Rch programme in india

RCH PROGRAMME

1. REPRODUCTIVE AND CHILD HEALTH PROGRAMME SOBANA.M., M.Sc (N) LECTURER

2. WHAT IS RCH APPRAOCH? 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 successful 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.

3. RCH PHASE - I The programme was formally launched on 15 th October 1997.

4. RCH PHASE 1 PROGRAMME INCORPORATED THE 4 COMPONENT

5. RCH phase – I interventions in all districts Child survival interventions i.e immunization, vit -A, ORT and prevention of pneumonia. Safe motherhood interventions e.g. antenatal check up, immunization for tetanus, safe delivery, anaemia control programme . Implementation of target free approach High quality training at all levels IEC activities Specially designed RCH package for urban slums and tribal areas District sub-projects under local capacity enhancement RTI/STD clinics at district hospitals Facility for safe abortions at PHC by providing equipments and contractual doctors. Enhanced community participation through panchayats , women’s groups and NGOs Adolescent health and reproductive hygiene

6. RCH phase – I interventions in selected states Screening and treatment of RTI/STD at sub-divisional level Emergency obstetric care at selected FRUs Essential obstetric care Additional ANM at sub- centres Improved delivery services and emergency care by providing drug and equipments, ANM kits at sub- centres Facility of referral transport for pregnant women during emergency (through panchayats )

7. RCH – I services and major interventions 1.Essential obstetric care 2.Emergency obstetrical care 3.24 -hour delivery services at PHCs\CHCs 4.Medical termination of pregnancy MTP act 1971 5. Control of reproductive tract infections and sexually transited diseases 6.Immunization 7.Drug and equipment kits : equipment kits supplied at various levels as follows:

8. At sub-centre level : United Nations Office for Project Services Drug kit A Drug kit B Mid- wifery kit Sub- centre equipment kit At PHC level- PHC equipment kit At CHC level- equipment kits from kit E to kit P 8.Essential newborn care 9.Oral rehydration therapy 10.Prevention and control of vitamin A deficiency in children

9. Under the program , doses of vitamin A are given to all children under 5 years of age. The first dose( 1 lakh units) is given at nine months of age along with measles vaccination The second dose is given along with DPT\ OPV booster doses Subsequent doses ( 2 lakh units each) six months intervals 11. Acute respiratory disease control cotrimoxazole is being supplied to the health worker through the CSSM drug kit 12. Prevention and control of anemia in children under this program of control and prevention of anemia ,tablets containing 20 mg of elemental iron and 100 mcg for of folic acid for 5 years, 30 mg iron and 250 mcg 6-10 years for 100 days are provided at sub-centre level . The health workers to provide 100 tablets to children clinically found to be anemic. 13. Training of Dais

10. RCH –PHASE II RCH –PHASE II began from 1st April 2005,the focus is to reduce maternal and child mortality and morbidity with emphasis on rural health care. The major strategies are 1 ) Essential obstetric care a. Institutional delivery b. Skilled attendance at delivery c. Policy decisions 2) Emergency obstetric care a. operationalizing first referral units b. operationalizing PHCs and CHCs for round clock delivery services 3) Strengthening referral system

11. 1 ) Essential obstetric care A) INSTITUTIONAL DELIVERY: to promote institutional delivery 50% of PHC and CHC would be made operational as 24 hours delivery centre. B) SKILLED ATTENDANCE AT DELIVERY: for MOs/ ANMs/LHVs – guidelines for conducting normal delivery and management of obstetric complications. C) POLICY DECISIONS: ANMs/LHVs/SNs – Permitted to use drugs in specific emergency situations to reduce maternal mortality.

12. 2) Emergency obstetric care ( EmOC ) The FRUs be made operational for providing emergency obstetric care The minimum services provided by a fully functional FRUs 24 hrs delivery services including normal and assisted deliveries EmOC including surgical interventions like caesarean section. New-born care Emergency care of sick children. Full range of family planning services including laproscopic services. Safe abortion services Treatment of RTIs/STIs. Blood storage facility Essential lab services Referral (transport ) services.

13. 3) Strengthening referral system Funds were given to panchayat for providing assistance to poor people in case of obstetric emergencies. Involvement of local self-help groups, NGOs and women groups.

14. NEW INTIATIVES 1. Training of MBBS doctors in life saving anesthetic skills for emergency obstetric care. Govt .of India is also introducing training of MBBS doctors of obstetric management skills, prepared training plan for 16 weeks in all obstetric management skills,inculding caesarean section operation. 2.Setting up of blood storage centres at FRUs according to government of India guidelines

15. 3.JANANI SURAKSHA YOJANA The national maternity benefit scheme has been modified into a (JSY) JANANI SURAKSHA YOJANA. It was launched on 12th April 2005. It is a 100% centrally sponsored scheme Under national rural health mission ,it integrates the cash assistance with institutional care during antenatal, delivery and immediate post-partum care ASHA would work as a link worker

16. THE SCALE OF ASSISTANCE UNDER THE SCHEME FROM 2012-13 CATEGORY RURAL AREA URBAN AREA MOTHER’S PACKAGE ASHAS’S PACKAGE * TOTAL Rs MOTHER’S PACKAGE ASHAS’S PACKAGE ** TOTAL Rs LPS 1400 600 2000 1000 400 1400 HPS 700 600 1300 600 400 1000 *ASHA incentives of Rs-600 in rural area: Rs-300 for ANC component and Rs-300 for accompanying PWs for institutional delivery ** ASHA incentives of Rs-400 in urban area: Rs-200 for ANC component and Rs-200 for accompanying PWs for institutional delivery

17. The eligibility of cash assistance In LPS: all women including SC &ST families. In HPS: BPL women and SC,ST pregnant women. In LPS: all births. In HPS: upto 2 live births. The limitation of cash assistance for institutional delivery

18. 4.VANDEMATARAM SCHEME It is a voluntary scheme wherein any obstetric and gynaec specialist, maternity home, nursing home, MBBS DOCTORS can volunteer themselves for providing 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.

19. 5.Safe abortion services Under RCH – II the following services are provided: Medical method of abortion: Under preview of MTP act-1971; Mifepristone (RU 486) followed by Misoprostol . It is recommended upto 7 weeks(49 days) of amenorrhoea . Manual vacuum aspiration: MVA technique has been piloted in coordination with FOGSI (FEDERATION OF OBSTETRIC AND GYNECOLOGICAL SOCIETIES OF INDIA), WHO and respective state Govts .

20. 6.Village health and nutrition day Once in a month at AWCs To provide antenatal/post-partum care to PW, promote institutional delivery, health education, immunization, family planning and nutrition services.

21. 7.Maternal death review Both facility and community maternal death review To improve the quality of obstetric care and reduce the maternal morbidity and mortality.

22. 8.JANANI-SHISHU SURAKSHA KARYAKRAM (JSSK) Launched on 1 st June 2011 To make available better health facilities for women and child. The facilities to pregnant women: all PW delivering in PH institutions to have absolutely free and no expense including C-Section. The entitlements include free drugs & consumables, free diet upto 3 days during normal delivery and upto 7 days for C-section, free diagnostics and free blood, free transport from home to institution & between facilities an case of referral. Similar entitlements for all sick newborns. The scheme has now been extended to cover the complications during ANC, PNC & sick newborn.

23. CHILD HEALTH COMPONENTS

24. The strategy for child health care, aims to reduce under-five child mortality through improved child care practices and child nutrition.

25. 1.Nutritional rehabilitation centres ( NRCs) Medical and nutritional care to severe acute malnutrition children under 5 years of age. The services provided: 24 hrs care and monitoring of the child Treatment of medical complications Therapeutic feeding Sensory stimulation and emotional care Counselling on appropriate feed, care and hygiene Demonstration and practice by doing of energy dense food Social assessment of family Follow-up of the children discharged from the facility.

26. 2.IMNCI (INTEGRATED MANAGEMENT OF NEONATAL AND CHILDHOOD ILLNESS) IMNCI is one of the main intervention under RCH-II. The objective is to implement IMNCI package at the level of household, and through ANMs at sub-centre level; through MOs, nurses and LHVs at PHC level.

27. Pre-service IMNCI IMNCI is being included in the curriculum of medical colleges. This will help in providing trained IMNCI manpower in public and private sector.

28. Facility based IMNCI (F-IMNCI) Integration of facility based care package with IMNCI package, to empower the health personnel with the skill to manage newborn and childhood illness at community level as well as the health facility.

29. Facility based newborn care Health facility All newborns at birth Sick newborn PHC/SC identified as MCH level -I NBCC (newborn care corner) in labor rooms Prompt referral CHC/FRUs identified as MCH level - II NBCC in labor rooms and in operation theatre NBSU (newborn stabilization unit) District hospitals identified as MCH level-III NBCC in labor rooms and in operation theatre SNCU (special newborn care unit)

30. 3. HOME BASED NEWBORN CARE (HBNC) Aimed at improving newborn survival Strategy is to universal access to home based newborn care The providers of service include AWWs, ANM, ASHA and the MO. However ASHA is the main person involved in home based newborn care.

31. 4. NAVJAT SHISHU SURAKSHA KARYAKRAM (NSSK) Is a programme aimed to train health personnel in basic newborn care and resuscitation. Launched to address care at birth issue i.e prevention of hypothermia, prevention of infection, early initiation of breat -feeding and basic newborn resuscitation.

32. 5. RASHTRIYA BAL SWASTHYA KARYAKRAM (RBSK) Launched in February 2013. Provision for child health screening and early intervention services through early detection and management of 4 Ds prevalent in children. 4 Ds: Defects at birth Deficiency conditions Diseases in children Developmental delays including disabilities

33. Quality indicators % Pregnancy Registered before 12 weeks % ANC with 3 visits % ANC receiving all RCH services % High risk cases referred % High risk cases followed up % deliveries by ANM/TBA %PNC with 3 PNC visits % PNC receiving all counselling

34. Cont… % PNC complications referred % Eligible couple offered FP choices % women screened for RTI/STDs % Eligible couple counselled for prevention of RTI/STDs % ADD given ORS % ARI treated % children fully immunized

35. Reference Park's Textbook of Preventive and Social Medicine 24 th Edition/2017.