NATIONAL FAMILY WELFARE PROGRAM

India launched the National Family Welfare Program in 1951, with the objective of reducing
the birth rate to the extent necessary to stabilize the population at a level consistent with the
requirement of the national economy. The family welfare program in India is recognized as a
priority area and is being implemented as 100 percent centrally sponsored program.

Evaluation of the family Welfare Program

The approach under the program during the first and second five year plan was mainly
‘clinical’ under which facilities for provision of services were created. However, on the basis
of data brought out by the 1961 census, clinical approach adopted in the first two plans was
replaced by ‘Extension and Education Approach’ which envisaged expansion of service
facilities along with spread of message on small family norm.

In the 4th plan (1961-1970) high priority was accorded to the program and it was proposed to
reduce birth rate from 35 per 1000 to 32 per 1000 by the end of the plan. 16.5 million
Couples, constituting about 16.5 percent of the couples in the reproductive age group were
protected against conception by the end of the 4th plan.

The objective of the 5th plan (1974-1979) was to bring down the birth rate to 30 per 1000 by
the end of 1978-1979 by increasing integration of family planning services with those of
Maternal and Child Health (MCH) and Nutrition so that, the program become more, readily
acceptable.

There was phenomenal increase recorded in the performance of sterilization in 1975-1977

periods. In view of the rigidity of enforcement of targets by field functionaries and an
element of coercion in the implementation of the program in some areas the program received
a set back during 1977-1978.

This lead to a change in approach and the government made it clear that there was no place
for force or coercion or pressure of any sort and the program had to be implemented as an
integral part of Family Welfare relying solely on mass education and motivation. The name
of the program was changed to family welfare from family planning.

In the 6th plan (1980-1985), certain demographic goals of reaching net reproduction rate of
unity were envisaged. These were to achieve the following by the year 2000:

 Reduction of average family size from 4.4 children in 1995 to 2.3 children
 Reduction of birth rate to 21 from the level of 33 in 1978 and death rate to 9 from 14,
and infant mortality to 67 from 127
 Increasing the couple protection level from 22 to 60 percent.

The family welfare program during the 7th five year plan (1985-1990) was continued on a
purely voluntary basis with emphasis on promoting spacing methods, securing maximum
community participation and promoting maternal and child health care. In order to provide
facilities/services nearer to the door steps of population, the following initiatives were taken.
  To have one subcenter for every 5000 population in plain areas and fro 3000
population in hilly and tribal areas. At the end of 7th plan, i.e. 1990, 1.3 lakhs
subcenters were established in the country.
 To extend the postpartum program progressively to subdistrict level hospitals. At the
end of 7th plan 1012 subdistrict level hospitals and 870 health posts were established
 To extend the universal immunization program (UIP) to cover all the districts in the
country by 1990
 To improve primary health care in urban slums in the cities of Mumbai and Chennai
with assistance from World Bank
 To implement area development projects in selected districts in 15 major states.

The achievements of the family welfare program at the end of 7th plan were:

 Reduction in crude birth rate from 41.7 (1951-1961) to 30.2 (1990)

 Reduction in total fertility rate from 5.97 (1950-1955) to 3.8 (1990)
 Reduction in infant mortality rate from 146 (1970-1971) to 80 (1990)
 Increase in couple protection rate 10.4 percent (1990-1971) to 43.3 percent (1990)
 Setting up of a large network of service delivery infrastructure
 Over 118 million births were averted by the end of March 1990.

In the 8th five year plan (1992-1997), several new initiatives were introduced to introduce
new dynamism to the family welfare program. Ongoing schemes were revamped and new
initiatives were introduced as under:

 World Bank assisted area projects which seek to upgrade infrastructure and
development of trained manpower. Indian Population projects (IPP) 8th and 9th were
initiated during the 8th plan. The IPP 8th project aims at improving health and family
welfare services in urban slums of Delhi, Kolkata, Hyderabad and Bengaluru. IPP 9th
will operate in the states of Rajasthan, Assam and Karnataka.
 An USAID assisted project named “Innovations in Family Planning Services” was
taken up in Uttar Pradesh with the specific objective of reducing total fertility rate
(TFR) from 5.4 to 4 and increasing couple protection rate (CPR) from 35 to 50
percent over 10 years project period.
 Realizing that Government efforts alone in propagating and motivating the people for
adoption of small family norm would not be sufficient, greater stress was laid on
involvement of NGOs to supplement and complement the Government efforts.

The Universal Immunization Program (UIP) was launched in 1985 to provide universal
coverage of infant and pregnant women with immunization against identified vaccine
preventable diseases. From the year 1992-1993, the UIP has been strengthened and expanded
into the Child Survival and Safe Motherhood (CSSM) project. It involves sustaining the high
immunization coverage level under UIP, and augmenting activities under Oral Rehydration
Therapy (ORT), prophylaxis for control blindness in children and control of acute respiratory
infections. Under the safe motherhood component, training of traditional birth attendants
(TBA), provision of aseptic delivery kits and strengthening of first referral units to deal with
high risk and obstetric emergencies were taken up.

The targets fixed for the 8th plan national level birth rate of 26 was achieved by all states
except the state of Assam, Bihar, Haryana, Madhya Pradesh, Orissa, Rajasthan and Uttar
Pradesh.

In the 9th five year plan (1997-2002), reduction in the population growth has been recognized
as one of the priority objectives. The objectives were:

 To meet all the felt needs for contraception.

 To reduce the infant and maternal morbidity and mortality so that, there is a reduction
in the desired level of fertility.

The strategies during the plan would be:

 Assess the needs for reproductive and child health at PHC level and undertake area
specific micro planning.
 To provide need based demand driven, high quality, integrated reproductive and child
health care.

The expected levels of achievement by the terminal year of 2002 were:

 Crude birth rate (CBR) 23/1000

 Infant mortality rate (IMR) 50/1000
 Total fertility rate (TFR) 2.6
 Couple protection rate (CPR) 60 percent
 Neonatal mortality rate (NNMR) 35/1000
 Maternal mortality rate (MMR) 3/1000

Implementation of the FEP

The following were the main component of Family Welfare Program:

 Maternal health
 Child health
 Population control/stabilization

The following were the schemes and programs for implementation of national family welfare:

 Reproductive and child health program (RCH)

 Janani Suraksha yojana
 Vandemataram scheme
 Safe Abortion services
 National Rural Health mission (NRHM)
 Integrated Child Development services (ICDS)
 REPRODUCTIVE AND CHILD HEALTH PROGRAM (RCH)
 Population growth and health of women and children had been a major
problem in India despite implementation of several programs since 1951.
Maternal and Child Health (MCH) and Child Survival and Safe motherhood
(CSSM) programs were implemented through organized health care systems.
 In 1994, durning the International conference on Population Development
(ICPD), a new approach to tackle the problem was recommended. The
government of India adopted the Reproductive Health Approach and launched
the RCH program in October 1997.
 The objective of the RCH program was to provide quality, integrated and
sustainable primary health care services to women in the reproductive age
group and children with special focus on family planning and immunization.
 Essential Components of RCH Program:
 Prevention and management of unwanted pregnancy.
 Services for mothers during pregnancy, childbirth and postpartum period.
 Child survival services for newborns and infants.
 Management of reproductive tract infection (RTI) and sexually transmitted
diseases.
 Establishment of an effective referral system.
 Reproductive services for adolescent health.
 Health services including counseling on sexuality and family life.
 Services Included in the Program for Mothers and Children:
1. Essential care for all mothers and children:
 Registration by 12th to 16th week of pregnancy.
 Antenatal check-up at least three times during pregnancy.
 Tetanus toxoid to all women as early as possible during pregnancy with two
doses at one month interval.
 Iron and folic acid tablets daily for 100 days. Women with clinical signs of
anemia to receive 2 tablets daily for 100 days.
 De- worming with Mebendazole during 2nd or 3rd trimester in areas where
hookworm infestation is common.
 Safe and clean delivery services.
 Preparation of women for exclusive breast feeding and timely weaning.
 Postpartum care, including advices and services for limiting and spacing
births.
2. Early detection of complication:
 Clinical examination to detect anemia.
 Referral and transportation to the nearest hospital of women with
hemorrhage or complication.
 Referral of all women identified as having pregnancy induced
hypertension ( BP > 140/90 mm Hg and weight gain > 3 kg/month ).
  Referral of all women who develop signs of infection following delivery
or abortion.
 Transfer of women in labor for more than 12 hours to the nearest hospital
that has facilities for cesarean delivery.
3. Emergency care to those who need it:
 Early identification of obstetric emergencies.
 Initial management of emergencies and transfer to referral hospital without
delay using the fastest available mode of transport.
4. Care to women in the reproductive age group:
 Counselling on:
 Optimal timing and spacing birth
 Small family norm
 Use and choice of contraceptives
 Prevention of sexually transmitted diseases and reproductive
tract infections
 Importance of girl child.
 Information on availability of:
 Medical termination of pregnancy ( MTP) services
 IUCD and sterilization services.
 Family planning Services:
 Condom distribution
 Oral contraceptive dispensing
 IUCD services
 Recognition and referral of clients with sexually transmitted diseases
and reproductive tract infections.
5. Provision of clean and safe delivery practices at the community level:
 Creation of awareness about the need for clean and safe deliveries.
 Deliveries by trained personnel
 Provision of disposable delivery kits for deliveries
 Promotion of institutional deliveries.
 Early identification and referral of high-risk cases.
6. Newborn care:
 Weighing all newborns at birth. Normal weight 2500 to 2800 gm.
Referral of newborns weighing > 2000gm
 Resuscitation of asphyxiated newborns using mucus sucker or
breathing as required.
 Prevention of hypothermia
 Breastfeeding of newborns who show signs of illness
 Education of mother on newborn care and feeding.
7. Immunization:
Infants:
 BCG one dose at birth
  DPT: Three doses, beginning at 6th week at monthly interval
 Polio: ‘0’ dose at birth for all institutional deliveries and 3 doses at
one month interval
 Measles: one dose at completion of 9 months
 Vitamin A: First dose of 100000 IU along with measles vaccination.

Children 1 to 3 years

 DPT
 OPV booster dose at 16th to 18th month
 Vitamin A
 2nd dose 200000 IU at 16th to 18th month
 3rd to 5th dose 200000 IU each at 6 monthly interval

Children 3 to 5 years

 Iron and folic acid ( smaller dose) for children with signs of
anemia
 Treatment for worm infestation with mebendazole.

8. Prevention of deaths due to diarrheal disease

 Correct management
 Teaching mothers to increase body fluid with ORS and normal feeding.

9. Prevention of deaths due to pneumonia

 Correct management of all cases of acute respiratory infections
 Referral of children with severe pneumonia or severe illness.

RCH phase II: Began in April 2005. The focus of the program was to reduce maternal and
child morbidity and mortality with emphasis on rural health care. The major strategies of the
second phase of RCH are:

1. Essential obstetric care

a. Institutional delivery
b. Skilled attendance at delivery
c. Policy decisions

2. Emergency obstetric care

a. Operationalizing first referral units
b. Operationalizing PHCs and CHCs for round the clock delivery services

3.Strengthening the referral system.

1. Essential obstetric care

a. Institutional delivery: In order to promote institutional deliveries, it is envisaged that 50
percent of the PHCs and all the CHCs would be made operational as 24 hour delivery centers
in phased manner by 2010. Basic emergency obstetric care essential newborn care and basic
newborn resuscitation services will be provided in these centers round the clock.

b. Skilled attendance at delivery: Guidelines for counducting normal delivery and

management of obstetric complications at PHC and CHC for medical officers and for skilled
attendance at birth for ANM and LHVs have been formulated and disseminated to the states.

c. Policy decisions regarding use of drugs and interventions: ANMs, LHVs and SNs have
now been permitted to use certain drugs in specific emergency situations to reduce maternal
mortality. They have also been permitted to carry out certain emergency interventions when
the life of the mother is at stake.

2. Emergency obstetric care: The first referral units (FRU) will be made
operational/functional with following services on a 24- hour basis.

 24- hour delivery services including normal and assisted deliveries.

 Emergency obstetric care including surgical interventions like cesarean sections:
 Newborn care
 Emergency care of sick newborns
 Full range of family planning services including laparoscopic services
 Treatment for sexually transmitted infections and respiratory tract infections
 Blood storage facility
 Essential laboratory services
 Referral ( transport) services
 In order to perform full range of FRU functions a health facility must have:
a. Minimum bed strength of 20 to 30
b. Fully functional labor room with well equipped care area
c. Fully functional operation theater
d. A functional laboratory and blood storage facility
e. 24- hour water and electricity supply
f. Arrangements for waste disposal
g. Ambulance facility

3. Strengthening referral system

 In order to improve referral linkage practiced in RCH Phase I, new initiativies were
added.
 Training of MBBS doctors in life-saving anesthetic skills for emergency
obstetric care
 Setting up of blood storage centers at FRUs according to Government of India
guidelines
 Janani Suraksha Yojana: The national maternity benefit scheme has been
modified into a new scheme called Janani Suraksha Yojana.
 REPRODUCTIVE AND CHILD HEALTH PROGRAM (RCH)
 Population growth and health of women and children had been a major
problem in India despite implementation of several programs since 1951.
Maternal and Child Health (MCH) and Child Survival and Safe motherhood
(CSSM) programs were implemented through organized health care systems.
 In 1994, durning the International conference on Population Development
(ICPD), a new approach to tackle the problem was recommended. The
government of India adopted the Reproductive Health Approach and launched
the RCH program in October 1997.
 The objective of the RCH program was to provide quality, integrated and
sustainable primary health care services to women in the reproductive age
group and children with special focus on family planning and immunization.
 Essential Components of RCH Program:
 Prevention and management of unwanted pregnancy.
 Services for mothers during pregnancy, childbirth and postpartum period.
 Child survival services for newborns and infants.
 Management of reproductive tract infection (RTI) and sexually transmitted
diseases.
 Establishment of an effective referral system.
 Reproductive services for adolescent health.
 Health services including counseling on sexuality and family life.
 Services Included in the Program for Mothers and Children:
10. Essential care for all mothers and children:
 Registration by 12th to 16th week of pregnancy.
 Antenatal check-up at least three times during pregnancy.
 Tetanus toxoid to all women as early as possible during pregnancy with two
doses at one month interval.
 Iron and folic acid tablets daily for 100 days. Women with clinical signs of
anemia to receive 2 tablets daily for 100 days.
 De- worming with Mebendazole during 2nd or 3rd trimester in areas where
hookworm infestation is common.
 Safe and clean delivery services.
 Preparation of women for exclusive breast feeding and timely weaning.
 Postpartum care, including advices and services for limiting and spacing
births.
11. Early detection of complication:
 Clinical examination to detect anemia.
 Referral and transportation to the nearest hospital of women with
hemorrhage or complication.
 Referral of all women identified as having pregnancy induced
hypertension ( BP > 140/90 mm Hg and weight gain > 3 kg/month ).
  Referral of all women who develop signs of infection following delivery
or abortion.
 Transfer of women in labor for more than 12 hours to the nearest hospital
that has facilities for cesarean delivery.
12. Emergency care to those who need it:
 Early identification of obstetric emergencies.
 Initial management of emergencies and transfer to referral hospital without
delay using the fastest available mode of transport.
13. Care to women in the reproductive age group:
 Counselling on:
 Optimal timing and spacing birth
 Small family norm
 Use and choice of contraceptives
 Prevention of sexually transmitted diseases and reproductive
tract infections
 Importance of girl child.
 Information on availability of:
 Medical termination of pregnancy ( MTP) services
 IUCD and sterilization services.
 Family planning Services:
 Condom distribution
 Oral contraceptive dispensing
 IUCD services
 Recognition and referral of clients with sexually transmitted diseases
and reproductive tract infections.
14. Provision of clean and safe delivery practices at the community level:
 Creation of awareness about the need for clean and safe deliveries.
 Deliveries by trained personnel
 Provision of disposable delivery kits for deliveries
 Promotion of institutional deliveries.
 Early identification and referral of high-risk cases.
15. Newborn care:
 Weighing all newborns at birth. Normal weight 2500 to 2800 gm.
Referral of newborns weighing > 2000gm
 Resuscitation of asphyxiated newborns using mucus sucker or
breathing as required.
 Prevention of hypothermia
 Breastfeeding of newborns who show signs of illness
 Education of mother on newborn care and feeding.
16. Immunization:
Infants:
 BCG one dose at birth
  DPT: Three doses, beginning at 6th week at monthly interval
 Polio: ‘0’ dose at birth for all institutional deliveries and 3 doses at
one month interval
 Measles: one dose at completion of 9 months
 Vitamin A: First dose of 100000 IU along with measles vaccination.

Children 1 to 3 years

 DPT
 OPV booster dose at 16th to 18th month
 Vitamin A
 2nd dose 200000 IU at 16th to 18th month
 3rd to 5th dose 200000 IU each at 6 monthly interval

Children 3 to 5 years

 Iron and folic acid ( smaller dose) for children with signs of
anemia
 Treatment for worm infestation with mebendazole.

17. Prevention of deaths due to diarrheal disease

 Correct management
 Teaching mothers to increase body fluid with ORS and normal feeding.

18. Prevention of deaths due to pneumonia

 Correct management of all cases of acute respiratory infections
 Referral of children with severe pneumonia or severe illness.

RCH phase II: Began in April 2005. The focus of the program was to reduce maternal and
child morbidity and mortality with emphasis on rural health care. The major strategies of the
second phase of RCH are:

4. Essential obstetric care

d. Institutional delivery
e. Skilled attendance at delivery
f. Policy decisions

5. Emergency obstetric care

c. Operationalizing first referral units
d. Operationalizing PHCs and CHCs for round the clock delivery services

3.Strengthening the referral system.

1. Essential obstetric care

a. Institutional delivery: In order to promote institutional deliveries, it is envisaged that 50
percent of the PHCs and all the CHCs would be made operational as 24 hour delivery centers
in phased manner by 2010. Basic emergency obstetric care essential newborn care and basic
newborn resuscitation services will be provided in these centers round the clock.

b. Skilled attendance at delivery: Guidelines for counducting normal delivery and

management of obstetric complications at PHC and CHC for medical officers and for skilled
attendance at birth for ANM and LHVs have been formulated and disseminated to the states.

c. Policy decisions regarding use of drugs and interventions: ANMs, LHVs and SNs have
now been permitted to use certain drugs in specific emergency situations to reduce maternal
mortality. They have also been permitted to carry out certain emergency interventions when
the life of the mother is at stake.

2. Emergency obstetric care: The first referral units (FRU) will be made
operational/functional with following services on a 24- hour basis.

 24- hour delivery services including normal and assisted deliveries.

 Emergency obstetric care including surgical interventions like cesarean sections:
 Newborn care
 Emergency care of sick newborns
 Full range of family planning services including laparoscopic services
 Treatment for sexually transmitted infections and respiratory tract infections
 Blood storage facility
 Essential laboratory services
 Referral ( transport) services
 In order to perform full range of FRU functions a health facility must have:
h. Minimum bed strength of 20 to 30
i. Fully functional labor room with well equipped care area
j. Fully functional operation theater
k. A functional laboratory and blood storage facility
l. 24- hour water and electricity supply
m. Arrangements for waste disposal
n. Ambulance facility

6. Strengthening referral system

 In order to improve referral linkage practiced in RCH Phase I, new initiativies were
added.
 Training of MBBS doctors in life-saving anesthetic skills for emergency
obstetric care
 Setting up of blood storage centers at FRUs according to Government of India
guidelines
 Janani Suraksha Yojana: The national maternity benefit scheme has been
modified into a new scheme called Janani Suraksha Yojana.
 JANANI SURAKSHA YOJANA
This program was launched on 12th April 2005. The objectives of the scheme are: reducing
maternal mortality & infant mortality through encouraging delivery at health institutions &
focusing at institutional care among women below poverty line families.

SILENCE FEATURES OF THE JSY:

 It is a 100 percent centrally sponsored scheme

 Benefit of cash assistance with institutional care during antenatal, delivery &post
partum care to all women both rural & urban belonging to below poverty line
households & aged 19 years or above, up to first two line births. In ten low
performing states, the cash benefit will be extended up to the third child, if the
mother chooses to undergo sterilization in the health facility where she delivered.
The accrediated social health activist (ASHA) will be responsible for making
institutional care available. She would be responsible for escorting the pregnant
woman to the health center.
The cash assistance will be Rs. 1,400 to all mothers in rural areas of low
performing states &Rs. 1,200 to mothers in urban areas. All women including those
from SC & ST families delivering in government institutions or accrediated private
institutions are eligible for cash assistance. Women from rural areas of high
performing states get Rs.700 while those from urban areas get Rs.600.
The yojana gives cash assistance of Rs.250 for transportation of women to the
transfortation of women to the nearest health center for delivery. The women to the
nearest health center for delivery. The women get a subsidy of Rs. 1500 for cesarean
deliveries & management of obstetrics complications. According to the government
report of 2008, in the years 2006-2008 about 28.11 lakhs pregnant women received
benefits from this scheme, out which 18.72 lakhs had institutional deliveries.

VANDEMATARAM SCHEME

This is a voluntary scheme wherein any obstetric or gynac specialist, maternity home
or nursing home lady doctor or MBBS doctor can olunteer herself/himself for
providing safe motherhood services. The enrolled doctor will display “vandemataram
logo” at the clinic. Iron & folic acid tablets, oral pills, TT injections, etc. will be
provided by the respective distric Medical Officers (DMO) to the “vandemataram
doctors or clinics” for distribution to beneficiaries. The cases needing special care &
treatment can be referred to the government hospitals that have been achieved to take
dur care of such patients coming with vandematarm cards.

SAFE ABORTION SERVICES

In india abortion is a major cause of maternal morbidity & mortality & accounts for
nearly 8.9 percent of maternal deaths. Majority of abortions take place outside
authorized health services &/or by unauthorized & unskilled persons. Under RCH
Phase II, following facilities are provided:
 Medical method of abortion : termination of early pregnancy with drugs-
Mifepristone (RU486) followed by misoprostol, currently the use of these two
drugs are recommended up to 7 weeks (49 days) of amenorrhea in a facility
with provision for safe abortion services & blood transfusion. Termination of
pregnancy using these two drugs is offered to women under the preview of
the MTP Act 1971.
 Manual Vaccum Aspiration (MVA): manual vacuum aspiration is a safe &
simple technique for termination of early pregnancy, & is feasible to be used
in primary health centers or comparable facilities, thereby increasing the
access to safe abortion services.

All the below listed interventions included in RCH phase I will continue in the
phase II implementation period.

 Appointing additional public health nurses, ANMs, anesthetists, & safe

motherhood consultants
 Providing 24-hours delivery services at PHCs & CHCs
 Providing referral transport, & integrated financial package.
 Conducting RCH camps & training of Dais.
 Implementating interventions for newborn care & child health
(Immunization, control of ARI & diarrhea, vitamin A & iron
supplementation, etc).

NATIONAL RURAL HEALTH MISSION (NRHM):

The government of india launched National Rural Health Mission (NRHM)
on 5th April 2005 for a period of 7 years (2005-2012) in order to improve the
quality of life of its citizens. The mission seeks to improve the health care
delivery system. It is operational in the whole country with special focus on
North East states.

The main aim of NRHM is to provide accessible, accountable, effective &

reliable primary health care & to bridge the gap in rurarhelath care through
creation of a caderodaccrediated social health activist (ASHA), &
strengthening the services of sub centers, primary health centers &
community health centers.

The Goals to be Achieved by NRHM :

A. At national level
o Reduction of infant mortality rate to 30/1000 live births
o Reduction of maternal mortality rate to 100/10000
 o Reduction of total fertility
o Reduction of mortality rates of malria, filarial, dengue, kala-
azar& Japanese encephalitis
o Reduction of prevalence rates of leprosy & tuberculosis
o Upgrading community health centers to indian public health
standards
o Increasing first referral units from less than 20 to 75 percent
o Engaging 250000 female accredited social health activists.
B. At community level :
o Availing trained community level workers at village level with
a drug kit for general ailments
o Provision of immunization, antenatal & postnatal checkup, &
services related to health of mother & child including
nutritition at anganwadi level
o Availing of generic drugs for common ailments at sub-center
level
o Providing good hospital care through assured availability of
doctors, drugs & quality services at PHC & CHC level
o Improved access to universal immunization
o Improve facilities for institutional deliveries
o Availability of assured health care at reduced financial risk
o Improved outreach services through mobile medical units at
district level
o Provision of household toilets.

Plan of implementation of NRHM

Implementation of the NRHM program will be through ASHAs and ANMs.

Selection of ASHA

ASHA must be a resident of the village-a woman (married/widowed/divorced)

preferably in the age group of 25-45 with formal education up to eight class, having
communication skills and leadership qualities. The general norm will be one ASHA for 1,000
populations. In tribal, hilly and desert areas, the norm could be relaxed to one ASHA per
habitation. The selected ASHA will be trained to carry out specific responsibilities.

Roles and responsibilities of ASHA

The ASHA will function as a health activist in the community and carry out the
following responsibilities:
  Take steps to create awareness and provide information on health determinants
such as nutrition, basic sanitation and hygienic practices, healthy living and
the need for utilization of existing health and family welfare services.
 Counsel women on birth preparedness, safe delivery, breastfeeding,
complementary feeding, immunization, contraception and prevention of
common infections including reproductive tract infections and sexually
transmitted infections.
 Mobilize community in accessing health related services available at the
anganwadi, sub center, and primary health center such as immunization,
antenatal check up, supplementary nutrition, sanitation and other services
being provided by the government.
 Identify women in families below poverty line (BPL) as benificiaries of the
scheme (NRHM) and assist them to obtain BPL registration.
 Ensure that the janani suraksha yojana (JSY) card is filled up at least 16-20
weeks prior to delivery.
 Work with village health and sanitation committee of the Gram panchayat to
develop comprehensive village health plan.
 Arrange escort/accompany pregnant women and children requiring treatment /
admission to the nearest pre-identified health facility (sub-center or PHC)
 Provide primary medical care for minor ailments such as fever, diarrhea, and
first aid for minor injuries.
 Be a provider of ‘directly observed treatment short-course’ (DOTS) under
national tuberculosis control programme.
 Will act as a direct depot holder for essential provisions like oral rehydration
solution (ORS), iron and folic acid tablets, chloroquin, disposable delivery
kits, oral pills and condoms and keep a medicine kit with AYUSH and
allopathic formulations recommended by the technical /expert advisory group
of the government.
 Ensure registration of births and deaths in her village, any unusual health
problems or disease outbreaks in the community.
 Promote construction of household toilets under total sanitation campaign.

Role and integration with ANM

The auxiliary nurse midwife will guide ASHA in performing her functions through
activities such as:

 Holding week/fortnightly meetings to discuss activities.

 Acting as resource person for training of ASHA.
 Guiding ASHA regarding arrangement for outreach programs.
 Participating and guiding ASHA in organizing health days in anganwadi
center.
  Utilizing ASHA to motivate pregnant women to go to subcenter for check ups,
take full course of iron and folic acid tablets and tetanus toxoid injections.

The ANMs will inform ASHA on date, time and place for initial and periodic
training schedule and also ensure that ASHA gets the compensation for performance
and TA/DA for attending training.

INTEGRATED CHILD DEVELOPMENT SERVICES (ICDS)

This program adopts a multi-sectoral approach to child well-being incorporating
health education and nutrition interventions health eduction and nutrition intervention and is
implemented through a network or anganwadi centers at community level. Malnutrition is
fought through interventions targeted at unmarried adolescent girls, pregnant women,
mothers and children up to 6 years.

The key services provided through ICDS are:

 Supplementary feeding’
 Immunization
 Health and nutrition education
 Micronutrient supplementation
 Preschool education for 3 to 6 year olds
 Nutrition, health awareness and skills development for adolescent girls
 Income generation schemes for women.

Supplementary nutrition service includes growth monitoring, prophylaxis

against vitamin A deficiency and control of nutritional anemia. All families in the the
community are surveyed to identify children below the age sex, pregnant and nursing
mothers. They are given supplementary nutritional support for 300 days in a year. The
program aims to bridge the caloric gap between the national recommended and
average intake of children and women in low income and disadvantaged groups.

Children below the age of three are weighed once a month and children below
3 to 6 are weighed quarterly. Growth rate and nutritional status are assessed and
malnourished children are given supplementary feeding and refered to medical
centers.

Immunization of pregnant women against tetanus is undertaken towards

reducing maternal and neonatal mortality. Vaccination of infants and children for six
vaccine preventable disease- poliomyelitis, diphtheria, pertusis, tetanus, tuberculosis
and measles are also included.

Health check-ups are offered to children up to 6 years, and expectant and

nursing mothers. The services are provided by anganwadi workers and primary health
center (PHC) staff and include weight checking, immunization, management of
malnutrition, treatment of diarrhea, de- worming and distribution of simple medicines.
Through the 1.4 million anganwadi centers, the education component of the ICDS
 program is implemented. The early learning provides foundation for cumulative, life-
long learning and development. This also contribute to universalization of primary
education. Providing to children the necessary preparation for primary schooling,
nutrition, and health education are key elements of the work of anganwadi workers.
Capacity building of women, especially in the age group of 15 to 45 year is a long
term goal to be achieved.

The ICDS Team

The ICDS team comprises the anganwadi workers, anganwadi helper, supervisors,
child development project officers (CDPOs) and district program officers (DPOs).
Anganwadi workers are ladies selected from the local communities and such as community-
based front line workers of the ICDS programme. The health teams include medical officers,
auxiliary nurse midwives (ANMs) and accrediated social health activist (ASHAs) as
functionaries of ICDS to provide different services.

FAMILY WELFARE SERVICES IN URBAN AREAS

1. The post partum programme :

This programme was started during the year 1969 in 59 district level hospital. The
post partum programme is defined as a maternity- central hospital based
approach to family welfare programme to motivate women within the
reproductive age group (15-45 years) or their husband to adopt small family
norms through education and motivation particularly during pre-
natal,intranatal, postnatal period.
Over the years, the concept of post partum has changed considerably and accordingly
the function of the post partum centres have also functions as referral centres for
providing MCH and family welfare services.
At present only 550 post partum centres are functioning at the district level.
The success of the programme at the district level encouraged the government
of india to extend the post partum programme to subdivisional, taluka level hospital as
well. At present 1012 sub district level post partum centres are functioning uder the
programme. Under the post partum programme , a set pattern of inputs in the form of
staff, equipment construction of a ward and operation theatre etc. Are provided.
The programme is 100 percent centrally assisted and is implemented through state
governments. The contribution in terms of performance of the post partum
programme, both at the district level and sub-district level is quite encouraging.
Under this programme, 19.0 percent sterilisation and 8.5 percent IUD insertion were
performed during 1999-2000.

2. PAP smear TEST FACILITY PROGRAMME

For early detection of cervical cancer among women, this programme has been
approved by government of india in 105 medical colleges which are equipped with a
full-fledged department of pathology and services of a senior pathologist,i.e.
 professor of pathology. Under this programme, a post of cyto-technician for
preparation/ examination of slides and contingent expenditure for purchase of
glassware and chemicals etc. Have been provided by the government of india.
3. STERILISATION BED SCHEME:
This scheme was introduced during 1964 by reservation of sterilisation beds in
government/ voluntary organisation and local body institutions. The purpose of
introducing this scheme was to provide facilities for tubectomy operation , as the beds
for such cases were not readily available in the hospitals.
Under this scheme, a total of 3217 beds are functioning at present ( as on 1st april,
2000). A recurring amounts of Rs 4500 per bed per annum is admissible for
maintenance of the sterilization beds to local bodies/ voluntary organization on
achievement of 60 tubectomies per bed per annum.
4. URBAN REVAMPING SCHEME :
This scheme has been introduced with a view to provide improved services, delivery
outreach services of primary health care, family welfare and maternity services in
urban areas particularly in slum areas. The state governments have established 871
health posts and 10 city family welfare bureaux. The city family bureaux are entrusted
with the responsibility of coordination, monitoring, supervision etc.of the family
welfare services provided by various institution in the city .

5. URBAN FAMILY WELFARE CENTRES (UFWCS) :

Urban family welfare centres have been functioning since 1950 to provide
family welfare services in urban areas.there are three types of urban family welfare
centres based on the population covered by them. In all there are 1083 urban family
centres functioning in the states/ union territories on 1st april 2000. These UFWCs will
be reorganised in to health posts gradually, as and when these cities are consideration
for expansion under the urban revamping scheme.

FAMILY WELFARE SERVICES IN RURAL AREAS

 VILLAGE HEALTH POST :

At village level village health posts are created which are manned by :
(i) Village health guides to out reach services to people with
their active participation . one village health post serves
1000 people and manned by one village health guide
preferably a women. She or he is responsible for giving
information and to motivation of eligible couples and
supply them with condom and oral pills. There are about
3.23 lakhs of VHG who are working in villages.
(ii) Indigenous dais are another village level workers who are
trained to conduct safe normal deliveries and motivate
mothers for family planning .The target is to have one
trained dais for 1000 population.
(iii) Under national rural health Mission (NRHM) a cadre of
accredited social health activists (ASHA) is created at the
village level to create awareness on health matters such as
nutrition. Basic sanitation and hygienic practices, healthy
living conditions, availability and utilization of health
services, in addition she will also counsel women on family
planning aspects.

The village health guides, trained dais and ASHA are the lynchpins of
the family planning services in india.

 SUB-CENTRES (SCS) :
The sub centres are the most peripheral contact point between the
primary health care system and the community. These centres have
mainly promotional and educational function relating to maternal
child health, family welfare, nutrition, immunization, diarrhoea
control and control of communicable disease programme.
The sub-centres are also provided with basic drugs for minor
ailments needed for taking care of essential health needs women
and children. It is managed by one mutli-purpose worker (male)
and one multi-purpose worker (female)/ANM. Out of a total
number of the functioning 1,46,036 sub-centre, 1,06,036 SCs are
funded by the department of family welfare and the remaining are
funded by the state government. It has been decided during 1997
that the states will have the choice of opening new sub-centre out of
funds provided to them under the basic minimum services (BMS)
programme. under this scheme there is provision for salary of
female health workers/ANM and LHV/health assistant (F) ,
Honorarium for voluntary workers, rentals, contingencies and
medicine the salary of male health worker is provided by the state
government. Funds for construction of building is also provided
under state plan.

 PRIMARY HEALTH CENTRES (PHC)

The primary health centre is the first contact point between the
village community and the medical officer. These are established
and maintained by the state government under the minimum
needs/basic minimum services programmes.
A PHC is manned by a medical officer, health assistant (female and
male) , health workers (female )/ANM , nurse and midwife , block
extension educators, pharmacist, laboratory technician, and is
supported by 14 para medical and other staff.
 It acts as a referral unit for six sub-centres and has 4-6 beds. The
activities of PHC involves curative, preventive, promotive , and
family welfare services. The number of PHC functioning in the
country as on 2008 were 25498.

 COMMUNITY HEALTH CENTRE (CHC) :

The community health centres are established and maintained by
the state government under MNP/BMS programme. It is manned by
four medical specialists, i.e. surgeon, physician, gynaecologist, and
paediatrician, 7 nurse and midwife ; one each, pharmacist/
compounder, dresser, lab technician , radio grapher and other staff.
There is a provision for I anaesthetist and 1 eye surgeon.
A non-medical post called community health officer has been
created to strengthen preventive and promotive services.
It has 30 indoor beds with x-rays, labour room,operation theatre
, and laboratory facilities. Its serves as a referral centre for four
PHC in each block and also provides facilities for obstetric care,
specialised consultations.
It provides full range of family planning services including safe
abortion and laproscopics services. The number of CHC by march
2008 were 4276.

 RURAL FAMILY WELFARE CENTRES (RFWCS ):

There are 5435 Rural Family Welfare Centres functioning in the
country at present. These were established at all the block level
PHC sanctioned up to 1st April 1980. The states have integrated the
RFWC in to their primary health care system. Therefore, no
separates identify for these RFWC today. The government of india,
however, countries to provide financial supports for maintaining
these centres, one medical officer supported by 11 paramedical and
other staff operates an RFWCs.