RMNCH+A (1).pptx

RMNCH+A

1. REPRODUCTIVE, MATERNAL, NEONATAL, CHILD AND ADOLESCENT HEALTH ( RMNCH+A) Presented by :- Chandrika-19026 Chinmay-19027 Dalmeet-19028 Deepak-19029 Deepak-19030

2. CONTENT Introduction to RMNCH+A Reproductive Health And Programmes Maternal Health and Its Components Maternal Health Programme Score Card, Data and Success of RMNCH+A

3. RMNCH+A Introduction & Overview

4. BACKGROUND In June 2012, Government of India (GOI), Ethiopia, USA and UNICEF convened the “Global child survival call to action : a promise to keep. ” In Feb. 2013, GOI launched- “ A strategic approach to reproductive, maternal, newborn , child and adolescent health(RMNCH+A).

5. RMNCH +A Adolescent included Linkage of home and community based service to facility based care. Linkage of maternal and child health to - reproductive health, - family planning, - adolescent health and - prenatal diagnostic techniques. Ensuring linkages, referrals and counter referrals .

6. AIMS T o reach the maximum number of people in the remotest corners of the country through - Continuum of services - Constant innovation - Routine monitoring of interventions

7. GOALS AND OBJECTIVES By 2017:- Reduction in infant mortality rate to 25 per 1000 live births Reduction in maternal mortality rate to 100 per 100,000 live births Reduction in total fertility rate to 2.1

8. COVERAGE TARGETS RMNCH+A focuses on Increase of : Delivery Points (@100% Institution ) Institutional deliveries (@5.6% annually from 61 %) Improve ANC (@6% annually from 53 %) Improve PNC (@7.5 % annually from 45%) Deliveries by SBAs (@2 % annually from 76%)

9. COVERAGE TARGETS RMNCH+A focuses on Increase of (2009 ) Exclusive breast feeding (@ 9.6% annually from 35 %) 3 doses of DPT ( @ 3.5% annually from 7% ) ORS use in Diarrhea (@7.2% annually from 43%) Child sex ratio ( 0.6% annually of base line of 91 .4%)

10. COVERAGE TARGETS RMNCH+A focuses on Decrease of: Underweight children prevalence (@ 5.5% annually from 45%) Unmet need for NFP methods (@8.8% annually from 21%) Anemia in adolescent girls & boys (@6% annually from 56 %) Total fertility contributed by adolescents (@3.8% annually from 16 % )

11. HEALTH SYSTEMS STRENGTHENING Cases load based deployment of HR at all levels. Ambulances, drugs, diagnostics, RCH commodities. Health education, demand promotion & behavior change communication. Supportive supervision and scorecards based on HMIS. Public grievances redressal mechanism, client satisfaction and patient safety through quality assurance.

12. CROSS CUTTING INTERVENTIONS Bring down out of pocket expenses. ANMs and Nurses to provide specialized and quality care to pregnant women and children. Address social determinants of health through convergence. Focus on un-served and undeserved villages, urban slums and blocks. Introduce difficult area and performance based incentives .

13. REPRODUCTIVE HEALTH

14. Definition A state of complete physical, mental and social well being and not merely the absence of disease, in all matters relating to the reproductive system and to its functions and processes- WHO

15. Reproductive Health Under 5x5 matrix has five interventions Focus on spacing methods, particularly PPIUCD at high case load facilities. F ocus on interval IUCD at all facilities including subcentres on fixed days. H ome Delivery of Contraceptives (HDC) and Ensuring Spacing at Birth (ESB) through ASHA. M aintaining quality sterilization services. Ensuring access to pregnancy testing kits and strengthening comprehensive abortion care services.

16. Interventions

17. 1. Focus on spacing methods SPACING METHOD SERVICE PROVIDER SERVICE LOCATION IUCD 380 A IUCD 375 Trained & certified ANMs, LHVs, SNs and Doctors Sub centre & higher levels Injectable contraceptive MPA Trained ANMs, SNs and Doctors Sub centre & higher levels OCPs Trained ASHAs, ANMs, LHVs, SNs and doctors Village level Sub centre & higher levels Condoms Trained ASHAs, ANMs, LHVs, SNs and doctors Village level Sub centre & higher levels

18. 2. F ixed day Interval IUCD At all facility on fixed days Including Sub centre Interval IUCD: Inserted in the uterus at any time of menstrual cycle after 6 weeks of giving birth. Education, Motivation and counseling to adopt appropriate Family planning methods. Provision of contraceptives such as condoms, OCPs, IUCD insertions.

19. 3. H ome Delivery of Contraceptives I mprove access to contraceptives by eligible couples through ASHA workers. List of eligible couples and selection of contraceptive ASHA would charge Rs 1/- for a pack of three condoms, Rs 1/- for a cycle of OCP Rs 2/-for a pack of one tablet of ECP

20. 4. Comprehensive abortion care services To prevent maternal death or injury Counselling for P o st abortion contraceptive methods. Clinical assessment of women with various medical conditions . P roviding different methods and techniques of termination at 1 st and 2 nd trimester . Providing free pregnancy test kits to Health workers/ASHA/USHA.

21. 5 . Quality sterilization services Provide quality of care in sterilization at both static facilities and camps . Tubectomy and Vasectomy by MBBS doctor/or a post graduate doctor. Laparoscopic sterilization for females by a gynecologist with DGO/MS qualification or by a surgeon with an MS degree.

22. Sequence of care at different levels of health system

23. Clinical: Health facility level Comprehensive abortion care RTI/STI case management. Postpartum IUCD and sterilization; interval IUCD procedures Adolescent friendly health services under RKSK Eg : Yuva Swasthya Pramarsh Kender

24. Outreach: Sub-centre Family planning. Prevention and management of STIs. Peri -conception folic acid supplementation .

25. Family & community Weekly IFA supplementation: WIFS To meet the challenge of high prevalence and incidence of anaemia and Tab contain Elemental Iron -100 mg and Folic Acid 500mcg by fixed day approach Biannual de-worming ( Albendazole 400mg) 6 months apart (1-19)

26. 2) Information and counselling on sexual reproductive health and family planning. 3) Community based promotion and delivery of contraceptives. 4) Menstrual hygiene: MHS (Age group covered- 10 to 19 yrs) -Ensures adequate knowledge and information on menstrual hygiene. -Sanitary napkins are provided to (10-19 yrs) girls -Provision of incinerators in education institutes to dispose sanitary napkins

27. MATERNAL HEALTH UNDER RMNCH+A

28. Maternal Health Maternal health refers to health of women during pregnancy , childbirth and postnatal period. About 15% pregnancies may develops complication which mostly can be prevented. Complication can be averted by: Preventive care Skilled care Early detection of risk Management of obstetric complications

29. NEED FOR LINKAGE: MATERNAL HEALTH Worldwide 810 women/ day die due to pregnancy related complication . 94% of these deaths occur in poor and lower socio-economic country COMPREHENSIVE APPROCH To tackle: Maternal morbidity Maternal mortality "CONTINUUM OF CARE”

30. Key Intervention : Maternal Health in RMNCH+A Use MCTS to ensure early registration of pregnancy and full ANC. Detect high risk pregnancies and line list including severely anaemic mothers and ensure proper management. Equip delivery points with highly trained HR and ensure equitable access to Emergency OC services Review maternal, infant and child deaths for corrective actions. Identify villages with high numbers of home deliveries .

31. MOTHER AND CHILD TRACKING SYSTEM (MCTS) COMPONENTS : Initiated by Ministry of health and family welfare. “ Ensure timely delivery of full spectrum of heath services to beneficiaries” Pregnant women Children up to 5 years of age Capturing detailed information about beneficiaries. Maternal health card Mobile bases SMS technology Mother and child tracking facilitation Centre.

32. Components of maternal health care ESSENTIAL OBSTETRIC CARE EMERGENCY OBSTETRIC CARE

33. ESSENTIAL OBSTETRIC CARE To provide basic maternity services All pregnant women Quality antenatal care Essential obstetric care during delivery Essential Postnatal care for mother and New born STRATEGIES

34. 1)QUALITY ANC- Minimum of 4 antenatal visits ANC package Detect of high risk pregnancies follow up and treatment. 2)CARE DURING DELIVERIES (INTRA NATAL CARE) Free institutional deliveries at its network of health facility. 24 X 7 PHCs services Safe and clean delivery. Through FRU, Delivery units E essential Obstetric Care Strategies

35. POSTNATAL CARE FOR MOTHER AND NEWBORN Diet of mother Hygiene Emotional support Prevention of any disease Breastfeeding and breast care PNC within first 24 hours& Subsequent visits by ASHA on 3,7 and 42 day (total of 4 visits) E essential Obstetric Care Strategies…..Conti…

36. EMERGENCY OBSTETRIC CARE DELIVERY POINTS FIRST REFERRAL UNIT(FRUs) MATERNAL AND CHILD HEALTH WING

37. EMERGENCY OBSTETRICAL CARE INTRODUCED BY WHO, UNICEF AND UNFPA IN1997 To prevent morbidity and mortality. Operational first referral units Skilled birth attendant Tackling obstetric emergencies

38. DELIVERY POINTS: Designated based on provision of services for delivery care . L1 L2 L3 CONDUCT MINIMUM 3 NORMAL DELIVERIES /MONTH CONDUCT MIMIMUM 10 DELIVERIES/MONTH INCLUDING MANAGEMENT OF COMPLICATIONS MINIMUM 20-50 DELIVERY/MONTH INCLUDING C- SECTION EMERGENCY OBSTETRICAL CARE

39. DELIVERY POINTS : Purpose: Short term goals: Strengthening of facilities –providing comprehensive RMNCH services. Should be supported by referral transport system. LONG TERM GOAL: To establish and operationalize basic emergency obstetric care as well as comprehensive care centres.

40. FIRST REFERRAL UNIT(FRUs) FRUs is an upgraded CHC It is the first unit going to receive the referred cases. 3 Component: 2 Objectives 1)Availability of obstetrician 2)Availability of Anaesthetic 3)Availability of Blood bank 24 X 7 functional units. To promote basic emergency obstetric care & early neonatal care

41. Services at FRU

42. Maternal and Child Health Wing Dedicated MCH wing In high load facilities with adequate provision of beds . The New MCH wings Comprehensive units (30/50/100 bedded) Antenatal waiting room Labour wing , essential New born care room, SNCU ,operation theatres, blood banks, Also Ensure quality postnatal care to mothers and new-borns

43. MATERNAL DEATH SURVEILLANCE RESPONSE AIM : routine identification & timely notification of maternal death. Review of maternal death Implementation and monitoring of steps to prevent similar deaths in future.

44. STEPS IN PLANNING MDSR

45. MA TERNAL DEATH REVIEW SOFTWARE LAUNCED QUICK ANALYSIS PAPER BASED DATA DIGITALIZED INTEGRATION OF SOFTWARE WITH MCTS THROUGH MOTHER ID

46. MATERNAL HEALTH PROGRAMS

47. LIST OF PROGRAMMES 1) Janani Suraksha yojana 2) Safe abortion Services 3) Village health &nutrition day 4) Janani Shishu Suraksha Karyakram

48. 5) Pradhan Mantri Surakshit matritva Abhiyan 6) Surakshit Matritva Aashwasan 7) LAQSHYA Programme 8) Anaemia Mukt Bharat

49. 1)JANANI SURAKSHA YOJANA Initially called national maternity Benefit scheme Launched on 12 th April 2005 OBJECTIVES Is to reduce the maternal mortality rate and neonatal mortality rate By encouraging delivery at health institution F ocusing at institutional care among the women below poverty line

50. Features of JSY:- Its is 100% centrally sponsored. Benefit of cash assistance with institutional care Benefit given to the all women of rural and urban area Special focus on the 10 low performing state like up ,MP ,Uttarakhand , Odisha , assam etc.

51. Scale of assistance from 2012-13 Rural area Urban area Mother ASHA Mother ASHA package package package package LPS 1400 600 1000 400 HPS 700 600 600 400 Eligibility:- In LPS :- All pregnant women In HPS :-Pregnant women of BPL and SC & ST categories .

52. 2)SAFE ABORTION SERVICE Main cause of maternal mortality and morbidity Account for nearly 8.9% of maternal death Facilities provided are 1)Medical method of abortion:- 1 TAB of Mifepristone followed by 4 tablets of misoprostol 2)Medical termination can be done up to 7 weeks.

53. 2) Manual vacuum aspiration Safe and simple technique to terminate early pregnancy Feasible to be used in PHC or comparable facilities

54. 3)VILLAGE HEALTH AND NUTRITION DAY Organised once a month At Anganwadi centre to provide Antenatal/post natal care Promote institutional delivery Health education Nutrition services etc.

55. 4)JANNI SHISHU SURAKHSA KARYAKRAM Launched by Govt of India on 1 st June 2011 Initiative provide the following facilities to pregnant women Absolute free and no expanse delivery including C-section Free drug and consumable ,free diet up to 3 days during normal delivery & up to 7 days for C-section

56. Free diagnostic and free blood transfusion facility. Free transport in case of referral and drop back. Scheme is now been extended to cover the complication during ANC ,PNC &also sick infant Scheme estimate to benefit more than 12 million pregnant women

57. 5)PRADHAN MANTRI SURAKSHT MATRITVA ABHIYAN [PMSMA] Launched by the MOH&FW on June 2016 Free of cost assured and quality antenatal care. These service are provided on 9 th of every month. Approximately 3 crore pregnant women are examined under PMSMA scheme

58. OBJECTIVE of scheme :- Ensure at least one antenatal checkup for all pregnant women in their second or third trimester I mprove the quality of care during ante-natal visits Identification and line-listing of high risk pregnancy based on medical conditions Special emphasis on early diagnosis, adequate and appropriate management of women with malnutrition

59. 6 )SURAKSHIT MATRITVA AASHWASAN [SUMAN] Ministry launched this initiative on 10 th October 2019 AIM :- Assured, dignified and respectful delivery of quality healthcare services at no cost and zero tolerance for denial of services to any woman and newborn visiting a public health facility . Expected outcome of this is ‘zero preventable maternal and new born death and high quality of maternal care delivery with dignity and respect

60. 7) LAQSHAY PROGRAMME MOFHW launched this program to improve quality of care in labour room and Maternity OTs in 2017 GOAL – Reduce the preventable maternal and new born mortality and morbidity IMPLIMENTED at District hospital, Sub district hospital , high case load CHC , First Referral unit and Medical college.

61. OBJECTIVE- To reduce the maternal and new born mortality due to APH ,PPH , eclampsia preeclampsia ,obstructive labour etc. To improve quality of care during the delivery and immediate post partum care Stabilisation of complication and ensure timely referrals To enhance satisfaction of beneficiary visiting the health facility and provide respectful maternity care

62. 8)ANAEMIA MUKT BHARAT PROGRAMME Launched by MOH&FW in 2018 Intensified iron plus initiative AIM :- S trengthen the existing mechanisms and foster new strategies for tackling anaemia OBJECTIVE :- To reduce prevalence of anaemia by 3% points per year among children, adolescent & women of reproductive age (15-49 year).

63. PROPHYLACTIC DOSE AND REGIMEN AGE GROUP Children(6-59 month age ) Children(5-9 year) Adolescent (10-19 year) Reproductive age women (20 – 49 year) 5. Pregnant women DOSE AND REGIMEN -1ml iron and folic acid(20mg+100mcg) -Weekly 45mg elemental iron + 400 mcg FA 60 mg iron + 500 mcg folic acid 60 mg iron + 500 mcg folic acid iron and folic acid from 4 th month of pregnancy

64. DEWORMING Biannual dose of 400 mg albendazole 1/2 tab to children of 12 – 24 month 1 tab to children of 24-59 month 1 tab to 5-9 year age children 1 tab to adolescent 10-19 year 1 tab to women of reproductive age (20-49year) For the pregnant and lactating women 1 dose of 400 mg albendazole

65. NATIONAL AND STATE ‘SCORECARD’ Introduced as a tool to increase transparency and track progress against indicators related with intervention coverage. Refers to two distinct but related management tools: HMIS based dashboard monitoring system Survey based child survival 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

66. HMIS-based dashboard monitoring system: Choice of indicators for dashboard system are based on life cycle approach. All India average for each indicator will be taken as the reference point. State scores will determine on the basis of national average Positive score 1to 4 for those above national average(for positive indicators) Negative score -1 to -4 for those national average

67. States have been classified into four categories based on the state score (based on four quartiles)

68. 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 )  S tates will be colour coded based on Mortality indicators, nutrition and fertility

69. NATIONAL MORTALITY, NUTRITION, FERTILITY INDICATORS Green less than 20% Yellow 20% below and above national average Red More than 20% of the average. REMAINING INDICATORS Green greater than 20% Yellow 20% below and above national average Red less than 20% of the average.

70. ACHIEIVEMENT UNDER MATERNAL HEALTH First Referral Unit: 81 FRUs are providing C section services out of 94 FRUs Delivery points: state has target of 1190 delivery points of which 550 institutions are functional. Janani Suraksha yojana Karyakram : free services which include free drug, blood, diagnostics, diet and referral services are provided to all sick newborn and infants(up to 1yr).5,06,843 pregnant women have received various JSYK entitlements during 2020-2021. Skilled Attendant at Birth training was given to paramedical and AYUSH doctors

71. PMSMA: This programme focused on screening of antenatal cases by doctor preferably O&G specialist at least once during 2 nd or 3 rd trimester. This activity is implemented on 9 th of every month on fixed day basis. LaQshya: under this programme the LR & MOT( labor room & maternity OT) are standardized for providing quality care services. Initiatives for Anemia control: IFA & Calcium Supplementation – about 7 lakhs pregnant women covered during 2020-21.