REPRODUCTIVE AND CHILD HEALTH PROGRAMME Dr. Bhuwan Sharma Assistant Professor Dept. of PSM Grant Govt. Medical College
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
Objectives•Reduction of Maternal Morbidity andMortality (MMR)•Reduction of Infant Morbidity and Mortality(IMR)•Reduction of Under 5 Morbidity andMortality (U5MR)•Promotion of adolescent health•Control of reproductive tract infections andsexually 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 ofchildren
Camp Oriented . Client Oriented• Sterilization Camps • Full Range of RCH Services• IUD Camps • Need Based• Immunisation Camps
Target Oriented Goal Oriented Performance by Performance by Numbers Quality• Top Down • Bottom up • Client Need Based• Target Driven • Community Participation• To the Govt. System • To the Clients, Community
Safe Motherhood Services- Essential Care for All Child Survival- Early Identification of Complications Services- Emergency Services those who are in need Family Welfare- Increased access to Healthy Prevention and Contraceptives Mother Management of &- Safe Abortion Child RTI /STI Services Adolescent Health Care and Family Life Education
COMPONENTS OF RCH PROGRAMMEPrevention and management of unwanted pregnancyMaternal care that includes antenatal, delivery, and postpartum servicesChild survival services for newborns and infantsManagement of reproductive tract infections and sexually transmitted infections
REPRODUCTIVE HEALTH ELEMENTS Responsible and healthy sexual behaviour Intervention to promote safe motherhood Prevention of unwanted pregnancy To increase accessibility of contraceptives Safe abortions Pregnancy and delivery services Management of RTI/STD Referral facility by government/private sector for pregnant women at risk Reproductive health services for adolescents Screening 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 PLANNING COMMUNITY NEED ASSESSMENT APPROACH DECENTRALISED PARTICIPATORY PLANNING & IMPLEMENTATION STRENGTHENING INFRASTUCTURE INTEGRATED TRAINING PACKAGE IMPROVED MANAGEMENT SYSTEM INTERVENTIONS MONITORING & 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
REFERAL1. BLEEDING 1.FIRST LEVEL REFERRAL CENTER2. OBSTRUTED LABOUR 2.COMMUNITY HEALTH CENTER/DISTRIC HOSPITAL1. SEPSIS2. TOXAEMIA PRIMARY HEALTH3. ABORTION CENTER1.ANAEMIA SUB CENTER2.FAMILY PLANNING
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 CAREDelivery 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 careof 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 Slogan Make Every Mother And Child CountReflects 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
THE 5 YEAR PHASE OF RCH IIVISION 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
1. MATERNAL HEALTHa) 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 proposedb) 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 HEALTHa.Reduction of new-born deaths, infant deaths and child deathsby 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 andchildhood 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 ofknowledge and function as link volunteers in the community.b) Utilising the services of trained adolescents forpropagating Indian System of Medicines.c) Broadcasting and Telecasting of programme by AIR/TVfocusing adolescent, gender and health related subjects.d) Formation of co-ordination committee at the district leveland monitoring committee at the State level for overseeingthe AIR/TV programme.
4. FAMILY WELFAREa)While sustaining the ongoing family welfareinterventions in all districts, 19 districts with Higherorder births will be targeted for intensifiedinterventions.b) Social marketing programme for condom and otherhealth commodities, promotion of IUD insertions,familiarizing the concept of one-stop Family WelfareCentre.c) Increasing access to safe abortion services bypopularising manual vacuum aspiration (MVA)technique.d) Establishment of one-stop family welfare services atComprehensive Emergency Obstetric and New BornCare (CEMONC) Centres.e) Popularizing No Scalpel Vasectomy.
5. Reproductive tract infections / Sexually transmittedinfections / Cancer control.a)Establishment of Reproductive Tract Infection /Sexually Transmitted Infection, early Cancer detectionclinics .b) Strengthening RCH outreach services.c) RTI/STD clinic in selected 70 primary health centers
6. Infrastructure strengthening for service deliverya) Construction of HSC buildings where HSCs arecurrently functioning in rented premisesb) Rebuilding HSCs which are unfit for occupation.c) Taking up of repairs/renovation and provision ofwater supply/electrical works to PHCs/HSCs.d) Need-based supply of equipment/furniture to theHSCs and PHCs as per the standard list including gasconnections.e) Provision of Cell phones to HSCs where largenumber of deliveries take place.f) Provision of telephones to PHCs
7. TRAININGa)Skill upgradation training with focus onimproving/upgrading the skills of health careproviders.b) Integrated skill training for peripheral healthfunctionaries such as VHNs, SHNs, medical officers andhealth inspectors.c) Improving managerial and communication skills ofhealth staff.
8. BEHAVIOURAL CHANGE COMMUNICATION (BCC)a) Social mobilisation activity against female infanticide andfoeticide by preventive counselling.b) Formation of HSC, Block, District level committees for savingfemale babies.c) Conducting of Kalaipayanam (travelling street theatre) topromote social mobilization and to improve health care amongthe target populationd) Telecasting of TV serials, Radio broadcasts, wall paintings,hoardings and glow signs for popularizing health andreproductive health messages in important places.
9. HEALTH MANAGEMENT INFORMATION SYSTEMSIntroduction of IT-enabled HMIS for planning and monitoring healthservices at the State/District /Block levels10. STRENGTHENING OF TEACHING INSTITUTIONSStrengthening the facilities at teaching institutions for providingoptimum obstetric, family welfare, neonatal child health services.11. ESTABLISHING URBAN HEALTH POSTSTo provide an integrated and sustainable system for primary healthcare service delivery catering to the requirements of urban slumpopulation and other vulnerable groups
12. HEALTH FINANCINGThe health care expenditure in India currentlystands at 6.1% of GDP. The private out of pocketexpenditure being 4.7% of Gross DomesticProduct (GDP). The total government expenditureon family welfare has shown an increasing trendfrom 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 OFSTERILIZATION•PREVALENCE OF SPACING METHOD•% ABORTION RELATED MORBIDITY•PREVALENCE OF ADD•PREVALENCE OF ARI•PREVALENCE OF RTI/STDs