Reproductive and Child Health Programme

National Health Programme

1. Reproductive & child health
programme
Dr. ShubhangiS. Kshirsagar
Assistant professor
Department of Swasthavritta& Yoga

2. RCHphaseI–launchedon15
th
october1997.
Reproductivehealthapproachescanbedefinedasa
stateinwhichpeoplehavethe-
Abilitytoreproduceandregulatetheirfertility.
Womenareabletogothroughpregnancyandchild
birthsafely.
Outcomeofpregnancyissuccessfulintermsof
maternalandinfantsurvivalandwellbeing
Couplesareabletohavesexualrelationsfreeofthe
fearofpregnancyandofcontractingdiseases.
Dr. ShubhangiKshirsagar

3. RCH phase I-intervention in all district
•Child survival intervention i.e. immunization, VitA, ORT and prevention of
pneumonia.
•Safe motherhood intervention eg, ANC check up, immunization for tetanus,
safe delivery, anemia control programme.
•Facility for safe abortions at PHC by providing equipments and contractual
doctors.
•Enhanced community participation through Panchayats, women’s group and
NGOs.
•Adolescent health and reproductive hygiene.
•IEC activities.
•Specially designed RCH package for urban slum and tribal areas.
•High quality training at all levels.
•RTI/STD clinics at district hospitals.
•High quality training at all levels.
•District sub-project under local capacity enhancement.
•Implementation of target free approach.
Dr. Shubhangi Kshirsagar

4. Interventions in selected States/Districts
ScreeningandtreatmentofRTI/STDatsub-divisionallevel.
EmergencyobstetriccareatselectedFRUsbyproviding
drugs.
EssentialobstetriccarebyprovidingdrugsandPHN/Staff
NurseatPHCs.
AdditionalANMatsub-centresintheweakdistrictsfor
ensuringMCHcare.
Improveddeliveryservicesandemergencycareby
providingequipmentkits,IUDinsertionsandANMkits
atsub-centres.
Facilityofreferraltransportforpregnantwomenduring
emergency.
Dr. Shubhangi Kshirsagar

5. Major intervention under RCH –
Phase I
1.Essential obstetric care
2.Emergency obstetric care
3.24 hour delivery services at PHCs/CHCs
4.Medical termination of pregnancy
5.Control of RTI/STD
6.Immunization
7.Essential newborn care
8.Diarrhoealdisease control
9.Acute respiratory disease control
10.Prevention & control of vitA deficiency in children
11.Prevention & control of anaemiain children
12.Introduction of hepatitis B vaccination
13.Training of dais
Dr. Shubhangi Kshirsagar

6. Major intervention under RCH
Phase I
1.Essentialobstetriccare
Toprovidethebasicmaternityservicetoallpregnant
womenthrough-
a.Earlyregistrationofpregnancy(within12-16wks)
b.Provisionofminimum3antenatalcheck-upsby
ANMormedicalofficertomonitorprogressof
pregnancy&detectanycomplication.
c.Provisionofsafedeliveryathomeorinan
institution.
d.Provisionof3postnatalcheckupstomonitor
postnatalrecovery&todetectcomplications
Dr. Shubhangi Kshirsagar

7. 2.Emergencyobstetriccare
Aim-Topreventmaternalmortality&
morbidity.
FRUs(firstreferralunits)strengthenedthrough
supplyofemergencyobstetrickit,equipment
kitandprovisionofskilledmanpoweron
contractbasis.
3.24hourdeliveryservicesatPHCs/CHCs
Aim-Topromoteinstitutionaldeliveries
Provisionhasmadetogiveadditional
honorariumtostafftoencourageroundthe
clockdeliveryfacilitiesathealthcenters.
Dr. Shubhangi Kshirsagar

8. 4. Medical termination of pregnancy
Aim –To reduce maternal mortality & morbidity
from unsafe abortion.
5. Control of reproductive tract infection(RTI) &
STD
Component of RTI/STI control is linked with HIV
& AIDS control and implemented in
collaboration with NACO.
Dr. Shubhangi Kshirsagar

9. 6. Immunization –
UIP become a part of RCH in 1997
UIP provides vaccines for Polio, tetanus, DPT,
DT, measles, TB
Dr. Shubhangi Kshirsagar

10. 7. Essential newborn care
Aim –To reduce perinatal& neonatal mortality
Component –
Resuscitation of newborn with asphyxia,
Prevention of infection
Exclusive breast feeding
Referral of sick newborn
Strategies –
To train medical and other health personnel in
essential newborn care,
Provide basic facilities for care of LBW and sick
new born in FRUs and district
Dr. Shubhangi Kshirsagar

11. 8. Diarrhoealdisease control
Low osmolarityORS introduced.
Zincis used as an adjunct to ORS for
management of diarrhoea.
(Zn –reduces number, severity of episodes and
duration of dirrhoea)
De-worming guidelines
9.Acute respiratory disease control
Peripheral health workers are trained to
recognize and treat pneumonia.
Cotrimoxazolesupplied to the health
workers through the drug kit.
Dr. Shubhangi Kshirsagar

12. 10. Prevention & control of vitamin A deficiency in
children
VitA given to all childrensbelow 5 yrs
1
st
dose –at 9 months (1lakh unit)
Subsequent doses are given at 6 months
intervals up to 5 yrs of age (2lakh unit)
Severe malnutrition –one additional dose
Dr. Shubhangi Kshirsagar

13. 11. Prevention and control of anemia in
children
Iron and folic acid supplement to infants from 6
months to 5 years age .
•Above 10yrs –adult dose
Dose acc to age Duration
6month -5yrs 6-10yrs
Elemental iron 20mg 100mcg 100days in a yr
Folic acid 30mg 250mcg 100days in a yr
Dr. Shubhangi Kshirsagar

14. 12. Introduction of Hepatitis B
HepB vaccine with DPT vaccine
13. Training of Dais
Aim –to train at least one daiin every village
Objective –making deliveries safe.
Dr. Shubhangi Kshirsagar

15. RCH phase -II
Dr. Shubhangi Kshirsagar

16. RCHphase-II
RCH-phaseIIbeganfrom1stApril,2005.Thefocusisto
reducematernalandchildmorbidityandmortalitywith
emphasisonruralhealthcare.
Themajorstrategiesare-
1.Essentialobstetriccare
a.Institutionaldelivery
b.Skilledattendanceatdelivery
c.Policydecision
2.Emergencyobstetriccare
a.OperationalizingFirstReferralUnits
b.OperationalizingPHCsandCHCsforroundtheclock
deliveryservices
3. Strengthening referral system
Dr. Shubhangi Kshirsagar

17. 1.Essentialobstetriccare
a.Institutionaldelivery
Topromoteinstitutionaldelivery50%ofthePHCsandall
theCHCswouldbemadeoperationalas24-hourdelivery
centers.
b.Skilledattendanceatdelivery
Guidelinesfornormaldeliveryandmanagementofobstetric
complicationsatPHC/CHCformedicalofficersandfor
ANCandskilledattendanceatbirthforANM/LHVshave
beenformulated.
c.Thepolicydecisions-ANMsILHVsISNspermitted-
tousedrugsinspecificemergencysituationstoreduce
maternalmortality.
tocarryoutcertainemergencyinterventionswhenthe
lifeof the mother isatstake.
Dr. Shubhangi Kshirsagar

18. 2.Emergencyobstetriccare
FRUs made operational for providing emergency and
essential obstetric care.
The minimum services to be provided by a fully functional FRU are -
1.24 hour delivery services (normal and assisted deliveries.
2.Emergency obstetric care including surgical interventions like
caesarean sections.
3.New-born care.
4.Emergency care of sick children.
5.Full range of family planning services including laproscopicservices.
6.Safe abortion services.
7.Treatment of STl/RTI.
8.Blood storage facility.
9.Essential laboratory services.
10.Referral (transport) services.
Dr. Shubhangi Kshirsagar

19. FundsweregiventothePanchayatforproviding
assistancetopoorpeopleincaseofobstetric
emergencies.
Involvement of local self help groups, NGOs and
women groups.
3. Strengthening referral system
Dr. Shubhangi Kshirsagar

20. New initiatives
1.TrainingofMBBSdoctorsinlifesaving
anaestheticskillsforemergencyobstetric
care-
GovernmentofIndiaisintroducingtrainingof
MBBSdoctorsinobstetricmanagementskills.
FederationofObstetricandGynaecologySocietyof
Indiahaspreparedatrainingplanfor16weeksinall
obstetricmanagementskills,includingcaesarean
sectionoperation.
2.SettingupofbloodstoragecentersatFRUs
accordingtogovernmentofIndiaguidelines.
Dr. Shubhangi Kshirsagar

21. 3. JANANI SURAKSHA YOJANA
TheNationalMaternityBenefitschemehasbeen
modifiedintoanewschemecalledJananiSuraksha
Yojana(JSY).
Itwaslaunchedon12thApril,2005.
Objectives-Toreducematernalmortalityandinfant
mortalitythroughencouragingdeliveryathealth
institutions,andfocusingatinstitutionalcareamong
womeninbelowpovertylinefamilies.
Dr. Shubhangi Kshirsagar

22. ThesalientfeaturesofJananiSurakshaYojanaare
Itisa100percentcentrallysponsoredscheme.
UnderNationalRuralHealthMission,itintegratesthe
benefitofcashassistancewithinstitutionalcareduring
antenatal,deliveryandimmediatepost-partumcare.
Thisbenefitwillbegiventoallwomen,bothruraland
urban,belongingtobelowpovertylinehouseholdand
aged19yearsorabove,uptofirsttwolivebirths.
TheAccreditedSocialHealthActivist(ASHA)wouldwork
asalinkhealthworkerbetweenthepoorpregnant
womenandpublicsectorhealthinstitution.
Dr. Shubhangi Kshirsagar

23. Dr. Shubhangi Kshirsagar

24. Scale of assistance under JSY
Category Rural Area Urban Area
Mother’s
package
ASHA’s
package *
Total
Rs.
Mother’s
package
ASHA’s
Package**
Total
Rs.
LPS 1400 600 2000 1000 400 1400
HPS 700 600 1300 600 400 1000
LPS-Lowperformingstates,HPS-Highperformingstates
*ASHAincentiveofRs.600/-inruralareasincludesRs.300/-forANCcomponent
andRs.300/-foraccompanyingpregnantwomanforinstitutionaldelivery.
**ASHAincentiveofRs.AOO/-inurbanareaincludesRs.200/-forANC
componentandRs.200/-foraccompanyingpregnantwomanforinstitutional
delivery.
Dr. Shubhangi Kshirsagar

25. Eligibility & limitation of cash assistance
Low performing
states (LPS)
Highperforming
states (HPS)
Eligibility of cash
assistance
All women, including
those from SC and ST
families, delivering in
government health
Below poverty line
(BPL) women, aged 19
years and above and
the SC and ST
pregnant women.
Limitation of cash
assistance
All births 2 live births.
Dr. Shubhangi Kshirsagar

26. 4. Vandemataramscheme
This is a voluntary scheme where any obstetric and
gynaecologyspecialist, maternity home, nursing home, lady
doctor/MBBS doctor can volunteer themselves for providing
safe motherhood services.
The enrolled doctors will display 'Vandemataramlogo' at
their clinic.
Iron and Folic Acid tablets, oral pills, TT injections etc. will be
provided by the respective District Medical Officers to the
'Vandemataramdoctors/clinics' for free distribution to
beneficiaries.
The cases needing special care and treatment can be referred
to the government hospitals.
Dr. Shubhangi Kshirsagar

27. 5. Safe abortion services
1.Medicalmethodofabortion
Terminationofearlypregnancywithtwodrugs
Mifepristone(RU486)followedbyMisoprostol.
Itisrecommendedupto7weeks(49days)of
amenorrhoeainafacilitywithprovisionforsafe
abortionservicesandbloodtransfusion.
2.ManualVacuumAspiration(MVA)–
ThedepartmentoffamilywelfarehasintroducedManual
VacuumAspiration(MVA)techniqueinthefamily
welfareprogramme.
Dr. Shubhangi Kshirsagar

28. 6. Village Health and Nutrition Day
OrganizingVillageHealthandNutritionDayoncea
monthatanganwadicentre.
Aim-Toprovideantenatal/postpartumcareforpregnant
women,promoteinstitutionaldelivery,healtheducation,
immunization,familyplanningandnutritionservicesetc.
Dr. Shubhangi Kshirsagar

29. Maternaldeathaudit,bothfacilityandcommunity
based.
Itisanimportantstrategytoimprovethequalityof
obstetriccareandreducematernalmortalityand
morbidity.
Guidelinesandtoolsforinitiatingmaternaldeath
reviewhavebeenformulated
7.Maternal death review
Dr. Shubhangi Kshirsagar

30. RCH-11 stresses the need for universal screening
of pregnant womenand providing essential and
emergency obstetric care.
Focused antenatal care, birth preparedness and
complication readiness, skilled attendance at birth,
care within the first seven days etc. are the factors
that can reduce the maternal mortality.
8. Pregnancy tracking
Dr. Shubhangi Kshirsagar

31. Launched on1st June 2011.
To provide better health facilities for women and child.
It provides following facilities to the pregnant women -
All pregnant women delivering in public health institutions
to have
Free and no expense delivery, including caesarean section.
Free drugs and consumables
Free diet upto3 days during normal delivery and upto7 days
for C-section
Free diagnostics
Free blood wherever required.
Free transport from home to institution
Similar facilities for all sick newborns accessing public health
institutions for treatment till 30 days after birth.
Now it is extended to cover the complications during ANC, PNC and
also sick infants.
8. JANANl-SHISHU SURAKSHA KARYAKRAM (JSSK)
Dr. Shubhangi Kshirsagar

32. Dr. Shubhangi Kshirsagar

33. Child Health Component
Dr. Shubhangi Kshirsagar

34. Child Health Component
Component
The strategy for child health care, aims to
reduce underfivechild mortality through
interventions at every level of service delivery
and through improved child care practices and
child nutrition
Dr. Shubhangi Kshirsagar

35. 1. Nutritional rehabilitation centres(NRCs)
NRCs provides medical and nutritional care to severe acute
malnutrition (SAM) children under 5 years of age who have
medical complications.
It also focus on improving the skill of mothers on child care
and feeding practices.
The services provided at the NRCs include –
24 hours care and monitoring of the child
Treatment of medical complication
Therapeutic feeding
Sensory stimulation and emotional care
Counseling on appropriate feed, care and hygiene
Demonstration and practice-by-doing on the preparation of
energy dense food using locally available, culturally acceptable
and affordable food items.
Dr. Shubhangi Kshirsagar

36. Thestrategyconsistarangeofinterventionsto
preventandmanagethecommonestmajorchildhood
diseases.
FacilitybasedIMNCI(F-IMNCI)
2. Integrated Management of Neonatal and
Childhood Illness (IMNCI)
Dr. Shubhangi Kshirsagar

37. •Itistheintegrationofthefacilitybasedcarepackage
withtheIMNCIpackage,toempowerthehealth
personnelwiththeskilltomanagenewborn
andchildhoodillnessatthecommunitylevelaswell
asthehealthfacility.
•Itfocusesonprovidingappropriateinpatient
managementofthemajorcausesofneonataland
childhoodmortalitysuchasasphyxia,sepsis,lowbirth
weight,pneumonia,diarrhoea,malaria,meningitisand
severemalnutritioninchildren.
Facility based IMNCI (F-IMNCI)
Dr. Shubhangi Kshirsagar

38. Health facility All new born at
birth
Sick newborn
PHC/Sub-center
identified as MCH
level 1
New born corner in
labourroom s
Promptreferral
CHC/FRUidentified
as MCH level II
New born corner in
labourroom s &
operation theatre
New born
stabilizationunits
(SNBU)
Districthospital
identified as MCH
level III
New born corner in
labourroom s &
operationtheatre
Special newborn
care unit (SNCU)
Facility Based Newborn Care
Dr. Shubhangi Kshirsagar

39. Aim -To improve newborn survival.
The strategy is to universal access to home based
newborn care
The providers of service include anganwadiworkers,
ANM, ASHA and the medical officer.
ASHA is the main person involved in home based
newborn care.
Home Based Newborn Care (HBNC)
Dr. Shubhangi Kshirsagar

40. ThemajorobjectiveofHBNCistodecreaseneonatal
mortalityandmorbiditythrough-
1.Theprovisionofessentialnewborncaretoall
newbornsandthepreventionofcomplications.
2.Earlydetectionandspecialcareofpretermandlow
birthweightnewborns.
3.Earlyidentificationofillnessinthenewbornand
provisionofappropriatecareandreferral.
4.Supportthefamilyforadoptionofhealthypractices
andbuildconfidenceandskillsofthemotherto
safeguardherhealthandthatofthenewborn.
Dr. Shubhangi Kshirsagar

41. •Aim-Totrainhealthpersonnelinbasicnewborn
careandresuscitation.
•Ithasbeenlaunchedtoaddresscareatbirthissue
i.e.preventionofhypothermia,preventionof
infection,earlyinitiationofbreast-feedingandbasic
newbornresuscitation.
NavjatShishuSurakshaKaryakram(NSSK)
Dr. Shubhangi Kshirsagar

42. launchedinFebruary2013.
ItincludesprovisionforChildHealthScreening
andEarlyInterventionServicesthroughearly
detectionandmanagementof4Ds,prevalentin
India.
4Dsare
1.Defectsatbirth
2.Diseasesinchildren
3.Deficiencyconditions
4.Developmentdelaysincludingdisabilities.
RashtriyaBal SwasthyaKaryakram(RBSK)
Dr. Shubhangi Kshirsagar

43. Thank you !
Dr. Shubhangi Kshirsagar