The Reproductive Health Services (RHS)-A centres are hospital based service delivery units.
These RHS ‘A’ centres provide full range of Reproductive Health services comprising of :-
i) Comprehensive Family Planning (FP) services which include conventional and clinical methods as well as male and female contraceptive surgery facilities in static units and in extension service camps under safe and sterile circumstances.
ii) Mother and Child Health (MCH) care.
iii) Prevention and management of RTIs/STIs and HIV/AIDS.
iv) Management of reproductive health related issues of adolescent boys and girls.
v) Management of other RH related issues of man and women.
vi) Management of Infertility
vii) Early detection of breast and cervical cancers by promoting self examination.
These services by reducing maternal and infant mortality, will improve general Health, of the population of Sindh.
Besides these RH related issues the RHS ‘A’ centers provide treatment for minor / general ailments, especially to mother and child.
TYPES OF RHS CENTRES
RHS TRAINING CENTRES AND TRAINING / ORIENTATION ACTIVITIES
The Reproductive Health Service, Master Training and Training Centres conduct training of medical and paramedical staff of both programme and non-programme cadre.
The RHS Training Centres are responsible for following training activities:
a) Training (Basic/Refresher) of Programme and non-programme doctors including those from NGOs, Public Sector Organization (PSO) and Provincial Line Departments (PLDs), in clinical contraceptives and comprehensive Reproductive Health Services:
- Counseling, interpersonal communication conventional and clinical contraceptives including IUCD insertion / removal techniques.
- Norplant / Implanon insertion / removal techniques
- Contraceptive Surgical techniques (Male & Female)
- Infection Prevention / Asepsis
- Surgical skills Development & Emergency Handling.
- Diagnosis / management of infertility cases.
- Promotion of self examination of breast for early detection of cancer.
- Emphasis on breast feeding and child nutrition.
- Creation of awareness on personal hygiene.
i) Training (basic/refresher) of programme and non-programme paramedics in theatre management and other techniques with particular emphasis on Asepsis/Infection prevention as per National Stranded of Reproductive Health Services.
ii) Development of training curricula, strategy, methodology and annual training plan for all the above mentioned training activities; and thereafter undertaking all training activities as per plan.
iii) Undertake the FP/health education programme at educational institutions and PLDs.
iv) Hold orientation workshops for doctors and paramedics for all categories to update knowledge of available FP services for the clients.
v) Responsible for providing on-the-job technical monitoring/supervision and guidance/assistance for strengthening the institutional set up of RHS ‘A’ Centres and improvement in the quality of service provision.
vi) Medical Officer, Incharge from MTC and RHS Training centres will undertake 02 supervisory visits (of 3 days duration) every year. During each visit a minimum of 4 RHS ‘A’ Centres will be covered for technical guidance and support.
vii) The RHS Master Training Centre will ensure accomplishment of approved training activities and also evaluate different training activities including seminars and workshops/meetings carried out by the RHS Training Centres.
In view of the above stated training activities and work load, the staff of RHS Training Centres will be provided teaching allowance as permissible under the Government rules.
For basic clinical training in Minilaparotomy Techniques, the duration for the programme doctors will be of 28 days, extendable upto 06 months as per requirement, The basic training of Theatre nurses and Theatre technicians will be of 90 days. The training of non-programme doctors will be of 28 days duration extendable upto 2-4 months as per requirement. The training imparted to medical & paramedical staff will be as per national standards.
Ten days training of Post-graduate doctors in FP is mandatory and imparted to post graduate students nominated by College of Physicians and Surgeons of Pakistan (CPSP) at the Master Training Centre JPMC. Therefore efforts will made that Master Training Centre shall be recognized by CPSP (College of Physicians and Surgeons Pakistan).
RHS ‘A’ CENTRES
RHS Centres are functioning in the province. Types of RHS ‘A’ centres are:
- RHS MTC JPMC, Karachi and 01 MTC Shaikh Zaid Hospital Larkana planned to be upgraded during this plan period.
- RHS training centre: 05
(Established in teaching hospitals)
(Established in DHQ / THQ hospitals).
Most of these centres are located in separate buildings constructed by Population Welfare Department Sindh, in or adjacent to Gynae OPD for back-up support of Gynecologist as well as motivation and counseling of female patients visiting gynae OPD for contraception.
STANDARD LIST OF POSTS FOR RHS MASTER TRAINING CETNRE, TRAINING CENTRE AND RHS 'A' CENTRES FOR 11TH PLAN PERIOD 2010-15
· 40 RHS-A centers are working under regular PC-I, 34 RHS’A’ centers at THQ hospital working under additional PC-I would be merged in regular scheme in 2010-2011.
ADMINISTRATIVE & TECHNICAL MONITORING AND SUPERVISION:
The performance of the Reproductive Health Service Centres will be reviewed and monitored jointly by the Incharge RHS-A Centres and the DPWOs to ensure availability of all inputs, staff presence, contraceptive performance compared to previous month and amongst the centres, quality of service provision, payment for CS/IRC, training of staff and collaboration with Hospital. The Deputy DPWO (Tech) will assist the DPWO and Incharge of RHS-A Centres to provide technical guidance/support for ensuring availability of RH services. Technical Wing of MoPW and PWDs would act as the next tier for supervision and technical support to the Reproductive Health Service Centres.
QUALITY OF CARE:
MoPW achieved International accreditation ISO 9001-2000 Certification for Quality service for selected service delivery points. On the basis of the experience from above process and to ensure quality of care throughout service delivery Net work of Population Programme. Standardization and optimization of reproductive health facilities in order to achieve clients satisfaction through continued improvement in quality services.
FP SERVICES AT RHS-A CENTRS
Comprehensive FP Services at RHS-A Centres include motivation, counseling regarding temporary contraceptives like Norplant and Implnon insertion / removal techniques, IUCDs insertion / removal, Injectables, Oral Pills and Condoms, and permanent contraceptive methods i.e Contraceptive Surgery services for females and males and Emergency Contraception will also be provided.
CONTRACEPTIVE SURGERY PROCEDURES
Minilaprotomy is the internationally recommended and preferred method for female voluntary surgical contraception. It is cost effective, simpler and safer surgical technique, and CS programme is geared to perform Minilaprotomy procedure. Therefore at static RHS Centres, the accepted proportion of Minilaprotomy procedure for CS will be more than 75% of the total CS performance, whereas during RHS extension camps 25% CS will be performed.
For male CS No-Scalpel Vasectomy (NSV) technique is the preferred method as it is more simple and safe.
The Medical Officer, Incharge of the RHS ‘A’ Centre / Vasectomy Centre is required to note the complete address of the surgical clients and also ensure that:
Ø The ID Card of the clients should be provided at the time of contraceptive surgery.
Ø In case the ID Card of the client is not available, then the ID card of the husband should attached with IRC claims.
Ø If both are not available, then the ID card of the referrer should be attached with IRC claims.
Ø In addition, the complete addresses and phone number (if any) of the client should also be recorded carefully.
Ø Complete address of the referrer or whosoever accompanies the client be recorded as well.
EXTENSION CAMPS ACTIVITY
To ensure availability of CS services on wider scale and to improve performance, the RHS Centres will hold extension camp at appropriately equipped Rural Health Centres.
Camping site will be selected/finalized jointly by concerned DPWO/TPWO, Deputy District Population Welfare Officer (Technical) and Medical Officer, Incharge, RHS ‘A’ Centre. For camping activity the policy/guidelines given in the “Manual of National Standard for Family Planning Services” will be strictly adhered to. Quality of care should be maintained at the camps.
STRENGTHENING OF HOSPITAL MANAGEMENT COMMITTEES
The RHS-A Centre functioning within the hospital setup according to an agreement of payment on per case basis to the gynecologist and the MS of the hospitals for assistance and support will be strengthened and revised guidelines for strengthening Hospital Management Committees (HMCs) will be prepared. The salient features of Hospital Management Committee are as under:
The Medical Officer Incharge will be responsible for:
Ø Convening monthly meeting of HMC on regular basis.
Ø DPWO, M.S, Gynecologist and other relevant department of the hospital will be requested to attend the meeting for discussing the issues for smooth running of RHS-A centres.
Permanent agenda points for discussion:
Ø Assignment roster of staff of RHS –A centres in the Gynae/Obst./Paeds wards and OPDs.
Ø Record of number of antenatal, postnatal and high risk cases motivated/counseled.
Ø Liaison with Registrar and senior doctors for facilitating ligation of complicated and difficult cases.
Ø Training of doctors and paramedics in contraceptive methods.
Ø Development of mechanism for validation of CS cases in the hospital and its regular monitoring.
Ø Other relevant issues.
CHARTER OF DUTIES OF RHS TRAINING CENTRES
i) Train (basic/refresher) programme and non-programme doctors including those from NGOs sector, Target Group Institutions (TGIs) and Provincial Line Department (PLDs) in contraceptive surgical techniques, counseling, interpersonal communication, Norplant/ Implanon insertion / removal techniques, asepsis, Management Information System (MIS) and provision of comprehensive Reproductive Health Service Package (CRHSP).
ii) Identification of difficult surgical cases, deal with surgical problems, assess and diagnose abnormal obstetric / gynaecological problems and diagnosis / management of infertility cases., Impart training in Norplant / Implanon insertion / removal techniques to the medical officers from RHS-A centres.
iii) Train (Basic / refresher) programme and non-programme paramedics in theatre management and other techniques with particular emphasis on asepsis / infection prevention.
iv) Develop training curricula, strategy, methodology and annual training plan for all the above mentioned training activities.
v) Undertake the FP/Health education programmes at educational institutions and PLDs.
vi) Hold orientation workshops for doctors and paramedics for all categories to update knowledge of what is available for the clients in the way of contraceptive services.
vii) Provide on-the-job technical monitoring/supervision and guidance/assistance for strengthening the institutional set up of RHS centres and improvement in the quality of service provision.
viii) Undertake four supervisory visits of RHS ‘A’ Centres every month.
ix) Ensure accomplishment of approved training activities.
MALE INVOLVEMENT & VASECTOMY SERVICES
Like all other male dominating societies, women in Pakistan including some of those who belong to educated class are not allowed to make a decision themselves especially for contraceptive surgery, though it is strictly adviced by the gynecologist in view that the poor woman can not bear one more pregnancy and she is at high risk for mortality, more emphasis is given on male participation by creating awareness and motivation with special focus on provision of vasectomy services preferably by No-Scalpel vasectomy (NSV) techniques. Male doctors (Health/Private/NGOs etc) will continue to be involved during this Five year plan through training, enhancing IRC per case and enlistment of more RHS ‘B’ Centres.
STAFFING PATTERN PER VASECTOMY CENTRE