Post on 15-Dec-2015
FAMILY PLANNING FAMILY PLANNING PROGRAMPROGRAM
FAMILY PLANNING FAMILY PLANNING DIVISIONDIVISION
Ministry of Health & Family Ministry of Health & Family WelfareWelfare
Government of IndiaGovernment of India
22
POPULATION OF INDIA
25125
2
279 31
9
361
439 10
29
548
686
846
1.25
1.96 1.932.14
0.56
-0.03
1.041.33
2.20 2.22
0
200
400
600
800
1000
1200
19
01
-11
19
11
-21
19
21
-31
19
31
-41
19
41
-51
19
51
-61
19
61
-71
19
71
-81
19
81
-91
19
91
-20
01
*
-0.5
0.0
0.5
1.0
1.5
2.0
2.5
PO PULATIO N GRO WTH RATE %
Source:- Registrar General India
33
DEMOGRAPHIC SCENARIO
1. India is the second most populous country in the world.
2. India has 17 % of world’s population and has less than 3% of earth’s land area.
3. While the global population has increased 3 times, India has increased its population 5 times during the last century.
4. India’s population is expected to exceed that of China before 2030 to become the most populous country in the world.
44
PERFORMANCE OF STERILISATION
0.88 0.96
3.73
0.91 1.010.83 0.94
2.86 3.003.34
3.172.88
4.70 4.835.04
4.504.29
1.201.211.12
3.673.673.693.54
0.74
0
1
2
3
4
5
6
'2002-03
'2003-04
2004-05
2005-06
2006-07
LA
KH
S
Bihar MP Orissa Rajasthan UP
55
PROJECTED POPULATION OF INDIA AS ON Ist MARCH (IN CRORES)
102.9111.2
119.3126.9
134.0140.0
0
20
40
60
80
100
120
140
160
2001 2006 2011 2016 2021 2026
Cro
res
66
WHAT IS TFRWHAT IS TFR The total fertility rate is the average number of The total fertility rate is the average number of
children a woman would have if she were to pass children a woman would have if she were to pass through her reproductive years bearing children at through her reproductive years bearing children at the same rates as the women now in each age group.the same rates as the women now in each age group.
It is computed by summing the age specific fertility It is computed by summing the age specific fertility rates for all ages.rates for all ages.
It gives a magnitude of It gives a magnitude of completed family sizecompleted family size
In simple terms TFR denotes In simple terms TFR denotes
the average number of children borne per the average number of children borne per womanwoman
77
TOTAL FERTILITY RATE, NFHS (2005-06)
3.39
2.85 2.68
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
NFHS-I (1992-93) NFHS-II (1998-99) NFHS-III (2005-06)
TOTAL FERTILITY RATE
TFR
88
Benefits of family Benefits of family planningplanning
Stabilises populationStabilises population
ReducesReduces maternal mortalitymaternal mortality
Reduces infant and child Reduces infant and child mortalitymortality
99
Slower rates of population growth Slower rates of population growth benefit all aspects of developmentbenefit all aspects of development
Population
Agriculture
Health
Education
Economy
Urbanisation
Environment
1010
National Population Policy, 2000National Population Policy, 2000
IMMEDIATE OBJECTIVEIMMEDIATE OBJECTIVE
Address the unmet needs of contraception, Address the unmet needs of contraception, Reproductive and Reproductive and Child Health careChild Health care
MEDIUM TERM OBJECTIVEMEDIUM TERM OBJECTIVE
Achieve Replacement Level Fertility by 2010Achieve Replacement Level Fertility by 2010
LONG TERM OBJECTIVELONG TERM OBJECTIVE
Bring about population stabilisation by 2045Bring about population stabilisation by 2045
1111
Situation analysisSituation analysis NPP 2000 and the present scenario:NPP 2000 and the present scenario:
1.1. 20102010 Population replacement (put Population replacement (put back now to back now to 20212021) )
2.2. 20452045 Population Stabilization (put Population Stabilization (put back now to back now to 20602060 (1.53 billion in (1.53 billion in 2060).2060).
3.3. EAG states constitute EAG states constitute 42%42% of the of the population (population (TFR between 3.4 and 4.3)TFR between 3.4 and 4.3)
1212
GOI POLICYGOI POLICY(Servicing the unmet need)(Servicing the unmet need)
Based on felt needs of the community Based on felt needs of the community TARGET FREE TARGET FREE Children by choice & not chanceChildren by choice & not chance Equal emphasisEqual emphasis on both limiting and on both limiting and
spacing methodsspacing methods ELAELA :Scientific and statistically significant :Scientific and statistically significant
way being formulated for calculating state way being formulated for calculating state wise performance level based on unmet wise performance level based on unmet needneed
Population stabilization is a Population stabilization is a priority area of the GOIpriority area of the GOI
1313
MEETING UNMET NEEDSMEETING UNMET NEEDS
11 Two third Indians want to use Two third Indians want to use contraceptioncontraception
22 There is no scope for coercionThere is no scope for coercion
33 Ensure availability of quality RH servicesEnsure availability of quality RH services
44 Meet the felt needs of coupleMeet the felt needs of couple
55 Enable couple to achieve their RH goalsEnable couple to achieve their RH goals
1414
Programatic interventions in Family Programatic interventions in Family Planning (GOI)Planning (GOI)
1.1. Addressing the unmet need in contraception Addressing the unmet need in contraception throughthrough
Assured deliveryAssured delivery of family planning of family planning servicesservices
Developing Developing skilled manpowerskilled manpower for the same for the same
2.2. Increasing Increasing male participationmale participation through through intensive promotion of NSVintensive promotion of NSV
3.3. Promotion of Promotion of IUDsIUDs as a short & long term as a short & long term spacing methodspacing method
4.4. Promotion of Promotion of Emergency Contraceptive Emergency Contraceptive PillsPills
5.5. Increasing basket of choicesIncreasing basket of choices
1515
Promotional Interventions in Family Promotional Interventions in Family Planning (GOI)Planning (GOI)
1.1. Ensuring quality care in FP servicesEnsuring quality care in FP services
2.2. Revised compensation schemeRevised compensation scheme
3.3. Family planning insurance schemeFamily planning insurance scheme
4.4. Promoting Public Private PartnershipsPromoting Public Private Partnerships
5.5. Promoting contraception through Promoting contraception through increased advocacyincreased advocacy
1616
Temporary (Spacing) Temporary (Spacing) MethodsMethods
IUD 380 A IUD 380 A
EC PillsEC Pills
OC PillsOC Pills
CC ( dual purpose condoms)CC ( dual purpose condoms)
1717
Reduce unmet need in SpacingReduce unmet need in Spacing (advantages of IUD 380 A) (advantages of IUD 380 A)
10 years10 years’ duration & not 3 years’ duration & not 3 years Can cover reproductive life span in Can cover reproductive life span in
2 insertions only (25- 45 yrs.)2 insertions only (25- 45 yrs.) Can potentially Can potentially replace the replace the
sterilizationsterilization procedures procedures Can be inserted at Can be inserted at subcentresubcentre level level ANM/ MOs could be given refresher ANM/ MOs could be given refresher
trainingtraining
1818
Promotion of EC Promotion of EC PillsPills
2 tabs of 0.75mg or 1 tab of 1.5mg within 72 2 tabs of 0.75mg or 1 tab of 1.5mg within 72 hrs of intercourse in the following situations:hrs of intercourse in the following situations:
Unprotected intercourseUnprotected intercourseUnplanned intercourseUnplanned intercourseFailed CC (Nirodh- torn)Failed CC (Nirodh- torn)Assault/ rapeAssault/ rape
Levonorgesterol onlyLevonorgesterol only No side effectNo side effect One time activity to replace MTP One time activity to replace MTP Reduces Maternal Mortality by 10-15%Reduces Maternal Mortality by 10-15%
1919
Reducing unmet need in Reducing unmet need in Terminal methodTerminal method
Assuring service provision throughAssuring service provision throughFixed day service round the yearFixed day service round the yearPeriodic campsPeriodic camps
Augmenting trained manpower inAugmenting trained manpower in NSVNSV MinilapMinilap Lap. Ster.Lap. Ster.
2020
Male participationMale participation(Why No Scalpel Vasectomy- NSV (Why No Scalpel Vasectomy- NSV
?)?)
1.1. Attain population Attain population stabilization in a short periodstabilization in a short period
2.2. Shifting responsibility of Shifting responsibility of family planning from females family planning from females to malesto males
2121
Why NSV ?Why NSV ?
6 Ss:- (advantages)6 Ss:- (advantages)Scalpel lessScalpel lessStitch less Stitch less SafeSafeSoundSoundSimpleSimpleShortShort
2222
TubectomyTubectomy(If client chooses it after all options have been (If client chooses it after all options have been
explained)explained) Offer minilap becauseOffer minilap because
No postgraduate surgeon/ gynaecologist No postgraduate surgeon/ gynaecologist requiredrequired
No anesthetistNo anesthetist required normally required normally No pneumoperitoneum (inflating with gas)No pneumoperitoneum (inflating with gas) Less post operative distressLess post operative distress
If client still demands Laparoscopic If client still demands Laparoscopic TubectomyTubectomyOffer services routinely at DH, FRU, CHC, Offer services routinely at DH, FRU, CHC,
BLOCK PHC (wherever OT is available)BLOCK PHC (wherever OT is available)
2323
Camps in tubectomyCamps in tubectomy Should preferably start by 9 AMShould preferably start by 9 AM As the client is fasting since the As the client is fasting since the
previous eveningprevious evening Has travelled long distances to reach Has travelled long distances to reach
the camp site andthe camp site and Is dehydratedIs dehydrated Has to have 4 hrs post operative Has to have 4 hrs post operative
observation before being discharged observation before being discharged after being rehydratedafter being rehydrated
2424
Ensuring quality care in FPEnsuring quality care in FP
The manual on The manual on StandardsStandards in sterilization has in sterilization has been updated, printed & uploaded on the website.been updated, printed & uploaded on the website.
The manual on The manual on Quality assuranceQuality assurance in sterilization in sterilization has been updated, printed & uploaded on the has been updated, printed & uploaded on the website.website.
Six Regional Six Regional Dissemination WorkshopsDissemination Workshops on the on the
revised Standards and QA manuals held revised Standards and QA manuals held countrywide in 06-07. countrywide in 06-07.
2525
Ensuring quality care in FPEnsuring quality care in FP All states reported to have set up the All states reported to have set up the QACsQACs
at state and district levels as per affidavit at state and district levels as per affidavit filed by them in the supreme courtfiled by them in the supreme court
Revised extended QACRevised extended QAC as per the as per the updated manuals are in place in most of the updated manuals are in place in most of the states.states.
Most states have completed their Most states have completed their orientation of the districts for QAorientation of the districts for QA
2626
COMPENSATIONA.For Public (Govt.) facilities
Breakage of Breakage of the the CompensatiCompensation packageon package
AcceAcceptorptor
MotivaMotivatortor
Drugs Drugs and and dressindressingg
SurgeoSurgeon n chargescharges
AnestAnesthetisthetist
Staff Staff nursenurse
OT OT technitechnician/hcian/helperelper
RefreshRefreshmentment
Camp Camp managemmanagementent
TotalTotal
High High focus focus statesstates
VAS.VAS.(ALL)(ALL)
TUB.TUB.(ALL)(ALL)
11001100
600600
200200
150150
5050
100100
100100
7575
--
2525
1515
1515
1515
1515
1010
1010
1010
1010
15001500
10001000
Non Non High High focus focus statesstates
VAS.VAS.(ALL) (ALL)
TUBTUB(BPL + (BPL + SC/ST SC/ST only))only))
11001100
600600
200200
150150
5050
100100
100100
7575
----
2525
1515
1515
1515
1515
1010
1010
1010
1010
15001500
10001000
Non Non High High focus focus statesstates
TUBTUB(APL)(APL) 250250 150150 100100 7575 2525 1515 1515 1010 1010
650650
2727
COMPENSATIONB For Private Facilities:
CategoryCategory Type of operationType of operation FacilityFacility MotivatorMotivator TotalTotal
High High focus focus statesstates
Vasectomy Vasectomy (ALL)(ALL)Tubectomy Tubectomy (ALL)(ALL)
1300130013501350
200200150150
1500150015001500
Non High Non High focus focus statesstates
Vasectomy Vasectomy (ALL)(ALL)Tubectomy (BPL Tubectomy (BPL + SC/ST)+ SC/ST)
1300130013501350
200200150150
1500150015001500
2828
Family Planning Insurance SchemeFamily Planning Insurance Scheme((limit of indemnity)limit of indemnity)
Claims arising out of Sterilization OperationClaims arising out of Sterilization Operation AmountAmount
AA DeathDeath at hospital/ within seven days of discharge at hospital/ within seven days of discharge Rs. Rs. 2,00,000/-2,00,000/-
BB DeathDeath due to sterilization (8 due to sterilization (8thth – 30 – 30thth day from the day from the date of discharge ) date of discharge ) Rs. 50,000/-Rs. 50,000/-
CC Expenses for treatment of Medical Expenses for treatment of Medical ComplicationsComplications Rs. 25,000/-Rs. 25,000/- DD Failure Failure of Sterilization of Sterilization Rs. 30,000/-Rs. 30,000/-
EE Doctors/ Facilities Doctors/ Facilities covered for litigations up tocovered for litigations up to4 cases per year including defence cost4 cases per year including defence cost Rs. 2,00,000/-Rs. 2,00,000/-
Dissemination meetings conducted for all state officialsDissemination meetings conducted for all state officials Public institutions to display boards on the schemePublic institutions to display boards on the scheme
_________________________
2929
9. Strengthening contraceptive 9. Strengthening contraceptive supplysupply
NSV instrumentsNSV instruments Revised Specifications prepared in 2006 (on website)Revised Specifications prepared in 2006 (on website)• States asked to procure as per their requirements through States asked to procure as per their requirements through
PIPPIP LaparoscopesLaparoscopes
Revised Specifications prepared in 2006 (on website)Revised Specifications prepared in 2006 (on website) States asked to procure as per their requirements from States asked to procure as per their requirements from
central funds as per approved specifications (can place central funds as per approved specifications (can place indents with the TNMSC )indents with the TNMSC )
ECP supplyECP supply Procurement has restarted recentlyProcurement has restarted recently Requirements from states received and being suppliedRequirements from states received and being supplied
3030
10. Promotion of contraception through 10. Promotion of contraception through intensive advocacyintensive advocacy
Advocacy kit on contraceptivesAdvocacy kit on contraceptives
Expert committee and core committee set upExpert committee and core committee set up All existing material reviewed and updatedAll existing material reviewed and updated New materials developed for NSV, IUD380A, ECP, OCPNew materials developed for NSV, IUD380A, ECP, OCP All prototypes for All prototypes for
audio, audio, video and video and print (leaflets, flip charts, posters)print (leaflets, flip charts, posters)finalised and passed on to the IEC division for production finalised and passed on to the IEC division for production
and distribution to the states (Jan, 08)and distribution to the states (Jan, 08)
Dissemination of FP capsule through regional Dissemination of FP capsule through regional workshops (WHO biennium 08-09)workshops (WHO biennium 08-09) Approval obtainedApproval obtained Funding awaitedFunding awaited
3131
Family PlanningFamily Planning Components Components (What the SFT should look (What the SFT should look
for)for)ContraceptionContraceptionConception (infertility management)Conception (infertility management)Quality Assurance Quality Assurance Accreditation of facilitiesAccreditation of facilitiesEmpanelment of providers Empanelment of providers CompensationCompensationInsuranceInsurance
3232
Responsibilities of the states/ Responsibilities of the states/ districtsdistricts
Increase number of services centresIncrease number of services centres Availability of services Availability of services Accessibility of services Accessibility of services Affordability of services Affordability of services
(Upgradaiton of DHs, FRUs, CHCs, PHCs & (Upgradaiton of DHs, FRUs, CHCs, PHCs & SCs under NRHM)SCs under NRHM)
Accreditation of private providers (PPP)Accreditation of private providers (PPP)
3333
Responsibilities of the states/ Responsibilities of the states/ districtsdistricts
Regular fixed day services round the Regular fixed day services round the yearyear
a) DHa) DH - on demand (daily/ weekly)- on demand (daily/ weekly)b) FRU/CHCb) FRU/CHC - weekly/fortnightly/monthly- weekly/fortnightly/monthlyc) PHCc) PHC - monthly/ bimonthly- monthly/ bimonthly
- (Tubectomy only if OT available)- (Tubectomy only if OT available)d) SCd) SC - IUD/ ECP (on demand)- IUD/ ECP (on demand)
Tubectomy:Tubectomy: Wednesday (optional)Wednesday (optional)Vasectomy:Vasectomy: Saturday (optional) Saturday (optional)
3434
Responsibilities of the states/ Responsibilities of the states/ districtsdistricts
1.1. Ensure at leastEnsure at least One NSV One NSV Surgeon per PHC Surgeon per PHC (ultimate aim) (ultimate aim) One Tubectomy One Tubectomy Surgeon per PHC Surgeon per PHC (ultimate aim)(ultimate aim) One IUDOne IUD Provider per SC Provider per SC
(ultimate aim)(ultimate aim)
2.2. Effect Manpower Rationalization Effect Manpower Rationalization Manpower Planning (based on ELA)Manpower Planning (based on ELA) Manpower Training Manpower Training Manpower PlacementManpower Placement
3.3. Develop Comprehensive Training Plan for Develop Comprehensive Training Plan for NSV NSV MinilapMinilap LTTLTT IUDIUD ECPECP
3535
Action at State/Dist. Action at State/Dist. level level
Appoint Nodal officer for Family Planning Appoint Nodal officer for Family Planning (for Planning, Implementing, Monitoring, Supervising & Evaluation)(for Planning, Implementing, Monitoring, Supervising & Evaluation)
Constitute QAC at state level (10 members) & Constitute QAC at state level (10 members) & notifynotify
Constitute DQAC at dist. level (9 members) & Constitute DQAC at dist. level (9 members) & notifynotify
Accredit facilities (Public/Private/NGO)Accredit facilities (Public/Private/NGO) Empanel doctors (Public/Private/NGO)Empanel doctors (Public/Private/NGO) Conduct Conduct
Half yearly meetings of state QAC (to be minuted)Half yearly meetings of state QAC (to be minuted) Quarterly meetings of Dist. QAC (to be minuted)Quarterly meetings of Dist. QAC (to be minuted)
3636
Action at State/Dist. levelAction at State/Dist. levelOrientation of CMOs onOrientation of CMOs on
NFPIS (National Family Planning Insurance Scheme)NFPIS (National Family Planning Insurance Scheme) Compensation Scheme (Revised)Compensation Scheme (Revised) ELA district wise for limiting & spacing methods ELA district wise for limiting & spacing methods
(based on dist. Unmet Need)(based on dist. Unmet Need) Manpower development (district action plan) Manpower development (district action plan)
NSV NSV (MOs)(MOs) Minilap/ LTT Minilap/ LTT (MOs)(MOs) IUD IUD (MOs/ SNs/ LHVs/ ANMs)(MOs/ SNs/ LHVs/ ANMs) ECPs ECPs (MOs/ SNs/ LHVs/ ANMs/ ASHAs)(MOs/ SNs/ LHVs/ ANMs/ ASHAs)
Contraceptive updatesContraceptive updates District budget allocation and disbursement District budget allocation and disbursement
Monthly Review of FP performance with Monthly Review of FP performance with CMOsCMOs
3737
Action at State/Dist. levelAction at State/Dist. levelDisplay prominently (facility wise)Display prominently (facility wise)
Revised Revised compensationcompensation scheme scheme Family planning Family planning insuranceinsurance scheme scheme Service availability (district action plan)Service availability (district action plan)
Fixed day serviceFixed day service calendar calendar NSVNSV Minilap/ LTTMinilap/ LTT IUDIUD
Camp calendarCamp calendar for above for above IEC materialsIEC materials on on
NSVNSV IUDIUD ECPsECPs
Budget may be provided accordinglyBudget may be provided accordingly
3838
Action at State/Dist. Action at State/Dist. levellevel
Lay down benchmarks (performance Lay down benchmarks (performance indicators) andindicators) and
Rank DistrictsRank Districts Reward districtsReward districts Reward CMOs (state award)Reward CMOs (state award) Recommend for national Recommend for national
recognitionrecognition
3939