Rch ppt

A short presentation on introduction to RCH care in India till 2019

1. Reproductive and Child Health BY KRITI SINGH Junior resident DEPARTMENT OF COMMUNITY MEDICINE GSVM MEDICAL COLLEGE

2. Background The RCH Programme was launched in India on 15 th 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, - T he 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

3. Phase II of RCH program started on 1 st A pril, 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(3.1,3.2,3.9), service coverage, risk factors and health determinants. Following are the indicators :

4. 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(CSSM) Programme 1996 - Adoption of Target Free Approach and renamed to Community Needs Assessment Approach(CNAA) 1997 - Launch of Community Needs Assessment and Monitoring Approach(CNAMA) under RCH Programme 1997 - RCH Programme Phase‐1 (15.10. 1997) 2005 - RCH Programme Phase‐2 (01‐04‐2005)

5. 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.

6. RCH I

7. RCH Phase‐II AIM : Reduction of IMR,MMR and TFR Increase of CPR and 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%

8. Indicator Tenth Plan Goals (2002‐ 2007) RCH II Goals (2005‐2010) National Population Policy 2000 (by 2010) Millennium Development Goals (By 2015) Sustainable Development Goals( By Targets under NHP 2017) Population Growth 16.2% (2001‐ 2011) 16.2% (2001 ‐ 2011) ‐ ‐ - Infant Mortality Rate 45/1000 35/1000 30/1000 ‐ 28 by 2019 Under 5 Mortality Rate ‐ ‐ ‐ Reduce by 2/3rds 23 by 2025 Maternal Mortality Ratio 200/100,000 150/100,000 100/100,000 Reduce by 3/4th 100 by2020 Total Fertility Rate 2.3 2.2 2.1 ‐ 2.2 in 2016 Co ntraceptive Pr evalence Rate 65% 65% Meet 100% needs ‐ 54%

9. 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.

10. Components Essential obstetrical care Emergency obstetrical care Strengthening referral system Strengthening project management Strengthening infrastructure Capacity building Improving referral syst em

11. 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

12. 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

13. 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 Integrate d Managemen t o f Neonata l & Childhood illnesses (IMNCI).

14. 24 hrs. Functioning of PHCs 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.)

15. 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

16. Janan i Surkash a Yojna To promote Institutional Deliveries To reduce Maternal Mortality Ratio and Infant Mortality Rate A saf e motherhoo d intervention , replacin g the “National Maternity Benefit Scheme”, under NRHM 100 % centrally sponsored Integrate s cash assistance wit h deliver y & post ‐ delivery care.

17. State Type Eligibilty Criteria LPS All pregnant women delivering in public or accredited private institutions HPS 1. Houehold of pregnant women has below poverty line card,or /and 2. Household of the pregnant women is scheduled caste, or/and 3. Household of the pregnant women is tribe, and 4. The pregnant women aged 19 years and above, and 5. Give birth in public or accredited private institutions, and 6. In every above case, receive program benefit up to the second birth Soure : Ministry of Health and Family Welfare, India(Yojana 2006)

18. Cash Incentives

19. Vandematram Scheme To promote public private partnership Launched in 9 th 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

20. 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

21. 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 and Condoms etc. Adolescents Health Counsellor. One ASHA for every 2500 population.

22. 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 ( MC TS) Maternal Death Review ( MDR )

23. Newborn Care Health Facility All Newborns at Birth Sick Newborn PHC/SC Newborn Care Corner (NBCC) in labor room Prompt referral CHC/FRU Newborn Care Corner (NBCC) in labor room and in O.T. Newborn Stabilization Unit (NBSU) District Hospital Newborn Care Corner (NBCC) in labor room and in O.T. Special Newborn Care Unit (SNCU)

24. 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 Proportio n o f trainin g tim e devote d t o sick young infant and sick child is almost equal Skill based

25. Contd …

26. Adolescent Reproductive and 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.

27. Services at Adolescent Clinic/ Health Facility : Core Package : - ARSH: information, counselling and services related to sexual concerns, pregnancy, contraception, abortion, menstrual problems etc. -Nutrition counselling, prevention and management of anaemia - STI/ RTI management - Referral services for VCTC(Voluntary Counselling and Testing Centre)and PPTCT(Prevention of Parent to Child Transmission) Outreach Services : School Health and Community camps : - Health check-ups, health education and awareness generation

28. 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

29. R eproductive Maternal, Newborn , Child Plus Adolescent Health(RMNCH+A) Continnum of Care approach: All stages of life- life cycle approach 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

30. Health Outcome Goals established in the 12th Five Year Plan Reduction of : Infant Mortality Rate (IMR) to 2 5 pe r 1,000 live births by 2017 Maternal Mortality Ratio (MMR) t o 10 per 100,000 live births by 2017 Total Fertility Rate(TFR) to 2.1 by 2017