(GIST OF YOJANA) Empowering Women through ‘Continuum of Care' [OCTOBER-2018]
(GIST OF YOJANA) Empowering Women through ‘Continuum of Care'
Empowering Women through ‘Continuum of Care'
At the Ministry of Health and Family Welfare, we believe that women empowerment begins from the womb ! Preventing sex selection and stopping sex selective elimination is the first step towards empowerment of women. The Government has enacted the Pre-conception and Pre-natal Diagnostic Techniques (Prohibition of Sex Selection) Act, 1994 for prohibition of sex selection before or after conception and for prevention of misuse of pre-conception and pre- natal diagnostic techniques for sex determination. Alongside this regulatory provision, we also work on the socio economic aspects of enhancing the society's understanding of the immense value of the girl child through our flagship initiative of Beti Bachao, Beti Padhao.
If a country aims to build a civilization where women are strong, equal, active and productive members of their society, ensuring quality and equitable health care services to women is critical. Recognizing this, Ministry of Health implements several programmes for health of women following a life-cycle "continuum of care' approach to ensure equal focus on various life stages of women, ranging from a spectrum of programmes for pregnant women, the neonates, infants, young children, adolescents, and family planning programmes for women in the reproductive age group. In addition to providing healthcare services, the public health departments also pave the way for economic empowerment of women by engaging women in positions ranging from village level Accredited Social Health Activists (ASHAs) to health care providers such as Auxillary Nurse Midwives (ANMs), health care administrators and policy makers at State and National levels. Nearly 10,31,805 ASHAs and 2,20,707 ANMS (as of March 2018) are in position and employed as frontline health workers. It is these women who form the backbone of the healthcare infrastructure of the country.
For the pregnancy, every woman is entitled to quality antenatal, intra-natal and postnatal care services. Carrying forward this vision of our Prime Minister, the Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) has been launched to provide quality ante-natal care (ANC) to pregnant women on the 9th of every month (symbolizing nine months of pregnancy). While antenatal care is routinely provided to pregnant women at public health facilities throughout the month, special ANC services are provided by Obstetrician Gynecologist (OBGY) specialists/ radiologist/ physicians at government health facilities under PMSMA. Till April 2018, more than 1.42 crore ANCs have been conducted and more than 7 lakh high risk pregnancies have been identified under PMSMA. In addition, antenatal care services are also provided at the village level through Village Health & Nutrition Days (VHNDs) and at health facilities routinely to ensure at least four ANCs to women. These checkups are essential as iron folic acid, calcium etc., are provided to pregnant women at the checkups and investigations are conducted to identify any complications of pregnancy and to ensure safe delivery. Mother and Child Protection (MCP) Cards and safe motherhood booklets are provided to pregnant women to inform them about the essential care to be taken during pregnancy. Not only this, to harness IT in reaching the most vulnerable and most inaccessible, the Ministry runs a Mother and Child Tracking System (MCTS)/Reproductive Child Health (RCH) portal and Kilkari mobile services which tracks and facilitates timely delivery of antenatal, postnatal care services to women and immunization services to children by the front line workers through proper line listing and also targeted agespecific messages and calls.
Janani Shishu Suraksha Karyakaram (JSSK) entitles all pregnant women delivering in public health institutions to absolutely free and no- expense delivery including Caesarean section. The initiative stipulates free drugs, diagnostics, blood and diet, besides free transport from home to institution, between facilities in case of a referral and drop back home. Over 1.33 crore pregnant women have benefitted from this. Women can call 102/ 108 to avail free transportation services under this programme and contact their nearest ASHA (Accredited Social Health Activist)/ ANM (Auxillary Nurse Midwife/ public health facility) for further information. While at the facility, to ensure quality of services around childbirth, we have recently launched the LaQshya program- Labour room Quality improvement initiative for focused and targeted approach to strengthen key processes related to the labour rooms and maternity operation theatres. MoHFW also implements the Janani Suraksha Yojana (JSY)- a cash transfer scheme to promote institutional deliveries. Also, First Referral Units (FRUS), Maternal and Child Health wings, Obstetric Intensive Care Units and delivery points are established to provide basic and emergency obstetric care services. All these have resulted in the institutional delivery in the country rising to 78.9 per cent (NFHS-4, 2015-16) from 47 per cent (DLHS-3, 2007-08).
The first one thousand days in the life of a child hold the key to unlock and shape the life-long potential of a person. By the age of two years, 85 per cent of a person's brain is developed; these are the formative years, where factors such as adequate healthcare, good nutrition, early learning and stimulation, quality childcare practices and a clean safe environment have significant and crucial influence on the future of a child. In a conscious efforts and caregivers A rearing practices, to educate the parents and about good child rearing a book titled “Journey o Days” has been published Ministry of Health.
A healthy adolescence pr women the platform to their full potential. Conside magnitude of various health and risk factors among adole which may have impact on and child health outcomes, Mir of Health initiated Rashtriya K Swasthya Karyakaram (RKSK) the objectives to increase the award and access to information adolescent health, provide counsel and health services and provide special services such as sanitarv nani Ministry Rashtriya Kishore pureed specific services such as sanitary napkins: iron folic acid supplementation etc. Under this programme, Weekly Iron-Foli Acid Supplementation (WIFS) entails provision of weekly supervised Iron Folic Acid (IFA) tablets to in-school boys and girls and out-of-school girls and biannual Albendazole tablets for helminthic control for prevention of iron and folic acid deficiency anaemia. As part of it, 3.7 crore adolescents have been provided weekly iron folic acid supplement and 2 lakh Peer Educators (PES) selected and trained for sustained peer education, as of April 2018. The Ministry of Health and Family Welfare is also implementing the Scheme for Promotion of Menstrual Hygiene among adolescent girls in the age group of 10-19 years primarily in rural areas, with specific reference to ensuring health for adolescent girls. 7516 Adolescent Friendly Health Clinics (AFHCs) have also been established at health care facilities to provide care and counseling services to adolescents.
Every woman has the right to plan her pregnancy. The family planning programme implemented by MOH provides a basket of choices to the parents decide, freely and response the number and the spacing of children. Recently, MOHI introduced new contraceptive Injectable contraceptive Medro) Progesterone Acetate (MPA) - Antara and a non-hormonal, non-steroidal weekly Centchroman pill, Chhaya to meet the changing needs of people. The programme also focuses on Post Partum IUCD (PPIUCD), post partum Sterilization and on Post Abortion IUCD (PAIUCD) to help women ensure adequate spacing between children. Home delivery of contraceptives by ASHAs aims to improve access to contraceptives for eligible couples, through distribution of contraceptives at the doorstep of the beneficiaries. ASHAs have been trained to counsel newly married couples to ensure spacing of two years after marriage and to have spacing of three years after the birth of the first child.
Caring for the Girl Child
Apart from the above, a host of services are available for ensuring a healthy childhood for the girl child. In order to provide specialized care to infants in case of complications, Special Newborn Care Units have been established at district level and Newborn Stabilization Units and newborn care comers have been established at sub distaste level. ASHAs undertake visits to provide Home-Based Newborn Care to newborns. It is a matter of immense pride that India has the world's largest Universal Immunization Program. To ensure full immunization for children up to two years of age and pregnant women, a special initiative, Mission Indradhanush, was started in 2014 to immunize all the left out and missed children, and pregnant women. Till date, we have vaccinated 3.15 crore children (of which 80.58 lakh children are fully immunized), immunized 80.63 lakh pregnant females and administered 91.94 lakh Vitamin A doses as part of this. 1150 Nutrition Rehabilitation Centres (NRC) have also been established to provide specialized care to children having severe acute malnutrition. Rashtriya Bal Swasthya Karyakram (RBSK), is an initiative to improve the overall quality of life of children through early detection of birth defects, diseases, deficiencies, development delays. As part of this program, till September 2017, around 70.9 crore children have been screened of which 1.55 crore children have received treatment.
Drugs and Diagnostics
Free Drugs and Free Diagnostics Scheme for essential medicines at public health facilities, mobile medical units etc., are other platforms where women can avail free healthcare services. More than Rs. 16,000 cr have been allocated to the States during the last three years for this. Ayushman Bharat also brings with it several preventive and promotive services for women through the 'Health & Wellness Centres' (HWCs) which shall provide comprehensive primary care in addition to specialized mother and child care services. The aim is to establish about 1.5 lakh HWCs in a phased manner. Mid-Level providers are being trained to provide comprehensive services at these centres ranging from reproductive and child health services to services for communicable and non-communicable diseases. These centers will also provide employment to many women frontline health workers.
Government of India is striving to ensure comprehensive healthcare services to women across the country and these efforts have led to significant reduction in under-five and maternal mortality of India. Not only was India validated for Maternal and Neonatal Tetanus Elimination (MNTE) in April 2015, much ahead of the global target date of December 2015,India has achieved another laurel recently. We have accomplished the Millennium Development Goal (MDG) for Maternal Mortality. The Maternal Mortality Ratio (MMR) has substantially dropped from by a massive 37 points. From 167/ lakh live births in 2011-13, it is now 130/ lakh live births! This is the highest since the last several decades. This means that we are now saving 12,000 more pregnant women, as compared to 2011-13.
With the steadfast support of the States, and our dedicated and committed
frontline health workers, we are confident to achieve the Sustainable
Development Goal (SDG) for
maternal health much before the timeline of 2030, paving the way for a healthy, empowered and bright future for the women of India.