Rmnch+a

RMNCH+A approach has been launched in 2013 and it essentially looks to address the major causes of mortality among women and children as well as the delays in accessing and utilizing health care and services. The RMNCH+A strategic approach has been developed to provide an understanding of ‘continuum of care’ to ensure equal focus on various life stages.

The RMNCH+A appropriately directs the States to focus their efforts on the most vulnerable population and disadvantaged groups in the country. It also emphasizes on the need to reinforce efforts in those poor performing districts that have already been identified as the high focus districts.

1. A strategic approach to Reproductive, Maternal, Newborn, Child and Adolescent health in India 8/14/2018 1 RMNCH+A Dr. Aparna Sen Chaudhary

2. Background In June 2012, GOI, Ethiopia, USA and The UNICEF – “ Global Child Survival Call for Action : A promise to Keep ” In February 2013, India launched – “ A Strategic Approach to Reproductive, Maternal, New-born Child and Adolescent Health (RMNCH + A) ” 8/14/2018 2

3. Background 8/14/2018 3 +

4. Five pillars in the Strategy 8/14/2018 4

5. “Plus” within the strategy Including adolescence Linking maternal health to reproductive health, FP, adolescent health, HIV, gender, preconception and prenatal diagnostic techniques Linking home and community based services to facility based care Ensuring linkages, referrals and counter referrals 8/14/2018 5

6. Aim Reach the maximum number of people in the remotest corners of the country through Continuum of services Constant Innovations Routine monitoring 8/14/2018 6

7. Goals For 12 th Five Year Plan Reduction of Infant Mortality Rate to 25/1000 live births by 2017. Reduction in Maternal Mortality Ratio to 100/100000 live births by 2017 Reduction in Total Fertility Rate to 2.1 by 2017 8/14/2018 7

8. Coverage Targets 8/14/2018 8 Aspects to be covered From baseline Annual increase rate Annual increase rate Facilities equipped for perinatal care by 100% Institutional deliveries 61%(SRS 2010) 5.6% ANC’s 53% (CES 2009) 6% Postnatal care 45% (CES 2009) 7.5% Deliveries by skilled birth attendants 76% (CES 2009) 2% Exclusive breast feeding rates 35% (CES 2009) 9.6% Reduce prevalence of under-five children with underweight 45% (NFHS -3) 5.5% Reduce Unmet need for family planning method 21% (DHLS 3) 8.8% Increase met need for family planning 47% (DLHS-3) 4.5% Reduce Anaemia in adolescent girls and boys 56%(G); 30% (B) 6% Total fertility contributed by adolescents (15-19y) 16% (NFHS -3) 3.8% Raise child sex ratio (0-6 years) 914 (Census 2011) 0.6%

9. RMNCH+A strategy Focuses on high priority districts To address inter- state and inter- district variation Tailored programs to meet the needs of the underserved Includes adolescents, urban poor, tribal population Management tools and job aids 5x5 matrix –five thematic areas – important tool which explains strategy Minimum essential commodities 8/14/2018 9

10. High Priority Districts (HPDs) Emphasis – High Impact Interventions HPDs – Districts with relatively weak performance against RMNCH+A indicators. 184 HPDs in India 8/14/2018 10

11. 8/14/2018 11

12. RMNCH+A Interventions 8/14/2018 12 M aternal Health 1.Use MCTS 2.High risk pregnancies 3.Highly trained HR 4.Review maternal and infant deaths 5.Identify low institutional delivery areas and incentivize ANMs for domiciliary care services R eproductive Health 1. Spacing methods-PPIUCD 2. Interval IUCD 3. HDC and ESB 4. PTK-" Nischay Kits 5. Sterilization services. N ewborn Health 1.Exclusive breastfeeding 2.HBNC through ASHA 3.Essential Newborn Care 4.Special Newborn Care Units 5.Use of Gentamycin by ANM C hild Health 1.Focus on nutrition 2.Diarrhoea management 3.Management of pneumonia 4.Full immunization coverage 5.RBSK A dolescent Health 1. Teenage pregnancy 2.Peer educators 3.Strengthen ARSH clinics 3.Iron Plus Initiative 4.Promote Menstrual Hygiene

13. Implementation strategies Key intervention “Continuum of Care” Reducing mortality and improving survival 8/14/2018 13

14. Continuum of care across life cycle and level of care 8/14/2018 14 Clinical Outreach/SC Family & Community

15. Adolescent Health Programme Priority interventions Adolescent nutrition; iron and folic acid supplementation Facility-based adolescent reproductive and sexual health services (Adolescent health clinics) Information and counselling on adolescent sexual reproductive health and other health issues Menstrual hygiene Preventive health check-ups 8/14/2018 15

16. A. Adolescent Reproductive and Sexual health programme (ARSH) Routine check-up at primary, secondary and tertiary levels on fixed days Promotive, Preventive, Curative and Counselling Management of menstrual problems Approaches Facility based health services Counselling (ARSH and ICTC) Community based interventions 8/14/2018 16

17. ARSH… Adolescent Friendly Health Clinics: Routine health checkups Health related needs – contraceptives provision, management of menstrual problems, RTI/STI management, antenatal care and anemia. Facility based counselling services: On nutrition, puberty, STI/RTI prevention, contraception, abortion services, sexual abuse, substance misuse, mental health problems. Outreach activities: In schools, colleges, Village Health Nutrition Day. 8/14/2018 17

18. B. Weekly Iron and Folic acid Supplementation (WIFS) Reduce incidence of anemia amongst adolescent girls and boys. Goal – to break intergenerational cycle of anemia Interventions Supervised weekly Fe-FA supplements – 100mg Fe & 500 𝜇g FA. Screening of the target groups Biannual de-worming Information and counselling 8/14/2018 18

19. C. Menstrual hygiene scheme Promotion of menstrual hygiene among adolescent girls (10-19 yrs.) in rural areas. Activities Community based health education and outreach Ensuring regular availability of sanitary napkins Storage and distribution of sanitary napkins Training of ASHA and nodal teachers in menstrual health Safe disposal of sanitary napkins 8/14/2018 19

20. Other Interventions Care during pregnancy and child birth Newborn and child care Care through reproductive years 8/14/2018 20

21. Other Interventions 8/14/2018 21

22. Delivery points Designated based on provision of services for delivery care 8/14/2018 22

23. Delivery points Strengthening of facilities - providing comprehensive RMNCH services Address the shortage of human resource - sub centres and those in high focus districts (HFDs)/tribal/remote areas Supported by a referral transport system that reaches the patient within 30 minutes of receiving a call and the health facility within the next 30 minutes 8/14/2018 23

24. Maternal and child health wing High case load of pregnant women and newborns at secondary and tertiary level MCH wings-comprehensive units (30/50/100 bedded) To ensure provision of emergency maternal and newborn care services as well as 48 hours stay 8/14/2018 24

25. Score card HMIS-based dashboard monitoring system Indicators based on life-cycle approach Survey based score card Latest available data from national surveys will be taken into consideration (SRS, Coverage Evaluation Survey, DLHS, NFHS, Census, Annual Health Survey ) The scorecard will be updated as and when (every 1–2 years) new survey data is available 8/14/2018 25

26. Indicators for survey based score card Mortality U5MR, IMR,NMR, MMR Fertility TFR Births to women during the age of 15-19 years out of total births Nutrition Child with birth weight < 2.5kg Children < 3years who are underweight Gender Child sex ratio 0-6 Cross cutting Full immunization of children 12 -23 months Household having access to toilet facility Couples using spacing methods for more than 6 months Diarrhoea ORT provided Pneumonia Child seeking ARI in any health facility Service delivery Women received 4+ANC SBA Mothers received postnatal care from health personnel within 2 days of delivery Early initiation (<1hr) and exclusive breast feeding 8/14/2018 26

27. Thank you 8/14/2018 27