the impact of family health programme … impact of family health programme on family well-being sri...
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DR. CHITHRAMALEE DE SILVA
FAMILY HEALTH BUREAU
MINISTRY OF HEALTHCARE AND NUTRITION
THE IMPACT OF FAMILY HEALTH PROGRAMME ON FAMILY WELL-BEING
SRI LANKA
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Population: 19.6 million(2005)
Women in reproductive age : 5.4 million (27.7%)
Married women : 3 million (14.5%)
Mean Age at Marriage for Females: 25.5 yrs (1994)
Birth rate : 18.8 /1000 LB
MMR: 37.8 / 100,000 LB (2004)
Institutional births: 95%
IMR : 11.2 /1000 LB (2003)
Family Health Centered towards…………..
Health and well-being of the mother
Health of the children
Participation of father and family members inwellbeing of the family
Thereby improve the quality of life of the family3
Vision of the Family Health Programme
A Sri Lankan nation where healthy families and individuals play a pivotal
role in human development
Mission
To contribute to the attainment of the highest possible levels of health by individuals, families and communities through provision of comprehensive, sustainable, evidence-based, equitable, and quality maternal and child health services.
Family Well being thro’ Family Health
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Care for E ligiblecouples
Care for pregnant mothers Domiciliary & clinic care
Intra natal carePost natal care
Organized and continued MCH care
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Secretary of Health
Director General of Health Services
Deputy Director Generals• Public Health Services• Medical Services• Planning• Administration• Finance• Lab Services
Epidemiologist Director MCHDirector HEB
EpidemiologicalUnit
Family HealthBureau
Health EducationBureau
ORGANIZATIONAL STRUCTURE OF FHPCentral Level
Provincial Director of Health Services
MO. MCH
ORGANIZATIONAL STRUCTURE OF FHPProvincial Level
Regional Director of Health Services
RSPHNO
RE SSO/HEO
MOH
PHNS SPHM PHI PHMSPHI
1. Ensure a safe outcome for both mother and newborn through provision of best available care during pre-pregnancy, pregnancy, delivery and post partum period.
2. Ensure survival and optimal health for all neonates through provision of best possible care.
Maternal and Newborn health
Antenatal Care Provided through clinic based and home based care
Registration of pregnant mothers preferably before 8 weeks
Domiciliary care at the door step by PHM on regular basis
Routine Antenatal care includes Regular monitoring of wellbeing of the mother and the foetusNutritional assessment and supplementationHigh risk screening and appropriate referralImmunization against tetanus
Approximately 98% receive care from Government Programme
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Intranatal Care
Mainly in Institutional setting75% occur in institutions with comprehensive EmOCfacilities
98% receive trained assistance at delivery
95% in hospitals3 % by PHM at home
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Enable all children to survive and reach their full potential for growth and development through provision of optimal care.
Enable marginalized children and those with special needs to optimally develop their mental, physical and social capacities to function as productive members of society.
Expansion of the child health programme to incorporate services to optimize development (ECCD programme)15
Child health
Provision of domiciliary and clinic care
Registration of infants for child care services and regular follow up
Necessary education and advice on breast-feeding, complementary feeding and immunization etc.
Routine immunization at child health clinics
Regular monitoring of growth and development regularly
Provision of food supplements at clinics
Monitoring psycho-social development
Provision of instructions on prevention and control of diarrhoealdiseases and ARI
Referral of any abnormalities/complications to higher level institutions for appropriate management.
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Trends in IMR since 1945 - 2003
Source- Registrar General’s Dept
0
10
20
30
40
50
60
70
1975-76 1977-78 1980-82 1987 1993 1995-96 2000
Year
Perc
ent
Underweight Stunting Wasting
Source: MRI database & DHS survey
Trends in under-nutrition among < 5 yr children
SCHOOL HEALTH PROGRAMME SCHOOL HEALTH PROGRAMME 1. 1. Engages health and education officials, teachers,
students, parents, and community leaders and other relevant organizations in efforts to promote health.
2. 2. Strives to provide a safe, healthy environment, both physical and psychosocial
3. 3.Provides skills based health education
4. Reorientation of school Health services
5. Implementing health promoting practices
6. Empower children to act as change agents of community Health
Enable all couples to have a desired number of children with optimal spacing
Cafeteria approach to Family Planning Modern temporary methods provided through MCH clinic services & NGOsPermanent methods through Govt. hospitals and NGOsSignificant proportion use traditional & natural methods
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Family Planning
A choice of contraceptivesTemporary
Hormonal
IUD
Barrier
Permanent
Male
Female
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Decline in Total Fertility Rate 1953 - 2000
0
1
2
3
4
5
6
52/54 62/64 70/72 80/82 85/87 91/93 98/99
Tota
l Fer
tility
Rat
e
Trends in Contraceptive use – National surveys
010203040506070
WFS
1975
CP
S19
82
DH
S19
87
DH
S19
93
DH
S20
00
Percent currently using
Any Modern Method Any Traditional Method Any Method
Unmet need
Unintended pregnancies
Unwanted pregnancies
ABORTIONS(Illegal, maternal morbidity & mortality)
Addressing special reproductive health needs of women
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Established in Sri Lanka in 1996
Screening services for women over 35 years
Women are screened for common NCDsand reproductive cancers
Pap smear screening facilities available in all districts
• Diabetes Mellitus• Hypertension• Breast malignancies and abnormalities• Cervical cancers
Well Woman Clinics
Trends in establishment of Well woman clinics
397
446
350
418
240
310330
349379
168140
305
260247
0
50
100
150
200
250
300
350
400
450
50020
00
2001
2002
2003
2004
2005
2006
No. of WWCsNo. with Pap facilities
Promote gender equity and equality in relation to MCH.
Develop MCH-related gender equity and equality.Ensure gender main streaming in health services
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Family health programme linked to MDGs
Improve maternal Health with reduction of Maternal MortalityReduction of Infant MortalityIncrease skilled attendance at deliveryReduction of Child malnutrition
MCH related MDG Targets for 2015
Indicator Current Year Target Year
Infant mortality rate 13.3 2000 9.0 2015
Maternal mortality rate 53.6 2002 36.0 2015
Contraceptive Prevalence RateModern methods 49.5% 2000 60.0% 2015
Nutrition status of children aged 3-59 months
2015
underweight 29.4% 2000 15% 2015
Deliveries attended by unskilled personnel (%)
1.8% 2000 <1.0% 2015
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