MCH PART OF RMNCH+A HIGH IMPACT INTERVENTIONS

1. HIGHIMPACTINTERVENTIONSINRMNCH+A

2.  OUTPUT…..OUTCOME …..IMPACT

3. Factsheet
Global India
3,60,000 births/day
15000 births/hour
250 births/min
4 births/sec
49,481 births/day
2062 births/hour
34 births/min
1 birth/2 sec

4. 5“W”
 Every day, approximately 830 women die from
preventable causes related to pregnancy and
childbirth.(when)
 99% of all maternal deaths occur in developing
countries.(where)
 Maternal mortality is higher in women living in rural
areas and among poorer communities.(Where)
 Young adolescents face a higher risk of complications
and death as a result of pregnancy than other
women.(who)
 Main Causes of maternal mortality –
Hgh,infection,obstruction,HTN (What)
 3 Delays(why)

5. CausesofMaternal&
U5DeathsinIndia

6. 3 Delays

7. RMNCH+A HighImpact
Interventions
The approach
 RMNCHA+A is a comprehensive strategy for
improving the maternal and child health outcomes
under NRHM
 It is based on the evidence that maternal and child
health can not be improved in isolation as adolescent
health and family planning have an important bearing
on the outcomes.
 This strategy encompasses various high impact
interventions across the life cycle
 This strategy is based on the concept of ‘CONTINUUM
OF CARE’

8. Plus+Denotes
Inclusion of adolescents as a distinct
life stage
Linking of Maternal Child Health to
Reproductive Health and other
components like Family planning
Linking of community and facility
based care as well as referrals
between various levels of health care
system

9. GOALS
 Health outcome goals established in
the 12th Five Year Plan.
 Reduction of Infant Mortality Rate
(IMR) to 25 Per 1,000 live births by
2017
 Reduction in Maternal Mortality
Ratio (MMR) to 100 per 100,000 live
births by 2017
 Reduction in Total Fertility
Rate(TFR) to 2.1 by 2017

10. Strategic
RMNCH+A
Interventions
AcrossLifeStages
 There are two dimensions to health care
1)Stages of the life cycle
2)Places where the care is provided
These two together constitute the ‘Continuum of
Care’
Adolescents
&Prepregnancies
Pregnancy Birth Postnatal Childhood

11. Whyhigh
impact
 implementation of the RMNCH+A strategy across the
continuum of care,
 • Five high-impact interventions across each of the five
thematic areas.
 • Five cross-cutting and health systems strengthening
interventions.
 • The minimum essential commodities across each of
the thematic areas.
 The matrix focus on 25 actions for desired outcomes.
When implemented with high coverage and high
quality, these interventions are expected to have a
great impact on reducing maternal and child mortality
and morbidity.

12. 5*5MatrixofHighimpactinterventions

13. Maternal Health
1.Name-based tracking
of pregnant women and
children with intention
o track every pregnant
woman, infant and
child up to the age of
hree years
2.Universal access to
ull antenatal package
3.Tracking and
monitoring of severely
Anaemic women ,low
birth weight babies and
sick neonates
4.A more recent
nitiative is to link
MCTS with AADHAR
n order to track
1.line listing of severely
anaemic women
2.Timely and
appropriate
management of severely
anaemic women.
3.In malaria endemic
areas, provision of
insecticidal bed nets
and timely check up of
anaemia is required.
1.Sub centres and Primary
Health Centres designated
as delivery points
2. Community Health
Centres (FRUs) and
District Hospitals made
functional 24 X 7 to
provide basic and
comprehensive obstetric
and new born care
services.
3.Multi skilling of doctors
in the public health
system
• Maternal Death
Review (MDR) To
identify causes of
maternal deaths
and the gaps in
service delivery
• The Perinatal and
Child Death
Review is an
important strategy
to
•
Identify villages with
high numbers of home
deliveries and
distribute Misoprostol
to selected women in
8th month of pregnancy
for consumption during
third stage of labour
Incentivize ANMs for
Home deliveries

14. NEW BORN CARE
1.Early Initiation of
Breast Feeding (<1hr)
2.Exclusive Breast feeding
for 6 months (among 6–9
months children)
1.The home-based
Newborn care scheme,
launched in 2011, for
immediate postnatal care
(especially in the cases of
home delivery)
2Essential Newborn care
to all Newborn up to the
age of 42 days.
3.Frontline workers
(ASHAs) trained and
incentivised to provide
special care to Preterm
and Newborns;
4.Identification of
illnesses, appropriate care
and referral through home
visits.
1.Newborn Care Corners
at delivery points
2.Trained providers for
basic new-born care and
resuscitation through
Navjaat Shishu
Suraksha Karyakram
(NSSK).
3.The saturation of all
delivery points with
Skilled Birth Attendance
and NSSK trained
personnel
4..Linkages with sick
Newborn Care Units at
health facilities
5.The immediate routine
newborn care, comprising
drying, warming, skin to
skin contact and initiation
of breast feeding within
To strengthen the care of
sick, premature and low
birth weight New-borns,
Special New-born Care
Units (SNCU) at District
Hospitals and tertiary
care hospitals.
Under IMNCI, use of
recommended antibiotics
based on national
guidelines) in children
aged 2 months to 5 years
with non-severe
pneumonia must be
ensured through frontline
workers (ASHA, ANM)
and at all levels of health
facilities.

15. CHILD HEALTH
1.Promotion of ‘infant
and young child
feeding practices’
.
2. Line listing of
babies born with low
birth weight
3.follow up to ensure
optimum feeding and
child care practices
4. Iron and folic acid
tablets or syrup for
100 days in a year
5.Bi-weekly iron and
folic acid
supplementation for
preschool
children of 6 months
to 5 years as part of
the National Iron +
initiative.
1. Availability of ORS
and Zinc
2.Use of Zinc should be
actively promoted along
with use of ORS
1..Use of recommended
antibiotics (based on
national guidelines) in
children aged 2 months to
5 years with non-severe
pneumonia
through frontline workers
(ASHA, ANM) and at all
levels of health facilities
2.Emergency
management of children
with pneumonia included
in the facility-based
IMNCI trainings .
1.largest immunisation
programmes in the world
2.The second dose of
measles has been
introduced
3.Hepatitis B made
available in whole
country
4.Incorporation of
Pentavalent vaccine, a
combination vaccine
(DPT + Hep-B + Hib)
,
5.Provision for Auto
Disable (AD) Syringes to
ensure injection safety,
6.The cold chain must be
further strengthened
7.The district AEFI
Committees must be in
place
1.A new initiative “Child
Screening and Early
Intervention Services”
2.screening to detect
medical conditions at an
early stage, thus enabling
early intervention and
management, ultimately
leading to reduction in
mortality, morbidity and
lifelong disability

16. PregnancyandChildbirth(PriorityInterventions)
1. Preventive use of folic acid in Peri conception period
2. Delivery of antenatal care package and tracking of High Risk
Pregnancies
3. Skilled Obstetric care
4. Immediate essential newborn care and resuscitation
5. Emergency Obstetric and new born care
6. Postpartum care for mother and newborn
7. Postpartum IUCD and sterilization
8. Implementation of PC&PNDT Act

17. Newborncareand
ChildCare(Priority
Interventions)
 Home Based newborn care and prompt referral
 Facility Based care of the sick newborn
 Integrated management of common childhood
illnesses( Diarrhoea, pneumonia and malaria)
 Child nutrition and essential micronutrient
supplementation
 Immunization
 Early detection and management of Defects at Birth,
Deficiencies, Diseases and Disability in children(0-
18yrs)

18. HealthSystem
Strengtheningfor
RMNCH+AServices
Case load based deployment of HR at all levels
•Ambulances, drugs, diagnostics, reproductive health
commodities
•Health Education, Demand Promotion & Behaviour
change communication
•Supportive supervision and use of data for monitoring
and review, including scorecards based on HMIS
•Public grievances redressal mechanism; client
satisfaction and patient safety through all round quality
assurance
System
strengthening

19. CrosscuttingInterventions
 Bring down out of pocket expenses by ensuring JSSK,
and other free entitlements
 ANMs & Nurses to provide specialized and quality care
to pregnant women and children
 Address social determinants of health through
convergence
 Focus on un-served and underserved villages, urban
slums and blocks
 Introduce difficult area and performance based
incentives

20.  The creation of regular posts under state governments so
that contractual appointments can be slowly reduced and
sustainable HR Structure is developed
 Strengthening subcentres through additional human
resources: In subcentres of remote and hilly areas there
will be two ANMs,1 multipurpose worker ,1 pharmacist
and 1 AYUSH doctor
 Capacity building of MO for reproductive, adolescent,
maternal ,newborn and child health.
 Training of nurses and ANM for SBA,IMNCI,NSSK and
IUCD insertion
Resources

21. Drugsandlogistics
 Availability of free generic drugs for out/in patients in
public health facilities is to be made by states for
minimizing out of pocket expenses
 Rational prescriptions and use of drugs
 Timely procurement of drugs and consumables
 Distribution of drugs to facilities from DH to
subcentres; and uninterrupted availability to patients
is to be ensured
 Placing essential drug lists(EDL) in the public domain
 Computerized drugs and logistics MIS system