Eleventh Five Year Plan

Health and Family Welfare and AYUSH 89steps have been taken to ensure tackling obstetric emergencies.Under the NRHM, efforts are being made tomake FRUs operational for providing Emergency andEssential Obstetric Care. Other steps include trainingof MBBS doctors in life saving anaesthetic skills forEmOC, establishment of blood storage at FRUs, andguidelines for operationalization of the FRUs. There isalso a plan for training MBBS doctors in managementof obstetric cases including caesarean section withthe help of professional organizations of obstetriciansand gynaecologists. Over the next five years, effortswill be made to improve the Emergency Obstetric Carein all CHCs in a phased manner. CHCs will havewell equipped operation theatre, access to safe bankedblood, qualified obstetricians, paediatricians, andanaesthetists. Roads linking habitations to CHCswill get special attention. The objective is to ensureavailability of EmOC facilities within two hours oftravel time.ESSENTIAL POSTPARTUM CARE3.1.125 Early postpartum care is essential to diagnoseand treat complications such as puerperal infections,secondary postpartum haemorrhage, and ecclampsia,which are major causes of postpartum mortality. Postpartumcare provides an opportunity to check the generalwell-being of mother and infant and to ensure thatthe infant is nursing well and there is enough supplyof breast milk. Exclusive breastfeeding should bestarted within the first hour of birth. It can save manyinfant lives by preventing malnutrition and infections.Birth spacing and methods of contraception need tobe discussed at this time. During the Eleventh Five YearPlan, Community Health Workers (ASHAs) will beappropriately oriented to this and their remunerationwould also be linked to health checks of both themother and newborns.SAFE ABORTION SERVICES3.1.126 The Medical Termination of Pregnancy(MTP) Act was passed by the Indian Parliament in 1971and came into force from 1 April 1972. The aim ofthis Act was to reduce maternal mortality andmorbidity due to unsafe abortions. The MTP Act, 1971laid down conditions under which a pregnancy can beterminated and the place where such terminationscan be performed. A recent amendment to the Act(2003) includes decentralization of power for approvalof places and enlarging the network of safe MTPservice providers. The amendment also provides forspecific punitive measures for performing MTPsby unqualified persons and in places not approvedby the government.3.1.127 States are being provided flexibility to adoptstrategies for the delivery of services to suit their localsituations. Interventions for safe abortion services thatwere being provided in RCH Programme will howevercontinue to be available and implemented moreeffectively during the Eleventh Five Year Plan.REPRODUCTIVE TRACT INFECTIONS/SEXUALLYTRANSMITTED INFECTIONS (RTI/STI)3.1.128 The spread of HIV infection and the role thatRTI/STI play in the transmission of HIV has focusedurgent attention on the problem. Identification andmanagement of RTI is an important objective of theRCH Programme. The RCH strategies, under NRHM,for prevention, early detection, and effective managementof common lower RTI through the existingprimary health care infrastructure; and provision ofthe RTI/STI services at sub-district level will be implementedduring the Eleventh Five Year Plan.3.1.129 During the Eleventh Five Year Plan, forimproving maternal health, special attention will befocused on the following areas:• Ensuring universal provision of comprehensiveANC• Providing widespread screening for anaemia andhigh-risk conditions• Ensuring comprehensive training programme forskilled birth attendants• Ensuring the services of skilled birth attendant atchild birth, both for home deliveries and in institutionalsettings• Providing SBA training to dais who are ubiquitousin every nook and corner of the country• Enhancing availability of facilities for institutionaldeliveries and effective EmOC• Providing 24-Hours Delivery Service at PHCs andCHCs• Training of health personnel at PHCs and CHCs to