What gets measured, gets managed

Strategies To Improve Access To & RCH Services

Maternal Health Services

Maternal health services, particularly antenatal care and postnatal care services, require special attention to reduce both maternal and infant mortality. A large proportion of women in both urban and rural areas are anaemic and are not protected against tetanus. The proportion availing of postnatal care services are also very low. Prophylaxis against nutritional deficiency would be able to save many lives.

  • ANMs will register all pregnant women in rural areas in the first trimester with the help of periodic surveys
  • Pregnant women will be given two doses of TT injections and 100 tablets of iron and folic acid (IFA) twice a year, following the special campaign approach in addition to the regular services at all service delivery points
  • Logistic systems related to the procurement and distribution of TT injections and IFA tablets will be streamlined
  • Antenatal check-ups will be conducted to identify pregnant women at risk and the referral system will be strengthened to serve these women
  • Supplementary nutrition will be provided to all pregnant and lactating women and an IEC campaign will be launched to promote healthy food habits
  • Postnatal check-ups will be done by ANMs at both subcentres and also during home visits
  • Infertility clinics will be opened in all district hospitals and services will be provided to couples having infertility problems
  • Maternal health care centres will be set up in all villages with more than 1,000 people, initially by involving community members and mobilizing resources from the community
  • Facilities and trained personnel will be made available at the CHC level to treat women with reproductive tract infections
Deliveries by Trained Personnel

Deliveries conducted by trained personnel are extremely low in UP. Most of the deliveries take place at home and are attended by untrained personnel. This has led to high infant mortality, particularly neonatal mortality and also maternal mortality. To reduce infant and maternal mortality, added emphasis will be placed on increasing institutional deliveries and the proportion of deliveries attended by trained personnel.

  • The proportion of institutional deliveries will be increased substantially by encouraging women to avail of the facilities available at block PHC, CHC, and health institutions above the CHC level
  • In a phased manner, round-the-clock service centres will be opened in all health institutions with facilities to conduct deliveries
  • Panchayats will be provided funds to provide transport and other facilities for emergency delivery.
  • Traditional birth attendants will be trained in all villages in conducting safe deliveries, and innovative approaches will be initiated to provide safe delivery kits to trained dais.
  • Refresher training programmes will be conducted for trained traditional birth attendants on a regular basis.
Child Health Services

The reach of child health services and their acceptability have to be considerably increased in order to reduce infant mortality. Immunization of children against vaccine-preventable diseases, proper management of diarrhoea, treatment of acute respiratory infection and improved nutrition are the important measures that need to be strengthened further. There has been considerable improvement in the recent past in immunization coverage and in the use of ORS packets or home-made solutions in the case of diarrhoea.

  • IEC campaign will be launched to create awareness about vaccine-preventable diseases and to encourage utilization of immunization services
  • Complete immunization of children will be given the highest priority and services of NGOs, community leaders, and other civil society organizations will be utilized to achieve complete immunization coverage of children
  • Mothers will be educated about the use of oral rehydration and home-made solutions, and social marketing of ORS packets will be encouraged
  • Facilities at PHCs and CHCs will be augmented to detect and treat children having acute respiratory problems.
  • Supplementary nutrition will be provided to all children, particularly those from below the poverty line to eliminate all forms of nutritional deficiencies
Sterilization Services

Sterilization services have a major role to play in the reduction of fertility. Demand for sterilization services is extremely high and has increased over time. The sterilization performance in the state has declined in the recent past, particularly after the introduction of the target-free approach. Health workers' visits to villages and their contacts with women to promote informed choice have also declined. There is an urgent need to streamline the service delivery systems to provide services to voluntary acceptors of sterilization methods.

Integrated RCH camps conducted in select districts of UP have helped to improve access to and quality of services. RCH camps planned in advance and publicised through various media have substantially improved access to services. The camp approach may not be the best approach to provide high-quality services on a regular and continuous basis but, given the current service delivery situation in the state, is the best suited to reach those in need of services. The RCH camp approach will be further strengthened and expanded to cover the entire state.

  • Sterilization camps, in addition to RCH camps, will be conducted in a systematic and planned way in the entire state throughout the year
  • CHCs and PHCs will be upgraded to provide quality counselling and sterilization services
  • Visits of health workers to villages and households, particularly pregnant women, will be monitored and strict action will be initiated against those who are not making regular visits
  • All women who availed of medical termination of pregnancy (MTP) services and desired to limit their families will be counselled to adopt permanent methods
  • Panchayat members, NGOs, and personnel from other departments will be involved to mobilize additional resources to improve the quality of sterilization camps and to make each camp conducted in the state a major success
  • The frequency of camps will be increased and systems in place to organize camps will be streamlined
  • A pool of medical officers consisting of surgeons would be created at both the divisional and district levels to provide services at RCH and sterilization camps. This will enable Chief Medical Officers (CMOs) to ensure availability of clinical services at camps on an assured basis as per a predetermined calendar
  • Measures will be initiated to ensure follow-up services to all clients who received services at RCH/sterilization camps
  • A periodic review of the RCH/sterilization camp approach will be undertaken to identify areas that need to be strengthened, and all attempts will be made to strengthen the quality of services provided in the camps
Involvement of Men

Involvement of men in family planning has sharply declined in the past two decades. Vasectomy, once the most accepted method, has hardly any users now. Male participation is essential not only to increase the use of contraceptives but also to reduce the enormous burden the non-participation of men imposes on women. UP has already trained several medical officers to conduct no-scalpel vasectomy operations.

  • More medical officers will be trained in conducting no-scalpel vasectomy operations, and male sterilization services will be made available in all CHCs and block PHCs in a phased manner
  • Special IEC campaigns will be launched to educate men about responsible parenthood and to encourage them to use family planning methods
  • Training curricula of health workers, supervisors, and medical officers will be modified to include material on involvement of men
  • Facilities will be provided at CHCs and PHCs to treat men having reproductive tract infections, and effective counselling services will be provided to prevent the spread of infection

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