TRAININGS UNDER RCH PROGRAMME

MATERNAL HEALTH:

1.SBA ( SKILLED BIRTH ATTENDANT):

India has a high Maternal Mortality Rate. Provision of emergency obstetric care is the answer to this problem. Every woman should be cared for by a skilled birth attendant (SBA) during pregnancy, childbirth and the postpartum period. The SBA is a person who can handle obstetric emergencies and is also aware when the situation reaches a point beyond his/her capability, and hence needs to refer the woman to a higher centre. Therefore, the presence of an SBA at every delivery, along with the availability of an effective referral system, can help reduce the maternal morbidity and mortality to a considerable extent. Planned for Medical Officers (AYUSH) and Staff Nurses ( SNs) and Auxiliary Nurse Midwifes ( ANMs) for a period of 21 days.

2.EmOC (EMERGENCY OBSTETRIC CARE):

Maternal mortality remains one of the most daunting health challenges in our country and reduction in the same has been one of the focus areas of work. Sample Registration Systems (SRS) estimates that 9% of all maternal mortality is due to unsafe abortions. One of the key contributing factors for this situation is the lack of skills among rural general doctors and medical officers in primary health care system to provide high quality Emergency Obstetric Care (EmOC) and MTP services.Ministry of Health and Family Welfare, Government of India in partnership Federation Of Obstetric Societies of India (FOGSI) and Indian College of Obstetrics and Gynecology (ICOG) has embarked upon implementing the Comprehensive Emergency Obstetric (EmOC) Certificate Program to help our country achieve the goals set as per NRHM and MDG. The overall objective of the program is to develop capacity of doctors (General practitioners & Medical officers – non-specialists) in India to provide high quality emergency obstetric care services in underserved areas to prevent maternal mortality and morbidity. Planned for a period of 112 days.

3.LSAS ( LIFE SAVING ANAESTHETIC SKILLS):

All pregnant women are at risk of obstetric complication and life-threatening complications occurduring labour and delivery. Every year more than 1,00,000 women die in India due to causes related to pregnancy. The main causes of maternal mortality are the complications resulting from hemorrhage,unsafe abortions, eclampsia, sepsis and obstructed labour. Death from most of these causes is preventable with provision of good quality antenatal, natal and post-natal care, safe institutional delivery services, timely referral and provision of emergency obstetric care. The actual operationalisation of First Referral Units (FRUs) is suffering due to lack ofspecialist/trained manpower, particularly in the field of anesthesia. TheTenth Plan Working Group on Health of Women and Children has observed that ‘Shortage of Anesthetists is perhaps the single most important cause of inadequacy of emergency care in Government Hospitals particularly in rural areas’. Therefore “Life saving anesthetic skills for emergency obstetric care” has been designed to provide the selected MBBS doctors with necessary skills and competencies to manage cases requiring life saving emergency obstetric care at FRUs. Planned for a period of 18 weeks.

4.MTP/MVA (MATERNAL TERMINATION OF PREGNANCY/ MANUAL VACUUM ASPIRATION):

Although mortality due to complications of abortions has decreased over the years, it is still a major contributor to maternal death and maternal morbidity and is a significant contributor of subsequent infertility. This is an indication of the unmet need for safe abortion services. The National Population Policy 2000 lays great emphasis on the provision of safe abortion services. It has listed number of operational strategies with key points : (a) increasing access to safe abortion services through increased number of recognised facilities and providers and use of simpler, well-tested technologies such as Manual Vacuum Aspiration. (b) improving quality of services by setting standards for services and by training providers. (c) ensure services for termination of pregnancy at primary health centres and at community health centres. Planned for a period of 12 days.

5.RTI/STI (REPRODUCTIVE TRACT INFECTION/SEXUALLY TRANSMITTED INFECTION):

The prevention, control and management of STI/RTI is a well recognized cost effective strategy for controlling the spread of HIV/AIDS in the country as well as to reduce reproductive morbidity among sexually active population. Individuals with STI/RTI have a significantly higher chance of acquiring and transmitting HIV. Moreover STI/RTI are also known to cause infertility and reproductive morbidity. Controlling STI/RTI helps decrease HIV infection rates and provides a window of opportunity for counselling about HIV prevention and reproductive health. Thus, the availability and reach of standardized STI/RTI care at all levels of health facilities needs to be ensured. The NACP III Strategy and Implementation Plan (2007-2012) makes a strong reference to expanding access to a package of STI management services both in the general population as well as for high risk behavior groups. For this, nation-wide training for various functionaries involved in provision of STI/RTI care have been developed to train doctors, ANMs/Nurses, and to technicians on Syndromic Case Management of STI/RTI for a period of 2 days.

6.BEmOC ( BASIC EMERGENCY OBSTETRIC CARE):

Timely identification and management of obstetric complications is the key to the survival of mothers. To achieve this, Govt of India envisages that 50% of the PHCs and all CHCs should be operationalised as 24-hour delivery centres. Training will help in providing services to women in labour and onstetric emergencies thereby reducing maternal mortality. Training is planned for MOs for a period of 10 days.

7.IMEP (INFECTION MAMAGEMENT AND ENVIRONMENT PLAN):

The Infection Management and Environment Plan (IMEP) is an approach or framework for managing – avoiding, reducing and controlling – health and environmental risks arising from healthcare facilities. Health and environmental risks arise out of poor infection control practices and unsound environment management systems such as (i) inappropriate disinfection, (ii) poor sterilisation techniques, (iii) inadequate use of protective gears, (iv) poor bio-medical waste handling, treatment and disposal practices, (v) unhygienic and unsanitary conditions and inadequate potable water within the healthcare facilities. Through a structured and systematic approach, the IMEP aims to bring in state-of-the-art, best practices in managing these health and environmental risks effectively.

Planned for MOs and SNs/HWs for a period of 1 day.

CHILD HEALTH

1. F-IMNCI ( FACILITY BASED INTEGRATED MANAGEMENT OF NEONATAL AND CHILDHOOD ILLNESS):

The Government of India is committed to achieve a reduction in infant and child mortality to achieve the National Population Policy and National Rural Health Mission Goal of Infant mortality of 30 per thousand live births. The Integrated Management of Neonatal and Childhood Illness (IMNCI) is the centerpiece of newborn and child health strategy under Reproductive Child Health II and National Rural health Mission. F-IMNCI is the integration of the Facility based Care package with the IMNCI package, to empower the Health personnel with the skills to manage new born and childhood illness at the community level as well as the facility. It helps to build capacities to handle referrals taking place from the community. Referrals include the most common childhood conditions responsible for over 70 per cent of all deaths in children under the age of 5 years in resource poor setting. The implementation of F-IMNCI strategy will help improve the performance and quality of health workers. The critical element of this strategy is the evidence-based integrated approach with a focus on new born and child hood illness. This will also help address the acute shortage of pediatricians at facilities. Planned for MOs and SNs for a period of 11 days.

2. NSSK ( NAVJAAT SHISHU SURAKSHA KARYAKRAM):

Nearly two-thirds infant deaths each year occur within the first four weeks of life, and about two-thirds of those occur within the first week. Thus, the first days and weeks of life are critical for the future health and of a child. Effective Newborn care is a crucial challenge that is faced by every health care setting dealing in maternal and child health. A key component is to equip the staff with appropriate knowledge and skill to improve the quality of service delivery. This programme provides evidence-based knowledge in improving newborn heath especially care at birth. This training course on basic newborn care and resuscitation program has been developed to address the high early neonatal mortality in the country. The course aims to impart the basic skills essential to manage common neonatal problems like asphyxia, infections, hypothermia and breast feeding. The course has been developed for Medical officers, Nurses and ANMs,who are based at health centres (CHCs/FRUs/24x7 PHCs) and small hospitals (not referral hospitals) and those who are responsible for conducting deliveries and managing newborn babies. The objective of this new initiative is to have persons trained in Basic newborn care and resuscitation available at every delivery and thus help prevent a significant number of newborn deaths and ensure newborn survival. Planned for MOs and SNs for a period of 2 days.

3. IYCF ( INFANT AND YOUNG CHILD FEEDING):

Analysis of data from NFHS 3 (2007-08) shows that underweight prevalence increases rapidly with child’s age from birth to age 20-23 months. Even during first six months of life, when most children are breastfed, 20-30 percent are underweight. One of the key reasons for malnutrition setting in early in life is the faulty and sub-optimal infant and young child feeding practices , which is further compounded by factors such as repeated episodes of childhood illnesses and low birth weight. Malnutrition in turn is a contributory factor in one third to half of all deaths taking place in children under five years of age.Looking at the national scenario of child malnutrition, it is apparent that early preventive action is crucial for accelerating reductions in infant and young child undernutrition and related mortality, on a large scale. Optimal infant and young child feeding is recognised as the most effective intervention to improve child health, prevent malnutrition and reduce child mortality.

Therefore IYCF training has been implemented with key indicatorsincluding (1) early initiation of breastfeeding (within the first hour), (2) exclusive breastfeeding among children less than six months and (3) complementary feeding after six months together with continued breastfeeding up to 2 years. Children are likely to falter in growth during this critical period of life. For this situation to improve, infant and young child feeding interventions require to be scaled up in the country through adequate resource allocation, capacity development and effective communication at all levels of the health system. Planned for MOs and SNs/ANMs for a period of 3 days.

4. SAM (SEVERE ACUTE MALNUTRITION):

Undernutrition is one of the most concerning health and development issues in India as in other patrs of the world. The high mortality and disease burden resulting from undernutrition call for urgent implementation and interventions to reduce their occurence and consequences which include determined action on the social determinents of undernutrition. NRCs (Nutritional Rehabilitation Centres) has been planned and established at District Hospitals and CHCs for management of SAM children. And for the smooth functioning of these NRCs, training package is included for doctors and nurses to be posted in NRCs. Planned for MOs and SNs for a period of 3 days.

5. FBNC (FACILITY BASED NEWBORN CARE):

The goal of this training is to improve the skills of health workers so that they can save newborn lives. Training will help in skill building of the Medical Officers and Staff Nurses posted in NBCC (Newborn Care Corner), NBSU(Newborn StabilizingUnit) and SNCU (Special Newborn Care Unit) to provide quality care which thus helps in reduction of mortality of newborn. Planned for MOs and SNs for 4 days training and 2 weeks observership.

6. IMNCI ( INTEGRATED MANAGEMENT OF NEONATAL AND CHILDHOOD ILLNESS):

In children under five years of age, pneumonia, diarrhoea, malaria and neonatal infections are the most important causes of death. Many children suffer from more than one illnesses at a time. IMNCI is an integrated approach that includes the assessment , classification and management of the major problems a sick infant or a child aged less than 5 years may have. It also includes assessment of nutritional and immunization status of all sick infants and children. IMNCI training has been developed for Health Workers to ensure early recognition of illnesses and seeking timely care and also to teach mothers ways to prevent illnesses through exclusive breast feeding and essential newborn care. Planned for a period of 8 days.

FAMILY PLANNING

1. MINILAPAROTOMY:

To ensure broad access to female sterilization, the method offered at a service site should be safe, simple, highly effective, and relatively pain-free, affect only fertility, inexpensive, suitable to be performed as an ambulatory procedure and cause minimal tubal damage on order to facilitate ( WHO, 1992) . Mimilaparotomy and laparoscopy both fit these criteria and are acceptable procedures and preferred for female sterilization. The goal of clinical training is to assist health professionals in learning to provide safe high quality reproductive health services through improved work performance. To achieve this goal, the clinical training is based on mastery learning approach. Training is essential to empower service providers with the knowledge, attitude and skillls for competent delivery of services and efficiently managed training can have a substantial impact on performance. Planned for MOs for a period of 12 days.

2. PPIUCD ( POST PARTUM INTRAUTERINE CONTRACEPTIVE DEVICE):

As we all know that the immediate postpartum period is an ideal time to educate and counsel a woman on exclusive breastfeeding as a contraceptive method, counselling on future fertility, birth spacing or limiting intentions, and provision of appropriate family planning methods like IUCD, sterilization should also be provided during this period. Training is planned for Medical Officers ( MOs), MOs (AYUSH) and Staff Nurses ( SNs) for a period of 3 days.

3. LAPAROSCOPIC STERILIZATION:

Quality of services provided plays a major role in acceptance of any service. This training documents sets out the criteria for eligibility, physical requirements, counselling, informed consent, preoperative, postoperative, and follow-up procedures, and procedures for management of complications and side effects. This training comprises of a team of one MO and three SNs for a period of 3 days.

4. INTERVAL IUCD ( INTERVAL INTRAUTERINE CONTRACEPTIVE DEVICE):

Provision of quality IUCD services is a key intervention of the Govt of India in its endeavour to provide spacing methods of family planning to the clients. Healthy timing and spacing of pregnancies is the cornerstone of improvinf maternal and child health care outcomes. This training has been developed to equip trainers and service providers with the updated knowledge and skills for provision of quality IUCD services. Training is planned for Medical Officers ( MOs), MOs (AYUSH) , Staff Nurses ( SNs) and Health Workers (HWs) for a period of 3 days.