In August 2015, the Government of India shared an update on its commitment to FP2020. Here are the government’s responses.
- 34 million eligible couples in India have been provided with modern contraceptives in 2014 (3.9 million female sterilization, 0.78 million male sterilization, 5.2 million IUCD insertions, 4.5 million condom users and 3.2 million [oral contraceptive pill] (OCP) users)
- India has already developed indigenous capacity, in public and private sector, to manufacture the entire range of family planning commodities in use under the national program. The procurement is done through federal funds. Commodities worth Rs. 254 crore (42.3 million USD) is being procured each year in the country.
- For 2014-15, the financial outlay under NHM was Rs. 18020 crore (3003 million USD). The country has differential share for high-focus and non-high focus states. States have now built the in-house capacity for training of providers and fund allocation. Under NHM rational deployment of human resource is one of the key conditionality for fund allocation. The financial outlay for family planning has increased by 45% from 2012 to 2014.
- The process of resource and budget allocation under NHM is a structured process where the states are provided the platform to discuss their budget with the national officials
- India has already launched National Urban Health Mission (NUHM), covering the urban poor population in the country. NUHM was launched in 2013-14.
- The detailed framework has been devised and shared with all the states of the country. National Rural Health Mission and National Urban Health Mission has been subsumed under the umbrella of National Health Mission. Each year, approx. Rs. 18020 crore ($3003 million USD) is approved under NHM. Rs. 2288.31 crore ($381.4 million USD) has been approved so far for infrastructural strengthening specifically under NUHM. The service delivery cost is covered for both urban and rural population under the NHM framework
- Annual costed plans covering all RMNCH+A activities are formulated in all districts, which are consolidated at the state level and further appraised at national level. To fulfil the gaps and effective implementation of family planning activities and to achieve Family Planning 2020 goals, all districts across the country were oriented, mentored and facilitated for development of their district action plans and further the costing was reflected and approved under the state PIPs. These district action plans were the result of detailed gap analysis for different resources needed to achieve FP 2020 goals (e.g. equipment, infrastructure, training needs, etc.)
- Besides helping in estimation of costs, the district action plans also acted as a guiding tool for structured implementation of planned activities. Moreover these plans augmented the rationalization of both human resources and logistics. The progress of implementation has been closely monitored through supportive supervision visits and report reviews thereon.
- All the family planning commodities in India are being manufactured indigenously and no donor support is being sought for the same. All the commodities are procured centrally and distributed to states. Annual forecasting is being done for commodity estimation in the country. In 2014-15 FP commodities worth Rs. 254.3 crore (USD $42.3 million) were budgeted.
- All the family planning services are being provided free at public health facilities and accredited private health facilities in India. Family planning services are being rendered by 0.18 million primary level public health facilities, more than 6000 secondary level facilities and 755 tertiary level facilities besides a large pool of accredited private health facilities.
- India has a pool of 0.87 million community health workers (ASHA), acting as depot holders for contraceptives at the village level and 0.64 million villages across 670 districts are being covered under the scheme. ASHAs are an important source for accessing contraceptives in rural areas by eligible couples in the privacy of their homes. The Government of India believes ASHAs are also helping reduce the gender differentials for contraceptive usage as ASHAs distribute contraceptives to male beneficiaries too. Another scheme has been designed for the high-fertility states and is operational in 18 states covering 0.4 million villages across 410 districts. 0.59 million ASHAs are involved in counseling the beneficiaries on the advantages of spacing, delaying the first birth by two years and maintaining the birth interval of at least three years between the two children. In addition, more than 1,600 positions of RMNCH+A counselors were created in 2014 to ensure counseling for family planning at high case load facilities.
- In 2013 and 2014 India updated the national standards in sterilization services and technical guidelines for IUCD and sterilization for equipping the service providers with latest protocols. It has been widely disseminated by state level workshops in all 36 states of India.
- Government of India developed the RMNCH+A strategy, which included family planning as the first pillar. The country has witnessed an increase of 9.2% from 2012 to 2014 in secondary and tertiary care public health infrastructure.
- Almost 5,000 new primary level facilities, 567 secondary level and 33 tertiary level public health facilities were created in a short span of two years. More than 10,000 female and more than 3,500 male health workers were added to the workforce in the same period. A new cadre of RMNCH+A counselors were recruited in all the states to ensure counselling services in high-case load facilities. To ensure skill building of the providers certain innovative steps were taken recently which included onsite training model especially for the high-focus states which face a huge human resource crunch. Another strategy includes mobile teams for the provision of family planning services. The team is equipped with necessary logistics, medical and paramedical staff.
- The initiatives are being taken to launch social franchising and social marketing scheme in the country which will address the service delivery gaps as well as demand generation.
- Every year, the states are being supported through central and state budgets for procuring equipment and drugs. All drugs are provided free of cost in all public health facilities across the country. Few states have already operationalized logistic management software for family planning supply chain management. The national government is advocating that other states do the same (the guidelines have already been shared with the states). Besides this a gap analysis is being undertaken for further strengthening of supply chain. Additionally for strengthening service delivery, all sterilization clients are being offered free transportation back to their homes after the procedure in public health facilities.
- Programmatically there is a focus on increasing birth spacing and discouraging teenage marriages. The Rashtriya Kishor Swasthya Karyakram (RKSK( strategy was launched in 2013-14 to address the needs of adolescents, including the reproductive health. ASHAs are being utilized for providing field level counseling in the community for these issues.
