Dr. S.K Sikdar Additional Commissioner Ministry of Health and Family Welfare Government of India

1. RMNCAH +N 13th CRM National Briefing Workshop Dr. S.K Sikdar Additional Commissioner Ministry of Health and Family Welfare Government of India

2. Reproductive Maternal Newborn Child Adolescent Health + Nutrition RMNCAH+N APPROACH Reproductive & Child Health

3. Reproductive Health

4. Reproductive Health Contraceptive choices and Schemes under National Family Planning Program Schemes: • Sterilization Compensation Scheme- Enhanced in 11 high focus high TFR states. Higher Package for PPS and Male Sterilization • Clinical Outreach Teams (COT) for quality sterilization services • Drop back scheme- for Sterilization clients • PPIUCD/ PAIUCD Incentive Scheme- for Provider, Acceptor and ASHA • Mission Parivar Vikas- in 146 high TFR districts • ASHA schemes: • Home delivery of Contraceptives by ASHA • Ensuring spacing at Birth Scheme • Pregnancy Testing Kit (with ASHA/ at SC) Temporary Methods • Condoms (Nirodh) • Oral Contraceptive Pills- • Combined Oral Contraceptives (Mala N) • Centchroman (Chhaya) • Emergency Contraceptive Pills (Ezy Pill) • IUCD-380A, 375 • Injectable MPA Permanent Methods • Male Sterilization (Conventional Vasectomy/NSV) • Female Sterilization (Minilap/Laparoscopic)

5. Streamlining Contraceptive SuppliesUnified Software for FP logistics Generating mass awareness on contraceptives and healthy reproductive practices • Web based, App based and SMS based application • Instant access to stock information from National level to ASHA level • Auto forecasting of contraceptives • SMS alerts for key indicators • Auto generated reports for program review

6. What to look for in CRM: Reproductive Health Review delivery and quality of Family Planning services (including PPIUCD, Sterilization services, Injectable contraceptives etc) Review the status of State Quality Assurance Committees (SQAC/SISC), District Quality Assurance Committees (DQAC/DISC) etc Review of ASHA schemes (Home Delivery of Contraceptives, ensuring spacing at birth scheme, pregnancy testing kits) etc In Mission Parivar Vikas (MPV) States check for implementation of initiatives such as Nayi Pahel Kit, Saas Bahu Samellan etc Review the availability and utilization of FP commodities & implementation of Family Planning Logistics information System (FPLMIS). Assess the quality of counseling services by RMNCH+A counsellors/ home based distribution of contraceptives

7. Maternal Health

8. Janani Shishu Suraksha Karyakram Capacity Building of HR: Dakshata, LSAS, SBA, Safe Delivery Application Maternal Health Janani SurkshaYojana Universal screening for HIV and Syphilis Strengthening FRUs Delivery Points MCH Wings Obs HDUs/ ICUs Comprehensive Abortion Care Services Maternal Death Surveillance & Response MCH Wing PradhanMantriSurakshitMatritvaAbhiyan

9. Key Components LaQshya| लक्ष्य (Labour Room & Maternity OT Quality Improvement Initiative) Expected Outcomes LaQshya Badges – Platinum/ Gold/ Silver Labour Room Certification 75% achievement of targets for quality Facility level Incentives 80% satisfaction of beneficiaries Organization and standardization of Labour rooms, OTs and Obstetric HDUs/ ICUs as per national guidelines and standards Structured Quality Improvement efforts/processes to improve adherence to critical practices around childbirth Improved client satisfaction - “Respectful Maternity Care” (RMC).

10. Midwifery Initiative • Midwifery Initiative launched during Partners Forum - 2018 • To be skilled as per competencies prescribed by International Confederation of Midwives- training curriculum being designed Lancet Series on Midwifery (2014): Safeand effective midwifery care can avert 83% of all maternal deaths, stillbirths and newborn deaths • To provide access to quality maternal and newborn health services: • Promote natural birthing by promoting positive child birthing experience • Ensure respectful care • Reduce over medicalization

11. What to look for in CRM: Maternal Health Impact of PMSMA on Coverage and Quality of ANC Services Availability of comprehensive ANC services including HIV/ Syphilis testin, high risk pregnancy tracking mechanisms Use of MCP Card Impact of JSSK on OOPE for maternal and newborn health – availability of JSSK entitlements and grievance redressal mechanisms Progress in operationalizing FRUs and emergency obstetric care services Quality of Intrapartum and immediate postpartum care services – progress under LaQshya Initiative and certification of facilities Availability and impact of JSY incentives Issues in updation of the JSY beneficiaries details into the PMMVY-CAS (Software of PMMVY, MoWCD) Focus on availability of respectful maternity care and positive pregnancy experience for women Plan for Roll out of Midwifery Initiative and introduction of Midwifery Cadre

12. What to look for in CRM: Maternal Health Status of Community engagement for maternal health Systems for Maternal Death Surveillance and Response & Maternal Near Miss Reviews Availability of Comprehensive Abortion Care Services Focus and impact of trainings such as Dakshata, LSAS, CEmOC, SBA etc Progress under MCH wings, Obstetric HDUs/ ICUs etc Innovations for Maternal Health

13. Child Health

14. Strategic Interventions under Child Health Programme Child Death Review

15. Focus on Early Childhood Development • 1000 day Booklet released • Messages integrated in MCP Card • HBYC Platform to be leveraged • AyushmanBhava app developed • Call Centre approach

16. Anemia Mukt Bharat Estimated 450 million beneficiaries Reaching nearly 50% of the country’s population

17. What to look for in CRM: Child Health • Uptake of services in SNCUs, NBSUs and NBCCs (referal management, Outpatient clinical services for common childhood illnesses etc) • Establishment of MNCU in high Case Load and better performing units • Status of progress on implementation of Home Based Newborn Care / Home based care of Young Children interventions • Training of ASHA in Module 6&7 • Home visits by ASHA during first 42 days of life • Status of Follow up of SNCU discharges and LBW babies • Implementation status of Defeat Diarrhoea Campaign • Status of Community based management of common neonatal and childhood illnesses (status of Zn- ORS distribution , identification of sick newborns by ASHAs etc)

18. What to look for in CRM: Child Health • Issues of Malnutrition, Convergence with AWW under POSHAN Abhiyaan • IFA Supplementation under AnaemiaMukt Bharat • Status of activities carried out to improve child nutrition such as MAA programme, IYCF, Micronutrient supplementation and deworming, Management of children with severe acute malnutrition (SAM) • Implementation of RashtriyaBalSwasthayaKaryakram (RBSK) Screening of Children • 0-3 years of age group • Operational status of DEICs, Mobile health teams, screening and management 4Ds. • Whether adequate IEC, IPC,BCC Activity at the community level initiated to generate community awareness on interventions such as breast feeding practices, vaccine preventable diseases etc.

19. Immunization

20. Revised National Immunization Schedule *in select states and districts ** one dose if previously vaccinated within 3 years

21. New vaccines Rotavirus Vaccine: • Recently expanded to the entire country PCV Vaccine: • PCV vaccine introduced in routine immunization in entire Bihar, Himachal Pradesh, Madhya Pradesh, 19 districts of Uttar Pradesh and 18 districts of Rajasthan. Measles-Rubella Vaccine: • MR vaccination campaign has been completed in 32 states/UTs – now part of RI as two doses at 9-12 months and 16-24 months and ongoing in 2 states (Sikkim & Rajasthan) • MR campaign not conducted in Delhi & West Bengal yet

22. Mission Indradhanush & Intensified Mission Indradhanush Aims at increasing full immunization coverage to 90%. Focus on underserved populations/areas 554 districts across country covered. Also implemented under Gram Swaraj & Extended Gram Swaraj Abhiyan IMI 2.0 • Intensified Mission Indradhanush planned to be implemented from December 2019 to March 2020 • 271 districts across 27 States /UTs and 652 Blocks in 109 districts of 2 states (UP & Bihar) have been selected for IMI 2.0

23. What to look for in CRM: Immunization • Status of coverage of all vaccines in routine immunization(RI). • Implementation of State Task Force/District Task Force meeting for Immunization. • Status of AEFI management system • Availability of communication plan at district level • Alternate Vaccine delivery arrangements • Maintenance of Cold chain. • Awareness of ASHAs regarding incentives in RI & also review the status of payment of incentives. • Availability and use of due list, MCP cards, counterfoils • Updation & compliance of micro-plans and • Document the constraints for 100% immunization & Plans for improving RI Coverage.

24. Adolescent Health

25. Healthy Lifestyle Rashtriya Kishor Swasthya Karyakram (RKSK) Mental and Emotional Well Being Violence free living RKSK Objectives Reproductive and Sexual Health Improved nutritional status Substance misuse prevention • Being implemented to reach 253 millions adolescents (aged 10-19 years) across the country

26. RKSK : Key Implementation Approaches FACILITY BASED APPROACH SCHOOL BASED APPROACH COMMUNITY BASED APPROACH • Weekly Iron Folic Acid Supplementation (WIFS) Program • Deworming during National Deworming Day (NDD) • Provision of sanitary napkins • Peer Educator (Saathiya) program for out of school/vulnerable adolescent groups • Quarterly Adolescent Health Day (AHD) • Adolescent Friendly Clubs (AFCs) • Screening of Adolescents for 4 Ds (RBSK) • Weekly Iron Folic Acid Supplementation (WIFS) Program • Deworming during National Deworming Day (NDD) • Provision of sanitary napkins • Adolescent Friendly Health Clinics (AFHCs) providing counselling and clinical services • Adolescent Health Resource Centre at District Hospital • Health promotion and prevention activities

27. What to look for in CRM: Adolescent Health • Knowledge and Information about adolescent Health issues and awareness about available adolescent health services. • Sensitization of frontline workers-ANMs,ASHA and AWWs on adolescent health issues. • Administration of Blue IFA tablets in schools and AanganwadiCentres • PeerEducation Program (Applicable for PE districts)

28. Decline in Sex Ratio and PC&PNDT Act Review Steps taken by the State for Implementation of the PC & PNDT Act • The Pre-conception and Pre-natal Diagnostic techniques (Prohibition of Sex Selection) Act, 1994 (PC& PNDT Act) was enacted in 1996 and further amended in 2003 • Prohibits sex selection before and after conception and imposes penalty. • Policy making bodies both at national and state levels-(Central/ State Supervisory Boards) • Implementation lies with the States though State and District Appropriate Authorities assisted by Advisory Committees

29. Mission Mode Project

30. Review Agenda Points for RCH Portal/ANMOL • Frequency of meeting conducted to review RCH Portal/ ANMOL • Adequacy of HR, and IT infrastructure at facilities reporting on RCH Portal • Availability and utilization of RCH register at field level. • Timely updation of RCH services (including ANC, Delivery, PNC, Routine Immunization data) on RCH Portal • Monitoring and validation of data quality on RCH Portal • Performance review of ANMs regards to ANMOL tablet application usage for data entry • Review on trainings and refresher trainings on ANMOL for ANMs • Management and maintenance of tablets for increasing the life of the tablets.

31. Review Agenda Points Kilkari/ Mobile Academy/ MCTFC Kilkari and Mobile Academy is currently functional in 13 States – Assam, Bihar, Chhattisgarh, Delhi, Haryana, Himachal Pradesh, Jharkhand, Madhya Pradesh, Odisha, Rajasthan, Uttarakhand, Uttar Pradesh and West Bengal . • Kilkari and Mobile Academy:- • 100% registration of all Pregnant Women and parents of children upto 1 year of age and ASHAs with validated contact detail in RCH Portal • Have awareness/ IEC activities been taken up at field level? • Have Trainings at districts/blocks been conducted? • Timely distribution of Mobile Academy course completion certificate • Mobile Number data accuracy in MCTS/RCH Portal. • MCTFC • Have correct mobile numbers of PW/ASHAs and ANMs been provided in RCH Portal?

32. National Iodine Deficiency Disorders Control Programme (NIDDCP) • Have sanctioned posts of Technical Officer, Statistical Assistant, LDC, Lab Technician and Lab Assistant under NIDDCP been filled? • Whether District IDD survey/resurvey has been conducted in the State/UT in the specific District being visited by the CRM Team? • Whether the State IDD monitoring laboratory has been carrying out salt & urine analysis for iodine content and urinary iodine excretion (UIE)? • Status of procurement of Salt Testing Kits (STKs) for conducting salt testing by ASHA in IDD endemic District at community/household level • Status of IEC activities required for creating awareness about IDD

33. Aspirational Districts • Aspirational districts identified by NITI Ayog Aspirational Districts: Addressing the health and well being of 117 districts across 28 States for transformation by the year 2022 RMNCAH+N coalition working towards improvement of indicators in these districts • Health & nutrition (30%) • Education (30%) • Agriculture & • Water Resources (20%) • Basic Infrastructure (10%) • Financial Inclusion (10%) Agenda Points CRM Teams: Review Impact of Aspirational District Approach on RMNCAH+N Services in these areas A set of 13 core and 31 sub-core indicators identified for demonstrating the progress on health & nutrition in these districts

34. Remember!!! As part of CRM teams your responsibility is enormous and your feedback critical! You have the opportunity to influence the future of women & children in India!