FAMILY PLANNING

Action Plan for

2011-12
Date: 20th April 2011

Presented by:
Dr. P.N. Bora
State Programme Manager
NRHM, Assam
Indicator Assam India

480 333 254

MMR (Source 2004-06, (Source 2009, (Source 2004-
RGI) CES, RRC-NE) 06, RGI)

61 46 53
(Source SRS,
(Source SRS, RGI, (Source 2009,
IMR January 2011) CES, RRC-NE)
RGI, October
2009)

2.6 2.6
TFR (Source RGI, 2009)
(Source RGI,
2009)
Sl. Total unmet need
District For spacing (%) For limiting (%)
No. (%)
1 Barpeta 23.7 6.3 17.4
2 Baska 20.9 4.2 16.7
3 Bongaigaon 36.8 6.7 30.1
4 Cachar 23.7 5.4 18.3
5 Chirang 27.4 7.5 19.9
6 Darrang 15.6 5.2 10.4
7 Dhemaji 20.5 6.3 22.3
8 Dhubri 37.2 10.1 27.1
9 Dibrugarh 32.0 7.4 24.6
10 Goalpara 20.5 5.8 14.7
11 Golaghat 47.0 8.6 38.4
12 Hailakandi 21.4 5.6 15.8
13 Jorhat 22.7 5.9 16.8
14 Kamrup Metro 30.9 6.5 24.4
Sl. Total unmet need
District For spacing (%) For limiting (%)
No. (%)

15 Kamrup Rural 23.3 4.5 18.8

16 Karbi Anglong 16.2 2.6 13.6
17 Karimganj 26.3 6.6 19.7
18 Kokrajhar 32.8 8.5 24.3
19 Lakhimpur 36.6 9.2 27.4
20 Morigaon 34.4 9.2 25.2
21 N.C.Hills 23.3 4.2 19.1
22 Nagaon 21.5 5.7 15.8
23 Nalbari 21.2 6.4 14.8
24 Sivsagar 30.0 5.2 24.8
25 Sonitpur 32.1 7.1 25.0
26 Tinsukia 30.5 8.0 22.5
27 Udalguri 14.5 3.9 10.6
Assam 24.3 5.8 18.5
District wise Population & Decadal Growth Rate
Decadal Decadal
Sl. Population Population (as Increase in
District Growth Rate Growth Rate
No. (as per 2001) per 2011) Poplulation
(1991-01) (2001-11)
1 Dhubri 15,66,396 19,48,632 23.40 24.40% 3,82,236
2 Morigaon 7,76,256 9,57,853 21.30 23.39% 1,81,597
3 Goalpara 8,22,035 10,08,959 23.10 22.74% 1,86,924
4 Nagaon 23,14,629 28,26,006 22.30 22.09% 5,11,377
5 Hailakandi 5,42,872 6,59,260 20.90 21.44% 1,16,388
6 Barpeta 13,94,755 16,93,190 18.50 21.40% 2,98,435
7 Karimganj 10,07,976 12,17,002 21.40 20.74% 2,09,026
8 Dhemaji 5,71,944 6,88,077 18.90 20.30% 1,16,133
9 Cachar 14,44,921 17,36,319 18.70 20.17% 2,91,398
10 Bongaigaon 6,12,665 7,32,639 12.20 19.58% 1,19,974
11 Darrang 7,59,858 9,08,090 15.80 19.51% 1,48,232
12 Kamrup ( M ) 10,59,578 12,60,419 25.80 18.95% 2,00,841
13 K-Anglong 8,13,311 9,65,280 22.60 18.69% 1,51,969
District wise Population & Decadal Growth Rate
Decadal
Sl. Population Population (as Decadal Growth Increase in
District Growth Rate
No. (as per 2001) per 2011) Rate (2001-11) Poplulation
(1991-01)
14 Lakhimpur 8,89,010 10,40,644 18.30 17.06% 1,51,634
15 Kamrup (R) 13,11,698 15,17,202 25.80 15.67% 2,05,504
16 Sonitpur 16,65,125 19,25,975 17.80 15.67% 2,60,850
17 Tinsukia 11,50,062 13,16,948 19.50 14.51% 1,66,886
18 N.C.Hills 1,88,079 2,13,529 23.50 13.53% 25,450
19 Dibrugarh 11,85,072 13,27,748 12.40 12.04% 1,42,676
20 Golaghat 9,46,279 10,58,674 14.20 11.88% 1,12,395
21 Nalbari 6,89,053 7,69,919 12.00 11.74% 80,866
22 Chirang 4,33,061 4,81,818 12.20 11.26% 48,757
23 Baksa 8,57,947 9,53,773 12.00 11.17% 95,826
24 Udalguri 7,58,746 8,32,769 15.80 9.76% 74,023
25 Sivasagar 10,51,736 11,50,253 16.00 9.37% 98,517
26 Jorhat 9,99,221 10,91,295 15.80 9.21% 92,074
27 Kokrajhar 8,43,243 8,86,999 15.10 5.19% 43,756
Assam 1,29,68,332 1,45,67,546 18.90 12.33% 15,99,214
Population of 2011 : 13,27,748

EC (17% of Projected Population) : 225717

Unmet Need of Dibrugarh District

: 32% of Eligible Couple = 72229

Unmet need for Limiting of Dibrugarh District

: 24.6 % of Unmet Need of Population
= 17768 i.e target of sterilization

Unmet need for Spacing of Dibrugarh District

: 7.4 % of Unmet Need of Population
= 5345 i.e target of IUCD

Hence ELA will be calculated as per resources.

Important Issues to be taken up by the
districts

 District level Quality Assurance Committee (FP) chaired by DC

/Principal Secretary to be made functional
 Doctors trained in Laparoscopic Sterilization / Mini lap / PPS / NSV
are to be empanelled by Jt. DHS after getting certificate from the
DQAC in order to get benefit of Insurance scheme.

 To ensure uninterrupted supply of Nirodh / Oral Pills / E-Pills up

to the village levels.

 Claim for FP Insurance Scheme is to be submitted within one week

after the incidence.

 Monthly updating of eligible couple register at SC level and

thereby conducting FP Counseling to the couple who are not
using any modern FP methods are to be ensured.
Contd….
Important Issues to be taken up by the
districts
 JSY Beneficiaries are to be motivated for PPS / Minilap in the FRU and
district where trained Doctors are there.

 To Prepare District Level Action Plan indicating fix strategy and camp
approach for sterilization (male and female) with schedule (date, place and
time).

 To ensure fixed day LS / PPS / Mini Lap / NSV operation every week in
district hospital, SDCH and FRUs. Every two months CHC/PHC

 To ensure IUD insertion every week in all health institution and in the Sub
center in Govt. building where trained GNMs/ANMs are there.

 Regular Male & Female sterilization camps at Block PHC, CHC, FRU
bimonthly.
Important Issues to be taken up by the
districts

 TE and other private hospitals are to be accredited

for family planning service, Specially for PPP Tea
Garden ANM/GNM are to be trained for IUCD
insertion, and after training IUCD Kits are to be
provided.

 MO, GNM and ANM of Boat Clinic are to be trained

for IUCD insertion and after completion of training
IUCD insertion Kit is to be provided
STRATEGY 1

To raise awareness amongst the couples and

communities about the advantage of contraceptives and
small family.
Activities
Communication messages through Print Media, electronic
media working jointly by DEMO, Dy DEMO & DME.
Information board for Male and Female Sterilization
indicating compensation for the acceptor and motivator are to
be placed in every institution where NSV and Female
sterilization are performed.
IPC by ASHA / ASHA Facilitator / ANM in VHND and also
during Home visit and OPD at Sub Center.
In all District Hospital a separate room naming “TIPS of
Happy Family” has to be established.
STRATEGY 1
To raise awareness amongst the couples and communities
about the advantage of contraceptives and small family.
Activities
Updating of eligible Couple Register at Sub Center level by
ANM and ASHA during Home Visit on Monday, Thursday and
VHND and motivating the couple to adopt FP methods and to
attend Sub center on Tuesday and Friday for counseling.

Counseling of the EC who had not adopted FP methods is to

be done on Tuesday and Friday at SC and thereby enlisting
there names as per their choice of FP method viz., IUCD, Oral
Pill, Permanent Method(LS, Minilap, PPS, NSV) etc. Enlisted
names for a permanent method are to be submitted to i/c
BPHC at the end of the month so that He/She can arrange
camps. IUCD and Distribution of Oral Pill, E-Pill, Nirodh is to
be done at SC level.
STRATEGY 2

To incorporate Family Planning in Ante Natal

Clinic, Post Natal Clinic and MCP Session.
Activities
During ANC 3rd and 4th visit examination of the breast of
the pregnant women will be made mandatory to exclude
crack nipple and retracted nipple.
Motivation and counseling of the pregnant women
during ANC and PNC to initiate breast feeding within
half an hour after delivery and to continue exclusive
breast feeding upto six months. This LAM method will
prevent pregnancy for 5 months.
Counseling of the mother after delivery to adopt PPS
within 48 hrs. of delivery.
STRATEGY 3

To Increase the number of service delivery

points.
Activities
ASHA is acting as FP depot holder having wider basket of
contraceptives (OCP, ECP, and Nirodh). Regular replenishing of the
contraceptives are to be ensured by DCM, BPM, ABPM and ASHA
Facilitator. DCM will monitor the activity.
Fixed day (Friday) IUD insertion will have to be provided in Civil
Hospitals and CHC/ FRU / BPHC/ PHC and Sub Center. IUD Kit is to
be provided after completion of training
Facilities and Training for insertion of IUCD and Contraceptive
Distribution will be made available in the Boat Clinic/PPP T.E. during
2011-12.
STRATEGY 3

To Increase the number of service delivery

points.
Activities

To confirm retention of Copper-T, all ANMs are directed to

examine the thread of Copper-T after 3 months, 6 months
and 12 months. ASHA will bring the beneficiaries to the
institution where Copper-T was inserted and not to the
other institution for which ASHA will get the incentive.

MTP followed by IUD insertion will be ensured in all Health

Institutions except sub center.
STRATEGY 4

Improve the service delivery to provide quality Family

planning services by capacity building.
Activities
• Minilap (PPS) will be conducted in all DHs/ SDCHs/ CHCs/
FRUs. It is expected that at least 5% of pregnant women
coming for institutional delivery and availing JSY benefit will be
motivated for Post partum sterilization.

• Fixed day FP service (LS/ Mini Lap / PPS / NSV / IUD

insertion / Contraceptives) on Tuesday in all DH, SDCH, FRU
and CHC where trained service provider are there. On that day,
FP sterilization will get priority than other operation except
emergency cases. Information board will be displayed
regarding these activities in all BPHCs so that FP acceptors
can be sent to the fixed day sterilization.
STRATEGY 4

• Fixed day FP service (LS/ Mini Lap / PPS / NSV / IUD

insertion / distribution of condom / EC pill) on Thursday in 5
identified centers where service provider are not there. Service
providers will be mobilized from DH or from other Institutions
where available.

• District Administration (ADC- Health) will organize one

special Family Planning Camp for 3 days, preferably in the
CHC for performing FP sterilization (LS/ Mini Lap / PPS / NSV /
IUD insertion / distribution of condom / EC pill) monthly.
Extensive publicity to be given 15 days prior to the camp
involving all Block level healthcare provider including ASHA,
ASHA Facilitator, DFPC and DCM.
STRATEGY 5

Camp Approach
Activities:
– Block PHC and CHC where fixed day sterilization
services are not possible will organise LS or NSV
Camp once in two months. The enlisted beneficiaries at
the SC are to be collected by i/c, BPHC every month.
STRATEGY 6

To Improve NSV Programme

Activities:
- Extensive Media Coverage of the sensitization meeting
and NSV / other service camps
– By Changing the attitude of the officials
– Try to bridge the gap between the officials and common
people.
– Starting of Intensive Training Programme
• Doctors from Medical Colleges
• M.O.s from District Hospital and PHCs.
• Awarded Certificate for District Trainers and State
service provider
STRATEGY 6

Public Awareness Meetings on Population

Explosion.
•Involvement of religious leaders and community
leaders.
•Involving the women
•Involving public representatives
•Involvement of Media personals
•Involvement of local NGOs
•Involvement of Opinion leaders
STRATEGY 6

Agenda for Public Awareness Meetings.

– Deleterious impact of Population
Explosion.
– Religious views regarding conservation of
nature and ecology.
– Education, Particularly women education.
– Empowerment of the women.

Contd…
STRATEGY 6

Agenda for Public Awareness Meetings.

– Childhood marriage
– Multiple marriage
– Breast feeding for birth spacing (LAM
method).
– Religious views for Family Planning,
particularly Islamic views.
– Family Planning in Islamic Countries.
Comparative performance of NSV
Comparative performance of NSV
Comparative performance of NSV
DISTRICT Difference

Nagaon -1207
Barpeta -600
Udalguri -524
Cachar -519
Sonitpur -480
Darrang -260
Lakhimpur -231
Dhemaji -226
Tinsukia -156
Karimganj -145
Kamrup(R) -140
Nalbari -100
Sivasagar -75
Morigaon -69
Kokrajhar -60
Bongaigaon -55
Dhubri -43
Comparative performance of NSV

Kamrup (M) 2843

Dibrugarh 289

Baska 179

Hailakandi 155

Jorhat 136

Golaghat 58

K-Anglong 56

Goalpara 31

Chirang 9

N.CHills 0
ACTIVITES TO BE PERFORMED AT THE
DIFFERENT LEVELS

Village Level

–ASHA , ASHA Facilitator, AWW, ANM will conduct Family

Planning Counseling to the eligible couples after updating the
issue register in the VHND and also at the Subcenter at Tuesday
and Friday.

–The updating of Eligible Couple is to be done during Home Visit by

ANM along with ASHA on Monday and Thursday and also in VHND.

–IEC / BCC Materials are to be made available for ASHA, AWW and
ANM.

–ASHA will act as a depot holder for Condom, Oral Pill and E-Pill.
Regular replenishment of the contraceptives on exhaustion is to be
ensured by ASHA Facilitator, DCM and Pharmacists of the Block.
Sub Center Level

Counseling and motivation of the eligible couples who had

not adopted any FP methods, identified during updating of
EC register is to be done on Tuesday and Friday. Enlisting
of Eligible Couple as per their chosen method is to be
done and list is to be sent to BPHC for organising camp for
LS and NSV. Copper-T, Oral Pill, Condom, E-Pill are to be
distributed in the SC itself.

JSY Beneficiaries are to be motivated for accepting Post

Partum Sterilization (Mini Lap) and refer the acceptor to
FRU/CHC/SDCH/DH where PPS can be done.
Sub Center Level

During Health Day disadvantages of early marriage (too

early, too many and too frequently) are to be explained
especially to adolescent girls with the help of opinion and
religious leaders of the village.

On Tuesday and Friday of every week Family planning

services including IUD Insertion (after training) are to be
provided in the Sub Center itself.

All contraceptives (Condoms, Oral Pills, E-Pills) are to be

made available throughout the year.
24 X 7 PHC Level Excluding BPHC

Fixed day for family planning counseling along with Ante Natal and
Post Natal check up is to be ensured.
JSY Beneficiaries are to be motivated for accepting Post Partum
Sterilization and refer the acceptor to FRU/CHC/SDCH/DH where
PPS can be done.
All contraceptives (Condoms, Oral Pills, E-Pills) are to be made
available throughout the year.
A day is to be fixed for IUD insertion.
All GNM and ANM will have to be trained in alternate methodology of
Copper-T 380A
Doctors trained in MTP will perform safe abortion using MVA/EVA
IEC materials for NSV is to be distributed among the male member of
the eligible couples
One NSV workshop cum training for MO is to be organised registering
at least 20 acceptors (State Level Trainers is to be invited).
Block PHC Level

The list of ANM trained for IUD insertion are to be prepared and target
is to be given after calculating ELA of a particular Sub Center. The
ANM working in the Sub Center having Govt. Building are to be
selected for IUCD Training.

Method and Technique of Counseling are to be taught to the ANM in

the PHC level Review meeting engaging DME, DFPC and Medical
Officers.

The list of Beneficiaries for LS and NSV are to be collected every

month from Sub Centers.

Camps for LS and NSV are to be organised at the interval of 2

months. If facilities for LS camp is not available in the BPHC, the CHC
under the Block is to be selected for LS Camp. Extensive IEC is to be
done 15 days prior to the camp. Beneficiaries listed in the Sub Center
are to be visited by ANM, ASHA, ASHA Facilitator to motivate for
Sterilization and also to inform the date of sterilization camp.
Block PHC Level

Fixed day static- One day in a week is to be fixed for

Family Planning activity in the BPHC for IUD insertion
and distribution of contraceptives (Condoms, Oral Pills, E-
Pills).
To confirm retention of Copper-T, all ANMs are directed to
examine the thread of Copper-T after 3 months, 6 months
and 12 months. ASHA will bring the beneficiaries to the
institution where Copper-T was inserted and not to the
other institution for which ASHA will get the incentive.
Record Keeping:
The Reporting Format (Next Slide) is to be submitted along with HMIS report .
To fill up this format separate registers for Male and Female Sterilization, IUD
with the columns as indicated in the reporting format are to be maintained
strictly.
Block PHC Level
Supervision and Monitoring: All ANM in the Sub Center must
complete updating of eligible couple register and listing of
beneficiaries monthly. This process is to be regularly monitored by
BEE, Health Educator, LHV, BPM, ABPM.

Follow up of FP Beneficiaries is mandatory. The responsibility is to be

fixed to the ANM of the Sub center. She will have to visit all the FP
Beneficiaries of her area on Thursday. This activity is to be
supervised by LHV, Health Educator, BPM, ABPM and BEE. Failure
cases, cases with complication after sterilization and death cases are
to be enlisted and reported immediately so that benefit of insurance
scheme can be provided in stipulated time.

VHND is the best platform for IPC and counseling of eligible couple.
DCM, DME, BPM, ABPM, BEE, Health Educator will monitor and
guide ANM how to perform IPC and Counseling to the Eligible Couple
by visiting VHND regularly
Reporting of FP Activities from April 2011 as per
following format
REPORT ON No. of Camps (Male and Female Sterilization)
YEAR:
Month:
Total Cumulative Female Sterilization Total Cumulative
NSV Camps during
Sl BPHC for the Year Camps during the for the Year
the Month
Month

1 2 3 4 5 6

FAILURE & DEATHS AFTER STERILISATION

YEAR:
Month:
Total death
Total Conception/Failure
reported after the
after sterilization
Sterilization
BPHC Death/Failure Audit and
during Cumulativ Action taken , if any
during the Cumulative
the e for the
Month for the Year
Month Year

         
Reporting of FP Activities from April 2011 as per
following format

Family Planning Reporting

During the Cumulative since
No. of NSV conducted
reporting month April

At fixed day static

No. of acceptors with 1-2 children    

No. of acceptors with 3 children    

1
No. of acceptors with 4 or more children    
Total    
At NSV Camp
No. of acceptors with 1-2 children    

No. of acceptors with 3 children    

No. of acceptors with 4 or more children    

Total    
Reporting of FP Activities from April 2011 as per
following format
During the reporting Cumulative
No. of Female Sterilization (Lap. Sterilization)
month since April
At fixed day static
No. of acceptors with 1-2 children    
No. of acceptors with 3 children    
No. of acceptors with 4 or more children    
Total    
At LS Camp
No. of acceptors with 1-2 children    
No. of acceptors with 3 children    
No. of acceptors with 4 or more children    
Total    
2
During the reporting Cumulative
No. of Female Sterilization (PPS)
month since April
At fixed day static
No. of acceptors with 1-2 children    
No. of acceptors with 3 children    
No. of acceptors with 4 or more children    
Total    
During the reporting Cumulative
No. of Female Sterilization (Minilap)
month since April
At fixed day static
No. of acceptors with 1-2 children    
Reporting of FP Activities from April 2011 as per
following format
No. of acceptors with 3 children    
No. of acceptors with 4 or more
   
children
Total    
 
During the
No. of IUCD (Copper-T) Acceptors Cumulative since April
reporting month
No. of acceptors with 1 children    
No. of acceptors with 2 children    
No. of acceptors with 3 children    
3 Total    
No. of non retention of Copper-T in
During the
Acceptors confirmed after examination Cumulative since April
reporting month
of thread
After 3 months    
After 6 Months    
After 1 Year    
During the
  Cumulative since April
reporting month
4 Oral Pill User    
5 C.C. User    
FRU/CHC Level

Fixed day for family planning counseling along with Ante Natal and
Post Natal check up is to be ensured.
JSY Beneficiaries are to be motivated for accepting Post Partum
Sterilization.
All contraceptives (Condoms, Oral Pills, E-Pills) are to be made
available throughout the year.
A day is to be fixed for IUD insertion.
Fixed day female sterilization (LS and PPS) is to be observed strictly
Doctors trained in MTP will perform safe abortion upto using
MVA/EVA
IEC materials for NSV is to be distributed among the male member
of the eligible couples
One NSV workshop cum training for MO is to be organised
registering at least 20 acceptors (State Level Trainers is to be
invited).
MO-MBBS are to be trained for conducting mini lap (PPS)
District Hospital/ SDCH Level

– One separate room is to be allotted in the outdoor complex

for family planning services where a sign board mentioning
“Tips for Happy family” should be placed in front of the
room. In that room family planning services are to be
rendered including distribution of contraceptives. One staff
nurse is to be engaged in that room during the OPD hours
(8:30 AM – 1:30 PM) in working days and (8:30 AM to
12:00 PM) in Sundays and Holidays.

Contd..
District Hospital/ SDCH Level

Fixed day for family planning counseling along with

Ante Natal and Post Natal check up is to be ensured.
– JSY Beneficiaries are to be motivated for accepting Post
Partum Sterilization.
– A day is to be fixed for IUD insertion.
– Fixed day (once a week) female sterilization (LS , PPS
and NSV) is to be observed strictly
– Doctors trained in MTP will perform safe abortion upto
using MVA/EVA
– IEC materials for NSV is to be distributed among the
male member of the eligible couples
– MO-MBBS are to be trained for conducting mini lap
(PPS)
District Level

Uninterrupted supply of contraceptives upto the Village level-

As the district Stores for FP materials is maintained separately by
storekeeper, Addl. CM&HO(FW) will have to utilize the service of
District Drug Store Manager and Pharmacist in the BPHCs.
Wide Publicity of the new compensation package (mentioned
below) is to be given in the entire district. An information board is to
be hanged in each Health Institution where Male and Female
Sterilization is done indicating compensation of acceptors and
motivators. DME, DEMO or Dy. DEMO will design the board and
will identify the Health Institution of the district.
Sensitization meeting for population explosion with special
preference to male participation is to be organised in the remote
areas where acceptance of FP methods are less. District Family
Planning Bureau have to take the initiative.
Contd…
District Level

All guidelines are to be made available to all the

institutions upto 24 X 7 PHC level. Important Guidelines
like Standards for Female and Male sterilization Services
(Oct. 2006), Manual for Family Planning Insurance
Scheme (Jan 2008) and MTP Rules.
Compensation Money are to be made available in the
institutions, where LS, PPS and IUD insertion are
conducted. 50% of the camp money is to be released to
the Block PHC at least 15 days ahead of the camp for
preparation of Camp. MO, i/c PHC must ensure
participation of required no. of acceptors as schedule.
Regular Monitoring by district and Block Monitoring Team
are to be ensured.

Contd…
District Level

To provide training load of LS / Mini Lap / MTP / IUD

insertion.
One day district workshop is to be organized by the
District Family Welfare officials involving DC, Joint DHS,
President- Zila Parishad (PRI), Opinion leaders, MNGO,
CDPO, Mahila Samitee, to sensitize them on the role of
male participation and promotion of NSV.
An implementation team for NSV will have to be
constituted with DC, Joint DHS, Addl. CM&HO, DEMO/
Deputy DEMO, District NSV trainer.
Tea Garden Hospitals and Pvt. Hospitals where facilities
are available are to be accredited for family planning
services
Procedure of calculating equivalent sterilization
Against Condom user and Oral Pill/IUCD User

Condom

Net Condom user = Total pieces of condom distributed- Total

pieces of condoms distributed to vasectomy acceptors
Procedure of calculating equivalent sterilization
Against Condom user and Oral Pill/IUCD User

Oral Pill

IUCD
Thank you