REPRODUCTIVE AND CHILD HEALTH PROJECT

Reproductive and Child Health (RCH) Programme:

???????????? Government of Tamil Nadu health policy 2003 focuses on greatly improving access, equity and quality of care and reforming health care financing.

The IMR of the State is almost stagnant and some districts like Theni, Salem, Namakkal and Dharmapuri had high IMR. Various initiatives have been taken by Government to address the issue of stagnant IMR &MMR. With a view to strengthen the existing Maternal and Child health activities in Tamil Nadu, the Reproductive and Child Health project was formulated and commenced during the year 1997-98 for implementation over a period of 6 year with a financial outlay of 23.14 crores It is a World Bank aided?? 100% centrally sponsored project.? It has the following two major components

National Component for implementation in all districts of Tamil Nadu. This component is to strengthen the infrastructure needs of districts excluding?? Madurai and Theni districts.

Sub-project covering the districts of Madurai and Theni both urban and rural excluding Madurai Corporation, with financial outlay of Rs.15.24 crores for rural and Rs. 7.9 crores for urban.?

Sub-Project:

The following activities were carried out under Sub-Project from 1997 - 98 to March 2004.

Rural:

In addition to construction of 21 new HSCs in Madurai and Theni districts, additional constructions were provided in the selected 40 PHCs where more number of deliveries are conducted. The minor repairs were also carried out in 77 HSCs, which had encouraged the VHNs to provide quality services.?? An amount of Rs. 486.74 lakhs? have been spent? for improving the infrastructure? facilities? in the HSCs and PHCs during the project period.

Considering the non availability of essential equipments in the HSCs and PHCs in the Sub Project districts, the RCH Project procured?? and supplied maternity, paediatric?? and operation theatre equipments for the PHCs at a cost of Rs.125 lakhs.? The availability of essential equipments to the PHCs have improved the institutional deliveries and the tubectomy performance in Madurai and Theni districts. The Maximum number of deliveries are conducted in the state?? per PHC per month in Madurai district.? The number of deliveries have increased by100% in Madurai and Theni districts.???

To improve the outreach services and strengthen the referral services 30 vehicles have been supplied to the PHCs at cost of Rs. 108 lakhs.

To mobilize the community?? against the social evil of female infanticide and to empower the women, moving street theatre? Kalaipayanam programme was conducted in Theni District by using the services of Arivoli Iyakkam volunteers at a cost of Rs.25.64 lakhs.

Computer Systems with its accessories had been installed in all PHCs and Government Hospitals in Madurai and Theni districts and the RCH directorate?? at Chennai to improve the?? health management information system at a cost of Rs.145 lakhs.? The staff of Madurai and Theni districts were trained on the use of computer.

To empower the field health functionaries with communication skills and to develop skills in driving the mopeds, mobility cum communication skills training was organized in Madurai and Theni districts. All the field health functionaries were given loan to purchase mopeds at lower interest rate.?

Selected IEC health messages have been?? was broadcast through AIR?? to create awareness on various RCH activities.

To meet the Emergency Transport needs of complicated deliveries and accident victims a pilot initiative was started under which two vehicles equipped with life saving equipments were given to NGO by name Sevanilayam at Theni district. Prior to the commencement of this initiative hardly one emergency case was transported per month by the PHC vehicle. The NGO supported emergency transport services are now transporting nearly 30- 45 emergency cases per month per vehicle.?????

The RCH outreach services in Madurai and Theni Sub Project District has been strengthened with a block level team consisting of lady medical officer, VHN, HI, BEE and hired lab technician?? who visit various villages on a fixed day schedule. The total cost for the conduct of one round of camps is Rs.16,76,150/- .? In Madurai 1238 Camps and in Theni 648 camps were completed. In these camps large number of antenatal?? cases were examined, post natal care, new born care, family welfare services were provided. Lab services were also provided to screen various communicable diseases by hiring the services private lab technician. Ultrasonogram was used to screen pregnant mothers for any risk factors. All complicated cases needing higher level of care were referred to referral institutions.

A programme for Capacity Building of adolescent girls in order to empower them as link persons in the community for health programme has been implemented in the Districts of Madurai and Theni Districts at a cost of Rs.73,05,020. The adolescent girls were selected at the rate of two per habitation and they were trained in various RCH issues. These trained girls will take care of pregnant women, provide support services?? and act as link person between the health worker and the community.

Using the services of talented health functionaries street theatre troupe has been formed in Madurai district to perform street plays during the weekend period in the villages. These activities have been carried out at a cost of Rs.25.64 lakhs.

To eliminate the female infanticide, HSC level?? committees have been formed to target the high-risk mothers. The family of high-risk mothers are periodically counselled about the value of the girl child and the various benefits provided by the Government for the?? girl child. The family is also apprised about the penal provisions of the law if the family resort to female infanticide.

Urban:

Urban Health Post buildings have been constructed in Theni, Cumbum, Chinnamanur, Melur, Thirumangalam, Bodi and Usilampatti and major renovation work at Periyakulam at a cost of Rs.126.88 lakhs. In addition Furniture, Maternity Instruments, Cots, Mattress and Pillows etc. worth Rs.30 lakhs were supplied to 8 Urban Health Posts. Drugs worth Rs.10.80 lakhs per annum were also supplied to 8 Urban Health Posts.

The Sub-project came to a closure on 31.3.04.

State Implementation Plan (National Component):

Under the National component?? Major Civil Works i.e. construction / Repairs to Operation Theatre / Labour Room, provision of water supply and electricity are being provided at a cost of Rs.9.40 Crores in PHCs, HSCs and FRUs through Public Works Department. In addition minor Civil Works have been carried out in selected PHCs at a cost of Rs.220 lakhs. The renovation / provision of additional buildings, major repairs have helped to improve the quality of services in the health facilities.?

To provide round the clock delivery care in the PHCs, a pilot initiative in which 3 staff nurses, one driver and 2 sanitary workers?? are provided to 90 PHCs in Thanjavur, Thiruvarur, Nagapattinam, Dharmapuri, Krishnagiri, Madurai and Theni. Districts.

The maternal mortality has to be reduced to less than 1 per 1000 live births from the present level of 1.4 per 1000 live births. Hence under RCH project funds have been provided to Joint Director of Health services and Deputy Director of health services to hire ealth? Health??????? the services of private anesthetists and obstetricians?? to provide emergency obstetric care and tubectomy services. Nearly 2600 caesareans were performed during the project period in addition to tubectomies and major gynecological surgeries. The PHCs are also permitted to hire private anesthetists and by hiring their services and?? nearly 44,533 tubectomies were performed.

RTI/STI clinics have been established to treat Reproductive Tract Infections / Sexually Transmitted Infections in selected 70 PHCs in the Districts viz., Thanjavur, Thiruvarur, Nagapattinam, Dharmapuri, Krishnagiri, Madurai, Theni, Cuddalore, Kallakurichi, Villupuram, Salem, Namakkal, Pudukottai and IPH Poonamallee.

The Drug Kits A, B, Essential Obstetric Care Kits, Emergency Obstetric Kits, RTI/STI Drug Kits worth Rs.1496 lakhs were procured and supplied to HSCs / PHCs / FRUs by Tamil Nadu Medical Services Corporation out of RCH funds.

Medical Equipment Kits are supplied by Government of India for?? use of?? PHCs / FRUs? / Headquarters Hospitals to provide newborn care, emergency obstetric care.

Training under RCH Programme:

The following trainings for all the categories of Medical and Paramedical have been completed in co-ordination with National Institute of Health and Family Welfare, New Delhi.

????? Awareness Generation Training (about RCH, Population Indicators of the country) completed

????? Integration Skill Development Training (Skills under essential Obstetric Care and New Born Care)

????? Specialized Skill Development Training (Skill training on MTP, Tubectomy and IUD)

????? Communication Training

????? Management Training for the District Health Administrators

????? MVA training (Manual Vacuum Aspiration) at Dindigul and Salem Districts

The??? Sub Project component part of the first phase of the RCH Project has come to a close by March, 2004. The National component of the RCH Project?? is being continued beyond March 2004.

The planning for the second phase of the RCH Project?? is under progress.

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