Family Welfare Programme in India

Family Welfare Programme in India FAMILY WELFARE STATISTICS IN INDIA - 2009 SUMMARY DEMOGRAPHIC PROFILE OF INDIA 1.0 POPULATION 1.1 As per Census 2001, the population of the country was 1029 million with 533 million males and 496 million females. Every year around 16 million people are added to the population,creating more demand for additional resources like clothing, housing, food, education, health etc. At present, India accounts for only 2.4% of world land area, supports as much as about 17% of the world s population. The projected population and proportion (percent) of population by broad age-group as on 1st March, 2001-2026 as per Report of the Technical group on Population Projections Ministry of Health & FW(May 2006) are as below: - Year Population (in millions) 0-14 (years) Proportion (percent) 15-59 (years) 15-49 (years) (Female Population) 60+ (years) 2001 1029 35.4 57.7 51.1 6.9 2006 1112 32.1 60.4 53.1 7.5 2011 1193 29.1 62.6 54.5 8.3 2016 1269 26.8 63.9 54.8 9.3 2021 1340 25.1 64.2 54.1 10.7 2026 1400 23.4 64.3 53.3 12.4 Although, the net addition in population during each decade has increased consistently, the change in net addition has shown a steady declining trend over the decades starting from 1961 India continues to grow in size but its pace of net addition is on the decrease since 1961 1.2 As per 2001 Population census, the sex ratio (number of females for every 1000 males), of the country is 933, which is higher than 927 as per 1991 census. 1.3 Crude Birth Rate (CBR) as per Sample Registration System (SRS)-2008 at the national level has declined to 22.8 per 1000 population from 29.5 in 1991. Among major States, Uttar Pradesh (29.1) Bihar (28.9), Madhya Pradesh (28.0), Rajasthan (27.5), Assam (23.9) and 25

Haryana (23.0) recorded higher crude birth rate than the national average. Among smaller States/UTs, D&N Haveli (27.0), Chattisgarh (26.1), Jharkhand (25.8) and Meghalaya (25.2) recorded higher birth rate than the national average. The lowest birth rate was recorded in the state of Kerala (14.6) among major States while Tripura (15.4) recorded the lowest birth rate during 2008 among smaller States/UTs. The Crude Birth Rate (CBR) at all India level has declined from 36.9 in 1971 to 33.9 in 1981 registering a fall of about 8.1 percent, whereas during the period from 1991 to 2008, the decline is 22.7 percent from 29.5 to 22.8. The rural urban differential has narrowed down, though CBR in rural areas is higher than in urban. 1.4 Crude Death Rate (CDR) as per SRS 2008 at the national level is 7.4. The States of Assam (8.6), Bihar(7.3), Chattisgarh (8.1) Madhya Pradesh (8.6), Orissa (9.0), Uttar Pradesh (8.4), recorded higher CDR than the national average while among the smaller states and UTs, Meghalaya & Puducherry has recorded higher CDR than the national average. 1.5 Infant Mortality Rate (IMR) at national level was estimated at 53 as per SRS 2008. The State of Assam (64) Bihar (56) Chhattisgarh (57) Madhya Pradesh (70), Orissa (69), Rajasthan (63) and Uttar Pradesh (67) recorded higher IMR than the national average. The state of Kerala has the lowest IMR at 12 followed by Tamil Nadu (31), Maharashtra (33) and West Bengal (35). 26

1.6 Child Mortality Rate (0-4): As per SRS estimates, the Child Mortality Rate has come down from 57.3 in 1972 to 26.5 in 1991 and 16.0 in 2007. The Child Mortality Rate has been recorded the highest in Madhya Pradesh (23.5) followed by Uttar Pradesh (22.3) and Orissa (20.0) and the lowest in Kerala (2.8) per thousand children. SUMMARY 1.7 Natural Growth Rate: The natural growth rate, which is the difference between the birth rate and death rate, was estimated 1.57% in 2007 against 1.97 % in 1991. 1.8 The State/UT wise position of selected Demographic indicators of the States/Union Territories are given Section-A. 2.0 IMPACT OF FAMILY WELFARE PROGRAMMES SINCE INCEPTION 2.1 The achievement of the Family Welfare Programme since its inception is as below: Sl. No. Parameters 1951 1981 1991 Current Levels 1 Crude Birth Rate (per 1000 population 2 Crude Death Rate (per 1000 population) 40.8 33.9 29.5 22.8 (2008) 25.1 12.5 9.8 7.4 (2008) 3 Total Fertility Rate 6.0 4.5 3.6 2.6 (2008) 4 Maternal Mortality Ratio (per 100,000 live births) 5 Infant Mortality Rate (per 1000 live births) 6 Child Mortality Rate (0-4 yrs.) per 1000 children NA NA 398 SRS (1997-98) 146 (1951-61) 57.3 (1972) 7 Couple Protection Rate (%) 10.4 (1971) 8 Expectation of life at birth in years -Male -Female 37.1 36.1 (1951) 254 SRS (2004-06) 110 80 53 (2008) 41.2 26.5 16.0 (2007) 22.8 44.1 46.5 (2008) 54.1 54.7 60.6 61.7 (1991-96) 62.6 64.2 (2002-06) Source: Office of Registrar General of India, except 7 above which is based on estimation done by statistics Division of Ministry of Health and Family Welafre. NA Not available 2.2 Growth Rate as per Census: In-spite of steep fall in death rate from 22.8 during 1951-61 to 8.7 in 1999, the annual exponential growth rate of population had been steadily increasing from 1.25% during 1941-51 to 2.22% during 1971-81. But, it came down to 2.14% during 1981-91 and finally to 1.93% during 1991-2001. The states of J&K, Bihar, Rajasthan, Haryana, UP, MP, Jharkhand, Maharashtra and Gujarat recorded higher exponential growth rate than national average during 1991-2001. The lowest growth rate has been observed in respect of Kerala (0.90%). 27

3.0 FAMILY PLANNING PROGRAMME Deep-rooted customs, traditions and socio-cultural beliefs favour large family size in many parts of the country and impede the process of change which would accelerate the willing adoption of the small family norm. Socio-economic factors such as female literacy, age at marriage of girls, status of women, strong son preference and status of employment of women have a crucial bearing on the fertility behaviour of the people. The total number of family planning acceptors have increased from 6.49 million 1980-81 to 27.36 million in 1990-91 and 36.63 million in 2000-01. The total number of acceptors in the year 2007-08 were 48.78 million 28

The number of couples accepting limiting method though have increased from 2.05 million in 1980-81 to 4.9 million in 1985-86 but there is a sharp decline in performance level during 1996-97, the year Target Free Approach was adopted by the Government of India. The declining trend observed in 2005-06 and 2006-07 has also been reversed in 2007-08. SUMMARY 3.1 All India Family Planning Acceptors by Methods since inception of the Programme Year Sterilisations IUD Insertions Equivalent CC Users Equivalent O.P. Users 1956 7 - - - 1957 14 - - - 1958 25 - - - 1959 42 - - - 1960 64 - - - 1961 105 - - - 1962 158 - - - 1963 170 298-1964 270 439-1965-66* 671 813 582-1966-67 887 910 465-1967-68 1840 669 475-1968-69 1665 479 961-1969-70 1422 459 1509-1970-71 1330 476 1963 @ - 1971-72 2187 488 2354 @ - 1972-73 3122 355 2398 @ - 1973-74 942 372 3010 @ - 1974-75 1354 433 2521 @ - 1975-76 2669 607 3527 @ 32 1976-77 8261 581 3634 58 1977-78 949 326 3175 78 1978-79 1484 552 3387 82 1979-80 1778 635 2987 82 1980-81 2053 628 3718 91 1981-82 2792 751 4439 120 1982-83 3983 1097 5765 183 29

3.1 All India Family Planning Acceptors by Methods since inception of the Programme Year Sterilisations IUD Insertions Equivalent CC Users Equivalent O.P. Users 1983-84 4532 2134 7661 729 1984-85 4085 2562 8505 1290 1985-86 4902 3274 9387 1358 1986-87 5043 3935 9825 1829 1987-88 4940 4356 11342 2064 1988-89 4678 4851 12422 2416 1989-90 4188 4942 14159 2793 1990-91 4126 5370 14735 3125 1991-92 4090 4386 13875 3366 1992-93 4286 4740 15004 3001 1993-94 4497 6017 17283 4302 1994-95 4580 6702 17707 4873 1995-96 4422 6858 17297 5091 1996-97 3870 5681 17214 5250 1997-98 4,239 6,173 16,796 6,395 1998-99 4,207 6,083 17,448 6,944 1999-00 4,595 6,200 18,135 7,747 2000-01 4,735 6,047 18,204 7,640 2001-02 4,828 6,273 17,820 8,685 2002-03 4,903 6,148 22,604 9,413 2003-04 4,926 6,115 23,837 9,918 2004-05 4,926 6,172 23,724 9,135 2005-06 4,705 6,184 26,188 9,516 2006-07 4,577 5,978 26,737 9,714 2007-08** 5,019 6,072 26,799 10,893 * - Fig. Jan to March @ - Net of Nirodh distributed free to vasectomisied cases; ** - provisional $ Excluding Branded Fig. 3.2 Family Planning Performance The year 2007-08 ended with 48.78 million total family planning acceptors at national level comprising 5.02 million Sterilisations, 6.07 million IUD insertions, 26.80 million condom users and 10.89 million O.P. users as against 47.01 million total family planning acceptors in 2006-07. 3.2.1 Sterilisation: A total of 5.02 million sterilisations were done in the country during 2007-08 as against 4.58 million in 2006-07. Assam, Bihar, Chattisgarh, Gujarat, Jharkhand,Madhya Pradesh, Orissa, Punjab, Rajasthan, Uttar Pradesh, West Bengal Arunachal Pradesh, Delhi, Himachal Pradesh, Jammu & Kashmir, Nagaland, Uttarakhand, reported better performance in 2007-08 than in 2006-07. 3.2.2 Vasectomy and Tubectomy: The proportion of tubectomies to total sterilistions was 30

95.5 percent in 2007-08 as against 97.3 percent in 2006-07. Of the total number of 4.79 million tubectomy operations reported for 2007-08, technique-wise break-up was available for all the operations, of these, 33.0 per cent were done by laparoscopic technique. SUMMARY 3.2.3 IUD Insertions: During the year 2007-08, 6.07 million insertions were reported as against 5.98 in 2006-07. Andhra Pradesh, Chhatisgarh, Gujarat, Haryana, Jharkhand, Madhya Pr, Rajasthan, Uttar Pradesh, West Bengal, Nagaland, Sikkim and Uttarakhand reported better performance in 2007-08 than in 2006-07. 3.2.4 Condom Users and O.P. Users: Based on the distribution figures reported, there were 26.80 million equivalent users of Condoms and 10.89 million equivalent users of Oral Pills during 2007-08. 4.0 POLICY FRAMEWORK 4.1 POPULATION STABILISATION 4.1.1 National Population Policy, 2000 4.1.1.1 Government has adopted a National Population Policy in February, 2000 which provides for holistic approach for achieving population stabilization in the country. The Policy affirms the commitment of the Government towards voluntary and informed choice and consent of citizens while availing of reproductive health care services, and continuation of the target free approach in administering family planning services. The Policy enumerates certain sociodemographic goals to be achieved by 2010, which will lead to achieving population stabilization by 2045. The Policy has also prescribed an Action Plan for implementing the strategic themes listed in the Policy. 4.1.1.2 The immediate objective of the National Population Policy is to address the unmet needs of contraception, health care infrastructure, health personnel and to provide integrated service delivery for basic reproductive and child health care. The medium term objective is to bring the total fertility rate to replacement level by 2010, through vigorous implementation of inter sectoral operational strategies. The long-term objective is to achieve population stabilization by 2045, at a level consistent with the requirements of sustainable economic growth, social development and environmental protection. 4.2.1 National Commission on Population National Commission on Population was constituted under the Chairmanship of Hon ble Prime Minister of India vide Government of India Gazette Notification dated 11th May 2000. The Commission started functioning from its Secretariat at Planning Commission, Yojana Bhavan. However, in February 2005, the Commission was re-constituted as per the decision of Cabinet and its Secretariat was shifted from Planning Commission, Yojana Bhavan to Ministry of Health & FW. The Chairman of the re-constituted Commission remained Hon ble Prime Minister of India, Deputy Chairman of the Planning Commission and the Minister of Health & FW, the two Vice Chairmen and Secretary, FW, as the Member-Secretary of the Commission. 31

The Terms of reference of the Commission are as follows: - To review, monitor and give directions for the implementation of the National Population Policy with a view to meeting the goals set out in the policy. To promote synergy between demographic, educational, environmental and developmental programmes so as to hasten population stabilization. To promote inter-sectoral coordination in planning and implementation across government agencies of the Central and State Governments, to involve the civil society and the private sector and to explore the possibilities of international cooperation in support of the goals set out in the Policy. To facilitate the development of a vigorous people s movement in support of this national effort. 4.2.2 The first meeting of the reconstituted National commission on Population was held under the chairmanship of Hon ble Prime Minister on 23rd July 2005. The following decisions were taken in the meeting: - Conduct of an Annual Health Survey of all districts which could be published annually so that health indicators at district level are periodically published, monitored and compared against benchmarks Setting up of five groups of experts for studying the population profile of the States of Bihar, Uttar Pradesh, Rajasthan, Madhya Pradesh and Orissa to identify weaknesses in the health delivery systems and to suggest measures that would be taken to improve the health and demographic status of the States. 4.2.3 In accordance with the above decision, the following measures have been taken to implement the decisions:- i. Ministry of Health & Family Welfare had wide ranging discussion with Office of Registrar General, Planning Commission and Prime Minister Office for conducting Annual Health Survey (AHS) and Office of Registrar General of India (RGI) has been identified as the nodal organization for conducting the AHS. Subsequently 108 posts have been created in the office of RGI for supervising the work of AHS. The fieldwork shall be undertaken through independent agencies selected through open bidding. ii. Five Experts Groups have been constituted on 29th September 2005 for studying the population profile of the States of Bihar, Uttar Pradesh, Rajasthan, Madhya Pradesh and Orissa in order to identify weaknesses in the health delivery systems and to suggest measures to improve the health and demographic status of these States. 32

4.2.4 State Population Commissions FAMILY WELFARE STATISTICS IN INDIA - 2009 SUMMARY State Population Commissions have been constituted in 20 States/UTs. viz. Andhra Pradesh, Arunachal Pradesh, Assam, Haryana, Himachal Pradesh, J&K, Kerala, Madhya Pradesh, Gujarat, Uttar Pradesh, Maharashtra, West Bengal, Meghalaya, Mizoram, Punjab, Rajasthan, Sikkim, Tamil Nadu, Andaman & Nicobar Island and Lakshadweep. 4.2.5 Janasankhya Sthirata Kosh In the inaugural address of National Commission on Population held on 22nd July 2000, the Prime Minister had announced the constitution of the National Population Stabilization Fund (NPSF), which was set up under National Commission on Population. Subsequently, the NPSF was transferred to the Department of Family Welfare in April 2002. It was renamed and registered as Janasankhya Sthirata Kosh (JSK) under the Societies Registration Act, 1860 in June, 2003. The objective of JSK is to facilitate the attainment of the goals of National Population Policy 2000 and support projects, schemes, initiatives and innovative ideas designed to help population stabilization both in the Government and Voluntary sectors, and provide a window for canalizing resources through voluntary contributions from individuals, industry, trade organizations and other legal entities in furtherance of the national cause of population stabilization. The General Body of the JSK is chaired by the Minister for Health and Family Welfare, while the Governing Board is chaired by the Secretary (H&FW). The Executive Director, selected from the civil society, is the Chief Executive Officer of the Kosh. Some of the major strategies initiated by JSK are given below: - GIS Mapping JSK has mapped 485 districts through a unique amalgamation of GIS Maps and Census Data which gives a picture of each district, its sub-division and the population of every village along with its basic health infrastructure. Easily accessible on the internet the maps highlight inequalities in coverage down to every village of the country at the touch of a button. Call Centre JSK has established a Call Centre to give authentic information on reproductive and infant health in English and Hindi, using computer based software. Trained agents give advice to adolescents, newly married and about-to-be married couples and others who seek guidance. The Call Centre number (011-66665555) is being accessed from different parts of the country and provides information anonymously in English or Hindi. Website JSK s website is accessed on an average 475 pages per day with 89% Indian visits and 11% international visits. Most sought after subjects are sexual health (in Hindi) and the district health facilities through GIS mapping. 33

Prerna Strategy JSK has introduce a Responsible Parenthood model called Prerna to reward couples in high focus districts who voluntarily delay the age of marriage, allow girls stay in school and to couples that plan their family in the interest of the health of the mother and child. JSK gives rewards for couples if they satisfy the following conditions: Girl s marriage after 19 years of age. (Reward of Rs.5000/-) Giving birth to the first child after the mother was 21 years old. (Reward of Rs.7000/- if it s a girl child & Rs 5000/- if it s a boy) Keeping a 36 month gap between first and second child, and one parent getting sterilized after the second child is born.(reward of Rs.7000/- if it s a girl child & Rs 5000/- if it s a boy) Coupled with: Registration of Marriage Registration of birth JSK has introduced the Prerna strategy in Madhya Pradesh and Rajasthan. Santushti Strategy: This strategy provides an opportunity to private sector gynaecologists / vasectomy surgeons to conduct operations in Public Private Partnership mode and to receive payment according to compensation rates notified by the Ministry of Health and Family Welfare. Santushti is a fast-track strategy which enables an accredited facility to get Rs.1.5 lakhs for conducting 100 surgeries with a Rs.15,000 start up advance. Rs. 500 more is also being given per case provided an accredited nursing home conducts 30 or more cases in a day. This strategy was initiated in Madhya Pradesh and Rajasthan. Involving Private O&G Practitioner for IUCD 380 A: JSK has involved the private sector in promoting the intra-uterine contraceptive device called IUCD 380A which gives protection for 10 years. 4.3 NATIONAL RURAL HEALTH MISSION The honorable Prime minister of India launched the National Rural Health Mission in April 2005. The National Rural Health Mission (2005-12) seeks to provide effective healthcare to rural population throughout the country with special focus on 18 states, which have weak public health indicators and/or weak infrastructure. These 18 States are Arunachal Pradesh, Assam, Bihar, Chhattisgarh, Himachal Pradesh, Jharkhand, Jammu & Kashmir, Manipur, Mizoram, Meghalaya, Madhya Pradesh, Nagaland, Orissa, Rajasthan, Sikkim, Tripura, Uttaranchal and Uttar Pradesh. The Mission is an articulation of the commitment of the Government to raise public spending on Health from 0.9% of GDP to 2-3% of GDP. It aims to undertake architectural 34

correction of the health system to enable it to effectively handle increased allocations as promised under the National Common Minimum Programme and promote policies that strengthen public health management and service delivery in the country. It has as its key components provision of a female health activist (ASHA) in each village; a village health plan prepared through a local team headed by the Health & Sanitation Committee of the Panchayat; strengthening of the rural hospital for effective curative care and made measurable and accountable to the community through Indian Public Health Standards (IPHS); and integration of vertical Health & Family Welfare Programmes and Funds for optimal utilization of funds and infrastructure and strengthening delivery of primary healthcare. It seeks to revitalize local health traditions and mainstream AYUSH into the public health system. It aims at effective integration of health concerns with determinants of health like sanitation & hygiene, nutrition, and safe drinking water through a District Plan for Health. It seeks decentralization of programmes for district management of health. It seeks to address the inter-state and inter-district disparities, especially among the 18 high focus States, including unmet needs for public health infrastructure. It shall define time-bound goals and report publicly on their progress. It seeks to improve access of rural people, especially poor women and children, to equitable, affordable, accountable and effective primary healthcare. SUMMARY 4.3.1 GOALS Reduction in Infant Mortality Rate (IMR) and Maternal Mortality Ratio (MMR) Universal access to public health services such as Women s health, child health, water, sanitation & hygiene, immunization, and Nutrition. Prevention and control of communicable and non-communicable diseases, including locally endemic diseases Access to integrated comprehensive primary healthcare Population stabilization, gender and demographic balance. Revitalize local health traditions and mainstream AYUSH. Promotion of healthy life styles. 4.4 PRE-CONCEPTION & PRE NATAL DIAGNOSTIC TECHNIQUES (PROHIBITION OF SEX SELECTION) ACT, 1994 4.4.1 The Pre-natal diagnostic techniques like amniocentesis and Sonography are useful for the detection of genetic or chromosomal disorders or congenital malformations or sex linked disorders, etc. However, this technology is misused on a large scale for sex determination of the foetus and mostly if the foetus is pronounced as female, this prompts termination of the pregnancy and brings to an end the unborn child. 4.4.2 In order to check female foeticide, the Pre-conception & Pre-natal Diagnostic Techniques(Prohibition of Sex Selection) Act, 1994 and the Rules framed there-under were 35

brought into operation from 1st January, 1996. The Act prohibits determination and disclosure of the sex of foetus, advertisements of facilities relating to pre-natal determination of sex and prescribes punishment for contravention of its provisions. The person who contravenes the provisions of this Act is punishable with imprisonment upto 5 years and fine upto Rs 100,000. 4.4.3 Under the Act, facility of pre-natal diagnostic techniques and genetic counseling is to be provided only at clinics registered under the Act. Use of these techniques is permissible solely for detection of certain abnormalities (like Chromosomal abnormalities, genetic metabolic diseases, sex linked genetic diseases, etc.) subject to specified conditions. 4.4.4 As per the direction of the Hon ble Supreme Court of India the Act has been amended keeping in view the emerging technologies like selection of sex before conception and difficulties encountered in implementation of the Act. 4.4.5 Overall guidance for implementation of the Act is provided through a Central Supervisory Board under the chairmanship of Minister of Health and Family Welfare. The Board consists of 23 Members including 10 Non-official Members from various fields, Members of Parliament and representatives of States/UTs. The main functions of the Central Supervisory Board are to advise the Government on the Act and Rules and recommend changes therein to create public awareness against sex selection and sex determination. Meetings of the Central Supervisory Board are held within six months. 4.4.6 The PC&PNDT Act provides for two main instruments for implementation: (a) Central Supervisory Board at the Central Government level and (b) State Supervisory Board at State level, Appropriate Authorities at States/UTs, district and sub-district level assisted by the Advisory Committees. 4.4.7 Workshops/Seminars are organised at National, State/district level, to create awareness about the provisions of the Act. Voluntary Organisations are also being involved to carry out projects for creating awareness about the provisions of the Act. 5.0 PROGRAMMES/SCHEMES 5.1 Basic Infrastructure 5.1.1 Family Welfare services are provided to the community through a network of Subcentres, Primary Health Centres(PHCs) and Community Health Centres (CHCs) in the rural areas and Hospitals and Dispensaries etc. in the urban areas. 5.1.2 An Auxiliary Nurse Midwife (ANM), a female paramedical worker posted at the Sub- Centre and supported by a Male Multipurpose Worker MPW (M) is the front line worker in providing the Family Welfare services to the community. ANM is supervised by the Lady Health Visitor (LHV) posted at PHC. 5.1.3 For skill development of medical and paramedical workers deployed at the sub-centres, PHCs and CHCs etc., training is being imparted through 47 Health and Family Welfare Training centres; 42 Lady Health Visitor Training Schools, 56 Basic Training Schools for Multipurpose 36

Worker (Male) and 324 ANM Training Schools. FAMILY WELFARE STATISTICS IN INDIA - 2009 SUMMARY 5.1.4 The Primary Health Care infrastructure in rural areas has been developed as a threetier system. The norms for establishing Sub centres, PHCs and CHCs are as under: Centre Plain Area Populatiton Norms Hilly/Tribal Area Sub Centre 5000 3000 PHC 30000 20000 CHC 120000 80000 5.1.5 Sub-Centres (SCs) The Sub-Centre is the most peripheral and first contact point between the primary health care system and the community. Each Sub-Centre is manned by one Auxiliary Nurse Midwife (ANM) and one Male Health Worker MPW(M). One Lady Health Worker (LHV) is entrusted with the task of supervision of six Sub-Centres. Sub-Centres are assigned tasks relating to interpersonal communication in order to bring about behavioural change and provide services in relation to maternal and child health, family welfare, nutrition, immunization, diarrhoea control and control of communicable diseases programmes. The Sub-Centres are provided with basic drugs for minor ailments needed for taking care of essential health needs of men, women and children. The Ministry of Health & Family Welfare is providing 100% Central assistance to all the Sub- Centres in the country since April 2002 in the form of salary of ANMs and LHVs, rent at the rate of Rs.3000/- per annum and contingency at the rate of Rs.3200/- per annum, in addition to drugs and equipment kits. An amount of Rs.10,000 per annum is also provided to each sub-centre as untied fund under NRHM. The salary of the Male Worker is borne by the State Governments. Under the Swap Scheme, the Government of India has taken over an additional 39,554 Sub Centres from State Governments1Union Territories since April, 2002 in lieu of 5,434 number of Rural Family Welfare Centres transferred to the State Governments/Union Territories. There are 1,46,036 Sub Centres functioning in the country as on March 2008. 5.1.6 Primary Health Centres (PHCs) PHC is the first contact point between village community and the Medical Officer. The PHCs were envisaged to provide an integrated curative and preventive health care to the rural population with emphasis on preventive and promotive aspects of health care. The PHCs are established and maintained by the State Governments under the Minimum Needs Programme (MNP)/ Basic Minimum Services Programme (BMS). At present, a PHC is manned by a Medical Officer supported by 14 paramedical and other staff. It acts as a referral unit for 6 Sub Centres. It has 4-6 beds for patients. The activities of PHC involve curative, preventive, primitive and Family Welfare Services. There are 23458 PHCs functioning as on March 2008 in the country. 5.1.7 Community Health Centres (CHCs) CHCs are being established and maintained by the State Government under MNP/BMS 37

programme.it is manned by four medical specialists i.e. Surgeon, Physician, Gynecologist and Pediatrician supported by 21 paramedical and other staff. It has 30 in-door beds with one OT, X-ray, Labour Room and Laboratory facilities. It serves as a referral centre for 4 PHCs and also provides facilities for obstetric care and specialist consultations. As on March, 2008, there are 4,276 CHCs functioning in the country. 5.2 Reproductive Child Health (RCH) Programme Reproductive and Child Health Programme is a major component of NRHM and aims at reduction of Infant Mortality Rate to 30/1000, Maternal Mortality Ratio to 100/100000 live births and Total Fertility Rate to 2.1. These targets are to be achieved by 2010. Against these goals, IMR of 55/1000 live births, (SRS 2007) MMR of 254/100000 live births (SRS 2006) and Total Fertility Rate of 2.7 (SRS 2007) have been achieved. Rapid urbanization has led to rapid increase in the number of urban poor, majority of whom live in slums. In order to improve the health status of the urban poor particularly the slum dwellers and other disadvantaged sections by facilitating equitable access to quality health care with the active involvement of the Urban Local Bodies (ULBs) in cities with population of one lakh and above and State Capitals, the National Urban Health Mission (NUHM) has been planned. The NUHM would be covering 21.07 crore urban population with a special focus on 6.25 crore urban poor living in slums and beyond, spread over 430 cities. The proposed financial outlay is Rs.6207.84 crore in the XIth Plan. 5.3 Janani Suraksha Yojana The Jannani Suraksha Yojana (JSY) is a 100% centrally sponsored scheme and it integrates cash assistance with delivery and post delivery care. The scheme was launched with focus on demand promotion for institutional deliveries in states and regions where these are low. It targeted lowering of MMR by ensuring that deliveries were conducted by Skilled Birth Attendants at every birth. The Yojana has identified ASHA, the accredited social health activist as an effective link between the Government and the poor pregnant women in l0 low performing states, namely the 8 EAG states and Assam and J&K and the remaining NE States. In other eligible states and UTs, wherever, AWW and TBAs or ASHA like activist has been engaged for this purpose, they can be associated with this Yojana for providing the services. The JSY scheme has shown phenomenal growth in the last three years. Starting with a modest number of 7.39 Lakhs beneficiaries in 2006-07, the total number reached 73.29 Lakhs in the year 2007-08 -a Ten Fold growth. 5.4 Family Welfare Linked Health Insurance Scheme As a measure to encourage people to adopt permanent method of Family Planning, this Ministry has been implementing a Centrally Sponsored Scheme since 1981 to compensate the acceptors of sterilization for the loss of wages for the day on which he/she attended the medical facility for undergoing sterilization. Apart from providing for cash compensation to the acceptor of sterilisaion some States/UTs were apportioning some amount for creating a miscellaneous purpose fund utilized for payment of ex-gratia to the acceptor of sterilisaion or his/her nominee in the unlikely event of his/her death or incapacitation or for treatment of post operative complications attributable to the procedure of sterilization. 38

Under the existing government scheme no compensation was payable for failure of sterilization, and no indemnity cover was provided to Doctors/health facilities providing professional services for conducting sterilization procedures etc. With a view to do away with the complicated process of payment of ex-gratia to the acceptors of Sterilisation for treatment of post operative complications, incapacitation or death attributable to the procedure of sterilization, the Family Planning Insurance Scheme was introduced w.e.f 29th November, 2005 for a period of one year to take care of the cases of failure of Sterilisation, medical complications or death resulting from Sterilisation, and also provide indemnity cover to the doctor / health facility performing Sterilisation procedure, with Oriental Insurance Co. and was subsequently renewed for one more year from 29.11.2006 to 31.12.2007 with OIC. SUMMARY Benefits after renewal of the Scheme w.e.f. 29th November, 2006 to 31.12.2007 (2nd Year) Section Coverage Limits I IA Death following sterilization in hospital or within 7 days from the date of discharge from the hospital. II IB Death following sterilization within 8-30 days from the date of discharge from the hospital. Total liability of the insurance Company shall not exceed Rs. 9 crores in a year under each section. Renewal of the Scheme/Policy for the third year i.e.1.1.2008 to 31.12.2008 has been done with ICICI with the increase in the amount for sterilization failure from Rs.25,000 to Rs.30,000 and other benefits to the acceptors and indemnity cover to the doctors remaining the same as in the previous year policy,i.e., table as above. ICICI has again qualified through open tender process for continuation of the Policy under Family Planning Insurance Scheme. 5.5 Compensation for Acceptors of Sterilisation Rs. 2 lakh. Rs. 50,000/-. IC Failure of Sterilisation Rs 25,000/-. ID Cost of treatment upto 60 days arising out of complication from the date of discharge. Indemnity Insurance per Doctor/facility but not more than 4 cases in a year. Upto Rs. 2 Lakh per claim Actual not exceeding Rs 25,000/-. With a view to encourage people to adopt permanent method of Family Planning, Government has been implementing a Centrally Sponsored Scheme since 1981 to compensate the acceptors of sterilization for the loss of wages for the day on which he/she attended the medical facility for undergoing sterilization. Under the Scheme, the Central Government have been releasing funds to States/UTs. The compensation package has been revised w.e.f. 7.9.2007 to acceptors of sterilization with particular boost to male participation in family planning as shown below: 39

Over-view of compensation schemes Public facilities Accredited Private/NG facilities Vasectomy Tubectomy Vasectomy Tubectomy High Focus States 1500 1000 1500 1500 Non-high focus States 1500 1000(BPL/SC/ ST) 650 (APL) 1500 1500(BPL/SC/ST) 6.0 FAMILY WELFARE STATISTICS The Information System to measure the process and impact of the Family Welfare Programme is as below: a) Service Statistics/Routine Monitoring by State & implementing agency b) Sample Registration System & Population Census, Office of Registrar General India c) Large scale surveys- National Family Health Surveys & District Surveys d) Area specific surveys by Population Research Centres e) Other specific surveys by National & International agencies f) Field Evaluation through Regional Evaluation Teams 6.1 Service Statistics/Routine Monitoring The Statistics Division in the Ministry of Health & Family Welfare is responsible for Monitoring & Evaluation activities. 6.1.1 Collection of Statistics/data: The services are provided through the network of health centers spread throughout rural and urban areas of the country. Each centre maintains record of its activities in one or more of the primary registers. For example at the Sub Centre level, various registers such as Eligible Couple Registers, Maternal Health Register, Family Planning registers, immunization register, Supply Registers etc., are maintained to record the services provided and also for planning. 6.1.2 The performance data are collected and compiled primarily at peripheral levels (Rural/ Urban) such as Subcentre, Primary Health Centres, Urban Family Welfare Centres / Post Partum Centres / Hospitals / Dispensaries and sent to the next higher level i.e the District. The District in turn compile data for all their units including those of voluntary organization and local bodies and sent reports on different facets of the programme to the State. These are consolidated at the State level and the performance reports compiled at district / state levels are passed on to the Statistics Division in the Department. At the Centre regular performance review are prepared on the basis of service statistics furnished by all the state Governments and UTs. The Statistics Division has launched a web-based portal where reports can now be directly uploaded on the web portal http://nrhm-mis.nic.in by the districts. Thus the system has now been changed from manual to electronic. The states /UTs have been asked to send their reports only through the portal. 40

6.1.3 The collection and maintenance of information and its submission to the higher level is systematically done through various forms / formats. The Department has recently rationalized formats / returns for various activities for each level of reporting. The reports are received monthly, quarterly and annually as per requirement for monitoring the programme. SUMMARY 6.1.5 A note Review on Performance of Family Welfare Programme is prepared on the basis of the reports received from States/UTs for monitoring the monthly progress of the Programme. 6.2 Large Scale/Demographic Surveys At the instance of the Ministry of Health and Family Welfare a number of surveys are being conducted are as under: 6.2.1 National Family Health Survey: The overall objectives of conducting the National Family Health Survey are: To strengthen India s demographic and health database by estimating reliable statelevel and national-level indicators of population, maternal and child health, HIV/AIDS, and nutrition; To facilitate evidence-based decision making in population, health and nutrition; To strengthen the survey research capabilities of Indian institutions and to provide high quality data to policymakers, family welfare and health programme managers, government agencies, NGOs, international agencies, and researchers. 6.2.1.1 The first National Family Health Surveys (NFHS) was conducted during the year 1992-93, second in 1998-99 and third in 2005-06. The results of all three rounds of the survey are available. 6.2.1.2 Each successive round of NFHS has two specific goals, namely, to provide data on health and family welfare needed by the Ministry and other agencies for policy and programme purposes and to provide information on important emerging health and family welfare issues. The NFHS provides estimates of the levels of fertility, infant and child mortality, and other family welfare and health indicators by background characteristics at the national and state levels and also measures trends in most of these indicators over time. The NFHS III, in addition, to information collected in earlier two rounds on fertility, mortality, maternal and child health, family planning, nutrition, anaemia etc provided information on several new and emerging issues including: perinatal mortality, male involvement in family welfare, adolescent reproductive health, high-risk sexual behaviour, family life education, safe injections, tuberculosis, and malaria; family welfare and health conditions among slum dwellers in eight cities; and HIV prevalence for adult women and men at the national level and for each of the six high HIV prevalence states, namely, Andhra Pradesh, Karnataka, Maharashtra, Manipur, Nagaland, and Tamil Nadu. 6.2.2 Rapid Household Survey (RHS) / District Level Household Survey (DLHS): With a view 41

to assess the impact of Reproductive Child Health Programme, it was necessary to generate district level data on the utilization of services provided by government and other health facilities. 6.2.2.1 The first round of RCH survey (RHS-DLHS) in India was conducted during the year 1998 99 in two phases for which International Institute for Population Sciences (IIPS) Mumbai was designated as nodal agency. 6.2.2.2 The second round of RHS- DLHS, 2002-04 covered 593 districts of the country. About 297 districts were covered in the first phase and the remaining districts were taken up in phase II. The survey was coordinated by IIPS, Mumbai. 6.2.2.3 In RHS-DLHS round II, information about Reproductive Child Health interventions was collected in more detail than the first round with extended questionnaires by adding new dimensions such as testing cooking salt to assess iodine content, testing blood of children, adolescents and pregnant women to assess level of anemia and weighing children to assess the nutritional status. 6.2.2.4 The main focus of the District Level Household Survey so far conducted has been on the following aspects: Coverage of ANC & immunization services Proportion of safe deliveries Contraceptive Prevalence Rates Unmet need for Family Planning Awareness about RTI/ STI and HIV/AIDS Utilisation of government health Services and the users satisfaction. 6.2.2.5 The District Level Household Survey - 3 (DLHS -3) is the third in the series of district survey. As in earlier rounds, the International Institute for Population Sciences (IIPS) was the nodal agency to conduct the survey. DLHS-3 gives estimates on important indicators on maternal and child health, family planning and other reproductive health services. In addition, it provides information on important interventions of National Rural Health Mission (NRHM). Unlike other two rounds in which only currently married women age 15-44 years were interviewed, DLHS -3 interviewed ever-married women (age 15-49years) and never married women (age 15-24). The final state factsheets for 31 States/UTs and provisional all-india facts sheet have been released. 6.3 Facility Survey: The Ministry of Health and Family Welfare conducted facility survey at the district level in 1999, to assess the availability of health care facilities and their utilization in terms of infrastructure, staff, supply of health care items and equipment in the Government Health Care Establishments in the districts. The survey covered, all the government Health Care Establishments (HCEs) starting from Primary Health Centre (PHC) to District Hospitals(DH). 6.3.1 The first phase of the Survey covered 221 districts from all the States/ UTs in the country. The second phase of the facility survey (2002-03) also included Subcentre as well the ISM (Indian System of Medicine) hospitals and dispensaries under the government. Which were 42

not covered during the phase I. The reports of both the phases of Facility Survey have been released and are available. SUMMARY 6.3.3 For the first time, population-linked facility survey has been conducted in DLHS-3. In a district, all Community Health Centres (CHCs) and District Hospital (DH) were covered. Further, all Sub-centres (SC) and Primary Health Centres (PHC) which were expected to serve the population of the selected PSU were also covered. 6.4 Population Research Centre 6.4.1 The Ministry of Health and Family Welfare has established a network of 18 Population Research Centres (PRCs) scattered in 17 major States. These PRCs are located in various Universities (12) and other Institutions (6) of national repute. These Centres are responsible for carrying out research on various topics of population stabilization, demographic, socio-demographic surveys and communication aspects of population and family welfare programme. 6.4.2 The PRCs are autonomous in their functioning. Government of India provides 100% financial assistance in the form of grants-in-aid on year-to-year basis towards salaries of staff, books and journals, stationery, vehicle for field surveys and other infrastructure equipments. 6.4.3 At present, there are two types of Population Research Centres, one designated as Fully Developed and other Not Fully Developed. The variation in the two types being is in terms of staffing pattern. 6.4.5 The PRCs activities are monitored centrally to ensure that the research effort is not merely academic but also action oriented. The process of allocation of area specific studies to these Population Research Centres by the Ministry of Health & Family Welfare is an ongoing process. These area specific studies are selected every year and cover a wide range of Reproductive & Child Health Programme topics. 6.4.6 The studies conducted by the PRCs are on varying topics such as:- Population Size and Growth; General Demography; Socio-economic characteristics of rural/urban population; Evaluation of Family Welfare Programme for non-acceptance of Family Planning methods; Evaluation of Special School Health Check up Scheme; Fertility and Socio-economic Indicators; Family and Nuptiality; Population Distribution and Migration; Methodology and Demographic Analysis; Population and Development. 43

In 2008, all the PRCs were also given a uniform study on Rapid Appraisal of NRHM covering 36 districts across 20 states. Each of the 18 PRCs were allotted specific districts for the study. After completing the field work and data entry, the reports are being finalized. 6.4.6 There is a dedicated home page for all PRC http://prcs-mohfw.nic.in. All PRCs have been provided administrative control, userid and password to upload their events, research papers/studies, newsletters etc. 6.5 Regional Evaluation Teams 6.5.1 The system of sample check of family planning acceptors was introduced in the year, 1972 by the State Demographic and Evaluation Cell followed by the Regional Health Offices in 1974-75. The two agencies were assigned multifarious duties and thus could carry out the evaluation in limited manner. In the year 1976, four field evaluation teams, each consisting of one Evaluation Officer and four evaluation assistants were created to conduct an independent, both qualitative and quantitative evaluation under the control of E & I Division (renamed as Statistics Division/M&E) in the Department of Family Welfare. At present there are seven functional regional evaluation teams. 6.5.2 Each Regional Evaluation Team undertakes a tour of 20 days each month covering 2 adjoining districts of one of the States allocated to them. During their visits the teams visit district head quarter and facilities likechcs, PHCs, sub-centres and urban F.W etc. The teams also cover acceptors of family planning, beneficiaries of maternal and child health services, Janani Suraksha Yojna, and also interact with ASHA and Village health and Sanitation Committee members. The samples of beneficiaries are selected from the records/registers maintained by the health centres. The teams undertake both qualitative and quantitative assessment of beneficiaries. This direct physical verification enable to check the genuineness of the acceptors, as well as their demographic characteristics, problem/complaints associated with use of Family Welfare methods etc. 6.6 Other Evaluation Activities The ministry has undertaken an exercise of concurrent evaluation of NRHM activities. In the first round about 200 districts are being covered and district-wise reports shall be available from October / November 2009 onwards. An Annual Health Survey in 284 districts of erstwhile EAG States shall be launched during 2009-10. For the annual Health Survey, the Office of Registrar General of India has been designated as the nodal agency and 108 posts for supervision of the survey work have been created in that office. A Steering Committee constituted in the Ministry of Health and Family Welfare shall be monitoring the progress of the survey activities and provide guidance. 44