The RMNCH+A program in India aims to improve maternal and child health outcomes through a comprehensive strategy across the life cycle based on a continuum of care model. Key goals include reducing infant mortality to 25 per 1000 live births, maternal mortality to 100 per 100,000 live births, and total fertility rate to 2.1 by 2017. The program focuses on reproductive health, maternal health, newborn care, child health, and adolescent care through various high-impact interventions delivered at different levels of care from community to facilities. A key aspect of RMNCH+A is linking interventions between different life stages like reproductive health, family planning, and maternal, child and adolescent health.

1. REPRODUCTIVE, MATERNAL.
NEWBORN, CHILD AND ADOLESCENT
HEALTH (RMNCH+A) PROGRAMME
Dr Sanjay Ranaut
MPH 1st Year

2. HISTORICAL BACKGROUND
1. 1950: MCH services as a basic health service in PHC
2. 1952: National Family Planning Programme
3. 1966: All India Hospital Post Partum Programme
4. 1977: National Family Welfare Programme
5. 1992: National Child Survival & Safe Motherhood programme
6. 1997: RCH phase-I
7. 2005: NRHM
8. 2005: RCH phase -II
9. 2013: RMNCH+A

3. Special focus under RCH-II
1. Essential obstetric care:
- Institutional delivery
- Delivery by SBA
2. Emergency Obstetric Care:
- Operationalizing FRU
- PHC 24 ˣ 7 delivery services
3. Essential Newborn Care / Care of the sick Newborn
RCH-II, not included the underserved groups including Adolescent, urban
poor and tribal population

4. 8 May 2018

5. RMNCH+A STRATEGIC APPROCH 2013
1.This was a comprehensive strategy for improving the maternal and child
health outcomes , under NRHM
2.It was based on the evidence that maternal and child health cannot be
improved in isolation as adolescent health and family planning have an
important bearing on the outcomes.
3.This strategy encompasses various high impact interventions across the
life cycle.
4.The strategy was based on the concept of ‘CONTINUUM OF CARE’

6. • There are two dimensions to healthcare:
• (1) stages of the life cycle
• (2) places where the care is provided
• These together constitute the
‘Continuum of Care’

7. GOALS
• 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

11. Reproductive Health
• Focus on spacing methods, particularly PPIUCD at high case
load facilities
• Focus on Interval IUCDat all facilities including subcenters
on fixed days
• Home delivery of Contraceptives (HDC) and ensuring
spacing at birth (ESB) through ASHAs

12. • Ensuring access to pregnancy testing kits and strengthening
Comprehensive Abortion care services
• Maintaining quality sterilization services

14. Maternal Health
• Use of MCTS/ RCH portal for early registration of pregnancy
• Detect High risk pregnancies and ensuring appropriate
management. PMSMA clinics on 9th of every month (Pradhan
Mantri Surakshit Matritva Abhiyaan)
• Equip Delivery Points with highly trained HR and ensure
equitable access to EmOC (basic and advanced) services through
FRUs. Add MCH wings as per need.

15. • Review maternal, infant and child death review and take
corrective actions.
• Identify villages with high number of home deliveries and
distribute Misoprostol to select women during pregnancy;
incentivize ANMs for domiciliary deliveries

17. Newborn Care
• Early Initiation and exclusive breastfeeding
• Home based New born care through ASHA
• Essential Newborn care and resuscitation: NSSK (Navjat
Shishu Suraksha Karyakram)
• Special Newborn care Unit (SNCU), New born Stabilization
Unit (NBSU), Newborn care corner (NBCC).
• Community level use of Gentamycin by ANM

19. Child Health
• IYCF: Infant and young child feeding- Complimentary feeding
starting at age 6 months.
• NIPI: National Iron Plus Initaitive starting at 6 months of age (6 -60
mths 1 ml IFA biweekly, 5-10 years weekly WIFS Junior -pink)
• Management of Diarrhoea at community level using ORS and Zn
Tab (special Intensified Diarrhoea Control Fornight drives in July
every year). Also covered under IMNCI trainings

20. • Management of pneumonia: IMNCI trainings
• Full Immunization coverage
• RBSK: Rashtriya Bal Swasthya Karyakram- birth to 18 years

22. Rashtriya Kishor Swasthya Karyakram
4 pronged strategy

23. Adolescent Care
• Menstrual hygiene programme: Sanitary pad supplied through
ASHA/ANM @ Rs 6 per pack of 6 sanitary napkins
• Yuva Paramarsh Clinics for counselling of adolescents on sexual/
reproductive/ mental health. Addressal of teenage pregnancy
and increase contraceptive prevalence in adolescents
• Weekly Iron Folic Acid Supplements to adolescents in Govt and
Govt Aided schools
• Peer educators in high priority districts where adolescents act
as educators for fellow adolescents at community level.

24. WHAT IS NEW IN RMNCH+A?
Inter-linkages between different interventions at various stages of the life
cycle
2. Linking child survival to other inventions such as reproductive health,
family planning , maternal health
3. Sharper focus on adolescents
4. Recognizing nurses as ‘pivots’ for service delivery
5. Expanding focus on child development and quality of life
6. Intensification of activities in High Priority districts.

25. References
• A Strategic Approach to Reproductive, Maternal, Newborn, Child and
Adolescent Health(RMNCH+A) in India. Ministry of Health & Family Welfare
Government of India February 2013
• Revised operating manual for preparation and monitering of RCH-II &
immunization component of NRHM state programme implementation plans
(PIPs). Ministry of Health & Family Welfare Government of India. November
2010
• Guidelines for Preparation of Annual Programme Implementation Plan
National Rural Health Mission. 2013-2014
• Govt. of India(2014),Annaul Report 2013-14,Ministry of Health and Family
Welfare ,New Delhi.

26. • Guidance note on gap analysis of RMNCH+A implementation in
India.Ministry of Health & Family Welfare Government of India
February 2013
• Guidance note for RMNCH+A implementation in High priority
districts. India. Ministry of Health & Family Welfare Government
of India February 2013
• Coverage Evaluation Survey 2009 annual report: UNICEF

27. Thank You