1.
Unit-X(B.Sc IV)
Micro Birth Planning Process
Dr.Anjalatchi
M.sc(N)MD(AM)MBA(HA)
Era University , Lucknow

2.
NRHM
• National Rural Health Mission launched in
April, 2005
Rejuvenate the Health delivery System
Universal Health Care
• - Accessible
• - Affordable
• -Equitable Care

3.
CRAFTING NRHM

4.
GOAL OF NRHM
 Reduction of Infant Mortality Rate (IMR)
 Reduction of Maternal Mortality Ratio (MMR)
 Reduction of Total Fertility Rate (TFR)
 Universal Access to Public Health service viz. Women’s
Health/Child Health, Water Sanitation Hygiene and
Nutrition.
 Prevention and Control of Communicable and Non
Communicable Disease,
 Population Stabilization, Gender & Demographic balance
 Main Streaming AYUSH
 Promotion of Healthy Lifestyle.

5.
Strategies –
 Improve Infrastructure
Augment manpower
 Improve management
Flexibility to states to deploy funds
Decentralization
Communitization

6.
The Paradigm Shift –
Community Participation
Flexible Funding at all levels

7.
NHM ROLE
Governance reform
o Manpower Management
o Logistics & Procurement processes.
o Decision making processes
o Institutional design
o Accountability framework
Convergence
Water and sanitation
Nutrition
Education

8.
New Paradigms under NRHM –
1. Community Link Worker – ASHA Supervisor
/ASHA
2. Involvement of PRIs through Village Health &
Sanitation Committee
3. Reforms in Medical Education – Compulsory
Rural posting of Doctors
4. Integration of AYUSH
5. Better programme management through
recruitment of Management Experts,
Accountants, Computer Experts

9.
• Action Taken to Reduction MMR –
• Implementation of JSY & JSSK
• Micro Birth Planning:

10.
JSY
Early Registration ANC
 (1st Check-up) before 12 weeks,
 *2nd Check-up 16-20 weeks,
 *3rd check-up 28-32 weeks *
 4th Check-up 36 weeks
Promoting Institutional Delivery:
 Identifying the Institution for delivery as per merit.
Post Natal Check-up:
 Within 48 hours/within 1st week/within 6 weeks
INVOLVEMENT OF ASHA:
Involvement of ASHAs equipped with drug kit and pregnancy kit for
maternal and child health care.
 Support to ASHAs by appointing 18 ASHA Supervisor.
 Organizing Village Health & Nutrition Day every month.
 Micro Birth Planning by the ANM for all the pregnant women

11.
CONTINUED
• “Mamoni” Nutritional Support of Rs. 1000/- to pregnant
women – an initiative by Govt. of Assam.
• *Cash assistance to mothers under JSY scheme.
• * Encouraging mothers to stay in the Hospital up to 48
hours after delivery to prevent post partum hemorrhage by
providing Baby Kit (Mamata Kit).
• * Training of ANMs/Staff Nurse for SBA
• * Training of Medical Officers on EmOC/BEmOC and LSAS
• * All the SCs have been provided with SC Kit – A and B.
• * Up-gradation of Sub Center for Delivery (191 SCs taken
up in 14 high focus districts).

12.
Continued
• Rural Health Practitioners have been posted in the Sub-
centres
• * Compulsory one year Rural Posting for MBBS doctors to
get admission in the PG courses.
• * Construction of Labour Room/ Ward in PHC/SD/SHC and
operationalizing as 24X7.
• * Up-gradation of SDCH/ CHC to First Referral (FRU) Unit
having specialist doctor with provision of C-section
operation and Blood Storage facility.
• * Strengthening of referral mechanism from village to
Health Institutions through ‘108 Mrityunjoy’ Emergency
Referral Transport and by providing ambulances to health
institutions.

13.
Child birth
• Childbirth, also known as labour or delivery,
is the ending of pregnancy where one or
more babies leaves the uterus by passing
through the vagina or by Caesarean section.

14.
Micro birth plan
• This is a tool basically to structure the
events/actions related with pregnancy and
delivery (To be drawn up by ANM/ASHA).
• Essentially it consists of –
a. Registration and filling up of JSY card
b. Calculation of EDD(Expected date of delivery)
c. Informing dates of three essential check ups
d. Identification of health facility where delivery
will take place
e. Identification of means of transport

15.
Why is a birth plan necessary?
• A birth plan is a way for you to communicate
your wishes to those caring for you during
your labor and after the birth of your baby.
• Every birth is a unique experience.
• Creating a birth plan empowers you to
become informed of all your options during
labor.
• At the same time, it’s a tool to let the team
caring for you know about your preferences.

16.
Introduction (JSY)
Janani Suraksha Yojana (JSY)
• Janani Suraksha Yojana (JSY) is a safe motherhood
intervention under the National Rural Health Mission
(NRHM) being implemented with the objective of reducing
maternal and neo-natal mortality by promoting
institutional delivery among the poor pregnant women.
• The Yojana, launched on 12th April 2005, by the Hon’ble
Prime Minister, is being implemented in all states and UTs
with special focus on low performing states.
• JSY is a 100 % centrally sponsored scheme and it integrates
cash assistance with delivery and post-delivery care.

17.
Fact about the Micro birth Plan
• The Yojana has identified ASHA, the accredited
social health activist as an effective link between
the Government and the poor pregnant women
in l0 low performing states, namely the 8 EAG
states and Assam and J&K and the remaining NE
States.
• In other eligible states and UTs, wherever, AWW
((Anganwadi workers )and TBAs or ASHA like
activist has been engaged in this purpose, she can
be associated with this Yojana for providing the
services.

18.
Important Features of JSY:
• The scheme focuses on the poor pregnant
woman with special dispensation for states
having low institutional delivery rates namely the
states of Uttar Pradesh, Uttaranchal, Bihar,
Jharkhand, Madhya Pradesh, Chhattisgarh,
Assam, Rajasthan, Orissa and Jammu and
Kashmir. While these states have been named as
Low Performing States (LPS), the remaining states
have been named as High performing States
(HPS).
•

19.
Continued
• Tracking Each Pregnancy: Each beneficiary registered under
this Yojana should have a JSY card along with a MCH card.
• ASHA/AWW/ any other identified link worker under the
overall supervision of the ANM and the MO, PHC should
mandatorily prepare a micro-birth plan. This will effectively
help in monitoring Antenatal Check-up, and the post
delivery care.
• Eligibility for Cash Assistance: BPL Certification – This is
required in all HPS states. However, where BPL cards have
not yet been issued or have not been updated, States/UTs
would formulate a simple criterion for certification of poor
and needy status of the expectant mother’s family by
empowering the gram pradhan or ward member.

20.
JSY ELIGIBILITY

21.
CASH ASSISTANCE

22.
SPECIAL DISPENSATION

23.
Disbursement of Cash Assistance:
• As the cash assistance to the mother is mainly to meet the
cost of delivery, it should be disbursed effectively at the
institution itself.
• For pregnant women going to a public health institution for
delivery, entire cash entitlement should be disbursed to her
in one go, at the health institution.
• Considering that some women would access accrediting
private institution for antenatal care,
• they would require some financial support to get at least 3
ANCs including the TT injections.
• In such cases, at least three-fourth (3/4) of the cash
assistance under JSY should be paid to the beneficiary in
one go, importantly, at the time of delivery.

24.
MBP ACTIVITIES

25.
Vande mataram scheme

26.
Challenges MH

27.
JSSK
• Government of India has launched the Janani
Shishu Suraksha Karyakaram (JSSK) on 1st
June, 2011. The scheme is to benefit pregnant
women who access Government health
facilities for their delivery. Moreover it will
motivate those who still choose to deliver at
their homes to opt for institutional deliveries.

28.
Introduction
• Government of India has launched the Janani
Shishu Suraksha Karyakaram (JSSK) on 1st June,
2011. The scheme is to benefit pregnant women
who access Government health facilities for their
delivery. Moreover it will motivate those who still
choose to deliver at their homes to opt for
institutional deliveries. All the States and UTs
have initiated implementation of the scheme.

29.
Situation
• High out of pocket expenses being incurred by
pregnant women and their families in the case
of institutional deliveries in form of drugs,
User charges, diagnostic tests, diet, for C –
sections.
•

30.
The New Initiative
• In view of the difficulty being faced by the
pregnant women and parents of sick new- born
along-with high out of pocket expenses incurred
by them on delivery and treatment of sick- new-
born, Ministry of Health and Family Welfare
(MoHFW) has taken a major initiative to evolve a
consensus on the part of all States to provide
completely free and cashless services to pregnant
women including normal deliveries and
caesarean operations and sick new born (up to 30
days after birth) in Government health
institutions in both rural and urban areas.

31.
FREE ENTITLEMENT FOR ANC
• The following are the Free Entitlements for pregnant
women:Free and cashless delivery
• Free C-Section
• Free drugs and consumables
• Free diagnostics
• Free diet during stay in the health institutions
• Free provision of blood
• Exemption from user charges
• Free transport from home to health institutions
• Free transport between facilities in case of referral
• Free drop back from Institutions to home after 48hrs stay

32.
FREE SERVICE FOR NEWBORN
• The following are the Free Entitlements for Sick newborns
till 30 days after birth.This has now been expanded to
cover sick infants:Free treatment
• Free drugs and consumables
• Free diagnostics
• Free provision of blood
• Exemption from user charges
• Free Transport from Home to Health Institutions
• Free Transport between facilities in case of referral
• Free drop Back from Institutions to home
•

33.
Key features of the scheme
• The initiative entitles all pregnant women delivering in public health institutions to
absolutely free and no expense delivery, including caesarean section.
• The entitlements include free drugs and consumables, free diet up to 3 days
during normal delivery and up to 7 days for C-section, free diagnostics, and free
blood wherever required.
• This initiative also provides for free transport from home to institution, between
facilities in case of a referral and drop back home. Similar entitlements have been
put in place for all sick newborns accessing public health institutions for treatment
till 30 days after birth.This has now been expanded to cover sick infants:
• The scheme aims to eliminate out of pocket expenses incurred by the pregnant
women and sick new borne while accessing services at Government health
facilities.
• The scheme is estimated to benefit more than 12 million pregnant women who
access Government health facilities for their delivery. Moreover it will motivate
those who still choose to deliver at their homes to opt for institutional deliveries.
• All the States and UTs have initiated implementation of the scheme

34.
Macro-planning
• At State Level:
Seek commitment and support from various
departments and stakeholders
• Develop advocacy and social mobilization activity
plan
• Prepare a training plan
• Disseminate immunization guidelines (e.g.
injection safety, cold chain, AEFI surveillance)
• Develop plans for supervision, monitoring and
evaluation, including providing of feedback.

35.
Micro-planning
• At District, Sub-district levels:
• Revise micro-plans: use prescribed formats for UIP at each level
• Estimate: Calculate vaccine and logistics requirement at each level
• Cold chain: evaluate the availability and adequacy at all levels
• Indenting and delivery: ensure availability of required vaccine and
other logistics needed to introduce the vaccine
• Modify and disseminate revised formats: reporting, recording and
immunization card etc
• Trainings: health workers and staff at all levels
• Advocacy and social mobilization activities around the introduction
of the new vaccine,Supervise and monitor.

36.
Update Recording and Reporting
Systems
•
Vaccine stock forms and registers,
• Immunization cards and counter
foilsMCH/Immunization
• RegisterUIP reporting formats (Tally Sheets,
Monthly Progress Report at all levels)
• Monitoring Chart Supervisory
• checklists posted immunization schedules, (tin-
plates, posters, wall paintings and billboards)
• materials for parents Computer databases

37.
Prepare and Train Staff
•
Target: District Immunization Officers (DIO), Medical
Officers (MO), cold chain handlers, supervisors, data
managers and frontline Health Workers (HW)
• Approach: Orientation of district-level trainers at the State
level should be followed by the training of Medical Officers,
supervisors and cold chain handlers.Finally, MOs should
conduct sensitization of the frontline Health
Workers.Integrate in all the training courses, review
meetings etc.
• Resources:Operational guidelines for pentavalent vaccine
introduction in the UIPImmunization Handbook for Health
WorkersImmunization Handbook for Medical Officers

38.
Supervise and Monitor
• Supervise planning and implementation
Schedule supervisory visits Monitor
implementation
• Monitor vaccines and logistics supply
• Monitor vaccine utilization (coverage)
• Use reported coverage data
• Use RI monitoring data for appropriate
actions.

39.
Micro-Birth Planning and Counseling
• Registration of pregnant woman and filling up of the Maternal and
Child Protection Card and JSY card/below poverty line (BPL)
certificates/necessary proofs or certificates for the purpose of
keeping a record.
• Informing the woman about the dates of antenatal visits, schedule
for TT injections and the Expected Date of Delivery.
• Identifying the place of delivery and the person who would conduct
the delivery.
• Identifying a referral facility and the mode of referral.
• Source : Guidebook for Enhancing Performance of Multi-Purpose
Worker (Female)
•

40.
Hospital Functionality –
Services to be available in 24 X 7 PHCs
• * 24 hours delivery – normal and assisted
• * Essential newborn care
• * Referral of emergencies
• * Antenatal care and routine immunization of
children and pregnant women
• * Post natal care
• * Family planning services (IUCD, OCP and
CC)
• * Essential Laboratory services.

41.
To Reduce IMR –
the following activities
• IMNCI Training of AWW & ANMs
• NSSK training to the Health Care Provider working in 24x7 PHC.
• Constructing New Born Care Corner along with labour rooms of
24x7 PHC.
• Strengthening Routine Immunization with special focus in Difficult
areas.
• Special Vit. A and Deworming drive bi-annually.
• Establishment of Sick Newborn Care Unit in District Hospital (6
functional)
• Establishment of Newborn Stabilization Unit in all the SDCH/ CHC/
PHC, manpower training under process)
• Setting up of Nutritional Rehabilitation Center for malnourished
children.

42.
To Reduce TFR –
• Fixed day sterilization in all the District Hospital.
• Special monthly sterilization camp in CHC/ PHC
• IUCD insertion facility in all Govt. hospital and
Sub Center
• No scalpel Vasectomy (NSV) camp cum training
• Training of Medical Officers and O&G Doctors on
Mini Lap and Laparoscopic Sterilization
• Training of ANMs, Staff Nurse and Medical
Officer on IUCD insertion.

43.
HOME MESSAGE

44.
REFERENCES
• Source: National Health Mission
• Related Resources
• Guidelines of JSSK