Dr. Bhuwan SharmaAssistant Professor

Dept. of PSMGrant Govt. Medical College

REPRODUCTIVE AND CHILD HEALTH

PROGRAMME

MILES STONE IN MCH CARE IN INDIA• 1880 – ESTABLISHMENT OF TRAINING OF DAIS IN AMRITSTAR• 1902 - 1st MIDWIFERY ACT TO PROMOTE SAFE DELIVERY• 1930 - SETTING UP OF ADVISORY COMMITTEE ON MATERNAL

MORTALITY.• 1946 - BHORE COMMITTEE RECOMMENDATION ON

COMPREHENSIVE & INTEGRATED HEALTH CARE• 1952 – PRIMARY HEALTH CENTER NET WORK & FAMILY PLANNING

PROGRAMME• 1956 – MCH CENTERS BECOME INTEGRAL PART OF PHCS• 1961 - DEPARTMENT OF FAMILY PLANNING CREATED• 1971 – MTP ACT• 1974 – FAMILY PLANNING SERVICES INCORPORATED IN MCH CARE• 1977 – RENAMING FAMILY PLANNING TO FAMILY WELFARE• 1978 – EXPANDED PROGRAMME ON IMMUNIZATION• 1985 – UNIVERSAL IMMUNIZATION PROGRAMME• 1992 – CHILD SURVIVAL& SAFE MOTHERHOOD PROGRAMME• 1996 – TARGET FREE APPROACH• 1997 – RCH PROGRAMME PHASE-1• 2005 – RCH PROGRAMME PHASE-2

RCH – Ι PROGRAMME

15.10. 1997

Objectives

•Reduction of Maternal Morbidity and Mortality (MMR)

•Reduction of Infant Morbidity and Mortality (IMR)

•Reduction of Under 5 Morbidity and Mortality (U5MR)

•Promotion of adolescent health

•Control of reproductive tract infections and sexually transmitted infections.

• The first phase of the programme had started from 1997

• To bring down the birth rate below 21 per 1000 population

• To reduce the infant mortality rate below 60 per 1000 life born

• To bring down the maternal mortality rate below 400 per one lakh.

• Eighty per cent institutional delivery,

• 100 per cent antenatal care

• and 100 per cent immunization of children

Vertical Programmes Integrated Service Delivery

Camp Oriented Client Oriented

Target Oriented Goal Oriented

Quantity Oriented Quality Oriented

Camp Oriented Client Oriented

• Sterilization Camps

• IUD Camps

• Immunisation Camps

• Full Range of RCH Services

• Need Based

.

Target Oriented Goal Oriented

Performance by

Numbers

Performance by Quality

• Top Down

• Target Driven

• Bottom up• Client Need Based• Community

Participation

• To the Govt. System • To the Clients, Community

HealthyMother

& Child

Safe Motherhood Services - Essential Care for All - Early Identification of Complications - Emergency Services those who are in need

Child Survival Services

Prevention and Management of

RTI /STI

Family Welfare

- Increased access to Contraceptives

- Safe Abortion Services

Adolescent Health Care and Family Life Education

COMPONENTS OF RCH PROGRAMME

Prevention and management of unwanted pregnancy

Maternal care that includes antenatal, delivery, and postpartum services

Child survival services for newborns and infants

Management of reproductive tract infections and sexually transmitted infections

REPRODUCTIVE HEALTH ELEMENTS

Responsible and healthy sexual behaviourIntervention to promote safe motherhoodPrevention of unwanted pregnancyTo increase accessibility of contraceptivesSafe abortionsPregnancy and delivery servicesManagement of RTI/STDReferral facility by government/private

sector for pregnant women at riskReproductive health services for

adolescentsScreening and treatment of infertility,

cancer & other gynecological disorders

CHILD SURVIVAL ELEMENTS Essential New Born Care Prevention and management of vaccine

preventable disease Urban measles campaign Neonatal tetanus elimination Surveillance of vaccine preventable diseases Cold chain system Polio eradication : pulse polio programme ARI control programme Diarrhea control programme and ORS programme Prevention and control of Vitamin A deficiency

among children Baby Friendly Hospital Initiative (BFHI)

STRATEGY

BOTTOM-UP PLANNINGCOMMUNITY NEED ASSESSMENT

APPROACHDECENTRALISED PARTICIPATORY

PLANNING & IMPLEMENTATIONSTRENGTHENING INFRASTUCTUREINTEGRATED TRAINING PACKAGEIMPROVED MANAGEMENT SYSTEMINTERVENTIONSMONITORING & EVALUATION

ANTE NATAL CARE Early registration of pregnancies (12 – 16 weeks) Minimum 3 antenatal visits (20,32,36 weeks) check-

ups Anaemia prophylaxis ( Iron and Folic acid tablets) Two doses of TT Minimum investigations( Weight, B.P,Blood group, Rh

typing, Urine examination,VDRL,HIV (TRIDOT TEST) Identification of high risk group, Early detection of

complication of pregnancy & timely , safely referral to FRU

Treatment of worm infestation with Mebendazole Health education on diet, breast feeding, care of

breast, personnel hygiene during pregnancy,& family planning

1. BLEEDING

2. OBSTRUTED LABOUR

1. SEPSIS

2. TOXAEMIA

3. ABORTION

1.ANAEMIA

2.FAMILY PLANNING

1.FIRST LEVEL REFERRAL CENTER

2.COMMUNITY HEALTH CENTER/DISTRIC HOSPITAL

PRIMARY HEALTH CENTER

SUB CENTER

REFERAL

PACKAGES OF SERVICES AT FRU

•VACCUM EXTRACTIONS•ADMINISTRATION OF ANAESTHESIA•BLOOD TRANSFUSION•CASEAREAN SECTION•MANUAL REMOVAL OF PLACENTA•CARRY OUT SUCTION CURETTAGE FOR INCOMPLETE ABORTION•INSERTION OF INTRAUTERINE DEVICES•STERILIZATION OPERATION

TYPES OF KIT for FRU•Kit-E – Laparotomy set•Kit-F - Mini– Laparotomy set•Kit-G – IUD insertion set•Kit-H – Vasectomy set•Kit- I – Normal delivery set•Kit- J – Vacuum extraction set•Kit- k – Embryotomy set•Kit- L – Uterine evacuation set•Kit-M – Equipment for anesthesia•Kit-N- Neonatal resuscitation set•Kit-O- Equipment and reagent for blood test•Kit-P – Donor blood transfusion set

INTRANATAL CARE

Delivery by trained personnel (100%)Institutional delivery (80%)Care at birth ( Five cleans: Clean Birth

Canal,Clean surface for delivery,Clean Hands,Clean Cutting, & Clean Cord)

POST NATAL CARE

3 post natal check-ups of mothers after delivery

Breast feeding – early & exclusive breast feeding

Spacing – minimum 3 years between two pregnancies

NEW STRATEGY

Empowered action group has been consituted on 20.03.2001

Training of dais in 156 districts 18 states/uts 2001-2002

RCH camps & RCH out reach scheme

Gadchiroli model to take care of home based neonatel care in 2002

Kangaroo mother care to take care of low birth weight infants

Border district cluster strategy – 49 districts/17 states

Integrated management of childhood illness (IMNCI) strategy to take care of sick newborns

STEPS TO REDUCE MATERNAL MORTALITY

• HEALTH SECTOR ACTIONS

Basic antenatal , intra natal &post natal care.

skilled attendants @ every birth.

EOC & Comprehensive obstetric care.

Prevention of unwanted pregnancy &unsafe abortions.

Joint consultations -medical disorders.

Maternal mortality audit .

STEPS TO REDUCE

• COMMUNITY , SOCIETY & FAMILY ACTIONS .

• HEALTH PLANNERS /POLICY MAKERS ACTIONS

community education ,motivation.

Strengthen referral system.

management protocols for obstetric emergencies.

CME – Improve quality & standard of care.

Maternal mortality audit .

STEPS TO REDUCE

• LEGISLATIVE & POLICY ACTIONS

Girl children & adolescents :nutrition , education ,economic opportunities.

Remove barriers to access health care. Cost Socio cultural factors Safe abortions & post abortion care -MVA Remove social inequalities- gender , age

marital status.

World Health Day 2005 SloganMake Every Mother And Child Count

Reflects that health of women and children should be given higher priority at all levels of health care system.

Every one is accountable for health of mothers & children

RCH - II PROGRAMME

01-04-2005

THE 5 YEAR PHASE OF RCH II

VISION To bring about outcomes as envisioned in the

1. Millennium Development Goals

2. The National Population Policy 2000 (NPP 2000)Goals

3. The Tenth Plan Goals

4. The National Health Policy 2002

5. and Vision 2020 India

1728 - FRU

PHC-22928

SUB CENTER-38044

1. MATERNAL HEALTH

a) 260 Primary Health Centres are proposed to be taken up for improving access to Essential Obstetric and New Born Care services round the clock in TN. All CHC, & 50% PHCs to be made functional for 24 hrs delivery services,& 2000 FRU are proposed

b) Improving quality of antenatal, neonatal and postnatal care by providing increased number of antenatal checkups, fixed day antenatal clinics, linking visits of neonates with postnatal care, empowering the VHNs in performing obstetric first aid and newborn care.

c) Improvement of the referral networking systems by establishing emergency help line.

d) Regular conduct of blood donation camps for the continued availability of blood in the blood banks.

e) Universalizing the concept of birth companionship during the process of labour in all health facilities conducting deliveries.

f) Operationalisation of maternal death audit to address the issues that have led to maternal deaths.

2. INFANT AND CHILD HEALTH

a.Reduction of new-born deaths, infant deaths and child deaths by providing continuous health care and strengthening of new-born care infrastructure facilities.

b. Organizing counseling sessions for the mothers.

c. Implementing integrated management of neonatal and childhood illness.

d. Operationalization infant death/stillbirth verbal autopsy.

e. Addressing the issue of female infanticide and foeticide.

Integrated Management of Neonatal & childhood Illnesses (IMNCI)

IMNCI is a strategy for an integrated approach to the management of childhood illness as it is important for child health programmes to look beyond the treatment of single disease.

Major highlights

Inclusion of 0-7 days in the programme

Incorporation of national guidelines

Training of health personnel

Proportion of training time devoted to sick young infant and sick child is equal

Skill based

3. ADOLESCENT HEALTH.

a)Focusing adolescents as receivers and providers of knowledge and function as link volunteers in the community.

b) Utilising the services of trained adolescents for propagating Indian System of Medicines.

c) Broadcasting and Telecasting of programme by AIR/TV focusing adolescent, gender and health related subjects.

d) Formation of co-ordination committee at the district level and monitoring committee at the State level for overseeing the AIR/TV programme.

a)While sustaining the ongoing family welfare interventions in all districts, 19 districts with Higher order births will be targeted for intensified interventions.

b) Social marketing programme for condom and other health commodities, promotion of IUD insertions, familiarizing the concept of one-stop Family Welfare Centre.

c) Increasing access to safe abortion services by popularising manual vacuum aspiration (MVA) technique.

d) Establishment of one-stop family welfare services at Comprehensive Emergency Obstetric and New Born Care (CEMONC) Centres.

e) Popularizing No Scalpel Vasectomy.

4. FAMILY WELFARE

5. Reproductive tract infections / Sexually transmitted infections / Cancer control.

a)Establishment of Reproductive Tract Infection / Sexually Transmitted Infection, early Cancer detection clinics .

b) Strengthening RCH outreach services.

c) RTI/STD clinic in selected 70 primary health centers

6. Infrastructure strengthening for service delivery

a) Construction of HSC buildings where HSCs are currently functioning in rented premises

b) Rebuilding HSCs which are unfit for occupation.

c) Taking up of repairs/renovation and provision of water supply/electrical works to PHCs/HSCs.

d) Need-based supply of equipment/furniture to the HSCs and PHCs as per the standard list including gas connections.

e) Provision of Cell phones to HSCs where large number of deliveries take place.

f) Provision of telephones to PHCs

7. TRAINING

a)Skill upgradation training with focus on improving/upgrading the skills of health care providers.

b) Integrated skill training for peripheral health functionaries such as VHNs, SHNs, medical officers and health inspectors.

c) Improving managerial and communication skills of health staff.

8. BEHAVIOURAL CHANGE COMMUNICATION (BCC)

a) Social mobilisation activity against female infanticide and foeticide by preventive counselling.

b) Formation of HSC, Block, District level committees for saving female babies.

c) Conducting of Kalaipayanam (travelling street theatre) to promote social mobilization and to improve health care among the target population

d) Telecasting of TV serials, Radio broadcasts, wall paintings, hoardings and glow signs for popularizing health and reproductive health messages in important places.

9. HEALTH MANAGEMENT INFORMATION SYSTEMS

Introduction of IT-enabled HMIS for planning and monitoring health services at the State/District /Block levels

10. STRENGTHENING OF TEACHING INSTITUTIONS

Strengthening the facilities at teaching institutions for providing optimum obstetric, family welfare, neonatal child health services.

11. ESTABLISHING URBAN HEALTH POSTS

To provide an integrated and sustainable system for primary health care service delivery catering to the requirements of urban slum population and other vulnerable groups

12. HEALTH FINANCING

The health care expenditure in India currently stands at 6.1% of GDP. The private out of pocket expenditure being 4.7% of Gross Domestic Product (GDP). The total government expenditure on family welfare has shown an increasing trend from 4.9 billion in fifth plan (1974-79) to Rs. 271.25 billion in the tenth plan (2002-07)

ACCESSIBILITY INDICATOR

•No. of eligible couples registered/ANM•No. of Antenatal Care sessions held as planned•% of sub Centers with no ANM•% of sub Centers with working equipment of ANC•% ANM/TBA without requisite skill•% sub centers with DDKs•% of sub centers with infant weighing machine•% subcenters with vaccine supplies•% sub centers with ORS packets•% sub centers with FP supplies

QUALITY INDICATOR•% Pregnancy Registered before 12 weeks•% ANC with 5 visits•% ANC receiving all RCH services•% High risk cases referred•% High risk cases followed up•% deliveries by ANM/TBA•%PNC with 3 PNC visits•% PNC receiving all counselling•% PNC complications referred•% Eligible couple offered FP choices•% women screened for RTI/STDs•% Eligible couple counselled for prevention of RTI/STDs•% ADD given ORS•% ARI treated•% children fully immunized

IMPACT INDICATOR•% DEATHS FROM MATERNAL CAUSES•MATERNAL MORTALITY RATIO•PREVALENCE OF MATERNAL MORBIDITY•% LOW BIRTH WEIGHT•NEO-NATAL MORTALITY RATIO•PREVALENCE OF POST NATAL MATERNAL MORBIDITY•% BABY BREAST FEED WITHIN 6 HRS OF DELIVERY•COUPLE PROTECTION RATE•PREVALENCE OF TERMINAL METHOD OF STERILIZATION•PREVALENCE OF SPACING METHOD•% ABORTION RELATED MORBIDITY•PREVALENCE OF ADD•PREVALENCE OF ARI•PREVALENCE OF RTI/STDs

THANK YOU