Health Facilities
  Schemes/Activities of the Department
  Major Schemes Family Welfare
  Post Partum PAP Smear testing facility programme
Sterilization Bed Scheme
Medical Termination of Pregnancy
Third India Population Project.
Coastal Health Project
Water Shed Project
Social Safety Net Scheme
Baby Friendly Hospital Initiative
First Referral Units
Family Welfare Award
Community Award
Target Free Approach
Integrated Child Development Services
Information Education and Communication (IEC)
Community participation and involvement
Mahila Swasthya Sangh
World Population day
SCOVA (Standing Committee on Voluntary Action)
Swathya Mela
Special School Health Check-up Programme
Pulse Polio Immunisation Campaign
Target Free Approach in Family Welfare
  Prevention of food adulteration
  Health Transport Organisation
  Insurance Medical Service
  National Aids Control Programme
  Blood Safety
  STD Control Programme
  Information,Education &Communication
  Medical Education
  R C C
  SCT Institute of Medical Sciences
  Health Status of Kerala
  Kerala Health Research & welfare Society
  Government Orders
  Vital Statistics

Major Schemes Implemented under Family Welfare

All India Hospital Post Partum Programme

The programme was started in 1969 with the main objective of maximising the extent of effective contraception among the target population in the community. Presumably it caters to a large number of confinement / abortion cases adopting a maternity centred hospital bases approach. Under this programme post partum centres are functioning in 22 District level medical institutes, which include 5 medical colleges and 4 private institutions. All these institutions are provided with a set pattern of inputs in the form if staff and equipment including at least 6 bedded sterilization ward and operation theatre. With a view to providing maternal and child health and also family welfare services in rural and semi urban areas the programme was extended to taluk levels and intermediary hospitals and at present there are 60 such sub-divisional units in the state including one Ayurveda Hospital at Poojappura in Thiruvananthapuram city.

Post Partum PAP Smear testing facility programme
The programme with the aim of early detection of cervical cancer among women irrespective of the fact that they are accepted or not is being implemented through medical colleges at Thiruvananthapuram, Alappuzha, Kottayam and Kozhikode.

Sterilization Bed Scheme
This scheme for the reservation of beds in hospitals run by Government, Local bodies and voluntary organisations was introduced in 1964, so as to provide immediate facilities for tubectomy operation. There are 128 such beds in 25 hospitals run by voluntary organisations as against 393 beds in the Government sector in 10 districts.

Medical Termination of Pregnancy
The MTP act of 1971 which came into force on 1-4-1972 primarily aims, as a health care measure, at eradicating a large number of criminal and clandestine abortions, thereby considerably reducing mortality and morbidity among pregnant women. A certifying board was constituted in May 1972 with Director of Health Services as Chairman for authorising the doctors and institutions to do MTP. Services are rendered by qualified and trained doctors in well equipped Government hospitals and approved private institutions. There are 564 such institutions in 1996 of which 343 are Government and 221 are private. A separate MTP cell was established at the Directorate of Health Services in the early 1990’s for expansion of MTP services.

Third India Population Project.
India Population Project III was one of the area specific projects sanctioned under soft loan for Kerala for a period from 1985-90 by World Bank.

Growth rate of population if IPP districts are:
















The state had successfully implemented the IPP III in 4 backwards districts of Idukki, Wayanad, Palakkad and Malappuram with the objective to control birth rate on one side and to improve the health condition of the infants and mothers on the other through multiple devises according to norms laid down under National Family Welfare Programme.

Coastal Health Project
The Kerala Coastal Health Project was launched during the year 1994 with a view to improving the health care delivery system available at present in the coastal region of Kerala which lags behind in the overall health status of the state. This is a time-bound project for 4 years from 1994 to 1997. The project is implemented in coastal panchayats of 9 districts viz. Kasargode, Kannur, Kozhikode, Malappuram, Thrissur, Ernakulam, Alappuzha, Kollam and Thiruvananthapuram.

The major objective of the project is the qualitative improvement of the health delivery system through systematic utilisation of additional resources provided and with the active participation of the local community.
As on 31-3-1997 under this project 169 coastal institutions were included. Minor civil works, supply of machine and equipment, ventilators and cardiac monitor and operation theatre equipments for major hospitals in the coastal districts etc. Come under the project.

Water Shed Project
The project is being implemented in the water shed areas for the development of rain fed areas. Villages are identified in various districts under each PHC. In certain areas under the scheme a sum of Rs.5000/- can be utilised for the welfare of the people. The purpose of the fund is to utilise this for purchasing necessary medicines and other facilities for CSSM and for the propaganda of family planning methods among the people residing in the water sheds. The fund will be utilised by the committee Mithra Krishak Mandal consisting of five members selected from each village.

Social Safety Net Scheme
The scheme is being implemented in the poor performing district Malappuram through World Bank assistance with a view to reducing the high maternal mortality rate by increasing institutional deliveries and providing care to high risk pregnancies, upgradation of facilities like operation theatre, labour room, observations ward and quarters and providing generator, running water supply, ambulance etc.

Baby Friendly Hospital Initiative
Baby friendly hospital initiative is a WHO / UNICEF sponsored global programme launched in 1992 for promoting, protecting and supporting exclusive breast feeding. The programme is hospital based and aims at training of health personnel for properly motivating and correctly initiating mothers into breast feeding.

In Kerala, the programme was sponsored by UNICEF from 1993. Under this programme, Government and private hospitals are identified., assessed and declared as baby friendly. So fare 209 hospitals are declared as baby friendly. It is hoped that the new programme will go a long way in promoting early breast feeding which is turn will pave the way for child survival especially during early months of life.

First Referral Units
Essential obstetric care for all pregnant women early detection of complicates and emergency obstetric care are the three main strategies for safe motherhood. The most important service for reducing the maternal death is the provision of emergency care for women with obstetric complications. The FRUs plays vital role in reducing the maternal mortality by providing timely emergency care to women and obstetric complications. At present there are 71 FRUs attached to various hospitals and measures are taken to strengthen the facilities in these. Skill development training to FRU staff is also carried out in the medical colleges.

Family Welfare Award
The scheme of family welfare award to family welfare workers and institutions was started during 1980-81 and was revised in 1986-87. The award was given in cash for the best performance both the state level and district level.

Community Award
The Scheme was introduced in 1996-97. The award is in cash and for decreasing infant mortality rate, crude birth rate, child mortality rate and maternal mortality rate. Villages are selected and award presented to village pradhans. The same is utilised for developmental activities in the village.

Target Free Approach
From April 1st 1996 the Family Welfare Programme is implemented all over India on the basis of target free approach. Government of India has recognised that contraceptive target and cash incentive have resulted in the inflation of performance statistics and the neglect of quality of service. The change over to target free approach necessitates decentralised planning in consultation with the community at the grass root level to provide quality services. Government of India did not fix contraceptive targets for Kerala and Tamilnadu during 1995-96 and in other states one or two districts were made target free. In target free approach importance is given to client satisfaction and community involvement. The National Family Welfare Programme has changed to Reproductive and Child Health (RCH), which includes Family Planning, CSSM, prevention and management of RTI/STD and HIV/AIDS and a client-centred approach to Family Welfare and Health Care. The target free approach has since been renamed as Decentralised Participatory Planning Approach.

Though the present infant mortality rate is 16 per thousand live births, about 65% of the deaths are neonatal, the reason for the same being low birth weight. In Kerala attention is now focused on reducing the neonatal and maternal death as far as possible, by giving proper education to adolescents, detection and treatment of disease at an early stage, giving proper treatment and increasing the nutritional status.

The strategies adopted by WHO for 2000 AD are :

1. Improved status and education for women

2. Improved primary health care

3. Improved family planning service; so as to:

i. ensure that every pregnancy is intended and every child is wanted.

ii. Protect women from the consequences of unsafe abortion.

iii. Protect the health of adolescents and encourage responsible sexual behaviour.

iv. Bring women at least into the mainstream of development, protect their health, promote their education and encourage and reward their contribution.

The International Conference on Population and Development (ICPD) held at Cairo 1994 defined reproductive health as a state of complete physical, mental and social well being on all matters relating to the reproductive system and its functions and processes.
The concept of reproductive health is bases in holistic, life cycle approach to the health of women from adolescence to post menopausal age. It represents a chronological continuity. Reproductive health care also includes sexual health, the purpose of which is the improvement in personal relations. Problems of adolescent sexuality, HIV/AIDS and education / counselling interventions place a great deal of responsibility on family members especially parents.
The problems with respect to the health of women and children cannot be dealt with separately. They are interdependent. The reproductive health care is a move towards quality health care for the entire age period from childhood to menopause.

Integrated Child Development Services
The Integrated Child Development Services (ICDS) scheme was formulated by Government of India in 1975 against a grim background of high infant mortality rate, high levels of morbidity, high incidence of malnutrition and nutrition related diseases and low literacy rates.

Improvement of the nutritional and health status of children in the age group of 0 – 6 years proper psychological-physical and social development of the child, reduction of mortality, morbidity malnutrition and school dropouts, effective coordination of policy and implementation among various departments to promote child development, proper health and nutrition education of mothers to look after the child in normal health and nutrition needs of the child are the important objectives of the programme.
Expectant and nursing mothers, women of reproductive age group and children below six years of age the beneficiaries of the programme. Antenatal, postnatal and new born care are provided, besides nonformal education to children of 3-6 years and health and nutritional education to women of reproductive age group.
In rural areas for every 1000 population planes and 700 population in tribal area there will be one Anganwadi with an Anganwadi worker and helper. There are urban ICDS projects in a few towns and AWs under Upgraded Special Nutrition Programme (USNP) in a few towns. In addition there will be one supervisor for 20 Anganwadis on rural and 25 in urban and 17 in tribal areas. There are 113 ICDS projects in Kerala and services are provided through 17014 Anganwadis.
All children below the age of 6 are weighed periodically and weights are recorded in the growth chart. Those children who suffer from malnutrition are given special supplementary nutrition and acute cases are referred to hospitals. Adequate funds for supplementary nutrition programmes are provided in the state plans under minimum needs programmes.
Immunization against six killer diseases such as Diphtheria , whooping cough, tetanus, measles, poliomyelitis and tuberculosis is given to all infants in the project area. All expectant mothers are immunized against tetanus.
The medical officer, the lady health visitors and female health workers of the nearby Primary Health Centre provide health input for ICDS scheme. Medical check up of children in Anganwadis is also conducted periodically.

Information Education and Communication (IEC)
For accelerating the Family Welfare Programme the need for information, Education and Communication is well recognised. The success of the Family Welfare Programme depends mainly on the voluntary and widespread acceptance of the concept of small family norm. The efforts undertaken so far through mass education and media activities have helped to create almost hundred percent awareness among the people of Family Welfare.
By the constant and continuous utilisation of educational methods and media, it has become possible to remove the deep-rooted attitudes, beliefs and misconceptions which were detrimental to the acceptance of health and family welfare programmes. Strategies of different types have been evolved and implemented with a view to achieving behavioural and attitudinal changes among the resistant groups. Efforts are continued to convert the existing widespread awareness into acceptance, and use of Family Planning methods by dissemination of information and education.

Community participation and involvement
The success of implementing every programme depends on the involvement and participation of the community. Propagation of small family norm among the eligible couples, removal of misconceptions and misunderstandings are effectively done through individual contact and group approach with the participation of Non-Governmental Organisations like Mahila Samajams, Youth Clubs and similar Socio-Cultural Organisations.

Mahila Swasthya Sangh
India is committed to the twin goal of “Health for All” and ‘Net Reproduction Rate of Unity” by the year 2000. These goals are recognised to be intimately intertwined and further their achievement contributing to the improvement of the condition of women and children. It was realised that a major component of Family Welfare Programme is related to health problems of women and children and these groups are vulnerable to health disorders and diseases. In order to mobilise community participation and to create a viable support structure within the community to sensitise rural women and to increase demand for integrated Health & Family Welfare Services available, the scheme of M.S.S was launched in 1990-91 in selected districts of Kerala.
To overcome various problems like low age at marriage, risk factors during pregnancy, unsafe and unplanned deliveries and high rate of child mortality, it was desired that women may be educated, motivated and persuaded to accept programmes to increase demand for services.
The scheme called Mahila Swasthya Sangh (MSS) was designed to include some of the village level functionaries already working with Social Welfare Department and Directorate of Health Services at state level. Besides the above 10 to 15 women members of the village called “Community leaders” were to be involved with the programme.
Initially the scheme was introduced in the state in 1990-91, constituting 888 MSSS. Subsequently based upon the feed back the scheme was extended to all districts. According to the design, it was planned to constitute MSS in villages having population more than 1000 to 2000 house holds. Those C.D. Blocks which were covered by the Social Welfare Department having adult education centre under ICDS projects were involved so that co-ordination with the female functionaries of these departments is obtained effectively. The members of MSS serve as a link between the community and local health functionaries.
The programme is still continuing. The total number of MSS functioning in the state till 1996-97 is 3440.
It was decided that an evaluation should be carried out by an independent agency about the functioning of MSS and its utility during the previous years. Consequently the Institute of Management in Government has done an evaluation study and the result showed that the functioning of MSS satisfactory.
Training of Mahila Swasthya Sangh members and other grass root level functionaries at sub-centre level.
For developing communication skills, enriching the knowledge and to bring about coverage of related activities at the grass root level, training was imparted to MSS members on to topics viz. Child Survival & Safe Motherhood and spacing methods for family planning, saturation of weak areas with multimedia and local-specific interactive scheme.
IEC efforts need to be focussed and targeted for specific beneficiaries in demographically weak districts by utilising local specific folk media as interactive mode of communication. Specific and innovative cultural activities such as street plays, folk dances, dances, mimicry, puppetry, oppana were organised in identified weak districts having high CBR and IMR with the objective of creating awareness amongst all eligible couples regarding the various family welfare programme.
For saturation of weak districts, troops/registered folk parties etc. were identified to give song and drama performances, under local specific interactive scheme.

World Population day
The rapid increase in population is a cause of major concern to all developmental efforts. It is estimated that the present rate of growth of population of the country will be crossing one billion mark by the end of this century.

Keeping this in view, 11th of July every year is observed as World Population Day. The observance of the day is a grim reminder of the World Population increase which touched five billion mark on 11th July 1987. The objectives of observance of the day is to organise Mass Media Campaign and to take effective steps to bring the population growth rate to a sustainable level. All media and field organisations are to be harnessed to put the message that the only choice before humanity is to reduce the number.
Enhancement of the role of the NGOs in Family Welfare and Health sector
The Government of India policy statement on the National Family Welfare Programme spells out the need to promote Family Planning as a people’s movement. The association of voluntary organisations in the Governments’ programme ensures greater acceptability of the Family Welfare activities among the people. This is so because the voluntary organisations enjoy greater credibility and are closer to the community than the Government staff. The supplementary and complementary role played by the voluntary sector in the propagation of the small family norm is therefore vital for the success of the family welfare programme.

In order to involve voluntary organisations in the implementation of the Family Welfare Programme, and to make it a peoples’ movement, Government have evolved a policy for financial assistance to these organisations for their projects.

SCOVA (Standing Committee on Voluntary Action)
To consider applications received from voluntary organisations working at the grass-root level in the rural areas and urban slums for setting up family welfare projects relating to MCH, Family Planning, at state level, a Committee (SCOVA) consisting of State Government Officials, representatives of established Voluntary Organisations in the state and the Regional Director of Health and Family Welfare was constituted in the State.
The Committee is to recommended projects in FW from the voluntary sector for funding from the centre. The Standing Committee on Voluntary Action (SCOVA) have sanctioned model schemes for promotion of small family norm and population control by encouraging spacing methods and sterilization.

Swathya Mela
In remote and difficult areas, provision of health services particularly to the vulnerable groups have been very difficult. To ill the gaps in delivery of health services created by inadequate infrastructure, and to increase accessibility of health services to the community relating to prevention of diseases and their cure, as well as for promotion of a healthy way of life, a Mela approach has been introduced.

Wide publicity is required for ensuring a large turnout for seeking health services during these Swathya Melas.
Counselling is another area taken up n the melas. Counseling has a district advantage in leading to informed choice in contraception, assisting individuals in acting upon health information received by them, increasing access to give points of service delivery, promoting good relation between service providers and clients.

Special School Health Check-up Programme
A special school health checkup of students in primary schools was carried out in 1996 using the health workers, AWWs and Volunteers. An effective IEC campaign was organised by the State, giving emphasis to create awareness among the parents to send their wards to schools on the checkup day and to provide wide publicity regarding referral cards and referral services.

Pulse Polio Immunisation Campaign
Pulse Polio Immunisation campaign are carried in December and January. Intensive social mobilisation campaign and media announcements is a unique feature in all Pulse Polio Immunisation campaigns. Awareness is created through IEC efforts on the benefits of PPI and why fully immunized children also should receive OPV during this campaign.

Target Free Approach in Family Welfare
Communication programmes aim at generating demand and better utilisation of health and family welfare services in the community and empower people to take care of their health. Now it is being realised that the IEC programmes have to be area specific and addressed to the problems of the area. This warrants decentralised planning approach in designing IEC programme. Another important dimension of the IEC programme is based on needs of the area. The proposed IEC strategies are:

1. identify the communication needs to plan IEC activities.

2. Involve community and NGOs through unified messages.

3. Effective use of mass media for back up.

4. Strengthening inter-personnel communication.

Moving from Family Welfare to Reproductive Health

New direction in the Family Welfare Programme towards a client – oriented reproductive health approach has major implications for IEC. As is evident from the services identifying as components of an essential reproductive health packages, the range of activities which IEC must now take-up are considerably broader in scope than before. In addition to prevention of unwanted pregnancies and the promotion of childhood immunization, IEC strategies are concerned with safe abortion (Medical Termination of Pregnancy) safe motherhood, prevention and management of RTIs/STIs, sexuality and gender information education and counselling.
The goals require a strategic approach to IEC identifying meaningful segments of the target audience, promoting a number of new behaviours that are closely linked but complex, identifying messages, and using a mix of communication channels to effectively reach these various audience segments.
Thrust areas have been identified for Family Welfare Programme, for which audience-specific message and use of suitable media were to be discussed and finalised from individual, group and mass approach point of view. The situation analysis reveals the following thrust area for designing IEC Programmes.

· Reproductive Health of Adolescent girls
· Counselling of adolescents entering the reproductive age group for Family Life education
· Women’s education
· Higher age at marriage
· Early Ante-natal registration and care
· Nutrition during pregnancy and lactation
· Institutional delivery
· Vaccine preventable diseases
· Protected water supply
· Diarrhoea and ARI management
· Low birth weight
· Birth interval, birth spacing
· Medical Termination of Pregnancy
· Childhood disability
· Breast feeding.


Designed & Maintained by: C-DIT, Thiruvananthapuram,
for Public Relations Department, Govt. of Kerala.