NRHM - NEW.pptx

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1. NRHM PROGRAMMES RELATED MCH PRESENTED BY: Mrs.m.r.abisha M.Sc.(N) I Year Govt. college of nursing Cuddalore EVALUATOR: Dr.mrs.s.kalaivani , MSc.(N), ph.d Nursing Tutor Govt. college of nursing Cuddalore

2. INTRODUCTION: According to the world bank almost 64.61% of the Indian population lived in rural areas in 2021. Most rural regions lack of modern health care facilities and the advanced infrastructure required to provide quality services. The NRHM is a step in solving such issues and enabling the rural population to access free health care .

3. DEFINITION: NRHM is a Government aided health insurance scheme that was launched in 2005 to provide accessible, affordable, and quality health care in the rural areas. The primary focus of this scheme is on the low income households in rural areas.

4. OBJECTIVES OF NRHM: To reduce MMR and IMR To decrease disease and injury related MMR Ensuring population stabilization Prevention and control of communicable and Non communicable disease Decreased in Total fertility rate To improve the quality of health services delivery at all levels. To make quality health care affordable & accessible to the rural population.

5. INFRASTRUCTURE OF NRHM : VILLAGE LEVEL SUBCENTER LEVEL BLOCK LEVEL PHC LEVEL

6. FUNCTIONS OF NRHM: Antenatal & Postnatal checkup Institutional delivery Trained community level workers Complete immunization Good hospital care Provision of household toilets. Mobile medical units Health and Nutrition services .

7. MILESTONES IN MCH: 1882 - Establishment of training of dais 1902 - 1 st Midwifery act for safe delivery 1952 - Family planning program adopted by Govt. of India 1961 - Dept. of. Family planning created in ministry of health 1971 - Medical termination of pregnancy 1977 - Renaming of family planning to family welfare 1978 - Expanded program of immunization 1985 - Universal immunization programme & National oral rehydration therapy.

8. Contd.. 1992- CSSM 1996- Target free approach 1997- Reproductive and child health programme 2005- RCH phase -2

9. NRHM PROGRAMMES RELATED MCH: Integrated Child Development Scheme: - ICDS launched in 1975 Objectives: To improve the nutritional and health status of children in the age group 0- 6 years To lay the foundation for proper psychological, physical and social development of the child.

10. BENEFICIARIES: Children in the age group of 0-6 years Women Lactating services Adolescent girls.

11. SERVICES UNDER ICDS: The ICDS scheme offers a package of 6 services, Supplementary Nutrition Immunization Pre school Non formal education Health checkup Nutrition and Health services Referral services

12. CHILD SURVIVAL AND SAFE MOTHERHOOD : CSSM program launched in 1992. This programme with assistance from world bank, UNICEF and other donors. Objectives: To reduce MMR and IMR Improve the MCH services at Village, Sub center and CHC level Beneficiaries: Pregnant womens Childrens

13. SERVICES UNDER CSSM: For Children: Newborn care at home Primary immunization by 12 months Vitamin A prophylaxis Correction & Management of pneumonia at Health facilities ORT at home / health facility

14. For Pregnant Women: Anemia prophylaxis and therapy Antenatal check up at least 3 Referral services. Care at birth and promotion of clean delivery

15. JSY is a safe motherhood intervention launched in 12 th April 2005 by the Honorable Prime minister. Objectives: Reducing MMR and IMR Promotion of child birth deliveries in Govt. institutions To provide Good medical care during pregnancy at the time of delivery and after delivery period. JANANI SURAKSHA YOJANA:

16. Eligibility: All pregnant women are, Eligible who are ready to deliver the child in Government accredited private health care institutions. “CASH ASSISTANCE PROVIDED UNDER JSY TO MOTHER AND ASHA WORKER IN RURAL AREAS”.

17. Cash assistance to Mother Cash assistance to ASHA worker Total Assistance Low Performing State Rs.1400 RS.300 FOR Antenatal care component RS.300- For facilitating institutional delivery Rs. 600 Rs . 2000 High Performing State Rs.700 Rs.300 for Antenatal care component Rs.300 for facilitating institutional delivery Rs . 1300

18. RCH PROGRAMME: RCH Programme was formally launched on 15 October 1997. Components of RCH Programme:- Family planning CSSM Prevention & Management of RTI/STI Adolescent health care & Family life education Client approach to Health care

19. Objectives: Promotion of MCH to ensure safe motherhood & Child survival Reduction of MMR & IMR Attainment of population stabilization Highlights of the Programme : Integration of all programs related fertility regulation, maternal and child health and reproductive health. Upgradation of facilities: Creation of FRU Provision of specialist services & Outreach services

20. RCH PROGRAMME & PHASE - II RCH Programme Phase-2 launched in 1 April 2005. Services package: Emergency Obstetric care Strengthening of referral services Strengthening of infrastructure Strengthening of MIS Promotion of institutional deliveries. Skilled birth attendance Policy decision to permit health workers to use drugs in emergency situation.

21. Training of PHC doctors in life saving anesthetic skills for emergency obstetrics care. Setting up of blood storage centers at FRU 24 hours functioning of PHC Family planning & counselling services Training of MBBS doctors in obstetrical management Expert group is considering other details.

22. NSSK PROGRAM (NAVJAT SISHU SURAKSHA KARYAKRAM) NSSK program launched in September 2009 by union health minister. Aim: To train health professional in basic newborn care and resuscitation Purpose: Prevention of hypothermia Prevention of infections EIBF Basic newborn resuscitation

23. RBSK ( RASHTRIYA BAL SWASTHYA KARYAKRAM) RBSK program launched by the ministry of health and family welfare, Govt.of India under the NHM in the year of February 2013. Aim: - To improve the overall quality of life of children Objectives: - Early detection & management of 4Ds prevalent in children .

24. 4 Ds are, Defects Diseases Developmental delays Deficiencies

25. IMPLEMENTATION MECHANISM OF RBSK: BENEFICIARIES NEWBORN CHILDREN OF AGE 6 WKS TO 6 YEARS CHILDREN 6 YEARRS TO 18 YEARS Site of Screening Facility Community Based Based Anganwadi Centre Govt or Govt aided school Personal team Responsible Existing ASHA Health manpower Dedicated mobile health team Dedicated mobile health team

26. JSSK (JANANI SHISHU SURAKSHA KARYKARAM) JSSK scheme was launched in June 2011, to eliminate out of pocket expenses for both pregnant women and sick infants. Goals of JSSK : Provision of maternal and newborn care. Diet Delivery Provision of blood Essential diagnosis Transport and drugs

27. RMNCH + A In India RMNCH programme launched in Feb 2013. Reproductive Health : Spacing methods Interval Iucd PTK - Nischay kits Sterilization Maternal Health: High-risk pregnancies Review maternal and infant death

28. - Identify low institutional delivery areas. Newborn Health: Exclusive Breastfeeding Essential newborn care Special newborn care units . Child Health: Focus on Nutrition Diarrhea management Management of Pneumonia

29. Adolescent Health : Teenage Pregnancy Strengthen ARSH Clinic. Iron plus initiative Promote Menstrual Hygiene Objectives: Reducing the Global MMR & IMR

30. CEmONC In September 2004 government order was passed to establishment of CEmONC centres in the state. 1 st Phase – 66 centre 2 nd phase – 32 centre 3 rd phase – 27 center Salient Features of CEmONC Centres : CEmONC centers is well equipped with both the manpower & the infrastructure required to care for the mother and the newborn

31. Round the clock, the Centre has Obstetricians, Pediatrician, staff Nurses, Lab technician, and Support staff on duty and anesthetics on call. Services available in CEmONC: Resuscitation of all obstetric emergencies. Resuscitation of all newborn emergencies. Blood transfusion facilities with all groups of blood. Supportive lab & imaging services. PPTCT services

32. Free Antenatal services & postnatal counselling services Free 108 Ambulance Uninterrupted power supply Health care waste management facility

33. Services available in the Labour Room : Emergencies met by trained Obstetrician and staff Nurses and round the clock Emergency treatment Protocols, equipment & drugs are available in the casualty, labour room & newborn care services. Emergency USG are taken for maternal emergencies Partographs are used Biomedical waste management procedure followed.

34. Services available in the care of newborn : Resuscitation of newborn by trained pediatrician. Emergency treatment protocols, equipment and drugs are available in the casualty Labour room & New born care services. Initiation of breast feeding immediately after birth.

35. SUMAN - (SURAKSHIT MATRIVA ASHWASHAN) SUMAN program was launched by the Honorable health minister on October 10, 2019. Aims of SUMAN : An initiative For zero preventable Maternal & Newborn deaths. Services undergone SUMAN : Provision of at-least 4 ANC checkup and 6 HBNC visits. Early initiation & Support for BF Zero dose vaccination Management of sick neonates & Infants

36. Safe motherhood booklet & MCP card Respectful care with privacy & dignity Free transport from home to health institutions (Dial 102/108) Time bound redresser of grievances through a responsive call center/ helpline. Postpartum FP Counseling Delivered by trained personnel. Choice for delayed cord clamping beyond 5 minutes/up to delivery of placenta.

37. Assured referral services with scope of reaching health facility within 1 hour of any critical care emergency. Birth Registration certificates from health care facilities. Counseling and IEC for safe motherhood. Free and zero expense access for identification and management of maternal complications. Elimination of mother to child transmission of HIV, HBV and Syphilis. Drop back from institution to home after due discharge. Conditional cash transfers / Directs benefit transfer under various schemes.

38. LaQshya LaQshya : LaQshya initiative was launched on 11 th December 2017, by the Ministry of Health & Family welfare. Objectives : Reduce MMR & IMR Improve the quality of care during and the immediate postpartum period. Stabilization of complications and ensure timely referrals and enable an effective two way follow up system.

39. Enhance satisfaction of beneficiaries positive birthing experience and provide respectful maternal care to all women. FEATURES OF LaQSHYA : LaQShya program focuses on improving the quality of care in the labour room and maternity OT. Under the initiative the multi prolonged strategy has been adopted such as, - Upgrading infrastructure.

40. Ensuring the availability of essential equipment Provide adequate Human resources. Capacity building of Healthcare Improving quality process in labour room Implementation of fast track interventions Capacity of building of healthcare workers by skill based training Strengthening critical care in obstetrician ,dedicated obstetric ICU at medical college hospital level & obstetric HDU at district hospital are operationalized under LaQshya programme.

41. PMSMA: Pradhan Mantri Surakshit Matriva Abhiyan (PMSMA) launched in 31 st July 2016, by Honorable Prime minister.( Ministry of Health &Family Welfare, Govt of India ) ABOUT THE COMPAIGN: A Minimum package of Antenatal care services is to be provided to the beneficiaries on the 9 th day of every month.

42. Target Beneficiaries : To reach out to all pregnant women who are in the 2 nd & 3 rd trimester of pregnancy . Provision of Beneficiaries : Identification of High risk pregnancies. All investigations done for this c amp. Conducted counselling sessions Filling out MCP cards.

43. NO Risk factor detected High risk pregnancy PIH With co morbid conditions

44. ASHA PROGRAMME-ACCREDITED SOCIAL HEALTH ACTIVIST: India launched ASHA Programme in 2005-06 as part of the National Rural Health Mission. Job duties for ASHA worker : Act as a care provider at the community level. Facilitating access to Health care medicines & Sanitation Services. Raising the level of awareness Advocate for female health & hygiene standards.

45. EXPANDED PROGRAM OF IMMUNIZATION: Expanded programme of immunization is a world Health Organization with the goal to make vaccines available to all children through out the world. Disease Covered by EPI : Diphtheria Polio myelitis Measles & tetanus Pertussis & Influenza Pneumococcal meningitis Hepatitis B & Diarrhea Influenza

46. Target groups for immunization: Every pregnant women for TT All children under 1 year of age Other children who have not fully immunized Women who are of child bearing age 15-49 yrs but not immunized against tetanus. GOALS: To improve immunization coverage focuses on the following 4 items. Standardized immunization schedule

47. Improving the stocking and availability of vaccines Promoting safe injection techniques Protecting vaccines potency through cold chain management. To achieve 100% coverage for eligible children by an ongoing integrated program. Eradication of polio to maintain polio free status. Elimination of measles

48. Elimination of neonatal status Maintain zero level of diphtheria. Reducing pertussis incidence Reducing childhood TB To reduce the incidence of bacterial meningitis due to haemophelus influenza.

49. UNIVERSAL IMMUNIZATION PROGRAMME: Vaccination programme launched by the Govt. of India in 1985. OBJECTIVES: Elimination of neonatal status Eradication of paralytic polio -Myelitis

50. BABY FRIENDLY HOSPITAL INITIATIVE: - BFHI Launched in 1991. AIM : Protection and promotion of breastfeeding Ensuring the proper use of breast milk substitutes, when these are necessary on basis of adequate information & through appropriate marketing and distribution. STEPS OF BFHI : Have a written breastfeeding policy that is routinely communicated to all health care staff.

51. Train all Healthcare staff in skill necessary to implement this policy. Inform all pregnant women about the benefits and management of breastfeeding. Help mothers initiate breastfeeding within a half hour of birth. Show mothers how to breastfeed and how to maintain lactation even if they should be separated from their infants. Give newborn infant no food or drink other than breast milk unless medically indicated.

52. Practice rooming in. Encourage breastfeeding on demand. Foster the establishment of breastfeeding support group and refer mothers to them on discharge from hospital or clinic supports can include.

53. VANDEMATARAM : Vande Mataram scheme is a voluntary scheme launched on 9 th February 2004 under the auspicious of f o g s I and private clinics. This is a voluntary scheme where in any obstetrics and gynaec specialist maternity home nursing Home lady doctors or MBBS doctor can volunteer themselves for providing safe mother group services. The enrolled doctors will display vande Mataram logo at their clinic.

54. Mission indradhanush is the Health mission of the Govt. of India. It was launched by Union Health Minister J.P.NADDA on 25 th December 2014 AIM : The mission focuses on to ensure high coverage of children and pregnant women with all available vaccines through out the country. MISSION INDRADHANUSH:

55. RASHTRIYA KISHOR SWASTHYA KARYAKRAM: The RKSK program was launched on 7 th January 2014. Objectives: Improve nutrition Improve sexual and Reproductive health Enhance mental health Prevent insurance and violence Prevent substance misuse Address NCD

56. HEALTHCARE DELIVERY SYSTEM: INTRODUCTION: India has a worst healthy car systems but the remain many differences in quality between rural and urban areas as well as between public and private Health care the challenge that exist today in many countries is to reach the whole population with adequate health care services and to ensure there utilization

57. Definition of Health: Health is a state of complete physical mental and social will being and not Nelly the absence of disease are infirmity. - WHO Definition of Healthcare Delivery System: Healthcare delivery system concern is to develop the system which ensures based comprehensive Healthcare services to people at large especially those living in remote and backward areas using available resources as effectively as possible. - K. Park

58. Healthcare Delivery System in India: India is a union of 29 th state and 7 union territories Under the constitution of India the states are largely independent of the people. The responsibility consist mainly of policy making, planning, guiding assisting availability and coordinating the work of the state help ministers so that health services convey a very part of the community.

59. The health systems in India has three main links, Central State Local Or Peripheral

60. Functions of Union List: International health relations and administration of post quarantine. Administration of Central institute Promotion of research through research centres Regulation and development of medical, pharmaceutical, dental and nursing professionals Establishment and maintenance of drug standards

61. Census and collection and application of other statistical data Immigration and emigration Regulation of labour in the working of mines and oil fields Coordination with states and with other ministries for promotion of health

62. Functions of Concurrent List: The functions responsibility of both the union and State governments Prevention and extension of communicable disease Prevention of adulteration of food steps Control of drugs and poisons vital statistics Labour welfare

63. Economic and the social planning Population control and family planning Preparation of health education material for creating awareness through Central health education bureau.

64. Functions of DGHS: International health relations and quarantine. Control of drug standard Medical store depot Post graduate training Medical education

65. Medical research Central government health schemes Central health education bureau Health intelligence National medical library

66. Functions of Central Council of Health : Policy making Legislation Recommendation

67. To consider and recommend broad outline of policy in record to matters concerning health in all its aspects such as the provision of remedial and preventive care, environmental hygiene, nutrition, health education and the promotion of facilities for training and research.

68. To make proposals for legislation in fields of activity relating to medical and public Health matters and to lay the pattern of development for the country as a whole. To make recommendations to the central government regarding distribution of available grants- in -aid for the health purpose to the states.

69. Functions: Support and safe guard the total policies of the government because of the collective responsibility of the cabinet. As a member of the ministry he brings all the bills pertaining to his department for approval of the legislature. As a member of government he performs ceremonial duties.

70. Functions of Municipal Boards: Construction Maintenance of roads Sanitation and drainage Street lighting Water supply Maintenance of hospital and dispensaries Education Registration of birth and death

71. Functions of Health organization at district level: Investigate communicable diseases Maintain free clinic for the early diagnosis of communicable disease. Provide laboratory services to assist doctors. Conduct clinics for administration of vaccines. Collect vital statistics

72. Provide MCH services. Supervise water supply and sewage disposal. Conduct health education programs. Provide mental Health services. Provide family planning services.

73. Functions of Gram Sabha: Proposals for taxation. Discusses the annual program. Elect members of the gram Panchayat. Functions of Nyaya Panchayat: They ensure quick and in expensive justice to villages.

74. ROLE OF NGO IN HEALTHCARE DELIVERY SYSTEM: Definition of NGO: A non government organization is any non profit volunteers citizens group which is organized on a local national or international - WHO

75. Types of NGO: Voluntary agencies Professional agencies Philanthropic agencies Social service and religious organization Cooperative agencies .

76. Role of NGO: Protection Prevention Promotion Transformation

77. Protection: - Providing release to victims of disaster and assisting the poor Prevention: - Reducing peoples vulnerability through income diversification and savings. Promotion: - Increasing people chances and opportunities. Transformation: - Red dressing social political and economic exclusion or oppression.

78. NGO Roles on Healthcare System: Policy setting Resource mobilization and allocation Health services Health promotion and information exchange Monitoring responsiveness and quality of Health services.

79. Policy Setting: Representing public and community interest in policy. Negotiating public Health standards and approaches. Enhancing public support. Resource Mobilization and Allocation : Financing Healthcare services. Raising community preferences. Monitoring quality of care and responsiveness.

80. Health Services: Facilitating community interaction with services. Distributing health resources such as condoms betnuts and information packs. Building health worker capacity morale and confidence.

81. Health Promotion and Information Exchange: Obtaining health information. Helping to shift social attitude. Implementing and using health research Mobilizing and organizing for health.

82. Monitor responsiveness and quality of Health services : Representing clients rights in quality of care issues. Channeling and negotiating patient complaints and claims. Informing policy on quality assess and equity .

83. SUMMARY: So far we discussed about National Health and Family welfare programs related MCH Healthcare delivery system and role of NGO in Healthcare delivery system.

84. CONCLUSION: Through this seminar I have learned about National Health and Family welfare programs related MCH Healthcare delivery system and role of NGO in Healthcare derivative system. I would like to thank my OBG Nursing Faculty Dr.Mrs.S.Kalaivani , M.Sc.(N), Ph.D , Nursing Tutor for giving this golden opportunity.

85. ASSIGNMENT: - Write an assignment about committees involved in family welfare programs.

86. JOURNAL PRESENTATION: Suresh Ray 2016 conducted year quantitative study of awareness and utilization of NRHM services among peoples are selected rural areas in the state of Maharashtra. Kya multi basic random sampling was used for the selection of representative samples for the study. Structure questionnaire related to NRHM was given to the respondents. Most of the people 63% where not ever about the difference services under NRHM except jsy . The researcher concluded that the awareness and utilization of NRHM services among people residing in rural area of the Maharashtra state is inadequate.

87. THEORY APPLICATION - GENERAL SYSTEM THEORY: IN PUT The Students having lack of Knowledge on “NRHM Programs ” THROUGH PUT Discussion about NRHM Programmes which includes Definition, Purposes and Structure. OUT PUT Students gained Knowledge on NRHM Programmes FEED BACK

88. JOURNAL REFERENCE: Nouralsalhin Abdalhamid Alaagib . Comparison of the effectiveness of lectures based on problems and traditional lectures in physiology teaching in Sudan – BMC Medical Education Article no: 365(2019) ABSTRACT: Lectures are one of the most common teaching methods in Medical Education. Didactic lectures were perceived by the students as the least effective method. Teaching methods that encourage self directed learning .It can be effective in delivering care knowledge leading to increased learning.

89. THANK YOU…..