Major Schemes Implemented under Family Welfare
All India Hospital Post Partum
Programme
The programme was started in 1969 with
the main objective of maximising the extent of effective
contraception among the target population in the community.
Presumably it caters to a large number of confinement
/ abortion cases adopting a maternity centred hospital
bases approach. Under this programme post partum centres
are functioning in 22 District level medical institutes,
which include 5 medical colleges and 4 private institutions.
All these institutions are provided with a set pattern
of inputs in the form if staff and equipment including
at least 6 bedded sterilization ward and operation theatre.
With a view to providing maternal and child health and
also family welfare services in rural and semi urban areas
the programme was extended to taluk levels and intermediary
hospitals and at present there are 60 such sub-divisional
units in the state including one Ayurveda Hospital at
Poojappura in Thiruvananthapuram city.
Post Partum PAP
Smear testing facility programme
The programme with the aim
of early detection of cervical cancer among women irrespective
of the fact that they are accepted or not is being implemented
through medical colleges at Thiruvananthapuram, Alappuzha,
Kottayam and Kozhikode.
Sterilization
Bed Scheme
This scheme for the reservation of beds in hospitals run
by Government, Local bodies and voluntary organisations
was introduced in 1964, so as to provide immediate facilities
for tubectomy operation. There are 128 such beds in 25
hospitals run by voluntary organisations as against 393
beds in the Government sector in 10 districts.
Medical Termination
of Pregnancy
The MTP act of 1971 which came into force on 1-4-1972
primarily aims, as a health care measure, at eradicating
a large number of criminal and clandestine abortions,
thereby considerably reducing mortality and morbidity
among pregnant women. A certifying board was constituted
in May 1972 with Director of Health Services as Chairman
for authorising the doctors and institutions to do MTP.
Services are rendered by qualified and trained doctors
in well equipped Government hospitals and approved private
institutions. There are 564 such institutions in 1996
of which 343 are Government and 221 are private. A separate
MTP cell was established at the Directorate of Health
Services in the early 1990’s for expansion of MTP
services.
Third India Population
Project.
India Population Project III
was one of the area specific projects sanctioned under
soft loan for Kerala for a period from 1985-90 by World
Bank.
Growth rate of population if IPP districts
are:
| District |
1971-81 |
1981-91 |
| Wayanad |
33.81 |
21.32 |
| Palakkad |
21.30 |
16.53 |
| Malappuram |
29.43 |
28.87 |
| Idukki |
26.64 |
11.23 |
The state had successfully implemented
the IPP III in 4 backwards districts of Idukki, Wayanad,
Palakkad and Malappuram with the objective to control
birth rate on one side and to improve the health condition
of the infants and mothers on the other through multiple
devises according to norms laid down under National Family
Welfare Programme.
Coastal
Health Project
The Kerala Coastal Health Project was launched during
the year 1994 with a view to improving the health care
delivery system available at present in the coastal region
of Kerala which lags behind in the overall health status
of the state. This is a time-bound project for 4 years
from 1994 to 1997. The project is implemented in coastal
panchayats of 9 districts viz. Kasargode, Kannur, Kozhikode,
Malappuram, Thrissur, Ernakulam, Alappuzha, Kollam and
Thiruvananthapuram.
The major objective of the project is the
qualitative improvement of the health delivery system
through systematic utilisation of additional resources
provided and with the active participation of the local
community.
As on 31-3-1997 under this project 169
coastal institutions were included. Minor civil works,
supply of machine and equipment, ventilators and cardiac
monitor and operation theatre equipments for major hospitals
in the coastal districts etc. Come under the project.
Water Shed Project
The project is being implemented in the water shed areas
for the development of rain fed areas. Villages are identified
in various districts under each PHC. In certain areas
under the scheme a sum of Rs.5000/- can be utilised for
the welfare of the people. The purpose of the fund is
to utilise this for purchasing necessary medicines and
other facilities for CSSM and for the propaganda of family
planning methods among the people residing in the water
sheds. The fund will be utilised by the committee Mithra
Krishak Mandal consisting of five members selected from
each village.
Social Safety
Net Scheme
The scheme is being implemented in the poor performing
district Malappuram through World Bank assistance with
a view to reducing the high maternal mortality rate by
increasing institutional deliveries and providing care
to high risk pregnancies, upgradation of facilities like
operation theatre, labour room, observations ward and
quarters and providing generator, running water supply,
ambulance etc.
Baby Friendly
Hospital Initiative
Baby friendly hospital initiative is a WHO / UNICEF sponsored
global programme launched in 1992 for promoting, protecting
and supporting exclusive breast feeding. The programme
is hospital based and aims at training of health personnel
for properly motivating and correctly initiating mothers
into breast feeding.
In Kerala, the programme was sponsored
by UNICEF from 1993. Under this programme, Government
and private hospitals are identified., assessed and declared
as baby friendly. So fare 209 hospitals are declared as
baby friendly. It is hoped that the new programme will
go a long way in promoting early breast feeding which
is turn will pave the way for child survival especially
during early months of life.
First Referral
Units
Essential obstetric care for all pregnant women early
detection of complicates and emergency obstetric care
are the three main strategies for safe motherhood. The
most important service for reducing the maternal death
is the provision of emergency care for women with obstetric
complications. The FRUs plays vital role in reducing the
maternal mortality by providing timely emergency care
to women and obstetric complications. At present there
are 71 FRUs attached to various hospitals and measures
are taken to strengthen the facilities in these. Skill
development training to FRU staff is also carried out
in the medical colleges.
Family Welfare
Award
The scheme of family welfare award to family welfare workers
and institutions was started during 1980-81 and was revised
in 1986-87. The award was given in cash for the best performance
both the state level and district level.
Community Award
The Scheme was introduced in 1996-97. The award is in
cash and for decreasing infant mortality rate, crude birth
rate, child mortality rate and maternal mortality rate.
Villages are selected and award presented to village pradhans.
The same is utilised for developmental activities in the
village.
Target Free Approach
From April 1st 1996 the Family Welfare Programme is implemented
all over India on the basis of target free approach. Government
of India has recognised that contraceptive target and
cash incentive have resulted in the inflation of performance
statistics and the neglect of quality of service. The
change over to target free approach necessitates decentralised
planning in consultation with the community at the grass
root level to provide quality services. Government of
India did not fix contraceptive targets for Kerala and
Tamilnadu during 1995-96 and in other states one or two
districts were made target free. In target free approach
importance is given to client satisfaction and community
involvement. The National Family Welfare Programme has
changed to Reproductive and Child Health (RCH), which
includes Family Planning, CSSM, prevention and management
of RTI/STD and HIV/AIDS and a client-centred approach
to Family Welfare and Health Care. The target free approach
has since been renamed as Decentralised Participatory
Planning Approach.
Though the present infant mortality rate
is 16 per thousand live births, about 65% of the deaths
are neonatal, the reason for the same being low birth
weight. In Kerala attention is now focused on reducing
the neonatal and maternal death as far as possible, by
giving proper education to adolescents, detection and
treatment of disease at an early stage, giving proper
treatment and increasing the nutritional status.
The strategies adopted by WHO for 2000
AD are :
1. Improved status and education for women
2. Improved primary health care
3. Improved family planning service; so
as to:
i. ensure that every pregnancy is intended
and every child is wanted.
ii. Protect women from the consequences
of unsafe abortion.
iii. Protect the health of adolescents
and encourage responsible sexual behaviour.
iv. Bring women at least into the mainstream
of development, protect their health, promote their education
and encourage and reward their contribution.
The International Conference on Population
and Development (ICPD) held at Cairo 1994 defined reproductive
health as a state of complete physical, mental and social
well being on all matters relating to the reproductive
system and its functions and processes.
The concept of reproductive health is bases
in holistic, life cycle approach to the health of women
from adolescence to post menopausal age. It represents
a chronological continuity. Reproductive health care also
includes sexual health, the purpose of which is the improvement
in personal relations. Problems of adolescent sexuality,
HIV/AIDS and education / counselling interventions place
a great deal of responsibility on family members especially
parents.
The problems with respect to the health
of women and children cannot be dealt with separately.
They are interdependent. The reproductive health care
is a move towards quality health care for the entire age
period from childhood to menopause.
Integrated Child
Development Services
The Integrated Child Development Services (ICDS) scheme
was formulated by Government of India in 1975 against
a grim background of high infant mortality rate, high
levels of morbidity, high incidence of malnutrition and
nutrition related diseases and low literacy rates.
Improvement of the nutritional and health
status of children in the age group of 0 – 6 years
proper psychological-physical and social development of
the child, reduction of mortality, morbidity malnutrition
and school dropouts, effective coordination of policy
and implementation among various departments to promote
child development, proper health and nutrition education
of mothers to look after the child in normal health and
nutrition needs of the child are the important objectives
of the programme.
Expectant and nursing mothers, women of
reproductive age group and children below six years of
age the beneficiaries of the programme. Antenatal, postnatal
and new born care are provided, besides nonformal education
to children of 3-6 years and health and nutritional education
to women of reproductive age group.
In rural areas for every 1000 population
planes and 700 population in tribal area there will be
one Anganwadi with an Anganwadi worker and helper. There
are urban ICDS projects in a few towns and AWs under Upgraded
Special Nutrition Programme (USNP) in a few towns. In
addition there will be one supervisor for 20 Anganwadis
on rural and 25 in urban and 17 in tribal areas. There
are 113 ICDS projects in Kerala and services are provided
through 17014 Anganwadis.
All children below the age of 6 are weighed
periodically and weights are recorded in the growth chart.
Those children who suffer from malnutrition are given
special supplementary nutrition and acute cases are referred
to hospitals. Adequate funds for supplementary nutrition
programmes are provided in the state plans under minimum
needs programmes.
Immunization against six killer diseases
such as Diphtheria , whooping cough, tetanus, measles,
poliomyelitis and tuberculosis is given to all infants
in the project area. All expectant mothers are immunized
against tetanus.
The medical officer, the lady health visitors
and female health workers of the nearby Primary Health
Centre provide health input for ICDS scheme. Medical check
up of children in Anganwadis is also conducted periodically.
Information Education
and Communication (IEC)
For accelerating the Family
Welfare Programme the need for information, Education
and Communication is well recognised. The success of the
Family Welfare Programme depends mainly on the voluntary
and widespread acceptance of the concept of small family
norm. The efforts undertaken so far through mass education
and media activities have helped to create almost hundred
percent awareness among the people of Family Welfare.
By the constant and continuous utilisation
of educational methods and media, it has become possible
to remove the deep-rooted attitudes, beliefs and misconceptions
which were detrimental to the acceptance of health and
family welfare programmes. Strategies of different types
have been evolved and implemented with a view to achieving
behavioural and attitudinal changes among the resistant
groups. Efforts are continued to convert the existing
widespread awareness into acceptance, and use of Family
Planning methods by dissemination of information and education.
Community participation
and involvement
The success of implementing every programme depends on
the involvement and participation of the community. Propagation
of small family norm among the eligible couples, removal
of misconceptions and misunderstandings are effectively
done through individual contact and group approach with
the participation of Non-Governmental Organisations like
Mahila Samajams, Youth Clubs and similar Socio-Cultural
Organisations.
Mahila Swasthya Sangh
India is committed to the twin
goal of “Health for All” and ‘Net Reproduction
Rate of Unity” by the year 2000. These goals are
recognised to be intimately intertwined and further their
achievement contributing to the improvement of the condition
of women and children. It was realised that a major component
of Family Welfare Programme is related to health problems
of women and children and these groups are vulnerable
to health disorders and diseases. In order to mobilise
community participation and to create a viable support
structure within the community to sensitise rural women
and to increase demand for integrated Health & Family
Welfare Services available, the scheme of M.S.S was launched
in 1990-91 in selected districts of Kerala.
To overcome various problems like low age
at marriage, risk factors during pregnancy, unsafe and
unplanned deliveries and high rate of child mortality,
it was desired that women may be educated, motivated and
persuaded to accept programmes to increase demand for
services.
The scheme called Mahila Swasthya Sangh
(MSS) was designed to include some of the village level
functionaries already working with Social Welfare Department
and Directorate of Health Services at state level. Besides
the above 10 to 15 women members of the village called
“Community leaders” were to be involved with
the programme.
Initially the scheme was introduced in
the state in 1990-91, constituting 888 MSSS. Subsequently
based upon the feed back the scheme was extended to all
districts. According to the design, it was planned to
constitute MSS in villages having population more than
1000 to 2000 house holds. Those C.D. Blocks which were
covered by the Social Welfare Department having adult
education centre under ICDS projects were involved so
that co-ordination with the female functionaries of these
departments is obtained effectively. The members of MSS
serve as a link between the community and local health
functionaries.
The programme is still continuing. The
total number of MSS functioning in the state till 1996-97
is 3440.
It was decided that an evaluation should
be carried out by an independent agency about the functioning
of MSS and its utility during the previous years. Consequently
the Institute of Management in Government has done an
evaluation study and the result showed that the functioning
of MSS satisfactory.
Training of Mahila Swasthya Sangh
members and other grass root level functionaries at sub-centre
level.
For developing communication skills, enriching
the knowledge and to bring about coverage of related activities
at the grass root level, training was imparted to MSS
members on to topics viz. Child Survival & Safe Motherhood
and spacing methods for family planning, saturation of
weak areas with multimedia and local-specific interactive
scheme.
IEC efforts need to be focussed and targeted
for specific beneficiaries in demographically weak districts
by utilising local specific folk media as interactive
mode of communication. Specific and innovative cultural
activities such as street plays, folk dances, dances,
mimicry, puppetry, oppana were organised in identified
weak districts having high CBR and IMR with the objective
of creating awareness amongst all eligible couples regarding
the various family welfare programme.
For saturation of weak districts, troops/registered
folk parties etc. were identified to give song and drama
performances, under local specific interactive scheme.
World Population
day
The rapid increase in population is a cause of major concern
to all developmental efforts. It is estimated that the
present rate of growth of population of the country will
be crossing one billion mark by the end of this century.
Keeping this in view, 11th of July every
year is observed as World Population Day. The observance
of the day is a grim reminder of the World Population
increase which touched five billion mark on 11th July
1987. The objectives of observance of the day is to organise
Mass Media Campaign and to take effective steps to bring
the population growth rate to a sustainable level. All
media and field organisations are to be harnessed to put
the message that the only choice before humanity is to
reduce the number.
Enhancement of the role of the NGOs
in Family Welfare and Health sector
The Government of India policy statement on the National
Family Welfare Programme spells out the need to promote
Family Planning as a people’s movement. The association
of voluntary organisations in the Governments’ programme
ensures greater acceptability of the Family Welfare activities
among the people. This is so because the voluntary organisations
enjoy greater credibility and are closer to the community
than the Government staff. The supplementary and complementary
role played by the voluntary sector in the propagation
of the small family norm is therefore vital for the success
of the family welfare programme.
In order to involve voluntary organisations
in the implementation of the Family Welfare Programme,
and to make it a peoples’ movement, Government have
evolved a policy for financial assistance to these organisations
for their projects.
SCOVA (Standing Committee
on Voluntary Action)
To consider applications received
from voluntary organisations working at the grass-root
level in the rural areas and urban slums for setting up
family welfare projects relating to MCH, Family Planning,
at state level, a Committee (SCOVA) consisting of State
Government Officials, representatives of established Voluntary
Organisations in the state and the Regional Director of
Health and Family Welfare was constituted in the State.
The Committee is to recommended projects
in FW from the voluntary sector for funding from the centre.
The Standing Committee on Voluntary Action (SCOVA) have
sanctioned model schemes for promotion of small family
norm and population control by encouraging spacing methods
and sterilization.
Swathya Mela
In remote and difficult areas, provision of health services
particularly to the vulnerable groups have been very difficult.
To ill the gaps in delivery of health services created
by inadequate infrastructure, and to increase accessibility
of health services to the community relating to prevention
of diseases and their cure, as well as for promotion of
a healthy way of life, a Mela approach has been introduced.
Wide publicity is required for ensuring
a large turnout for seeking health services during these
Swathya Melas.
Counselling is another area taken up n
the melas. Counseling has a district advantage in leading
to informed choice in contraception, assisting individuals
in acting upon health information received by them, increasing
access to give points of service delivery, promoting good
relation between service providers and clients.
Special School
Health Check-up Programme
A special school health checkup of students in primary
schools was carried out in 1996 using the health workers,
AWWs and Volunteers. An effective IEC campaign was organised
by the State, giving emphasis to create awareness among
the parents to send their wards to schools on the checkup
day and to provide wide publicity regarding referral cards
and referral services.
Pulse Polio Immunisation
Campaign
Pulse Polio Immunisation campaign are carried in December
and January. Intensive social mobilisation campaign and
media announcements is a unique feature in all Pulse Polio
Immunisation campaigns. Awareness is created through IEC
efforts on the benefits of PPI and why fully immunized
children also should receive OPV during this campaign.
Target Free Approach
in Family Welfare
Communication programmes aim at generating demand and
better utilisation of health and family welfare services
in the community and empower people to take care of their
health. Now it is being realised that the IEC programmes
have to be area specific and addressed to the problems
of the area. This warrants decentralised planning approach
in designing IEC programme. Another important dimension
of the IEC programme is based on needs of the area. The
proposed IEC strategies are:
1. identify the communication needs to
plan IEC activities.
2. Involve community and NGOs through
unified messages.
3. Effective use of mass media for back
up.
4. Strengthening inter-personnel communication.
Moving from Family Welfare to Reproductive
Health
New direction in the Family Welfare Programme
towards a client – oriented reproductive health approach
has major implications for IEC. As is evident from the
services identifying as components of an essential reproductive
health packages, the range of activities which IEC must
now take-up are considerably broader in scope than before.
In addition to prevention of unwanted pregnancies and
the promotion of childhood immunization, IEC strategies
are concerned with safe abortion (Medical Termination
of Pregnancy) safe motherhood, prevention and management
of RTIs/STIs, sexuality and gender information education
and counselling.
The goals require a strategic approach
to IEC identifying meaningful segments of the target audience,
promoting a number of new behaviours that are closely
linked but complex, identifying messages, and using a
mix of communication channels to effectively reach these
various audience segments.
Thrust areas have been identified for Family
Welfare Programme, for which audience-specific message
and use of suitable media were to be discussed and finalised
from individual, group and mass approach point of view.
The situation analysis reveals the following thrust area
for designing IEC Programmes.
· Reproductive Health of Adolescent
girls
· Counselling of adolescents
entering the reproductive age group for Family Life education
· Women’s education
· Higher age at marriage
· Early Ante-natal registration
and care
· Nutrition during pregnancy
and lactation
· Institutional delivery
· Vaccine preventable diseases
· Protected water supply
· Diarrhoea and ARI management
· Low birth weight
· Birth interval, birth spacing
· Medical Termination of
Pregnancy
· Childhood disability
· Breast feeding.
