FRU Operationalization

Operationalisation of 24* 7 PHCs:

ANC, INC, PNC
Institutional Delivery including JSY:
Safe Abortion Services:
RTI/STI services:
MH Training
VHNDs:
Referral Transport:
Maternal Death Review:
RCH Camps:
Quality Assurance:
Three (3) facilities in each of the 50 districts shall be taken up for
complete operationalisation,

 The Districts Hospital

 One Civil Hospital
 One Community Health Centre

 120 CemONC is to be Operastionalised in Year 2009-11 .

 Sustained availability of specialists, general duty doctors and para-

medical staff (and their functional competence)

 The focus shall be on the output (actual services to be rendered to

the population) rather than on just inputs (buildings, equipment,
generators or similar resources).
 List of CEmOnc issued, planning to be done for new identifed
CEmONC .
 FRU Operationalization
• Holistic
planning for FRUs should be done linking HR,
procurement, BSUs, logistics,
manpower, training etc.

•Facilities operationalized should be as per GOI Guidelines

including establishment
of BSCs.

•Funds for heads like equipments, infrastructure etc. should be

budgeted under
respective RCH II/ NRHM head.
S. Districts Total No of FRUs Target for 2009- *FRUs Operationalized
No Planned till 2010 10 till December, 2009
 Operationalisation of 24* 7 PHCs
(BEmONC):

 Holistic planning for operationalization of 24* 7 PHCs

should be done and should be linked to infrastructure,
procurement, drugs/medicines; training of MOs esp. in Basic
Obstetric Care and SNs/LHVs/ANMs in Skilled Birth
Attendance.

Funds for heads like equipments, infrastructure etc. should

be budgeted under respective RCH II/ NRHM head.

Facilities operationalized should be as per GOI Guidelines.

S. Districts Total No of 24x7 Target for 2009- *24x7 PHCs
N PHCs Planned till 10 Operationalized till
o 2010 December, 2009
 ANC, INC, PNC:
Post delivery mother should stay for at least 48 hours, Any
infrastructure improvement plan if needed should be undertaken
accordingly.

Monitoring during OR/VHNDs sessions should be strengthened so

that quality of ANC including IFA tab etc, ASHA to be involved for
PNC .

Tracking of missed out and left out cases of ANC, PNC should be
done.

 Interventions to gear up to provide full ANC of good quality.

Comprehensive Monitoring plan for these activities should be

developed and budgeted.
VHNDs Monitoring for ANC, PNC follow up
 VHNDS is a platform for ANC, PNC, Immunization and Counseling
services as per the GOI guidelines.

Too many types of the out reaches should be avoided and thrust should
be on comprehensive VHNDs.

Wherever possible FGDs should be conducted for maternal deaths

taking place.

Funds for monitoring of VHNDs session should be kept.

Stress should be also on missed/lost cases for ANC.

VHNDs should be linked with provision of facilities at institutions.

The focus should be on regular VHNDS and mobile units should be

utilized only for those areas where VHNDs cannot be organized.
 Institutional Delivery including JSY:
Micro Birth Planning should be emphasized as a part of JSY.

48 hr stay post delivery should be emphasized especially among JSY

beneficiaries.

Qualities of services to be emphasised.

JSY deliveries should be co-linked with service provision and facility

upgradation and budgeted accordingly.

 Tertiary facilities are overloaded so micro plan should promote

primary and secondary facilities for services.

Grievance-redressal mechanism and Help-desk should be established.

Funds should also be kept for monitoring visits.

•Guidelines on record up keeping (physical and financial)
should be disseminated.

•TBAs should not be promoted as primary provider of

deliveries.

•At the accredited private health facilities, financial incentives

under JSY are available only to the pregnant mother.
S. Districts Budget Budget utilized Budget Budget
under
N allocated allocated utilized
MH( excluding
o under MH JSY till December under JSY under JSY
(excluding JSY 2009) 2009-10 till December
2009-10) 2009
 Life Saving Anesthesia and EmOC Training
•Nomination for LSAS training should be calculated after
taking into account the no. of FRUs to be operationalized,
CEmOC target and total no. of specialist to be appointed.

• DHs should also be strengthened simultaneously for the

practical part of the training. Funds can be kept under Training
head.

• Regular monitoring both during and post training.

•Ensure that MOs are posted at Facilities which have been

operationalized for CEmOC services.
•Funds should be kept for monitoring during and after
training.
S. State No of No of Total No Target No No of
N Medical District of MBBS for trained trained
o Colleges Hospitals Doctors to 2009-10 till MOs posted
conducting conducting be trained Decemb at FRU till
LSAS LSAS in LSAS er 2009 December
Training Training till 2010 2009

S. State No of No of Total No Target No No of

N Medical District of MBBS for trained trained
o Colleges Hospitals Doctors to 2009-10 till MOs posted
conducting conducting be trained Decemb at FRU till
EmOC EmOC in EmOC er 2009 December
Training Training till 2010 2009
 BEmOC Training:
 BEmOC training is designed for MOs posted at CEmONC
BEmONC and PHCs.

 Training should be as per GoI protocols of 10 days.

 Training institutes should be strengthened as per the GoI

protocols. Funds can be kept under Training head.

Districts should undertake regular monitoring both during

and post training.
State should ensure that MOs are posted at Facilities which
have been operationalized for BEmOC services.
Funds should be kept for monitoring of the training and post
training follow-up.
 Skilled Birth Attendant Training

 Training should be as per GoI norms i.e. a 3-6 week

training of ANMs/LHVs/SN in SBA .

 To emphasize that training centres follow protocols of

SBA training i.e. practise of partograph, AMTSL, ENBC etc.
Funds for centre strengthening can be kept under Training
head.

 Districts should undertake regular monitoring both during

and post training.

 Funds for monitoring of the training and post training

follow up should be kept
S. District s No of Master No. of Target for No trained till
hospitals/training
No Trainers SNs/ANMs/ 2009-10 December 2009
institutes
practicing SBA trained LHVs to be
Protocols trained till
particularly 2010
Partograph
Name of the Type of Level of Amoun Performa No of Quantifi
Scheme worker Facility t of nce worker able
(CHCs/ Incenti Expected given Output
PHCs/ Sub- ve incentive
Centers
Performance Regular All CEmONC 8000/-
Based & Except head Per
Incentive Contract Quarter Months
scheme ual Level
Specalist CEmONC
Incentive To ANM/A SHC/AWC 1000/-
ANM WW/MP AMN ,
/AWW /MPW W 500/-
male AWW,
500/-
MPW
Male
 Referral Transport
(Janani Express & EMRI)
Tribal and hilly areas must have linkages with more vehicles.

There is a need for assured referral linkage both from the

beneficiary/community to the facilities and also between the facilities.

Norms for reimbursement to beneficiary should be as per JSY.

Cost benefit analysis of referral transport mechanism should be done taking

into consideration cost incurred per referral, no. of patient being referred to
private sector and no. of lives saved in public sector.

EMRI model /Call Centre's for referral should be evaluated in terms of cost &
benefit before scaling up.

Payment for referral can be differential and may be linked with range of km
travelled.

 Call Centers in all district except EMRI Districts.

 Maternal Death Review:

. Focus should be on organizing FGD for knowing the

reasons and avoiding such deaths by using the platform of
VHNDs, Involving mobilizer ASHA.

The tools of MDR/IDR initially limited to 2-3 districts

( GWL, DAMOH, GUNA, SHIVPURI ) as a pilot.

FGD on the issue can be organized during VHNDs; there is

no need for a separate scheme of verbal autopsy.

Districts can also initiate facility based maternal death audit

in selected facilities at tertiary and secondary level.
 RCH Camps :

In RCH II focus is on operationalizing health facilities and

as such camp mode is suggested as only for hard to reach
areas.
RCH Camps should be organized and funded as per GoI
norms.
Stress should be kept on organizing VHNDS regularly.
Intersectoral co-ordination should be emphasized while
organizing these camps.
 Districts to analyze the functioning and benefits of Mobile
Medical Unit.
While planning for such outreach activities it should be
ensured that routine service delivery by MOs/ health workers
at fixed health facilities (PHCS/CHCs/DHs etc) does not
suffer.
 Quality Assurance:
Districts to enlarge the scope of QA cells for RCH services
including FP services.

QA cell established both at the level of State and District for
all MCH activities.

TORs of the QA cell communicated by the State should be

followed.

QA cell should ensure quality and monitoring of all MCH

activities which should also include monitoring of the training.

Budget has to be indicated for monitoring activities by QA

Cell under MH or M & E.
 Miscellaneous:
 Districts may clarify “Hard Areas” as per geographical location or in
terms of difficulty to find HR for these areas.

Districts should take measure to ensure continuity of contractual

appointments and take steps to regularize them.

Additional allowances should be for regular staff, so as to promote

them to work in rural/hard areas with clear deliverables.

Incentives for specialist and MOs for difficult areas and on

performance basis should be defined clearly and tabulated.

Incentives on ‘per case basis’ should be avoided, however the same

can be given to a group of service providers i.e. doctor, staff nurses etc.
if a particular protocol of the service is maintained for e.g. conducting
normal delivery should be linked with 48 hrs stay, EBF and provision of
PNC protocols to both the mother and child.
 Janani Sahyogi Yojna

The accreditation guidelines for any of the RCH services

should synchronize with State guidelines on accreditation of
private health facilities.

The focus of such accreditation scheme should be at

sub-district level.

Accreditation of SHC should be as per State Guideline