FAMILY PLANNING PROGRAM

1. FAMILY PLANNING PROGRAM FAMILY PLANNING DIVISION Ministry of Health & Family Welfare Government of India

2. 2 GOI POLICY(Servicing the unmet need) Based on felt needs of the community TARGET FREE Children by choice & not chance Equal emphasis on both limiting and spacing methods ELA :Scientific and statistically significant way being formulated for calculating state wise performance level based on unmet need Population stabilization is a priority area of the GOI

3. 3 MEETING UNMET NEEDS 1 Two third Indians want to use contraception 2 There is no scope for coercion 3 Ensure availability of quality RH services 4 Meet the felt needs of couple 5 Enable couple to achieve their RH goals

4. 4 Programatic interventions in Family Planning (GOI) Addressing the unmet need in contraception through Assured delivery of family planning services Developing skilled manpower for the same Increasing male participation through intensive promotion of NSV Promotion of IUDs as a short & long term spacing method Promotion of Emergency Contraceptive Pills Increasing basket of choices

5. 5 Promotional Interventions in Family Planning (GOI) Ensuring quality care in FP services Revised compensation scheme Family planning insurance scheme Promoting Public Private Partnerships Promoting contraception through increased advocacy

6. 6 Temporary (Spacing) Methods IUD 380 A EC Pills OC Pills CC ( dual purpose condoms)

7. 7 Reduce unmet need in Spacing (advantages of IUD 380 A) 10 years’ duration & not 3 years Can cover reproductive life span in 2 insertions only (25- 45 yrs.) Can potentially replace the sterilization procedures Can be inserted at subcentre level ANM/ MOs could be given refresher training

8. 8 Promotion of EC Pills 2 tabs of 0.75mg or 1 tab of 1.5mg within 72 hrs of intercourse in the following situations: Unprotected intercourse Unplanned intercourse Failed CC (Nirodh- torn) Assault/ rape Levonorgesterol only No side effect One time activity to replace MTP Reduces Maternal Mortality by 10-15%

9. 9 Reducing unmet need in Terminal method Assuring service provision through Fixed day service round the year Periodic camps Augmenting trained manpower in NSV Minilap Lap. Ster.

10. 10 Male participation(Why No Scalpel Vasectomy- NSV ?) Attain population stabilization in a short period Shifting responsibility of family planning from females to males

11. 11 Why NSV ? 6 Ss:- (advantages) Scalpel less Stitch less Safe Sound Simple Short

12. 12 Tubectomy (If client chooses it after all options have been explained) Offer minilap because No postgraduate surgeon/ gynaecologist required No anesthetist required normally No pneumoperitoneum (inflating with gas) Less post operative distress If client still demands Laparoscopic Tubectomy Offer services routinely at DH, FRU, CHC, BLOCK PHC (wherever OT is available)

13. 13 Camps in tubectomy Should preferably start by 9 AM As the client is fasting since the previous evening Has travelled long distances to reach the camp site and Is dehydrated Has to have 4 hrs post operative observation before being discharged after being rehydrated

14. 14 Ensuring quality care in FP The manual on Standards in sterilization has been updated, printed & uploaded on the website. The manual on Quality assurance in sterilization has been updated, printed & uploaded on the website. Six Regional Dissemination Workshops on the revised Standards and QA manuals held countrywide in 06-07.

15. 15 Ensuring quality care in FP All states reported to have set up the QACs at state and district levels as per affidavit filed by them in the supreme court Revised extended QAC as per the updated manuals are in place in most of the states. Most states have completed their orientation of the districts for QA

16. 16

17. 17

18. 18 Family Planning Insurance Scheme(limit of indemnity) Claims arising out of Sterilization Operation Amount A Death at hospital/ within seven days of discharge Rs. 2,00,000/- B Death due to sterilization (8th – 30th day from the date of discharge ) Rs. 50,000/- C Expenses for treatment of Medical Complications Rs. 25,000/- D Failure of Sterilization Rs. 25,000/- E Doctors/ Facilities covered for litigations up to 4 cases per year including defence cost Rs. 2,00,000/- Dissemination meetings conducted for all state officials Public institutions to display boards on the scheme

19. 19

20. 20 10. Promotion of contraception through intensive advocacy Advocacy kit on contraceptives Expert committee and core committee set up All existing material reviewed and updated New materials developed for NSV, IUD380A, ECP, OCP All prototypes for audio, video and print (leaflets, flip charts, posters) finalised and passed on to the IEC division for production and distribution to the states (Jan, 08) Dissemination of FP capsule through regional workshops (WHO biennium 08-09) Approval obtained Funding awaited

21. 21 Family Planning Components (What the SFT should look for) Contraception Conception (infertility management) Quality Assurance Accreditation of facilities Empanelment of providers Compensation Insurance

22. 22 Responsibilities of the states/ districts Increase number of services centres Availability of services Accessibility of services Affordability of services (Upgradaiton of DHs, FRUs, CHCs, PHCs & SCs under NRHM) Accreditation of private providers (PPP)

23. 23 Responsibilities of the states/ districts Regular fixed day services round the year a) DH - on demand (daily/ weekly) b) FRU/CHC - weekly/fortnightly/monthly c) PHC - monthly/ bimonthly - (Tubectomy only if OT available) d) SC - IUD/ ECP (on demand) Tubectomy: Wednesday (optional) Vasectomy: Saturday (optional)

24. 24 Responsibilities of the states/ districts 1. Ensure at least One NSV Surgeon per PHC (ultimate aim) One Tubectomy Surgeon per PHC (ultimate aim) One IUD Provider per SC (ultimate aim) 2. Effect Manpower Rationalization Manpower Planning (based on ELA) Manpower Training Manpower Placement 3. Develop Comprehensive Training Plan for NSV Minilap LTT IUD ECP

25. 25 Action at State/Dist. level Appoint Nodal officer for Family Planning (for Planning, Implementing, Monitoring, Supervising & Evaluation) Constitute QAC at state level (10 members) & notify Constitute DQAC at dist. level (9 members) & notify Accredit facilities (Public/Private/NGO) Empanel doctors (Public/Private/NGO) Conduct Half yearly meetings of state QAC (to be minuted) Quarterly meetings of Dist. QAC (to be minuted)

26. 26 Action at State/Dist. level Orientation of CMOs on NFPIS (National Family Planning Insurance Scheme) Compensation Scheme (Revised) ELA district wise for limiting & spacing methods (based on dist. Unmet Need) Manpower development (district action plan) NSV (MOs) Minilap/ LTT (MOs) IUD (MOs/ SNs/ LHVs/ ANMs) ECPs (MOs/ SNs/ LHVs/ ANMs/ ASHAs) Contraceptive updates District budget allocation and disbursement Monthly Review of FP performance with CMOs

27. 27 Action at State/Dist. level Display prominently (facility wise) Revised compensation scheme Family planning insurance scheme Service availability (district action plan) Fixed day service calendar NSV Minilap/ LTT IUD Camp calendar for above IEC materials on NSV IUD ECPs Budget may be provided accordingly

28. 28 Action at State/Dist. level Lay down benchmarks (performance indicators) and Rank Districts Reward districts Reward CMOs (state award) Recommend for national recognition

29. 29