Rmnch+a

RMNCH+A

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2. RMNCH+A 2

3. INTRODUCTION Improving the maternal and child health and their survival are central to the achievement of national health goals under the National health Mission (NHM) SDG goal 3 also includes the focus on reducing maternal, newborn , and child mortality. In the past years, innovative strategies evolved under the national programme to deliver evidence-based interventionsto various population group. 3

4. CONT… Following the Government of India’s “Call to Action Summit” in Feb. 2013, the Ministry of Health and Family Welfare launched Reproductive, maternal, Newborn , Child PLUS Adolescent Health (RMNCH+A) to influence the key intervention for reducing maternal and child morbidity and mortality. 4

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6. GOALS COVERAGE TARGET For Key RMNCH+A Interventions For 2017: Increases facilities equipped for perinatal care by 100% . Increase proportion of all births in govt. and accredited private institutions at annual rate of 5.6% from the baseline of 61%. 6

7. CONT… Increase proportion of pregnant women receiving antenatal care at annual rate of 6% from baseline of 53%. Increase coverage of 3 doses of DPT (12-23 months) at annual rate of 3.5% from baseline of 7%. Increase ORS use in under 5 children with diarrhoea at annual rate of 7.2% from baseline of 43%.. Reduce anemia in adolescent girls and boys (15-19 years) at annual rate of 6% from baseline of 56%. 7

8. CONT… Decrease the proportion of total fertility contributed by adolescents (15-19 years) at annual rate of 3.8% per year from baseline of 16%. Increase proportion of deliveries conducted by skilled birth attendants at annual rate of 2% from baseline of 76%. Increase exclusive breastfeeding rates at annual rate of 9.6% from baseline of 36%. 8

9. CONT… Reduce prevalence of children who are underweight at annual rates of 5.5% from baseline of 45%. Raise child sex ratio in the 0-6 year age group at annual rate of 0.6% per year from baseline of 914. Reduce unmet needs for family planning methods at annual rate of 8.8% from baseline of 21%. Increase met need for modern family planning methods among eligible couples at annual rate of 4.5% from baseline of 47%. 9

10. CURRENT CHALLENGES OF RCH II PROGRAMME Adolescent health was the weakest pillar of our RCH II programme which is now one of the key strategic of RMNCH+A. Absence of system approach to health is affecting the RCH programme implementation adversely. Some districts are yet to use HIMS data to chart their progress against the target effectively. Timely data and transparent payments for JSY are not properly implemented. 10

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14. KEY TARGETS – SDG-3/ NHP 2017 Reduction of TFR to 2.1 by 2025. Reduce MMR from current level to 100 by 2020. Reduce Under Five Mortality to 23 by 2025. Reduce Infant mortality Rate to 28 by 2019. Reduce Neo-natal mortality to 16 by 2025. Antenatal care coverage above 90% by 2025. 90% full immunization by 2025. 14

15. RATIONALE OF RMNCH+A STRATAGIES It is important to recognize that reproductive, maternal, and child health cannot be addressed in isolation. To improve an understanding of comprehensive approach to improve child survival and safe motherhood. 15

16. WHY “PLUS” ??? Inclusion of adolescence as a distinct ‘Life Stage’ in the overall strategy. Linking of maternal and child health to reproductive health and other components like family planning, adolescent health, HIV and PC and PNDT. Linking of community and facility based cares as well as referrals between various levels of health care system to create a continuous care pathway. 16

17. STRATEGIC RMNCH+A INTERVENTIONS ACROSS LIFE STAGES There are 2 dimensions of a health care : Stages of life care Places where the care is provided CONTINUUM OF CARE 17

18. RMNCH+A INTERVENTIONS 18

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20. REPRODUCTIVE CARE PRIORITY INTERVENTIONS Community-based promotion and delivery of contraceptives Promotion of spacing methods (Insertion of IUCD) Sterilization services Comprehensive abortion care (includes MTP act) Prevention and management of STI/RTIs Ensuring assess to Pregnancy Testing Kits ( Nischay Kits) 20

21. FAMILY PLANNING Family Planning • Expansion of the basket of FP Choices • Home Delivery of Contraceptives by ASHAs • Fixed Day Static Services at all facilities • Enhanced Compensation Scheme • National Family Planning Indemnity Scheme • Emphasis on Post Partum and Post Abortion FP services 21

22. MATERNAL HEALTH PRIORITY INTERVENTIONS Use MCTS to ensure early registration of pregnancy and full ANC Detect high risk pregnancy and line list including severely anemic mothers and ensure appropriate management Equip delivery points with highly trained HR and ensure equitable access to Emoc services through FRUs; add MCH wings as per need Review maternal, infant and child deaths for corrective actions 22

23. CONT… Early registration of pregnancy ANC services, detection and follow-up of high risk cases using MCTS Encouraging institutional deliveries, improving access by setting up delivery points & FRUs – Over 20000 delivery points & 2200 FRUs 23

24. CONT… Janani Shishu Suraksha Karyakram - Free and Zero Expense delivery including C-section, free care in case of ante-natal & post-natal complications for pregnant women and infants Nearly 1.3 crore women are availing for free entitlements every year. Janani Surksha Yojana - Cash assistance to eligible pregnant women who give birth in a government health facility. In the year 2016- 17, the number of JSY beneficiaries was 1,04,59,547 24

25. PREGNANCY AND CHILDBIRTH PRIORITY INTERVENTIONS Delivery of ANC package and tracking of high risk pregnancy Skilled obstetric care Immediate essential newborn care and resuscitation Emergency obstetric care and newborn care Postpartum care for mother and newborn Postpartum IUCD and sterilization Implementation on PC and PNDT Act 25

26. NEWBORN HEALTH PRIORITY INTERVENTIONS Early initiation and exclusive breast feeding Home based newborn care by ASHAs and prompt referrals Facility based care of the sick newborn Essential newborn care and resuscitation services at all delivery points Special newborn care units (SNCU) with highly trained human resources and oyher infrastructure 26

27. CHILD HEALTH PRIORITY INTERVENTION Complementary feeding and IFA supplementation and focus on nutrition Diarrhoea management at community level by using ORS and Zinc Management of common childhood disease (Pneumonia) Full immunization coverage Micronutrients supplementation Screening of children for 4Ds 27

28. ADOLESCENT HEALTH PRIORITY INTERVENTIONS Adolescent nutrition; IFA supplement. Facility-based adolescent reproductive and sexual health services. Information and counselling on adolescent sexual reproductive health and other health issues. Menstrual hygiene. Preventive health checkups . Address teenage pregnancy and increase contraceptive prevelance in adolescents. 28

29. HEALTH SYSTEM STRENGTHNING Prepare and implement facility specific plans for ensuring quality and meeting services guararntees as specified. Assess the need for new infrastructure, extension of existing infrastructure on the basis of patient load and location of facility. Equip health facilities to support 48 hours stay of mother and newborn . Engage private facilities for family planning services, management of sick newborns and children and pregnancy complications. Strengthen referral mechanisms b/w facilities at various levels and communities. Provision for adequate infrastructure for waste management. 29

30. CROSS CUTTING INTERVENTIONS Bring down out of pocket expenses by ensuring JSSK, RBSK and other free entitlement. ANMs and Nurses to provide specialized and quality care to pregnant women and children. Introduce difficult areas and performances based incentives. Focus on un-served and underserved villages, urban, slums and blocks. 30

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32. Mission Indradhanush Mission Indradhanush to reach out to unreached children. 6% to 7% annual expansion in the immunization coverage. 2.53 crore children provided vaccination. 66.16 lakh children were fully vaccinated. 68.43 lakh pregnant women also vaccinated with Tetanus Toxoid. 32

33. CONT… New Vaccines launched  Inactivated Polio Vaccine (IPV)  Adult Japanese Encephalitis (JE)  Rotavirus  Measles Rubella  Pneumococcal 33

34. PMSMA Pradhan Mantri Surakshit Matritva Abhiyaan (PMSMA) - special ANC checkups for pregnant women (in 2nd / 3rd Trimester) on 9th of every month • More than 4300 volunteers registered • More than 12000 facilities provide PMSMA services • More than 75 lakh antenatal checkups conducted 34

35. Family Planning Family Planning: Three new methods introduced  Injectable Contraceptive DMPA (Antara) – a 3-monthly injection  Centchroman pill ( Chhaya )– non-hormonal once a week pill  Progesterone-only pills (POP) – for lactating mothers Mission Parivar Vikas & New Family Planning Media Campaign launched - scheme for 146 High Fertility Districts 35

36. Intensified Diarrhoea Control Fortnight Intensified Diarrhoea Control Fortnight is being observed annually during July-August, with the ultimate aim of ‘zero child deaths due to childhood diarrhoea ’. More than 14.7 crore children were reached through this campaign since 2014. 36

37. National Deworming Day National Deworming Day (NDD) is being observed annually targeting all children in the age group of 1-19 years (both school enrolled and non-enrolled). More than 75 Crore doses of Albendazole were administered to children 1-19 years since 2014. 37

38. MAA MAA- Mothers Absolute Affection program has been launched during World Breastfeeding week in August 2016 to promote breast feeding and improve child feeding practices, with special emphasis on early initiation of breastfeeding in health facilities 38

39. ROLE OF A NURSE 39

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