Introduction Maternal and child health care including family planning• Antenatal care• Intra-natal care• Post natal care• New born care• Care of the child• Family planning
Each year, lakhs of women, newborns, and children die from preventable causes. While the interventions that could save their lives are widely known, they are often not available to those most in need. With the intention of avoiding these preventable deaths the government of Karnataka set up the Primary Health Care Centre in rural villages.
A look at the statistics worldwide shows thateach year: • More than 60 million women deliver at home without skilled care. • About 530,000 women die from pregnancy related complications, with some 68,000 of those deaths resulting from unsafe abortion.
• About 4 million babies die within the firstmonth of life (the newborn period), and morethan 3 million die as stillbirths.• Over 10 million children under the age of 5 die.• Moreover, nearly all (99 percent) maternal, newborn, and child deaths occur in low- and middle-income countries.
MATERNAL AND CHILD HEALTH CAREINCLUDING FAMILY PLANNING Antenatal care: Early registration of all pregnancies ideally in the first trimester (before 12th week of pregnancy). However, even if a woman comes late in her pregnancy for registration she should be registered and care given to her according to gestational age.
• Minimum 3 antenatal checkups and provision of complete package of services. First visit as soon as pregnancy is suspected/between 4th and 6th month (before 26 weeks), second visit at 8th month (around 32weeks) and third visit at 9th month (around 36 weeks).• Associated services like providing iron and folic acid tablets, injection Tetanus toxoid etc (as per the “guidelines for ante-natal care and skilled attendance at birth by ANMs and LHVs)
• Minimum laboratory investigations like haemoglobin, urine albumin, and sugar, RPR test for syphilis• Nutrition and health counseling• Identification of high-risk pregnancies/ appropriate management• Chemoprophylaxis for Malaria in high malaria endemic areas as per NVBDCP (National Vector Borne Disease Control Programme) guidelines.
• Referral to First Referral Units (FRUs)/other hospitals of high risk pregnancy beyond the capability of Medical Officer, PHC to manage.
Intra-natal care:(24-hour delivery services both normal and assisted)i) Promotion of institutional deliveriesii) Conducting normal deliveriesiii) Assisted vaginal deliveries including forceps /vacuum delivery whenever required
iv) Manual removal of placentav) Appropriate and prompt referral for cases needingspecialist care.vi) Management of Pregnancy Induced hypertensionincluding referralvii) Pre-referral management (Obstetric first-aid) inObstetric emergencies that need expert assistance(Training of staff for emergency management to beensured)
Postnatal Care:• A minimum of 2 postpartum home visits, first within 48 hours of delivery, 2nd within 7 days through Sub-centre staff.• Initiation of early breast-feeding within half-hour of birth• Education on nutrition, hygiene, contraception, essential new born care (As per Guidelines of GOI on Essential new-born care)• Others: Provision of facilities under Janani Suraksha Yojana (JSY)
New Born care: Facilities and care for neonatal resuscitation Management of neonatal hypothermia / jaundiceCare of the child: Emergency care of sick children including Integrated Management of Neonatal and Childhood Illness (IMNCI)
• Care of routine childhood illness• Essential Newborn Care• Promotion of exclusive breast-feeding for 6 months.• Full Immunization of all infants and children against vaccine preventable diseases as per guidelines of GOI.• Vitamin A prophylaxis to the children as per guidelines.• Prevention and control of childhood diseases, infections, etc.
Family Planning:• Education, Motivation and counseling to adopt appropriate Family planning methods.• Provision of contraceptives such as condoms, oral pills, emergency contraceptives, IUD insertions.• Permanent methods like Tubal ligation and vasectomy / NSV.• Follow up services to the eligible couples adopting permanent methods (Tubectomy/Vasectomy).• Counseling and appropriate referral for safe abortion services (MTP) for those in need.
• Counseling and appropriate referral for couples having infertility. Medical Termination of Pregnancies using Manual Vacuum Aspiration (MVA) technique. (wherever trained personnel and facility exists) Management of Reproductive Tract Infections / Sexually Transmitted Infections: Health education for prevention of RTI/ STIs Treatment of RTI/ STIs
Nutrition Services (coordinated with ICDS) Diagnosis of and nutrition advice to malnourished children, pregnant women and others. Diagnosis and management of anaemia, and vitamin A deficiency. Coordination with ICDS. School Health: Regular check ups, appropriate treatment including deworming, referral and follow-ups. Adolescent Health Care: Life style education, counseling, appropriate treatment.