STATE RMNCH+A UNIT, J&Kjknhm.com/pdf/rmcha.pdf · Nadu, it has been decided that intensification of...

STATE RMNCH+A UNIT, J&K

Introduction: As a follow up of India’s Call to Action: Child Survival and Development held in February, 2013 in Tamil Nadu, it has been decided that intensification of RMNCH+A(Reproductive, Maternal, Neonatal, Child and Adolescent Health) activities should be undertaken across 184 priority districts in the country, with emphasis on focused action in backward blocks. These 184 high priority districts across 29 states have been identified by MOHFW, based on a “composite health index”.

For each state, MOHFW has identified one Development Partner as a State Lead Partner, who will spearhead necessary technical support especially to these priority districts, harmonized with other Development Partners, to accelerate achievement of desired health outcomes under RMNCH+A. For Jammu & Kashmir NIPI has been entrusted as State Development Partner to accelerate the RMNCH+A strategy in 6 HPDs of Jammu & Kashmir.

NIPI and PHFI in the last year have established a team to support states implementation of RMNCHA activities. 6 District Coordinators are posted at all high priority districts and 2 State Coordinators at State NHM Office for implementation of RMNCH+A strategy in 6 HPDs, J&K. A national coordinator has also been recruited.

For implementation of RMNCH+A strategy in Jammu and Kashmir five (5) major areas have been decided in first State Coordination Committee (SCC) meeting with NIPI, which was held on December,2014. Five objectives were identified for the year 2015 to strengthen the RMNCH+A activities in Jammu & Kashmir. However technical support provided to state and district in other domain of RMNCH+A strategy. This report includes a comprehensive status of supportive supervision in 6 HPDs and technical support provided by District Coordinators in RMNCH+A strategy strengthening. Supportive Supervision data from April to November’15 analyze and thematic indicator wise findings discussed where major thrust need to be given. This reports is doesn’t intend to fault findings but its shows the areas where all of our involvement and interventions are required for the betterment of service delivery.

Supportive Supervision Status April-November’15: A total number of 150 supportive supervision visits conducted by District Coordinator RMNCH+A in 6 HPDs. Each level of facilities covered during Supportive Supervision.

0

20

40

60

80

100

L1 L2 L3

24

85

41

No of visit (April-November'15)

0

10

20

30

40

50

60

DH FRU CHC SDH 24X7 PHC PHC Non FRUCHC

23

38

4

60

16

3

No of visit according to the facility

District Wise Status of supportive Supervision (April-November’15)

0

5

10

15

20

L1 L2 L3

5

20

4

No visit (Doda)

0

5

10

15

20

L1 L2 L3

1

19

5

No visit (Kishtwar)

0

5

10

15

L1 L2 L3

1

14

8

No visit (Poonch)

0

5

10

15

L1 L2 L3

812

12

No visit (Rajouri)

0

2

4

6

8

L1 L2 L3

1

47

No visit (Ramban)

0

5

10

15

20

L1 L2 L3

8

16

5

No visit (Leh)

Training Status of labour room staffs:

Availability of skilled manpower for labour room is a major concern though the districts have adequate number of trained manpower (SBA, NSSK) but they are looking after other ward or posted in non-delivery points. . There is an unrest need to post SBA, NSSK trained staff at labour room.

30.4 33.0 30.1 32.2

3.00.0

10.0

20.0

30.0

40.0

SN/ANMstrainedSBA

SN/ANMsTrainedin NSSK

MO trainedSBA/BEMOC

MO Trained inNSSK

MO Trained inPPIUCD

Training Status: N=150

34.8 36.5

25.621.7

30.636.0

0.0

10.0

20.0

30.0

40.0

L1 (n=24) L2 (n=85) L3 (n=41)

Training Status of SN/ANM (%)

SN/ANMs trained SBA SN/ANMsTrained in NSSK

33.330.0 29.6

16.7

34.4 33.0

0.0

10.0

20.0

30.0

40.0

L1 (n=24) L2 (n=85) L3 (n=41)

Training Status of MO (%)

MO trained SBA/BEMOC MO Trained in NSSK

District Wise Training Status:

20.0 21.417.9

35.7

0.0

10.0

20.0

30.0

40.0

SN/ANMstrained SBA SN/ANMsTrained inNSSK

MO trainedSBA/BEMOC

MO Trained in NSSK

Training Status of LR Staffs (No. of visits=29): Doda District

88.1 83.3 78.263.6

0.0

20.0

40.0

60.0

80.0

100.0


MO trainedSBA/BEMOC

MO Trained in NSSK

Training Status of LR Staffs (No. of visits=25): Kishtwar District

18.5

33.1

0.6

15.9

0.05.0

10.015.020.025.030.035.0


MO trainedSBA/BEMOC

MO Trained in NSSK

Training Status of LR Staffs (No. of visits=29): Leh District

70.7

34.1

64.4

44.4

0.010.020.030.040.050.060.070.080.0


MO trainedSBA/BEMOC

MO Trained in NSSK

Training Status of LR Staffs (No. of visits=23): Poonch District

39.5

18.5

49.2

33.9

0.0

10.0

20.0

30.0

40.0

50.0

60.0


MO trainedSBA/BEMOC

MO Trained in NSSK

Training Status of LR Staffs (No. of visits=32): Rajouri District

42.9 44.6

22.7

40.9

0.05.0

10.015.020.025.030.035.040.045.050.0


MO trainedSBA/BEMOC

MO Trained in NSSK

Training Status of LR Staffs (No. of visits=12): Ramban District

Status Family Planning:

District Wise Status of Family Planning as Per Supportive Supervision Data:

Female sterilization, 95.8

Male sterilization, 4.2

Female post partum sterilization, 3.5

Female interval, 96.5

STERILIZATION STATUS

99.5

1.0Status of IUCD (%)

Interval IUCD PPIUCD

97.4

2.6Sterilization Staus Doda District (%)

Female sterilization Male sterilization

70.0

30.0

Sterilization Staus Leh District (%)


Family planning services throughout the districts are very poor. Especially Male sterilization is very poor in comparision to other family planning services.

Availability of family planning commodities:

100.0

0.0

Sterilization Staus Kishtwar District (%)


100.0

0.0

Sterilization Staus Poonch District (%)


100.0

0.0

Sterilization Staus Rajouri District (%)


100.0

0.0

Sterilization Staus Ramban District (%)


55.065.075.085.095.0

105.0

IUCD 375, 380 OCP ECP Condoms

83.392.7

89.397.3

% of facility where found available (n=150)

79.2 78.895.187.5 94.1 92.7

79.291.8 90.2

100.0 97.6 95.1

0.020.040.060.080.0

100.0120.0

L1 (n=24) L2 (n=85) L3 (n=41)

Availability of Family Planning Commodities (%)

IUCD 375, 380 OCP ECP Condoms

84.0

42.7

86.0

0.0

20.0

40.0

60.0

80.0

100.0

Pregnancy Testing Kit withASHA

Incentive for ASHA fordelaying and spacing birth

Home delivery ofcontraceptive by ASHAs

Operationalization of family planning schemes

Very low performing Low performing Promising Good performing

Reproductive Health Indicator status of HPDs as on November’15:

Maternal Health: Antenatal Care:

100.0 100.0 100.0100.0 100.0 100.0

0.0

50.0

100.0

150.0

L1 (n=24) L2 (n=85) L3 (n=41)

Antenatal Care (At Facility Level) : Blood Pressure

Available BP Apparatus with stheoscope BP Measured during ANC

79.295.3 100.0

79.292.9 97.6

0.020.040.060.080.0

100.0120.0

L1 (n=24) L2 (n=85) L3 (n=41)

Antenatal Care (At Facility Level) : Urine Albumin

Available Urine Albumin Kit Urine estimation during ANC

83.398.8 100.0

79.297.6 97.6

0.020.040.060.080.0

100.0120.0

L1 (n=24) L2 (n=85) L3 (n=41)

Antenatal Care (At Facility Level) : Haemoglobin Estimation

Available Haemoglobinometer HB measured during ANC

Intra partum care:

79.271.8

95.1

66.7 67.1

95.1

0.0

20.0

40.0

60.0

80.0

100.0

L1 (n=24) L2 (n=85) L3 (n=41)

Intrapartum Care (At Facility Level) : Uterotonics

Availability of uterotonics(Oxytocin/misoprostol) Use of uterotonics

Pregnancy Care Indicator status of HPDs as on November’15:


91.7

60.073.2

33.3 31.8

73.2

0.020.040.060.080.0

100.0

L1 (n=24) L2 (n=85) L3 (n=41)

Intrapartum Care (At Facility Level) : Antenatal Corticosteroids

Availability of Inj. Dexamethasone Use of Inj. Dexamethasone

33.3 32.9

61.0

20.829.4

61.0

0.010.020.030.040.050.060.070.0

L1 (n=24) L2 (n=85) L3 (n=41)

Intrapartum Care (At Facility Level) : Inj.Magnesium Sulphate

Availability of Inj. Magnesium Sulphate Use of Inj. Magnesium Sulphate

0

12.914.6

0

9.4

14.6

0

5

10

15

20

L1 (n=24) L2 (n=85) L3 (n=41)

Intrapartum Care (At Facility Level) : Partograph Use (%)

Partograph available Partograph used

District wise status of Intra partum care

6.9 0

69.051.7

6.9 3.4

62.1

20.7

0.020.040.060.080.0

Parto

grap

hav

aila

ble

Parto

grap

hus

ed

Ava

ilabi

lity

ofut

erot

onic

s(O

xyto

cin…

Use

of

uter

oton

ics

Ava

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of In

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agne

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Sulp

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Use

of I

nj.

Mag

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te

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Use

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Dex

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Intrapartum Care: Doda District (N=29)

0.0 0

68.056.0 52.0 48.0

60.0

24.0

0.010.020.030.040.050.060.070.080.0

Parto

grap

hav

aila

ble

Parto

grap

hus

ed

Ava

ilabi

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ofut

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onic

s(O

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ocin

/mis

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Use

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Ava

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Use

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Mag

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te

Ava

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exam

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son

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Use

of I

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Dex

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haso

ne

Intrapartum Care: Kishtwar District (N=25)

31.0 31.0

93.1 82.8 93.1 86.2 96.6 86.2

0.020.040.060.080.0

100.0120.0

Parto

grap

hav

aila

ble

Parto

grap

h us

ed

Ava

ilabi

lity

ofut

erot

onic

s(O

xyto

cin/

mis

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sto

l) Use

of

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Ava

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Use

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Mag

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Use

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Dex

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Intrapartum Care: Leh District (N=29)

0.0 0.0

60.9 60.9

34.8 34.8

13.00.0

0.010.020.030.040.050.060.070.0

Parto

grap

hav

aila

ble

Parto

grap

h us

ed

Ava

ilabi

lity

ofut

erot

onic

s(O

xyto

cin/

mis

opro

stol

) Use

of

uter

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Ava

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ofIn

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Use

of I

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Mag

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Ava

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Use

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Dex

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Intrapartum Care: Poonch District (N=23)

3.1 3.1

96.9 96.9

31.3 28.1

93.8

59.4

0.020.040.060.080.0

100.0120.0

Parto

grap

hav

aila

ble

Parto

grap

h us

ed

Ava

ilabi

lity

ofut

erot

onic

s(O

xyto

cin/

mis

opro

stol

) Use

of

uter

oton

ics

Ava

ilabi

lity

ofIn

j. M

agne

sium

Sulp

hate

Use

of I

nj.

Mag

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Ava

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Use

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Dex

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Intrapartum Care: Rajouri District (N=23)

0.0 0.0

100.0 100.0

16.7 8.3

100.083.3

0.020.040.060.080.0

100.0120.0

Parto

grap

hav

aila

ble

Parto

grap

h us

ed

Ava

ilabi

lity

ofut

erot

onic

s(O

xyto

cin/

mis

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)

Use

of u

tero

toni

cs

Ava

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Sulp

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Use

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nj.

Mag

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Ava

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Use

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Dex

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Intrapartum Care: Ramban District (N=12)

Glimpses of monitoring findings: Partograph Availability

Partograph used in DH Leh Partograph Used in SDH Nubra Partograph used in Khaltsi

Newborn Health & Postnatal Care:

41.7

82.495.1

25.0 29.4

63.4

41.7 42.4

75.6

0.020.040.060.080.0

100.0

L1 (n=24) L2 (n=85) L3 (n=41)

Newborn Care Management (%)

Designated Newborn care CornerNewborn care corner adequately equippedProvider aware about the steps of new-born resuscitation

District Wise Status of NBCC:

79.289.4 92.7

62.5 71.8 73.275.0 72.995.1

0.020.040.060.080.0

100.0

L1 (n=24) L2 (n=85) L3 (n=41)

Home based newborn Care (%)

Home-based new born care by ASHAHBNC kits available with ASHAReferrals of sick newborns or newborns with danger signs being undertaken

79.2 82.497.6

70.8 77.692.7

0.0

50.0

100.0

150.0

L1 (n=24) L2 (n=85) L3 (n=41)

Breast Feeding Practices (%)

Early initiation of breastfeeding practicesExclusive breastfeeding practised upto six months (no water)

82.8

41.4 37.9

0.010.020.030.040.050.060.070.080.090.0

Des

igna

ted

New

born

car

eC

orne

r

New

born

car

eco

rner

adeq

uate

lyeq

uipp

ed

Prov

ider

aw

are

abou

t the

step

sof

new

-bor

nre

susc

itatio

nNewborn Care: Doda District (N=29)

84.0

28

64.0

0.010.020.030.040.050.060.070.080.090.0

Des

igna

ted

New

born

car

eC

orne

r

New

born

car

eco

rner

adeq

uate

lyeq

uipp

ed

Prov

ider

aw

are

abou

t the

step

s of

new

-bor

nre

susc

itatio

n

Newborn Care: Kishtwar District (N=25)

79.3

51.772.4

0.010.020.030.040.050.060.070.080.090.0

Des

igna

ted

New

born

car

eC

orne

r

New

born

car

eco

rner

adeq

uate

lyeq

uipp

ed

Prov

ider

aw

are

abou

t the

step

sof

new

-bor

nre

susc

itatio

n

Newborn Care: Leh District (N=29)

87.0

52.239.1

0.020.040.060.080.0

100.0

Des

igna

ted

New

born

car

eC

orne

r

New

born

car

eco

rner

adeq

uate

lyeq

uipp

ed

Prov

ider

aw

are

abou

t the

step

sof

new

-bor

nre

susc

itatio

nNewborn Care: Poonch District (N=23)

Postnatal & Newborn Care Indicator Status of HPDs as on November’15:

59.4

15.6

43.8

0.020.040.060.080.0

Des

igna

ted

New

born

care

Cor

ner

New

born

care

cor

ner

adeq

uate

lyeq

uipp

ed

Prov

ider

awar

e ab

out

the

step

s of

new

-bor

nre

susc

itatio

n

Newborn Care: Rajouri District (N=23)

100.0

50.0 50.0

0.020.040.060.080.0

100.0120.0

Des

igna

ted

New

born

care

Cor

ner

New

born

care

cor

ner

adeq

uate

lyeq

uipp

ed

Prov

ider

awar

eab

out t

hest

eps o

fne

w-b

orn

resu

scita

tion

Newborn Care: Ramban District (N=12)


Child Health:

26.7 31.3

0.0

58.0

98.7

0.0

20.0

40.0

60.0

80.0

100.0

120.0

ORS & ZincAvailable with

ASHA

Growth monitoringat AWC & VHND

MalnourishedChildern refer to

NRC

VHND beingconducted onmonthly basis

RBSK Operational

Implementation of child health schemes

75.063.5

82.9

12.5

25.9 26.837.5

21.226.8

33.3 37.648.8

100

80.090.291.7 95.3 100

0.0

20.0

40.0

60.0

80.0

100.0

120.0

L1 (n=24) L2 (n=85) L3 (n=41)

Availability of child health commodities (%)

ORS Zinc (10mg & 20mg)

Syp Salbutamol/Salbutamol Nebulizing Solution Syrup Albendazole

Syrup Vit. A MCP cards

Child Health Indicator Status of HPDs as on November’15:

Client Satisfaction:

70.0

79.3

71.3

54.0

59.0

64.0

69.0

74.0

79.0

84.0

Privacy provided duringdelivery

Transport being provided fordrop back

Free diet provided

Client Satisfaction: N=150


Supportive Supervision findings:

Availability of trained (SBA & NSSK) SNs/ANM and Medical Officer in labour room is a major concern.

Only 36.5% SBA trained ANMs/SNs are available in L2 level facilities where as only 30% are trained in

NSSK. 25.6% SBA trained SNs are posted in labour room at L3 level facilities and only 36% are trained

in NSSK. Kishtwar district where more than 80% SBA and NSSK trained SNs/ANMs are posted in labour

room and lowest in Leh district ( only 18% SBA trained SNs/ANMs are posted in labour room)

Family planning service is also a major concern especially Male sterilization. As per the monitoring data

out of total sterilization only 4.2% is Male Sterilization. Special awareness as well as major thrust need

to be given on camp based approach on family planning.

Family planning commodities especially IUCD 375,380, OCP and ECP need to be made available at all

level of facility at all time.

ASHA should be more active for home delivery of contraceptive and incentive of ASHA for delaying

and spacing birth need to be regularized.

Poonch district is very poor performing in all family planning indicators.

Only 12 % L2 facilities whereas 14 % L3 facilities are using Partograph for monitoring of labour. Use of

Partograph must be ensured through regular monitoring from district and block level officials/officers.

Special focus on Partograph need to be given during SBA training.

Only 71.8% L2 facilities have Uterotonics drugs and out of them 67% facilities are using

Oxytocin/Misoprostol. Use of uterotonics must be ensured at all level.

Availability of Inj. Magnesium Sulphate and use of Magnesium Sulphate is also a major concern. Only

32.9% L2 facilities and 61% L3 facilities have Inj. Magnesium Sulphate. Use of Inj. Magnesium Sulphate

need to be ensured.

Though 82% L2 facilities have designated Newborn Care Corner but only 29.4% facilities have

adequately equipped NBCC whereas only 63% NBCC in L3 facility are adequately equipped. It is very

essential to strengthen the NBCC at all delivery point and major thrust need be given on Essential New

Born Care Management (ENBC) during NSSK training.

HBNC Kit must be made available with ASHA for proper home based new born care.

District Leh and Kistwar are very poor performing in postnatal and newborn care indicators.

Availability of Zinc tablet, Dicyclomine and Albendazole must be ensured.

Ramban and Doda districts are very poor performing in child health indicators.

Glimpses of support provided by District Coordinators:

Not only monitoring but a hand holding support to facility staff:

A team work for facility strengthening:

Glimpses of advocacy done by District Coordinators at District Level:

Sensitization and feedback sharing during meeting: Every month District Coordinators are particpating in monthly meeting at district as well as block level, where monitoring findings shared with all concerned for better service delivery. During block meeting ANMS are sensitzed on differnet programme related issues. Total number of 54 block monthly meetings and 42 district level meetings attended by District Coordinators since January to November’15.

12

78

11 11

5

0

2

4

6

8

10

12

14

DODA KISHTWAR LEH PUNCH RAJAURI RAMBAN

Block level monthly meeting attened

4

7

11 11

6

3

0

2

4

6

8

10

12


District level meeting attened

Glimpses of meeting attended by District Coordinator-RMNCH+A:

Strengthening RMNCH+A through vigorous monitoring:

Strengthening VHND through regular monitoring and advocacy: A total number of 115 VHND sessions monitored by District Coordinator, RMNCH+A since January to November’15. Due to severe cold VHND sessions was stopped in Leh.

Major recommendation:

1. Service delivery at VHND session need to be improved 2. Availability of essential logistics and drugs need to be ensured 3. VHND reporting mechanism and monitoring mechanism must be strengthened 4. VHND performances need to be discussed during monthly meeting 5. Rationalization of VHND micro plan 6. Develop more IEC on VHND and strengthening of community awareness on VHND is required 7. Ensure monthly meeting with Women & Child Welfare department and BMO at block level for the

betterment of VHND and strong coordination.

17

27

7

23 2219

0

5

10

15

20

25

30


VHND Monitoring (Jan-November'15)

Glimpses of VHND Monitoring:

Monitoring of Routine Immunization Sessions and cold chain point: District Coordinators are regularly monitoring Routine Immunization sessions and cold chain point and monitoring findings are shared with CMO, Dy.CMO and concerned medical officers. Total number of 73 Immunizations Sessions are monitored by District Coordinator RMNCH+A since January to November’15.

Recommendation on RI and Cold Chain Point strengthening:

Printed log book for record keeping of temperature need to be maintained for each ILR and DF Vaccine management protocols must be displayed at all cold chain point. Open vial policy need to be more strengthened, it was also observed that date and time is not

mentioned on the open vials. More IEC on Immunization is required Ensure proper use of Tickler box. Due list is not prepared for the vaccination day, a standard due list register must be kept available

with ANM and ASHA RI Monitoring mechanism at district and block level need to be strengthened Standard stock register must be kept at cold chain point.

Doable recommendation for District for effective implementation of RMNCH+A strategy:

Ensure the quality of SBA, NSSK, IMNCI and other training. Rational deployment of SBA trained manpower at delivery point. Ensure joint monitoring of DPM/DMEO/DAM and District Coordinator-RMNCH+A. Ensure line listing of severe anemic mothers and regular follow up at all levels. Orientation of labour room staff on Essential New Born Care Management. Ensure 48 hours retention delivered women and compliance of JSSK services. Ensure display of “Diet Chart” at prominent places in all delivery points. Strengthen the review mechanism of maternal death and establish a standard review mechanism for

CDR at district and block level. Standardized VHND reporting system and involve district and block ASHA Coordinator in VHND

monitoring. Proper use of HMIS data for performance evaluation of facility. Timely updation of MCTS data. More emphasis should be given on IUCD insertion and other family planning methods. Cleanliness and sterilization protocols must be followed as per MNH tool kit at all facilities. Ensure the birth dose vaccination at all delivery points. Strengthen the AFHC (Adolescent Friendly Health Clinic) at district level. Special focus on cold chain point and RI monitoring. Give importance of facility wise findings and feedback shared by District Coordinator-RMNCH+A.

Support required from state for effective implementation of RMNCH+A strategy:

Timely and regular supply of essential drugs & consumable (IFA, Zinc, Misoprostol, Inj. Magnesium Sulfate etc.).

Man power planning and rational deployment of skilled manpower at delivery points in HPDs. Engaged state officials to monitor the quality of district level training and develop a training

monitoring mechanism. Special thrust on VHND, HBNC, SNCU, MDR and CDR. It requested to disseminate monthly monitoring reports with CMO of HPDs on monthly basis.

Conclusion: RMNCH+A strategy launched to provide a complete service throughout the life cycle. Increasingly, across the globe, there is emphasis on establishing the “Continuum of Care”, which includes integrated service delivery in various life stages including adolescent, pre-pregnancy, childbirth and postnatal period, childhood and reproductive age. The field visits reveals that there is a need for improving awareness about the standards of performances among service providers. The 5x5 matrix helps us in giving focused attention on different program activities to ensure performance and quality aspects in service delivery. Skilled manpower is a felt need to maintain the quality standards and overall performance of the State. Hence continuous skill enhancement center is need of hour for the state. Progress of all 16 indicators need to be reviewed on the monthly basis at state, district as well as Block level. And necessary decisions must be taken based on the data and its analysis with follow up actions. Proper review mechanism on the basis of RMNCH +A indicators analysis and monitoring findings need to be established.

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Prepared by State RMNCH+A Unit, NIPI-PHFI O.O-The Mission Director, NHM

Jammu & Kashmir

Thankful to all Programme Manager and Asst. Programme Manager, NHM for their time to time valuable inputs & support for strengthening RMNCH+A.

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