Recent Advances in RCH - India 2015

1. Recent advances in
RCH
PRESENTOR: Dr. Jitendra
MODERATOR: Dr. Rajesh Kumar

2. PLAN OF PRESENTATION
1. Background
2. Reproductive, Maternal, Newborn, Child Plus
Adolescent Health (RMNCH+A)
• Pregnancy and child birth
• Newborn and child health
• Adolescents
• Reproductive health and family planning
• Monitoring and evaluation

3. Background
 The RCH Programme was launched in India on
15th October 1997.
 It was based on RCH approach-
 “People have the ability to reproduce and regulate
their fertility, women are able to go through
pregnancy and child birth safely, the outcome of
pregnancies is successful in terms of maternal and
infant survival and well being, and couples are able
to have sexual relations free of fear of pregnancy
and contracting diseases”.
• Target free approach

4. Background
• Phase II of RCH program started on 1st april
2005.
• Decentralization (promotion of state ownership)
• Community Needs Assessment and Monitoring
Approach (CNAMA).
• RMNCH+A approach-
• Need to accelerate progress towards MDG 4,5
(2015) and redefine national agenda a coordinated
“life cycle approach” was introduced in the
program.

5. 12th plan MCH goals
• Targets by 2017-
• Reduce MMR to 1/1000 live births
• Reduce IMR to 25/1000 live birth
• Reduce TFR to 2.1
• Reduce by half under nutrition in children
under 3 years (46% > 23%)
• Reduce by half anemia among reproductive
aged women (56% > 28%)
• Improve child sex ratio (914 > 950)

6. Reproductive, Maternal, Newborn, Child
Plus Adolescent Health (RMNCH+A)
• Continuum of Care approach :
1. All stages of life
2. All places of Health care delivery
• INCLUSION of ADOLESCENCE
• LINKING of MATERNAL AND CHILD HEALTH TO
REPRODUCTIVE HEALTH & OTHER COMPONENTS
(family planning, adolescent health, HIV, gender and
PC&PNDT)
• LINKING of COMMUNITY AND FACILITY-BASED CARE

7. PREGNANCY AND CHILD
BIRTH

8. RMNCH+A Package for
mothers
1. Early registration
2. Antenatal care (4 or more visits)
3. Anemia prophylaxis and treatment
4. Two doses of tetanus toxoid and boosters
5. Institutional deliveries or by SBAs
6. Referrals to FRUs
7. Home based postnatal care
8. Counseling for birth spacing and limiting
9. Increased facilities for MTP

9. Antenatal care
Pregnancy testing
• Pregnancy Testing Kits : Nishchay - supplied to
all the sub centres and through ASHAs.
• FA supplementation: by frontline workers and
facility-based service providers.
(periconceptional)
Mother and Child Tracking system (MCTS)
• Register and track every pregnant woman,
neonate, infant and child by name for quality
ANC, INC,PNC, FP and immunization services.

10. Antenatal care
Anaemia
• Line listing of severely anaemic women, tracking
during pregnancy and childbirth (high priority)
• The ANMs and PHC In-charges - timely and
appropriate management of severely anaemic
women.
Mother and child protection card
• A joint MCP card by MOHFW and MOWCD is
being used by all states as a tool for monitoring
and improving quality of MCH and nutrition

11. Antenatal care
Parent-to-child transmission of HIV
• National strategic plan (PPTCT) wef 1st jan 2014
• HIV positive pregnant women -TDF+3TC+EFV
lifelong
• HIV exposed infants - syp. Nevirapine daily for
minimum of 6 weeks followed by cotrimoxazole
prophylactic therapy.
Fixed day ANC clinic
• Targeting BPL, SC/ST other marginalised groups
and primigravida and adolescent mothers.
• Introduction of stick based rapid estimation of
haemoglobin and urine examination.

12. SKILLED OBSTETRIC CARE
Operationalizing delivery points:
• Health facilities located across the health system
are now designated as ‘delivery points’.
Designated as L1, L2 and L3.
Transport system
• Referral transport system that reaches patient
within 30 min and health facility within 30 min.
(Golden hour) eg- janani express yojna (MP)

13. SKILLED OBSTETRIC CARE
 Hard-to-reach areas
• Maternity waiting homes
• Delivery huts (haryana)
• Equipping subcentres for normal delivery
Obstetric emergencies
• ANMs permitted to use- inj oxytocin, inj MgSo4, inj
gentamycine and oral misoprostol and antibiotics after
training.
• Also to start i.v infusion in case of emergency.

14. SKILLED OBSTETRIC CARE
Maternal and Child Health (MCH) Wing:
• Most health facilities, especially those at secondary
and tertiary level are overwhelmed by a very high
case load of pregnant women and newborns due to
the increase in institutional deliveries following launch
of JSY and JSSK.
• The new MCH wings will be comprehensive units
(30/50/100 bedded) with antenatal waiting rooms,
labour wing, Essential Newborn Care room, SNCU,
operation theatres, blood storage units and a
postnatal ward as well as an academic wing.

15. EMERGENCY OBSTETRIC CARE
MULTI SKILLING OF HEALTH PROFESSIONALS
DOCTORS
• 18 week- long training programme of MBBS qualified
doctors in Life Saving Anaesthetic Skills (LSAS)
• 16-week-long training programme in Obstetric
Management Skills including Caesarean section
• A 10-day-long training for Medical Officers in Basic
Emergency Obstetric Care (BEmOC)
PARAMEDICAL TRAINING
• A 3 week- long Skilled Birth Attendance training for
ANMs/LHVs /Staff Nurses.

16. EMERGENCY OBSTETRIC
CARE
Misoprostol for prevention of PPH
• In places with home deliveries >80%, 3 tablets of
Misoprostol (200 mcg) are given to pregnant
women at 8 months of gestation.
• taken immediately after delivery.
 Comprehensive safe MTP
• MVA facilities to be available at all CHCs and 50%
PHCs. (24*7)
• Private and NGO sector encouraged and frontline
workers trained to provide confidential counselling
and promote post abortion adoption of
contraception.

17. Janani Suraksha Yojana (JSY)
• From 8th may 2013 conditionalities of mother like
minimum age and parity have been removed.
• Incentives to ASHA has been revised Rs 600
(rural) and Rs 400 (urban)
• A new development under JSY is the decision to
make direct cash payments through AADHAR
enabled payment system.
• Enrolment of all potential JSY beneficiaries on
the MCTS portal, facilitating registration for
AADHAR and opening/linking bank accounts to
AADHAR for all potential JSY beneficiaries.

18. Janani Shishu Suraksha
Karyakram (JSSK)
• To reduce out-of-pocket expenses related to
maternal and newborn care.
• The scheme implemented across the country
entitles all pregnant women delivering in public
health institutions to absolutely free and no
expense normal delivery (3 days), including
caesarean section (7 days).
• Similar entitlements are in place for all sick
newborn (first 30 days of life) accessing public
health institutions for treatment.
• Free assured transport (ambulance service) from
home to health facility, inter-facility transfer in
case of referral and drop back is an entitlement

19. Indra Gandhi Matritva Sahyog
Yojna (IGMSY)
• Conditional Maternity benefit scheme under
MOWCD.
• Launched in 52 districts in pilot phase (2010-11)
• Now covered under Aadhar enabled direct
benefit transfer program (DBT).
• A cash incentive of Rs 4000 is given in 3
installments to mothers above 19yrs for the first
two live birth on fulfilling specific conditions.
• It uses ICDS platform for implementation and
AWW and helper receive Rs 200 and Rs 100
each per beneficiary.

20. Post Natal care
 Postpartum care for mother and baby
• To ensure postpartum care for mothers
and newborns, 48 hours of stay at the
health facility is mandated in case of
institutional delivery.
Postnatal home visits
• Are made by frontline workers irrespective
of the place of delivery for 6 weeks.

21. NEWBORN AND CHILD
HEALTH

22. RMNCH+A package for Newborn
and Child health
1. Skilled care at birth
2. Early initiation and promotion of EBF and
appropriate complementary feeding
3. IMNCI for common childhood illness
4. Immunization
5. Management of children with malnutrition
6. Vit A, iron and folic acid prophylaxis
7. Child health screening and early intervention
services.

23. HOME-BASED NEWBORN CARE
SCHEME
• Launched in 2011 to ensure Immediate postnatal
care (especially in the cases of home delivery)
and essential newborn care to all newborns up
to the age of 42 days.
• Frontline workers (ASHAs) are trained and
incentivised to provide special care to preterm
and newborns discharged from SNCUs.
• ASHA records weight in MCP card, ensures
BCG-OPV-DPT vaccination, birth registration
and maternal & child health.
• She receives Rs 50 per visit of around 1hr
duration

24. Navjaat Shishu Suraksha Karyakram
(NSSK)
• Doctors, ANM and Nurses posted at
delivery points are trained in basic
newborn care and resuscitation for 2 days.
• Launched to address issues of care at
birth.
The saturation of all delivery points with
Skilled Birth Attendance and NSSK trained
personnel and functional Newborn Care
Corners are the topmost priorities.

25. FACILITY-BASED NEWBORN
CARE
Newborn Stabilisation Unit (NBSU),
• Is a four-bedded unit providing basic level
of sick newborn care at CHCs/FRUs.
• 1,737 NBSU functional
New born care corners
• Established at all delivery points in the
labour room.
• 13,653 NBCC functional

26. FACILITY-BASED NEWBORN
CARE
SPECIAL NEWBORN CARE UNITS
(SNCU)
• District Hospitals and tertiary care hospitals.
• To provide of advanced care for sick
newborns and those with very low birth
weight.
• Referral centre for the entire district.
• The goal is to have one SNCU in each district
of the country. (507 SNCUs functional)
• Additionally, health facilities with more than
3,000 deliveries per year can be considered

27. Follow up Services
Follow up of the sick newborn after
discharge
• Home visits
• Sick newborns discharged from health facilities
should be followed up for Developmental
Screening and Early Intervention and also
provided special care or treatment required.
• During these follow ups, counselling on
exclusive breastfeeding, complementary
feeding, monitoring of survival, growth
monitoring, and screening for neuro-
developmental disorders (such as visual,
hearing) done.

28. Child health provisions
Empowering health service providers
• The ANMs can now give prereferral dose of inj.
Dexamethasone in pregnant women in preterm
labour.
• Administration of prereferral dose of inj.
Gentamycine to newborns for management of
sepsis.
IMNCI & F-IMNCI
• Main intervention under RCH II for management of
newborn and childhood illnesses. (IMNCI plus-
skilled care at birth, inpatient care and
immunization)
• In non IMNCI districts vertical program for common
causes of mortality – diarrhea & pneumonia

29. Child health provisions
• Management of diarrhea
• Low osmolarity oral rehydration solution (ORS)
• Zinc has been approved as adjunct to ORS for
diarrhea management.
• Intensified diarrhea control fortnight:
• Held under aeigis of NHM from 28 july to 8 aug
2014 with goal as “ zero child deaths due to
childhood diarrhea”.
• Activities- advocacy, awareness, diarrhea mx, ors
zinc demonstration sites, ors distribution by ASHA
and promotion of IYCF activities.

30. CHILD NUTRITION
• National iron plus initiative
• Ensures continuum of care across all ages.
• 6m-5yrs (20mg e.Iron, 100 mcg FA) liquid formulations
biweekly through ASHA and deworming of children
above 1 yrs.
• 5-10yrs (45mg e.Iron, 400 mcg FA) weekly and biannual
deworming.
• >10yr (100 e.Iron, 500 mcg FA) weekly.
• To simplify administration of deworming tablets/syrup,
this intervention can be combined with Vitamin A
supplementation during biannual rounds.
• ASHA incentivised (home visits- one dose per week
under direct observation) and educate the mothers
about benefits of iron supplements and also how to
administer it.

31. National Iron Plus Initiative
• NEW COMPONENT
• IFA to be distributed by
ASHA during doorstep
delivery of
contraceptives
• As part of the
antenatal care
package, at all
levels of health
facilities , sub
centre and
outreach
•NEW COMPONENT
•Weekly IFA
supplementation
(WIFS) for both
adolescents boys &
girls in
Government/Govern
ment aided/municipal
schools
• 6-60 months: IFA
administered
biweekly, on fixed
days , under direct
supervision of
ASHAs ;
5-10 years: at
AWC & through
schools
Children Adolescent
Reproductive
Age group
Pregnant &
lactating
women

32. Nutritional Rehabilitation
Centres(NRCs)
• To reduce the risk of mortality in children with severe
acute malnutrition (SAM gd 3,4), by providing medical
and nutritional care for 2-3 wks.
• Established at the District Hospitals or FRUs,
depending upon the availability of infrastructure and
human resources. (872 NRC functional in the country)
• Tribal areas and high focus districts must be prioritised
for setting up these units.
• The NRCs should be linked to community-based
programmes and to the Integrated Child Development
Scheme (ICDS) for identification and referral of
severely undernourished children.

33. Immunisation
Intensification of routine immunisation (IRI)
• GOI declared year 2012 as year of IRI.
• Special immunisation weeks were carried out as a
strategy to reach the unreached population.
• Goal of universal immunisation.
Pentavalent vaccine
• A combination vaccine(DPT + Hep-B + Hib).
• Used in 8 states and being scaled up to 11 more
states.
New Vaccines
• Rotavirus, rubella and inactivated poliovirus
vaccine (IPV) will be made available to all children
through India’s Universal Immunization

34. Immunisation
• Measles 2nd dose
• Introduced in India since 2010-11.
• NTAGI had recommended administration through
SIA in states with less than 80% coverage of
measles vaccine and through RI in other states.
• Japanese encephlatitis
• JE vaccine is now being provided in two dosages
in 179 endemic districts across nine states.
• Mission Indradhanush
• Launched on December 25, 2014.
• Aims to immunize all children against seven
vaccine preventable diseases namely diphtheria,
whooping cough, tetanus, polio, tuberculosis,
measles and hepatitis B by 2020.

35. Rashtriya Bal Swasthya Karyakram
• Principle
• Expanding focus from child survival to a more
comprehensive approach of improving child
development and quality of life.
• Child Health Screening and Early Intervention
Services
• Objective:
• To detect medical conditions at an early stage, thus
enabling early intervention and management,
ultimately leading to reduction in mortality, morbidity
and lifelong disability.
• RBSK envisages to cover 30 medical conditions for
screening, free treatment and management.

36. Rashtriya Bal Swasthya Karyakram
• The health screening will be conducted to detect
4Ds: defects, deficiencies, diseases,
development delays including disabilities.
• First level screening will be done at delivery
points.
• After 48hrs till 6 weeks the screening will be
done by ASHA as a part of HBNC.
• Outreach screening done for 6wks to 6yr
children by mobile health teams at block level.

37. Rashtriya Bal Swasthya Karyakram
• These team- two doctors one male & female
(MBBS /AYUSH qualified) and two paramedics
(ANM/staff nurse, pharmacist).
• 0–6 years children enrolled at AWC at least
twice a year and school children annually.
• Arrangements will be made to provide free
management of these children at District Early
Interventions Centres or identified tertiary level
institutions.

38. Intensified Newborn Action
Plan
• Recently launched with goal to achieve single digit
Neonatal Mortality Rate & Still Birth Rate by 2030.
• It envisages bringing down NMR to 24, 21 and 15
per thousand by year 2017, 2020, 2015.
• Six pillars of interventions include-
1. Preconception and antenatal care
2. Care during labor and child birth
3. Immediate newborn care
4. Care of healthy newborn
5. Care of small & sick newborn
6. Care beyond newborn survival

39. PC&PNDT Act
• Act of the Parliament of India enacted to stop
female foeticides and arrest the declining sex ratio
in India.
• New focus on forming dedicated cells at
state/district level.
• Digitalization of records, monitoring, inspections
and evaluations. (sting operations)
• Beti-Bachao, beti padhao Andolan
• launched the programme on January 22, 2015
from Panipat, Haryana
• Ensure survival & protection of the Girl Child
Ensure education of the Girl Child Improve the
Nutrition Status of Girl Child Promote a protective
environment for Girl Child

40. ADOLESCENTS

41. RMNCH+A package for
adolescent
1. Adolescent nutrition: IFA supplementation
2. Mental health, substance abuse, injuries,
violence, NCD
3. Facility based ARSH services
(Adolescent health clinics)
4. IEC, BCC activities
5. Menstrual hygiene
6. Preventive health screening and
checkups

42. ADOLESCENT NUTRITION
AT THE COMMUNITY LEVEL: TO CREATE AWARENESS
Nutrition education sessions
• At the community level using existing platforms
like VHND, Kishori Diwas, school setting,
Anganwadi Centres (AWC) and Nehru Yuva
Kendra Sangathan (NYKS).
Nutritional counselling
• On a dedicated quarterly Adolescent Health Day
(to coincide with Kishori Diwas in SABLA districts)
.

43. ADOLESCENT NUTRITION
 School curriculum
• Working linkages with ‘Sakshar Bharat’ Abhiyan to
include nutrition education in school curriculum.
 Linkages
• With MWCD (SABLA scheme) and MoHRD (Mid-Day
Meal Programme) for supplementary nutrition,
fortification and nutritional assessment.
 Child health screening and early intervention
services(RBSK)
Screening of adolescents for low Body Mass Index
proposed and this will be followed by counselling at
adolescent health clinics.

44. Iron & Folic acid
supplementation
NATIONAL IRON + INITIATIVE
• Already running for pregnant, lactating women and
children (6-60 months) proposes to include
adolescent, reproductive age women.
• It will cover adolescents both in & out of schools.
• Blue coloured tablet “ iron ki nili goli” for adolescents.
• Those in school will be reached through WIFS
scheme and others through AWC.

45. Weekly Iron Folic acid
supplementation scheme (WIFS)
• It aims to cover school children (class VI-XII) of
government, govt. Aided and municipal schools as well
as ‘out of school ‘ girls.
• Weekly Iron and Folic Acid Supplementation as
supervised administration of weekly-100 mg elemental
iron and 500 mcg folic acid.
 Screening Of target groups for moderate and severe
anaemia and referral to an appropriate health facility
 Bi-annual de-worming (Albendazole 400 mg)
 Information and counselling for improving dietary
intake and preventive actions for intestinal worm
infestation.

46. Adolescent Friendly Health Services
 Sub centre - By the ANM.
 Primary Health Centre
• Adolescent friendly health clinics
• By the Medical Officer and ANM on a weekly basis.
 At theCommunity Health Centre onwards
 Adolescent Health Clinics
• Daily basis.
• A dedicated counsellor
Centralised call centre
• National helpline – toll free (1800-11-6555)

47. MENTAL HEALTH, SUBSTANCE USE
Life Skills Education
• A mechanism to create awareness and skill
building to counter pressure to experiment with
addictions such as tobacco, alcohol or drugs.
• To promote favourable attitudes against gender
based violence, stereotypes and discrimination.
(saksham)
• It will be imparted both through educational
institutions and in community settings.
• The health service providers will be trained to
screen and make appropriate referrals and
linkages with de-addiction centres.

48. PROMOTION OF MENSTRUAL
HYGIENE
• To promote better health and hygiene among
adolescent girls (aged 10 to 19 years) in rural
areas by ensuring that they have adequate
knowledge and information about the use and
safe disposal of sanitary napkins.
• The sanitary napkins are provided under
NRHM’s brand ‘Free days’. These napkins are
being sold to adolescent girls by ASHAs. (Rs 1
bpl, Rs 6 apl per pack)

49. School Health Programme
• Bi-annual health screening (RBSK) is
undertaken for students (6–19 years age group)
enrolled in government and government-aided
schools for disease, deficiency and disability,
with referrals and linkages to secondary and
tertiary health facilities, as required.
• Students in need for secondary or tertiary care
are entitled to free treatment through RSBY or
State health insurance scheme or NHM.

50. RASHTRIYA KISHOR SWASTHYA
KARAYAKRAM (RKSK)
• Launched On 7th January 2014 to improve
health of adolescents (10-19yrs) who comprises
21% population of the country.
• Focus on community based intervention rather
than doctor driven approach.
• Brings in focus- life skills, nutrition, injuries,
violence, NCDs, mental health and substance
abuse.
• Focuses on community based interventions
through peer educator supported by
augmentation of facility based services.

52. RASHTRIYA KISHOR SWASTHYA
KARAYAKRAM (RKSK)
• Interventions-
1. Community based interventions-
• Peer educators
• Quarterly adolescent health days
• WIFS
• Menstrual hygiene scheme
2. Facility based interventions (AFHC)
3. Intersectoral convergence
4. Advocay, BCC and interpersonal
communications.

53. REPRODUCTIVE HEALTH AND
FAMILY PLANNING

54. Family planning 2020
• Global partnership that supports the right
of women and girls to decide freely and for
themselves, whether, when and how many
children they want to have.
• FP 2020 works with governments, civil
society, multilateral organizations, donors,
private sector and R&D community to
enable 120 million more women and girls
use modern contraceptives.

55. Family planning 2020
• India committed to London summit 2012
on family planning (FP as central element
of UHC)
• Strategy shift from limiting to spacing
methods (IUDs).
• Community level distribution of
contraceptives by front line health workers.
• Training of health workers to provide IUDs.
• Counseling services for women after
childbirth.

56. Community based doorstep
distribution of contraceptives
• ASHA charges a nominal amount from
beneficiaries for her effort to deliver
contraceptives at the doorstep.
• INR 1 for a pack of 3 condoms, INR 1 for a cycle
of OCPs and INR 2 for a pack of emergency
contraceptive pills (ECP).
• Initially, the scheme was implemented in 233
districts across 17 states; now the scheme has
been extended to all the districts in the country.

57. Birth Spacing
• As the ASHAs are now incentivised for
delaying the birth of the first child by 2 yrs
post marriage and for spacing between
births (3 yrs).
• Rs 500 incentive for spacing and Rs 1000
for sterilisation post 2 children by either of
parents.
• Prerna ( responsible parenthood scheme-
BPL)

58. Promotion of spacing methods
(interval IUCD)
• Availability of IUCD 380 A (that provides
protection for over 10 years) and ‘fixed day
services’ at all facilities are to be ensured.
• In RCH phase II expansion of choices of
contraceptives from the current (condom,
IUD, OCP, sterilisations) to more methods
like injectables, centchroman, ECPs and
natural methods like- lactational
amenorrhea method, standard days
method.

59. Postpartum IUCD insertion (PPIUCD)
• Currently the focus is on placement of trained
providers for post-partum IUCD (PPIUCD)
insertion at district and sub-district hospital
levels , considering the high institutional delivery
load at these facilities.’
• To tap the opportunity offered by institutional
delivery PPIUCD insertion done within 48 hrs of
delivery.
• Service providers, ASHA accompanying clients
are being provided with incentive of Rs 150.

60. Sterilization services
• Promotion of non-scalpel vasectomy for increasing
male participation.
• Emphasis on Minilap tubectomy services,
accreditation of private providers and NGOs for
service delivery, and increasing the pool of trained
service providers (Minilap, Laparoscopic
sterilization and non-scalpel vasectomy).
• Operationalising fixed day centers for sterilization
is an essential step in this direction.
• Santushti scheme

61. Comprehensive abortion care
Comprehensive Medical Termination of
Pregnancy (MTP) services
• To be made available at all District Hospitals and
Sub-district level hospitals with priority given to
‘delivery points’, and also by encouraging private
and NGO sector to provide quality MTP services.
• The certification and regulation by district level
committee.
• Manual vaccum aspiration (MVA) [8wks] to be made
available at at CHCs and 50% PHCs.
• Medical abortion (mifepristone+ misoprostol) upto 7
wks and confidential counselling services.

62. Management of RTI and STIs
• For syndromic management of RTIs/STIs,
availability of colour-coded kits, RPR testing kits
for syphilis and also whole blood finger prick
testing for HIV should be ensured first at the
delivery points and then at all levels of facilities
and with service providers trained in syndromic
management of STI and RTI.
• Convergence with the National AIDS Control
Programme (NACP)- for the provision of
services for case management, laboratory
services, HIV counselling services, anti-retroviral
drugs, equipment and blood safety.

63. MULTIPURPOSE PREVENTIVE
TECHNOLOGIES FOR
REPRODUCTIVE HEALTH

64. MULTIPURPOSE PREVENTIVE
TECHNOLOGIES
• MPTs are some of the most innovative SRH products
currently under development, with the potential to
simultaneously prevent unintended pregnancy,
sexually transmitted infections (STIs) including the
human immunodeficiency virus (HIV), and
reproductive tract infections (RTIs).
• The International Symposium on Accelerating
Research on Multipurpose Prevention Technologies
for Reproductive Health was convened on 11-1 2
December 201 2 in New Delhi, India.
• The meeting was organized by the Indian Council for
Medical Research (ICMR), along with Coalition
Advancing Multipurpose Innovations (CAMI ).

65. DEVICES
• The SILCS Diaphragm with tenofovir gel
• Woman’s Condom makes it possible to
include any microbicide.
• Intravaginal rings (IVR)
• RISUG – a non hormonal intravasal
injectable male contraceptive
• LNG/tenofovir IVR

66. Progress reporting , M & E
• RCH-NHM has incorporated various systems-
• Civil registration system, MCTS, Maternal and
child death reviews, HMIS, Review missions,
National surveys etc.
• Way forward- GIS maps & databases for planning
and monitoring
• GPS tracking for ambulances & mobile health
units.
• Mobile phones for real time data entry (eVIN)
• Video conferencing for regular reviews
• Closed user group mobile network for health staff.

68. Score Card: HMIS
Score card: HMIS based score card captures only service
delivery indicators and assists in comparative assessment
of state and district performance
―16 indicators selected based on life cycle approach (
RMNCH+A) representing various phases
―State average is the reference point for each indicator ;
Each indicator is scored based on its contribution
towards the state average: Positive scores (> state
average)|Negative scores (< state average)
―Districts classified into four categories based on total
score ; Total score between +64 to -64 ( 4ˣ16 indicators)

69. Score Card: Indicators across the life cycle
Proportion of:
Newborns breast fed within 1 hour to total live births
Women discharged in less than 48 hours of delivery in
public institutions to total no. of deliveries in public
institutions
Newborns weighing less than 2.5 kg to newborns weighed at
birth
Newborns visited within 24hrs of home delivery to total
reported home deliveries
Infants 0 to 11 months old who received Measles vaccine to
reported live births
Proportion of:
SBA attended home deliveries to total reported home deliveries
Institutional deliveries to ANC registration
C-Section to reported deliveries
Proportion of:
Post-partum sterilization to total female sterilization
Male sterilization to total sterilization
IUD insertions in public plus private accredited institution to all
family planning methods (IUD plus permanent)
Proportion of:
1st Trimester registration to ANC registration
Pregnant women received 3 ANC check-ups to total ANC
registration
Pregnant women given 100 IFA to total ANC registration
Cases of pregnant women with Obstetric Complications and
attended to reported deliveries
Pregnant women receiving TT2 or Booster to total number of ANC
registered

70. References
• Guidance note for RMNCH+A implementation in High priority
districts. India. Ministry of Health & Family Welfare
Government of India February 2013
• 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 monitoring of
RCH-II & immunization component of NRHM state
programme implementation plans (PIPs). Ministry of Health &
Family Welfare Government of India. November 2010
• Health policies and programmes in India, 13th edition, Dr. D.K.
Taneja
• Park’s textbook of preventive and social medicine. 22nd edition
• http://nrhm.gov.in/nrhm-components/rmnch-a/maternal-
health/guidelines.html