> Reproductive Child Health Project

The concept of €˜Reproductive and Child Health€™ (RCH) emerged through a global consensus at the International Conference of Population and Development (ICPD) held in Cairo in 1994.

RCH focuses on empowerment of women and recognizes their right to reproductive choice. It focuses on enhancing the health status of women and children.

RCH priorities:

· Reduction of infant and maternal mortality and morbidity.

· Reduction and management of reproductive tract infections (RTI) and sexually transmitted infections (STI)

· A life cycle approach to women€™s health from conception and birth through adolescence and child bearing to post menopausal and geriatric care.

· Child health, especially reduction of under-five mortality and morbidity rates and elimination of micronutrient and vitamin A deficiencies.

Achievements of RCHP in Tamil Nadu

The RCH project, based on the RCH concept and approach, commenced in 1997 and completed its first phase in 2004.

The RCH project was implemented throughout the country. The World Bank provided the required funds as a loan to the Government of India. The Government of India provided the funds as grants to the States and Union Territories.

Tamil Nadu was an outstanding performer in the first phase of the RCH project. Its achievements included the following:

· A substantial reduction in infant mortality rate, from around 53 infant deaths per 1000 live births in 1997 to 43 by 2003.

· Maternal deaths have been reduced by 25% during the last four years (2001-2004)

· A decline in crude birth rate from 19.0 in 1997 to 18.3 in 2003.

· A significant increase in the number of tubectomies and reduction in the proportion of higher order births (third and above) to total births.

· A substantial increase in the degree of utilization of primary health centers (PHCs) and health sub centers (HSCs). In terms of significant increase in both the average number of outpatients treated per day per PHC, and the number of deliveries performed in PHCs and HSCs, as well as their shares in total deliveries.

· Significant increase in percentage of institutional deliveries from 71.6% in 1997 to 94.3% in 2004.

· An increase in percentage of all deliveries involving skilled attendance at birth from 85% in 1996 to 99.6% in 2004.

Lessons from RCH Project Phase-I

Assured availability of services improves the degree of utilization of the health system. The significant increase in the number of deliveries in PHCs that were provided with three staff nurses to enable 24 hour delivery care is a good example.

Expanding provision of emergency obstetric care through employment of specialists outside the government health sector helped to increase the number of caesarean sections in district and sub district hospitals and tubectomies in PHCs, and also to bring down the number of maternal deaths.

REPRODUCTIVE AND CHILD HEALTH PROJECT PHASE-II

Reproductive and Child Health phase II was launched by the Hon€™ble Chief Minister of Tamil Nadu on 9^th August 2005.

Planning and Budgetary Support

Based on the lessons learnt and achievements of the RCH project phase.I interventions. RCH project phase.II has been planned to scale up the interventions to cover the entire State at a cost of Rs.426 crores for a period of 5 years from 2005-06.

Objectives of RCHP Phase-II

RCHP Phase.II seeks to build on the successes and lessons of RCHP Phase.I.

The objectives include:

· Reduction of maternal mortality and morbidity

· Reduction of infant mortality and morbidity

· Reduction of under-five mortality and morbidity

· Reduction of total fertility rate

· Promotion of the health of adolescent girls

· Control of RTI and STI

All these objectives are to be achieved with a policy framework that addresses the issues of patriarchy and son preference and actively promotes gender equality.

PROJECT COMPONENTS

Maternal Health

• Promotion of maternal nutrition

• Improving quality of antenatal and postnatal care

• Round the clock access to essential obstetric and newborn care in 1415 PHCs

• Emergency obstetric first aid services in all the PHCs and HSCs

• Referral information networking system

• Emergency Help-Line in the districts in association with Tamil Nadu Health Systems Project (TNHSP)

• Blood donation programme

• Birth companionship programme

• Mentoring programme for field health functionaries

• Ensuring systematic conduct of verbal autopsy in the case of every maternal death

• Emergency Ambulance service

Infant and Child Health

• Ensuring provision of Basic Emergency Obstetric and Newborn Care (BEmONC) services in the PHCs. Provision of first aid services for scorpion bite, snake bite, other insect bites and poisoning in the PHCs.

• Empowering Village Health Nurses (VHN) for management of sick neonates

• Sustaining 100% immunization focus on the remote areas

• Vitamin A prophylaxis programme

• Quality care to sick children through the strategy of Integrated Management of Neonatal and Childhood Illness (IMNCI)

• Promoting exclusive breast feeding

• Institutionalizing infant death and still birth verbal autopsies

• Prevention and early detection of disability among newborns

Adolescent Health

• Adolescent-friendly health services

• Provision of adolescent clinics in 66 Comprehensive Emergency Obstetric Newborn Care (CEmONC) hospitals

• Adolescent health counselling services

• Adolescent health education

• Anaemia prophylaxis programme for adolescent girls

• Advocacy campaign for Rubella immunisation

• Capacity building of adolescent girls to act as link volunteers in the community

Mainstreaming India Systems of Medicine (ISM)

• Training of about 12,000 female field health functionaries in the concepts of ISM and use of ISM drugs in the promotion of maternal health, adolescent health, correction of maternal and adolescent anaemia, management of childhood problems and treatment of minor ailments.

• Provision of ISM drug kits containing 50 ISM drugs to all the 8682 HSCs to complement the institutional ISM services

• To establish ISM antenatal and delivery care in the CEmONC centres.

Family Welfare and Population Stabilization

• Address the unmet needs for contraception

• Increase couple protection rate (CPR)

• Increase the age of marriage of girls

• Promotion of spacing methods

• Reduce higher order births

• Ensure access to safe abortion services, promoting safe techniques such as manual vacuum aspiration

• Enhance male participation in contraception through social mobilization, counseling and making available safe and easy medical procedures

• Establishment of one-stop family welfare service centre in all CEmONC hospitals.

• Establishment of RTI / STI clinics

• Early detection of cancer cervix by the use of visual inspection with acetic acid and management using cryotherapy

• Early detection of breast cancer by training women in self-breast examination

Urban Health

• To provide an integrated and sustainable system for delivery of primary health care services in the urban areas of the State to cater to the requirements of urban slum population and other vulnerable groups.

Human Resource Development

• Training aimed at improving/upgrading the professional skills of health care providers.

Management Training

• Upgradation of skills of female field health functionaries (FFHFs) to provide emergency obstetric and newborn first aid.

• Training for FFHFs in mobility and communication skills.

• Developing a separate cadre of nurses for maternal and newborn care services in the hospitals

Behavior Change Communication (BCC)

• Social mobilization, using such strategies as traveling street theatre (Kalaipayanam) as well as individual and family counselling to promote gender equality and eliminate female infanticide and foeticide.

• Orientation training for elected local body members.

Health Management Information System

Block PHCs, Health Unit District Offices and Directorate of Public Health and Preventive Medicine tobe networked electronically, and the secondary and tertiary medical institutions to be linked to this network for referral and follow-up

• Feedback to service providers at field level to be ensured.

BEYOND RCH PROJECT PHASE-II

RCHP Phase.II is a time-bound project. The objectives of the project will certainly be achieved within the specified period. The Government of Tamil Nadu is, however, determined to go well beyond these objectives to the broader and noble goal of achieving €œHealth for all€ as proclaimed in the Alma Ata declaration. This goal will be achieved through an inclusive and participatory process, informed by a strong commitment to gender equality, child welfare and elimination of inequalities in access to health and nutrition.