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Dr. Ashok Kumar Walia
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Family Welfare

The Directorate of Family Welfare was established in the year 1976 as a part of the Directorate of Health Services subsequently around 1992-93, the department of Family Welfare was separately administratively from Director of Health Services .The need to reduce the IMR, MMR & TFR, it became imperative to have an independent organizational set up for the Directorate of Family Welfare on the pattern of similar directorates countrywide. The various activities include planning, implementing, supervising, collaborating, monitoring and evaluating various aspects of RCH Program. RCH,  a flagship program under NRHM has five components :-  (i)   Population stabilization (ii) Maternal Health  (iii) Child Health  (iv)Adolescent Health  (v) STI & HIV AIDS.


Inspite of being the smallest state in the country with an area of 1483 sq. km. Delhi stands tall with a population of 1, 67, 53,235(Census2011). Population density of Delhi is almost 11,300 per sq km as compared to All India population density of 340 only and is the highest in the country. The population due to its dynamic nature as a result of opportunities of higher Job and health services availability in Delhi, imposes an additional important role for addressing the related needs of the target beneficiaries through its various services so that survival rates and quality of life of the most vulnerable improves over time. Hence there is a need to propagate ‘small family norm’ as a way of life among the eligible population. In this context, the role of the Directorate of Family Welfare is vital

Goals:
1) Infant Mortality Rate (IMR): Existing 22(CRS2010) to be less than 15 by 2015.
2) Maternal Mortality Rate (MMR): Existing 130 per lakh live births (CRS 2010), to be less than100 by 2015).
3) Total Fertility Rate (TFR): Existing 2.1(already achieved replacement level) to 1.9 by 2015
 
Dte. of Family Welfare is responsible for planning, co-ordinating, monitoring, supervising and evaluating activities with other agencies of Delhi Govt including NGO’s in the following primary health care activities:
  1. To facilitate provision of antenatal and natal services to pregnant women.
  2. To facilitate implementation of Post partum program.
  3. To facilitate provision of family planning services (Basket of contraceptives, female/male sterilization, Counseling etc.)
  4. Implementation of UIP (Universal Immunization Program).
  5. Surveillance of VPD (Vaccine Preventable Diseases)
  6. Implementation of Pulse Polio Program.
  7. Implementation of PC & PNDT (Pre conception & Pre Natal Diagnostic Techniques Act 1994 Prevention of Sex Selection) and MTP (Medical Termination of Pregnancy) Act.
  8. Co-ordination and execution of IEC activities through Mass Education Media.
  9. Procurement of State Specific vaccines such as MMR, vaccine and Typhoid. Stocking, maintaining cold chain, disbursing vaccines and family welfare logistics to all health providing agencies in the state.
  10. To monitor performance and quality of family welfare activities by NGO’s and release of Grant-in-Aid to them.
  11. To facilitate provision of Adolescent Health Services in the state of Delhi.
  12. Capacity Building to update knowledge & skills of various categories of health functionaries by providing RCH trainings by the H&FW Training Centre.
 
 
Various Activities under Dte. of Family Welfare :-
Family Welfare: - One of the immediate objectives of the National Population Policy is to address the unmet need of contraception. In Delhi the unmet need of Family planning is 7.8% and for spacing it is 3.3%.The Contraceptive prevalence rate is 66.9 % for any method and for any modern method it is 56.5%. (NFHS-3). Family Planning pertains not only to population stabilization but also brings down the IMR and MMR hence improving the quality of life.
  • The DFW coordinates with all the various agencies of Delhi Govt. MCD, NDMC, ESI, CGHS and NGO’s to provide basket of choice in a Cafeteria approach with a goal to provide spacing and limiting methods. Contraceptives are received from GOI at the State Medical Stores under DFW and are distributed to all the agencies. The contraceptives available at all the health care centers free of cost are- condoms, Copper T 380A, Emergency pills and Oral contraceptive pills. IUCD 375 will be soon added to the existing basket of choice. Apart from these the hospitals also provide Sterilization services namely Tubectomy, No-Scalpel Vasectomy and Post-Partum IUCD services.  
  • DFW also procures stocks, maintains & distributes Family Welfare logistics to all health care providing agencies in the State of Delhi. Procurement of laparoscopes, their maintenance and repair is another initiative under Family Welfare Programme.
  • Empanelment of all service providers for providing Sterilization services as per GOI Guidelines for Quality Assurance, for performing Minilaparotomy & Laparoscopic Sterilization/NSV/Vasectomy.
  • Ensuring provision of Quality services by implementing Standard Operating Procedures for Sterilization as laid down by GOI and holding regular QAC meetings at district and state level.
  • Family Planning Insurance Scheme is implemented through ICICI Lombard insurance Company. If there is any failure/complication or Death following sterilization operation, the District Quality Assurance Committee examines the case and recommends compensation to the client through ICICI Lombard Insurance Company.
  • Other activities: Celebration of World Population Day, Increasing Male participation, IEC and Contraceptive Updates, Organizing camps etc.
 
Immunization:  - Directorate of Family Welfare is involved in the state in planning, implementing, co-ordinating, supervising and monitoring immunization services in the state of Delhi through more than 700 health units under administrative controls of various organizations like DHS, MCD, NDMC, etc.  In a recent Concurrent Evaluation of NRHM 2009, percentage of fully immunized children in Delhi is 88.7%.
The various activities under Immunisation programme being done at the state level are:
    1. To procure vaccines and other logistics, stock, maintain cold chain and distribute the same to all health units.
    2. To plan state specific special immunization program for MMR and Typhoid vaccination.
    3. Surveillance of vaccine preventable diseases with specific objectives of eradication of Polio, elimination of Neonatal Tetanus and control of measles.
    4. To implement Pulse Polio Program in the State of Delhi through number of Pulse Polio immunization booths supplemented by house to house activity in the next five days.
    5. Celebration of Special Immunization, Breast Feeding, Hepatitis B and Newborn Care Weeks are special innovations undertaken by the State as a regular feature of Routine Immunization services.
    6.    To procure State specific Immunization cards which includes nutritional surveillance of children <5 year of age along with growth monitoring and nutritional advise to the families/care givers.
    7. Holding of RCH Camps in the slums and JJ clusters and the outskirts of rural   Delhi as well as monthly Health and Nutrition Days at Anganwadies are additional outreach services offered in Routine Immunization.
Maternal health : Maternal Health refers to the health of women during pregnancy, childbirth, and the postpartum period. It encompasses the healthcare dimensions of , preconception, prenatal, and postnatal care in order to reduce maternal morbidity and mortality.
Directorate of Family Welfare is involved in coordinating, monitoring & supervising with all the health agencies in the state providing maternal health for quality care to pregnant mothers, promotion of safe delivery and post partum care.
In addition DFW is also involved implementation of maternal health schemes like:
  • Janani Suraksha Yojana 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 infant mortality by promoting institutional delivery among the poor pregnant women. It integrates cash assistance with delivery and post-delivery care   The Yojana has identified ASHA, the accredited social health activist as an effective link between the Government and the poor pregnant women
  • Janani Shishu Suraksha Karyakram : The new initiative of JSSK would 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. JSSK supplements the cash assistance given to a pregnant woman under Janani Suraksha Yojana and is aimed at mitigating the burden of out of pocket expenses incurred by pregnant women and sick newborns. Besides it would be a major factor in enhancing access to public health institutions and help bring down the Maternal Mortality and Infant mortality rates.
The Free Entitlements under JSSK would include: Free and Cashless Delivery, Free C-Section, Free treatment of sick-new-born up to 30 days, Exemption from User Charges, Free Drugs and Consumables, Free Diagnostics, Free Diet during stay in the health institutions  for  3 days in case of normal delivery and 7 days in case of caesarean section, Free Provision of Blood, Free Transport from Home to Health Institutions, Free Transport between facilities in case of referral and also Drop Back from Institutions to home after 48hrs stay. Free Entitlements for Sick newborns till 30 days after birth similarly include 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 and Free drop Back from Institutions to home. 
 
CHILD HEALTH: The DFW plans, implements, coordinates and monitors various initiatives under child health in the state to bring down the IMR and NMR. These initiatives are:
    • Upgradation of SNCU’s, NBSU’s, NBCC’s and NRC’s in the hospitals of Delhi Govt to provide quality care to the sick and vulnerable newborns.
    • Tracking of sick admitted children through MCTS.
    • Coordination with ASHA and AWW for Home based newborn care
    • Identification and treatment of Severe Acute Malnutrition as per treatment protocols of GOI.
    • Implementation of IMNCI for identification and timely referral of sick children
    • Implementation of IYCF Counseling centers in hospitals and celebration of World Breast feeding Week for promotion of early initiation, exclusive breast feeding, timely complementary feeding and continuing breastfeeding up to at least 2 years.
    • Procurement of ORS packets, Zinc tablets and IFA tablets and distribution to the various health agencies of Delhi to reduce the morbidity and mortality from Diarrheal diseases and Anemia.
 
Preconception & Prenatal Diagnostics Techniques Act 1994(Prevention of Sex Selection) :-     DFW is involved in Implementation of PC & PNDT Act in the state of Delhi. and also acts as an Appellate authority for implementation of PNDT Act. Child sex ratio has been adversely affected by the practice of Pr- conception and Pre- natal Sex selection. The Pr- conception and Pre- natal diagnostic techniques Act ( PC and PNDT Act) enacted in 1994 seeks to address this problem legally. It is the end product of extensive deliberations among all stake holders i.e. the people’s representatives, medical practitioners and the civil society. The PNDT Act focuses on the need to eliminate the illegal practice of sex determination and female foeticide and echoes the collective concern of the people’s representative and the civil society.
MTP Act: - The Indian abortion laws fall under the Medical Termination of Pregnancy (MTP) Act, which was enacted by the Indian Parliament in the year 1971. The MTP Act came into effect from April 1, 1972 and was amended in 1975 and 2004.
The Medical Termination of Pregnancy (MTP) Act of India clearly states the conditions under which a pregnancy can be ended or aborted, the persons who are qualified to conduct the abortion and the place of implementation. MTP Act has been decentralized in Delhi and DFW is engaged in Co-ordination and overall supervision of implementation of the MTP Act at the state level.
Human Resource Development: - For successful implementation of any health programme capacity building is imperative. The directorate has a State level institute i.e. Health & Family Welfare Training Centre situated in Saraswati Vihar where the knowledge and skills of various categories of health functionaries is updated by providing various trainings like safe immunization, Adolescent health, IMNCI, Alternative methodology of IUCD insertion, IYCF practices etc. It also collaborates with major hospitals of Delhi for provision of hands on training for improving skills of health care functionaries like Skill Birth Attendant training, IUCD training, NSSK , IMNCI etc.The service providers of all the health agencies in Delhi are being trained here.
Post Partum Program: -    PPP is a hospital based maternity center approach for family welfare program as at this time women are most receptive to adopt F.W. services. There are number of P.P. units in various hospitals of Delhi under administrative control of different agencies for which manpower, logistics and finance is provided by this directorate.
Coordination with NGOs: -   Grant-in-Aid is provided to number of NGOs in the state of Delhi for efficient implementation of Family Welfare programs. The various responsibilities of DFW are to release timely grants, logistics, monitoring, hold quarterly meetings and training of the staff.
Mass Education Media Department: -    Co-ordination & execution for all IEC activities through print, outdoor and electronic media related to various programs.
Medical Store: - Situated at 2- Battery Lane, Rajpur Road, stocks, maintains cold chain, distributes all the vaccines and logistics related to UIP and Family Welfare programs to the entire state of Delhi (also working out requirement of Logistics in Delhi as per BR & TFR & project the need to GOI)
Monitoring & Evaluation: -    The directorate collects, compiles, analyses the information/data regarding family welfare activities undertaken by the health providing agencies.
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Sheila Dikshit
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Last Updated : 16 Apr,2012

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