CapaclLy 8ulldlng ln Chlld PealLh

lnlLlaLlves
Chlld PealLh ulvlslon
MlnlsLry of PealLh and lamlly Welfare
CovernmenL of lndla
9resenLaLlon ouLllnes
W SLaLus of Chlld healLh ln lndla (3 slldes)
W Chlld healLh servlces ln lndla (one sllde)
W CapaclLy bulldlng
Cenerlc (2 slldes)
lMnCl (7 slldes)
llMnCl (4 slldes)
nSSk (4 slldes)
CLhers (one sllde)
Chlld PealLh SLaLus ln lndla
0
10
20
30
40
50
60
70
2004 2005 2006 2007 2008 2009
IMR
NMR
58
4
1rend ln decllne ln lM8 nM8 All lndla
I
M
R
/
N
M
R

p
e
r

1
0
0

l
i
v
e

b
i
r
t
h
s

57
53
55
35
37 37
30
uecllne ln nM8 has been much slower Lhan lM8 Whlle lM8 dropped by 8
polnLs beLween 2003 2009 nM8 decllned by [usL polnLs beLween 2003
2009
MalnuLrlLlon
4
Causes of underflve deaLhs ln lndla 2010
CuLcome lndlcaLors ln Chlld healLh
W lnfanL MorLallLy
(30/1000 llve blrLhS8S 2009)
W neonaLal MorLallLy
(4/1000 Llve blrLhS8S 2009)
W MalnuLrlLlon (?)
nlPS 2003 (19 wasLed chlldren)
Chlld PealLh lnLervenLlons
W newborn care
Pome based Care (ASPA lMnCl)
laclllLy based care (nSSk llMnCl)
W nuLrlLlon (l?Cl)
8reasL feedlng
ComplemenLary feedlng
Macro and Mlcro nuLrlenL
W Care ln slckness (lMnCl llMnCl)
1reaLmenL
8eferral
Counsellng
PealLh lnfrasLrucLure
Puman 8esource
hys|ca| |nfrastructure
Inst|tut|on Status
AWW 110422
SC 143894
9PC 291
CPC 4310
uP 40+
Medlcal College 400+
numan kesource
Staff Status
AWW 11422
ASPA 824
AnM 190919
MC [ 9PC/CPC 1174
Sn 3973
LPv 1818
Chlld healLh Servlces ln lndla
Chlld healLh care servlces
Spec|a||zed
Serv|ces
New8orn Care 1ra|n|ng
needs
CommunlLy lMnCl Pome based new
born care
ASPA / AWW P8nC lMnCl
vlllage lMnCl Pome 8ased new
born care servlces
AnM from SC P8nC lMnCl
Sub CenLre lMnCl +nSSk new born care
corner
AnM P8nC lMnCl
nSSk
9PC Servlces aL
SC + llMnCl
new born care
corner
MC Sn nSSk lMnCl
CPC Servlces aL
9PC +
9edlaLrlclan
newborn
SLablllzaLlon unlL
MC Sn and
9edlaLrlclan
nSSk llMnCl
uP Servlces aL
CPC+ ln
paLlenL
servlces
Speclal new born
care unlL
MC Sn and
9edlaLrlclan
nSSk llMnCl
CapaclLy 8ulldlng
ducaLlon Lo ConsulLaLlon
W 8aslc ducaLlon (5ecooJoty CtoJootloo)
W 9rofesslonal ducaLlon (ANM CNM M885)
W ;uallflcaLlon (MeJlcol cooocll Notsloq cooocll)
W lnLernshlp / ApprenLlce (lte 5etvlce)
W lnducLlon
W 1ralnlng / CapaclLy bulldlng (lMNcl llMNcl N55k )
W 8eorlenLaLlon
W ConsulLaLlon
ln servlces Lralnlngs why ?
W 1o 8rldge Lhe gap ln 1heory 8eallLy
W 1o CpLlmlze Lhe avallable resources (urugs/
ulpmenLs / SLaff)
W 1o updaLe and lnform abouL recenL
developmenL
W 1o relnforce Lhe learned skllls knowledge
W .: :-,.:/.- -, :/. /.+::/ ::+,,
lMnCl
Comprehenslve package of capaclLy bulldlng of communlLy
based healLh workers Lo empower Lhem ln ldenLlfy danger
slgns manage lf posslble and refer Lhe chlldren ln case of
need
lMnCl
W Care of new born and ?oung
lnfanLs (under Lwo monLhs)
keeplng baby warm
8reasLfeedlng
Cord skln and eye care
8ecognlLlon of lllness ln
newborn managemenL and/
or referral
Pome vlslLs
W Care of young chlldren
(2monLhs Lo flve years)
ManagemenL of dlarrhea
Malarla Measles acuLe ear
lnfecLlon malnuLrlLlon
anemla
8ecognlLlon of lllness and rlsk
condlLlon and managemenL/
referral
9revenLlon and managemenL of
lron vlLamln A deflclency
Counsellng lf feedlng for all
chlldren below 2 years
Counsellng on feedlng for
malnourlshed chlldren
beLween 23 years
lmmunlzaLlon
lMnCl modules
,odu|es
W Module1 lnLroducLlon
W Module2Assess Classlfy Lhe slck
young lnfanL age up Lo 2 monLhs
W ModuleldenLlfy LreaLmenL for Lhe
slck young lnfanL
W Module41reaL Lhe young lnfanL
and Counsel Lhe moLher
W Module3Assess Classlfy Lhe slck
chlld age 2 monLhs up Lo 3 years
W ModuleldenLlfy LreaLmenL for Lhe
slck chlld
W Module71reaL Lhe chlld
W Module8Counsel Lhe moLher
W Module9lollow up
Chart book
<Case managemenL
sLrucLured algorlLhms for
declslon maklng
speclflc acLlons based on
classlflcaLlon
kLLN kLLN Not ||| counse| send home
LLLCW LLLCW ,||d|y ||| adv|se t]t send home
kLD kLD Severe |||ness refer
lMnCl norms
W 1ralners (MCs/LPvs/Sns/nCC)
+ (2 Cllnlcal Lralners)
W 1ralnee
24/baLch
subgroup of 8 each wlLh Lwo Lralners
1ralnee Lralners raLlo should noL be more Lhen 41
W uuraLlon
8 days
W 1ralnlng slLes
noL less Lhen CommunlLy PealLh CenLre (wlLh 100 dellvery/monLh)
W Cllnlcal Case load
8 (healLhy and slck) newborn avallable ln faclllLles
1218 slck chlldren admlLLed or reporLlng Lo ouL door
W CbservaLlon
SLaLe level Lralners or perLs
W urug klLs and loglsLlcs for pracLlclng skllls
8aslcs drugs le CenLlan vloleL 9CM and Small CoLrlmo LableLs
Case sheeL for eamlnaLlon of chlld should be made avallable Lo Lhe Lralnee
lMnCl supporLlve Supervlslon
W lMnCl Lralned supervlsors (LPv MC and lCuS supervlsors) are
furLher Lralned ln supervlsory skllls (2 days)
W Supervlsors
vlslL lMnCl Lralned workers ln communlLy
observe workers whlle conducLlng home vlslLs or eamlnlng Lhe chlld
provlde handholdlng supporL Lo workers ln case of need
ensure Lhe regular supply of Lhe drugs and oLher loglsLlcs
Pelps ln preparlng monLhly reporLs
9rovlde feedback Lo Lhe ulsLrlcL Cfflcers
W lMnCl model of supervlslon ls unlue and 8obusL buL lronlcally noL
effecLlvely lmplemenLed
SysLem supervlsors are noL effecLlve
Model of nCC supervlsors 1ralner cum Supervlsors have susLalnablllLy
lssues
WhaL Lo monlLor
Dur|ng 1ra|n|ng
W no of Lralnee
W no of Lralners
W AvallablllLy of modules
W AvallablllLy of Av eulpmenL
W Ask for fllled case sheeL by Lralnees
W Ask for 1ralners checkllsL for
Lralnees skllls
W Ask Lralnees regardlng no of cases
seen by lndlvldual
W vlslL hosplLal wards for avallablllLy
of cases
W Cbservers reporLs lf any
W LoglsLlcs (8esldenLlal lood
LransporL)
fter 1ra|n|ng (|n commun|ty)
W AvallablllLy of (see records)
CharL book
urugs
Case sheeL (fllled and 8lank)
W Ask for (verlfy fllled case sheeL)
laLesL blrLh ln vlllage and home
vlslLs
laLesL slck chlld LreaLed or referred
Copy of MonLhly reporL
LasL vlslL by Lhe supervlsors
W vlslL aL leasL one famlly wlLh new
born where Pome vlslL was
conducLed by worker
WhaL Lo monlLor aL ulsLrlcL level
W 1ralnlng CenLre (funcLlonal)
W no of 1ralners avallable ln dlsLrlcL
W 1oLal 1ralnlng load (all caLegory wlse)
W no of Lralned sLaff (CaLegory wlse)
W no of 1ralned workers reporLlng Lo ulsLrlcL
W no of supervlsors Lralned and reporLlng
W Any lMnCl based sLudy or evaluaLlon conducLed ln dlsLrlcL
W WheLher llMnCl ls sLarLed or noL
W When more Lhen 80 of workers wlll be Lralned ln dlsLrlcL (on Lhe basls of
presenL pace of Lralnlng)
lMnCl
CuLpuL lndlcaLors
W 9opulaLlon covered by lMnCl Lralned PealLh Worker
W no of newborn
vlslLed wlLhln 24 hours of blrLh
home vlslLs wlLhln 710 days of blrLh
Low blrLh welghL bables vlslLed Llmes (ln 28 days)
W no of slck neonaLes
1reaLed aL home
8eferred
W no of Slck Chlldren
1reaLed aL home
8eferred
W no of malnourlshed chlldren
ldenLlfled and LreaLed aL home
8eferred
llMnCl
Mojotlty of tbe beoltb focllltles (24x7 lncs lkus cncs ooJ
ulsttlct bospltols) Jo oot bove ttoloeJ peJlottlcloos
1o ptovlJes o cootlooom of poollty cote fot sevetely lll
oewbotos ooJ cbllJteo tefetteJ ftom tbe commoolty to loclllty
llMNcl ttololoq wlll tbetefote belp lo sklll bollJloq of tbe
meJlcol offlcets ooJ stoff ootses
ConLenLs ln llMnCl
W ln AddlLlon of lMnCl package llMnCl covers
1A1 (mergency 1rlage AssessmenL and 1reaLmenL)
W 1rlage
W MalnLaln 1emperaLure Check 1reaL hypoglycemla
W Alrway 8reaLhlng Clve oygen
W ClrculaLlon
W Coma and Convulslons
W uehydraLlon
laclllLy based care of slck young lnfanL
W Care aL blrLh lncludlng neonaLal resusclLaLlon
W Care of newborn ln posLnaLal ward
W ManagemenL of slck newborn
W ManagemenL of low blrLh welghL bables neonaLal LransporL
laclllLy based care of slck chlld
W Case ManagemenL of Chlldren 9resenLlng wlLh Cough or ulfflculL 8reaLhlng
W Case ManagemenL of Chlldren 9resenLlng wlLh ularrhoea
W Case ManagemenL of Chlldren 9resenLlng wlLh lever
W ManagemenL of Chlldren wlLh Severe Anaemla
W Case ManagemenL of Chlldren wlLh Severe MalnuLrlLlon
llMnCl norms
W 1ralners
4 Lralners (all Cllnlcal laculLy or Lralned pedlaLrlclan)
W 1ralnee (MCs and Sns)
1/baLch
2 subgroup of 8 each wlLh Lwo Lralners
1ralnee Lralners raLlo should noL be more Lhen 41
W 1ralnlng slLes
noL less Lhen Medlcal Colleges or eulvalenL
W Cllnlcal Case load
ln case of medlcal Colleges
W uuraLlon
11 days (for non lMnCl Lralned MC/Sn)
3 days for lMnCl Lralned MC and Sn (Covers laclllLy based modules)
W CbservaLlon
naLlonal / SLaLe level Lralners or perLs vlslLlng Lralnlng slLe and
feedback Lo Lhe dlsLrlcL offlcer for correcLlve measures
WhaL Lo monlLor
Dur|ng 1ra|n|ng
W no of Lralnee
W no of Lralners
W AvallablllLy of modules
W AvallablllLy of Av eulpmenL
W Ask for fllled case sheeL by Lralnees
W Ask for 1ralners checkllsL for
Lralnees skllls
W Ask Lralnees regardlng no of cases
seen by lndlvldual
W vlslL hosplLal wards for avallablllLy
of cases
W Cbservers reporLs lf any
W LoglsLlcs (8esldenLlal lood
LransporL)
fter tra|n|ng
W by llMnCl Lralned offlcer or
1ralners only
W lollow Lhe llMnCl guldellnes
W AvallablllLy of essenLlal drugs
eulpmenLs lab faclllLles
W no of Lralned MCs and Sns
W no of chlldren
referred ln
LreaLed ln faclllLles
referred ouL
dled ln faclllLles
MonlLorlng of llMnCl
no of medlcal offlcers and nurses Lralned
no of PealLh laclllLy wlLh llMnCl Lralned MC and Sn
AvallablllLy of essenLlal drugs and funcLlonal eulpmenL
number of slck young lnfanLs admlLLed and managed
(Sepsls Asphyla and Low blrLh welghL)
number of slck chlldren admlLLed and managed (Severe
pneumonla Severe dehydraLlon lever Severe acuLe
malnuLrlLlon)
Severely malnourlshed chlldren deLecLed should be llnked
wlLh Lhe n8C belng developed ln Lhe SLaLes
nSSk
1o eosote ovolloblllty of beoltb wotket ttoloeJ lo
oeoootol tesoscltotloo ot evety Jellvety polot
1o oJJtess tbe mojot klllet of oeoootes le blttb
Aspbyxlo lofectloos ooJ ptemototlty
nSSk
Neonata| morta||ty |s ma[or
contr|butor to US morta||ty |n Ind|a
NSSk empower nWs |n
W 1hermal 9roLecLlons
W Care of 8aby aL 8lrLh
W leedlng of normal and Low
blrLh welghL baby
W 8esusclLaLlon of new born
W 9revenLlon of lnfecLlons
W 1ransporL of neonaLes
0

10
1
14
20
23
,a|ar|a
Congen|ta| namo||es
In[ur|es
,eas|es
Neoanta| Seps|s
8|rth sphyx|a
D|arrhoea
rematur|ty
neumon|a
Cthers
lndla PealLh SLaLlsLlcs 2008 World PealLh CbservaLory WPC
nSSk
W 1ralnlng norms
1ralnees (AnMs Sn and MCs)
uuraLlon (2 days)
1ralnlng aL dlsLrlcL level hosplLal or eulvalenL
8aLch slze 0/ baLch
4 Lralners (cllnlcal hands 1ralned aL Plgher level)
Cbserver (lA9 / Medlcal laculLy)
More Pands on pracLlces or on manneulns
WhaL Lo monlLor
Dur|ng 1ra|n|ng
W no of Lralnee
W no of Lralners
W AvallablllLy of modules
W AvallablllLy of Av eulpmenL
W Ask Lralnees regardlng no of
cases seen by lndlvldual
W AvallablllLy of manneuln for
Lralnlngs
W Cbservers reporLs lf any
W LoglsLlcs (8esldenLlal lood
LransporL)
fter tra|n|ng
W nSSk ls also sklll based Lralnlng
W very rarely you may flnd
opporLunlLy Lo observe
resusclLaLlon whlle on vlslLs
W 9revlous records may be
revlewed
W luncLlonal new born care Corner
W AvallablllLy of drugs and
eulpmenL as llsLed ln modules
W AvallablllLy of nSSk Lralned
worker round Lhe clock ln faclllLy
W no of blrLh resusclLaLlon dled
and referral
MonlLorlng aL dlsLrlcL level
W number of 1ralnlng slLes ln dlsLrlcL
W number of 1ralners avallable ln dlsLrlcL
W number of Lralned sLaff ln dlsLrlcL
W no of neonaLes
born ln dlsLrlcLs
8esusclLaLed
dled
referred Lo hlgher cenLers (SnCu Medlcal college )
CLher Lralnlngs
W laclllLy based new born care
noL yeL endorsed by CCl
nnl deslgned course ls adopLed ln dlfferenL sLaLes
W lnfanL and young chlld feedlng
lA9 deslgned course
W Sever AcuLe MalnuLrlLlon managemenL
WPC/unlCl and oLher models are scaled up ln
varlous sLaLes
W SLaLe speclflc courses ln neonaLal care
lrom seven days Lo sl monLh course
Are we really 8Au?
ho//enqes Present 5totus
lokb wotkets to be ttoloeJ lo
lMNcl
Ooly 4J lokb wotkets ttoloeJ lo
lost flve yeots
2 5 lokb wotkets to be ttoloeJ lo
N55k
Ooly J6 wotkets ttoloeJ lo lost
ooe yeot
85 MOs ooJ 5Ns to be ttoloeJ
lo llMNcl
Ooly 2 wotkets ttoloeJ lo lost
ooe yeot
64+ Jlsttlcts Ooly 2 coosoltoots lo Nlnlw
J5 stotes Ooly 7 1ecbolcol Offlclols lo
MOnlw
Ooe coootty 2 blllloo popolotloo