Rch

1. Reproductive, Maternal and Child
Health
PRESENTORS
Aman Sharma, Roll Number 131
Tania Tarangini, Roll Number 101
Our Moderator
Dr. Rakesh Sarma Sir.

2. Reproductive and Child
Health
IT FOCUSES ON 4 POINTS =
1) ABILITY TO REPRODUCE AND REGULATE FERTILITY
2) SAFE PREGNANCY AND BIRTH
3) SUCCESSFUL OUTCOME OF PREGNANCY
4) SEXUAL RELATIONS FREE OF FEAR OF PREGNANCY AND DISEASES
HAS 2 PHASES:
RCH PHASE 1 = 1997
RCH PHASE 2 = 2005

3. RCH PHASE 1
 Established on 1997, 15th of October.
 Focuses on :
1) Child survival and safe motherhood
2) STD and UTI prevention
 RCH phase- I interventions at district level were as follows:
• Essential obstetric care (Safe booking, 4 ANC visits, safe delivery at home, etc.)
• Emergency obstetric care (Strengthening of FRUs)
• 24 hour delivery system
• MTP
• RTI and STI control
• Immunization
• Essential Newborn Care (Newborn resuscitation, prevent hypothermia and infections, exclusive
breast feeding)

4. • Diarrheal disease control
• ARDS control
• Prevention of Vit. A deficiency
• Prevention and control of anemia
• Training of DAIs

5. RCH PHASE 2
 Established on 2005, 1st of April.
 Focuses on reducing maternal and infant mortality with special emphasis on rural areas.
 The major strategies under the second phase of RCH are
• ESSESNTIAL OBSTETRIC CARE.
Increase institutional delivery in all PHCs by 50%
All CHCs will be made 24 hour delivery centers by 2010
Presence of skilled attendants at delivery
ANMs and LHVs are allowed to use drugs in specific emergency situations.
• EMERGENCY OBSTETRIC CARE.
All FRUs are to be made operational for emergency and essential obstetric care.

6. FIRST REFERRAL UNIT
 It is a Community Health Centre which is a clinical facility equipped to provide emergency care 24x7
hours.
 Main services in the FRUs are:
• 24 hour delivery, normal and assisted
• Cesarean section
• New born care
• Emergency care of sick children
• Family planning service
• Safe abortions
• Treatment of RTI and STI
• Blood storage
• Essential lab services
• Referral services

7.  MINIMUM FEATURES FOR A CHC TO BE AN FRU ARE:
 20-30 beds
 New born care area
 Blood storage facility
 Running water
 Active electricity
 Proper waste disposal
 Presence of ambulances

8. MICRONUTRIENT SUPPLEMENTATION
VITAMIN A

9.  Give Vitamin A in a single dose to all SAM children unless there is evidence that child has received
vitamin A dose in last 1 month.
 Recommended oral dose of Vitamin A according to child's age:
<6 MONTHS ======= 50,000 IU
6-12 MONTHS ======= 100,000 IU
>12 MONTHS ======= 200,000 IU
 Give same dose on Day 1, 2 and 14 if there is clinical evidence of vitamin A deficiency.
 Children more than twelve months but having weight less than 8 kg should be given 100,000 IU orally
irrespective of age.
 Oral treatment with vitamin A is preferred. For oral administration, an oil-based formulation is
preferred.
 IM treatment should be used in children with severe anorexia, edematous malnutrition, or septic
shock. Only water based formulations and half of oral dose should be used.

10. Integrated management of neonatal
and childhood illness
 IMNCI is a strategy for an integrated approach to the
management of childhood illness as it is important for child
health programs to look beyond the treatment of a single
disease.
 Most sick children present with signs and symptoms of more
than one conditions. This overlap means that a single
diagnosis may not be possible or appropriate, and
treatment may be complicated by the need to combine
several conditions.
 An integrated approach to manage sick children is,
therefore, necessary.

12. CHILD HEALTH COMPONENTS
The strategy for child health care aims to reduce under five child mortality
through interventions at every level of service delivery and through improved
child care practices

13. Nutritional Rehabilitation centres
The services provided at NRCs are:-
1) 24 hours care and monitoring of the child
2) Treatment of medical complications
3) Therapeutic feeding
4) Sensory stimulation amd emotional care
5) Counselling on appropriate feed,care and hygiene
6) Demonstration and practice by doing on preparation of energy
dense food using locally available,affordable and culturally
acceptable
7) Social assessment
8) Follow up of the children discharged from the facility .

14. Management of child with SAM at health facilities
1)Triage
2) Assessment at admission
3) Principles of hospital based management
The principles of management of SAM are :-
1) STABILIZATION PHASE
2)TRANSITION PHASE
3) REHABILITATIVE PHASE

15. STABILIZATION PHASE
Children with SAM without an adequate appetite and a major
medical complications are stabilised in a in patient facility.
This phase usually last for 1-2 days ,The feeding formula used
during this phase is starter diet .
This promotes recovery of normal metabolic function and
nutrition electrolytes balance . All children must be carefully
monitored for signs of over feeding and over hydration.

16. TRANSITION PHASE
— Subsequent part of first phase
— last for usually 2-3 days
— ensure child is clinically stable and can tolerate increased
energy and protein intake
— the type of diet is catch up diet
— Moves from from stabilization phase to transition phase when
:-
a) at least the beginning of loss of oedema
b) Return of appetite
c) No nasogastric tube ,infusions,no severe medical problem.

17. REHABILITATION PHASE
1) The aim is promote rapid weight gain ,stimulate emotional
and physical development and prepare the child for normal
feeding at home .
2) The child progresses from transition to Rehabilitation phase
when : she/he reasonable appetite ,finishes >90% of the feed
that is given , major reduction or loss of oedema ,no other
medical problems .

18. RASHTRIYA BAL SWASTHYA KARYAKRAM
RBSK was launched in February 2013
a) It includes provisions for child health screening and early
intervention services through early detection and management of
4Ds .
b) The defects are at birth ,diseases in children, deficiency
conditions, developmental delays including disabilities.

19. Programme implementation
1) For NEWBORN :- Family based newborn screening at public
health facilities,by health manpower . Community based
newborn screening at home through ASHAs for newborn till 6
weeks of age .
2) For CHILDREN ( 6 weeks to 16 years ) :- Anagawadi centre
based screening by dedicated mobile health themes
3) For CHILDREN ( 6 years to 18 years) :- Government and
Government aided schools based screening by dedicated
mobile health teams .

20. Integrated Child Development Services
It was launched on 2nd October ,1975
Under ministry of women and child development
A) Objectives:- Holistic development of the child and safe
motherhood
B) Beneficiaries:- Children (0 to 6 years of age), Pregnant women
and lactating mother , Adolescent group.
C) Benefits :- Supplementary nutrition,non formal
education,facilitating immunisation,promote family planning
services

21. Janani Suraksha Yojana

22.  1) Launched on 12th April,2005
 2) 100% centrally sponsored scheme
 3) iIt integrates the benefits of cash assistance with
institutional care during antenatal ,delivery ,and
immediate post partum care
 4) The accredited social health activist would work as
a link between the poor pregnant women and public
health institutions in low performing states , she
would be also responsible for making available
institutional antenatal and postnatal care
Salient features

23.  1) Reducing maternal mortality rate
 2) Reducing neonatal mortality rate
 3)Encouraging delivery at the health
institutions and focusing at
institutional care among women in
the below poverty line families
OBJECTIVES

24. 🌟
Eligibility:-
1)Pregnant women belonging to BPL
2) Pregnant women of families having an income of
less than 17,000
3) Women above 19 years up to first two live births
in high performing states
4) Women undergoing sterilization soon after the
delivery
5) Pregnant women should and must have
registered in the PHCs /Subcenter and had
received adequate antenatal care .

25.  Benefits (scale of assistance)
 Rural area
 1) Mother’s package :- ₹1400
 ASHA’s package :- ₹600( in case of LPS )
 2) Mother’s package :- ₹700
 ASHA’s package :- ₹600(in case of HPS).

26.  Urban area
 1)Mother’s package:- ₹1000
 ASHA package :- ₹400(in LPS)
 2) Mother’s package :- ₹600
 ASHA’s package :- ₹400(in HPS)

27. 1)In the low performing states ,All the births delivered in health centre
,government or accredited private institutions will get benefited .
2)In the high performing states the benefit is only up to 2 live births
3)ASHA’s package is only available in low performing states , north east
states ,in all the tribal districts of all the states ,UTs.
Limitation

28. 1)Cash assistance for referrals transport for pregnant women to go to
nearest health centre for delivery should be less than ₹250
2)Cash incentive :- This should not be less than ₹200, ASHA should get
her money after the post natal visit to beneficiary
3)The Yojana subsidies the cost of caesarean section and for
management of obstetrics complications up to ₹1500 per delivery to
the government institutions
4)Direct benefit transfer under Janani suraksha yojana through direct
benefit transfer mode .

29.  Launched on 1st June,2011
Janani Sishu Suraksha Karyakram
(JSSK)

30. 1)All pregnant women delivering in public health institutions to
have absolutely free and no expense delivery,including
caesarean section . The entitlements include free drugs and
consumables , free diet up to 3 days during normal delivery
and up to 7 days for caesarean section ,free diagnostic and free
blood whenever required . This initiative would also provide
free transport from home to institutions, between facilities in
case of referrals and drop back home .
3)Similar entitlements have been in place for all sick newborns
accessing public health institutions for treatment till 30 days
after the birth. Drugs and supplements like infusions,cotton
,dressing etc

31.  Was launched in the year 2013
Reproductive,
Maternal,Newborn,
Child And Adolescent
Health strategy
(RMNCH+A)

32.  STRATEGY
RMNCH+A
1) Comprehensive care through
the five pillars
2) The plus strategies focusses on
including adolescence for the first
time as a distinct life stage
3) Linking maternal and child
health to reproductive health
,family planning,adolescent health
,HIV ,Gender, preconception and
prenatal diagnostic techniques
4) Linking home and community
based services to facility based
care .

33. Interventions of RMNCH+A

34.  1) Focus on spacing methods ,particularly PPIUCD
at high case load facilities
 2) Focus on intervals IUCD at all facilities including
subcentres on fixed days
 3) Home deliveries of contraceptives,and ensuring
spacing at Birth through ASHAs.
 4) Ensuring access to pregnancy testing kits and
strengthening comprehensive abortion care services
 5) Maintaining quality sterilisation services .
Reproductive
Health

35.  1) Tracking each and every pregnancy and
ensuring early registration and full antenatal care
through the use of mother child tracking system .
 2) Detecting high risk pregnancy and maintaining
a line of severely anaemic mother and ensuring
appropriate management .
 3) In villages with high no of home
deliveries,distribute Misoprostol to the women for
consumption in the eight month of pregnancy.
Maternal Health

36.  1) Early initiation and exclusive
breastfeeding
 2) Home based newborn care through
ASHA
 3) Essential newborn care and
resuscitation services at all delivery points
 4) Special newborn care units
 5) Community level use of Gentamicin by
ANM
Newborn care

37.  1) Complementary feeding ,IFA
supplements, and focus on nutrition
 2) Diarrhea management at community
level using ORS and zinc
 3) Management of pneumonia
 4) Full immunization coverage
 5) RBSK , screening of Children for four
D’s
CHILD HEALTH

38.  1) Address teenage pregnancy and
increase contraceptive prevalence in
adolescent.
 2) Introduce community service through
peer educators
 3) Strengthen ARSH clinics
 4) Rolls out National Iron Plus Initiative
including weekly IFA
 5)Promote menstrual hygiene
ADOLESCENT
HEALTH

39. CHILD HEALTH COMPONENTS

40. The services provided

41.  — Cases based load deployment of HR
at all levels
 2)Ambulance, drugs, diagnostic,
reproductive health commodities
 3) Health education, demand promotion,
behavior change communication
 4) Supportive supervision and use of
data’s and scorecards
Health system
strengthening

42.  1) Bring down out of pocket
expenses by ensuring JSSK,RBSK,
 2) ANMs and Nurses to provide
specialised and quality care to
pregnant women and children
 3) Focus on un served and
undeserved villages , urban slums
and blocks .
Cross cutting
intervention

43. 1)Reduction of infant mortality rate to 25 per 1000 live births by
2017
2)Reduction in maternal mortality ratio to 100 per100,000 live
births by 2017
3)Reduction in Total Fertility rate to 2.1 by 2017
The 12th Five year plan goals that are relevant
to RMNCH+A strategies are as follows :-

44.  Ministry has launched a new initiative
namely SUMAN on 10th October,2019 with
an aim to provide assured
,dignified,respectful,and quality health care
at no cost and zero tolerance for denial of
services for every woman and newborn
visiting the public health facility in order to
end all preventable maternal ,and new born
deaths ,amd morbidities,and provide a
positive birthing experience .
SUMAN ( Surakshit
Matritva Aashwasan)

45. YOU !!
THANK