1. Ante Natal Care: Ensuring quality ANC has been an ongoing activity since the inception of RCH in Mizoram. This includes early registration of Pregnancy at the nearest health facility, at least 4 ANC check ups, Immunization with TT & IFA supplementation
2. Intra Natal Care: To promote safe delivery in the hands of skilled birth attendant, State is aiming at achieving 100% institutional delivery. The following schemes and programmes are implemented as per the GOI guidelines:-
1) Janani Suraksha Yojana (JSY): It is a safe motherhood intervention under the National Health Mission (NHM). It is a 100% centrally sponsored scheme and integrates cash assistance with delivery and post-delivery care and is being implemented with specific aims and objectives of reducing maternal mortality and neonatal mortality by promoting institutional delivery especially among poor pregnant women.
In Mizoram it is being implemented since May 2005, Since then incentives has been given to every pregnant woman delivering at Public Health Institution like District Hospitals, Community Health Centres, Primary Health Centres, Urban Health Centres Sub Centres and Accredited Private Hospitals like Durtlang, Serkawn, Bethesda, Nazareth, Seventhday, Greenwood Hospital, Aizawl Hospital, Newlife Hospital,
Eligibility Criteria for Financial Assistance:
To the Mother:
To ASHA :
2) Role of ASHA or other link health worker associated with JSY would be to:
a) Identify pregnant woman as a beneficiary of the scheme and report or facilitate registration for ANC,
b) Assist the pregnant woman to obtain necessary certifications wherever necessary
c) Provide and / or help the women in receiving at least three ANC checkups including TT injections, IFA tablets
d) Identify a functional Government health centre or an accredited private health institution for referral and delivery
e) Counsel for institutional delivery,
f) Escort the beneficiary women to the pre-determined health center and stay with her till the woman is discharged,
g) Arrange to immunize the newborn till the age of 14 weeks,
h) Inform about the birth or death of the child or mother to the ANM/MO
i) Post natal visit within 7 days of delivery to track mother's health after delivery and facilitate in obtaining care, wherever necessary,
j) Counsel for initiation of breastfeeding to the newborn within one-hour of delivery and its continuance till 3-6 months and promote family planning.
Janani Shishu Suraksha Karyakram (JSSK): Government of India has launched Janani Shishu Suraksha Karyakaram (JSSK) on 1st June, 2011 in view to eliminate difficulty being faced by the pregnant women and parents of sick new- born along-with high expenditure on delivery and treatment of sick- new-born. It is an initiative to provide completely free and cashless services to pregnant women including normal deliveries and caesarean operations .
The scheme was launched in Mizoram in June 2011 and has been implemented since then. The following are the Free Entitlements for pregnant women:
These free entitlements are met as per approval by the GOI as follows:
The scheme aims to eliminate out of pocket expenses incurred by the pregnant women and sick new borns while accessing services at Government health facilities.
Training of Health Care Providers:
a.Skilled Birth Attendance (SBA) Training : Staff Nurses and Health workers(ANM) at facilities conducting deliveries are being trained in SBA for their skill enhancement . Till date 208 SNs and 190 ANMs have been trained in SBA.
b.Basic Emergency Obstetric Care (BEmOC) Training : Medical Officers at Level 2 Facilities(24X7 PHCs and Non FRU CHCs) are being trained in BEmOC. Till date there are 44 Medical Officers have been trained in BEmOC.
c.Emergency Obstetric Care (EmOC) & Life Saving Anaesthetic Skill(LSAS): Medical Officers at Level 3 Facilities (FRU CHC & DH) where Specialists are not available, are being trained at EmOC & LSAS. Till date, there are 11 EmOC trained doctors and 12 LSAS trained doctors.
3.Post Natal Care: After Delivery, Health Worker/ ASHA pay visit to the mother and give them advice and necessary treatment if needed.
4.Safe Abortion Services/ Medical termination of Pregnancy (MTP):
Provision of comprehensive safe abortion services at public health facilities including 24*7 PHCs/ FRUs (DHs/ SDHs /CHCs) with a focus on "Delivery Points". Medical Officers at these facilities are also being trained in MTP to ensure safe abortion services . Till date there are 97 Medical Officers have been trained in MTP.
5.Provision of RTI/STI Services :
RTI/STI Clinics are being set up at District Hospitals. Such Clinics are in the process of functioning at Sub District levels as well. Training of Service Providers are being held across the state proper management as well as timely referral. Till date there are 112 Medical Officers & 865 SN/ANM/LHV have been trained in RTI/STI.
6.Performance Based Incentives
The following performance based incentives have been started in the High Priority Districts namely Lunglei, Lawngtlai, Saiha & Mamit as pilot projects :-
It is an established fact that anaemia is the commonest indirect cause of Maternal Deaths globally. This also stands true in the HPDs where anaemia is misunderstood and the symptoms neglected. This is also due to socio-economic factors as pregnant women go to work in the farms until close to the EDD. Health Workers involved in Ante natal check-ups are incentivised and provide quality ANCs, deaths and complications of anaemia can be averted. Line listing of pregnant woman with anemia (Hb <7gm%) has been rolled out and these women are managed by giving them a double dose of IFA tablets till their hemoglobin level comes up to 11gm%. Incentive for ANM @ Rs. 100 for line listing and follow up of every case of Pregnant woman with severe anaemia are being given.
7% of the total ANC are estimated to have High risk pregnancies. In order to detect these, meticulous history taking, competency and assured referral services are essential. ANMs need to be skilled and patient to elicit proper history to detect Bad Obstetric History, Post LSCS and pay serious attention to the complaints of the mother. They should also be able to recognize the danger signs from the examinations and tests performed at the Sub Centre level and refer accordingly. Incentive for ANM @ Rs. 1000 for identification & referral of every case of high risk pregnancy are being given.
Delay in receiving appropriate care at the facility is one of the deterrents of people approaching public hospitals. Timely intervention saves both the life of mother and child. EmOC Teams if available and render C-sections of more than 10 a month, provided 20% of the total deliveries are C-sections are entitled for an incentive of Rs 3000/- in order to enable women to have access to comprehensive emergency obstetric care.
Women living in areas that are isolated and difficult to access have to resort to home deliveries as situation does not permit them to access facility care. Services of trained personnel are also unavailable leading to unattended risks exposing them to higher morbidity and mortality. In order to render skilled birth attendant services in areas where home deliveries are high, SBA trained ANM are entitled with an incentive of Rs. 1000/- for conducting every home delivery under these notified villages
Special incentives @ Rs. 3000 for bringing pregnant women and sick neonates (by palkis, carts, etc) to the nearest road head that serves as a pickup point for referral transport.
Maternal Death Review
Every maternal death is audited and reviewd by the District MDR Committee