The document discusses the Reproductive and Child Health (RCH) program in India. It aims to integrate existing programs related to family planning, maternal and child health, and reproductive health. The RCH program incorporates components for family planning, child survival and safe motherhood, prevention of sexually transmitted diseases/infections, and adolescent health. It aims to promote maternal and child health, reduce mortality, and achieve population stabilization through a client-oriented and decentralized approach.

1. REPRODUCTIVE AND CHILD
HEALTH PROGRAM(RCH)
Dr. KANUPRIYA CHATURVEDI

2. Dr. KANUPRIYA CHATURVEDI 2
Lesson Objectives
 To Learn about the various components of RCH
program
 To know about the goals. objectives target groups,
service components and RCH program
 To know about the services/activities under the
program
 To know about the new initiatives in the program

3. Dr. KANUPRIYA CHATURVEDI 3
Components
 The RCH program incorporated the earlier
existing programs i.e. National Family
Welfare Program and Child Survival and
Survival & Safe Motherhood Program
( CSSM) and added two more components
one relating to sexually transmitted disease
and the other relating to reproductive tract
infections. The program was formally
launched on 15 October 1997.

4. Dr. KANUPRIYA CHATURVEDI 4
Components:
FAMILY PLANNING
CHILD SURVIVAL
AND SAFE
MOTHERHOOD
PREVENTION/
MANAGEMENTOF
RTI/STD/AIDS
CLIENT
APPROACH
TO HEALTH
CARE
Adolescent
Health Care
and Family
Life
Education

5. Dr. KANUPRIYA CHATURVEDI 5
RCH PROGRAM
Family
Planning
 Improved
method mix
 Private sector
inclusion
 Address quality
 Collaborate
with NACO in
condom
distribution
Maternal Health
•Quality ANC
•Institutional
Deliveries
•Skilled Birth
Attendance
• EmObstetric care
•Home based post-
partum & NBC
•Quality safe abortion
services
•RTI/STI
Child Health)
•Intensify existing
services :
Immunization,
NBC
Micronutrient
Supply
CDD
ARI
• IMNCI.
Adolescent
health
•Anemia
•Awareness about
RH issues

6. Dr. KANUPRIYA CHATURVEDI 6
RCH Program (cross cutting Issues)
Human
Resources
 Anesthetists
 Obstetricians
 Lady doctors
 Contractual
ANMs
 Staff Nurses in
24 Hrs PHCs
 Counselor
IEC
•Branding
•Involving
Professional
Agencies
•Media
•Inter-personal
Communication
•Celebrity
involvement
ISC
•Awareness
about RH
issues
•Anemia
MIS
•Output based
Monitoring
•Triangulation of
Data
•CES/DHS

7. Dr. KANUPRIYA CHATURVEDI 7
The Paradigm Shift
Vertical Programmes Integrated Service Delivery
Camp Oriented Client Oriented
Target Oriented Goal Oriented
Quantity Oriented Quality Oriented

8. Dr. KANUPRIYA CHATURVEDI 8
Camp Oriented Client Oriented
• Sterilization
Camps
• IUD Camps
• Immunisation
Camps
• Full Range of RCH
Services
• Need Based
.

9. Dr. KANUPRIYA CHATURVEDI 9
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

10. Dr. KANUPRIYA CHATURVEDI 10
Program Objectives
 Promotion of MCH to ensure safe
mother hood and child survival
 Reduction of maternal and child
morbidity and mortality
 Attainment of population stabilization

11. Dr. KANUPRIYA CHATURVEDI 11
Highlights of the program
 Integration of all programs related fertility regulation,
maternal and child health and reproductive health.
 Services are client oriented, demand driven through
decentralized participatory process and target free
approach
 Up-gradation of facilities : creation of First referral
units
 Provision of specialist services for STD and RTI
 Provision of out reach services for vulnerable groups

12. Dr. KANUPRIYA CHATURVEDI 12
Categories:
 Differential approach
 Based on CBR and female literacy rate,
 Category A:58 districts
 Category B:184 districts
 Category C:265 districts
 All the districts covered in a phased manner
over a period of 3yrs

13. Dr. KANUPRIYA CHATURVEDI 13
Service Package: for mothers
 Essential obstetric care
 Early registration
 Minimum 3 ANC
 Safe delivery
 3 PNC
 Referral
 More relevant for Assam, Bihar,Rajasthan,
Orissa,UP, MP

14. Dr. KANUPRIYA CHATURVEDI 14
Emergency obstetric care
 Strengthen FRUs
 Supply of kits and skilled manpower
 TBA (Traditional Birth Attendants) Dai training
 NGOs involved: More local specific
 24-hr Delivery services at
PHCs/CHCs:
 Promote institutional deliveries Additional
honorariumto staff
 Safe deliveries

15. Dr. KANUPRIYA CHATURVEDI 15
Contd.
 Deliveries by trained personnel in safe and hygienic
surroundings are encouraged
 Institutional deliveries are encouraged for women
having complications.
 In case of complication referrals are made to First
Referral Units for Management of obstetric
emergencies.
 Three postnatal checkups are given to mothers after
the delivery.
 Spacing of at least three years between children are
encouraged.

16. Dr. KANUPRIYA CHATURVEDI 16
For children
 Essential newborn care like keeping the baby
warm, checking the baby’s weight and giving
the baby mother’s first milk are encouraged.
 Babies that are premature or have low birth
weight are provided special care.
 Babies with any complications refereed to
the health center.
 Exclusive breast-feeding are encouraged for
the first three months.

17. Dr. KANUPRIYA CHATURVEDI 17
Contd.
 Immunization are administered to every child
meticulously to prevent death and disabilities.
 Vitamin A Prophylaxis
 ORT.
 Acute respiratory infection in children treated by
cotrimoxazole tablets.
 Treatment of Anemia

18. Dr. KANUPRIYA CHATURVEDI 18
For Eligible Couples
 Promoting use of contraceptive methods among
eligible couples is important to prevent unwanted
pregnancies. Couples should be able to choose from
various contraceptive methods including
condoms,oral pills, IUDs,male and female
sterilization
 Safe services for medical termination of pregnancies
should be encouraged for women desiring abortions
 Other New Services
 Treatment of RTI/STI is given.
 Promotion activities for adolescents health.

19. Dr. KANUPRIYA CHATURVEDI 19
Drug and equipment kits: Mid-wifery kit &
drug kit
 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

20. Dr. KANUPRIYA CHATURVEDI 20
Goals set for various national /int. policies

21. Dr. KANUPRIYA CHATURVEDI 21
RCH Program: Phase II
 RCH Phase II began from 1 April 2005. The components
being:
 Essential obstetrical care
 Emergency obstetrical care
 Strengthening referral system Strengthening project
management
 Strengthening infrastructure
 Capacity building
 Improving referral system
 Strengthening MIS
 Innovative schemes

22. Dr. KANUPRIYA CHATURVEDI 22
Essential obstetric care
 Promotion of institutional deliveries
 50% of the PHCs and CHCs made operational as 24
hours delivery centers.
 Skilled attendance at birth
 Policy descions to permit Health workers to use
drugs in emergency situations to reduce maternal
mortality

23. Dr. KANUPRIYA CHATURVEDI 23
Emergency obstetric care
 Operationalisation of FRUs to provide:
 24 hours delivery services
 Emergency obstetric care
 New born care and emergency care of the sick child
 Full range of family planning services
 Safe abortion services
 Treatment of RTI and STI
 Blood storage facility
 Essential laboratory services
 Referral ( transport ) services

24. Dr. KANUPRIYA CHATURVEDI 24
New initiatives
 Training of PHC doctors in life saving anesthetic
skills for emergency obstetric care a FRUs
 Setting up of blood storage centres at FRUs
 Janani suraksha yojana
 Vandemataram scheme
 Safe abortion services
 Integrated Management of Childhood illnesses.

25. Dr. KANUPRIYA CHATURVEDI 25
24 hrs. Functioning of PHCs
• It is planned to establish 2000 FRUs in phases in
RCH-II 50% PHCs and all CHCs to be
operationalised in phases
• Availability of Services such as
- 24 Hrs. Delivery services
- New Born care
- Family Planning, Counselling and services
- Availability of RTI, STI services
- Safe abortion services (MVA etc.)

26. Dr. KANUPRIYA CHATURVEDI 26
Training in Anaesthesia
• Training of MBBS Doctors in Life Saving
Anaesthetic Skills for Emergency Obstetric Care.
• 18 weeks training course
• The First Training Programme
Conducted at AIIMS for Chhattisgarh
• Training to be conducted in phases
and limited to the requirement at
FRUs.

27. Dr. KANUPRIYA CHATURVEDI 27
Training in Obstetric Management
• Training of MBBS doctors in obstetric
management and skills including C.S. in
RCH-II
• Training to be conducted in collaboration
with FOGSI
• Duration of training to be 16 weeks
• Expert Group is considering other details

28. Dr. KANUPRIYA CHATURVEDI 28
Blood Storage Facility
 Management of obstetric emergencies is sometimes
not possible due to non-availability of blood.
 The Drugs and Cosmetics Act was therefore
modified to facilitate establishment of blood
storage centres at FRU’s.

29. Dr. KANUPRIYA CHATURVEDI 29
Janani Surkasha Yojna
To promote Institutional Deliveries
 To reduce overall
 Maternal Mortality Ratio
 Infant Mortality Rate
A safe motherhood intervention, replacing the
“NationalMaternity Benefit Scheme”, under NRHM
100 % centrally sponsored
Integrates cash assistance with delivery
& post-delivery care.

30. Dr. KANUPRIYA CHATURVEDI 30
Vandematram Scheme
 It is a voluntary scheme wherein any obstetric and
gynaec specialist, maternity home can volunteer
 Enrolled doctors will display ‘vandemataram logo’
at their clinics.
 Iron and folic acid tablets, oral pills, TT injections,
etc will be provided for free distribution.

31. Dr. KANUPRIYA CHATURVEDI 31
Referral Transport
Key issues: Roads, transportation, RCH I funds
poorly Utilized, Community participation lacking
Under Consideration
– Place funds with AWW /ANM; [ JSY]
– Develop community mechanisms
– Provide out source ambulances at PHCs
CHCs, and FRUs
Easy access to ambulance & assistance from AWW

32. Dr. KANUPRIYA CHATURVEDI 32
Role of ASHA
• A village level link worker attached to
AWW/ANM
• Motivator for ANC, PNC, Institutional
Delivery, Immunization and
Family Planning Services
• Provide Escort to beneficiary for above
services.
• Adolescents Health Counsellor.

33. Dr. KANUPRIYA CHATURVEDI 33
Strategy for addressing Adolescent
Reproductive and Sexual Health (ARSH)
A two-pronged strategy will be supported:
 Incorporation of adolescent issues in all the
RCH training programs and all RCH materials
developed for communication and behaviour
change.
 Dedicated days and dedicated timings for
adolescents at PHC’s.

34. Dr. KANUPRIYA CHATURVEDI 34
Infection Management and Environment
Plan
IMEP which is being extended to health care
facilities includes:
a) Treatment and disposal of
biomedical wastes
b) Disposal of syringe waste
c) Provision of water sanitation and
good hygiene conditions

35. Dr. KANUPRIYA CHATURVEDI 35
Safe Abortion Practices
 MEDICAL METHOD
 Termination of early pregnancy (49days) using 2 drugs
- mifeprestone followed by mesoprostol
 MANUAL VACCUM ASPIRATION
 Safe and simple technique for termination of pregnancy.
 Can be used at PHC or comparable facility
 FOGSI, WHO & state govt. are coordinating the project

36. Dr. KANUPRIYA CHATURVEDI 36
Some Innovative State Initiatives
Gujarat
 Increase access to safe delivery services. It is in partnership
with private providers (Chiranjivi Yojana)
 A Dai Sangathan has been formed by 10 leading NGOs of
the state to facilitate interface between the health system and
the community
Punjab
 Proposed to pay an incentive of Rs. 500/- to BPL SCs
belonging to urban areas
 Purchase and supply of nutrients like iron, calcium, D-
worming tablets for pregnant mothers belonging to SC
classes.

37. Dr. KANUPRIYA CHATURVEDI 37
Contd….
 Screening code for Ca Cervix – Tamil Nadu
Subsidized Medical Practitioner (SMP) scheme-
Assam, Bihar
Nurse Practitioners Scheme
Laproscopic Training – Maharashtra
Implementation of Health Insurance scheme on
pilot basis.

38. Dr. KANUPRIYA CHATURVEDI 38
Monitoring :
Accessibility Indicators
 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

39. Dr. KANUPRIYA CHATURVEDI 39
Quality Indicators
Following are the quality indicators used to monitor and evaluate
RCH programme through monthly reports:
1. Number of antenatal cases registered
2. Number of pregnant women who had 3 antenatal checkups
3. Number of high risk pregnant women referred
4. Number of pregnant women who had 2 doses of TT
5. Number of pregnant women under prophylaxis and treatment of
anaemia
6. Number of deliveries by trained and untrained attendants
7. Number of cases with complications referred to
PHC/FRU
8. Number of newborn with birth weight recorded

40. Dr. KANUPRIYA CHATURVEDI 40
Contd..
9. No. of women given 3 post natal check-ups
10. No. of RTI/STD cases detected, treated and referred
11. No. of children fully immunized
12. No. of adverse reactions reported after immunization
13. No. of cases of ARI and diarrhea under 5yrs
14. No. of cases motivated and followed for contraception.

41. Dr. KANUPRIYA CHATURVEDI 41
Impact Indicators
 % 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