RMNCH+A ( REPRODUCTIVE,MATERNAL, NEWBORN, CHILD AND ADOLESCENT HEALTH) PROGRAM

Reproductive, Maternal, Newborn, Child, and Adolescent Health (RMNCH+A) is a comprehensive approach to health care that addresses the continuum of care needed at different life stages: from pre-pregnancy and pregnancy through childbirth, infancy, childhood, and adolescence. The aim of RMNCH+A is to improve health outcomes and reduce mortality and morbidity through integrated and equitable health services.

Key components include:

1. **Reproductive Health**: Ensuring access to contraception, fertility services, and safe abortion where legal.
2. **Maternal Health**: Providing antenatal care, skilled birth attendance, and postnatal care.
3. **Newborn Health**: Ensuring immediate newborn care, including resuscitation, breastfeeding support, and prevention of infections.
4. **Child Health**: Promoting immunization, nutrition, and treatment of common childhood illnesses.
5. **Adolescent Health**: Addressing health issues specific to adolescents, including sexual and reproductive health, mental health, and prevention of substance abuse.

RMNCH+A emphasizes the importance of a strong health system

1. REPRODUCTIVE, MATERNAL,
NEWBORN, CHILD AND ADOLESCENT
HEALTH (RMNCH+A) PROGRAMME
1

2. CONTENTS
Background
Development Partners
Five pillars of the strategy
Plus within the strategy
Aim of the strategy
Goals and Targets
RMNCH+A strategy
Adolescent Health Programme
Score card
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3. BACKGROUND
•Precursor of RCH(1992) : Child survival and safe motherhood
Programme(CSSM)
•RCH -1(1997): 1st time integration of mother and child health to
reduce neonatal deaths
•RCH-2 (2005): Started with NRHM to Strengthened mother
and child health ,family planning services , immunization &
child care services .
•RMNCH+A : 2013
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4. Cont.
•June2012:GovernmentsofIndia,Ethiopia,USAandthe
UNICEFconvenedthe“GlobalChildSurvivalCalltoAction:A
PromisetoKeep”summitinWashington,DC
•February2013:GovernmentofIndialaunched“AStrategic
ApproachtoReproductive,Maternal,Newborn,Childand
AdolescentHealthinIndia(RMNCH+A)”
•SincethenRMNCH+AhasbecometheheartofGoI’sflagship
publichealthprogramme,theNationalHealthMission
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5. DEVELOPMENT PARTNERS
•UNICEF (United Nations Children’s Fund)
•USAID (US Agency for International Development) and its
Maternal Child Health Integrated Programme(MCHIP)
•United Nations Population Fund (UNFPA)
•Norway India Partnership Initiative (NIPI)
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6. FIVE PILLARS OF THE STRATEGY
REPRODUCTIVE MATERNAL NEONATAL CHILD ADOLESCENT
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7. PLUS WITHIN THE STRATEGY
•Includingadolescenceforthefirsttimeasadistinctlifestage
•Linkingmaternalandchildhealthtoreproductivehealth,family
planning,adolescenthealth,HIV,gender,preconceptionand
prenataldiagnostictechniques
•Linkinghomeandcommunity-basedservicestofacility-based
care
•Ensuringlinkages,referrals,andcounterreferralsbetweenand
amongheathfacilitiesatdifferentlevels
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8. AIM OF THE STARTEGY
Toreachthemaximumnumberofpeopleintheremotestcorners
ofthecountrythrough
•Continuumofservices
•ConstantInnovation
•Routinemonitoringofinterventions
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9. GOALS AND TARGETS
For 12
th
Five Year Plan
•Reduction of Infant Mortality Rate (IMR) to 25 per 1000 live
births by 2017
•Reduction in Maternal Mortality Ratio (MMR) to 100 per 100000
live births by 2017
•Reduction in Total Fertility Rate (TFR) to 2.1 by 2017
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10. Coverage Targets
Aspects to be covered From baseline 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 35% (CES 2009) 9.6%
Reduce prevalence of under-five children with
underweight
45% (NFHS -3) 5.5%
Reduce Unmet need for family planning method21% (DHLS 3) 8.8%
Increase met need for family planning 47% (DLHS-3) 4.5%
Reduce Anemia 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%
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11. RMNCH+A STRATEGY
1.Focus on High-Priority Districts
•To address inter-state and inter-district variations
•Tailored programmesto meet the needs of the underserved
•Includes adolescents, urban poor and tribal populations
•Districts with relatively weak performance against RMNCH+A indicators
were identified: 184 HPDs in India
2.Management tools and job aids
•5x5 matrix: Five thematic areas-Important tool which explains strategy
•Minimum essential commodities
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12. 12/29

13. REPRODUCTIVE HEALTH
1.Focusonspacingmethods:PPIUCDathighcaseload
facilities
2.FocusonintervalIUCDatallfacilities
3.HomeDeliveryofContraceptives(HDC)andEnsuring
SpacingatBirth(ESB)throughASHAs
4.EnsuringaccesstoPregnancyTestingKits(PTK“Nischay
Kits”)andstrengtheningcomprehensiveabortioncare
services
5.Maintainingqualitysterilizationservices
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14. MATERNAL HEALTH
1.UseofMCTStoensureearlyregistrationofpregnancyandfullANC
2.Detecthighriskpregnanciesandlinelistincludingseverelyanaemic
mothersandensureappropriatemanagement
3.EquipdeliverypointswithhighlytrainedHRandensureequitable
accesstoEmOCservicesthroughFRUs,AddMCHwingsasperneed
4.Reviewmaternalinfantandchilddeathsforcorrectiveactions
5.Identifyvillageswithhighnumbersofhomedeliveriesanddistribute
Misoprostoltoselectedwomenin8
th
monthofpregnancyfor
consumptionduring3
rd
stageoflabour;incentivizeANMsforhome
deliveries
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15. NEWBORN HEALTH
1.Earlyinitiationandexclusivebreast-feeding
2.HomebasednewborncarethroughASHA
3.EssentialNewbornCareandresuscitationservicesatall
deliverypoints
4.SpecialNewbornCareUnitswithhighlytrainedhuman
resourceandotherinfrastructure
5.CommunityleveluseofGentamycinbyANM
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16. CHILD HEALTH
1.Complementaryfeeding,IFAsupplementationandfocuson
nutrition
2.DiarrhoeamanagementatcommunitylevelusingORSand
Zinc
3.Managementofpneumonia
4.Fullimmunizationcoverage
5.RashtriyaBalSwasthyaKaryakram(RBSK);screeningof
childrenfor4Ds(birthdefects,developmentaldelays,
deficienciesanddisease)anditsmanagement
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17. ADOLESCENT HEALTH
1.Addressteenagepregnancyandincreasecontraceptive
prevalenceinadolescents
2.Introducecommunitybasedservicesthroughpeereducators
3.StrengthenARSHclinics
4.RolloutNationalIronPlusInitiativeincludingweeklyIFA
supplementation
5.Promotemenstrualhygiene
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18. HEALTH SYSTEMS STRENGTHENING
1.CasesloadbaseddeploymentofHRatalllevels.
2.Ambulances,drugs,diagnostics,reproductivehealth
commodities.
3.Healtheducation,demandpromotion&behavioralchange
communication.
4.Supportivesupervisionanduseofdataformonitoringand
review,includingscorecardsbasedonHMIS.
5.Publicgrievancesredressalmechanism,clientsatisfaction
andpatientsafetythroughallroundqualityassurance.
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19. CROSS CUTTING INTERVENTIONS
1.Bring down out of pocket expenses by ensuring JSSK, RBSK
and other free entitlements.
2.ANMs & Nurses to provide specialized and quality care to
pregnant women and children.
3.Address social determinants of health through convergence .
4.Focus on un-served and underserved villages, urban slums
and blocks.
5.Introduce difficult area and performance based incentives.
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20. CONTINUUM OF CARE ACROSS LIFE CYCLE AND LEVELS OF CARE
CLINICAL
Reproductive care Pregnancy and child birth care Newborn and child care
•Comprehensive abortion care
•RTI/STI case management
•PPIUCD, Interval IUCD
•Adolescent friendly health services
•Skilled obstetric care, immediate
newborn care and resuscitation
•EmOC
•PPTCT of HIV
•Postpartum sterilization
•Essential newborn care
•Care of sick newborn (SNCU, NBSU)
•IMNCI (facility based)
•Care of children with SAM
•Immunization
OUTREACH/SUBCENTRE
Reproductive health care Antenatal care Postnatal care Child health care
•Family planning
•Prevention and management of STI
•Folic acid supplementation
•Full ANC package
•PPTCT
•Early detection and
management of illnesses
•Immunization
•Assessment and care for
newborn and childhood
illnesses
•Immunization
•Micro-nutrient
supplementation
FAMILY &
COMMINITY
•Weekly IFA supplementation
•IEC on sexual reproductive health
and family planning
•Community based promotion and
delivery of contraceptives.
•Menstrual hygiene
•Counselling and preparation for
newborn care, breast-feeding, birth
preparedness.
•Demand generation for pregnancy
care and institutional delivery (JSY,
JSSK)
•HBNC scheme
•Antibiotic for suspected case of newborn sepsis.
•Infant and Young Child Feeding (IYCF)
•Child health screening and early intervention services
•Early childhood development
•Danger sign recognition and care-seeking for illness
•Use of ORS and Zinc in case of diarrhea
Adolescence/Pre-pregnancy Pregnancy BirthNewborn/postnatal Childhood20/29

21. ADOLESCENT HEALTH PROGRAMME
Priority interventions:
1.Adolescent nutrition; iron and folic acid supplementation.
2.Facility-based adolescent reproductive and sexual health
services (ARSH) (Adolescent health clinics).
3.Information and counselling on adolescent sexual
reproductive health and other health issues.
4.Menstrual hygiene.
5.Preventive health check-ups.
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22. A. ADOLESCENT REPRODUCTIVE AND
SEXUAL HEALTH PROGRAMME (ARSH)
•Routinecheck-upatprimary,secondaryandtertiarylevelson
fixeddays
•Promotive,Preventive,CurativeandCounsellingManagement
ofmenstrualproblems
•Approaches
Facilitybasedhealthservices
Counselling(ARSHandICTC)
Communitybasedinterventions
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23. 1.AdolescentFriendlyHealthClinics(AFHC)
•Routinehealthcheck-ups
•Health–relatedneeds:Contraceptivesprovision,managementof
menstrualproblems,RTI/STImanagement,antenatalcareandanemia
2.Facilitybasedcounsellingservices
•Onnutrition,puberty,RTI/STIprevention,contraception,delaying
marriageandchildbearing,pre-maritalconcerns,substancemisuse,
sexualabuseandmentalhealthproblems
3.Outreachactivities
•Inschools,colleges,VillageHealthNutritionDay(VHND)
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24. B. WEEKLY IRON AND FOLIC ACID
SUPPLEMENTATION (WIFS)
•Tomeetthechallengeofhighprevalenceandincidenceof
anemiaamongadolescents
•Goal:Tobreaktheintergenerationalcycleofanemia
•Interventions
1.SupervisedweeklyIFAsupplements:100mgelementalironand500
μgFolicAcid
2.Screeningoftargetgroups
3.Bi-annualdeworming
4.Informationandcounselling
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25. C. MENSTRUAL HYGIENE
•Promotionofmenstrualhygieneadolescentgirlsintheage
groupof10-19yearsinruralareas
•Activities:
Communitybasedhealtheducationandoutreach
Ensuringregularavailabilityofsanitarynapkins
Sourcingandprocurementofsanitarynapkins
Storageanddistributionofsanitarynapkins
TrainingofASHAandnodalteachersinmenstrualhealth
Safedisposalofsanitarynapkins
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26. OTHER INTERVENTIONS
CARE DURING PREGNANCY
AND CHILDBIRTH
NEWBORN AND CHILD CARE
CARE THROUGH
REPRODUCTIVE YEARS
•ANC package
•High-risk pregnancies
tracking
•Skilled obstetric care
•Essential Newborn care
•Emergency obstetric and
newborn care
•Postpartum care
•PC&PNDT act
•Home-based care
•Facility-based care
•IMNCI (Diarrhoea,
Pneumonia and Malaria)
•Child nutrition and essential
micro-nutrients
•Immunization
•Detection and management
of birth defects
•Community-based promotion
•Delivery of contraceptives
•Promoting spacing methods
•Sterilization services
•Comprehensive abortion care
•STI/RTI prevention
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27. DELIVERY POINTS
Designated based on provision of services for delivery care
•Conducts minimum 3 normal deliveries per
monthL1
•Conducts minimum 10 deliveries per
month, including management of
complicationsL2
•Conducts minimum 20-50 deliveries per
month including C-sectionL3
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28. DELIVERY POINTS
•Strengtheningoffacilities-providingcomprehensiveRMNCH
services
•Addresstheshortageofhumanresource-subcentresand
thoseinhighfocusdistricts(HFDs)/tribal/remoteareas
•Supportedbyareferraltransportsystemthatreachesthe
patientwithin30minutesofreceivingacallandthehealth
facilitywithinthenext30minutes
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29. MATERNAL AND CHILD HEALTH WINGS
•Highcaseloadofpregnantwomenandnewbornsatsecondary
andtertiarylevel
•MCHwingscomprehensiveunits(30/50/100bedded)
•Toensureprovisionofemergencymaternalandnewborncare
servicesaswellas48hoursstay
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30. SCORE CARD
A.HMIS-baseddashboardmonitoringsystem
•Indicatorsbasedonlife-cycleapproach
B.Surveybasedscorecard
•Latestavailabledatafromnationalsurveyswillbetakeninto
consideration(SRS,CoverageEvaluationSurvey,DLHS,NFHS,
Census,AnnualHealthSurvey)
•Thescorecardwillbeupdatedasandwhen(every1-2years)new
surveydataisavailable
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31. 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 <2.5 kg
Children <3 years who are underweight
Gender Child sex ratio 0-6
Cross cutting Full immunization of children 12-23 months
Households having access to toilet facility
Couples using spacing methods for >6 months
Diarrhea ORT provided
Pneumonia Child seeking ARI in any health facility
Service deliveryWomen received 4+ ANC
SBA
Mothers received postnatal care from health personnel within 2 days of delivery
Early initiation (<1 hr) and exclusive breast feeding
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32. REPRODUCTIVE, MATERNAL, NEWBORN, CHILD,
ADOLESCENT HEALTH “PLUS” NUTRITION STRATEGY
(RMNCAH+N)
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34. REFERENCES
1.K Park. Health programmesin india. In: Park’s
Textbook of Preventive and Social Medicine; 27th edn. Jabalpur, M/s
BanarsidasBhanotPublishers: 2023. pp 530-35.
• 2.AM KADRI et al. Health policies and programmesin india.In:
IAPSM texbookof community medicine;2nd edn. New delhi,jaypee
brothers medical publishers :2021 pp 887-89.
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