convergence of services between nrhm and icds. nccp n b cp convergence of services idd pfa& d
TRANSCRIPT
Convergence of services between NRHM and ICDS
PEOPLENVBDCP
RNTCP
NACPIDSP
RCH
SHP
Nutrition
SanitationWater Supply
Ed
uca
tion
NCCP
NBCP
Convergence of services
IDD
PFA&D
CURRENT FUNCTIONING OF ANGANWADIS
0
20
40
60
80
100
<12 12-23 24-35 36-47 48-59 60-71
Not receiving supplementary food Any services Almost daily receving supplementary food
Figure 9.6: Percentage of children age 0-71 months recieving services from an AWC
Source Reference 9.8
During the first 2 years, less that a third of the children received any services and the proportion receiving food supplements were negligible. In the other age groups only one-fifth had received supplementary food.
Figure 9.7: Percentage of children 0-59 months in areas covered by AWC by frequency of weighing
0
20
40
60
80
100
120
<12 12-23 24-35 36-47 48-59
%
Not at all Atleast once a month Atleast once in three monthsSource Reference 9.8
Inspite of guidelines specifying that monthly weighing of children should be done in the crucial 0-24 months age group, the percentage of 0-12 and 12-23 months old children who were weighed every month was negligible. Among the 2-6 years old children, less than 10% have been weighed once in three months
Figure 9.9: Interstate differences in services received during pregnancy
0 10 20 30 40 50 60 70
Bihar
Delhi
J & K
Punjab
Uttar Pr.
Assam
Rajasthan
Gujarat
Andhra Pr.
Sikkim
Karnataka
Himachal Pr.
Meghalya
Goa
Mizoram
Supplementary food Health check-ups NHE
Source: Reference 9.8
There are huge interstate differences in pregnant women accessing AW based services Compared to other states Delhi performs poorly in ICDS based AN services. This might be partly attributable to ready access to ANC in hospitals and relatively low poverty ratio in Delhi
NFHS -3
Figure 9.10: Percentage of children 0-71 months receiving any services from an AWC
0 10 20 30 40 50 60 70
Bihar
Punjab
J & K
Uttar Pr.
Haryana
Manipur
Kerala
India
Karnataka
Nagaland
Jharkhand
TamilNadu
Meghalya
Madhya Pr.
Chhatisgarh
PercentageSource: Reference 9.8
NFHS 3
There are large interstate differences inchildren accessing anganwadi services . In Delhi proportion ofchildren accessing anganwadi is low . This might be due to low poverty ratio, ready access to hospitals providing child care and lack of space in anganwadi where children could sit and participate in activities .
Coverage under health mission
PRIMARY HEALTH CARE & NUTRITION PRIORITIES
Detection and correction of undernutrition and anaemia in pregnancy
Coping with low birth weight neonate
Reduction of IMR, high morbidity and undernutrition during infancy
Reduction of under five mortality rates& high undernutrition rates in preschool children
Reduction in anaemia in Indians
Ensuring universal access to iodised salt by 2010
Ante natal/intrapartum care Current status ANC coverage is low; content is suboptimal. Majority do not get weighed; detection of under-nourished pregnant women and targeted food supplementation and health care for those with under-nutrition not operationalisedVery few get Hb estimation done; appropriate management of anaemia is non existent; consumption fo IFA tablets low Majority go to hospital for delivery but care in home deliveries is poor
What can convergence between ICDS and Health Mission can achieve ?
Essential antenatal care for all pregnant women can be provided during the village health and nutrition daysAWW, AW helper and ASHA can inform women so that they reach a common place where ANMs can examine them and give appropriate advice, IFA tablets , TT injections and also refer those with problems. Most of Delhi anganwadi’s do not have enough space where pregnant women can be brought together for examination and advice However near most anganwadis there are community halls, dharmshalas.By approaching appropriate authorities, it might be possible to get the health and nutrition day as well as immunisation day organised in these buildings. As all pregnant women are collected in one place,group counseling will be possible. ANM can examine all women and get the forms completed with the help of the AWW, give TT injections and IFA tablets. Under weight women can be identified and AWW worker can try to provide food supplements on priority to them. Women requiring referral can be identified and ASHA can help them in reaching hospitals for care.
Synergy in delivery care
Decision regarding place of delivery (domiciliary & health facilities). ANM will identify low risk women who can deliver at home;
AWW and ASHA can monitor for clean delivery ;if there are complications during delivery ASHA can help the woman to access emergency care at the right place. All Anganwadis should have information on nearest hospital where pregnant women could be referred
In home deliveries AWW can weigh all neonates ( in Delhi perhaps 5 / year in an anganwadi) , identify those weighing less than 2 kg and refer them to nearest hospital for care; AWW should have the nearest hospital where neontes can be referred; ASHA may facilitate referral
This will help in reducing the neonatal mortality in home deliveries
What can an AWW do to reduce IMR
Weigh home born babies soon after birth; refer those who weigh less than 2.2 kg
Ensure early initiation of breast feeding
Ensure exclusive breast feeding for first six months
Collect infants in AWC on immunisation days so that infants get immunised on schedule by the ANM
Provide nutrition education and enable the mother to give adequate quantities of appropriate complementary feeds from home food
Advise regarding feeding during illness and convalescence
Act as depot holder for ORT,
Immunisation days can be utilised for providing immunisation and for advice regarding infant feeding and caring practices and contraceptive care
Immunisation rates can go up rapidly if there is good coordination between the AWW and the ANM
During immunisation days the AWW and ASHA can collect the children and pregnant women
ANM can immunise them in the anganwadi, advice mothers regarding appropriate infant feeding and caring practices and provide contraception related counseling
Convergence of services
AWW can weigh neonates in home deliveries and refer those requiring careadvise regarding exclusive breast feeding and complementary feeding identify undernourished pre-school children by weighing them at least once every three months and give food on priority to them;act as depot holder for ORS.assist in emergency referral
Convergence of services
ANM will Immunize all infants, pregnant women and
children as per schedule. Screen children – especially the under nourished
ones for health problems and manage/ refer those with problems.
AWW will Assist ANM in organizing immunization health
check ups in anganwadi; Assist ANM in administering massive dose
Vitamin A