1. REPRODUCTIVE AND CHILD HEALTH
PROGRAMME
Dr. Bhuwan Sharma
Assistant Professor
Dept. of PSM
Grant Govt. Medical College
2. MILES STONE IN MCH CARE IN INDIA
• 1880 – ESTABLISHMENT OF TRAINING OF DAIS IN AMRITSTAR
• 1902 - 1st MIDWIFERY ACT TO PROMOTE SAFE DELIVERY
• 1930 - SETTING UP OF ADVISORY COMMITTEE ON MATERNAL
MORTALITY.
• 1946 - BHORE COMMITTEE RECOMMENDATION ON
COMPREHENSIVE & INTEGRATED HEALTH CARE
• 1952 – PRIMARY HEALTH CENTER NET WORK & FAMILY PLANNING
PROGRAMME
• 1956 – MCH CENTERS BECOME INTEGRAL PART OF PHCS
• 1961 - DEPARTMENT OF FAMILY PLANNING CREATED
• 1971 – MTP ACT
• 1974 – FAMILY PLANNING SERVICES INCORPORATED IN MCH CARE
• 1977 – RENAMING FAMILY PLANNING TO FAMILY WELFARE
• 1978 – EXPANDED PROGRAMME ON IMMUNIZATION
• 1985 – UNIVERSAL IMMUNIZATION PROGRAMME
• 1992 – CHILD SURVIVAL& SAFE MOTHERHOOD PROGRAMME
• 1996 – TARGET FREE APPROACH
• 1997 – RCH PROGRAMME PHASE-1
• 2005 – RCH PROGRAMME PHASE-2
5. Objectives
•Reduction of Maternal Morbidity and
Mortality (MMR)
•Reduction of Infant Morbidity and Mortality
(IMR)
•Reduction of Under 5 Morbidity and
Mortality (U5MR)
•Promotion of adolescent health
•Control of reproductive tract infections and
sexually transmitted infections.
6. • The first phase of the programme had
started from 1997
• To bring down the birth rate below 21
per 1000 population
• To reduce the infant mortality rate
below 60 per 1000 life born
• To bring down the maternal mortality
rate below 400 per one lakh.
• Eighty per cent institutional delivery,
• 100 per cent antenatal care
• and 100 per cent immunization of
children
8. Camp Oriented . Client Oriented
• Sterilization
Camps • Full Range of RCH
Services
• IUD Camps
• Need Based
• Immunisation
Camps
9. Target Oriented Goal Oriented
Performance by Performance by
Numbers Quality
• Top Down • Bottom up
• Client Need Based
• Target Driven
• Community
Participation
• To the Govt. System • To the Clients,
Community
10. Safe Motherhood Services
- Essential Care for All Child Survival
- Early Identification of Complications Services
- Emergency Services those who are in need
Family Welfare
- Increased access to Healthy Prevention and
Contraceptives Mother Management of
&
- Safe Abortion Child RTI /STI
Services
Adolescent Health Care and
Family Life Education
11. COMPONENTS OF RCH
PROGRAMME
Prevention and management of unwanted pregnancy
Maternal care that includes antenatal, delivery, and
postpartum services
Child survival services for newborns and infants
Management of reproductive tract infections and
sexually transmitted infections
12. REPRODUCTIVE HEALTH ELEMENTS
Responsible and healthy sexual behaviour
Intervention to promote safe motherhood
Prevention of unwanted pregnancy
To increase accessibility of contraceptives
Safe abortions
Pregnancy and delivery services
Management of RTI/STD
Referral facility by government/private
sector for pregnant women at risk
Reproductive health services for
adolescents
Screening and treatment of infertility,
cancer & other gynecological disorders
13. CHILD SURVIVAL ELEMENTS
Essential New Born Care
Prevention and management of vaccine
preventable disease
Urban measles campaign
Neonatal tetanus elimination
Surveillance of vaccine preventable diseases
Cold chain system
Polio eradication : pulse polio programme
ARI control programme
Diarrhea control programme and ORS programme
Prevention and control of Vitamin A deficiency
among children
Baby Friendly Hospital Initiative (BFHI)
14. STRATEGY
BOTTOM-UP PLANNING
COMMUNITY NEED ASSESSMENT
APPROACH
DECENTRALISED PARTICIPATORY
PLANNING & IMPLEMENTATION
STRENGTHENING INFRASTUCTURE
INTEGRATED TRAINING PACKAGE
IMPROVED MANAGEMENT SYSTEM
INTERVENTIONS
MONITORING & EVALUATION
15. ANTE NATAL CARE
Early registration of pregnancies (12 – 16 weeks)
Minimum 3 antenatal visits (20,32,36 weeks) check-
ups
Anaemia prophylaxis ( Iron and Folic acid tablets)
Two doses of TT
Minimum investigations( Weight, B.P,Blood group, Rh
typing, Urine examination,VDRL,HIV (TRIDOT TEST)
Identification of high risk group, Early detection of
complication of pregnancy & timely , safely referral to
FRU
Treatment of worm infestation with Mebendazole
Health education on diet, breast feeding, care of
breast, personnel hygiene during pregnancy,& family
planning
16. REFERAL
1. BLEEDING 1.FIRST LEVEL
REFERRAL CENTER
2. OBSTRUTED LABOUR
2.COMMUNITY
HEALTH
CENTER/DISTRIC
HOSPITAL
1. SEPSIS
2. TOXAEMIA PRIMARY HEALTH
3. ABORTION CENTER
1.ANAEMIA
SUB CENTER
2.FAMILY PLANNING
17. PACKAGES OF SERVICES AT FRU
•VACCUM EXTRACTIONS
•ADMINISTRATION OF ANAESTHESIA
•BLOOD TRANSFUSION
•CASEAREAN SECTION
•MANUAL REMOVAL OF PLACENTA
•CARRY OUT SUCTION CURETTAGE FOR INCOMPLETE
ABORTION
•INSERTION OF INTRAUTERINE DEVICES
•STERILIZATION OPERATION
18. TYPES OF KIT for FRU
•Kit-E – Laparotomy set
•Kit-F - Mini– Laparotomy set
•Kit-G – IUD insertion set
•Kit-H – Vasectomy set
•Kit- I – Normal delivery set
•Kit- J – Vacuum extraction set
•Kit- k – Embryotomy set
•Kit- L – Uterine evacuation set
•Kit-M – Equipment for anesthesia
•Kit-N- Neonatal resuscitation set
•Kit-O- Equipment and reagent for blood test
•Kit-P – Donor blood transfusion set
19. INTRANATAL CARE
Delivery by trained personnel (100%)
Institutional delivery (80%)
Care at birth ( Five cleans: Clean Birth
Canal,Clean surface for delivery,Clean
Hands,Clean Cutting, & Clean Cord)
20. POST NATAL CARE
3 post natal check-ups of mothers after
delivery
Breast feeding – early & exclusive breast
feeding
Spacing – minimum 3 years between two
pregnancies
21. NEW STRATEGY
Empowered action group has been consituted on 20.03.2001
Training of dais in 156 districts 18 states/uts 2001-2002
RCH camps & RCH out reach scheme
Gadchiroli model to take care of home based neonatel care in 2002
Kangaroo mother care to take care of low birth weight infants
Border district cluster strategy – 49 districts/17 states
Integrated management of childhood illness (IMNCI) strategy to take care
of sick newborns
22. STEPS TO REDUCE MATERNAL
MORTALITY
• HEALTH SECTOR ACTIONS
Basic antenatal , intra natal &post natal care.
skilled attendants @ every birth.
EOC & Comprehensive obstetric care.
Prevention of unwanted pregnancy &unsafe
abortions.
Joint consultations -medical disorders.
Maternal mortality audit .
23. STEPS TO REDUCE
• COMMUNITY , SOCIETY & FAMILY ACTIONS .
• HEALTH PLANNERS /POLICY MAKERS ACTIONS
community education ,motivation.
Strengthen referral system.
management protocols for obstetric
emergencies.
CME – Improve quality & standard of care.
Maternal mortality audit .
24. STEPS TO REDUCE
• LEGISLATIVE & POLICY ACTIONS
Girl children & adolescents :
nutrition , education ,economic opportunities.
Remove barriers to access health care.
Cost
Socio cultural factors
Safe abortions & post abortion care -MVA
Remove social inequalities- gender , age
marital status.
25.
26. World Health Day 2005 Slogan
Make Every Mother And Child Count
Reflects that health of women
and children should be given
higher priority at all levels of
health care system.
Every one is accountable for
health of mothers & children
28. THE 5 YEAR PHASE OF RCH II
VISION To bring about outcomes as
envisioned in the
1. Millennium Development Goals
2. The National Population Policy 2000
(NPP 2000)Goals
3. The Tenth Plan Goals
4. The National Health Policy 2002
5. and Vision 2020 India
31. 1. MATERNAL HEALTH
a) 260 Primary Health Centres are proposed to be taken up for
improving access to Essential Obstetric and New Born Care
services round the clock in TN. All CHC, & 50% PHCs to be
made functional for 24 hrs delivery services,& 2000 FRU are
proposed
b) Improving quality of antenatal, neonatal and postnatal care
by providing increased number of antenatal checkups, fixed
day antenatal clinics, linking visits of neonates with
postnatal care, empowering the VHNs in performing
obstetric first aid and newborn care.
c) Improvement of the referral networking systems by
establishing emergency help line.
d) Regular conduct of blood donation camps for the continued
availability of blood in the blood banks.
e) Universalizing the concept of birth companionship during the
process of labour in all health facilities conducting deliveries.
f) Operationalisation of maternal death audit to address the
issues that have led to maternal deaths.
32.
33. 2. INFANT AND CHILD HEALTH
a.Reduction of new-born deaths, infant deaths and child deaths
by providing continuous health care and strengthening of new-
born care infrastructure facilities.
b. Organizing counseling sessions for the mothers.
c. Implementing integrated management of neonatal and
childhood illness.
d. Operationalization infant death/stillbirth verbal autopsy.
e. Addressing the issue of female infanticide and foeticide.
34. Integrated Management of Neonatal
& childhood Illnesses (IMNCI)
IMNCI is a strategy for an integrated
approach to the management of childhood
illness as it is important for child health
programmes to look beyond the treatment
of single disease.
35. Major highlights
Inclusion of 0-7 days in the programme
Incorporation of national guidelines
Training of health personnel
Proportion of training time devoted to sick young infant and
sick child is equal
Skill based
36. 3. ADOLESCENT HEALTH.
a)Focusing adolescents as receivers and providers of
knowledge and function as link volunteers in the community.
b) Utilising the services of trained adolescents for
propagating Indian System of Medicines.
c) Broadcasting and Telecasting of programme by AIR/TV
focusing adolescent, gender and health related subjects.
d) Formation of co-ordination committee at the district level
and monitoring committee at the State level for overseeing
the AIR/TV programme.
37. 4. FAMILY WELFARE
a)While sustaining the ongoing family welfare
interventions in all districts, 19 districts with Higher
order births will be targeted for intensified
interventions.
b) Social marketing programme for condom and other
health commodities, promotion of IUD insertions,
familiarizing the concept of one-stop Family Welfare
Centre.
c) Increasing access to safe abortion services by
popularising manual vacuum aspiration (MVA)
technique.
d) Establishment of one-stop family welfare services at
Comprehensive Emergency Obstetric and New Born
Care (CEMONC) Centres.
e) Popularizing No Scalpel Vasectomy.
38. 5. Reproductive tract infections / Sexually transmitted
infections / Cancer control.
a)Establishment of Reproductive Tract Infection /
Sexually Transmitted Infection, early Cancer detection
clinics .
b) Strengthening RCH outreach services.
c) RTI/STD clinic in selected 70 primary health centers
39. 6. Infrastructure strengthening for service delivery
a) Construction of HSC buildings where HSCs are
currently functioning in rented premises
b) Rebuilding HSCs which are unfit for occupation.
c) Taking up of repairs/renovation and provision of
water supply/electrical works to PHCs/HSCs.
d) Need-based supply of equipment/furniture to the
HSCs and PHCs as per the standard list including gas
connections.
e) Provision of Cell phones to HSCs where large
number of deliveries take place.
f) Provision of telephones to PHCs
40. 7. TRAINING
a)Skill upgradation training with focus on
improving/upgrading the skills of health care
providers.
b) Integrated skill training for peripheral health
functionaries such as VHNs, SHNs, medical officers and
health inspectors.
c) Improving managerial and communication skills of
health staff.
41. 8. BEHAVIOURAL CHANGE COMMUNICATION (BCC)
a) Social mobilisation activity against female infanticide and
foeticide by preventive counselling.
b) Formation of HSC, Block, District level committees for saving
female babies.
c) Conducting of Kalaipayanam (travelling street theatre) to
promote social mobilization and to improve health care among
the target population
d) Telecasting of TV serials, Radio broadcasts, wall paintings,
hoardings and glow signs for popularizing health and
reproductive health messages in important places.
42. 9. HEALTH MANAGEMENT INFORMATION SYSTEMS
Introduction of IT-enabled HMIS for planning and monitoring health
services at the State/District /Block levels
10. STRENGTHENING OF TEACHING INSTITUTIONS
Strengthening the facilities at teaching institutions for providing
optimum obstetric, family welfare, neonatal child health services.
11. ESTABLISHING URBAN HEALTH POSTS
To provide an integrated and sustainable system for primary health
care service delivery catering to the requirements of urban slum
population and other vulnerable groups
43. 12. HEALTH FINANCING
The health care expenditure in India currently
stands at 6.1% of GDP. The private out of pocket
expenditure being 4.7% of Gross Domestic
Product (GDP). The total government expenditure
on family welfare has shown an increasing trend
from 4.9 billion in fifth plan (1974-79) to Rs.
271.25 billion in the tenth plan (2002-07)
44. ACCESSIBILITY
INDICATOR
•No. of eligible couples registered/ANM
•No. of Antenatal Care sessions held as planned
•% of sub Centers with no ANM
•% of sub Centers with working equipment of ANC
•% ANM/TBA without requisite skill
•% sub centers with DDKs
•% of sub centers with infant weighing machine
•% subcenters with vaccine supplies
•% sub centers with ORS packets
•% sub centers with FP supplies
45. QUALITY INDICATOR
•% Pregnancy Registered before 12 weeks
•% ANC with 5 visits
•% ANC receiving all RCH services
•% High risk cases referred
•% High risk cases followed up
•% deliveries by ANM/TBA
•%PNC with 3 PNC visits
•% PNC receiving all counselling
•% PNC complications referred
•% Eligible couple offered FP choices
•% women screened for RTI/STDs
•% Eligible couple counselled for prevention of RTI/STDs
•% ADD given ORS
•% ARI treated
•% children fully immunized
46. IMPACT INDICATOR
•% DEATHS FROM MATERNAL CAUSES
•MATERNAL MORTALITY RATIO
•PREVALENCE OF MATERNAL MORBIDITY
•% LOW BIRTH WEIGHT
•NEO-NATAL MORTALITY RATIO
•PREVALENCE OF POST NATAL MATERNAL MORBIDITY
•% BABY BREAST FEED WITHIN 6 HRS OF DELIVERY
•COUPLE PROTECTION RATE
•PREVALENCE OF TERMINAL METHOD OF
STERILIZATION
•PREVALENCE OF SPACING METHOD
•% ABORTION RELATED MORBIDITY
•PREVALENCE OF ADD
•PREVALENCE OF ARI
•PREVALENCE OF RTI/STDs