One day Workshop on Development of Strategic Approach to Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCH+A)

Transcription

1 One day Workshop on Development of Strategic Approach to Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCH+A) Workshop Organized By RRC-VHAI in Collaboration with Department of MH&FWS, Government of Rajasthan and MOHFW, Govt. of India. Date- 3rd March 2014 Time A.M. to P.M Venue- State Institute of Health & Family Welfare (SIHFW), Jaipur, Rajasthan. 1

2 Executive Summery Background Improving the maternal and child health and their survival are central to the achievement of national health goals under the National Rural Health Mission (NRHM) as well as the Millennium Development Goals (MDG) 4 and 5. In the past seven years, innovative strategies evolved under the national program to deliver evidence-based interventions to various population groups. A substantial increase in the availability of financial resources for Reproductive and Child Health (RCH), healthcare infrastructure and workforce as the expansion of program management capacity since the launch of NRHM in 2005 provides an important opportunity to consolidate all our efforts. As we inch closer to 2015, there is an opportunity to further accelerate progress towards MDG and redefine the national agenda to come up with a coordinated approach to maternal and child health in the next five years. In order to bring greater impact through the RCH program, it is important to recognize that reproductive, maternal and child health cannot be addressed in isolation as these are closely linked to the health status of the population in various stages of life cycle. The health of an adolescent girl affects pregnancy while the health of a pregnant woman affects the health of the newborn and the child. As such, interventions may be required at various stages of life cycle, which should be mutually linked. The reasons for adopting such a strategy can be understood when the available data is taken into account and the close inter-linkages between different stages of life cycle are recognized. Birth weight is an important risk factor for child survival as children with low birth weight (LBW) are more likely to have impaired growth, higher mortality and risk of chronic adult diseases. The LBW is also a strong predictor for size in later life as most of these babies have intrauterine growth retardation, and they seldom catch-up with normal size during childhood. In India, 22% babies born each year have LBW, which has been linked to maternal under-nutrition and anemia among other causes. The mother s condition before pregnancy is a key determinant of its outcome; half of adolescents (boys and girls) have below normal body mass index (BMI) and almost 56% of adolescent girls aged years have anemia. Therefore, the nutritional status of adolescent girls and young women is inextricably linked to the birth weight of their children and subsequently to child survival. There is evidence to show that adolescent mothers are vulnerable to problems related to pregnancy and childbearing. Of all mothers, adolescent mothers are more likely to have preterm births. According to national surveys, adolescents (15 19 years) contribute about 16% of total fertility in the country and years age group contributes 45% of total maternal mortality. With substantial unmet need of contraception about 27% among married adolescents (15 19 years) and low condom use by adolescents in general, adolescent girls are at a high risk of contracting sexually transmitted infections, HIV and unintended and unplanned pregnancies. This in turn contributes to maternal morbidity and mortality due to unsafe abortions and infections. High maternal and child mortality in adolescent mothers and a smaller but significant contribution of adolescents to total fertility brings the focus back on the need to address adolescents as an integral part of the strategy so as to improve maternal and child health. 2

3 Just as different stages in the life cycle are interdependent so are the aspects of where and how healthcare is provided. Household or community education contributes to preventing health complications, quality care provided at the community level helps avoid the need for hospitalization, and sound referral systems at primary care level support early identification of risks and better treatment for acute and complicated conditions. Essential interventions to improve the health of women and children therefore need to take place at all levels in the health system, that is, from the home to the community level and through all the health facilities. Thus, there are two dimensions to healthcare: 1) Stages of the life cycle and 2) Places where the care is provided. These together constitute the Continuum of Care. This Continuum of Care approach of defining and implementing evidence-based packages of services for different stages of the lifecycle, at various levels in the health system, has been adopted under the national health program. The Plus in this strategic approach to Reproductive, Maternal, Newborn, Child plus Adolescent Health (RMNCH+A) denotes: 1) Inclusion of adolescence as a distinct life stage in the overall strategy; 2) Linking of maternal and child health to reproductive health and other components (like family planning, adolescent health, HIV, gender and Preconception and Prenatal Diagnostic Techniques (PC&PNDT); and 3) Linking of community and facility-based care as well as referrals between various levels of health care system to create a continuous care pathway, and to bring an additive /synergistic effect in terms of overall outcomes and impact This approach is likely to succeed given that India already has a community-based program (that has been given a huge fillip by the presence of 8.7 lakh ASHA workers) as well as the three-tiered health system in place. These provide a strong platform for delivery of services across the entire continuum of care, ranging from community to primary health care, as well as first referral level care to higher referral and tertiary level of care. This integrated strategy can potentially promote greater efficiencies while reducing duplication of resources and efforts in the ongoing program. By defining integrated packages of services, the Continuum of Care provides an effective framework for seamless delivery of services at state and district levels. 3

4 Taking the concern forward Regional Resource Centre VHAI organized a Workshop on Development of strategic approach to Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCH+A) on 3 March 2014 at the Conference Hall of State of Health and Family welfare, Jaipur, Rajasthan. The main objective of this workshop is to sensitize all NGOs in Rajasthan (mainly NGOs involved in state government programs and other field NGOs) on RMNCH+A strategy. The workshop was successful in bringing together the NGO's involved in Urban Health and other field NGO's for an exchange of their experiences and views of implementing RMNCH component under NRHM in Rajasthan. The workshop could bring forth the areas where the state government officials perceive the involvement of NGOs essential for an improved delivery and outreach of health services. Proceedings Mr. Satyen Chaturvedi, Executive Director, Rajasthan VHA welcomed the Chief Guest Mr. Niraj K Pawan - Additional Director, Dr. R.P. Jain- Director of Immunization and Maternal health, Dr. Santosh Gandhi, Ms. Archana Sharma- Consultant NGO & ARSH and all participant NGOs. He took few moments to explain the key focal areas of this one day workshop followed by a brief discussion on the situation of Maternal and Child Health in Rajasthan and his view point towards RMNCH+A initiative. Objectives of the workshop: An understanding of Continuum of care, which includes integrated service delivery in various life stages including the adolescence, pre-pregnancy, childbirth and postnatal period, childhood and through reproductive age. Introduction of new initiatives like the use of Score card to track the performance, National Iron + Initiative to address the issue of anemia across all age groups and the Comprehensive Screening and Early interventions for defects at birth, diseases and deficiencies among children and adolescents. 5 X 5 matrix for High Impact RMNCH+A Interventions. He told that the situation of health indicator in our country has been improving with the growing time but in comparison with some other state Rajasthan remains in the same situation as it was before 10 years. He said that the State needs to coordinate with NGOs for outreach RMNCH+A activities. 4

5 He discussed briefly about the objectives of the Development of strategic approach to Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCH+A) Ms. Mousumi Gupta, RRC coordinator has started the session with introduction of the entire participants. Then she briefed the participants about the Voluntary Health Association of India (VHAI) and Regional resource Centre (RRC). She said that undoubtedly NRHM has strengthened the Health Sector and ASHA being one of the important part in implementing the programme must be extended support in terms of regular training and recognition. She further explicated the RMNCH+A Strategy with special focus on the following points Historical background of RMNCH+A Milestone of Family welfare program Health outcome goals established in the 12 th five-year plan Rational of RMNCH+A Strategy Strategic RMNCH+A intervention across life stages The component of Health systems strengthening for RMNCH+A services Need of engaging Village Health and Nutrition Committees and Rogi Kalyan Samiti She then discussed about the meaning of plus in the strategic approach of RMNCH+A, which denotes inclusion of Adolescent as a distinct life style in overall strategy and linking of maternal and child health. Dr. Santosh Gandhi, discussed about the Reproductive, Maternal, Newborn, Child and Adolescent health strategy. She pointed out the below concerns regarding the improvement of health services. She further talked about the causes of maternal deaths like medical causes, social causes, economic causes and System causes; Medical Causes like lack of health care facility in the remote areas, Social causes like age of marriage, less spacing between pregnancies, Low literacy and Social disadvantages group (SC/ST) etc Economic causes like lack of proper awareness regarding the services, out of pocket expenditure increases and poverty play its role over there System causes like, access to family planning method, access to safe abortion service, quality of services, abuses etc. 5

6 She has mentioned about three delays i.e. delay in deciding, delay in reaching and delay in services as the main reason for maternal death. She also discussed briefly about pregnancy and newborn care, reproductive health care, antenatal care, postnatal care and child healthcare. Mr. Niraj K Pawan, Additional Mission Director, NHM talked about the importance of the implementation of the RMNCH+A program in Rajasthan. He showed his concern about the maternal and child death in our country by saying that though there is tons of effort implementing in order to improve the Maternal and child health scenario in our country, until today we allowed 255 per lakh mothers and 49 per thousand new born to die. He said Government cannot alone reach to the target of reducing of IMR and MMR that s why in RMNCH+A Strategy NGOs/MNGO/CSOs are called to collaborate in the mission of saving mother and child of our country. Government cannot alone curb this national problem of IMR and MMR. To achieve the Millennium Development Goals, partnership with NGOs/CBOs has been recognized as an important strategy of spreading awareness, trainings and capacity building and provision of health services. NGOs can have an important role in complementing the government initiatives in a meaningful implementation of the RMNCH+A strategy. Dr. R.P. Jain Director-Immunization and Maternal health discussed about Child health and Immunization. He shared milestone in the immunization program in India. He talked about the main component of full immunization. He also discussed about the ways and means of improving Immunization in Rajasthan. He pointed out some important components of Child Health like: Complementary feeding, IFA supplementation and focus on nutrition Diarrhoea management at community level using ORS and Zinc Management of pneumonia Full immunization coverage Rashtriya Bal Swasthya Karyakram (RBSK): screening of children for 4Ds (birth defects, development delays, deficiencies and disease) and its management Oral Rehydration Salt (ORS) Zinc Sulphate Dispersible Tablets Syrup Salbutamol & Salbutamol nebulising solution Vaccines - DPT, Measles 6

7 Syrup Vitamin A At the end of his session he shared the tag line MAKE YOUR CHILD A VIP ; V-Vaccinated, I- Immunized, P-Protected. As the Adolescent component is added in RMNCH+A intervention, there was a detailed discussion on the Adolescent Health under RMNCH+A Initiative by Ms. Archana Sharma, Consultant NGO & ARSH, Govt. of Rajasthan. She explained Coverage Targets for key RMNCH+A Interventions for 2017: Reduce anemia in adolescent girls and boys (15 19 years) at annual rate of 6% from the baseline of 56% and 30%, respectively(nfhs 3) Decrease the proportion of total fertility contributed by adolescents (15 19 years) at annual rate of 3.8% per year from the baseline of 16% (NFHS 3) In her discussion, Ms. Archana Sharma also discussed Adolescent Health - 5 X 5 Matrix; (High Coverage & High Quality) which indicate: Address teenage pregnancy and increase contraceptive prevalence in adolescents Introduce Community based services through peer educators Strengthen ARSH clinics Roll out National Iron Plus Initiative including weekly IFA supplementation Promote Menstrual Hygiene Then Ms. Mousumi Gupta, RRC Coordinator initiated a session on Experience Sharing on Implementation of NRHM in Rajasthan. All the participants shared their experience and specially mentioned that due to ASHA programme of NRHM helped the health status of Rajasthan to increase in all the indicators except few districts, which they hope that in next few years will change a lot. They also stressed upon the need of selection of credible NGOs for the capacity building of ASHAs and VHSC members on a sustained basis. They further stated that there is a need of proper handholding for ASHAs. The workshop ended with concluding remarks and vote of thanks by Ms. Mousumi Gupta, RRC Coordinator. She expressed the gratitude on behalf of all NGOs present to all the state and district officials for sparing time and actively participating in the workshop. She mentioned that the NGO representatives have shared the key areas of RMNCH+A where credible NGOs must work with the government for a better delivery of services. NGOs having community presence and ability of reaching the difficult areas must be involved towards realizing the vision of NRHM. The workshop was a very successful with thematic presentations and active discussion with district and state representatives. 7

8 ANNEXTURE 1 Clips of the Day 8

9 Annexure 2 News of the Day 9

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11 Annexure- 3 One day Workshop on Development of strategic approach to Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCH+A) Date: 03 March 2014 Venue: State Institute of health and family welfare, Jhalana Institutional Area, South of Doordarshan Kendra, Jaipur, Rajasthan. Participants- 50 S. No. Timings Session détails Resource Person 1. 9: a.m. Registration Session 1: Opening Session 2. 10:00-10:10 a.m. Welcome address Objectives of the workshop Shri Satyen Chaturvedi, Executive Director, Rajasthan VHA a.m. Introduction Facilitated by Ms. Mousumi Gupta a.m. Inauguration of the workshop & Inaugural Address by the Chief Guest Mission Director (NRHM) / Director RCH a.m. Introduction of RMNCH+A Ms. Mousumi Gupta, RRC Coordinator a.m. Tea Break a.m p.m. Maternal & Newborn Health Dr. Santosh Gandhi p.m. Child Health/ Immunization Dr. R.P. Jain, Director Immunization and Maternal Health, Govt. of Rajasthan p.m. Adolescent health in Rajsthan context Ms. Archana Sharma, Consultant NGO & ARSH, Govt. of Rajasthan p.m. Open Discussion p.m. Lunch p.m. Experience Sharing on Implementation of NRHM in Rajasthan NGO representative/s p.m. Tea Break p.m. Concluding remarks Facilitated by Ms. Mousumi Gupta, RRC Coordinator 11

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