National Family Welfare Program and National Population Policy

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National Family Welfare Program

1952: National Family Planning program launched 100% centrally sponsored program First country in the world

SIHFW: an ISO 9001: 2008 certified institution

National Family Welfare Program

Family Planning Dept.- created in 3rd FYP 4th FYP - integration of Family Planning services with MCH services MTP Act introduced 1972 N ti National F il W lf l Family Welfare P Programme started i 1977 t t d in
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j Objective
Reducing the birth rate to the extent necessary to t bili t stabilize th population at a l the l ti t level consistent l i t t with the requirement of the National economy. economy

SIHFW: an ISO 9001: 2008 certified institution

Stabilize Population p Targets as an end Reduction in Births Administrative &Performance

Informed decision Resentment, disownment client driven Quality

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Approach
VII FYP
Area Development Projects p j India Population Project-VIII & IX India Population Project-VIII & IX Differential planning scheme Differential Increasing involvement of NGOs UIP & CSSM TFA TFA
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Approach
1st and 2nd FYP- Clinical Clinical 2nd FYP - Target approach 3rd FYP Extension & Education approach 4th FYP - Post Partum scheme, reduce CBR to 32

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Approach
5th FYP NFPP replaced by NFWP, reduce CBR to 30 6th FYP- Net Reproduction Rate (NRR) of 1, family FYP size to 2.3 7th FYP - spacing methods, community participation and promotion of MCH care

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pp Approach
8th FYP stress on the involvement of NGOs to FYP-stress supplement and complement the Government efforts. 9thFYP stressed on reduction in population growth 10th FYP focused on reduction on IMR ,decadal g growth rate & increased literacy rate y
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IX FYP
Indicator If current trend continues If acceleration envisaged in Approach Paper to the Ninth Five Year Plan is achieved. achieved

CBR IMR TFR CPR

24/1000 56/1000 2.9 29 51%

23/1000 50/1000 2.6 26 60%

NNMR 35/1000 MMR 3/1000

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(Source: www.censusindia.net)

X FYP
Objectives: Reduction in the decadal rate of population growth between 2001 and 2011 t 16.2%; th b t d to 16 2% Increase in Literacy Rates to 75 per cent within the Tenth Plan period (2002 to 2007) Reduction of I f t mortality rate (IMR) to 45 R d ti f Infant t lit t t per 1000 live births by 2007 and to 28 by 2012
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 Population Policy NRHM IMR,MMR,TFR Unmet Needs- Increasing Contraceptive choices Male involvement Social marketing Private sector involvement g Infrastructure strengthen Involvement of PRI IEC IEC Training
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X-FYP

XI FYP g Targets Reduce IMR to 28 and MMR to 1 per 1000 live births Reduce TFR to 2 1 Reduce 2.1 Provide clean drinking water for all by 2009 and ensure that there are no slipp backs Reduce malnutrition among children of age group 0-3 to half its present level Reduce anemia among women and girls by 50% by the end of the plan Family planning insurance Scheme Jansankhya Sthirata Kosh
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Goals: XI FYP
Reducing MMR to 100 Reducing IMR to 28 Reducing TFR to 2.1 Providing l P idi clean d i ki water f all b 2009 drinking t for ll by Reducing malnutrition among children of age group 0 3 to half its present level 03 level. Reducing anemia among women and girls by 50%. R i i th sex ratio f age group 0 6 t 935 b Raising the ti for 06 to by 201112 and 950 by 201617.
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p Contraceptives
The National Family Welfare Program provides the following contraceptive services for spacing births: Condoms C d Oral Contraceptive Pill p Intra Uterine Devices (IUD)

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Terminal Methods: T b t Tubectomy i) Mini Lap Tubectomy ii) Lapro Tubectomy Vasectomy i) Conventional Vasectomy ii) No-Scalpel Vasectomy

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No. of beneficiaries of Sterilizations

Period No. of beneficiaries of Sterilizations in N fb fi i i f St ili ti i India Male Female Total 250496 228378 255605 17299 4756789 4754170 4951938 583903 5007285 4982548 5207543 601202
17

2008-2009 2008 2009 2009 2010 2009-2010 2010-2011 2011-2012

( (Till 30.6.11) )

Source: State wise Progress, NRHM, India (www.mohfw.nic.in)

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No. of beneficiaries of Sterilizations in Rajasthan R j th

S. N. 1 2 3 4 5 Period 2006-2007 2007-2008 2008-2009 2009-2010 2009 2010 2010-2011 Target 454665 457655 459569 471618 481248 Achieved % Achieved 288089 335029 356923 345900 338574 63.36% 73.21% 77.66% 73.34% 73 34% 70.35%
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Source: (Progress Report of Family Welfare Program ,Rajasthan)

SIHFW: an ISO 9001: 2008 certified institution

Family Welfare Achievement in India

No. of Institutional Deliveries (In Lakh) 2008-2009 2009-2010 2010-2011 148.23 148 23 162.22 162 22 168.04 168 04 No of Full Immunized Children (in 000s) 2008-2009 2009-2010 2010-2011 22454 23175 23653

Source:StatewiseProgressason30/06/2011,NRHM,India(www.mohfw.nic.in)

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Family Welfare achievement in Rajasthan

Particular P ti l Target T t Achievement A hi t % Achievement A hi t

Total Sterilization IUD Insertions Total OP Users Total CC Users ANC Registration ANC Registration within 12weeks ANC Registration Who have received 3 checkups TT(PW) Full Immunization u u a o

481248 458207 1231789 1452985 1931466 1931466 1931466 1931466 1645258

338574 407122 795327 987507 1869758 853792 1255982 1576257 1368591

70.35 70 35 88.85 64.57 67.96 96.81 44.20 65.03 81.61 83.18

Source: Progress Report of FWP&NRHM/RCH II (2010-11)Demographic Unit, Directorate of Medical, Health &Family Welfare services, Jaipur SIHFW: an ISO 9001: 2008 certified institution 20

Status of NSV: Rajasthan

Source: Pragati Prativaden 2010-11(www.rajswasthya.nic.in)

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Empowered Action Groups

GOI constituted an EAG w.e.f. 20th March,2001 To facilitate the preparation of area-specific programs, programs With special emphasis on eight states [Rajasthan, UP, Bihar, MP, Orissa, Chhattisgarh, Jh kh d Utt Chh tti h Jharkhand, Uttaranchal] h l]

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Strategies to be adopted to achieve the Goals Under XI FYP

1706 private nursing homes have been involved besides the Government institutions to provide family welfare services in the State. More number of unapproved private nursing homes will be approved to render Family Welfare services to the eligible couples.

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 All the untrained DGOs, M.D (Obstetrics & Gynaecology), M.S. (Surgery) will be trained in G naecolog ) M S (S rger ) ill Laparoscopic Sterilization. All the untrained MBBS doctors will be trained in tubectomy sterilization and N S l l V t ili ti d Non Scalpel Vasectomy. t At p present 254 Operation p theatres are

functioning in the Primary Health Centres. Steps will be taken to make the Operation theatres in all the Primary Health Centres functional in a y phased manner. SIHFW: an ISO 9001: 2008 certified institution
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 Area specific approach will be adopted to identify village wise eligible mothers with three and above children and motivate them by a block level team to accept Family Welfare Sterilization. All the untrained VHNs and ANMs will be given training i i i i in insertion of IUD i f

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Role of the EAG

Ensuring appropriate p g pp p policy development at the y p Centre, Provisioning for technical assistance to the member States, Addressing issues of coordination between member states and departments Deploying financial resources, as appropriate and feasible.

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Family Planning Insurance scheme

To encourage people to adopt permanent method of F il Pl th d f Family Planning i Centrally Sponsored Scheme since 1981 to compensate th acceptors of sterilization f th t the t f t ili ti for the loss of wages Implemented through ICICI Lombard General insurance Company Compensation: (w e f 07 09 07) (w.e.f-07.09.07) Compensation in case of adverse event (w.e.f. January 1st, 2009)
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Family Planning Insurance scheme: Compensation: (w.e.f 07.09.07) (w.e.f-07.09.07) In Govt. facilitiesCateg Intervention ory Accep Motivator Dru Surg Anes Staff OT Refr Cam tor gs eon thetis nurs Ass esh p t e tt. men mgt. t
200 150 50 100 100 75 25 15 15 15 15 10 10 10 10

High focus states Non high focus states

Vasectomy (all) 1100 Tubectomy(all) 600

Vasectomy (all) 1100 Tubectomy(BP 600 L, SC/ST only) 250 Tubectomy( APL only)

200 150 150

50 100 100

100 75 75

25 25

15 15 15

15 15 15

10 10 10

10 10 10

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In Pvt. facilities
Category Type of operation Facility Motiv Total ator High Focus States Non High focus states Vasectomy (All) Tubectomy (All) Vasectomy (All) Tubectomy (BPL+SC/ST) 1300 1350 1300 1350 200 150 200 150 1500 1500 1500 1500

Source: Manual for family Planning Insurance Scheme, Dept.of Health& Family Welfare (www.mohfw.nic.in)
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Q y y planning service g Quality of Family p

Quality in family Planning can be defined as offering a range of services that are safe and effective and that satisfy clients needs and wants. wants It can also be defined as the way clients the are treated by the system.

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Why Quality in FP?

Family planning is not just a demographic issue It is also an issue related to individual issue issue. rights, socio-economic development, preservation of the environment, and the health and wellbeing of women couples families and women, couples, society at large. There is a huge unmet need for Family Planning and improving Quality will increase the utilization of services.
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y Dimensions of Q Quality Services

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Strengthening Service Delivery in Family Planning

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/ g At Household/ Village Level

Services/ Activities HH visits: by ASHAs, ANMs& ASHAs VHNDs: Counseling FP services(OCs, services(OCs Condoms, ECPs) Follow up of IUCD, sterilization &Postpartum clients li Referral Community Mobilization Areas to be strengthened Availability f A il bilit of IEC materials Capacity building & Role Clarity Cl it Incentives to ASHA Regular supervision Active participation of PRIs

Creating Role Models: Jan Mangalcouples and PrernaScheme by JSK in some districts of Rajasthan NSV Champion in Jharkhand
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At Sub centre
Activities/Services Maintaining Eligible g g Couple Register Counselling and service provision during ANC ANC, PNC & Immunization visits IUCD insertions Follow up services Referral Services Contraceptive supply, Support &Supervision of ASHA & AWW Areas to be strengthened Facility readiness y according to IPHS standards Training in IUCD (No Touch Technique) Provision of IEC Materials Supportive supervision by LHV / MO PHC Strengthening Referral

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At PHC
Activities/Services All FP services including i i l di Tubal ligation (interval & p p postpartum)& NSV ) Follow up services Counselling and appropriate referral f i t f l for couples having infertility Training and supportive supervision of field level staff like ANMs, MPWs& ASHAs Areas to be strengthened Ensuring availability of 24/7Services as per IPHS Ensuring availability of g y trained personnel in Minilap/NSV/IUCD insertion Fixed Day Static Services for sterilization Regular supply of drugs, equipments & instruments Referral Services SIHFW: an ISO 9001: 2008 certified institution 36

At CHC
Activities/Services 24 7 24*7 specialist services All FP services including Laparoscopic Sterilization p p services Follow up services Training and supervision of field level staff Regular supply of drugs Diagnostic Services Areas to be strengthened Up g p gradation as p per Strengthening of counseling component Rational posting of specialists p Operationalize District Clinical Training Centres Fixed Day Static Services for t ili ti f sterilization Strengthening of RKS Management of couples having infertility
37

SIHFW: an ISO 9001: 2008 certified institution

Key Interventions for Improving Quality I i Q lit

Integration of Family Planning with MCH services at various opportunities: ANC/PNC/Institutional delivery/Immunization/HIV counseling/Adolescent clinics/ Home visits/ VHND. g p , Coordination among Department of Health, Directorate of Family Welfare and NRHM Programme Management Unit at various levels. Ensuring Availability of trained manpower and other resources at all levels.
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 Advocacy at all levels on importance of FP for improving maternal and child health Quality assurance committee (QAC) to be constituted at all the States/ Districts level as per norms set in Q alit Ass rance man al and Quality Assurance manual regular meetings to be held for assessing and ensuring the quality of services services. Facility up gradation as per the IPHS. Comprehensive training plan for MCH & FP services

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Quality Assurance
Quality Design
Policy & Goals- NPP, NHP, NRHM, MDG Service Protocols/ Manuals/ Guidelines Standardized Operating Procedures Indemnity insurance scheme Compensation for loss of wages

Quality Improvement
Periodic Reviews/ Audit Remedial Actions Monitoring of progress of Remedial implementation, Program Evaluation Program

Quality Control
Supportive Supervision Periodic Reports Quality Assurance Committee HMIS Nationwide Surveys

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p y National Population Policy 2000

Immediate objective : To address the unmet needs for contraception, health care infrastructure, and health personnel, and t provide i t d to id integrated service d li t d i delivery f for basic reproductive and child health care

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 Medium-term objective: j To bring the TFR to replacement levels by 2010, through vigorous implementation of inter-

sectoral operational strategies. p g

Long-term objective: To hi T achieve a stable population b 2045 t bl l ti by

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846.39

1200 3.33 683 1000 4 439.23 800 600 400 200 0 1951 1961 1971 1981 361 1.09 548.16

27.03 102

1400

1210.19 India Rajasthan 2011

43

Population Growth p

15.97

.15 20.

25. .76

34.36

1991

4.01 44

2001

Source: Census of India / data in millions

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56 6.47

68 8.62

Jansankhya Sthirata Kosh

National Population Stabilization Fund -registered as an autonomous Society Combination of government and civil society Working to promote innovations Promote initiatives which leverage the strength of different economic and social sectors To reach out needy population groups
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 Observation of World Population Day Prerna Awards at Dhaulpur and Jodhpur in Rajasthan and Nabarangpur in Orissa g p Working with the Private Sector Medical Specialists to enhance services for contraception. Induction of professional people [NGOs, CII, FICCI, IASP, IPHA, IAP & SM, FOGSI etc] p p y Material Development and display for IEC/BCC
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Innovative Strategy under JSK Prerna Prerna

Prerna provides reward for specific parenthood Girls marriage after 19 y g years - Rs.5000 First birth after 21 years - Rs.7000 (girl) ( y) Rs 5000 (boy) 3 years gap between first and second child with sterilization of 1 parent after the 2nd child (Reward p ( of Rs.7000/ if its a girl child & Rs 5000/ if its a boy)
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Conditions for getting rewards

Couple must belong to any of the 46 districts identified Must belong to BPL category Preference given to younger couples Only those couples who have completed registration of marriage and registration of the birth of each child The award shall be given in form of Kisan Vikas g Patra in the name of Couple and will be given at a public function
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Santushti
Motivate private gynecologists to perform 100 tubectomy /vasectomy, doctors are paid according y y g to already notified compensation rates (Rs 1500 per case) MOU is signed between the district CMHO and private facilities Funding is provided by JSK through the Collector and CHMO I iti t d i M dh P d h R j th and O i Initiated in Madhya Pradesh, Rajasthan d Orissa 64 MOUs and around 1600 sterilization operations [until Aug [ til A 09]
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p Measures for Population Stabilization

A number of primary and secondary care p y y facilities in the government sector are being geared t provide Fi d D S i d to id Fixed Day Services (FDS) f for sterilization. Compensation acceptors. scheme for sterilization

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 Quality Assurance Committees (QACs) have been constituted in all the states and districts so that adequate standards of care are maintained in family planning services. yp g A new and better IUD-T 380 A, which has tenyear effectiveness, has been introduced along with better training, both as a short and long term spacing method
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Virtual Resource Centre (VRC)

VRC is a virtual resource/documentation centre Provides access to films, posters, photos Subjects like anemia, gender, maternal and infant mortality, sex ratio, adolescent health, spacing etc. Media, Researchers, Students NGOs and General public has access to it Inter-university and school level quiz competitions
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Case Study: An Auxiliary Nurse-Midwife Sets an Example for Family Planning S t E l f F il Pl i

Seema Verma An a iliar n rse mid ife posted auxiliary nurse-midwife at CHC. The 32-year-old mother of two daughters wants to help other women make an informed choice about family planning services just as she was able to do. When she was pregnant for the p g second time and looking for a viable, long-term family planning method to limit future pregnancies,

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Seema received counseling by a visiting team. The team that counseled Seema explained the importance of using contraceptives after d li i t f i t ti ft delivery to delay or prevent the next pregnancy, and told her about the copper-bearing IUCD which can be copper bearing IUCD, inserted within 48 hours after delivery. As a result of this counseling, Seema chose to deliver her g, baby at Womens Hospital, so that she could get an IUCD immediately after the birth of her daughter, Ri ik who i now three months old. d h Ritika, h is h h ld

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For Seema, an IUCD was the best family planning choice because it was free under government policy, l t f 10 years and could b t li lasts for d ld be inserted while she was still in the hospital. Moreover, Moreover she appreciates that she doesnt need doesn t to remember to take an oral pill every day. Seema was so enthusiastic about her family planning y p g decision that while resting in the postpartum ward, she successfully counseled two other women who were sharing the room with h h h i h i h her.

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They, too, chose to have an IUCD inserted. Seema not only feels strongly that other women in her community can benefit from this method of family planning, she is also optimistic that it offers a promising future for her own two daughters. One of four children in a poor family, Seema struggled to finish her schooling and became the most educated member of her family

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Thank You
For more details log on to www. Sihfwrajasthan.com www Sihfwrajasthan com or contact : Director-SIHFW on [email protected] sihfwraj@yahoo co in

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