About the Project / Scheme

1)IMNCI Training under RCH -II:
Integrated Management of Neonatal Childhood Illness is the centerpiece of the Newborn and Child Health Strategy in RCH Phase -II. It includes the home and community based component (through ANM and AWWs) and the facility based out patient care component, as is being piloted in UNCEF's Border District Projects. In addition the component on Management of Sick Neonates and Children in the inpatient setting at PHC/ R.H./ FRUs. Health system strengthening and community participation components have been addressed effectively to ensure effective implementation.
IMNCI is the central pillar of Child Health Strategy that include three components
1) Improvement in case management skills of health staff
2) Improvement in health systems for effective managements
3) Improvement in Family & Community practices.

As per Govt. of India guidelines a new initiative under Integrated Management of Neonatal & Childhood Illness (IMNCI) initiatives is being implemented in State as a major step towards reduction of Infant Morbidity and IMR in selected 9 districts. And 11 more districts also being covered for training by July 2007 onwards.

Maharashtra State has decided to take up IMNCI initiative in 9 districts - From RCH flexi pool funds - Thane, Nashik, Amaravati and Gadchiroli.

UNICEF assistance - Osmanabad, Latur, Chandrapur, Nanded & Nandurbar.
In IInd Phase IMNCI strategy is introduced in Raigad, Beed, Ahemadnagar, Jalgaon, Dhule, Pune, Gondia, Yavatmal. Nagpur, Wardha. Districts. Dist Buldhana has been added recently. So out of 33 districts this training will be started in 20 districts from July 2007.

This initiative mainly involved is training doctors and Para medical staff in early diagnosis and proper management of common illnesses in infants and children below 5 years of age.

MOs, Supervisors (H.A. male / female, Mukhya Sevikas), Health Functionaries
(ANMs/ MPW/ AWW) will be trained under this project in 5 tribal districts and 4 other districts mentioned above. ToT for these 8 tribal districts is arranged with the help of UNICEF, Mumbai from March-April, 2007 in Nashik and Nagpur.
Important activities under IMNCI.

1) Nodal Officer for IMNCI:
Implementation of IMNCI needs to have co-ordination with other department of the state Government like ICDS, RDD, and Medical Education etc. State RCH Officer / Additional Director (FW) has taken this responsibility.

2) Establishment of a Co-ordination Group:
As per guidelines received by GOI that the coordination group has to be formed including donor agencies like UNICEF, other departments like ICDS / WCD, Rural Development, Department of Medical Education. Vide G R No. RCH/1005/CR13/05/FW-1 dated 1st April o5 the working group has been formed as follows: -

This group is responsible for monitoring, follow up and review up implementation of IMNCI in the state.
3) Formation of District Level Co-ordination Group:

District level Co-ordination group has been formed on similar lines that of state level co-ordination group. Vide G R No. RCH/1005/CR13/05/FW-1 dated 1st April o5 the working group has been formed as follows:-

Dean, of nearby Govt. Medical College is being included in the District Coordination working group as we are involving Medical Colleges in IMNCI training in No. of districts.This group is responsible for monitoring, follow up and review of implementation of IMNC in the district.

4) Arrange translation, Printing and supply of Training Material:
This activity has been already completed. The training material has been sent to Nashik, Thane, Amravati and Gadchiroli Districts. UNICEF has already supplied the training material in 5 districts assisted by them.

5)Create pool of State level Trainers:
GOI has expressed the opinion that about 40 to 50 trainers in a district are required for undertaking training of Health Staff on a continuous basis. It has been decided to conduct at least two TOT at HFWTC Aurangabad with clinical assistance from Government Medical College Aurangabad, UNICEF Mumbai has shown willingness to arrange national trainers during this TOT. We can further train Additional District Trainer from the trained MODTT, Medical Officers, LHV, PHN, Nursing Officer/ Tutor etc. by giving them an additional training of two days for supportive supervision and facilitation. It is under consideration to outsource this training activity to some NGO / Group of Experts like Retired Pediatrition, Public Health Specialist, Medical Officer, PHN / Nursing Officer, wherever feasible.

6)Identify the State Nodal Institute for IMNCI Training:
It is under consideration to develop HFWTC Aurangabad as State Nodal Institute for IMNCI Training. We have held two TOTs at Aurangabad. Government Medical College Aurangabad has an adequate caseload, excellent facilities for hands on training, HFWTC Aurangabad has adequate facilities for class room training.

7)Improvement of Health System:
GOI has directed to make available essential drugs with workers and at facilities covered under IMNCI. IMNCI kit is being issued to PHC, Subcenter & AWW. GOI has stressed to reinforce referral institutions like RH/FRUs or Private/ Public partnerships to be established. Action is under way to develop FRUs as per Indian Public Health Standards. Medicine kits are being provided to the trained ANM, AWW after completion of the training. Funds have been already allocated to the 9 IMNCI implemented districts.

8)Improvement of Family and Community Practices:
IEC campaign for awareness generation regarding breast-feeding practices, illness recognition, early case seeking etc. is being launched. Counseling of caregivers and families is being undertaken as part of management of sick child when they are brought health worker / health facility. BCC has to be focused on improving new born and childcare practices. IEC Bureau Pune has been entrusted to undertake this responsibility.

Name of Training	IMNCI
Category	MO,CDPO,ACDPO,MS,ANM,LHV,SN,MO,HA(M),MPW(M)
Training Duration	8 Days
Training Sites	DTT, HTT, of all 20 districts & 2 NGOs from Osmanabad district Aurangabad and Nasik HFWTC, PHI Nagpur, undertaking ToT and Physicians training.
No. of Districts	Osmanabad, Latur, Nanded, Chandrapur, Nandurbar, Nashik, Thane, Amaravati & Gadchiroli Nagpur Gondia, Bhandara, Yeotmal, Dhule, Jalgaon, Raigad, Wardha,,A'nagar, Beed , Buldhana
Important Points	Training Calender
	Drugs to trained ANM/AWW issued
	Monitoring of IMNCI Started by field staff
	Supervisory visits by trained supervisors carried out.
	Minimum three follow up PNC visits monitored.
	Case sheets maintained

2)Essential New Born Care Training
With the help of National Neonatal Forum we have Started Essential New Born Care Training of 2 days for MO PHCs and we have covered 7 districts of Vidarbha under EC-SIP funding and till last year we have trained 413 MBBS MOs in Essential New Born Care. This year we are covering districts of Thane Nasik Nandurbar Chandrapur and Gadchiroli. for this component.

3)Arogya Sakhi
The main goals under the Reproductive and child Health Programme are to reduce MMR, IMR and TFR. In tribal area due to geographical hurdles, customs and taboos as well as health seeking behaviour the rate of MMR and IMR and Pregnancy wastage is very high. Thane, Nandurbar, Nasik, Amaravati and Gadchiroli are very sensitive which need attention on priority basis. Hence it is proposed to implement Arogya Sakhi Yojana, which will aims towards improving Maternal Health especially focusing on reducing Maternal Morbidity and Morality related to Obstetric causes mainly by ANC, conducting Delivery and PNC.

Arogya Sakhi Yojana is being implemented in 150 villages in 5 tribal districts where there is no public health facility like Sub-center, PHC, PHU and MHU available. Preferably a village having population about 1,000 is selected. The eligibility criteria for 'Arogya Sakhi' is she should be married, age about 35 years, resident from same village, she should be literate and willing to undergo training for 6 months at District Hospital/ Sub-District/ Woman Hospital.

After training each Arogya Sakhi will function as Trained Birth Attendant by providing ANC, conducting normal deliveries, PNC, treatment for minor ailment as well as referral of the cases. After completion of the training, she will be issued delivery kit and honorarium and rent for room for clinic/ delivery room for 4 years. Total 130 Arogya Sakhis trained in 5 tribal disatricts and started functioning in the field Medicine kits provided

The expenditure for Arogya Sakhi training has been made available from the European Commission Supported Sector Investment Programme till March 2007 and next subsequent years the expenditure will be incurred under RCH - II Programme.

Name of Training	Arogya Sakhi
Category	Arogya Sakhi
Training Duration	6 Months
Training Sites	Nursing Schools/women Hospital
No. of Districts	Thane,Nashik,Nandurbar,Amaravati & Gadchiroli
Important Points	Uniform,watch,shoes,module issued to the trainees.
	Delivery kit and essential medicines issued to trained Arogya Sakhi
	Honorarium to trained Arogya Sakhis paid regularly
	Individual performance of trained Arogya Sakhi being monitored

4)Dai Training
Maternal Health is major issue especially in tribal area. It is necessary to address this under tribal RCH on priority basis. In order to reduce Maternal Mortality, it is very essential to promote the institutional delivery or delivery by SBA. Considering the vast difficult terrains, geographical and inaccessible health services and as well as population of villages. It will be difficult in the near future to achieve 100% institutional deliveries. Hence it is proposed to ensure the safe delivery by trained personal at village level. There are about 6,000 TBA available in Thane, Nandurbar, Nasik, Amaravati and Gadchiroli. There are still 489 villages remaining in these 5 tribal districts.
To impart the training it is essential to identify a woman from these villages. It is proposed to adopt the following eligibility for selection of such woman.

1. She should be married and resident of same village
2. She should be a middle age
3. She should be literate

The training center will be near by RH/ SDH for 3 weeks and one-week hands on training will be given at District Hospital.
The duration for training is 30 days. After the training each Dai will be provided Dai Kit. The expenditure for this training will be paid through RCH -II funds. So far we have trained 186 Dais in 5 tribal districts against the target of 489.

Name of Training	Dai
Category	TBAs
Training Duration	1 Months
Training Sites	Nursing Schools
No. of Districts	Thane,Nashik,Nandurbar,Amaravati & Gadchiroli
Important Points	Delivery kit and essential medicines issued to trained Dai
	Honorarium to trained Dai paid regularly
	Individual performance of trained Daii being monitored

There has been some difficulty noted in finding suitable candidates willing to under go Dai training course in Thane and Nashik districts.

5)Life Saving Skills in Anesthesia for EmOC
As per GOI guidelines 18 weeks certificate course for M.B.B.S. Doctors who has completed 5 years services will be undertaken in State, as there is acute shortage of Anaesthetist in state. The EmOC services cannot be given at FRU. 12 weeks training will be given at Medical Collage and 6 weeks at District Hospitals. 6 centers in the state are recognized for the training. The centers are: - Amaravati, , Kolhapur, Nanded and KEM Hospital, Mumbai and Sion Hospital, Mumbai. TOT was arranged at KEM Hospital Mumbai on 29th June 2006 conducted by Faculty members of AIIMS. New Delhi. A batch of 4 doctors will be sent to each Medical College. After completion of training the doctors will be posted at FRU and will work for at least 3 years. The Mannequin is received from UNICEF; hence training is started in 3 Medical Colleges, i.e. at KEM Hospital Mumbai, GMC Kolhapur and GMC Nanded. First batch of 4 doctors from KEM Hospital Mumbai will be completing the training by middle of August 2007. At Kolhapur 3 doctors have joined from 16th June 2007, and 4 doctors have joined at GMC Nanded from 2nd July 2007

Name of Training	Life Saving Skills in Anaesthesia
Category	MBBS doctor with 5 years of experience
Training Duration	18 weeks
Training Sites	Selected Medical Colleges and District Hospitals (as above)
No. of Districts	All Districts
Important Points	List of eligible & willing MO available
	Training will start on receipt of Mannequin from UNICEF.

6)Adolescent Health
Adolescent health component activity will be undertaken under RCH-II in 33 District Hospitals and 7 Woman Hospitals. The Gynecologists of these hospitals were trained w.e.f. 20-23rd June 2006. Instruction have been issued to start Adolescent Health Clinic at District Hospital and selected Sub-district Hospitals on fixed day of the week. On pilot basis WHO Delhi office has undertaken Adolescent Health Project in districts of Thane and Raigad

7)THO Training
During RCH-II the State decided to impart Managerial Training of health programmes to THOs of all districts. This training was conducted by PHCMRC - NGO. So far we have trained - THOs during last year.We have trained 211THOs against the target 276

8)BEmOC & SAB Training
Basic Emergency Obstetric Care Training has been decided to be given to Medical Officers of 24 X 7 days PHCs and MOs from R.H. Skilled attendance at Birth training will be imparted to ANM / LHV / Staff Nurse. The duration of the training is 15 days for both these trainings. It has been decided to conduct ToT for Gynaecologist, OT Nurse, Labour room Nurse, MODTT/ ADHO at divisional level. ToT workshops were conducted at PHI, Nagpur, HFWTC, Pune & Nashik. A batch comprising of 3 Medical Officers is to deputed for BEmOC training and 3 ANM/ LHV / Staff Nurse will be deputed for SBA training to district hospital and women hospital. Every month one batch will be conducted at District Hospital and Women Hospital alternatively of BEmOC followed by SBA. Rs. 50.000/- have been already issued for purchase of essential injections, drugs during training and after training for SBA training.

Name of Training	SBA
Category	ANM,LHV,SN
Training Duration	15 days
Training Sites	49 Training Sites (as below)
No. of Districts	All Districts
Important Points	Training calendar available ·
	Drugs & consumables purchased for trainees.
	Logbook with proficiency skills maintained
	Supervisory visits by HFWTCs faculties paid

Name of Training	BEmOC
Category	MO
Training Duration	15 days
Training Sites	49 Training Sites (as below)
No. of Districts	All Districts
Important Points	Training calendar available ·
	Drugs & consumables purchased for trainees.
	Logbook with proficiency skills maintained
	Supervisory visits by HFWTCs faculties paid

List of Training Sites for BEmOc & SAB
(Criteria –More than 150 deliveries per Month)

Both BEmOC and SAB training are going on in above 49 selected training sites in full swing in the state.

9) EmOC Training
Under Unicef EC – SIP funding we have trained 9 teams Gynecologists & at CM vellore during 2004 to 2006. Presently we have started EMoC Training at Daga Hospital Nagpur & 2 MBBS doctors for tribal district of Chandrapur are attending the training. Remaining 7 training sites will be made operational from Aug 2007 these are,

10) Laproscopic Training
There is increased trained of Laproscopic Sterilization. Laproscopic Sterilization is on going activity. To train eligible candidates (Gynaecologist & General Surgeon) in Laproscopic sterilization, the following institutes are identified -

Contribution from Private Sector is there in the form of performance as well as training to Surgeons. The training of Laproscopic Sterilization is to be imparted to team comprising of Gynaecologist / General Surgeon Private Practitioners who are eligible for training and has desired to under go training Family Planning Association of India and Sangamnerkar Dwarika Foundation Hospital are exclusively identified for private Gynaecologists and Surgeons for Laproscopic Ligation Training. We have trained 10 doctors in laproscopy during last year.

Name of Training	SSDT Laproscopic,Sterilization
Category	Gynaecologists/Sugeon
Training Duration	12 working days
Training Sites	6 Sites (as above)
No. of Districts	All Districts
Important Points	List of eligible Gynaecologists / Surgeon available.
	Individual performance of trained surgeon being monitored

11)Cu-T Training
This of ISDT has not been paid adequate attention by any Dist Health officers. As per recent guidelines received from Ministry of Health and Family Welfare the State has recognized Cama and albless Hospital Mumbai as nodal Training Training Centre on IUD Insertion for ANMs /LHVs and training of first batch has been started from 28th June 2007. at Cama and albless Hospital Mumbai. Norm of training is 5ANM/LHVs per batch with training period 5days expected expenditure per bath is Rs 12243

Name of Training	Cu-T
Category	ANM/LHV/MO
Training Duration	6 days to be included with MTP training
Training Sites	Selected Districts/ Women Hospitals
No. of Districts	All Districts
Important Points	Training calendar available ·
	Logbook with proficiency skills maintained

12) NSV Training
NSV training is imparted during camps of a period of 5 days. 2-4 Surgeons are trained in one batch. MBBS doctors with 5 years of experience are eligible for the training. Rs. 1.96 crores has been distributed to all the districts for undertaking this training. The norm of Rs. 53,000/- for organizing a 5-day camp for training of 4 Medical Officers has been already communicated.So far

Name of Training	NSV
Category	MBBS doctor with 5 years of experience
Training Duration	5 days during camp
Training Sites	all district selected R.H.
No. of Districts	All District
Important Points	Training calendar available ·
	List of district trainers and trained surgeons available
	Logbook with proficiency skills maintained
	Review SOE & training performance
	Individual perfomance of trained surgeon being monitored

13)Tubectomy / Minilap Training
As per GoI guidelines Tubectomy training was being conducted for a period of 12 working days. However in view of the feedback received from various sources, the hands on training experience obtained in 12 days were not found adequate. It has been decided to fix the duration of tubectomy training of 6 weeks. This training is being conducted in all district hospitals & women hospitals. Norm of training is 1MO, 2 SN & OT Tech per batch with training period 14 days expected expenditure per batch is Rs 17145/-

Name of Training	Minilap
Category	MBBS doctor with 5 years of experience
Training Duration	6 weeks
Training Sites	All district/women Hospital
No. of Districts	All district
Important Points	Training calendar available ·
	Logbook with proficiency skills maintained
	Regular flow of funs from district RCH flexi pool

This training load will be completed in next 3 years.

14) MTP Training
As per GoI guidelines MTP training was being conducted for a period of 12 working days. However in view of the feedback received from various sources, the hand on training experience obtained in 12 days was not found adequate. It has been decided to fix the duration of MTP training of 4 weeks. Manual Vacuum Aspiration (MVA), Medical Abortion has been included in the syllabus of this training.

Name of Training	MTP/MVA
Category	MBBS doctor
Training Duration	4 weeks
Training Sites	13 district/women Hospital
No. of Districts	All districts
Important Points	Training calendar available ·
	Logbook with proficiency skills maintained
	Regular flow of funs from district RCH flexi pool
	MVA kit issued to trained MO
	Any demand for equipment from C.S./DHO

IPAS, an International Organization has extended its support in providing Comprehensive Abortion Care.

15) Integrated ISDT under NRHM for newly recruited ANMs/LHVs on contract basis.
Under NRHM the state has recruited about 3500 ANMs/LHVs In 24hrsx7days PHCs/Sub-centers to strengthen RCH Services to community. It has been decided to train all these nursing candidates on RCH/NRHM issues by conducting training of 12 days at District Training Team level A ToT of Principal HFWTCs &MO DTTs has been finished at Nagpur recently. It is proposed to start actual training from 2nd July 2007 onwards for these ANMs/ LHVs in the state. Funds also have been released to Principal HFWTCs .

Name of Training	ISDT
Category	ANM,LHV,SN, MO,18 days for LHV, 6 days for HA(M), MPW (M)
Training Duration	12 days for ANM/SN, MO, 18 days for LHV, 6 days for HA(M),MPW (M)
Training Sites	ALL HFWTCs for MO training all DTTs for para medicals
No. of Districts	All districts
Important Points	Training calendar available ·
	Supervisory visits by HFWTCs faculties paid
	Review SOE & performance