National health programs related to maternal and child health

NATIONAL HEALTH PROGRAMES
MATERNAL AND CHILD HELTH
REPRODUCTIVE HEALTH

1. NATIONAL HEALTH PROGRAMS RELATED TO MATERNAL&CHILD HEALTH SHARON TREESA ANTONY First year M.Sc nursing

2. MATERNAL &CHILD HEALTH PROGRAM

3. Milesones In MCH Care 1886 – Establishment of Training of Dais 1902 ‐ 1st Midwifery Act for Safe delivery 1952 -Family planning program 1978 – Expanded Programme on Immunization 1985 – UniversaI Immunization Programme 1992 – Child Survival& Safe Motherhood Programme 1997 – RCH Programme Phase‐1 (15.10. 1997 ) 2005 – RCHProgramme Phase‐2 ( 01‐04‐2005)

4. 2005 –National Rural Health Mission 2013-RMNCH+A Strategy 2013-National Health Mission 2014-India Newborn Action Plan

5. CHANGING TRENDS IN MCH CARE Family planning and MCH care are integrated Provision of emergency obstetric care in FRUs Trained local dais

6. CHILD SURVIVAL AND SAFE MOTHERHOOD PROGRAMME (1992)

7. OBJECTIVES TO REDUCE IMR to 60/1000 live births MMR to 2/1000 live births CMR to 10/1000 child population

8. STRATEGIES FRUs for emergency & essential obstetric care Training Operation Theatres Equipments Emergency services to newborn & children Conversion of village level immunisation sections into maternal &child protection sections

9. Training of dais Delivery kits & Rs1000 /reported case Drugs & equipments for MCH care at subcentres Health education Training of health personnel

10. INTERVENTIONS Child Survival Essential Newborn care Immunisation Management of ARI & Diarrhea Vitamin A Prophylaxis

11. Safe Motherhood Immunisation of pregnant women Prevention & treatment of anaemia Antenatal care Institutional delivery Managing obstetric emergencies Birth spacing

12. REPRODUCTIVE AND CHILD HEALTH PROGRAMME

13. OBJECTIVES To meet all felt needs of contraception To reduce IMR by 1/3 rd &MMR by ½ To reduce maternal & infant morbidity

14. PHASE 1 AIMS To reduce Birth rate below 21/1000 population To reduce MMR below 400/1,00,000 To reduce IMR below 60/1000 live births 80% institutional delivery 100%antenatal care & immunisation of children

15. Major interventions Essential obstetric care Early registration of pregnancy Minimum 3 antenatal checkups Safe delivery in home or institution Minimum 3 postnatal checkups Emergency obstetric care Equipments & skilled manpower at FRUs

16. 24 hour delivery services at PHCs Additional honorarium to staff Facilities for MTP at health centres Control of RTI/STDs RTI/STD Clinics 2 Lab technicians at district level Skilled manpower & disposable equipments

17. Immunaisation Essential newborn care Resuscitation of newborn Prevention of hypothermia , infection Exclusive breast feeding Referral of sick newborn

18. Diarrheal disease control Safe drinking water ,ORT & zinc Acute respiratory disease control Cotrimoxazole to pneumonia cases Prevention of vitamin A deficiency At 9 months -1 lakh units At 16 months-2 lakh units Then every 6months up to 5 years

19. Prevention & control of anemia in children Iron &folic acid supplementation Introduction of hepatitis B vaccination Training of dais

20. PHASE 2 OBJECTIVES Reduction of morbidity & mortality among: Mothers Infants Under 5 children Promotion of adolescent health Control of RTI/STDs

21. STRATEGIES Essential obstetric care 3-4 ANM staff nurses for 24 hour delivery services in PHCs & CHCs Skilled attendance at birth Provision for ANMs/staff nurses to use drugs in emergency

22. Emergency obstetric care FRUs provide normal & assisted deliveries & surgeries like caesarean section Care of newborn Emergency care of sick newborn Family planning services including laparoscopy Safe abortion services

23. Treatment of STI/RTI Blood storage facility Essential lab facilities Referral transport services

24. New initiatives 16 weeks training of MBBS doctors in anaesthetic skills Setting up blood storage facilities at FRUs

25. Janani suraksha yojana (12-4-2005) OBJECTIVES Promote institutional delivery Promote institutional care among women in BPL families

26. Cash assistance to institutional care CATEGORY RURAL AREA URBAN AREA MOTHER’S PACKAGE ASHA’S PACKAGE TOTAL RUPEES MOTHER’S PACKAGE ASHA’S PACKAGE TOTAL RUPEES LOW PERFORMING STATES 1400 600 2000 1000 400 1400 HIGH PERFORMING STATES 700 600 1300 600 400 1000

27. Eligibility to cash assistance In low performing states All women delivering in govt. Hospitals up to 3 live births if she accepts PPS In high performing states SC/ST & BPL women>19 years up to first 2 live births Subsidy up to Rs 1500 for caesarean section &management of complications for deliveries in govt. hospitals if govt. specialists not in position

28. Vandematharam scheme Free Distribution of iron & folic acid tablets, oral pills TT injections etc through volunteers

29. Safe abortion services Medical method of abortion : mifepristone misoprostol Manual vacuum aspiration

30. Village health and nutrition day Once a month at anganwadies for: Antenatal/postpartum care Promote institutional delivery Health education Immunisation Family planning services Nutrition services

31. Maternal death review Pregnancy tracking Care during pregnancy ,delivery & postpartum to prevent maternal mortality

32. Janani shishu suraksha karyakram Launched on 1 st June 2011 An attempt to make all deliveries cost free by Free drugs & consumables Free diet Free diagnostics Free blood Free transport Free care of sick newborns

33. Child health components Nutritional rehabilitation centres Medical & nutritional services to malnourished under 5 children SERVICES 24 hours care & monitoring Therapeutic feeding Treatment of complications Counselling

34. Integrated management of neonatal &childhood illness Pre service IMNCI Training in medical colleges to provide trained IMNCI manpower Facility based IMNCI Training to health personnel Facility based newborn care Setting up newborn care corners , special newborn care units & stabilisation units

35. Newborn care corners To provide immediate care of newborns Newborn stabilisation units at CHCs For care of sick & low birth weight babies Special newborn care units at DHs For care of sick newborn except assisted ventilation & major surgery

36. Home based newborn care By ASHAs,ANMs,anganwadi workers etc through home visits 6 visits for institutional delivery-day 3,7,14,21,28,42 7 visits for home delivery-day 1,3,7,14,21,28,42 5 visits in caesarean delivery from day 7-42(incentive of Rs 250)

37. Newborn discharged from SNCU Rs 50 for monthly follow up visits & Rs 250 for completing the remaining visits Twin /triplets :2 or 3 times the normal incentive

38. Navjat shishu suraksha karyakram Aimed to train health personnel in basic newborn care

39. Rashtriya Bal Swasthya Karyakram Launched in February 2013 For early detection & management of 4Ds prevalent in children: D efects at birth D eficiencies D iseases in children D evelopmental delays &disabilities

40. REPRODUCTIVE, MATERNAL , NEWBORN ,CHILD AND ADOLESCENT HEALTH PROGRAMME (RMNCH+A)

41. GOALS To reduce: IMR to 25/1000 live births by 2017 MMR to 100/10000 live births by 2017 TFR to 2.1 by 2017

42. INTERVENTIONS Reproductive health Focus on PPIUCD in high case load facilities Focus on interval IUCD at all facilities Home delivery of contraceptives Access to pregnancy testing kits & strengthen abortion services Quality sterilisation services

43. Maternal health Early registration of pregnancy & full ANC Detect & manage high risk pregnancy Highly trained personnel & equitable access to emergency obstetric care Review maternal,infant & child death Give misoprostol to 8 months pregnant ladies opting home deliveries

44. Newborn health Early initiated & exclusive breast feeding Home based newborn care through ASHA Essential & resuscitation services at all delivery points Highly trained personnel & infrastructure at SNCUs Giving gentamycin for suspected infections by ANM

45. Child health Complimentary feeding &IFA supplementation Diarrhoea management through ORS & zinc Management of pneumonia –co trimoxazole Full immunisation coverage RBSK screening of children for 4 Ds

46. Adolescent health Address teenage pregnancy &increase contraceptive prevalence Introduce peer educators IFA supplementation Menstrual hygiene

47. Adolescent health programme Priority interventions Adolescent nutrition : IFA supplementation Health education on reproductive health & health issues Menstrual hygiene Preventive health check ups

48. A. Adolescent Reproductive & Sexual Health(ARSH) programme APPROACHES Adolescent friendly health clinics Facility based counselling services Outreach activities Weekly IFA supplementation 100mg iron&500 microgram folic acid Deworming by Albendazole Menstrual hygiene scheme

49. INDIA NEWBORN ACTION PLAN GOAL Attain single digit Neonatal Mortality Rate by 2030

50. Intervention packages Preconception &antenatal care Reproductive health and family planning Nutrition related interventions Counselling &birth preparedness Prevention against malaria Antenatal screening & treatment for anemia , hypertension,HIV,Hepatitis B,hypothyroidism

51. Adolescent friendly health services Maternal TT immunaisation Interval IUCD insertion Postpartum family planning services Use of anti D immunoglobulin

52. Care during labour and child birth Skilled birth attendance Clean birth practices Identification,referral,&treatment of complications Pre referral dose of antibiotics &steroid by ANM

53. Immediate newborn care Delayed cord clamping Prevention of hypothermia , infection Early & exclusive breast feeding Vitamin K at birth Neonatal resuscitation

54. Care of healthy newborn Home care till six weeks by trained ASHA Exclusive breast feeding Clean postnatal practices Immunisation

55. Care of small & sick children Thermal care & feeding support IMNCI & use of antibiotics Injectable Gentamycin by ANMs for sepsis Kangaroo mother care at facility Supportive care at block & district level Intensive care services at regional level

56. Care beyond newborn survival Screening Follow up visits Diagnosis & management of birth defects

57. NATIONAL FAMILY WELFARE PROGRAMME

58. National family planning program launched in 1952 1970-All India hospital postpartum program 1971-MTP act 1977-Family welfare program

59. Services in urban areas The postpartum program PAP smear test facility program Sterilisation bed scheme Urban revamping scheme Urban family welfare services

60. Services in rural areas Village health posts :1/1000 population consists of a VHG,an ASHA,&indigenous dais promotional & educational services at subcentres Motivation of eligible couples&distribution of contraceptives at PHCs Full range of family planning services at CHCs

61. UNIVERSAL IMMUNISATION PROGRAMME

62. 1974-Expanded programme on immunisation by WHO 1978-EPI launched in India 19 Nov 1985- Universal Immunisation Programme

63. National immunaization schedule For pregnant women TT -1:early in pregnancy TT-2: 4 weeks after TT-1 TT booster:if recieved 2 doses within last 3 years

64. For infants BCG:at birth /within 1 year Hep B:at birth / within 24 hours OPV 0:at birth / within 1st 15 days OPV 1,2,3:at 6,10,&14 weeks Hib:6,10,14 weeks Hep B:6,10&14 weeks Measles:9-12 months Vit A 1:At 9 months

65. For children DPT booster:16-24 months OPV booster:16-24 months Measles 2:16-24 months JE(in endemic areas):16-24 months Vit A(2-9):16 months ,then every 6 months up to 5years DPT booster:5-6 years TT :10year & 16 year

66. Optional vaccines Varicella:15 months or after 1 year Hep A:18 mon&6 months later Pneumococcal conjugate vaccine:6 weeks Influenza:6 months

67. Pulse poilo immunaization program Launched in 1995 OPV drops to under 5 children in december & january every year 27 march 2014 :India certified as polio free

68. Pentavalent vaccine DPT+Hepatitis B+hemophilus influenza b Started from December 2011 in Kerala & Tamil nadu

69. Mission Indrradhanush Launched on 25 th December 2014 To cover children who are unvaccinated/partially vaccinated against 7 vaccine preventable diseases special vaccination clinics between january & june

70. Baby Friendly Hospital Initiative Launched in 1991 10 steps Written breast feeding policy Train health care staff in skills to implement this policy Inform pregnant women about breast feeding Help to initiate breast feeding within ½ an hour of delivery

71. Teach the technique of breast feeding Never feed newborns with anything other than breast milk Practice rooming in Encourage breast feeding on demand No pacifiers Foster establishment of breast feeding support programs

72. INTEGRATED CHILD DEVELOPMENT SCHEME (1975)

73. Beneficiary Services Pregnant women Health check up TT immunaisation Supplementary nutrition Nutrition & health education Nursing mothers Nutrition&health education children<3 years Supplementary nutrition Immunaisation Health check up Referral services Children 3-6 years Supplementary nutrition Immunization Health check up Referral services Nonformal education Adolecent girls(11-18 years) Supplementary nutrition Nutritional &health education

74. Supplementary nutrition Calories Protein Children<3 years 500 12-15g Severely malnourished<3 years 800 20-25g Pregnant & nursing women 600 18-20g

75. 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

76. 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

77. 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

78. Special nutrition program Beneficiary calories protein <6 years 300 10-12g Pregnant& nursing mothers 500 25g

79. THANK YOU