Reproductive & Child Health II

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Historical Background/Periodical Development
Govt. of Maharashtra started Family Welfare Programme during 1957. It is implemented as per guidelines given by Govt. of India. It is 100% Centrally sponsored programme. It was target oriented programme till 1995–96. From the year 1996–97, the Target Free Approach was implemented as per guidelines given by Govt. of India.

The State is implementing Reproductive & Child Health Programme– Phase II. The period of RCH Phase II is 2005–06 to 2009–10. The programme has set the following goals to be achieved by 2007 & 2010.

Important goals identified ro RCH II by the state are as below

Goals Currrent Status Goal
2010
MMR 149 (MMR in India 1997 –2003 by RG) 100
IMR 36 (SRS 2006) 27
NMR 24 (SRS 2004) 27
TFR 2.1 (NFHS III) =<2.0


Govt. of India has approved the State Programme Implementation Plan (PIP) of RCH–II for Rs.660 crores (for next 5 years) and sanctioned Rs.115 crores per year for next two years. The activity wise budget allocation is shown as below:

(a) Technical strategies & activities – 46%.
(b) Urban RCH – 16%.
(c) Institutional strengthening – 14%.
(d) Trainings – 7%.
(e) Behavioural change communication – 8%.
(f) Programme Management – 9%.

Main outcomes

Priority key areas

Strategy of Reproductive & Child Health II
Planning at District Level
Considering the need of decentralization, districts have been directed to identify health needs based on available information of health indicators and plan for activities for the next 5 years. Districts have to prepare the plan of action for RCH – II

RCH Phase II in the format prescribed by GOI and indicate need of yearly grants. Districts have been communicated tentative annual grants for RCH– II activities (Statement enclosed ).

Availability of Component wise budget for next 2 years (Rs. In Lakhs)

Sr.No. Particulars Year
2005–06 2006–07 2007–08
1 Technical Strategies & Activities 2329 3821 2715.87
2 Urban RCH 781 1281 2172.57
3 Institutional Strengthening 3095 1099 1067.22
4 Training 675 868 407.69
5 Behavioural Change 826 857 912.56
6 Programme Management 785 930 607.20
  Total 9085 9476 7883.11


Special Plan for Urban Areas
Considering availability of RCH outreach services in very few municipal corporations, review of situation is being taken in 22 municipal corporation, 222 municipal councils and 7 cantonments areas. Provision of contractual ANMS and urban health post/mobile health clinic as per need is being planed and allocation has been made.

Activities for Tribal Areas
Out of 15 tribal districts 5 districts are sensitive where following important activities will be under taken

Operationlising a Primary Health Centre for providing 24 Hour Delivery and Newborn care under RCH – II
The following guidelines are given to assist the districts in operationalising their PHCs for 24 X 7:

Essentital Service Package

The Services mentioned above are in additon to all services that the PHC is normally required to provide. The first 3 services are critical for labeling a PHC as one providing round the clock delivery & new born care services.
List of 24 X 7 PHC’s


Important Features Planned Under RCH II

Innovative Inputs In RCH Phase II

Current Status of RCH – II programme

Achievements
Year wise Component wise important targets

Indicator Current Status (%)
NFHS II NFHS III 2005–06 2006–07
Maternal Health
Institutional Deliveries 52.6 66.1 65 67.5
Deliveries by trained persons 59.5 70.7 72 75
ANC’s with Minimum 3 checkup 54.8 75.3 60 65
Health institutes providing 24 Hr. delivery services (No.)
Rural Hospital 143 – 162 190
PHC 634 – 750 900
Institutes providing Emergency Obstetric care including LSCS and Blood Transfusion
District Hospital 31 – 33 33
FRU 43 – 68 93
Rural Hospital 22 – 30 40
Child Health
New born receiving breast feeding on day one 47.7 51.8 (within 1 Hr.) 55 60
Fully immunized children in the age group 13 to 24 months 78 58.8 (12–23 Months) 82 85
Family Welfare
Full–filling Unmet needs of spacing 8.1 5.6 7.5 6.5
Couple protection rate 60.9 66.9 65 67

IMNCI Training under RCH – II
Integrated Management of Neonatal Childhood Illness is the centerpiece of the Newborn and Child Health Strategy in RCH Phase –II. It includes the home and community based component (through ANM and AWWs) and the facility based out patient care component, as is being piloted in UNCEF's Border District Projects. In addition the component on Management of Sick Neonates and Children in the inpatient setting at PHC/ R.H./ FRUs. Health system strengthening and community participation components have been addressed effectively to ensure effective implementation.

IMNCI is the central pillar of Child Health Strategy that include three components
1) Improvement in case management skills of health staff.
2) Improvement in health systems for effective managements.
3) Improvement in Family & Community practices.

As per Govt. of India guidelines a new initiative under Integrated Management of Neonatal & Childhood Illness (IMNCI) initiatives is being implemented in State as a major step towards reduction of Infant Morbidity and IMR in selected 9 districts. And 11 more districts also being covered for training by July 2007 onwards.

Maharashtra State has decided to take up IMNCI initiative in 9 districts – From RCH flexi pool funds – Thane, Nashik, Amaravati and Gadchiroli.

UNICEF assistance – Osmanabad, Latur, Chandrapur, Nanded & Nandurbar.
In IInd Phase IMNCI strategy is introduced in Raigad, Beed, Ahemadnagar, Jalgaon, Dhule, Pune, Gondia, Yavatmal. Nagpur, Wardha. Districts. Dist Buldhana has been added recently.

This initiative mainly involved is training doctors and Para medical staff in early diagnosis and proper management of common illnesses in infants and children below 5 years of age.

MOs, Supervisors (H.A. male / female, Mukhya Sevikas), Health Functionaries.
(ANMs/ MPW/ AWW) are to be trained under this project in 5 tribal districts and 4 other districts mentioned above. ToT for these 8 tribal districts is arranged with the help of UNICEF, Mumbai from March–April, 2007 in Nashik and Nagpur.

Important activities under IMNCI
Nodal Officer for IMNCI
Implementation of IMNCI needs to have co–ordination with other department of the state Government like ICDS, RDD, and Medical Education etc. State RCH Officer/Additional Director (FW) has taken this responsibility.

Establishment of a Co–ordination Group
As per guidelines received by GOI that the coordination group has to be formed including donor agencies like UNICEF, other departments like ICDS / WCD, Rural Development, Department of Medical Education. Vide G R No. RCH/1005/CR13/05/FW–1 dated 1st April 05 the working group has been formed as follows

1. Director of Health Services,Mumbai Chairman
2. Additional Director of Health Services,(Fw,MCH,&SH),Pune Member
3. Joint Director of Health Services,(German Project), Pune Member
4. Deputy Director (FW) Member
5. Deputy Director (WCD)/RCH Co–ordinator Member
6. Deputy Director (RRD) Member
7. Representative from UNCIEF Member
8. Representative from UNFPA Member
9. Representative of LAP/NNF(One member from each organization) Member
10. Deputy Director of Health Sevices (RCH),SFWB,Pune Member Secretary


This group is responsible for monitoring, follow up and review up implementation of IMNCI in the state.

Formation of District Level Co–ordination Group
District level Co–ordination group has been formed on similar lines that of state level co–ordination group. Vide G R No. RCH/1005/CR13/05/FW–1 dated 1st April o5 the working group has been formed as follows

1. CEO ZP Chair Person
2. Deputy CEO (ICDS) Member
3. Civil Surgeon Member
4. Pediatrician Dist. Hospital Member
5. Representative of INF/NNF/IMA Member
6. NGO representative Member
7. Dist. RCH Officer Member
8. CDPO H.Q. Member
9. DHO, Z.P. Member Secretary


Dean, of nearby Govt. Medical College is being included in the District Coordination working group as we are involving Medical Colleges in IMNCI training in No. of districts.This group is responsible for monitoring, follow up and review of implementation of IMNC in the district.

Arrange translation, Printing and supply of Training Material
This activity has been already completed. The training material has been sent to Nashik, Thane, Amravati and Gadchiroli Districts. UNICEF has already supplied the training material in 5 districts assisted by them.

Create pool of State level Trainers
GOI has expressed the opinion that about 40 to 50 trainers in a district are required for undertaking training of Health Staff on a continuous basis. It has been decided to conduct at least two TOT at HFWTC Aurangabad with clinical assistance from Government Medical College Aurangabad, UNICEF Mumbai has shown willingness to arrange national trainers during this TOT. We can further train Additional District Trainer from the trained MODTT, Medical Officers, LHV, PHN, Nursing Officer/ Tutor etc. by giving them an additional training of two days for supportive supervision and facilitation. It is under consideration to outsource this training activity to some NGO / Group of Experts like Retired Pediatrition, Public Health Specialist, Medical Officer, PHN / Nursing Officer, wherever feasible.

Identify the State Nodal Institute for IMNCI Training
It is under consideration to develop HFWTC Aurangabad as State Nodal Institute for IMNCI Training. We have held two TOTs at Aurangabad. Government Medical College Aurangabad has an adequate caseload, excellent facilities for hands on training, HFWTC Aurangabad has adequate facilities for class room training.

Improvement of Health System
GOI has directed to make available essential drugs with workers and at facilities covered under IMNCI. IMNCI kit is being issued to PHC, Subcenter & AWW. GOI has stressed to reinforce referral institutions like RH/FRUs or Private/ Public partnerships to be established. Action is under way to develop FRUs as per Indian Public Health Standards. Medicine kits are being provided to the trained ANM, AWW after completion of the training. Funds have been already allocated to the 9 IMNCI implemented districts & also in more districts where also training has been started total 23 districts are under IMNCI Programme.

Improvement of Family and Community Practices
IEC campaign for awareness generation regarding breast–feeding practices, illness recognition, early case seeking etc. is being launched. Counseling of caregivers and families is being undertaken as part of management of sick child when they are brought health worker / health facility. BCC has to be focused on improving new born and childcare practices. IEC Bureau Pune has been entrusted to undertake this responsibility.

Status of IMNCI training (MOs & Paramedicals)
Sr.No. District Total Trg. Load Trained
1. Thane 1392 523
2. Pune 1594 264
3. Raigad 163 92
4. Nashik 2909 1440
5. Nandurbar 2984 554
6. Dhule 808 340
7. Jalgaon 522 258
8. Ahmednagar 620 165
9. Yeotamal 3576 89
10. Amaravati 744 522
11. Buldhana 365 275
12. Gadchiroli 5498 506
13. Chandrapur 3068 636
14. Nagpur 2509 57
15. Osmanabad 2061 1865
16. Latur 2588 2126
17. Nanded 3997 1009
18. Beed 480 329
  Total 35878 11050


Essential New Born Care Training
With the help of National Neonatal Forum we have Started Essential New Born Care Training of 2 days for MO PHCs and we have covered 7 districts of Vidarbha under EC–SIP funding and till last year we have trained 413 MBBS MOs in Essential New Born Care. This year we are covering districts of Thane Nasik Nandurbar Chandrapur and Gadchiroli. for this component.

Arogya Sakhi
The main goals under the Reproductive and child Health Programme are to reduce MMR, IMR and TFR. In tribal area due to geographical hurdles, customs and taboos as well as health seeking behaviour the rate of MMR and IMR and Pregnancy wastage is very high. Thane, Nandurbar, Nasik, Amaravati and Gadchiroli are very sensitive which need attention on priority basis. Hence it is proposed to implement Arogya Sakhi Yojana, which will aims towards improving Maternal Health especially focusing on reducing Maternal Morbidity and Morality related to Obstetric causes mainly by ANC, conducting Delivery and PNC.

Arogya Sakhi Yojana is being implemented in 150 villages in 5 tribal districts where there is no public health facility like Sub–center, PHC, PHU and MHU available. Preferably a village having population about 1,000 is selected. The eligibility criteria for 'Arogya Sakhi' is she should be married, age about 35 years, resident from same village, she should be literate and willing to undergo training for 6 months at District Hospital/ Sub–District/ Woman Hospital.

After training each Arogya Sakhi will function as Trained Birth Attendant by providing ANC, conducting normal deliveries, PNC, treatment for minor ailment as well as referral of the cases. After completion of the training, she will be issued delivery kit and honorarium and rent for room for clinic/ delivery room for 4 years.

The expenditure for Arogya Sakhi training has been made available from the European Commission Supported Sector Investment Programme till March 2007 and next subsequent years the expenditure will be incurred under RCH – II Programme.

Status of Arogya Sakhi training
SR. No. District Total Trg. Load Trained (I st batch) Trained (IInd batch) Total Trained under EC–SIP
1 Thane 30 19 9 28
2 Nandurbar 30 16 14 30
3 Nashik 30 12 9 21
4 Amaravati 30 16 14 30
5 Gadchiroli 30 27 3 30
  Total 150 90 49 139


Dai Training
Maternal Health is major issue especially in tribal area. It is necessary to address this under tribal RCH on priority basis. In order to reduce Maternal Mortality, it is very essential to promote the institutional delivery or delivery by SBA. Considering the vast difficult terrains, geographical and inaccessible health services and as well as population of villages. It will be difficult in the near future to achieve 100% institutional deliveries. Hence it is proposed to ensure the safe delivery by trained personal at village level. There are about 6,000 TBA available in Thane, Nandurbar, Nasik, Amaravati and Gadchiroli. There are still 489 villages remaining in these 5 tribal districts.

To impart the training it is essential to identify a woman from these villages. It is proposed to adopt the following eligibility for selection of such woman.

1. She should be married and resident of same village.
2. She should be a middle age.
3. She should be literate.

The training center will be near by RH/ SDH for 3 weeks and one–week hands on training will be given at District Hospital. The duration for training is 30 days. After the training each Dai will be provided Dai Kit. The expenditure for this training will be paid through RCH –II funds.

Status of Dai Training
SR. No. District Total Trg. Load No.Trained Remaining Load
1 Thane 64 9 55
2 Nandurbar 143 21 122
3 Nashik 62 11 51
4 Amaravati 74 74 0
5 Gadchiroli 146 121 25
  Total 489 236 253


There has been some difficulty noted in finding suitable candidates willing to under go Dai training course in Thane and Nashik districts.Now thsi Trainnig is going ononly in Gadchiroli district.

Life Saving Skills in Anesthesia for EmOC
As per GOI guidelines 18 weeks certificate course for M.B.B.S. Doctors who has completed 5 years services will be undertaken in State, as there is acute shortage of Anaesthetist in state. The EmOC services cannot be given at FRU. 12 weeks training will be given at Medical Collage and 6 weeks at District Hospitals. 6 centers in the state are recognized for the training. The centers are: – Amaravati, Dhule, Kolhapur, Nanded and KEM Hospital, Mumbai and Sion Hospital, Mumbai. TOT was arranged at KEM Hospital Mumbai on 29th June 2006 conducted by Faculty members of AIIMS, New Delhi. A batch of 4 doctors will be sent to each Medical College. After completion of training the doctors will be posted at FRU and will work for at least 3 years. The Mannequin is received from UNICEF; hence training is started in 3 Medical Colleges, i.e. at KEM Hospital Mumbai, GMC Kolhapur and GMC Nanded. Total 15 Doctors were trained last Year. This year we have started ths training in 7 more Medical College, 4o more Doctores are under training at present.

Adolescent Health
Adolescent health component activity will be undertaken under RCH–II in 33 District Hospitals and 7 Woman Hospitals. The Gynecologists of these hospitals were trained w.e.f. 20–23rd June 2006. Instruction have been issued to start Adolescent Health Clinic at District Hospital and selected Sub–district Hospitals on fixed day of the week.

THO Training
During RCH–II the State decided to impart Managerial Training of health programmes to THOs of all districts. This training was conducted by PHCMRC – NGO. The duration of the training is 5 days. Training status is as follows. This training is over. Status of THO training

SR. No. District Total Trg. Load No.Trained Remaining Load
1 33 276 211 65


BEmOC & SAB Training
Basic Emergency Obstetric Care Training has been decided to be given to Medical Officers of 24 X 7 days PHCs and MOs from R.H. Skilled attendance at Birth training will be imparted to ANM/LHV/Staff Nurse. The duration of the training is 15 days for both these trainings. It has been decided to conduct ToT for Gynaecologist, OT Nurse, Labour room Nurse, MODTT/ ADHO at divisional level. ToT workshops were conducted at PHI, Nagpur, HFWTC, Pune & Nashik. A batch comprising of 3 Medical Officers is to deputed for BEmOC training and 3 ANM/LHV/Staff Nurse will be deputed for SBA training to district hospital and women hospital. Every month one batch will be conducted at District Hospital and Women Hospital alternatively of BEmOC followed by SBA. Rs. 50.000/– have been already issued for purchase of essential injections, drugs during training and after training for SBA training.

Status of BEmOC & SBA training
SR. No. Name of Training Total Trg. Load 2006–07 Trained Since inception Remaining Load
1 BEmOC 1251 703 548
2 SBA 1689 894 795


Both BEmOC and SAB training are going on in above 45 selected training sites in full swing in the state.

EmOC Training
Under Unicef EC – SIP funding we have trained 7 teams Gynecologists & Nurses at CMC Vellore during 2004 to 2006. Presently we have started EMoC Training at Daga Hospital Nagpur & 2 Sr MBBS doctors for tribal district of Chandrapur are attending the training.

Laproscopic Training
There is increased trained of Laproscopic Sterilization. Laproscopic Sterilization is on going activity. To train eligible candidates (Gynaecologist & General Surgeon) in Laproscopic sterilization, the following institutes are identified

Contribution from Private Sector is there in the form of performance as well as training to Surgeons. The training of Laproscopic Sterilization is to be imparted to team comprising of Gynaecologist / General Surgeon Private Practitioners who are eligible for training and has desired to under go training Family Planning Association of India and Sangamnerkar Dwarika Foundation Hospital are exclusively identified for private Gynaecologists and Surgeons for Laproscopic Ligation Training. We have trained 10 doctors in laproscopy during last year.

Cu–T Training
This of ISDT has not been paid adequate attention by any Dist Health officers. As per recent guidelines received from Ministry of Health and Family Welfare the State has recognized Cama and albless Hospital Mumbai as nodal Training Training Centre on IUD Insertion for ANMs /LHVs and training of first batch has been started from 28th June 2007. at Cama and albless Hospital Mumbai.

NSV Training
NSV training is imparted during camps of a period of 5 days. 2–4 Surgeons are trained in one batch. MBBS doctors with 5 years of experience are eligible for the training. Rs. 1.96 crores has been distributed to all the districts for undertaking this training. The norm of Rs. 53,000/– for organizing a 5–day camp for training of 4 Medical Officers has been already communicated.

No. of MOs trained: Up till now 223 (Year 2006–07)
Availability of Trainers

Tubectomy/Minilap Training
As per GoI guidelines Tubectomy training was being conducted for a period of 12 working days. However in view of the feedback received from various sources, the hands on training experience obtained in 12 days were not found adequate. It has been decided to fix the duration of tubectomy training of 6 weeks. This training is being conducted in all district hospitals & women hospitals.

Training Load Trained To be Trained
591 131 460


This training load will be completed in next 3 years.

Integrated ISDT under NRHM for newly recruited ANMs/LHVs on contract basis
Under NRHM the state has recruited about 3500 ANMs/LHVs In 24hrsx7days PHCs/Sub–centers to strengthen RCH Services to community. It has been decided to train all these nursing candidates on RCH/NRHM issues by conducting training of 12 days at District Training Team level A ToT of Principal HFWTCs &MO DTTs has been finished at Nagpur recently. It is proposed to start actual training from 2nd July 2007 onwards for these ANMs/ LHVs in the state. Funds also have been released to Principal HFWTCs . Now GOI has instructed to stop this training ISDT.


MTP Training
As per GoI guidelines MTP training was being conducted for a period of 12 working days. However in view of the feedback received from various sources, the hand on training experience obtained in 12 days was not found adequate. It has been decided to fix the duration of MTP training to 18 days for MBBS doctors and 4 days for ObGyns. Manual Vaccum Aspiration (MVA), Medical Abortion has been included in the syllabus of this training.

IPAS, is partnering Government of Maharashtra in providing MTP training (Safe Abortion) under RCH II.

Training Site: 20 (Medical Colleges/District Hospital/Women’s Hospital)
Details of training site:

Sr.No. Health Circle Training Site
1 Pune B. J. Medical College
Y.C.M., Pune
Satara DH
Sali Medical Foundation (Private)
2 Thane Ulhasnagar Maternity Home
3 Nashik Nashik District Hospital
Dhule Medical College
Jalgaon District Hospital (NEW)
4 Latur Nanded Medical College
Latur Medical College
5 Aurangabad Aurangabad GMC
Parbhani District Hospital
6 Akola Akola Women's Hosptial
Amaravati Women's Hosptial
Yevotmal GMC
Buldhana DH
7 Nagpur Daga women's Hosptial, Nagpur
IGMC, Nagpur
GMC, Nagpur
8 Kolhapur CPR, Kolhapur


MVA (Manual Vaccum Aspiration)

Increasing Access to Safe Abortion Services in Maharashtra
Ipas is an international non-governmental organization which has partnered with the Department of Health and Family Welfare, Government of Maharashtra and has been providing technical and programmatic support to the NRHM/ RCH II program in the state. As part of this program, the Government of Maharashtra envisages expanding access to safe and comprehensive abortion care (CAC) services.

In partnership with the Department of Health and Family Welfare, Ipas initiated a pilot project in the district of Pune to develop models for increasing access to comprehensive abortion care. The pilot involved strengthening training capacities and establishing a model for providing comprehensive abortion care services in three rural hospitals and six primary health centres.

Based on the experience gained and lessons learnt during the pilot project, it was decided to scale-up this component across the state under the NRHM/RCH II project. Ipas continues to provide technical assistance to operationalize this component based on the action plan. The key objective of the plan is to make available CAC services on a regular basis in public sector sites focusing on the rural hospitals and primary health centers in a phased manner.

Ipas along with Government of Maharashtra has been able to establish training and service delivery interventions in the following districts of the state:

Map of Maharashtra
Map of Maharashtra


Key accomplishments of the project till dat
20 functional CAC training sites have been established. (3 Sites for Only Private Doctors training)

  323 doctors and 153 support staff have been trained as the master trainers in TOTs till June 2008.
  Till Dec 2007, 667 doctors and 404 support staff have been trained at the CAC training sites in the state. These include 632 doctors and 404 support staff from the public sector, and 35 doctors from the private sector). Following is the facility level breakup of the trained providers:
Facility Level Breakup
Facility Level Breakup
  To increase access to safe abortion services in the private sector:
  four sites from the private sector have been approved as CAC training sites.
  operationalization of District Level Committees was facilitated to enable smooth approval of the private sector sites as MTP clinics.
  Training materials and curriculum for ToT workshops and second generation CAC trainings have been revised both for providers and support staff.
  A 'trainee tracking survey’ to assess the post training performance has been recently been completed by Ipas. A total of 447 doctors were tracked to see the initiation of CAC services following the training. Qualitative aspects of the service delivery (pain management, appropriate technology, contraceptive acceptance etc.) were also a part of the tracking. Following are the key findings of the survey:
Post Training Performance
  No. %
Ever Provided MTP 404 90.4
Never Provided MTP 43 9.6
     
Currently Providng MTP 332 74.3
Provided earlier and dropped out 72 16.1
Never initiated provding MTP 43 9.6
Total 447 100


Information on Medication Abortion
Medication abortion offers doctors and women choice and helps increase access to safe abortions. Medication abortion is a non-surgical method to terminate early pregnancies and is based on a proven regimen combining two drugs – Mifepristone and Misoprostol.

Medication Abortion became an option for early abortion in India when in April 2002, the Drugs Controller General approved the use of Mifepristone to terminate early pregnancies. In December 2006, the Drugs Controller General of India granted the permission for Misoprostol use in gynecological conditions like cervical ripening, prevention of post partum hemorrhage and first trimester abortion with Mifepristone.

In India, a combination of Mifepristone and Misoprostol is recommended for termination of early pregnancy up to 49 days/seven weeks from the last menstrual period (LMP).

Mechanism of Action of the drugs
Mifepristone is an anti-progestin, which stops the pregnancy from growing, detaches it from the lining of the uterus and softens the cervix.

Misoprostol is a prostaglandin E1 analogue that dilates the cervix, causes the uterus to contract and expel the pregnancy. Misoprostol is well absorbed through gastrointestinal as well as vaginal mucosa.

Medication Abortion is a process and therefore, it completes over a period of time. The beginning and duration of bleeding and cramping is different for every woman. Most (75%) women abort within four-six hours of taking Misoprostol, 30% of the remaining abort later at home on the same day. Remaining women mostly abort within the next five days. The heaviest bleeding lasts up to 4 hours, generally occurs during the actual abortion process and is almost always accompanied by cramps, bleeding might continue for about 8-13 days.

Effectiveness
The combination of Mifepristone and Misoprostol has been proven to be very effective. In combination, their efficacy rate is 95-99% for early abortions up to seven weeks. 1-2% may require aspiration methods due to heavy bleeding, 1-2% may fail to abort, 2-3% may have incomplete abortion for which aspiration methods are to be used, 0.1-0.2% may have profuse bleeding requiring blood transfusion.

Key Steps for Medication Abortion

Important Points to be Emphasized during Counseling

Medication Abortion & the MTP Act
It is a termination of pregnancy and therefore falls under the purview of the MTP Act 1971. A recent amendment in the MTP rules (made in 2003) allows certified practitioners to provide Medication Abortion from his/her clinic, even if it may not be an approved site) provided he/she has access to a site approved under MTP Act. The law requires that for the purpose of access, the provider should display a Certificate to this effect from the owner of the approved site. The providers should comply with the requirements of MTP Act.


Historical Background/Periodical Development
Maharashtra State is rich in its social & cultured heritage. In the last census, population wise Maharashtra was the third largest State in the country. However, as per latest 2001 census, it stands as second largest State in India. The percentage of 0–6 age group Population has decreased from 17.10 in 1981–91 to 13.63 in 1991–2001.

India was the first country to launch family planning program during 1952. The program was initiated in Maharashtra State during 1957. Initially the program had mainly Hospital based interventions. Later, the program adopted extension approach involving reaching to community for promotion of contraceptive Methods. The program achieved a boost during third year plan, wherein infra–structural inputs were provided. Supportive program like All India post partum program (1971), control of Diarrhoeal Diseases, Community Health Guide (CHG) scheme, Multipurpose Worker (MPW) scheme etc were introduced during subsequent years.

Major paradigm shift in the program was introduced in 1997 when Target Free Approach was initiated. This decentralized; Participary Planning Approach was later renamed as Community Needs Assessment Approach.

Maharashtra Government had taken continuous efforts to control its fast growing population. After reviewing the success and failures of existing strategies in 2000 the State Government introduced its own state population policy:
(Govt. Resolution No. Losandho–2000/Prakra57/00/Kuk–1, Mantralaya, Mumbai–32 Dt.9 May 2000)
&
(Govt .Resolution No. Losandho–2000/Prakra57/00/Kuk–1, Mantralaya, Mumbai–32 Dt.9 June 2000)
Objectives of National Family Welfare Programme

Main objective of the Family planning is to stabilize the population of the state. Fertility & Mortality are the major components of population change. Family planning program mainly regulates the fertility of population by protecting couples in reproductive ages by temporary & permanent methods .These services also help in reducing infant mortality as they increase the interval between two births and reduce the higher order births . Four activities are provided under the family planning program.

  1. Sterilization operation
    1. Male (Vasectomy/Non Scapel Vasectomy).
    2. Female (Abdominal Tubectomy/Laproscopic Tubectomy)
  2. IUD Insertion.
  3. Distribution of oral pills.
  4. Distribution of condoms.
  5. Re–canalization operation.

Main objective of the Family Planning is to stabilize the population of the state. Fertility & Mortality are the major component of Population Stabilization. The component Family Planning deals with fertility part.

Four activities are monitored under Family Planning Programme

For ensuring the quality, following steps have been under taken.

As per National Family Health Survey, II, (1998–99) the couple protection rate (CPR) for Maharashtra is 60.9 %.

Strategy of National Family Welfare Programme

Strategy Levels Strategy Levels

To identify beneficiaries
Health staff enumerates unprotected couples in the respective area at the beginning of the year through Eligible couple survey.

To motivate beneficiaries
After enumeration they list out unprotected Eligible couples, visit them to motivate for accepting family welfare method (Permanent or spacing).

To provide services
Sterilization operations are performed in Health Institutions. For Intra Uterine Device (IUD) insertions, Lady Doctor or Nurse Midwife (NM)/Lady Health Visitor (LHV) are trained.

Oral Pills (O.P.) cycle & Condom (C.C.) pieces distribution is through MPWs & ANMs at the Gross root level and also through all Health Institutes.

Support
Continuous follow–up after accepting family planning Method.

To ensure quality
Concurrent evaluation & reliability checks.
Monitoring of sterilization deaths at district, regional & state level.

To provide counseling to infertile couples


Services to Common People
The following services are available at free of cost at different levels

Health services
Primary Health care services
Village level services: Distribution of contraceptives (Oral Pills & Condom).
Sub center level: IUD insertion & Distribution of contraceptives.
Primary Health center level: Sterilization, IUD insertion & Distribution of contraceptives.

Hospital services
Rural Hospital: Sterilization, IUD insertion & Distribution of contraceptives.
Sub District Hospitals: Sterilization, IUD insertion & Distribution of contraceptives.
Other Hospitals: Sterilization, IUD insertion & Distribution of contraceptives.
District Hospitals: Sterilization, IUD insertion & Distribution of contraceptives.
Super specialty Hospitals: Sterilization, IUD insertion & Distribution of Contraceptives, Re–canalization.

In Urban area services are provided through Urban Family Welfare centers, Authorized Private medical practitioners, and Health posts.

National Family Welfare Programme
Services Center Available in each District
Sterilization (Male & Female) operations & spacing method services are available at the following Institution in the District

  1. PHC.
  2. Rural Hospital.
  3. Municipal Hospitals.
  4. Cantonment Hospitals.
  5. Medical college Hospitals.
  6. State Hospitals.
  7. Women’s Hospitals.
  8. Recognized private Medical practitioner Hospitals (Authorized by District Health Authority).
  9. NGO. Hospitals.(Grant in Aid Institutions).

Special Features of the Program
For male involvement in program new technique is introduced i.e. No scalpel vasectomy Technique. It is available in every district

Expected Community Participation
Family planning services are available for all the peoples in the Reproductive age Group. However participation of the people under the Low–income group in the Rural, Tribal area & peoples living in the slum area of the urban area is expected.

Role of NGOs

Important Health Education Messages

Role of other sectors
Co–operation of other Department is taken for motivating couples for acceptance of family welfare methods.

Rural Development Department/Integrated child Development Scheme/Education Department/Revenue Department/Urban Development Department.

Impact
State couple protection Rate was increased from 54.1(1992–93) to 60.9 (1998–99)
(Source: NFHS – 1 & NFHS – 2)

Sr.No. Indicator Status1995 (SRS) Present Status (SRS)
1 Birth Rate 24.5 19.1(2004)
2 Death Rate 7.5 6.2(2004)
3 Total fertility Rate 2.9 2.3(2003)
4 Infant Mortality Rate 55 36(2004)
5 Neonatal Mortality Rate – 26(2003)


NFHS – National Family Health Survey
SRS – Sample Registration Scheme

Achievements of National Family Welfare Programme
Last five years performance of the state in Family Welfare

Year Sterilisation I.U.D.
  E.L.A Vasec–tomy Tubec–tomy Total % E.L.A Achi–vement %
2003–04 750000 42028 647042 689070 92 525000 449972 86
2004–05 768000 41341 648406 689747 90 550000 467517 85
2005–06 725000 29795 629762 659557 91 500000 455862 91
2006–07 680000 20034 580016 610651 90 500000 433692 87
2007–08 625000 25611 528673 554284 89 450000 408689 91
2008–09 (May 08) 600000 1570 46250 47820 8 450000 45547 10

 

Performance of Sterilisation
Performance of Sterilisation


To promote the couples to accept sterilization only on female child, state has declared Revised Savitribai Phule Kanya Kalyan Yojana form 1st April 2007.
The scheme is applicable for

  1. Couples below poverty line.
  2. Couples accepting sterilization with only one daughter & no son.
    The person undergoing sterilization will receive Rs.2000/– in cash & Rs 8000/– in form of NSC ( in the name of daughter) .Total benefit of Rs.10000/– will be given to family.
  3. Similar scheme is applicable for couples with two daughters & no son . The person undergoing sterilization will receive Rs.2000/– in cash & Rs 4000 /– in form of NSC ( in the name of each daughter). Total benefit of Rs.10000/– will be given to family.

In Family Welfare Programme, stress has been given on improving demographic quality of performance also. The sterilization performance on 2 living children for last four years is as given below.

Year Total Sterilization Performance Sterilization on 2 issues %
2003–04 689070 336861 48.9
2004–05 689747 342350 49.6
2005–06 659557 350716 53.2
2006–07 610651 328691 55.1
2007–08 554284 318071 60.6
2008–09 47820 32345 3.3

 

Sterilization and Sterilization on two Issues
PSterilization and Sterilization on two Issues

Schemes
Various Schemes under Family Welfare Programme
The problem of population growth was visualized quite early by Country’s Planners Political Leaders and Administrators. It was therefore decided in first Five Year Plan to provide information and services in regard to Family Planning and married couples through existing health institutions and newly established centers. A large number of urban centers were subsequently established in a phased manner.

At present following categories of schemes in urban areas functioning in various districts/ Municipal Corporation in the State of Maharashatra.

Sr. No. Name of the Schemes Local Body NGO Govt. Total
1 City Family Welfare Bureau & Dist.F.W.B 06 –   06
2 Urban Family Welfare Centers 37 17 20 74
3 Urban Health Posts 209 209 32 39 280
4 A.N.M. Training Center. 00 06 00 06
5 Sterilization Beds scheme. 63 71 00 134


The working of the various schemes are described in brief as follows:

City Family Welfare Bureau
In view of the suggested changes in the organisation in urban areas for the delivery of Family Planning ,MCH and Primary Health Care Services. It would be necessary to modify the pattern of City Family Welfare Bureau for Co–ordination and Supervision is as follows

Staffing Pattern

Sr.No. Name of the Schemes I (5–10 Lakh) II (10–15 Lakh) III (15–25 Lakh)
1 Dy .Chief Medical Officer 0 0 1
2 Co–ordinator/Ext.M.O. 1 1 1
3 Senior Public Health Nurse 1 1 1
4 Statistical Assistant 1 1 1
5 L.D.C.Cum Typist 1 1 2
6 U.D.C.Cum Store Keeper 0 1 1
7 Attendant 1 1 2
8 Computer 0 1 2
9 Extension Educator 0 1 1
  Total 5 8 12


The town having population less than ten lakh and located in the district having total population less than Twenty Lakh, no separate CFWB is required. The existing district level organisation is able to co–ordinate the activities and provide requisite supervision. If the population of the city is more than Twenty–Five Lakh, the CFWB requirement should be worked out as per one unit of Type III per Twenty Five Lakh population and an overall cell for higher level co–ordination.

Sr.No. Local Body Type No.
1 Mumbai Corporation III 3+1DFWB
2 Pune Corporation II 1
3 Solapur Corporation II 1
4 Nagpur Corporation II 1
5 Kalyan Dombivali Corportaion I 1
  Total – 7+1DFWB


Objectives
To make publicity and awareness among people. Motivation of eligible couples for accepting Family Planning methods. Maternal Child Health, Reproductive Child Health, Outreach Services etc.

Activities

  1. Coordination.
  2. Supervision.
  3. To implement F.W., M.C.H R.C.H,programme.
  4. Monthly review meeting.
  5. Feedback.
  6. Submission of reports to State F.W.Bureau.
  7. Targets distribution.
  8. Supply of Cu–T, conraceptives,Publicity material et. to the F.W.Centers.

Urban Family Welfare Centers
The working of the Urban Family Welfare Centers (UFWC) was reviewed by Department of Family Welfare in 1976 and it is decided to recognize the four types of centers into three types with following reduced staffing pattern.

Sr.No. Type Population Posts Number
1 I 10000 to 25000 Auxillary Nurse Midwife 1
F. P. Field Worker(M)/ Co– co.ordinator 1
2 II 25000 to 50000 F. P. Field Worker (M)/ Co. ordinator 1
ANM 1
MPW 1
3 III 50000 to above Medical Officer 1
4 ANM 2
5 F. P. Field Worker (M)/ Co. ordinator 1
6 Store keeper–cum–clerk 1
7 MPW 1


UFWCs. (Type wise and Agency wise) – There are in all 83 UFWCs in the state. The Agency/Type wise number of UFWCs are given as below:

Sr.No. Agency/Type Sanctioned Functioning(as on 1/08/07
I II III Total I II III Total
1 Government 10 0 10 20 0 0 9 9
2 Local Body 11 9 20 40 11 8 19 38
3 Vol.Organ./NGOs 0 1 22 23 0 1 13 14
  Total 21 10 52 83 11 9 41 61


Objectives
The Main object of the Scheme is to make publicity & awareness among people.To motivate eligible couples for accepting FW, MCH, RCH Services.

Activities

  1. Sterelisation Operations.
  2. I.U.D. Cu–T insertions.
  3. Oral Pill & Nirodh distribution.
  4. Immunisations.
  5. M.C.H. services.
  6. Promotion and motivation of F.W. methods.
  7. F.W. Survey and registration.
  8. One day orientation camps, etc.
  9. Pulse Polio Campaign.
  10. Presumptive treatment of Malaria.
  11. Identification of the suspected cases of Tuberculosis/Leprosy.
  12. Infant Feeding.
  13. High risk maternity cases.
  14. Maintenance of records & registers.
  15. Survey of Eligible Couples.
  16. Monthly/Quarterly/Annual Reporting.

Urban Health Posts
Staffing Pattern

Sr.No. Category No. of post admissible by type of Urban Health Posts
A [Below–5000] B [5000 to 10000] C [10000 to 25000] D [25000 to 50000]
1 Lady Medical Officer 0 0 0 1
2 P.H.N. 0 0 0 1
3 Nurse Midwife 1 1 2 3–4
4 MPW (male)* 0 1 2 4
5 Class – IV 0 0 0 1
6 Computer cum clerk 0 0 0 1
7 Vol. women Health worker 0 0 0 1@
  Total 1 2 4 12–1


@ One for every 2000 Population. * At present there is ban on filling these posts.

There are in all 292 U.H.Ps sanction in the State. The Agency/Type wise No. of UHPs sanction and Functioning is as below

Sr.No. Agency/Type Sanctioned Functioning(as on 1/08/07
A B C D Total A B C D Total
1 Government 6 0 7 26 39 3 0 7 26 36
2 Local Body 7 15 36 151 209 7 15 33 138 193
3 Vol.Organ./NGOs 0 0 4 28 32 0 0 2 26 28
  Total 13 15 47 205 280 10 15 42 190 257


A.N.M. Training Schools
Auxiliary Nurse Midwife Training Centers conducting training courses for nurse having staffing pattern as follows
Staffing Pattern

Sr.No. Staff Category Type/Population 20 Student Capacity 30 Student Capacity 45 Student Capacity 60 Student Capacity
1 Nursing Officer Principal 0 1 1 1
2 Sister Tutor 1 2 2 3
3 Public Health Nurse 1 3 1 1
4 Warden 0 0 1 1
5 U.D.C. (part–time) 0 1 0 0
6 U.D.C. (full–time 0 0 1 1
7 Senior Sanitary Inspector 0 1 1 1
8 Driver 0 1 1 1
9 Class–IV 3 4 6 8
  Total 5 13 17 20


This course is of 18 months duration. The stipend of Rs.500/– p.m. is being given to the student. Salaries of the staff in Contigency of Rs. 10000/– p.a. is provided. As per the Govt. of India’s norms Rent up to Rs. 60000/– per annum is being given to the Training Institution if it is on rental basis. One vehicle is provided to the Trg. Institutions.

No. of A.N.M. Training Centers (All are Voluntary Organisations)

Sr.No. Name of the Training Centers Capacity of Students
1 K.E.M. Hospital, Pune. 60
2 Dwarika Sangamnerkar Medical Foundation, Pune 20
3 Seth Tarachand Ramanath Dharmarth Ayurvedic Hosp.,Pune 30
4 Matru Seva Sangh Sitabardi, Nagpur 60
5 Matru Seva Sangh Mahal, Nagpur 30
6 Dhanaraj Giriji Charitable Hospital, Sholapur 30


Activites
(1) Conducting A.N.M. Training
(2) Reorientation training for A.N.M.s

Sterilisation Bed Scheme
At present the scheme is only sanctioned to hospitals run by local bodies and voluntary organisation.These institutions would be entitled to claim bed maintenance grant Rs. 6000/– per bed per annum provided the target of sixty tubectomies per bed per annum is achieved. If the Voluntary Organisation/Local Bodies fails to achieve the target of sixty tubectomies then if the performance level is 45 tubectomies per bed per annum, the maintenance grant of Rs. 4000/– per bed per annum is admissible. And if the performance level of organization remains below 45 tubectomies per bed per annum ,proportionate grant of Rs.4000/– per bed per annum is admissible.

Activities & Main Objective
To Carry out Tubectomies operations. The scheme is only sanctioned to hospital run by Local Bodies and Non– Government/ Voluntary Organisation.

These institutions would be entitled to claim bed maintenance grant per bed per annum provided a target of tubectomies is full filled as per Government of India norms.

The norms are as follows
i) Rs.6000/– per bed, per annum provided if target of 60 tubectomies per bed per annum is achieved.
ii) Rs.4000/– per bed, per annum provided if 45 tubectomies, per bed, per annum is achieved.
iii) If the performance of tubs is less than 45 tubectomies, per bed, per annum then proportionate grant per bed, per annum is admissible.

Grant–in–aid.(G.I.A.)
The above schemes are 100% Central sponsored. The State Government has to pay grant first and then get it reimbursed from Govt. of India.

The Government of India has fixed the norms for distributing the assistant grant and they are follows

  1. Institution must be Charitable one, approved by charitable commissioner and it must be registered.
  2. The staff sanctioned to the N.G.O./ L.B.O. is as per the norms laid down by Govt. of India.
  3. The post must be filled by the Institution (NGO/LBO) as per their rules and regulations. The Govt. is only verifying the Education Status of the concerned worker posted on the particular post.
  4. Government is providing 100% assistant Grant–in–aid only for the salaries and wages of the Staff working under the Urban Family Welfare Schemes of NGO/LBO.
  5. Grant–in–aid is not provided for vacant post.
  6. Government is not providing expenditure on Pension, Gratuity, Bonus, Leave encashment, Provident fund etc. Institution has to bare the same as per their rules.
  7. Institution receives rent of the building if it is on rental basis. But the maximum limit of the rent is Rs. 25000/– per annum as per the norms decided by the Public Works Deptt. of Maharashatra State. This is provided to those Institutions who demands the rent.
  8. Under the Scheme of ANM Training Centers the vehicle is provided. The expenditure and repairs is being given as per the guidelines of the Central Government.
  9. Revised Contingency is being provided to the NGO/LBO as per the norms laid down by the Central Government from 2003–04 and they are as follow
Type of Center City F.W.B. Urban F.W.C. Urban Health Post
Type –III & IV Rs.8000/– – –
Type– I – Rs.5000/– –
Type– II – Rs.7000/– –
Type– III – Rs.15000/– –
Type– A – – Rs.5000/–
Type– B – – Rs.5000/–
Type– C – – Rs.15000/–
Type– D – – Rs.25000/–


For A.N.M. Training Center Contingency of Rs.10000/– is being provided.

  1. Distribution system of assistant grant:
    The assistant grant is being distributed in four installments as per the norms laid down by the Central Government.
Sr.No. Installment GIA Distribution System
1 1st Installment 1/6 th of the budget of the Institution
2 2nd Installment 50% GIA (Including 1st Inst.) will be released on receipt of un audited statement and if achievement of last year is satisfactory.
3 3rd Installment 75% GIA (Including 1st & 2nd Installment) will be released on receipt of Audited Statement and if performance of current year (up to September ) is satisfactory.
4 4th Installment On completion of balance–sheet and on reconciliation of last year’s expenditure ,the forth and final installment is being released

 

  1. It is the responsibility of the concerned NGO/LBO to pay the salaries of the staff in time without waiting for grants from Government as they have to pay first and get it reimbursed from Government.
  2. It present limit of sanctioning the GIA to NGO/LBO is as follow:
    1. Additional Director of Health Services,(FW )––––– up to Rs.5 lakh.
    2. State Government (PHD) –––––––up toRs.10 lakh.
    3. Government of India–––––––above Rs. 10 lakh.
    The GIA is released by Additional Director of Health Services (FW) to the concerned Institution through concerned Dy. Director of Health Services (Health) of respective Circles.
  3. The assistant grant is being distributed on fulfillment of performance of Family
    Welfare in equivalent sterilization and is as follow:
Sr.No. Equivalent Sterilisation GIA to be Sanction
1 85% and above 100%
2 50% – 84% 50%
3 Less than 50% NIL
  1. The Targets – The Family Welfare and Maternal Child Health Targets are being fixed and distributed by the concerned Medical Officer of Health, Municipal Corporation and Civil Surgeon, General Hospital.
  2. The The review of the programme is taken by Medical Officer of Health, Civil Surgeon, Mun.Commissioner & Dy. Director of Health Services, every month and feedback is being given for satisfactory performance of the Institution.
  3. Reporting – Quarterly Progress Report must be submitted to Addl. Director of Health Services, Family Welfare, MCH & SH, Pune– 411 001.

Historical Background
The Immunization programme was launched in 1985–86 in a phased manner. It has been launched to reduce morbidity and mortality due to vaccine preventable diseases. The “Expanded Programme of Immunization (EPI)” was launched in Oct. 1977 to control 5 vaccine preventable diseases viz. Diphtheria, Pertusis, Tetanus, Poliomyelitis and Tuberculosis. The “Universal immunization Programme” was introduced in 1985–86. The Measles vaccination was included in the programme during UIP.

In 1992 in the Universal Immunization programme became part of “Child Survival and Safe Motherhood Programme (CSSM)”. The programme has been well set involving organization of immunization/MCP Session at fixed places, at Fixed timings on Fixed days both institutional as well as outreach session. The Reproductive & Child Health Programme (RCH) was launched in Oct. 1997. It was targeted to cover all pregnant woman with immunization against Tetanus & all infants with Primary immunization.

Special Features of Programme
Cold Chain equipment and vaccine is supplied by Central Government free of cost. Vaccine is given to all beneficiaries free of cost at every immunization session. Surveillance of vaccine preventable diseases is done through home visits and OPD & IPD cases.

Objectives of MCH & Immunization

Strategy of MCH & Immunization
Health staff enumerates beneficiaries in their respective area. Health Assistants procures vaccine from their institution through proper Cold Chain. Vaccination is done under the supervision of Health Assistant. Defaulters are contacted. The vaccination schedule as recommended by Govt. of India is followed. The aim is to give primary immunization at proper age, proper dose and appropriate route before the first Birthday of child.

Activities of MCH and Immunization
Antenatal Services

Natal Service

Post Natal Services

Child Care

Implementation and Delivery System
The ANM at the subcenter and the trained birth attendants in the villages all the key person in the delivery of MCH Services. Immunization Clinics are utilized for providing regular antenatal services.

Primary vaccination is given to children before 1st birthday viz. 0 Polio, BCG, DPT, Polio, Measles and vit.A (1st dose). Booster dose of DPT, Polio & vit.A are given at 18 months to 24 months. 3 doses of vit.A are given after every 6 months. A dose of DT is given to children between 5 to 6 yrs. and a dose of TT is given to 10 years and 16 years. Pregnant women are given 2 doses/ Booster dose of TT.


Immunization services are available at following institution in district

Services to common people
Services Provided
Immunization services are provided to all the people free of cost through every Health institution.

MCH & Immunization
Performance
Last Five years Immunization Programmes

Sr.No. Indicator 2007-2008 (April to Jan. 2008)
ELA ACH. %
1 DPT III 1974375 1514079 77
2 OPV III 1974375 1476641 75
3 BCG 1974375 1633207 83
4 Measles 1974375 1472809 75
5 DPT (B ) 2253480 1462570 65
6 OPV(B) 2253480 1408211 62
7 DT 2467968 1539717 62
8 TT (10) 2467968 1492166 60
9 TT(16) 2253361 1301775 58
10 TT (M) 2254436 1246894 55


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Last five years MCH Performance

Sr. No. Activity 2006-2007
ELA ACH. %
1 ANC Registration 2405384 2229445 93
2 ANC Regi.< 16 Wks 1804056 1390380 77
3 Iron Folic Acid Prophylactic -IFA( PH) 1202683 705680 59
4 Iron Folic Acid Therapeutic- IFA( TH) 1202683 344115 29
5 Delivery U.Dai - 38340 -
T.Dai - 267504 -
ANM/Doctor - 173416 -
Institute - 1095143 -
Total 2405384 1574264 65
6 Vit A I 2098904 1608698 77
II 2014740 1454787 72
III 2014740 1356991 67
IV 2727660 1136068 42
V 2727660 1176116 43


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MCH & Immunization
Achievements
Incidence of vaccine preventable diseases has reduced to a measurable level.

Universal Immunization Programme
Vaccine Preventable Diseases

Years Diptheria Pertusis
Attack Deaths Attack Deaths
2003–04 27 4 1 0
2004–05 206 11 58 0
2005–06 151 19 6 0
2006–07 513 1 95 0
2007–08 240 0 78 0
2008–09 (up to May08) 13 0 7 0


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Background History
Janani Surkasha Yojana has been started during 2005–06 by Central Government. Maharashtra Government sanctioned this scheme by vide G.R. No. JSY 2005/670 Prs.Kra.171/FW3 dated 26/10/2005 for the rural area only. Vide Gr. No. JSY 2005/670/Pra.Kra.171/ FW dated 14/08/2006 urban area & benefit is given to beneficiaries below poverty line. Vide G.R. No. JSY2005/670 Prs.Kra.175/FW 3 dated 22/12/2006. Benefit is to be given Sc & ST beneficiaries.

Objectives
To increase the institutional deliveries in urban and rural areas and reduce the MMR & IMR and BPL,SC & ST.

Strategy

Service Centers
The scheme is available at all Sub Centres, Primary Health Centres, Community Health Centres, Rural Hospitals, Sub – District Hospitals, District Hospitals, Accredited Hospitals, Hospitals under Medical Colleges, Municipal Corporation Hospitals, Corporation Hospitals and all Government Granted Hospitals.

Achievements
No. of beneficiaries from the last two years:

Sr.No. Year No. of Beneficaries
1 2006–07 46728
2 2007–08 219552