Schemes will be

• ‘Vande Mataram’ scheme of Government Of India (GOI).
• Subsidized Medical Practitioner (SMP) specialist scheme.

Accreditation scheme
Private hospitals who wish to join on voluntary basis by developing a criteria and standard of performance

• Scheme of social franchising: Involving the interested private practitioners to popularize contraceptives like oral pills, emergency contraceptives and life saving Oral Rehydration Salt (ORS) packets etc.
• Government facilities will be shared with the private doctors on cost basis (e.g. X ray machines, laboratory investigations). The private practitioners will be oriented on government protocols of services through Continues Medical Education(CME).
• Supplementation through private specialists: Contractual Services of Private Gynecologist and Anesthetist.
• Outsourcing activities like Cleaning, Laundry, Ambulance Services, & Catering Services.

Promotion of entrepreneurship oriented schemes for sustainability
Subsidized Medical Practitioner Scheme in select districts: Availability of Medical and Health services through Govt. or private doctors is a critical issue in difficult and remote areas, To address this problem a scheme for newly passed out Indian System of Medicine (ISM) practitioners has been envisaged under European Commission (EC) –Sector Invensetment Programme (SIP).

Nurse practitioner scheme: The percentage of Home deliveries in some districts is between 20 to 30%. As it has been noticed that training of TBA will not be sufficient to reduce Infant Mortality Rate (IMR) and Maternal Mortality Rate (MMR). There is a need of Skilled Birth Attendants, i.e. Nurses in areas where population of Sub centers is more than the norm prescribed and the distance from Sub center head quarter, which makes ANM difficult to reach these villages for attending deliveries.

Appointment of Laboratory Technician on contractual basis: It is proposed to ask the lab. Technician to work on par as mentioned in the scheme of subsidized medical practitioner. It means initial support, for setting up the laboratory, is proposed under the project and honorarium to laboratory technician will be given on tapering basis. Another alternative is the Medical Officer will give the service voucher and the contract will be made with laboratory technician to extend the service against the service voucher, which will be reimbursed in later course by the Medical Officer.

Training and Capacity Building
Infrastructure Strengthening

• Strengthening of Training institutions.
• Clinical Training package.
• Institutional linkages.
• Exposure visits & study tours.
• Continuing Medical Education Bulletin.

Innovative strategies under training were initiated under externally aided projects
Continuing Medical Education (CME): Bulletin for Professionals.
Organization of seminars/hands on training with the help of private sector.
Discussions are going on with Federation of Obstetric and Gynaecological Societies of India (FOGSI) to develop the training course for basic Emergency Obstetric Care and Comprehensive Emergency Obstetric Care, which will be at par with the competency–based training organized at Vellore.

Comprehensive Training Policy.
Training organization and management.

Improving Management Systems
Financial Management System
The Programme Management Unit (PMU) proposes to establish a separate section for Finance and Accounts by pooling resources of other DP projects and developing a common Finance Section at state Level. The staff of Finance and audit section will be trained to fulfill the needs. Similar trainings and arrangement will be done at districts level. The state PMU will prepare and furnish financial reports on a quarterly basis.
Similarly District Level PMU having Manegerial & Accounts Staff as Contractual basis.

Procurement and Distribution System for drug and equipment

• Provision for drugs kits supplies.
• Provision of Equipment kits.
• Provision Of Vaccines, Cold Chain Equipments And Contraceptives.
• Improving Logistics Manegement at Divisional & District Level.

Safe Motherhood Services
Maharashtra is one of the four States implementing Integrated Financial Envelope by including need based special interventions/ innovative schemes under the Reproductive and Child Health (RCH) program.

The various initiatives started to strengthen MCH components are

• Dai (Traditional Birth Attendant (TBA)) Training.
• Promotion of institutional delivery: (24 Hour delivery scheme) – Janani Suraksha Yojana.
• Referral Transport Scheme: Dept. of Referral plan at village level.
• Reproductive and Child Health (RCH) Camps: At selected 5 – 6 Primary Health Center (PHC)s per district twice a year.
• Contractual services of Gynecologist and Anesthetist.

New Initiatives
State proposes to implement following new initiatives during Reproductive and Child Health (RCH) II
Nutrition demonstration
Considering the importance of nutritional status of women and children in reducing morbidity and mortality, the activity of nutritional demonstration will be taken up on priority during Reproductive and Child Health (RCH) II. It is planned to implement this activity with the help ofIntegrated Child Development Services(ICDS) functionaries and like Self Help Groups (SHG), who will be taking up this activity on a regular basis considering the local customs and availability of food articles. Especially the concept of providing formula F–75 and F–100 to the grade III and grade IV children.

Comprehensive EmOC Training (CEmOC)
Medical officers will be trained to get confidence for performing the skills like, tubectomy, Medical Termination of Pregnancy (MTP), General and Emergency Obstrective Care (EmOC)/Emergency EmPC at selected institutions. Postgraduates in DGO/ MO Gyn./MS (G.S) will be trained in Laproscopic Sterilisation & Lower Section Cesarian Section(LSCS).

‘Dada–Dadi’ (Ajoba–Aaji) scheme
Under this scheme, state proposes to identify and recognize the senior citizens as ‘Dada’ or ‘Dadi’, who will be joining voluntarily in the scheme to create awareness and demand generation. They will be given orientation especially about need of ANC, Neonatal care and child care as well as mother and child nutrition. Publicity will be given to this scheme. These ‘Dada’ and ‘Dadis’ will be recognized by govt. They will be working voluntarily in their own area at the time, which is convenient for them.

40 Plus Services
Care of 40 Plus population is an important component under Reproductive and Child Health (RCH).Hypertension, Diabetes, Cancer (preventive oncology), Cataract, Rerpoductive Tract Infection/Sexually Transmitted Infenction (RTI/STI) are the problems commonly observed in this population. Fornightly clinics at District Hospital & identified Rural Hospitals will be initiated in a phased manner.

EmOC/EmPC protocols
UNICEF has developed Protocols for management of EmOC, and EmPC. These will be adopted and monitored for the state.

Provision of Tab. Vitamin C Tab Calcium to Pregnant Women
To improve Hemoglobin level and reducing incidence of hyper– tensive disorders (Pre – eclampcia and Eclampcia) during pregnancy. Various reseaReproductive and Child Health (RCH) initiatives have indicated utility of supplementing Vitamin C and Calcium.