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Family Planning


Family planning Programme
Strengthen Planning processes of FP programs with focus on FDS delivery for both limiting and spacing methods.

Development of FP Sub Plan:
Effective and need based planning is the foundation for the success of any program. Ideal planning process always calls for a bottom up approach. Improved planning and coordination holds the key to better performance in family planning program. Prior to the year 2010, the family planning program planning was more or less centralized and was a desk exercise at the state level. For the first time in the state, district specific family planning sub plans were developed by the district teams. The plan encompasses facility strengthening, human resource development, ensuring equipment and supplies, IEC, and addressing district specific needs in family planning program. The exercise ensured an all inclusive integrated family planning sub plan for each district which not only prioritized district goals but also helped in making best use of available resources in order to achieve the set objectives. This unique attempt was acknowledged and appreciated by MOHFW, Govt. of India and other stake holders.

Fixed Day Static Center:
Monday was declared as “ParivarKalyanDiwas” by the honorable Chief Minister of Odisha Sri Naveen Pattnaik during the year 2010 world population day observation at state level. The intent is to ensure fixed day family planning services round the year. The fixed day static centers aim to provide choices to eligible couples along with counseling to enable them to make informed decisions for family planning and contraception. The fixed day static centers are being operationalized at all delivery points. Fixed day static centers posed challenge for the state, yet significant progress in this regard is being witnessed which is the result of effective planning and human resource development. Issues such as facility up gradation, maintaining equipments and supplies, skill enhancement, mapping of skilled human resources were being taken care off.

Promoting informed choices among eligible couples with focus on needs of young couples through ASHAs in 18 high focus districts.

Home Delivery of Contraceptives by ASHA at the doorstep of beneficiary:
Under the family planning program in Odisha, one of the key strategies adopted for improving access and utilization of contraceptives is by making them available at the door step of the community through ASHAs. The program which started initially in 18 high focus districts is now extended to all 30 districts. The strategy was considered important because promoting informed choices related to spacing among couples was highly critical to help them realize their reproductive intention. As eligible couples have limited access to family planning information and services, for counseling often costing a day's wage, it was essential to establish a community based family planning counselor with required knowledge to address needs of eligible couples. Efforts have been made to build the capacity of ASHA to understand the nuances of the family planning program paradigm like reproductive rights, addressing youth fertility and need of young couples, methods of contraception, conduct of eligible couple survey and be able to counsel regarding contraception. In a casade approach, key health functionaries at district and sub district levels were oriented who in turn train and mentor ASHAs in their respective districts. With technical support from UNFPA, a “Facilitator's guide book” was developed for master trainers covering pertinent topics in family planning.  ASHAs are now waited and welcomed by the couples in the community for her information and contraceptive supplies. Capacity building of service providers is being organized for ensuring fixed day IUCD services at all delivery points on Thursdays.

Eligible Couple Survey: Eligible Couple Survey (EC Survey) is an integral part of planning, monitoring and implementing family planning service delivery. It provides complete information of eligible couples in a village covering age, marital status, contraceptive use, pregnancy, number of children, etc that help in addressing unmet need. EC survey facilitates a process of promoting informed choices through cafeteria approach and helps in streamlining the family planning service delivery for reaching out to the eligible couples. Training programs were organized for key health functionaries and ASHAs to carry out the EC survey.

Sensitization programme for NGOs on FP service assessment: To involve NGOs in strengthening the family welfare programme in the state, an orientation program was undertaken on family planning and population stabilization issues. 29 MNGOs attended the workshop chaired by Director, Family Welfare (DFW). Sensitization of NGO functionaries on the process and modalities of rapid assessment of family planning services in L3 health facilities was organised and they were asked to carry out the exercise with a well drafted & technically relevant check list. Out of the 144 institutions in 30 districts, assessment reports of 124 institutions were received. Based on the findings several actions were initiated.

Contraceptive Updates: In an attempt to strengthen service training of ANM students on family planning a contraceptive update workshop was organized to orient and refresh the teaching faculty of ANMTCs on contraception for the sister tutors of 16 government ANMTC. Out of expected 32 participants 29 tutors participated in the one day the orientation cum refresher workshop held on 6 Feb.2013.Director Family Welfare chaired the workshop .Resource persons and exports covered sessions on various aspects of contraception. This endeavor will definitely improve pre-service training of ANMs on family planning.

World Population Fortnight: Communication plays a vital role in information dissemination and demand generation. The platform of "World Population Day" was utilized to renew commitments and high light need for client centric services in family planning. Prior to population stabilization fortnight, intensive IEC campaigns are taken up using mass media, mid media and through inter personal communication to inform he initiatives for promoting client centered approach in family planning. The efforts resulted in increased demand and acceptance of family planning services not just during the fortnight but throughout the year. This also created an enabling environment by addressing myths, misconceptions and overcoming socio cultural barriers that exist in the community. Focused IEC supported by assured service delivery during the population fortnight resulted in encouraging family planning performance and the state was able to register significant achievement. State level functions were organized on 11th July every year. The functions were graced by Honorable Chief Minister and Honorable Health Minister of Odisha. Best performing districts and individual surgeons were felicitated for their contribution to the family planning program in the state.

Strengthening logistics and supply system for reproductive health commodities security through Reproductive Health Commodities Logistics Management Information System (RHCLMIS)

Strengthening & Streamlining Logistics & Supply Chain: An improved Logistics & Supply System is the key to the success of any project intervention as well as for better management of the health care service delivery. To address the high unmet need in family planning to provide contraceptive commodity security, an innovative “Reproductive Health Commodities Logistics Management Information System (RHCLMIS)” was developed with UNFPA support to track the entire supply chain accurately and in time to streamline the supply chain operations; to reduce the supply imbalances and regulate the flow of family planning supplies to the end user through mobile text messages (Short Service Messages – SMS). This was crucial to ensure that the right goods, in the right quantities, in the right condition, are delivered to the right place, at the right time. The dual application using SMS and Web is the key feature of the software. Instant access to stock information, tracking supply from state to sub-center level, auto generated graphical reports for all  transactions at all levels, data transfer through SMS, , without computer and internet as a prerequisite are the highlights. District and sub district level key functionaries comprising of store pharmacists of district, and sub district health institutions, Logistics managers under NRHM, LHVs and ANMs, of all sub centers and post partumcenters are trained on RHCLMIS for effective implementation of the software.

 

Promoting Post Partum Contraception

Strengthening post partum contraception: After introduction of “JananiSurakhyaJojana”, over two thirds of all deliveries are institution based. This provides an excellent opportunity to deliver contraceptive services during the post partum stay. Medical Officers and their teams have been trained for post partum IUCD insertion. The staff nurses of the labour rooms and post natal wards are trained for family planning counseling. Trained RMNCH+A counselors are posted to high delivery load institutions for counseling the post partum mothers on family planning and contraception. Their role is immense in providing appropriate information and counseling. The PPIUCD program has taken off. However, it is still a challenge as both the providers and clients are yet to be fully convinced. Regular monitoring of post partum contraception performance and feed back is the way forward to enhance post partum contraceptive acceptance in the state. Post partum sterilization (PPS) in the state has registered regular improvement in recent years. During the last three years, the PPS has moved from 2.8 percent to 3.9 percent of total sterilizations in the state. Although, the post partum sterilization has been staggering, the increase is encouraging and owes efforts of the staff nurses and Yasoda coordinators coupled with IEC at the high case load health facilities. The challenge here is to convince the service providers and ensure service provision not only at peripheral health institutions but also at Medical College.

Compensation for Sterilisation Operation

Component

Vasoctomy

Tubectomy

Accredited facility

 

Vasoctomy

Tubectomy

Acceptor

1100

600

Facilitator

1300

1350

Motivator

200

150

Motivator

200

150

Drugs & Dressing

50

100

 

 

 

Surgeon charges

100

75

 

 

 

Anesthesist charges

0

25

 

 

 

Staff Nurse charges

15

15

 

 

 

OT Technician

15

15

 

 

 

Refreshment

10

10

 

 

 

Cam Management

10

10

 

 

 

TOTAL

1500

1000

 

1500

1500

Insurance Scheme

Incase of death within 7 days of sterilisation operation

2,00,000/-

Incase of death from 8 days to 30 days

50,000/-

Incase of failure of sterilisation

30,000/-

Complication  medical treatment from discharge upto 60days maximum

25,000/- or actual

N.B. Insurance per doctor/ facility but not more than 4 caes in a year upto 2 lakhs per claim.

Strengthening review, monitoring and supervision

Quality of care in FP services: Quality of Care has always been a matter of concern for health services irrespective of the level of health facility and resources made available for this purpose. It is about having trained human resource in place, regular supervision and monitoring for ensuring professional standards and adhering to quality norms in clinical practice, availability of essential equipments and facilities at the service centers. As per the Supreme Court verdict, District Quality Assurance Committee (DQAC) mandated to monitor quality of family planning services. But the activities of DQACs were confined to meetings and settling of insurance claims. During the year 2010, the DQACs were made fully functional by orienting program managers and DQAC members about role and responsibility of QAC. Since then, regular tracking of DQAC meetings is being undertaken and hand holding support is being provided on facility audit, process observation and client exit interview. Operating surgeons are being oriented regularly on standards and protocols for sterilization operation. Regular monitoring and field visits are undertaken to improve quality of family planning services. However, providing quality services and continuum of care in family planning service delivery is still a challenge and needs improvement.

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