National health intervention programme for mother and child

Intervention programme related to maternal health care

1. National health intervention programme for mother and child Presented by:- HIMIKA RATHI

2. DEFINITION According to WHO, Maternal and child health services can be defined as “promoting, preventing, therapeutic or rehabilitation facility or care for the mother and child.” Thus maternal and child health service is an important and essential service related to mother and child’s overall development.

3. NEED FOR SUCH INTERVENTIONS There are four main reasons why mother and child must be given top priority in health programme Mother and child below the age of 15 years make up the majority of the population. Also constitute a special risk or vulnerable group. By improving the health of mother and children we can improve the health of family and community. Ensuring child survival is a future investment for the family and community.

4. MATERNAL HEALTH PROGRAMME Government of India adopted the Reproductive, Maternal, New-born, Child and Adolescent Health (RMNCH+A) framework in 2013. It essentially aims to address the major causes of mortality and morbidity among women and children. This framework also helps to understand the delays in accessing and utilizing health care services.

5. OBJECTIVES To reduce Maternal Mortality Ratio To increase the Early ANC registration. To ensure 3 or more than 3 ANCs (Antenatal care) to all the expectant mothers and special attention to high risk pregnancies. To decrease the incidence and progress of anaemia in pregnant and lactating women .

6. OBJECTIVES Provide adequate opportunities for safe deliveries and to increase institutional deliveries. To improve the coverage of post partum care. To increase access to Emergency Obstetric Care for complicated deliveries through strengthening of FRUs (First Referral Units). To increase access to early and safe abortion services

7. INTERVENTIONS Janani Suraksha Yojana (JSY ): Janani Suraksha Yojana (JSY), a demand promotion and conditional cash transfer scheme was launched in April 2005 with the objective of reducing Maternal and Infant Mortality . It is being implemented with the objective of reducing maternal and neonatal mortality by promoting institutional delivery among poor pregnant women.

8. INTERVENTIONS Janani Shishu Suraksha Karyakram (JSSK ): Government of India has launched Janani Shishu Suraksha Karyakaram (JSSK) on 1st June, 2011. Entitles all pregnant women delivering in public health institutions to absolutely free and no expense delivery including Caesarean section. The initiative stipulates free drugs, diagnostics, blood and diet, besides free transport from home to institution, between facilities in case of a referral and drop back home .

9. INTERVENTIONS Janani Shishu Suraksha Karyakram (JSSK): Similar entitlements have been put in place for all sick new-born accessing public health institutions for treatment till 30 days after birth. In 2013, this has been expanded to sick infants and antenatal and postnatal complications.

10. INTERVENTIONS Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA):  Carrying forward the vision of our Hon’ble Prime Minister, the Pradhan Mantri Surakshit Matritva Abhiyan was launched in 2016. Ensures quality antenatal care and high risk pregnancy detection in pregnant women on 9th of every month.

11. INTERVENTIONS LaQshya : In order to further accelerate decline in MMR in the coming years, MoFHW (Ministry of Health and Family Welfare) has recently launched ' LaQshya - Labour room Quality improvement Initiative . LaQshya program is a focused and targeted approach to strengthen key processes related to the labour rooms and maternity operation theatres which aims at improving quality of care around birth and ensuring Respectful Maternity Care .

12. INTERVENTIONS Comprehensive Abortion Care Services:  Comprehensive and safe abortion services are provided at public health facilities including 24*7 PHCs/ FRUs (DHs/ SDHs /CHCs) including the Delivery Points . Supply of Nischay Pregnancy detection kits to sub centres for early detection of pregnancy is undertaken. Capacity Building of Medical officers is being carried out routinely in safe MTP Techniques .

13. INTERVENTIONS Comprehensive Abortion Care Services:  ANMs , ASHAs and other field functionaries are trained to provide confidential counselling for MTP and promote post-abortion care including adoption of contraception. Routine orientation and training of ASHAs to equip them with skills to create awareness on abortion issues in the community and facilitation of women's access to services . District Level Committees (DLCs) have been framed and empowered for accreditation the facilities for conducting safe abortion services under MTP Act including approval of private and NGO sector facilities for conducting MTPs.

14. INTERVENTIONS Provision of RTI/STI services:  Under NHM (National Health Mission) , provision of STI/RTI care services is an important strategy to prevent HIV transmission and to promote sexual and reproductive health services in all the FRUs, CHCs and at 24 X 7 PHCs .

15. INTERVENTIONS Village Health and Nutrition Day:  Village Health & Nutrition Day (VHNDs) are being organized at Anganwadi center atleast once every month . It is a platform to provide ante natal/ post partum care for pregnant women, promote institutional delivery, immunization, Family Planning & nutritional counseling .

16. NEWER INTERVENTIONS Midwifery : Government of India has initiated midwifery services throughout the country in 2018. Objective is to provide access to quality maternal and neonatal health services, to promote natural birthing, to ensure respectful care and to reduce over medicalization. The Midwifery services initiatives aim to create a cadre for Nurse Practitioners in Midwifery who are skilled in accordance to ICM competencies, knowledge and capable of providing compassionate women – centric pregnancy care.

17. CHILD HEALTH PROGRAMME

18. INTRODUCTION The Child Health programme under the National Rural Health Mission (NRHM) comprehensively integrates interventions that improve child survival and addresses factors contributing to infant and under-five mortality. TRENDS OF CHILD HEALTH INDICATORS: Infant Mortality Rate Under-five Mortality Rate ( U5MR) Neo-natal Mortality Rate (NMR)

19. INTERVENTIONS Facility Based Newborn Care (FBNC ) Facility Based Newborn Care (FBNC) is one of the key components under the National Rural Health Mission to improve the status of newborn health in the country. A continuum of newborn care has been established with the launch of home based and facility based newborn care components ensuring that every newborn receives essential care right from the time of birth and first 48 hours at the health facility and then at home during the first 42 days of life.

20. INTERVENTIONS Special Newborn Care Unit ( SNCUs): is located in close proximity to the labour room with 12 or more beds, and has dedicated and adequately trained doctors, staff nurses and support staff to provide 24x7 services . It delivers Level-II newborn care to sick and small new borns also training to medical officers and nurses in facility based newborn care.

21. INTERVENTIONS New born Stabilization Unit (NBSU ): is a 4 bedded unit providing basic level of sick new born care , established at Community Health Centres/ First Referral Units. Provision of new born care at these units increases the chances of survival for babies with health conditions requiring observation and stabilization soon after birth or in the period thereafter .

22. INTERVENTIONS New Born Care Corners (NBCCs ): Are operationalized within the labour rooms and operation theatres in public health facilities designated as delivery points. These units have NSSK ( Navjaat Shishu Suraksha Karyakram ) personnel who provide essential new born care and resuscitation, when required, to all new borns delivered at these health facilities.

23. INTERVENTIONS Navjaat Shishu Suraksha Karyakram (NSSK ): training was initiated in September, 2009 with the purpose of training all health care providers in essential newborn care and resuscitation when required .

24. INTERVENTIONS National Training Package for Facility Based Newborn Care: This training package has been developed with participation of national neonatal experts , and facilitated by the National Collaborative Centre for Facility Based Newborn Care at Kalawati Saran Children's Hospital under the mandate of Ministry of Health & Family Welfare . This package will improve the cognitive knowledge and build psychomotor skills of the medical officers and staff nurses posted in these units to provide quality newborn care.

25. INTERVENTIONS Empowering frontline health service providers: The ANMs are now empowered to give a prereferral dose of antenatal corticosteroid ( Injection Dexamethasone ) in pregnant women going into preterm labour. ANMs will also administer pre-referral dose of Injection Gentamycin to newborns for the management of sepsis in young infants (upto 2 months of age).

26. INFANT AND YOUNG CHILD FEEDING (IYCF) The importance of breastfeeding as the preventive intervention with potentially the single largest impact on reducing child mortality has been well recognised. Considering that reducing infant mortality is one of the goals of the NRHM, promotion of Breastfeeding and optimal Infant and Young Child Feeding practices through the public health system is another important intervention area under child health.

27. NUTRITIONAL REHABILITATION CENTRES (NRC) NRCs play a crucial role in averting deaths due to under-nutrition and promoting physical and psychosocial growth of children with severe under nutrition .

28. INTERVENTIONS Nutritional programs Prophylaxis against nutritional anaemia IFA tablets to pregnant women & young children Vitamin A prophylaxis program Single dose of 2 lakh units to preschool children

29. NEW INITIATIVES Rashtriya Bal Swasthya Karyakram (RBSK ) This is a new initiative launched in February 2013 which includes provision for Child Health Screening and Early Intervention Services through early detection and management of 4 Ds i.e. Defects at birth, Diseases, Deficiencies, Development delays including disability.

30. UNIVERSAL IMMUNIZATION PROGRAMME (UIP) Immunization Programme (IP) is one of the key interventions for protection of children from life threatening conditions, which are preventable. Under the Universal Immunization Programme, Government of India is providing vaccination to prevent seven vaccine preventable diseases i.e.: ● Diphtheria, Pertussis, Tetanus, Polio, Measles, severe form of Childhood Tuberculosis and Hepatitis B.

31. S. No Vaccine Protection Number of doses Vaccination Schedule 1 BCG (Bacillus Calmette Guerin) Tuberculosis 1 At birth (upto 1 year if not given earlier) 2 OPV (Oral Polio Vaccine) Polio 5 Birth dose for institutional deliveries within 15 days, Primary three doses at 6, 10 & 14 week and one booster dose at 16-24 month of age, given orally 3 Hepatitis B Hepatitis 4 Birth dose for institutional deliveries within 24 hour, Primary three doses at 6, 10 14 week 4 DPT (Diphtheria, Pertussis and Tetanus Toxoid Diphtheria Pertussis Tetanus 5 Three doses at 6, 10 & 14 week and two booster and dose at 16-24 month and 5 years of age 5 Measles Measles 2 9-12 months of age and 2nd dose at 16-24 months. 6 TT (Tetanus Toxoid) Tetanus 2 2 Children: 10 years and 16 years of age Pregnant woman: Two doses given (one dose, if previously vaccinated within 3 Year)

32. S. No Vaccine Protection Number of doses Vaccination Schedule 7 JE vaccination (in selected 113 JE endemic districts in 15 States) Japanese Encephalitis (Brain disease) 2 1st dose at 9-12 months of age & 2nd dose 16-24 month of age in JE endemic districts after 6 months of campaign 8 Hib containing Pentavalent vaccine ( Hib+DPT+Hep B), Presently in eight States (Tamil Nadu, Kerala, Gujarat, Haryana, Karnataka, Goa, J & K and Puducherry ) Diphtheria, Pertussis, Tetanus Hepatitis B and Haemophilus influenzae , type B associated Pneumonia meningitis 3 6, 10 & 14 week of age

33. PULSE POLIO IMMUNIZATION (PPI) Pulse Polio Immunization programme was launched in India in 1995. Children in the age group of 0-5 years administered polio drops during National and Sub-national immunization rounds (in high risk areas) every year. About 172 million children are immunized during each National Immunization Day (NID). Progress: ● India has not reported any case of polio due to wild polio virus since more than three years. The last polio case in the country was reported from Howrah district of West Bengal with date of onset 13th January 2011.

34. PULSE POLIO IMMUNIZATION (PPI) ● WHO on 24th February 2012 removed India from the list of countries with active endemic wild polio virus transmission. ● On 27thMarch 2014, India along with South-East Asia Region of WHO has been certified polio free by Regional Certification Commission for polio eradication.

35. Schemes for adolecscent girls Kishori sakthi yojana ( 11-18year girls) • For nutrition , self development, health status, vocational skills Nutrition program for adolescent girls • For 11-15 year girls<30kg & 15-19 year girls<35kg • 6kg free food grain/month

36. INTERVENTIONS Rajiv Gandhi scheme for empowerment of adolescent girls • SABLA : to improve nutritional & health status • Indira Gandhi marutva sahyog yojana • Conditional cash transfer to pregnant &lactating mothers to improve their nutritional & health status

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