Reproductive and child

health program
 Reproductive and child health
programme
• Launched 1997
• Reproductive and child health approach is defined
as
• 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 scuccessful in terms of maternal and
infant survival and well being and couples are able
to have sexual relations, free of fear of pregnancy
and of contracting diseases.
Family welfare
program
Oral rehydration Universal
therapy immunization
Acute respiratory program
infection Child survival
and safe
motherhood
program
1952 – Primary Health Center Net Work & Family Planning
Programme 1956 – MCH Centers Become Integral Part Of
PHCS
1961 ‐ Department Of Family Planning Created
1971 – MTP Act
1974 – Family Planning Services Incorporated In MCH Care
1977 – Renaming Family Planning To Family Welfare
1978 – Expanded Programme on Immunization •
1985 – Universal Immunization Programme
1992 – Child Survival& Safe Motherhood Programme
1997 – RCH Programme Phase‐1 (15.10. 1997)
2005 – RCH Programme Phase‐2 (01‐04‐2005)
RCH Phase I
RCH Phase I

• Components : child survival and safe

motherhood,
• additional components : STD, RTI
Interventions RCH Phase- I
1. Essential obstetric care
2. Emergency obstetric care
3. 24 hour delivery services at PHCs/CHCs
4. Medical termination of pregnancy
5. Control of reproductive tract infections (RTIs)
and sexually transmitted diseases (STD)
6. Immunization
7. Essential newborn care
8. Diarrheal disease control
9. Acute respiratory disease control
10. Prevention and control of vitamin A deficiency
in children
11. Prevention and control of anemia in children
12. Training of dias
Monitoring effectiveness of RCH I
Activities
RCH - II
• launched on 1st April, 2005
• Objectives three critical health indicators

Total
fertility Infant
rate mortality
Maternal
mortality
Objectives RCH -II
1. Reduction of Maternal Morbidity and Mortality
2. Reduction of Infant Morbidity and Mortality
3. Reduction of Under 5 Morbidity and Mortality
4. Promotion of Adolescent Health
5. Control of Reproductive Tract Infections and
Sexually Transmitted Infections.
Major strategies RCH - II
I. Essential obstetric care
a) Institutional delivery
b) Skilled attendance at delivery
• Emergency obstetric care
a) Operationalizing first referral units
b) Operationalizing PHCs and CHCs for round the
clock delivery services
1. 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
II. Emergency obstetric care
Minimum services provided in FRUs
1. 24 hours delivery services
2. Emergency obstetric care – Cesarean section
3. New born care
4. Emergency care of the sick child
5. Full range of family planning services – laproscopic services
Emergency obstetric care contd..
6. Safe abortion services
7. Treatment of RTI and STI
8. Blood storage facility
9. Essential laboratory services
10. Referral ( transport ) services
New initiatives
i. Training of PHC doctors in life saving anesthetic
skills for emergency obstetric care a FRUs
ii. Setting up of blood storage centers at FRUs
iii. Janani Suraksha Yojana (JSY)
iv. Vandemataram scheme
v. Safe abortion services
vi. Janani Shishu suraksha Karyakrama
vii. Village Health & Nutrition Day (VHND)
viii. Pregnancy Tracking (MCT i.e. Maternal & Child Tracking)
•
ix. Maternal Death Review (MDR)
X. Integrated Management of Neonatal & Childhood illnesses
(IMNCI).
xi. HMIS data
Janani Suraksha Yojana (JSY)
1
• launched on 12 April 2005
• safe motherhood intervention
Objective of JSY
• Reduction in maternal and neonatal mortality by
promoting institutional delivery among poor
pregnant women.
The eligibility for cash assistance
under the JSY :

LPS All pregnant women delivering in

government health centres, such as Sub
Centers (SCs)/Primary Health Centers
(PHCs)/Community Health Centers
(CHCs)/First Referral Units
(FRUs)/general wards of district or state
hospitals
HPS All BPL/Scheduled Caste/Scheduled
Tribe (SC/ST) women delivering in a
government health centre, such as
SC/PHC/CHC/FRU/general wards of
district or state hospital
Cash Assistance for Institutional
Delivery (in Rs)
Category Rural area Total
Mother’s ASHA’s
package package*
LPS 1400 600 2000
HPS 700 600 1300
ASHA package of Rs. 600 in rural areas include Rs.
300 for ANC component and Rs. 300 for facilitating
institutional delivery.
Category urban area Total
Mother’s ASHA’s (Amount in
package package** Rs.)
LPS 1000 400 1400
HPS 400 1000

***ASHA package of Rs. 400 in urban areas

include Rs. 200 for ANC component and Rs.
200 for facilitating institutional delivery
 Rural area also includes following
• Cash assistance for referral transport of pregnant
women to go to the nearest health care for delivery
(should not be less than 250 rupees)
Limitation of cash assistance
• Delivery is mandatory in health centre
• In high performing states up to 2 live births
Vandemataram scheme
2
It is a voluntary scheme wherein any obstetric
and gynaec specialist, maternity home can
volunteer to provide safe motherhood services
• 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
Safe Abortion Practices 3
• MEDICAL METHOD – Termination of early pregnancy
(49days) – 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
Janani‐Shishu Suraksha Karyakram 4
(JSSK)
• Launched June 2011
• All women delivering in public health institutions to
have absolutely free and no expense delivery including
caesarean section
• Free transport from home to institutions for referral and
back home including sick infant up to 30 days
Village health and nutrition day 5

• Once a month in anganwady centre

• Antenatal post partum care
• Promote institutional delivery
• Health education
• Immunization
• Family planning and nutrition services
Maternal death review 6

• Guidelines and tools have been formulated

Pregnancy Tracking (MCT i.e.
Maternal & Child Tracking)
7

• Link between antental care and maternal

mortality is established
Newborn Care 8

Health Facility All Newborns at Sick Newborn

Birth
PHC/SC Newborn Care Corner Prompt referral
(NBCC) in labor room
CHC/FRU Newborn Care Corner Newborn
(NBCC) in labor room Stabilization Unit
and OT (NBSU)

District Hospital Newborn Care Corner

(NBCC) in labor room
and OT
Integrated Management of Neonatal9
& 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 care
Navjat Shishu Suraksha Karyakram
Aim
• To train health personnel in basic newborn care
and resuscitation
Rastriya Bal Suraksha Karyakrama
• Launched – February 2013
• Aiming at early identification and early
intervention for children from birth to 18 years to
cover 4 ‘D’s viz. Defects at birth, Deficiencies,
Diseases, Development delays including
disability.
 Identified health
conditions for child
health screening and
early intervention
services under RBSK
Defects at Birth Deficiencies

1. Neural tube defect

2. Down's Syndrome
3. Cleft Lip & Palate / Cleft palate alone
4. Talipes (club foot)
5. Developmental dysplasia of the hip
6. Congenital cataract
7. Congenital deafness
8. Congenital heart diseases
9. Retinopathy of Prematurity
Deficiencies
1. Anaemia especially Severe anaemia
2. Vitamin A deficiency (Bitot spot)
3. Vitamin D Deficiency, (Rickets)
4. Severe Acute Malnutrition
5. Goitre
Diseases of Childhood
1. Skin conditions (Scabies, fungal infection
2. Otitis Media
3. Rheumatic heart disease
4. Reactive airway disease
5. Dental conditions
6. Convulsive disorders
Developmental delays
• Vision impairment
• Hearing impairment
• Neuro motor impairment
• Motor delay
• Cognitive delay
• Language delay
Facility based new born screening
• Screening at Anganwadi Centre:
• Screening at Schools- Government and Government
aided:
• Tool for screening for 0-6 years is supported by pictorial,
job aids specifically for developmental delays. For
developmental delays children would be screened using
age specific tools specific and those suspected would be
referred to DEIC for further management.
• The mobile health team will consist of four
members - two Doctors (AYUSH) one male and
one female, at least with a bachelor degree from
an approved institution, one ANM/Staff Nurse
and one Pharmacist with proficiency in computer
for data management.
District Early Intervention Centre
(DEIC)

Mobile health team

DEIC
Challenges of RCH II
• Three components of maternal, child and
reproductive health were vertically operated
• Adolescent health was the weakest pillar
• Usage of HMIS data chart to report the progress
was low
• Timely and transparent payment of JSY was not
properly implemented
• Inadequate implementation of fixed day strategy
RMNCH +A
Reproductive, Maternal,
Newborn, Child and Adolescent
Health

• The 12th Five year plan (2012‐2017)

• Launched on 2013
• Comprehensive approach to maternal child health
and adolescent health
 RMNCH +A
• Adolescent is a distinct stage of life
• Linking of maternal and child health to reproductive
health and other components like family planning,
adolescent health, HIV, preconception and prenatal
diagnostic test
• Linking of community and facility based care as well as
referrals between various levels of health care
Adolescent
Reproductive health MCH
Health
RMNCH +A
Adolescent/
Pregnancy
Preconceptio
Newborn
Birth
n

RMNCH+
A
Health Outcome Goals established
in the 12th Fiver Year Plan
Reduction in :
• 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
 Coverage targets for key RMNCH+A
interventions for 2017
Increase facilities equipped for perinatal care
(designated as ‘delivery points’) by 100%

Increase proportion of all births in government and

accredited private institutions at annual rate of 5.6 %
from the baseline of 61% (SRS 2010)

Increase proportion of pregnant women receiving

antenatal care at annual rate of 6% from the baseline
of 53% (Consumer Expenditure Survey 2009)
 Increase proportion of mothers and newborns
receiving postnatal care at annual rate of 7.5% from
the baseline of 45% (CES 2009)

Increase proportion of deliveries conducted by skilled

birth attendants at annual rate of 2% from the
baseline of 76% (CES 2009)

Increase exclusive breast feeding rates at annual rate

of 9.6% from the baseline of 36% (CES 2009)
Reduce prevalence of under‐five children who are
underweight at annual rate of 5.5% from the baseline
of 45% (NFHS 3)
••
Increase coverage of three doses of combined
diphtheria‐tetanus‐pertussis (DTP3) (12–23 months) at
annual rate of 3.5% from the baseline of 7% (CES
2009)

Increase ORS use in under‐five children with diarrhoea

at annual rate of 7.2% from the baseline of 43% (CES
2009)
Reduce unmet need for family planning methods
among eligible couples, married and unmarried, at
annual rate of 8.8% from the baseline of 21% (DLHS 3)

Increase met need for modern family planning

methods among eligible couples at annual rate of
4.5% from the baseline of 47% (DLHS -district level
household and facility survey 3)

Reduce anaemia in adolescent girls and boys (15–19

years) at annual rate of 6% from the baseline of 56%
and 30%, respectively(NFHS 3)
Decrease the proportion of total fertility contributed by
adolescents (15–19 years) at annual rate of 3.8% per
year from the baseline of 16% (NFHS 3)
• ••

Raise child sex ratio in the 0–6 years age group at

annual rate of 0.6% per year from the baseline of 914
(Census 2011)
 Adolescent
reproductive and
sexual health
(ARSH) under
1 RMNCH+A
Interventions under ARSH

1) Adolescent nutrition, IFA supplementation

2) Adolescent friendly clinics
3) Counselling : IEC on adolescent sexual health
and other issues
4) Menstrual hygiene
5) Preventive check ups
6) Outreach activities
Pregnancy and child
birth

2
Priority interventions -Pregnancy and child birth

1. Delivery of ANC package and tracking of high risk

pregnant others
2. Skilled obstetric care
3. Immediate essential newborn care and
resuscitation
4. Emergency obstetric and new born care
5. Post partum care for mother and newborn
6. Post partum IUCD and sterilization
7. Implementation of PC and PNDT Act
• Delaying first child scheme
• Nischay kit
• Mother and child tracking system
• Janani shishu suraksha karyakrama
Mother child tracking system
• Mother and Child Tracking System (MCTS) is an initiative
of Ministry of Health & Family Welfare
• ensuring delivery of full spectrum of healthcare and
immunization services to pregnant women and children
up to 5 years of age.
• establish a two way communication between the
service providers and beneficiaries.
Services offered MCT system
1. Registration of Pregnant Women : At first ANC
2. Ante-Natal Care (ANC), Delivery & Post-Natal
Care (PNC) Services: During the pregnancy period,
MCTS records 4 ANC services given to pregnant women
and then captures delivery details like date of delivery,
place of delivery and its outcome and then PNC Service.
Workplan for the ANM/ASHA is generated so that no
women is left without services.
3. Registration of Children for Immunization
Immunization is given to every child as per the
schedule and Workplan is generated to be
consumed by ANM/ASHA from the MCTS
application so that no child is left.
4. Integration with other applications like
PFMS, MDR ,MCTFC,Kilkari etc.
1.PFMS to make the DBT based JSY payments to
the beneficiary.
2.MCTs Facilitation Centre (MCTFC) to access the
quality of service being delivered in the field.
3. Kilkari Services - platform to educate
beneficiary about the pregnancy & child care.
5. USSD technology to update the service
live on the MCTS portal.
Data is updated through USSD by the ANMs on
real time basis on the MCTS portal from the
remotest part of the country.
 Reproductive
years
3
Priority intervention through
reproductive years
1. Community based promotion and delivery of
contraceptives
2. Promotion of spacing methods
3. Sterilization services (Tubectomy, Vasectomy)
4. Comprehensive abortion care
5. Prevention and management of STIs and RTIs
1. Community based promotion door step delivery of
contraceptives

• ASHA charges a nominal amount of money for

door step delivery of contraceptives
• INR 1 for a pack of 3 condoms
• INR 1 for a cycle of OCP
• INR 2 for a pack of emergency contraceptive pills
2. Promotion of spacing methods

• CuT380 A protection of 10 years

• Anthara and Chaya contraceptives
• Fixed day of IUCD services in PHC/SC
• Regular IUCD services at CHC, district hospital
3. Sterilization services (Tubectomy, Vasectomy)

• Promotion of NSV for male participation

3. Comprehensive abortion care

• Mannual vaccum aspiration in PHCs, CHCs and

district hospital
• Medical abortion using drugs : Mifepristone and
Misoprostol
4. Management of RTIs and STIs
• Provided at CHC
• Color coded kits
 Monitoring,
information and
evaluation system
Score card
• The dashboards and scorecards are proving to be an
effective tool to monitor programme performance at the
state and district levels.
• Score card is a simple management tool for converting
available HMIS information in to actionable points and
assist in comparison between districts and states
• The scorecards and dashboards improve accountability
in the public health system, enable comparative
assessments of state and district performance, and
monitor the major components of the national
Reproductive and Child Health (RCH) program and
RMNCH+A strategy
Indicators
National Mortality, Nutrition, Fertility Indicators :
• Green: < 20% of national average
• Yellow: +/- 20% of national average
• Red: > 20% of the national average
Remaining Indicators
Green: > 20% of national average
Yellow: +/- 20% national average
Red: < 20% of national average
Benefits of dash board
• HMIS dashboards are used as evaluation tools for
measuring performance of facilities and staff, which
increases accountability.
• Dashboards help block monitoring teams to prioritize
HPDs that require immediate and intensified attention.
• The ranking system has helped identify districts and
blocks that are lagging behind.
• The visual representation (color-coding) of performance
has helped even the lowest cadre of health workers to
understand in which areas they are lagging and on what
they must focus to improve their performance on a
quarterly basis.
RCH Phase 1 1997

RCH Phase 2005

RMNCH+A 2013
• Based on the identified problems of previous
phase new phase is been designed
Thank you