Reproductive and Child Health

District : Shivpuri, Tikamgarh

Criteria applied to categorize them as under or un-served area?

Poor immunization coverage

Uneven and scattered distances of villages from sub-centers.

Dacoit effected area, decreasing the visits and outreach of health workers to villages.

Migration population, often leaving villages and going to nearby areas in search of work.

Very low coverage of health services among tribal communities.

illiteracy

Percentage of institutional deliveries very low.

Outreach to roads in rainy seasons cuts off the villages from any service.

Summary of Key findings through Base line survey, FGDs and key informant interviews –

Very large proportion of home based deliveries

Very low percentage of visits by ANM or any health worker

Low prevelance of using family planning methods

Significant amount of STI cases reported among females

Very low cases where complete ANC has taken place, or complete doses of IFA tablets has been taken.

High prevalence of child marriage among girls

High rates of illiterates, very few people surveyed have received formal education to satisfactory levels.

People not keen on using methods for delaying pregnancy

Overview of the project –

Sambhav Social Service Organization is a voluntary agency working in the fields of health, water and sanitation, women empowerment, micro-finance programs, community based rehabilitation and integrated education since the past 18 years.

Sambhav had implemented the RCH phase 1 program in 6 districts of MP namely, Shivpuri, Tikamgarh, Guna, Sheopur, Panna, Shahdol and Chatarpur.

In the RCH II program implementation Sambhav has been allotted Shivpuri and Tikamgarh by the GoI.

Following are the expected targets proposed to be achieved in this phase

o 100% Registration of Pregnant mothers

o 100% Registration of Births

o 100% Registration of Deaths

o 100% Registration of Marriages

o 90% Complete ANC coverage (3 ANC Checkup, 2 TT, 100 IFA)

o 80% High risk mothers referred to institution

o 100% High risk mothers receive obstratic care

o 80% Children (0-2 Years) receive complete primary immunization services

o 90% Children (9 months to 5 Years receive all 5 dozes of Vitamin A

o 80% Eligible couples receive contraceptive services

o 80% cases of identified RTI / STI referred to Health centers and get treatment

Assumption: Out of the population 60000, 35% are arbitrarily taken in the reproductive age group, which is approximately 10500 eligible couples.

MNGO will facilitate FNGO implementation by setting the following objectives

Goal: Safe Childhood and Healthy Motherhood (To bring an improvement in the overall Reproductive and child health indicators in Shivpuri District, by leveraging and enhancing the work done in past, specifically focusing on service delivery.)

Specific Objectives:

-    To organise training of local health resource persons e.g. health workers, birth attendants and motivators.

-    To facilitate regular visits by the ANM and village level health workers especially for antenatal and postnatal care, and care of children mainly to prevent malnutrition.

-    To initiate measures for addressing the problem of anemia among pregnant women and adolescent girls e.g. by distributing iron and folic acid, encouraging the practice of kitchen garden, inculcating the habit of consuming green vegetables etc.

-     Spreading health awareness among women and adolescent girls by conducting health awareness for the groups of women and adolescent girls.

-     To promote the usage of Government Health Facilities, through generation of service demand from within the community.

-     To link up with local schools for health care and school health education.

-     To spread awareness and prevent STI/RTI among men and women.

3.2 Interventions:

Project Activities:

Health Camps For Women, Adolescent And Children

School Health Camps

RTI/STI Consultation Camps

Promotion Of Sanitary Napkins

Family Planning Counseling Camps

Social Marketing Of Contraceptives

Training Of Newly Married Couples

IEC Activities

Establishment Of Reference Cum Information Center

Exhibitions

Health Mela On RCH

Meetings Of TBA

Meetings With Government Service Providers

Meetings With Adolescent Groups

School Health Competition

PRA Exercise

Process of implementation

The project will have following three dimensions of implementation:

Capacity building of the staff, representatives of groups, birth attendants and health motivators, and awareness generation of the community through them.

Training and facilitation of ANM and village level health workers on antenatal and postnatal care, prevention of malnutrition among children. Health education of adolescent girls.

Networking with the government departments to ensure availability and accessibility of services so as to create gradual dependence on the existing government services and systems.

1.      Capacity building and awareness generation

Workshops by agencies resource persons for the staff, Birth Attendants, health motivators and the leaders of the groups on mother and childcare, communication and community organisation.

Imparting training to the staff to develop plays and street plays especially for imparting awareness on subjects relating to mother and childcare. Gradually imparting the same kind of training to children so that they can perform in local schools.

Wall writing will be done by the youth so that in that process they internalize the essence of the message and can elaborate the same to their peers or other villagers whenever needed.

Regular home visits by the health workers for identifying pregnant mothers, referring them to the Sub-center for check up by the doctors, ensuring timely immunization of the children. Maintaining regular contact with the Auxiliary Nurse Midwives (government employee) and ensuring they visit every family for immunization.

Target population

Awareness to be imparted on

Women, Adolescent Girls and males

·        Antenatal care, safe delivery and postnatal care.

·        Child care- immunization, breast feeding, weaning food etc.

·        Anemia, Malnutrition, Balanced diet, Kitchen garden

·        Information on the available Government Health and related services.

Children

·        Cleanliness

·        Safe drinking water

·        Awareness on diarrhea and malaria.

·        Plantation and protection of trees

Birth Attendants

·        Correct practices for pregnancy care

·        Immunization

·        Use of autoclaved kits

·        Timely identification and referral of high risk pregnancies

Health Motivators

·        Home visit

·        Follow up of simple mother and child care practices

·        Immunization

·        Mobilizing women and children for mobile clinics

·        Mobilizing the community for maximizing the use of government health care services.

2. Training and facilitation of ANM and village level health workers on antenatal and postnatal care, prevention of malnutrition among children. Health education of adolescent girls.

·    Health Education and camps for adolescent girls for their check ups, referral and special care for those identified as anemic.

·    Facilitation of groups of young men and women for collective community actions for better community health and sanitation e.g. sanitation drives etc.

Networking with the government authorities

·    Maintaining a regular contact with the Primary Health Centers to ensure regularity of their service delivery and better accessibility of services to the villagers and regular visit by the Auxiliary Nurse Midwives for maximum immunization coverage.

·     Keeping contact with the authorities for prevention of seasonal diseases e.g. diarrhea, malaria etc.

·     Facilitating the interaction of villagers with authorities like Block Development Officer etc. so as to ensure that Gram Sabhas take place in accordance with the schedule announced by him and the felt problems of the villagers are addressed.

·     Ensuring maximum participation of the villagers in the Pulse Polio Drives launched by Government from time to time.

3.3 Strategic Interventions:

Overall Achievement

Focus on partnership with existing government services and providers.

Liaison with ANM and PHC for better service delivery.

Prepare health promoters at community level that would act as voluntary support in the village.

Prepare a work plan in accordance to the schedule of ANM and PHC so that the outreach and coverage could be facilitated.

Mother and Child Health

a: Increasing access to institutional deliveries for safe and quality care

b: Linkages with private hospitals, community groups and other stakeholders

c: Upgrading the skills of birth attendants,local health volunteers, and ANMs.

d: Development and distribution of IEC material.

e: Development of referral linkages

Family Planning

a: Promoting uninterrupted supply of medicines, family planning and health products.

b: Development and distribution of IEC material.

Adolescents:

a: Pre-marital counseling.

b: Promotion of sanitary napkins.

c: Promotion of hygiene friendly practices.

STI/RTI Prevention

Behavior change communication on safe sex and use of condoms

Promotion and social marketing of condoms

STI counseling

Community meetings on awareness and identification of STI and RTI

Dissemination of awareness messages through IEC material.

Indicators:

Registration of Pregnant Mothers

ANC Coverage – Immunization against T.T., 100 IFA, 3 ANC checkups

No. of High risk mothers referred

Primary immunization among 0-2 yrs children

% of institutional deliveries

Deliveries conducted by Trained Birth Attendant/ ANM or Doctor

No. of RTI, STI identified and treated

IMR (at the beginning of the project and after 3 years)

MMR (at the beginning of the project and after 3 years)

Management:

Sambhav will build the capacity of FNGOs and make sure the management through:

Financial Management

Budgeting, costing and highlighting variance

Financial Reporting through: Quarterly statement of expenditure, utilization certificate and audited statement of accountants.

RCH Service Delivery Components

Bio-medical and socio-cultural as per community needs