Healthcare Programmes for Women and Children

The Government of India, under National Health Mission, has taken several steps in all the States and UTs with regard to health issues related to women and children. Programmes/strategy being carried out by the Ministry in this regard is given below: 1.                  Janani Suraksha Yojana (JSY) The Government of India is implementing Janani Suraksha Yojana (JSY) which is a safe motherhood scheme throughout the country. The objective of the JSY is to reduce maternal and infant mortality by promoting institutional delivery among pregnant women by providing conditional cash assistance. Important Features of JSY Financial assistance under JSY is available to all pregnant women in those States that have low institutional delivery rates, namely, the states of Uttar Pradesh, Uttarakhand, Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh, Assam, Rajasthan, Odisha, and Jammu and Kashmir are categorized as Low Performing States (LPS). However, in remaining States where the levels of institutional delivery are satisfactory, pregnant women from BPL/SC/ST households only are entitled for JSY benefit. These states are categorized as High Performing States (HPS) under JSY. Eligibility for Cash Assistance The eligibility for cash assistance under the JSY is as shown below: LPS All pregnant women delivering in government health centers, such as Sub Centers (SCs)/Primary Health Centers (PHCs)/Community Health Centers (CHCs)/First Referral Units (FRUs)/general wards of district or state hospitals HPS All BPL/Scheduled Caste/Scheduled Tribe (SC/ST) women delivering in a government health centre, such as SC/PHC/CHC/FRU/general wards of district or state hospital LPS & HPS All BPL/Scheduled Caste/Scheduled Tribe (SC/ST) women delivering in accredited private institutions Cash Assistance for Institutional Delivery (in Rs.) The cash entitlement for different categories of mothers is as follows: Category     Rural area Total     Urban area Total Mother’s package ASHA’s package* Mother’s package ASHA’s package** LPS 1400  600 2000 1000 400 1400 HPS   700  600 1300 600 400  1000 *ASHA package of Rs. 600 in rural areas include Rs. 300 for ANC component and Rs. 300 for facilitating institutional delivery. **ASHA package of Rs. 400 in urban areas include Rs. 200 for ANC component and Rs. 200 for facilitating institutional delivery. 2.                  Janani Shishu Suraksha Karyakaram (JSSK) The programme has been launched on 1st June, 2011, which entitles all pregnant women delivering in public health institutions to absolutely free and no expense delivery including Caesarean section.  The initiative stipulates free drugs, diagnostics, blood and diet, besides free transport from home to institution, between facilities in case of a referral and drop back home.  Similar entitlements have been put in place for all sick infants accessing public health institutions for treatment. Key steps which contribute to improving health of women and children ·         Capacity building of health care providers in basic and comprehensive obstetric care    including essential newborn care, early diagnosis and case management of common ailments of children. These trainings are on Navjaat Shishu, Suraksha Karyakram (NSSK), Integrated Management of Neonatal and Childhood Illnesses (IMNCI), Facility Based Newborn Care (FBNC), Infant and Young Child Feeding practices (IYCF), etc. ·         Operationalization of sub-centers, Primary Health Centres, Community Health Centres and District Hospitals for providing 24x7 basic and comprehensive obstetric care services. ·         Emphasis on facility based newborn care at different levels to reduce child morbidity and mortality: Setting up of facilities for care of sick newborn such as Special New Born Care Units (SNCUs), Newborn Stabilization Units (NBSUs) and Newborn Care Corners (NBCCs) at different levels is a thrust area under NHM. ·          Mother and Child Tracking System (MCTS): A name based Mother and Child Tracking System has been put in place which is web based to ensure registration and tracking of all pregnant women and new born babies so that provision of regular and complete services to them can be ensured. ·         Mother and Child Protection Card in collaboration with the Ministry of Women and Child Development to monitor service delivery for mothers and children. ·         Antenatal, Intranatal and Postnatal care including Iron and Folic Acid supplementation to pregnant & lactating women for prevention and treatment of anemia. ·         India Newborn Action Plan (INAP) has been launched with an aim to reduce neonatal mortality and stillbirths. ·         Newer interventions to reduce newborn mortality- Vitamin K injection at birth, Antenatal corticosteroids for preterm labour, kangaroo mother care and injection gentamicin to young infants in cases of suspected sepsis. ·         Intensified Diarrhoea Control Fortnight was observed in August 2014 focusing on ORS and Zinc distribution for management of diarrhoea and feeding practices. ·         Integrated Action Plan for Pneumonia and Diarrhoea (IAPPD) launched in four states with highest infant mortality (UP, MP, Bihar and Rajasthan). ·         Management of Malnutrition: Nutritional Rehabilitation Centres (NRCs) have been established for management of severe acute malnutrition in children. ·         Appropriate Infant and Young Child Feeding practices are being promoted in convergence with Ministry of Woman and Child Development. ·         Universal Immunization Programme (UIP): Vaccination protects children against many life threatening diseases such as Tuberculosis, Diphtheria, Pertussis, Polio, Tetanus, Hepatitis B and Measles. Infants are thus immunized against seven vaccine preventable diseases every year. The Government of India supports the vaccine programme by supply of vaccines and syringes, cold chain equipment and provision of operational costs. ·         Engagement of more than 8.9 lakhs Accredited Social Health Activists (ASHAs) to generate demand and facilitate accessing of health care services by the community. ·         Home Based New Born Care (HBNC): Home based newborn care through ASHAs has been initiated to improve new born practices at the community level and early detection and referral of sick new born babies. ·         Rashtriya Bal Swasthya Karyakram (RBSK) for health screening and early intervention services has been launched to provide comprehensive care to all the children in the age group of 0-18 years in the community. The purpose of these services is to improve the overall quality of life of children through early detection of birth defects, diseases, deficiencies, development delays including disability. ·         Village Health and Nutrition Days in rural areas as an outreach activity, for provision of maternal and child health services. ·         Health and nutrition education to promote dietary diversification, inclusion of iron and folate rich food as well as food items that promote iron absorption.  ·         Under National Iron Plus Initiative (NIPI), through life cycle approach, age and dose specific IFA supplementation programme is being implemented for the prevention of anaemia among the vulnerable age groups like under-5 children, children of 6 – 10 years of age group, adolescents, pregnant & lactating women and women in reproductive age along with treatment of anaemic children and pregnant mothers at health facilities.

Meeting MDG Target on Infant Mortality

Under the Millennium Development Goal (MDG) 4, target is to reduce Child Mortality by two-third between 1990 and 2015. In case of India, it translates into a goal of reducing Infant mortality rate from 88 per thousand live births in 1990 to 29 in 2015. As per Sample Registration System (SRS), 2013 reports published by Registrar General of India the Infant Mortality Rate (IMR) of India is 40 per 1000 live births. It may reach 35 by 2015 if the current trend of annual decline of 5.6 per cent continues. Under National Health Mission, the following interventions are being implemented to reduce infant mortality rate and maternal mortality ratio in the Country: 1.      Promotion of institutional deliveries through Janani Suraksha Yojana. 2.      Operationalization of sub-centres, Primary Health Centres, Community Health Centres and District Hospitals for providing 24x7 basic and comprehensive obstetric care services. 3.      Name Based Web enabled Tracking of Pregnant Women to ensure antenatal, intranatal and postnatal care. 4.      Mother and Child Protection Card in collaboration with the Ministry of Women and Child Development to monitor service delivery for mothers and children. 5.      Antenatal, intranatal and postnatal care including Iron and Folic Acid supplementation to pregnant & lactating women for prevention and treatment of anaemia. 6.      Engagement of more than 8.9 lakhs Accredited Social Health Activists (ASHAs) to generate demand and facilitate accessing of health care services by the community. 7.      Village Health and Nutrition Days in rural areas as an outreach activity, for provision of maternal and child health services. 8.      Adolescent Reproductive Sexual Health Programme (ARSH) – Especially for adolescents to have better access to family planning, prevention of sexually transmitted Infections, Provision of counselling and peer education. 9.      Health and nutrition education to promote dietary diversification, inclusion of iron and folate rich food as well as food items that promote iron absorption.   10.    Janani Shishu Suraksha Karyakaram (JSSK) entitles all pregnant women delivering in public health institutions to absolutely free and no expense delivery including Caesarean section.  The initiative stipulates free drugs, diagnostics, blood and diet, besides free transport from home to institution, between facilities in case of a referral and drop back home.  Similar entitlements have been put in place for all sick infants accessing public health institutions for treatment. 11.         Universal Immunization Programme (UIP): Vaccination protects children against many life threatening diseases such as Tuberculosis, Diphtheria, Pertussis, Polio, Tetanus, Hepatitis B and Measles. Infants are thus immunized against seven vaccine preventable diseases every year. The Government of India supports the vaccine programme by supply of vaccines and syringes, cold chain equipment and provision of operational costs. 12.         Strengthening Facility based newborn care: Newborn care corners (NBCC) are being set up at all health facilities where deliveries take place; Special New Born Care Units (SNCUs) and New Born Stabilization Units (NBSUs) are also being set up at appropriate facilities for the care of sick newborn including preterm babies. 13.         Home Based Newborn Care (HBNC):  Home based newborn care through ASHA has been initiated to improve new born practices at the community level and early detection and referral of sick new born babies 14.          Capacity building of health care providers: Various trainings are being conducted under National Health Mission (NHM) to build and upgrade the skills of health care providers in basic and comprehensive obstetric care of mother during pregnancy, delivery and essential newborn care. 15.          Management of Malnutrition: Nutritional Rehabilitation Centres (NRCs) have been established for management of severe acute malnutrition in children. 16.         India Newborn Action Plan (INAP) has been launched to reduce neonatal mortality and stillbirths. 17.            Newer interventions to reduce newborn mortality- Vitamin K injection at birth, Antenatal corticosteroids for preterm labour, kangaroo mother care and injection gentamicin for possible serious bacillary infection. 18.               Intensified Diarrhoea Control Fortnight was observed in August 2014 focusing on ORS and Zinc distribution for management of diarrhoea and feeding practices. 19.           Integrated Action Plan for Pneumonia and Diarrhoea (IAPPD) launched in four states with highest infant mortality (UP, MP, Bihar and Rajasthan). The prominent causes of death among infants as per RGI-SRS (2001-03) are perinatal conditions (46%), respiratory infections (22%), diarrhoeal disease (10%), other infectious and parasitic diseases (8%), and congenital anomalies (3.1%). Besides this, Illiteracy, low socio-economic status, early age of marriage, high parity, women’s empowerment, poor sanitation, hygiene and nutrition, poor access to health facilities are also contributing factors of Infant and Child mortality

Steps Taken to Accelerate Pace of Reduction in MMR

The steps taken to accelerate the pace of reduction for Maternal Mortality Ratio (MMR) under the National Health Mission (NHM) are: v  Promotion of institutional deliveries through Janani Suraksha Yojana. v  Capacity building of health care providers in basic and comprehensive obstetric care.   v  Operationalization of sub-centres, Primary Health Centres, Community Health Centres and District Hospitals for providing 24x7 basic and comprehensive obstetric care services. v  Name Based Web enabled Tracking of Pregnant Women to ensure antenatal, intranatal and postnatal care. v  Mother and Child Protection Card in collaboration with the Ministry of Women and Child Development to monitor service delivery for mothers and children. v  Antenatal, Intranatal and Postnatal care including Iron and Folic Acid supplementation to pregnant & lactating women for prevention and treatment of anaemia. v  Engagement of more than 8.9 lakh Accredited Social Health Activists (ASHAs) to generate demand and facilitate accessing of health care services by the community. v  Village Health and Nutrition Days in rural areas as an outreach activity, for provision of maternal and child health services. v  Health and nutrition education to promote dietary diversification, inclusion of iron and folate rich food as well as food items that promote iron absorption.   v  Janani Shishu Suraksha Karyakaram (JSSK) has been launched on 1st June, 2011, which entitles all pregnant women delivering in public health institutions to absolutely free and no expense delivery including Caesarean section.  The initiative stipulates free drugs, diagnostics, blood and diet, besides free transport from home to institution, between facilities in case of a referral and drop back home.  Similar entitlements have been put in place for all sick infants accessing public health institutions for treatment. v  To sharpen the focus on the low performing districts, 184 High Priority Districts (HPDs) have been prioritized for Reproductive Maternal Newborn Child Health+ Adolescent (RMNCH+A) interventions for achieving improved maternal and child health outcomes.

Measures to Reduce IMR and MMR

As per Sample Registration System (SRS), 2013, the Infant Mortality Rate (IMR) in the country is 40 per 1000 live births which translates into death of an estimated 10.68 lakh children up to the age of one year, annually. As per Sample Registration System (SRS) 2013, the Neonatal Mortality Rate in India is 28/1000 live births which means that estimated 7.47 lakh newborns die within first four weeks of birth every year in the country. As per the Sample Registration System (SRS), Maternal Mortality Ratio (MMR) for the period 2011-13is 167/100000 live births. This translates into an estimated 44,000 maternal deaths in the country, every year. The state-wise detail of Infant Mortality Rate (IMR) is given below: State-wise Infant Mortality Rates States/UTs Infant Mortality Rate (per 1000 Live Births) SRS (2013) India 40 Assam 54 Madhya Pradesh 54 Odisha 51 Uttar Pradesh 50 Meghalaya 47 Rajasthan 47 Chhattisgarh 46 Bihar 42 Haryana 41 Andhra Pradesh 39 Telangana 39 Jammu & Kashmir 37 Jharkhand 37 Gujarat 36 Mizoram 35 Himachal Pradesh 35 Arunachal Pradesh 32 Uttarakhand 32 Dadra & Nagar Haveli 31 West Bengal 31 Karnataka 31 Punjab 26 Tripura 26 Delhi 24 Andaman & Nicobar 24 Maharashtra 24 Lakshadweep 24 Sikkim 22 Chandigarh 21 Tamil Nadu 21 Daman & Diu 20 Nagaland 18 Puducherry 17 Kerala 12 Manipur 10 Goa 9 Infant Mortality Rates for the Asian countries, available in the State of World’s Children Report published by UNICEF (2015) are given below:

Promotion of use of Bio-Fertilizers in the Country

The country is fully dependent on imports in Potassic sector and to the extent of 90% in Phosphatic sector in the form of either finished products or its raw material. Despite having very limited reserves of rock phosphate in the country, the indigenous production of DAP is increasing for the last four years as per details below: Production of DAP  (Lakh MT) Year Production Import Total % of prod. % of prod. over import 2010-11 35.37 74.09 109.46 32.31 48 2011-12 39.63 68.97 108.6 36.49 57 2012-13 36.47 56.41 92.88 39.27 65 2013-14 36.11 32.61 68.72 52.55 111             The Government proposes to produce manure and energy from the urban waste. The proposal is in primary stage and a draft discussion paper on ‘Promotion of City Compost’ has been circulated for inter-ministerial consultation.  However, the Government has undertaken a number of steps for promotion of use of bio-fertilizers in the country.  They are as under: (1)       Financial support for establishment of bio-fertilizers production unit as back ended subsidy @ 25% of total financial outlay up to a maximum of Rs. 40.00 lakh through NABARD is provided.  Financial assistant of 50% of cost or Rs. 100/- per hectare, whichever is less, is provided to farmers for promotion of bio-fertilizers under Integrated Scheme for Oilseeds, Pulses, Oil Palm and Maize (ISOPOM). (2)                    To encourage the producers of organic fertilizers, the Government is providing financial assistance for setting up of production units of organic fertilizers under following schemes:- (i)        Under National Project on Organic Farming (NPOF), financial assistance is provided as credit linked back ended subsidy through NABARD for setting up of fruit/vegetable waste/agro-waste compost unit @33% of the total cost of project upto Rs. 60.00 lakh per unit. (ii)       Under National Horticulture Mission (NHM), financial assistance is provided for setting up vermi-compost production units @50% of the cost subject to a maximum of Rs. 30,000/- per beneficiary. This information was given by the Minister of State for Chemicals & Fertilizers Shri Hansraj Gangaram Ahir in reply to aquestion by Shri  Mukesh Rajput in the Lok Sabha today.