Health & 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 RMNCH + A Program, a flagship program under NRHM has six components:- Reproductive, Maternal, Neonatal, Child & Adolescent Health.
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 better Job opportunities 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.
Directorate of Family Welfare is responsible for planning, coordinating, 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)ery Services
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, Typhoid & Pentavalent Vaccines. 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.
Goals:
2) Maternal Mortality Rate (MMR): Existing 104 per lakh live births (CRS 2012), to be less than100 by 2015 & less than 75 by 2017).
3) Total Fertility Rate (TFR): Existing 1.8 (CRS 2011, TFR corresponding to replacement level of population being 2.1).
4) Sex Ratio at birth which was 809 (CRS 2001) and is 886 (CRS 2012) is planned to be brought up to 925 by 2015, 935 by 2017 and 954 by 2020.
Various Activities under Dte. of Family Welfare :-
Immunization
Directorate of Family Welfare under its RCH Program Unit is engaged in delivery of immunization services through more than 600 health delivery points. The immunization program aims to protect the children against more than 12 diseases namely tuberculosis, polio myelitis, Hepatitis-B, Diphtheria, Pertussis, Tetanus, Hib related diseases (menindgitis, pneumonia and septicaemia), measles, mumps, rubella and typhoid. Certain vaccines are unique to the State Immunization Schedule and there details are as under:-
State Introduced MMR vaccine in its EPI schedule in Nov 1999 & is the first state to have done so. Since then more than 3 million infants/young children have been immunized with MMR vaccine.
State Introduced Hepatitis B in its schedule in August 2001 & have so far been able to protect about 2.75 million infants against the dreaded hepatitis B disease & its late complications.
Delhi State is the only state in the country to have also included Typhoid vaccine in its immunization schedule since November 2004 & so far more than 2.0 million young children have been immunized and this has also helped to reduce the prevalence of multi drug resistant cases of typhoid fever among children in the State.
Introduction of Hib (Pentavalent Vaccine) as a part of Immunization activity has been launched in the State in March, 2013. It will help to immunize the children against five diseases namely Diphtheria, Pertussis, Hep. B, Hib related diseases and Tetanus through a single shot.
The percentage of fully immunized children is 73.2 % as per Coverage Evaluation Survey of UNICEF and this percentage as per HMIS data for the year 2012-13 is about more than 80%. But the State is still striving to achieve the goal of Universal Immunization. The State has taken various initiatives to achieve this objective. The State has observed four Special Immunization Weeks in April, June, July and August to focus on high risk areas which have been identified through house to house activity under taken under pulse polio program. Community health workers like ASHAs is also involved in improvement of immunization coverage by providing incentive for full immunization and provision of booster dose to the children. It has helped the State to improve the immunization coverage where it needs the most.
The percentage of fully immunized children is 73.2 % as per Coverage Evaluation Survey of UNICEF and this percentage as per HMIS data for the year 2012-13 is about more than 80%. But the State is still striving to achieve the goal of Universal Immunization. The State has taken various initiatives to achieve this objective. The State has observed four Special Immunization Weeks in April, June, July and August to focus on high risk areas which have been identified through house to house activity under taken under pulse polio program. Community health workers like ASHAs is also involved in improvement of immunization coverage by providing incentive for full immunization and provision of booster dose to the children. It has helped the State to improve the immunization coverage where it needs the most.
Health delivery units also liaison with Anganwadi under ICDS to immunize the children in Anganwadis. VHNDs (Village Health Nutrition Days) are also organized in unserved and underserved areas where immunization is one of the important services rendered. The State observes Wednesday and Friday as Universal Immunization Days in all the health centres across the State whereas hospital provide this service on all working days of the week.
Family Planning
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 10.1 % for limiting methods and 3.8% for spacing (DLHS-3). Family Planning pertains not only to population stabilization but also contributes to improved child & maternal survival & hence the health of the Community as a whole.
DFW coordinates with various agencies of Delhi Govt. MCD, NDMC, ESI, CGHS as well as NGO’s to provide basket of choice of Contraceptives in a Cafeteria approach with a goal to reduce the unmet need of eligible couples. Contraceptives are supplied free of cost to all the agencies. The contraceptives available at all the health care facilities include condoms, IUCD (of 5 yrs & 10 yrs durations), Oral contraceptive pills and also Emergency Pills. Apart from the above, hospitals & some Maternity Homes also provide Female & Male Sterilization services as well as Post-Partum IUCD services.
Child Health
Child Health is one of the important component of RCH Programme. The State is making concerted efforts to reduce Mortality and Morbidity among children. Infant Mortality Rate of Delhi is 25 (SRS 2012) which shown 5 point decline in 2 years. The aim of the State is to reduce Neonatal Mortality Rate, Infant Mortality Rate and Under 5 Mortality Rate. The reduction of theses rates also give assurance to the community regarding survival and longevity of children which will help the families to adopt small family norm.
In order to reduce Infant Mortality Rate the State has targeted to reduce neonatal mortality rate through new born care as neonatal mortality rate constitute two third of infant mortality rate.
To reduce Neonatal Mortality Rate State has improved Newborn Care Facilities by opening Sick Newborn Care Units (SNCUs), Newborn stabilization Unit (NBSUs) and New Born Care Corners (NBCCs). SNCUs have been established in 14 District Hospitals which provide intensive care to the babies who are sick and require resuscitation care, thermal control, hypothermia and ventilator support, 14 NBSUs are functioning in 14 district and sub-district hospital, and 32 NBCCs in Maternity Homes under the administrative control of local bodies, thereby ensuring New born care corner at all the delivery points in the State.
To reduce Post neonatal mortality rate and Infant mortality rate, State is implementing Diarrhoea Control Programme and ARI Control Programme.
Severe Acute Malnutrition is associated underlying cause in most of the under 5 deaths so the State has taken initiative to propagate Infant Young Child Feeding Practices (IYCF) strategy in approx. 25 Delhi govt. hospitals basically for promotion of early initiation (within first hour), exclusive breast feeding, timely complementary feeding and continuous breast feeding up to 2 years and establish Nutritional Rehabilitation Centre (NRC) in 11 hospitals to take care of severely malnourished children.
Anaemia is quite prevalent in under 5 populations which hamper their growth and development. In order to address the problem of micronutrient deficiencies amongst the population of under 5, State will be providing prophylactic , IFA tablet (Small) & Syrup Vitamin A.
State is organizing Home Based New Born Care to upgrade the skills of ASHAs in New born care and timely referral.
State is likely to introduce Rashtriya Bal Swasthya Karyakram (RBSK) to detect congenital abnormalities in early part of newborn life so that preventive action can be taken to rear the children into healthy adults. It is estimated that 3.2 lac births take place in state of Delhi. In the first instance we will be targeting 2.2 lac births which are occurring in public facilities.
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 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 in implementation of maternal health schemes like:
JANANI SURAKSHA YOJANA (JSY):
It 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 to pregnant women belonging to SC, ST and BPL category for delivery and post-delivery care. The accredited social health activist (ASHA) is being identified as an effective link between the Government and the pregnant women to facilitate in implementation of this programme.
JANANI SHISHU SURAKSHA KARYAKRAM (JSSK):
Under this scheme free and cashless services will be provided to all pregnant women irrespective of any caste or economical status including normal deliveries and caesarean operations and to sick infants (from birth to 1 year of age) in all 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 infant. Besides this, 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 infants up to 1 year, 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, between facilities in case of referral and also Drop Back from Institutions to home after discharge from the Govt. facility. Free Entitlements for Sick Infants till 1 year 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, between facilities in case of referral and Free drop Back from Institutions to home.
MATRI SHISHU SURAKSHA YOJNA (MSSY):
This is a new scheme to be implemented through Directorate of Family Welfare, Govt. of NCT of Delhi and will be funded by Department for the Welfare of SC/ST/OBC/Minorities, Delhi. Under this scheme financial assistance of Rs.1000/- will be given to poor pregnant SC woman of Delhi during 3rd trimester of pregnancy for providing nutritional support to the pregnant woman. It will prevent under nutrition and anemia in pregnant women thereby reducing pre-mature and under weight babies thus reducing both Maternal and Neonatal Morbidity and Mortality
Adolescent Health
Adolescents (10-19 years) represent over one-fifth of the population. During this transition period they undergo physical, emotional, social, behavioral and reproductive changes. This in turn may have serious social, economic and public health implications. It is imperative to address these issues at the appropriate time by skilled personnel as they are the future human resource of the country. 70% of the adulthood morbidity and mortality can be prevented by right kind of behavior and habits during this phase of life. Since adolescents are not a homogenous group, flexible and need based interventions are called for. Delhi state is committed to the cause of Adolescent Health and is imparting Adolescent Health services through 291 Adolescent health clinics named as “DISHA (Delhi Initiative for Safe Guarding Health of Adolescents” clinics. These services are being provided between 8:00 A.M. to 2:00 P.M. on all working days and in a dedicated manner every Saturday from 12.00 to 2.00 p.m.
The Services provided are an amalgamation of Preventive, Promotive, Curative and Referral services on Growth and development, Sexual & Reproductive Health, Nutrition, Contraception and Behavioral issues. In order to address their issues in a non-judgmental, empathetic and holistic manner these clinics have been mainstreamed in an integrated manner in already existing Health care delivery units- dispensaries, hospitals and M&CW centers. Adolescent Health Services are being catered to both married and unmarried adolescents.
Weekly Iron & Folic Acid Supplementation Programme (WIFS)
This program entails administration of IFA tablet free of cost every Wednesday once a week for 52 weeks in a year. The target beneficiaries are school going boys and girls of 6th to 12th class enrolled in Govt./Govt. Aided/NDMC schools and cantonment board schools and out of school Adolescent girls (10-19 year) in Anganwadi Centres. This tablet has to be swallowed with water after meals (not to be chewed). The department is entrusted with the implementation of WIFS Programme in Anganwadi Centres through ICDS Project.
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 law is governed by 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
Capacity building is an important intervention for successful implementation of any health program. Health & Family Welfare Training Centre (H&FWTC) is a State Level training institute under the Directorate of Family Welfare situated in Saraswati Vihar. The training centre enhances knowledge and skills by imparting trainings to various categories of health functionaries of different agencies like Delhi Govt., MCD, NDMC, CGHS, ESI, NGO’s and Railways etc. The skill based training programs are conducted in collaboration with major hospitals of Delhi Govt. Trainings are conducted on all the five components under the Reproductive and Child Health Program, i.e. Maternal Health, Child Health, Population Stabilization, Adolescent Health and RTI/STI’s. The various trainings conducted under each component are as under:-
1. Maternal Health:-
a) Basic Emergency Obstetric Care (BEmOC) for Medical Officers.
b) Skill Birth Attendant Training (SBA) for para medical Workers.
c) Medical Termination of Pregnancy (MTP) for Medical Officer.
2.Child Health:--
a) Safe Immunization Program (SIP) for Medical Officers and Paramedics
b) Infant and Young Child Feeding Practice (IYCF) for Medical Officers and Paramedics..
c) Integrated Management of Neonatal and Childhood Illnesses (IMNCI) for Medical Officers and Paramedics.
d) Facility Based IMNCI for Medical Officers..
e) Navjaat Shishu Suraksha Karyakram (NSSK) for Medical Officers and Paramedics..
f) Severe Acute Malnutrition (SAM) for Medical Officers.
3.Population Stabilization:-
a) Lap Sterilization Training for operating team.
b) No-Scalpel Vasectomy (NSV) for Medical Officers.
c) Alternate Methodology in IUCD insertion (Interval and Post-Partum) for Medical Officers and Paramedical workers.
d) IUCD 375 for Medical Officer, AYUSH Doctors and Paramedical workers.
4. Adolescent Health:--
a) Adolescent Reproductive and Sexual Health Training Program for Medical Officers
b) Adolescent Reproductive and Sexual Health Training Program for Paramedical workers.
5. RTI/STI:--
a) Training on RTI’s/STI’s for Medical Officers.
b) Training on RTI’s/STI’s for Paramedical Workers.
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 Family Welfare 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 under (CSS) Family Welfare Scheme in the state of Delhi for implementation of Family Welfare programs in various un-served/poorly served areas. Various responsibilities of DFW are to release grants, logistics, monitor, facilitate quarterly meetings and training of the staff for efficient and effective implementation of Family Welfare Programmes.
Mass Education Media Department
Publicity being the back-bone of any Public Health Programme, MEM Section in consultation with respective State Program Officer & Departmental IEC Committee plans, develops, distributes and executes the overall awareness generation activities utilizing various modes to ensure that public Health/Welfare Programs do reach to the target beneficiary and the purpose/objective of the programme is achieved.
Grant-in-Aid is provided to number of NGOs under (CSS) Family Welfare Scheme in the state of Delhi for implementation of Family Welfare programs in various un-served/poorly served areas. Various responsibilities of DFW are to release grants, logistics, monitor, facilitate quarterly meetings and training of the staff for efficient and effective implementation of Family Welfare Programmes.
MEM section ensures focus on Inter Personal Communication (IPC) & other on-ground activities like- Folk Media, Community Media & outdoor publicity.
Section also puts a lot of emphasis on community & tradition media like Nukkad-Natak, Magic & Puppet Shows through the agency of Pvt. registered troupes empanelled by Song & Drama division, GOI.
During the current & coming Financial Year the section plans to focus on strengthening the monitoring & evaluation activities which would include visits to health facilities across the agencies, objective evaluation of behavioral change among the beneficiaries/target group and is planning to get BCC indicators included in the HMIS portal system of GOI.
MEM section is also looking to strengthen the systematic & judicious inclusion of “Influencers” who can contribute in effective delivery of messages.
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 & CPA-DHS).
Monitoring & Evaluation
The directorate collects, compiles, analyses the information/data regarding family welfare activities undertaken by the health providing agencies.
MTP ACT