FIRST REFERRAL UNITS
of MCH Centres:
3 – (Comprehensive Level-FRU): All FRU-CHC/SDH/DH/area hospitals/referral
hospitals/ tertiary hospitals where complications are managed including
C-section and blood transfusion. An FRU shall be equipped also with a Newborn
Stabilization Unit (NBSU) at CHC/SDH/others or Special Newborn Care Unit (SNCU)
at DH and above. A District Hospital irrespective of caseload has to be a Level
Level 2 – (Basic Level): All 24x7 facilities (PHC/Non-FRU
CHC/others) providing BEmOC services; conducting deliveries and managing of
medical complications (not requiring surgery or blood transfusion) and have
either a NBCC or NBSU.
Level 1 – All sub-centres and some PHCs which have not yet reached
the next level of 24x7 PHC: where deliveries are conducted by a skilled-birth
attendant (SBA). An NBCC must be established in all such facilities.
Details of the year wise functional FRUs are as follows:
|Financial Year||Functional FRUs|
|2014-15 (up to Dec)||155|
FRUs act as a referral points for the surrounding PHCs and Sub Centers, for referring complicated delivery cases and high risk pregnancies. It is very essential that the FRUs are made functional with the provision of three critical specialists like Obstetricians, Anesthetists and Pediatricians along with functional operation theatres, lab facilities and Blood Banks/Blood Storage Centers. These FRUs handle complicated deliveries, conduct Cesarean Section deliveries and prevent maternal and infant deaths. These FRUs also provide new born and child care services through New Born Stabilization Units/Special Newborn Care Units and reduce infant and child deaths.
As on December 2014, 155 FRUs are functional, among these, 121 have either Blood Bank or Blood Storage Centers.
NHM Criteria for Functional Delivery Points
FRUs are being functionalized through the following initiatives:
• Hiring of Specialists: where ever specialists' posts are vacant; Obstetricians, Anesthetists and Pediatricians are hired on contract. In High Priority Districts they are being paid Rs 1.20 lakh and in Non-HPD Rs 0.80 lakh (including Performance Based Incentives) as salaries.
• Multi-Skill Training of MBBS Doctors: wherever specialists' posts are vacant and it is not possible to hire specialists on contract, interested MBBS doctors are being trained to provide Emergency Obstetric Care and Life Saving Anesthetic Skills and they are being posted to FRUs. These EMOC & LSAS doctors are performing elective and emergency Cesarean section deliveries, and they are being paid performance based incentives of Rs. 1500 per case, they would be getting this incentive from the 6th case of every month, up to a maximum of Rs 15,000/month.
• Hiring of MBBS Doctors: FRUs conducting more than 75 deliveries per month will be provided one additional contractual MBBS doctor for performing MCH duties.
• Training of doctors and lab technicians for establishing Blood Storage Centers.
• Establishing functional Operation Theatres for Comprehensive Emergency Obstetric Care.
• Assured Free Referral Transport to and between FRUs and free drop back facilities for pregnant women, mothers and infants.