OG

4. NRHM PROGRAMMES RELATED MCH

5. INTRODUCTION:
According to the world bank almost 64.61% of the Indian population
lived in rural areas in 2021. Most rural regions lack of modern health care
facilities and the advanced infrastructure required to provide quality services.
The NRHM is a step in solving such issues and enabling the rural population
to access free health care.

7. DEFINITION:
NRHM is a Government aided health insurance scheme that was
launched in 2005 to provide accessible, affordable, and quality health care in
the rural areas. The primary focus of this scheme is on the low income
households in rural areas.

8. OBJECTIVES OF NRHM:
A. To reduce MMR and IMR
B. To decrease disease and injury related MMR
C. Ensuring population stabilization
D. Prevention and control of communicable and Non communicable disease
E. Decreased in Total fertility rate
F. To improve the quality of health services delivery at all levels.
G. To make quality health care affordable & accessible to the rural
population.

9. INFRASTRUCTURE OF NRHM:
VILLAGE LEVEL
SUBCENTER LEVEL
BLOCK
LEVEL
PHC LEVEL

10. FUNCTIONS OF NRHM:
A. Antenatal & Postnatal checkup
B. Institutional delivery
C. Trained community level workers
D. Complete immunization
E. Good hospital care
F. Provision of household toilets.
G. Mobile medical units
H. Health and Nutrition services.

11. MILESTONES IN MCH:
1882 - Establishment of training of dais
1902 - 1st Midwifery act for safe delivery
1952 - Family planning program adopted by Govt. of India
1961 - Dept. of. Family planning created in ministry of health
1971 - Medical termination of pregnancy
1977 - Renaming of family planning to family welfare
1978 - Expanded program of immunization
1985 - Universal immunization programme & National oral rehydration
therapy.

12. Contd..
1992- CSSM
1996- Target free approach
1997- Reproductive and child health programme
2005- RCH phase -2

13. NRHM PROGRAMMES RELATED MCH:
Integrated Child Development Scheme:
- ICDS launched in 1975
Objectives:
A. To improve the nutritional and health status of children in the age group
0- 6 years
A. To lay the foundation for proper psychological, physical and social
development of the child.

15. BENEFICIARIES:
 Children in the age group of 0-6 years
 Women
 Lactating services
 Adolescent girls.

16. SERVICES UNDER ICDS:
The ICDS scheme offers a package of 6 services,
 Supplementary Nutrition
 Immunization
 Pre school Non formal education
 Health checkup
 Nutrition and Health services
 Referral services

17. CHILD SURVIVALAND SAFE MOTHERHOOD:
I. CSSM program launched in 1992.
II. This programme with assistance from world bank, UNICEF and other donors.
Objectives:
I. To reduce MMR and IMR
II. Improve the MCH services at Village, Sub center and CHC level
Beneficiaries:
I. Pregnant womens
II. Childrens

18. SERVICES UNDER CSSM:
 For Children:
 Newborn care at home
 Primary immunization by 12 months
 Vitamin A prophylaxis
 Correction & Management of pneumonia at Health facilities
 ORT at home / health facility

19. For Pregnant Women:
Anemia prophylaxis and therapy
Antenatal check up at least 3
Referral services.
Care at birth and promotion of clean delivery

20. JSY is a safe motherhood intervention launched in 12th April 2005
by the Honorable Prime minister.
Objectives:
I. Reducing MMR and IMR
II. Promotion of child birth deliveries in Govt. institutions
III. To provide Good medical care during pregnancy at the time of delivery
and after delivery period.
JANANI SURAKSHA YOJANA:

22. Eligibility:
I. All pregnant women are,
II. Eligible who are ready to deliver the child in Government accredited
private health care institutions.
“CASH ASSISTANCE PROVIDED UNDER JSY TO MOTHER
AND ASHA WORKER IN RURALAREAS”.

23. Cash assistance
to Mother
Cash assistance to
ASHA worker
Total
Assistance
Low Performing
State
Rs.1400
RS.300 FOR Antenatal care
component
RS.300- For facilitating
institutional delivery
Rs. 600
Rs. 2000
High Performing
State
Rs.700
Rs.300 for Antenatal care
component Rs.300 for
facilitating institutional
delivery
Rs. 1300

24. RCH PROGRAMME:
RCH Programme was formally launched on 15 October 1997.
Components of RCH Programme:-
1) Family planning
2) CSSM
3) Prevention & Management of RTI/STI
4) Adolescent health care & Family life education
5) Client approach to Health care

25. Objectives:
 Promotion of MCH to ensure safe motherhood & Child survival
 Reduction of MMR & IMR
 Attainment of population stabilization
Highlights of the Programme :
 Integration of all programs related fertility regulation, maternal and child
health and reproductive health.
 Upgradation of facilities: Creation of FRU
 Provision of specialist services & Outreach services

27. RCH PROGRAMME & PHASE - II
RCH Programme Phase-2 launched in 1 April 2005.
Services package:
 Emergency Obstetric care
 Strengthening of referral services
 Strengthening of infrastructure
 Strengthening of MIS
 Promotion of institutional deliveries.
 Skilled birth attendance
 Policy decision to permit health workers to use drugs in emergency situation.

28.  Training of PHC doctors in life saving anesthetic skills for emergency
obstetrics care.
 Setting up of blood storage centers at FRU
 24 hours functioning of PHC
 Family planning & counselling services
 Training of MBBS doctors in obstetrical management
 Expert group is considering other details.

29. NSSK PROGRAM (NAVJAT SISHU SURAKSHA KARYAKRAM)
NSSK program launched in September 2009 by union health minister.
Aim:
To train health professional in basic newborn care and resuscitation
Purpose:
I. Prevention of hypothermia
II. Prevention of infections
III. EIBF
IV. Basic newborn resuscitation

30. RBSK ( RASHTRIYA BAL SWASTHYA KARYAKRAM)
RBSK program launched by the ministry of health and family welfare,
Govt.of India under the NHM in the year of February 2013.
Aim:
- To improve the overall quality of life of children
Objectives:
- Early detection & management of 4Ds prevalent in children.

31. 4 Ds are,
 Defects
 Diseases
 Developmental delays
 Deficiencies

32. IMPLEMENTATION MECHANISM OF RBSK:
BENEFICIARIES NEWBORN
CHILDREN OF AGE 6
WKS TO 6 YEARS
CHILDREN 6 YEARRS
TO 18 YEARS
Site of Screening Facility Community
Based Based
Anganwadi Centre Govt or Govt aided
school
Personal team
Responsible
Existing ASHA
Health
manpower
Dedicated mobile
health team
Dedicated mobile
health team

33. JSSK (JANANI SHISHU SURAKSHA KARYKARAM)
JSSK scheme was launched in June 2011, to eliminate out of pocket
expenses for both pregnant women and sick infants.
Goals of JSSK :
Provision of maternal and newborn care.
 Diet
 Delivery
 Provision of blood
 Essential diagnosis
 Transport and drugs

34. RMNCH + A
In India RMNCH programme launched in Feb 2013.
Reproductive Health :
I. Spacing methods
II. Interval Iucd
III. PTK - Nischay kits
IV. Sterilization
Maternal Health:
I. High-risk pregnancies
II. Review maternal and infant death

35. - Identify low institutional delivery areas.
Newborn Health:
 Exclusive Breastfeeding
 Essential newborn care
 Special newborn care units.
Child Health:
 Focus on Nutrition
 Diarrhea management
 Management of Pneumonia

36. Adolescent Health:
Teenage Pregnancy
Strengthen ARSH Clinic.
Iron plus initiative
Promote Menstrual Hygiene
Objectives:
 Reducing the Global MMR & IMR

37. CEmONC
In September 2004 government order was passed to establishment of
CEmONC centres in the state.
1st Phase – 66 centre
2nd phase – 32 centre
3rd phase – 27 center
Salient Features of CEmONC Centres :
CEmONC centers is well equipped with both the manpower & the
infrastructure required to care for the mother and the newborn

38. Round the clock, the Centre has Obstetricians, Pediatrician, staff
Nurses, Lab technician, and Support staff on duty and anesthetics on call.
Services available in CEmONC:
 Resuscitation of all obstetric emergencies.
 Resuscitation of all newborn emergencies.
 Blood transfusion facilities with all groups of blood.
 Supportive lab & imaging services.
 PPTCT services

39.  Free Antenatal services & postnatal counselling services
 Free 108 Ambulance
 Uninterrupted power supply
 Health care waste management facility

40. Services available in the Labour Room :
 Emergencies met by trained Obstetrician and staff Nurses and round the
clock
 Emergency treatment Protocols, equipment & drugs are available in the
casualty, labour room & newborn care services.
 Emergency USG are taken for maternal emergencies
 Partographs are used
 Biomedical waste management procedure followed.

41. Services available in the care of newborn :
 Resuscitation of newborn by trained pediatrician.
 Emergency treatment protocols, equipment and drugs are available in the
casualty Labour room & New born care services.
 Initiation of breast feeding immediately after birth.

42. SUMAN - (SURAKSHIT MATRIVAASHWASHAN)
SUMAN program was launched by the Honorable health minister on
October 10, 2019.
Aims of SUMAN:
An initiative For zero preventable Maternal & Newborn deaths.
Services undergone SUMAN:
 Provision of at-least 4 ANC checkup and 6 HBNC visits.
 Early initiation & Support for BF
 Zero dose vaccination
 Management of sick neonates & Infants

43.  Safe motherhood booklet & MCP card
 Respectful care with privacy & dignity
 Free transport from home to health institutions (Dial 102/108)
 Time bound redresser of grievances through a responsive call center/
helpline.
 Postpartum FP Counseling
 Delivered by trained personnel.
 Choice for delayed cord clamping beyond 5 minutes/up to delivery of
placenta.

44.  Assured referral services with scope of reaching health facility within 1
hour of any critical care emergency.
 Birth Registration certificates from health care facilities.
 Counseling and IEC for safe motherhood.
 Free and zero expense access for identification and management of maternal
complications.
 Elimination of mother to child transmission of HIV, HBV and Syphilis.
 Drop back from institution to home after due discharge.
 Conditional cash transfers / Directs benefit transfer under various schemes.

46. LaQshya
LaQshya :
LaQshya initiative was launched on 11th December 2017, by the
Ministry of Health & Family welfare.
Objectives :
A. Reduce MMR & IMR
B. Improve the quality of care during and the immediate postpartum period.
C. Stabilization of complications and ensure timely referrals and enable an
effective two way follow up system.

47. Enhance satisfaction of beneficiaries positive birthing experience and
provide respectful maternal care to all women.
FEATURES OF LaQSHYA:
LaQShya program focuses on improving the quality of care in the
labour room and maternity OT.
 Under the initiative the multi prolonged strategy has been adopted such
as,
- Upgrading infrastructure.

48. Ensuring the availability of essential equipment
Provide adequate Human resources.
Capacity building of Healthcare
Improving quality process in labour room
Implementation of fast track interventions
Capacity of building of healthcare workers by skill based training
Strengthening critical care in obstetrician ,dedicated obstetric ICU at
medical college hospital level & obstetric HDU at district hospital are
operationalized under LaQshya programme.

50. PMSMA:
Pradhan Mantri Surakshit Matriva Abhiyan (PMSMA) launched
in 31st July 2016, by Honorable Prime minister.( Ministry of Health
&Family Welfare, Govt of India )
ABOUT THE COMPAIGN:
A Minimum package of Antenatal care services is to be provided
to the beneficiaries on the 9th day of every month.

51. Target Beneficiaries :
 To reach out to all pregnant women who are in the 2nd & 3rd trimester of
pregnancy.
Provision of Beneficiaries :
 Identification of High risk pregnancies.
 All investigations done for this camp.
 Conducted counselling sessions
 Filling out MCP cards.

52.  NO Risk factor detected
 High risk pregnancy
 PIH
 With co morbid conditions

54. ASHA PROGRAMME-ACCREDITED SOCIAL HEALTH
ACTIVIST:
India launched ASHA Programme in 2005-06 as part of
the National Rural Health Mission.
Job duties for ASHA worker:
 Act as a care provider at the community level.
 Facilitating access to Health care medicines & Sanitation
Services.
 Raising the level of awareness
 Advocate for female health & hygiene standards.

55. EXPANDED PROGRAM OF IMMUNIZATION:
Expanded programme of immunization is a world Health Organization with the goal
to make vaccines available to all children through out the world.
I. Disease Covered by EPI :
II. Diphtheria
III. Polio myelitis
IV. Measles & tetanus
V. Pertussis & Influenza
VI. Pneumococcal meningitis
VII. Hepatitis B & Diarrhea
Influenza

56. Target groups for immunization:
 Every pregnant women for TT
 All children under 1 year of age
 Other children who have not fully immunized
 Women who are of child bearing age 15-49 yrs but not immunized against tetanus.
 GOALS: To improve immunization coverage focuses on the following 4 items.
 Standardized immunization schedule

57.  Improving the stocking and availability of vaccines
 Promoting safe injection techniques
 Protecting vaccines potency through cold chain management.
 To achieve 100% coverage for eligible children by an ongoing integrated
program.
 Eradication of polio to maintain polio free status.
 Elimination of measles

58.  Elimination of neonatal status
 Maintain zero level of diphtheria.
 Reducing pertussis incidence
 Reducing childhood TB
 To reduce the incidence of bacterial meningitis due to haemophelus
influenza.

59. UNIVERSAL IMMUNIZATION PROGRAMME:
Vaccination programme launched by the Govt. of India in 1985.
OBJECTIVES:
Elimination of neonatal status
Eradication of paralytic polio
-Myelitis

60. BABY FRIENDLY HOSPITAL INITIATIVE:
- BFHI Launched in 1991.
AIM:
 Protection and promotion of breastfeeding
 Ensuring the proper use of breast milk substitutes, when these are
necessary on basis of adequate information & through appropriate
marketing and distribution.
STEPS OF BFHI:
Have a written breastfeeding policy that is routinely communicated to
all health care staff.

62.  Train all Healthcare staff in skill necessary to implement this policy.
 Inform all pregnant women about the benefits and management of breastfeeding.
 Help mothers initiate breastfeeding within a half hour of birth.
 Show mothers how to breastfeed and how to maintain lactation even if they should
be separated from their infants.
 Give newborn infant no food or drink other than breast milk unless medically
indicated.

63.  Practice rooming in.
 Encourage breastfeeding on demand.
 Foster the establishment of breastfeeding support group and refer mothers to
them on discharge from hospital or clinic supports can include.

64. VANDEMATARAM:
 Vande Mataram scheme is a voluntary scheme launched on 9th February
2004 under the auspicious of f o g s I and private clinics.
 This is a voluntary scheme where in any obstetrics and gynaec specialist
maternity home nursing Home lady doctors or MBBS doctor can volunteer
themselves for providing safe mother group services.
 The enrolled doctors will display vande Mataram logo at their clinic.

66.  Mission indradhanush is the Health mission of the Govt. of India.
 It was launched by Union Health Minister J.P.NADDA on 25th December
2014
AIM:
The mission focuses on to ensure high coverage of children and
pregnant women with all available vaccines through out the country.
MISSION INDRADHANUSH:

68. RASHTRIYA KISHOR SWASTHYA KARYAKRAM:
The RKSK program was launched on 7th January 2014.
Objectives:
 Improve nutrition
 Improve sexual and
Reproductive health
 Enhance mental health
 Prevent insurance and violence
 Prevent substance misuse
 Address NCD

69. HEALTHCARE DELIVERY SYSTEM:
INTRODUCTION:
India has a worst healthy car systems but the remain many differences
in quality between rural and urban areas as well as between public and private
Health care the challenge that exist today in many countries is to reach the
whole population with adequate health care services and to ensure there
utilization

70. Definition of Health:
Health is a state of complete physical mental and social will being and
not Nelly the absence of disease are infirmity.
- WHO
Definition of Healthcare Delivery System:
Healthcare delivery system concern is to develop the system which
ensures based comprehensive Healthcare services to people at large especially
those living in remote and backward areas using available resources as
effectively as possible. - K. Park

71. Healthcare Delivery System in India:
India is a union of 29th state and 7 union territories
Under the constitution of India the states are largely independent of the
people.
The responsibility consist mainly of policy making, planning, guiding
assisting availability and coordinating the work of the state help ministers so
that health services convey a very part of the community.

72. The health systems in India has three main links,
 Central
 State
 Local Or Peripheral

73. Functions of Union List:
 International health relations and administration of post quarantine.
 Administration of Central institute
 Promotion of research through research centres
 Regulation and development of medical, pharmaceutical, dental and nursing
professionals
 Establishment and maintenance of drug standards

74.  Census and collection and application of other statistical data
 Immigration and emigration
 Regulation of labour in the working of mines and oil fields
 Coordination with states and with other ministries for promotion of health

75. Functions of Concurrent List:
 The functions responsibility of both the union and State governments
 Prevention and extension of communicable disease
 Prevention of adulteration of food steps
 Control of drugs and poisons
 vital statistics
 Labour welfare

76.  Economic and the social planning
 Population control and family planning
 Preparation of health education material for creating awareness through
Central health education bureau.

77. Functions of DGHS:
International health relations and quarantine.
Control of drug standard
Medical store depot
Post graduate training
Medical education

78.  Medical research
 Central government health schemes
Central health education bureau
Health intelligence
National medical library

79. Functions of Central Council of Health :
 Policy making
 Legislation
 Recommendation

80.  To consider and recommend broad outline of policy in record to matters
concerning health in all its aspects such as the provision of remedial and
preventive care, environmental hygiene, nutrition, health education and the
promotion of facilities for training and research.

81.  To make proposals for legislation in fields of activity relating to medical
and public Health matters and to lay the pattern of development for the
country as a whole.
 To make recommendations to the central government regarding distribution
of available grants- in -aid for the health purpose to the states.

82. Functions:
 Support and safe guard the total policies of the government because of the
collective responsibility of the cabinet.
 As a member of the ministry he brings all the bills pertaining to his
department for approval of the legislature.
 As a member of government he performs ceremonial duties.

83. Functions of Municipal Boards:
 Construction
 Maintenance of roads
 Sanitation and drainage
 Street lighting
 Water supply
 Maintenance of hospital and dispensaries
 Education
 Registration of birth and death

84. Functions of Health organization at district level:
 Investigate communicable diseases
 Maintain free clinic for the early diagnosis of communicable disease.
 Provide laboratory services to assist doctors.
 Conduct clinics for administration of vaccines.
 Collect vital statistics

85.  Provide MCH services.
 Supervise water supply and sewage disposal.
 Conduct health education programs.
 Provide mental Health services.
 Provide family planning services.

86. Functions of Gram Sabha:
 Proposals for taxation.
 Discusses the annual program.
 Elect members of the gram Panchayat.
Functions of Nyaya Panchayat:
 They ensure quick and in expensive justice to villages.

87. ROLE OF NGO IN HEALTHCARE DELIVERY SYSTEM:
Definition of NGO:
A non government organization is any non profit volunteers citizens group
which is organized on a local national or international
- WHO

88. Types of NGO:
 Voluntary agencies
 Professional agencies
 Philanthropic agencies
 Social service and religious organization
 Cooperative agencies.

89. Role of NGO:
I. Protection
II. Prevention
III. Promotion
IV. Transformation

90. Protection:
- Providing release to victims of disaster and assisting the poor
Prevention:
- Reducing peoples vulnerability through income diversification and
savings.
Promotion:
- Increasing people chances and opportunities.
Transformation:
- Red dressing social political and economic exclusion or oppression.

91. NGO Roles on Healthcare System:
 Policy setting
 Resource mobilization and allocation
 Health services
 Health promotion and information exchange
 Monitoring responsiveness and quality of Health services.

92. Policy Setting:
 Representing public and community interest in policy.
 Negotiating public Health standards and approaches.
 Enhancing public support.
Resource Mobilization and Allocation:
 Financing Healthcare services.
 Raising community preferences.
 Monitoring quality of care and responsiveness.

93. Health Services:
 Facilitating community interaction with services.
 Distributing health resources such as condoms betnuts and information
packs.
 Building health worker capacity morale and confidence.

94. Health Promotion and Information Exchange:
Obtaining health information.
Helping to shift social attitude.
Implementing and using health research
Mobilizing and organizing for health.

95. Monitor responsiveness and quality of Health services:
I. Representing clients rights in quality of care issues.
II. Channeling and negotiating patient complaints and claims.
III. Informing policy on quality assess and equity.

96. SUMMARY:
So far we discussed about National Health and Family welfare programs
related MCH Healthcare delivery system and role of NGO in Healthcare
delivery system.

97. CONCLUSION:
Through this seminar I have learned about National Health and Family
welfare programs related MCH Healthcare delivery system and role of NGO in
Healthcare derivative system.
I would like to thank my OBG Nursing Faculty
Dr.Mrs.S.Kalaivani, M.Sc.(N), Ph.D, Nursing Tutor
for giving this golden opportunity.

98. ASSIGNMENT:
- Write an assignment about committees involved in family welfare
programs.

99. JOURNAL PRESENTATION:
 Suresh Ray 2016 conducted year quantitative study of awareness and utilization of
NRHM services among peoples are selected rural areas in the state of Maharashtra. Kya
multi basic random sampling was used for the selection of representative samples for the
study. Structure questionnaire related to NRHM was given to the respondents.
 Most of the people 63% where not ever about the difference services under NRHM
except jsy.
 The researcher concluded that the awareness and utilization of NRHM services among
people residing in rural area of the Maharashtra state is inadequate.

100. THEORY APPLICATION - GENERAL SYSTEM THEORY:
IN PUT
The Students
having lack of
Knowledge on
“NRHM
Programs”
THROUGH PUT
Discussion about
NRHM
Programmes
which includes
Definition,
Purposes and
Structure.
OUT PUT
Students gained
Knowledge on
NRHM
Programmes
FEED BACK

101. JOURNAL REFERENCE:
 Nouralsalhin Abdalhamid Alaagib. Comparison of the effectiveness of lectures
based on problems and traditional lectures in physiology teaching in Sudan –
BMC Medical Education
 Article no: 365(2019)
ABSTRACT:
Lectures are one of the most common teaching methods in Medical Education.
Didactic lectures were perceived by the students as the least effective method.
Teaching methods that encourage self directed learning .It can be effective in
delivering care knowledge leading to increased learning.