home after 48hrs stay
- 33. FREE SERVICE FOR NEWBORN • The following are the Free Entitlements for Sick newborns till 30 days after birth.This has now been expanded to cover sick infants:Free treatment • Free drugs and consumables • Free diagnostics • Free provision of blood • Exemption from user charges • Free Transport from Home to Health Institutions • Free Transport between facilities in case of referral • Free drop Back from Institutions to home •
- 34. Key features of the scheme • The initiative entitles all pregnant women delivering in public health institutions to absolutely free and no expense delivery, including caesarean section. • The entitlements include free drugs and consumables, free diet up to 3 days during normal delivery and up to 7 days for C-section, free diagnostics, and free blood wherever required. • This initiative also provides for free transport from home to institution, between facilities in case of a referral and drop back home. Similar entitlements have been put in place for all sick newborns accessing public health institutions for treatment till 30 days after birth.This has now been expanded to cover sick infants: • The scheme aims to eliminate out of pocket expenses incurred by the pregnant women and sick new borne while accessing services at Government health facilities. • The scheme is estimated to benefit more than 12 million pregnant women who access Government health facilities for their delivery. Moreover it will motivate those who still choose to deliver at their homes to opt for institutional deliveries. • All the States and UTs have initiated implementation of the scheme
- 35. Macro-planning • At State Level: Seek commitment and support from various departments and stakeholders • Develop advocacy and social mobilization activity plan • Prepare a training plan • Disseminate immunization guidelines (e.g. injection safety, cold chain, AEFI surveillance) • Develop plans for supervision, monitoring and evaluation, including providing of feedback.
- 36. Micro-planning • At District, Sub-district levels: • Revise micro-plans: use prescribed formats for UIP at each level • Estimate: Calculate vaccine and logistics requirement at each level • Cold chain: evaluate the availability and adequacy at all levels • Indenting and delivery: ensure availability of required vaccine and other logistics needed to introduce the vaccine • Modify and disseminate revised formats: reporting, recording and immunization card etc • Trainings: health workers and staff at all levels • Advocacy and social mobilization activities around the introduction of the new vaccine,Supervise and monitor.
- 37. Update Recording and Reporting Systems • Vaccine stock forms and registers, • Immunization cards and counter foilsMCH/Immunization • RegisterUIP reporting formats (Tally Sheets, Monthly Progress Report at all levels) • Monitoring Chart Supervisory • checklists posted immunization schedules, (tin- plates, posters, wall paintings and billboards) • materials for parents Computer databases
- 38. Prepare and Train Staff • Target: District Immunization Officers (DIO), Medical Officers (MO), cold chain handlers, supervisors, data managers and frontline Health Workers (HW) • Approach: Orientation of district-level trainers at the State level should be followed by the training of Medical Officers, supervisors and cold chain handlers.Finally, MOs should conduct sensitization of the frontline Health Workers.Integrate in all the training courses, review meetings etc. • Resources:Operational guidelines for pentavalent vaccine introduction in the UIPImmunization Handbook for Health WorkersImmunization Handbook for Medical Officers
- 39. Supervise and Monitor • Supervise planning and implementation Schedule supervisory visits Monitor implementation • Monitor vaccines and logistics supply • Monitor vaccine utilization (coverage) • Use reported coverage data • Use RI monitoring data for appropriate actions.
- 40. Micro-Birth Planning and Counseling • Registration of pregnant woman and filling up of the Maternal and Child Protection Card and JSY card/below poverty line (BPL) certificates/necessary proofs or certificates for the purpose of keeping a record. • Informing the woman about the dates of antenatal visits, schedule for TT injections and the Expected Date of Delivery. • Identifying the place of delivery and the person who would conduct the delivery. • Identifying a referral facility and the mode of referral. • Source : Guidebook for Enhancing Performance of Multi-Purpose Worker (Female) •
- 41. Hospital Functionality – Services to be available in 24 X 7 PHCs • * 24 hours delivery – normal and assisted • * Essential newborn care • * Referral of emergencies • * Antenatal care and routine immunization of children and pregnant women • * Post natal care • * Family planning services (IUCD, OCP and CC) • * Essential Laboratory services.
- 42. To Reduce IMR – the following activities • IMNCI Training of AWW & ANMs • NSSK training to the Health Care Provider working in 24x7 PHC. • Constructing New Born Care Corner along with labour rooms of 24x7 PHC. • Strengthening Routine Immunization with special focus in Difficult areas. • Special Vit. A and Deworming drive bi-annually. • Establishment of Sick Newborn Care Unit in District Hospital (6 functional) • Establishment of Newborn Stabilization Unit in all the SDCH/ CHC/ PHC, manpower training under process) • Setting up of Nutritional Rehabilitation Center for malnourished children.
- 43. To Reduce TFR – • Fixed day sterilization in all the District Hospital. • Special monthly sterilization camp in CHC/ PHC • IUCD insertion facility in all Govt. hospital and Sub Center • No scalpel Vasectomy (NSV) camp cum training • Training of Medical Officers and O&G Doctors on Mini Lap and Laparoscopic Sterilization • Training of ANMs, Staff Nurse and Medical Officer on IUCD insertion.
- 45. HOME MESSAGE
- 46. REFERENCES • Source: National Health Mission • Related Resources • Guidelines of JSSK