Integrated Reproductive Maternal Newborn, Child Health & Nutrition Program

This program is inspired by the desire of the government to reduce maternal, newborn and child morbidity and mortality, promote family planning services and improve nutritional status of women and children. The achievement of this objective is also part of the government's commitment to make speedy progress to achieve health related 'Millennium Development Goals' by 2015 and setting the roadmap towards achieving 'Universal Coverage' of health services in Punjab. This program will contribute in achieving health sectorial priorities in line with 'Poverty Reduction Strategy Paper –II'.
 
The salient features of the currently proposed program are that it adds on to what is already being done in the MNCH and LHWs Programs to achieve Millennium Development Goals 4 & 5. It will act as catalyst to assist ongoing initiatives. Additionally, new initiatives being proposed address malnutrition and aim to increase accessibility of MNCH services by provision of 24/7 service delivery at selected BHUS, all RHCs, THQs and DHQs. BHUs will be selected by a notified Provincial Management Committee (see Administrative Structure); the criteria for selection includes geographical distribution of and the community's accessibility to individual facilities.
 
The program will contribute to all health& nutrition sectorial priorities set in the 'Economic Growth Framework' of the Planning Commission, i.e.
  • Revamping/management of primary, secondary and tertiary healthcare
  • Healthcare Financing Reforms
  • Governance reforms in health sector (especially setting quality standards; essential services package; aid effectiveness, service structure; capacity; access to affordable medicine; etc.)

Goal

To improve maternal, new-born and child health in Punjab, especially of the poor thereby making real progress towards achieving health related MDGs and contribute to reduction in:

  • Maternal mortality ratio from 227/100,000 live births in 2006-07 to less than 140/100,000 live births by end 2016
  • Under-five mortality rate from 104/1000 live births in 2011 to 52/1000 live births by end 2016
  • Total fertility rate from 3.6 in 2011 to 3.2 by end 2016
  • Prevalence of stunting from 36% in 2011 to 32% by end 2016

Objectives

The Program objective is to improve access to Reproductive health, Child health and Nutrition services in the province especially for the poor through:
  • Improving contraceptive prevalence rate for modern methods from 23% in 2011 to 35 % by end 2016
  • Increasing skilled birth attendance from 59% in 2011 to 80% by end 2016
  • Increasing institutional deliveries from 53% to 70% by end 2016
  • Increasing coverage of complete immunization from 35% in 2011 to 70% by end 2016
  • Increasing percentage of children suffering from diarrhea treated with ORS and Zinc, up to 40% by end 2016
  • Increase in the proportion of severe acute malnourished (with complications) children 0-59 months successfully treated (for discharge) up to 75%by end 2016
  • Increasing percentage of early initiation of breast feeding from 15% in 2011 to 40% by the end of 2016
  • Increasing percentage of exclusive breast feeding from 22% (0-5 months) in 2011 to 35% by the end of 2016
  • Increased percentage of utilization of adequately Iodized salt at household level from 34% to 50%
  • Increase in the distribution of iron & folate tablets among pregnant women from 20% in 2012 to 50% by end 2016
  • Increase in proportion of children 6-23 months fed in accordance with all three infant and young child feeding (IYCF) practices (food diversity, feeding frequency, consumption of breast milk or milk), up to 40% in 2016
  • All districts implementing MNCH related MSDS by end 2016
The principal sources for the verification of Program performance against set targets will be independent Program evaluations; National and Provincial surveys e.g. Punjab MICS, PDHS and PSLM, in addition to Program monitoring and supervisory systems. 

Implementation of Strategies

The program will strengthen the health system by integrating different interventions, improving service delivery and introducing innovative strategies. The program will:

  • Strengthen district health system through integration of quality reproductive, maternal, newborn, child health and nutrition services at community, BHU,RHC, THQ and DHQ level and focusing on rural areas and gradually move towards delivery of EPHS (primary) at the district level
  • Strengthen linkages of community based health services with health facilities through LHWs and CMWs focusing on rural areas& urban slums
  • Streamline and strengthen services for provision of Basic and Comprehensive Emergency Obstetric and Newborn care (EmONC)
  • Enhance comprehensive Family Planning services at community and facility level
  • Enhance Nutrition services at community and facility level through multi-sectoral coordination mechanism
  • Increase coverage of micronutrient supplementation and fortified food through advocacy from consumer to production line
  • Implementing a Woman Focused Approach by using the 1000 days Plus Model for nutrition, which focuses on the critical window of 1000 days from conception to the first 24 months of the child's life
  • Involve local communities at different levels to enable them to participate in health improvement process
  • Improve technical and managerial capacities at all levels of health care delivery system and expand accountability mechanism vis a vis performance based incentives in health care delivery system
  • Introduce and implement e- monitoring and e-reporting system
  • Increase demand for preventive and primary healthcare services through targeted, socially acceptable communication