Health and Family Welfare programme is being implemented in the state to sustain the achievement of the previous years and to reach new goals. NRHM is working in a task mode to achieve goals set-in for the state and effectively deal with the challenges. NRHM has set the strategic direction that encompasses year wise objectives, technical strategies; interventions include program and services for improving maternal health, child health, family planning, adolescents' health etc. RCH –II has been bifurcated into core programmatic strategies and cross cutting program strategies for taking effective actions. The institutional and other strategies have impact on all the components of RCH viz. maternal health, child health, family planning, adolescent health and sex selection etc whereas specific core program strategies have wider impact on the specific program component. It has been built that all these strategies would converge and go hand in hand to achieve the program outcome.
The state considers that strengthening institutional mechanisms, infrastructural development, adequately trained human resources etc. are fundamental requirements for getting better RCH outcomes. Accordingly, the Programme Implementation Plan is presented with backward linkages from core programme strategies to institutional framework. RCH II in Kerala is focused to achieve health parameters in close proximity to that of the developed countries. The State has to improve on its health accomplishment to reach those levels. Women and Children constitute to 71% of the population, whose health and socio-economic condition needs improvement. Maternal Mortality Rate of 95 per 1 lakh deliveries needs to be brought down to below 65. As per NFHS 3 Infant Mortality Rate is 15 but it is 12 as per SRS 2008. Still IMR in Kerala is high when compared to the Developed countries. However the IMR continues reduction compared with the previous two NFHS survey. This has to be brought down to at least 10.
Though Kerala has the lowest perinatal mortality rate than any other state in India, when compared to developed countries this rate is high and needs to be brought down.
Infant Mortality in Kerala is lowest in the country 15 per thousand populations (NFHS3) and 12 as per SRS 2008. In NRHM further reduction of IMR is aimed.
Infant Mortality Rate of 15 (NFHS 2006) has been reduced to 12 (SRS 2008) which is still high when compared to the Developed countries. This has to be brought down to 10 by March 2009 and to single digit of 9 by 2011-12.
Maternal Mortality Ratio of 110 per 1 lakh deliveries as per SRS 2003 has been brought down to below 75 and the target for 2009-10 is to bring it below 50. As pert the Special Bulleting on MMR in India 2004-06 published by Sample Registration System MMR is 95. The perspective plan is that by 2012, MMR should be less than 30.
RCH PROGRAMME IS IMPLEMENTED TO ACHIEVE ALL THESE
Maternal Health activities
PART B Additionalities
Major components under NRHM addtionalities include:
Universal Immunization Programme was introduced in the State with all determination and vigour along with National launching of the scheme and could achieve set goals ahead of other States in the country.
The state population is distributed in 14 districts having 63 Taluks, 152 development blocks, 978 Panchayats, 1452 revenue villages, 5 municipal corporations and 59 municipalities. Population density of the state as per census 2001 is 819 persons per sq.km.with district Alapuzha having the highest density of 1496 and Idukki the lowest population density of 252 per sq.km. Scheduled castes and Scheduled tribe population forms 3.92 percent and 1.10 respectively of the total population.
The state recorded the lowest population growth rate, 9.42, in the country during the decade 1991-2001 as per 2001 census. The decadal growth rate has recorded substantial decline over the previous census, from 14.32 (1981-91) to 9.42 (1991-2001). As per the result of sample registration survey 2007, state of Kerala has recorded the lowest birth rate (14.7) and Infant Mortality Rate (13) far below the National average of 23.1and 55 respectively. Death rate in the State is 6.8 against National rate of 7.4 during the year. As per the results of NFHS-3 Kerala has achieved the target of hundred percent institutional deliveries there by reducing Maternal Mortality to considerable levels. Sex ratio as per census 2001 is 1058 female per thousand men. Child Sex ratio (age 0-6) is 960 females per thousand male children. Female literacy rate is (86.87%) is also the highest in the country. National Family Health Survey 2005-06 has recorded the total fertility rate as 1.9, which is below the replacement level of fertility. SRS 2007 has recorded a further reduction in TFR to 1.7 which is the lowest in the country.
However the results of NFHS 3 show that the state has gone down in vaccination coverage due to many reasons. Various action plans have been mooted to sustain the achievements already recorded and improve performance wherever required. As a result the latest Coverage Evaluation Survey shows that 87.9 % (CES 2008) of children are fully immunized though the percentage of full immunization by age 12 months is 82.9. Further the recently concluded DLHS III shows 79.5% coverage for full immunization.
Various initiatives to bridge the gaps are taken. Immunisation camps without the presence of Medical Officers, increased number of outreach sessions to cover floating population, local specific IEC/BCC, awards to best performing JPHNs are all planned to improve immunisation coverage. The state has decided to observe October as “Immunization Month” every year.
Arogyakeralam seeks convergence with other departments/institutions like Local Self Government, Social welfare, Education, Sanitation Mission etc towards comprehensive delivery of health services. Upgradation of Health institutions, School Health, Palliative care, ASHA, Strengthening Immunisation, Vector Control Programmes are run in convergence with related departments