REPRODECTIVE CHILD
HEALTH PROGRAM
Integration with Department of Community Medicine & Pediatrics
● 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,
-Couples are able to have sexual relations free of fear of pregnancy and
contracting diseases.
● Target free approach
● Phase II of RCH program started on 1stApril,2005
● Decentralization (promotion of state ownership)
● Community Needs Assessment and Monitoring Approach (CNAMA)
● RMNCH+A approach.
- Multiple targets in SDG and other goals refer to reproductive, maternal
,newborn and child health(RMNCH).
- These include targets for mortality, service coverage, risk factors and health
determinants. Following are the indicators :
• Maternal Mortality Ratio; Neo-natal & Under 5 Mortality Rates
•Immunisation of under 2 children
•Incidence of HIV/AIDS, Malaria & TB
•Medical Personnel per 10000 people
MILESTONES OF RCH
● 1952 -Launch of National Family Planning Programme
● 1966 -Launch of All India Hospital Post Partum Programme for hospital based maternity care
● 1971 -MTP Act
● 1976 -Formulation of First National Population Policy
● 1977 -Renamed to National Family Welfare Programme
● 1992 -Launch of Child Survival and Safe Motherhood Programme
● 1996 -Adoption of Target Free Approach and renamed to Community Needs Assessment Approach
● 1997 -Launch of Community Needs Assessment and Monitoring Approach under RCH Programme
● 1997 -RCH Programme Phase‐1
● 2005 -RCH Programme Phase‐2
● 2013 -RMNCH + A
● 2014 -India Newborn Action Plan
● 2022 -RMNCAH + N
RCH Phase I
Aim
● To bring down the birth rate below 21 per 1000 population,
● To reduce the infant mortality rate below 60 per 1000 live birth and
● To bring down the maternal mortality rate <400/1,00,000lakh.
● 80%% institutional delivery, 100% antenatal care and 100% immunization
of children were other targeted aims of the RCH programme
RCH Phase II
AIM:-
● Reduction of IMR, MMR & TFR
● Increase of CPR & Immunization coverage
GOALS:-
● Reduction of decadal growth to 16.2%(2001-2011)
● Reduction of IMR <30/1000 live births by 2010
● Reduction of MMR to <100/100000 live births by 2010
● Reduction of TFR TO 2.1 BY 2010
● Increase CPR to 65%, Immunization coverage to 100% ANC to 89%, Rural
Institutional deliveries to 80%
OBJECTIVES OF RCH PHASE II
● Reduction of Maternal Morbidity and Mortality
● Reduction of Infant Morbidity and Mortality
● Reduction of Under 5 Morbidity and Mortality
● Promotion of Adolescent Health
● Control of Reproductive Tract Infections and Sexually Transmitted Infections.
COMPONENTS
➢ Essential obstetrical care
➢ Emergency obstetrical care
➢ Strengthening referral system
➢ Strengthening infrastructure
➢ Capacity building
➢ Improving referral system
➢ Innovative schemes
ESSENTIAL OBSTETRIC CARE
This is the minimum obstetric care that must be made available to all pregnant
women
➢ Registration of pregnancy in the first 12-16 weeks of pregnancy
➢ Atleast 3 prenatal checkups by ANM or health facility
➢ Assistance during delivery( Skilled Birth Attendant)
➢ At least 3 postnatal checkups
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
NEW INITIATIVES
● Training of PHC doctors in life saving anesthetic skills for emergency obstetric
care a FRUs
● Setting up of blood storage centers at FRUs
● Janani Suraksha Yojana (JSY)
● Vandemataram scheme
● Safe abortion services
● Integrated Management of Neonatal & Childhood illnesses (IMNCI)
24 hrs. FUNCTIONING OF PHC's
● 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.)
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
JANANI SURKASHA YOJNA
● To promote Institutional Deliveries – To reduce Maternal Mortality Ratio and
Infant Mortality Rate
● A safe motherhood intervention, replacing the “National Maternity Benefit
Scheme”, under NRHM
● 100 % centrally sponsored
● Integrates cash assistance with delivery & post‐ delivery care.
VANDEMATRAM SCHEME
● To promote public private partnership
● Launched in 9th February with involvement of Indian medical ssociation,
federation of obstetrics and gynaecology society.
● Voluntary enrolment of doctors, nursing home; maternity home
● Antenatal and Postnatal Checkup
● Distribution of Iron and Folic Acid Tablets Immunization.
● Referal Case require special case
REFERRAL TRANSPORT
Key issues: –
● 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
ROLE OF ASHA
● ASHA must primarily be a women resident of the village-
married/widowed/divorced preferably in age group of 25-45 years.
● She receives performance based incentives for promoting universal
immunization, referral and escort services for Reproductive and Child Health
(RCH) and other heath programs.
● She act as a depot holder for essential provisions being made available to all
habitants like Oral Rehydration Therapy(ORS), Iron Folic Acid Tabs
(IFA),Chloroquine, Disposable Delivery Kits( DDK), Oral Pills etc.
● Adolescents Health Counsellor.
● One ASHA for every 2500 population.
● Janani‐Shishu Suraksha Karyakram (JSSK)
● Village Health & Nutrition Day (VHND- to be organized once every month:
preferably on Wednesdays and for those villages that have been left out, on
any other day in same month at AWC in the village)
● Maternal Child Tracking System (MCTS)
● Maternal Death Review (MDR)
Newborn Care
Health Facility All Newborns at Birth Sick Newborn
PHC/SC Newborn Care Corner (NBCC) Prompt referral
in labor room
CHC/FRU Newborn Care Corner (NBCC) Newborn Stabilization
in labor room and in O.T. Unit (NBSU)
District Newborn Care Corner (NBCC) Special Newborn Care
Hospital in labor room and in O.T. Unit (SNCU)
INTEGRATED MANAGEMENT OF NEONATAL &
CHILDHOOD ILLNESSES (IMNCI)
● Inclusion of 0‐7 days age in the programme
● Training of health personnel begins with sick young infants up to 2 months
● Proportion of training time devoted to sick young infant and sick child is
almost equal
● Skill based
ADOLESCENT REPRODUCTIVE & SEXUAL HEALTH
(ARSH)
● Involves young people for providing comprehensive accurate information in a
manner appropriate to their age, group and sex.
● Addresses barriers to accessing health and information services.
● Empower adolescents to make life choices that are best for them.
● Use information/ services through Media.
● Sex education to protect young people from some of potential risks of sexual
activity.
SAFE ABORTION PRACTICES
MEDICAL METHOD
● Termination of early pregnancy (49days)
● MTP Act,1971- lays down when and where pregnancies can be terminated,
who can terminate pregnancy, training requirements, approval process for
place etc.
● Mifepristone followed by Misoprostol
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
RMNCH + A
Continnum of Care approach:
1. All stages of life- life cycle approach
2. All places of Health care delivery
● Inclusion od ADOLESCENCE
● Linking of Maternal and Child Health to Reproductive Health and Other
Components( family planning, adolescent health, HIV, gender and PC& PNDT
)
● Linking of Community and Facility- Based Care
Health Outcome Goals established in the 12th Five
Year Plan
Reduction of :
● Infant Mortality Rate (IMR) to 25 per 1,000 live births by 2017
● Maternal Mortality Ratio (MMR) to 100 per 100,000 live births by 2017
● Total Fertility Rate(TFR) to 2.1 by 2017
