National family welfare programme

Presented By Mrs. sujatha

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INTRODUCTION
India is the second populous country in the world, next only to China. It holds 17.5% of the worlds population within just 2.5% of the total land mass of the earth. In an area of about one third of the United States, it supports a population three times of that country. This emphasizes the need for population programs to control population growth.

INTRODUCTION

The family planning aims at small family which will serve the welfare of the individual the family and the community. It is also associated with numerous misconceptions. The recognition of welfare concept came only a decade and half after its inception when it was named Family Welfare Programme (1977). Family Planning is a family welfare programme and its aim is to create a social welfare state.
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National Family Welfare Program

National Family Welfare Program 1952. National Family Planning program launched 100% centrally sponsored program First country in the world Family Planning Dept.- created in 3 rd FYP 4 th FYP - integration of Family Planning services with MCH services MTP Act introduced 1972 National Family Welfare Programme

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Objective
Reducing the birth rate to the extent necessary to stabilize the population at a level consistent with the requirement of the National economy Stabilize Population Targets as an end Reduction in Births Administrative &Performance Informed decision Resentment, disownment client driven Quality

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Basic Principles of Family Welfare Program

Basic Principles of Family Welfare Program Family welfare services are voluntary. Family Welfare Programme will provide comprehensive maternal and child health services and also family planning services . For creating awareness, information, education and communication will be used effectively. Popular and easily available family planning services will nhcon,bgl be provided free of cost. 12/23/2013

NATIONAL FAMILY WELFARE PROGRAMME

India launched a nationwide family planning programme in1952 making it the first country in the world to do so, though records show that birth control clinics have been functioning in the country since 1930. During the Third and Five Year Plan (1961-66),family planning was declared as "the very centre of planned development". The emphasis was shifted from the purely clinical approach to the more vigorous extension education approach" for motivating the people for acceptance of the "small family room".

The introduction of the Lippies Loop in 1965 necessitated a major structural reorganization of the programme, leading to the creation of a separate Department of Family Planning in 1966 in the Ministry of Health. 12/23/2013 7 nhcon,bgl

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During the years 1966 the family planning infrastructure (eg. primary health centres, subcentres, urban family planning centres, district and State bureaus) was strengthened. During the fourth five year plan (1966-1974).
The Govt. of India gave top priority to the programme. The Programme was made an integral part of MCH activities of PHCssand their subcentres. In 1970 an all India hospital postpartum programme and in 1972, the Medical Termination of Pregnancy (MTP) were introduced . The programme continues ever since and has, in fact, gathered momentum over the decades. And in the process, it has passed through four major phases of its development, signifying evolution of the programme. These phases, are known as family planning phase, family welfare phase, child survival and safe motherhood (CSSM) phase and reproductive and child health (RCH) phase.
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Approach
Approach VII FYP: Area Development Projects; India Population Project VIII & IX FYP: Differential planning scheme Increasing involvement of NGOs UIP & CSSM TFA Approach 1st and 2 nd FYP:Clinical approach 2 nd FYP - Target approach 3 rd FYP Extension & Education approach 4 th FYP - Post Partum scheme, reduce CBR to 32 5 th FYP NFPP replaced by NFWP, reduce CBR to 30 6 th FYP- Net Reproduction Rate (NRR)of 1,family size to 2.3 7 th FYP - spacing methods, community participation and promotion of MCH care

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8 th FYP-stress on the involvement of NGOs to supplement and complement the Government efforts. 9 th FYP stressed on reduction in population growth 10 th FYP focused on reduction on IMR, decadal growth rate & increased literacy rate. Objectives: Reduction in the decadal rate of population growth between 2001 and 2011 to 16.2%. Increase in Literacy Rates to 75 per cent within the Tenth Plan period (2002 to 2007). Reduction of Infant mortality rate (IMR) to 45 per 1000 live births by 2007 and to 28 by 2012 nhcon,bgl 12/23/2013 10

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XI FYP Targets / Goals: Reduce IMR to 28 and MMR to 1 per 1000 live births; Reduce TFR to 2.1

Provide clean drinking water for all by 2009 and ensure that there are no slip-backs.
Reduce malnutrition among children of age group 0-3 to half its present level Reduce anemia among women and girls by 50% by the end of the plan Family planning insurance Scheme Jansankhya Sthirata Kosh Raising the sex ratio for age group 06 to 935 by 201112 12/23/2013 nhcon,bgl 11 and 950 by 201617.

Strategies to be adopted to achieve the Goals of XI FYP:

1706 private nursing homes have been involved besides the Government institutions to provide family welfare services in the State. More number of unapproved private nursing homes will be approved to render Family Welfare services to the eligible couples.

All the untrained DGOs, M.D (Obstetrics & Gynaecology ), M.S. (Surgery) will be trained in Laparoscopic Sterilization.
All the untrained MBBS doctors will be trained in tubectomy sterilization and Non Scalpel Vasectomy. nhcon,bgl 12/23/2013 12

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At present 254 Operation theatres are functioning in the Primary Health Centres. Steps will be taken to make the Operation theatres in all the Primary Health Centres functional in a phased manner. Area specific approach will be adopted to identify village wise eligible mothers with three and above children and motivate them by a block level team to accept Family Welfare Sterilization. All the untrained VHNs and ANMs will be given training in insertion of IUD.
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PROGRAMME EVOLUTION
FAMILY PLANNING PHASE: The family planning phase was started by adopting a clinical approach and establishing a limited number of clinics that distributed educational material and offered opportunities for training and research in the field of family planning. The clinical approach extended for the first two Five Year Plan periods and obviously failed to create a dent on the population growth. The total outlay on the family planning during the first two Five Year Plans was just Rs 5.65 crores. However, during the Third Plan period, family planning was treated as an important area of national planned development, and its outlay was raised to Rs 27 crores. The clinical approach was replaced by an extension education approach, and the infrastructure for the family planning activity was established within the primary health care system of the country.
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Maternal health care

Maternal health care envisaged is expected to be able to (a) generate community awareness to promote universal screening of pregnant women to identify those with problems, (b) refer women with complications to appropriate institutions for care, achieve 100% coverage of women under Tetanus Toxoid immunization, refer obstetric emergency cases to the nearest first referral units (FRUs) for expert management and provide skilled attendance at delivery and advise institutional delivery, especially for those with health or obstetric problems.

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Child health care

The child health care envisaged is expected to ensure 1. universal newborn care at delivery, 2. immunization of infants/children against vaccinepreventable diseases, 3. food and micronutrient supplementation of children, 4. early detection and appropriate management of acute respiratory infections and acute diarrhoeal disease episodes in children, 5. nutrition promotion of children through exclusive breastfeeding for 6 months, 6. timely introduction of complementary feeding of infants and 7. detection and management of growth faltering in children.
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Fertility regulation

It is envisaged that the programme shall help

(a)

to improve access of consumers to fertility regulation services

(b) to recognize and strengthen institutions providing safe MTP (medical termination of pregnancy) service sand
to ensure that women do accept appropriate contraception at the time of MTP to prevent repeating of abortion service, following an unwanted pregnancy.
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Quality of Family planning service

Quality in family Planning can be defined as offering a range of services that are safe and effective and that satisfy clients needs and wants. It can also be defined as the way clients are treated by the system.

Family planning is not just a demographic issue It is also an issue related to individual issue rights, socio-economic development, preservation of the environment, and the health and wellbeing of women, couples, families and society at large.
There is a huge unmet need for Family Planning and improving Quality will increase the utilization of services.
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Family planning / Contraceptives

The National Family Welfare Program provides the following contraceptive services for spacing births: Condoms Oral Contraceptive Pill Intra Uterine Devices (IUD) Terminal Methods: Tubectomy : i)Mini Lap Tubectomy ii) Lapro Tubectomy Vasectomy : i) Conventional Vasectomy ii) No-Scalpel Vasectomy
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Family Planning Insurance scheme

To encourage people to adopt permanent method of Family Planning - Centrally Sponsored Scheme since 1981 to compensate the acceptors of sterilization for the loss of wages Implemented through ICICI Lombard General insurance Company Compensation: (w.e.f-07.09.07) Compensation in case of adverse event (w.e.f. January 1st , 2009).

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Strengthening Service Delivery in Family Planning

At Household/ Village Level: At Household/ Village Level Services /Activities Home to Home visits by ASHAs, ANMs& VHNDs: Counseling FP services(OCs, Condoms, ECPs), Follow up of IUCD, sterilization &Postpartum clients, Referral, Community Mobilization Areas to be strengthened, Availability of IEC materials, Capacity building & Role Clarity Incentives to ASHA, Regular supervision Active participation of PRIs, Creating Role Models
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At Sub centre Activities/Services

Maintaining Eligible Couple Register Counseling and service provision during ANC, PNC & Immunization visits IUCD insertions Follow up services Referral Services Contraceptive supply, Support &Supervision of ASHA & AWW Areas to be strengthened Facility readiness according to IPHS standards Training in IUCD (No Touch Technique) Provision of IEC Materials Supportive supervision by LHV / MO PHC Strengthening Referral nhcon

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At PHC Activities/Services
All FP services including Tubal ligation (interval & postpartum)& NSV Follow up services Counseling and appropriate referral for couples having infertility Training and supportive supervision of field level staff like ANMs, MPWs& ASHAs Areas to be strengthened : Ensuring availability of 24/7Services as per IPHS Ensuring availability of trained personnel in Minilap /NSV/IUCD insertion Fixed Day Static Services for sterilization Regular supply of drugs, equipments & instruments Referral Services

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At CHC Activities/Services
24*7 specialist services All FP services including Laparoscopic Sterilization services, Follow up services, Training and supervision of field level staff, Regular supply of drugs, Diagnostic Services Areas to be strengthened Up gradation as per Strengthening of counseling component Rational posting of specialists Operationalize District Clinical Training Centres Fixed Day Static Services for sterilization Strengthening of RKS Management of couples having infertility

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National Population Policy 2000

Immediate objective : To address the unmet needs for contraception, health care infrastructure, and health personnel, and to provide integrated service delivery for basic reproductive and child health care Medium-term objective: To bring the TFR to replacement levels by 2010, through vigorous implementation of intersectoral operational strategies. Long-term objective: To achieve a stable population by 2045
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Jansankhya Sthirata Kosh

National Population Stabilization Fund -registered as an autonomous Society Combination of government and civil society Working to promote innovations. Promote initiatives which leverage the strength of different economic and social sectors To reach out needy population groups

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ROLE OF NURSE IN FWP

Administrative role Supervisory role

Functional role

Educational role

Role in research

Role in evaluation
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ROLE OF NURSE (IN GENERAL)

Identifying people who desire to have children and those who dont Listening, understanding, counseling and making appropriate referrals for fertility control. Providing and interpreting family planning information and to tap community resources for health workers and community. Planning, participating and evaluating family welfare services and organizing camp. Supervising and guiding the other female paramedical personnel such as health workers, ANMs etc. Initializing and contributing toward research. Planning, conducting, evaluating in co-ordination with medical officer in community health centre level training for other paramedical staff inc. Dais.

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ADIMINISTRATIVE ROLE

Nurse who are in senior position participate in the organization Of FWP at national, Regional or community level and the development of nursing Activities.

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SUPERVISORY ROLE

As an supervisor nurse should encourage their staff to watch carefully for indication that mother or couples would accept on how to space their Children and so on.

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FUNCTIONAL ROLE

The primary role of nurse is case finding, making referral, routine clinical function and to help the client choose one of the more simplest methods of Contraception.

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EDUCATIONAL ROLE

Nurses must have sound knowledge of FWP, services available in FWP and they must be able to transmit this knowledge effectively to the community, family and for the individuals .

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ROLE IN RESEARCH
Nurses are essential members of the Multidisciplinary research team. Nurses know to keep careful records and reports relating to their nursing activities. These provides valuable data upon which research may be based.

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ROLE IN EVALUATION

Evaluation is an important part of planning for nursing Services.

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NURSES RESPONSIBILITY

UNDERSTANDING feelings and attitudes about sex and family planning. KNOWLEDGE ABOUT FP: Nature and family planning. Methods of FP. Resources available. Govt. Policies. KNOWLEDGE ABOUT PERSON: Individuals needs and awareness. Culture, beliefs. Customs. COMMUNICATION AND HEALTH EDUCATION : Be a good listner. She should provide counseling services. MOTIVATION: Motivation of eligible couple for family planning methods. CLINICS : Assist doctors in conducting clinics. Assist in postnatal checkups. FOLLOW UP :Through home visits. Through clinic visits.
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DOMICILARY SERVICES FOR PERINATAL CARE

RECORDS MAINTAINANCE IDENTIFICATION OF COMMUNITY LEADERS Involve community leaders to participate in programme.

MAINTAINING ADEQUATE SUPPLIES

EVALUATION OF PROGRAMME
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THANK YOU
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