Eleventh Five Year Plan

90 Eleventh Five Year Planperform emergency obstetrical procedures, especiallyc-sections• Providing additional ANMs and Public Health andStaff Nurses in certain SCs, PHCs, and CHCs• Providing skilled human resources on contractualbasis• Improving EmOC in all CHCs in a phased manner(CHCs will have well equipped operation theatre,access to safe banked blood, qualified obstetricians,paediatricians, and anaesthetists)• Operationalizing FRUs through supply of drugs inthe form of Emergency Obstetric drugs kits• Providing special attention to roads linking habitationsto CHCs• Providing Referral Transport• Orienting ASHAs to postpartum care and linkingher remuneration to health checks of both themother and newborns• Providing Safe Abortion Services• Preventing, detecting, and effectively managingcommon lower RTI through the existing primaryhealth care infrastructureChild Health3.1.130 Under the RCH Programme, newborn andchild health services are implemented in the countrywith the aim of reducing neonatal, infant, and childmortality. In order to reduce these, a continuum ofcare is needed at the community as well as facility level.The Eleventh Five Year Plan goal is to reduce IMR to28 per 1000 live births by 2012. State-specific goals havealso been suggested (Annexure 3.1.6).HOME BASED NEWBORN CARE (HBNC)3.1.131 Efforts to improve home based care haveproven successful at improving child survival. HomeBased Newborn and Child Care is to be provided by atrained Community Health Worker (such as the ASHA)who guides and supports the mother, family, and TBAin the care of newborn, and attends the newborn athome if she is sick. The worker is supervised by a fieldperson (ANM/LHV or a doctor) who visits the communityonce in 15 days. Community acceptance andcoverage of such care has been quite good.3.1.132 The GoI has recently approved the implementationof HBNC based on the Gadchiroli model (Box3.1.13), where appreciable decline in IMR has beendocumented on the basis of work done by a VOcalled SEARCH. Gadchiroli has shown how ordinarywomen can do extraordinary things: a well-trainedlocal woman can not only lower neonatal mortalitybut can also bring about attitudinal change. Thewomen Shishu Rakshaks of Gadchiroli have managedto dispel many myths surrounding pregnancy andhave been able to ensure better nutrition, care, immunization,and hygiene.3.1.133 During the Eleventh Five Year Plan, ASHAswill be trained on identified aspects of newborn careduring their training. This initiative will be initiallyimplemented in the five high focus States (MP,UP, Orissa, Rajasthan, and Bihar). To supervise andprovide onsite training and support to ASHAs, mentor-facilitatorswill be introduced for effective implementation.The national strategy during the Planwill be to introduce and make available high-qualityHBNC services in all districts/areas with an IMR morethan 45 per 1000 live births. Apart from performanceincentive to ASHAs, an award will be given to ASHAsand village community if no mother–newborn orchild death is reported in a year. For effective linkages,model Intensive Care Units will also be set up atthe district level, particularly in States with poorhealth indicators, in order to make facility based curativenewborn care available.INTEGRATED MANAGEMENT OF NEONATAL ANDCHILDHOOD ILLNESS (IMNCI)3.1.134 IMNCI strategy encompasses a range of interventionsto prevent and manage five major childhoodillnesses, that is, Acute Respiratory Infections(ARI), Diarrhoea, Measles, Malaria, and Malnutritionand the major causes of neonatal mortality, which areprematurity and sepsis. It focuses on preventive, promotive,and curative aspects. The major componentsof this strategy are:• Strengthening the skills of the health care workers• Strengthening the health care infrastructure• Involvement of the community3.1.135 The first two components of the strategyare the facility based IMNCI and the third is the