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krithiga rmnch

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RMNCHA draft

Publicado en: Salud y medicina

krithiga rmnch

  1. 1. RMNCH + A Dr. Krithiga S Post Graduate Community Medicine
  3. 3. INTRODUCTION AND RATIONALE • Improving the maternal and child health --NRHM & MDG . • To bring greater impact - recognise that reproductive, maternal and child health cannot be addressed in isolation • Different stages of life cycle and levels of provision of health care are interlinked
  4. 4. • The two dimensions of health care a) stages of life cycle b )places where the care is provided. RMNCH + A • (1) inclusion of adolescence as a distinct ‘life stage’ • (2) linking of maternal and child health to reproductive health and other components (like family planning, adolescent health, HIV, etc) • (3) linking of community and facility-based care as well as referrals between various levels of health care system • This integrated strategy promotes greater efficiencies & reduces duplication of resources and efforts in the ongoing programme.
  5. 5. PROBLEM STATEMENT STATISTICS OF 2010 Global maternal deaths (2010) Maternal Mortality Ratio 2,87,000 210/100,000 Indian maternal deaths 56000 CHILD MORTALITY(global) 76 LAKHS CHILD MORTALITY(India) under five mortality 15.8 LAKH 20% OF TOTAL 59 /1,000 live births 56% 1st month 79% in1st yr TFR IN INDIA 2.5
  6. 6. •RURAL – URBAN DIFFERENCE IN MMR IS ~ 28 / 100,000 •RATE OF DECLINE OF RURAL MMR greater •FOCUS SHOULD BE SHIFTED to areas of greatest concern & populations that carry the highest burden of illness PROGRESS IN INDIA OLDER STATS PRESENT STATS CHILD MORTALITY RATE 115 /1000 IN 1990 56 /1000 MATERNAL MORTALITY RATE 254/ 100’000 IN 2005 214/100’000 IN 2007-09
  7. 7. Causes of Under-Five Deaths
  8. 8. Causes of maternal deaths SOCIAL CAUSES 1. Marriage and child birth at young age 2. Less spacing between births 3. Low literacy level among women 4. Reduced Access to use of contraception / safe abortion methods
  9. 9. HEALTH SYSTEM RELATED CAUSES Lack of awareness Delay in decision to seek care Unavailability of basic health services Delay in reaching appropriate facility Poor quality of care Delay in receiving quality care
  10. 10. BOTTLENECK ANALYSIS 1. Availability of essential commodity 2. Access to services 3. Utilization of services 4. Adequate coverage 5. Effective coverage • Limited availability of skilled human resource • Low coverage of service • Inadequate supervision • Low quality of training • Lack of improvement of quality of services • Inadequate IEC
  11. 11. GOALS Health Goals- 12th Five Year Plan • IMR 25 / 1000 live births • MMR 100 per 100,000 live births 2017 • TFR 2.1 The country aims to set one collective goal towards reducing preventable maternal, newborn and child deaths by 2017
  12. 12. Coverage targets RMNCH+A 2017 Facilities equipped for perinatal care 100 Proportion of all births in government and accredited private institutions Annual rate of 5.6% Proportion of pregnant women receiving antenatal care at annual rate of 6% Annual rate of 6% Proportion of mothers and newborns receiving postnatal care Annual rate of 7.5% Proportion of deliveries conducted by skilled birth attendants at annual rate of 2% from the baseline Annual rate of 2%
  13. 13. Exclusive breast feeding rates annual rate of 9.6% Reduce prevalence of under-five children who are underweight annual rate of 5.5% Increase coverage of three doses of combined diphtheria-tetanus-pertussis Annual rate of 3.5% Increase ORS use in under-five children with diarrhoea at annual rate of 7.2 % Reduce unmet need for family planning methods annual rate of 8.8% Increase met need for modern family planning methods among eligible couples at annual rate of 4.5% Reduce anaemia in adolescent girls and boys (15–19 yrs) annual rate of 6% Decrease the proportion of total fertility contributed by adolescents annual rate of 3.8%
  15. 15. ADOLESCENCE Adolescent health has inter-generational effect. PROBLEMS IN ADOLESCENT AGE GROUP • Nutritional defects • Sexual and reproductive health related problems • Mental health based problems • Gender based violence • Substance use / non communicable disease 1/3 rd of married adolescents face domestic
  16. 16. ADOLESCENT NUTRITIONAL SUPPORT nutrition – growth and sexual maturation WEEKLY IFA SUPPLEMENTATION PROGRAM Supervised administration of weekly Fe (100mg) and F.A (500 mcg)in schools Screening for anemia and referral to health facility Bi annual deworming Counseling to improve dietary intake / prevent worm infestations Non school going adolescents – covered by anganwadi centre
  17. 17. SUB CENTRE LEVEL ANM PRIMARY HEALTH CENTRE Adolescent information and counseling centre ( M.O AND ANM) ALL HIGHER CENTRES Adolescent health clinics Adolescent counselors SPECIALACTIVITIES •Linkage with ICTC/ appropriate referrals for RTI s and STDs Adolescent friendly health services
  18. 18. INFORMATION AND COUNSELLING LIFE SKILL EDUCATION- schools / anganwadi centres / outreach Programmes •Promote healthy lifestyle •addictions and substance abuse •to reduce gender based violence •Risk of early conception PEER EDUCATION APPROACH :Peer educators to counsel the adolescents regarding mental health issues • screening &Appropriate referrals OTHER INVERVENTIONS
  19. 19. MENSTURAL HYGIENE •Information and knowledge about use of sanitary napkins, • quality products made available PREVENTIVE HEALTH CHECK UPS •Biannual health screening •Basic health services and referrals •Immunization •Micronutrient supplementation •Deworming
  20. 20. PREGNANCY AND CHILDBIRTH 1. Delivery of antenatal care package and tracking of high-risk pregnancies 2. Skilled obstetric care 3. Immediate essential newborn care and resuscitation 4. Emergency obstetric and new born care 5. Postpartum care for mother and newborn 6. Postpartum IUCD and sterilisation 7. Implementation of PC&PNDT Act
  21. 21. Newborn and Childcare • Home-based newborn care and prompt referral • Facility-based care of the sick newborn • Child nutrition and essential micronutrients supplementation • Immunisation • Integrated management of common childhood illnesses (diarrhoea, pneumonia and malaria) • Early detection and management of defects at birth, deficiencies, diseases and disability in children (0–18 years)
  22. 22. Home based newborn care and prompt referral • Neonatal deaths - 59% of under-five mortality at the national level • Reducing neonatal mortality is paramount imporatance to impact IMR • The home-based newborn care scheme,(2011,) provides for immediate postnatal care (especially in the cases of home delivery) and essential newborn care to all newborns up to the age of 42 days. • ASHA are trained and incentivised to provide special care to preterms and newborns & identification of illnesses, appropriate care and referral through home visits.
  23. 23. Facility-based care of the sick newborns • Special Newborn Care Units - established at District Hospitals and tertiary care hospitals • The goal - SNCU in each district of the country. Additionally, health facilities > 3,000 deliveries /yr can be considered for establishing an SNCU • Another smaller unit known as the Newborn Stabilisation Unit which is a four- bedded unit providing basic level of sick newborn care, is being established at Community Health Centres/First Referral Units. • Sick newborns - followed up for Developmental Screening and Early Intervention
  24. 24. Child nutrition and essential micronutrients supplementation • Line listing LBW babies maintained and follow up should be ensured • All children between the ages of 6 months to 5 years – IFA tablets or syrup (IFA) (for 100 days / year ) • Vitamin A supplementation ( 9 months to 5 years - six monthly doses of vitamin A. nine doses of Vitamin A by the 5th birthday) • Reduce the risk of mortality due severe acute malnutrition, Nutritional Rehabilitation Centres have been established for providing medical and nutritional care.
  25. 25. Immunisation • India - 2.6 crore/yr. • UIP - prevent seven vaccine preventable diseases New inclusions : • The 2nd dose of measles ,Hep B vaccine JE (endemic districts) • Pentavalent vaccine • Adverse effects investigation report - within 15 days
  26. 26. Through the Reproductive Years • Community-based promotion and delivery of contraceptives • Promotion of spacing methods (interval IUCD) • Sterilisation services (vasectomies and tubectomies) • Comprehensive abortion care (includes MTP Act) • Prevention and management of sexually transmitted and reproductive infections (STI/RTI)
  27. 27. Health Systems Strengthening for RMNCH+A Services •Infrastructure •New construction and renovation of existing facilities •Delivery points •Maternal and Child Health (MCH) Wing •Human resources •Policies on drugs, diagnostics, equipment ,procurement system and Logistics management • Providing and Improving Quality of care
  28. 28. Delivary point : These are be strengthened for providing comprehensive services • Referral transport system that reaches the patient within 30 minutes of receiving a call and the health facility within the next 30 minutes. • The long-term goal - establish a Basic Emergency Obstetric Care & Comprehensive Emergency Obstetric Care centres, No of deliveries/month type min 3 normal deliveries L1 min 10 deliveries & management of Complications L2 min 20-50 including C-section L3
  29. 29. Maternal and Child Health (MCH) Wing: • MCH wings will be comprehensive units (30/50/100 bedded) with antenatal waiting rooms, labour wing, Essential Newborn Care room, SNCU, operation theatres, blood storage units and a postnatal ward as well as an academic wing. • ensure provision of emergency maternal and newborn care services as well as 48 hrs stay & quality postnatal care to mothers and newborns.
  30. 30. Programme Management •Deputy Commissioners, •Assistant Commissioners,&team of technical consultants •Director for RCH •separate directorate officials for -facility operationalization, training and quality assurance systems. •Directorate official (possibly Additional Chief Medical and Health Officer /RCH Officer) for RMCNH+A, •supported by separate dedicated full-time staff for each components DISTRICT LEVEL STATE LEVEL NATIONAL LEVEL
  31. 31. Community participation • it is a key strategy NRHM • to ensure that services reach those for whom they were meant. • Engage women systematically at the community level • Engage Village Health Sanitation and Nutrition committees • Utilize the Village Health and Nutrition Days as a platform for outreach activity • Social audit and communitisation efforts at the Panchayati Raj level
  32. 32. Priority Actions in High Focus Districts and Vulnerable Population (Urban Disadvantaged and Tribals) • Reaching the Unreached- in under served areas the topmost priority. • Differential planning and need-based financing • Strengthening health infrastructure • Incentives for personnel in hard-to-reach areas • Public private partnerships • Mobile Medical Units (MMU) and Maternity waiting homes
  33. 33. Tribal Health • The states - map out tribal areas and pockets • closely monitor progress on all health activities in notified tribal areas. Strategies for inaccessible/remote hilly areas • Transport • Incentives • Birth waiting homes Health of the urban poor • UHC close to slums and urban community health centres(30-50 bedded ) with lab services • USHA – preventive and promotive actions
  34. 34. Convergence and Partnerships Convergence with on-going programmes • National Vector Borne Disease Control Programme (NVBDCP): • National AIDS Control Programme: • AYUSH • National Urban Health Mission (NUHM) • PC&PNDT Act implementation • Adolescent health, maternal and child health programmes Partnerships • The professional bodies like IAP IAPSM FOGSI key role in advancing knowledge,practice of evidence-based interventions & assist the government
  35. 35. Technical Support for RMNCH+A Service Delivery Ministry of Health and Family Welfare (MOHFW): Monitoring, management and coordination National Child Health Resource Centre Acts as repository of all technical and programme guidelines Regional Collaborative Centres for reproductive, maternal, newborn child and adolescent health To support the states in capacity building, research and programme monitoring RMNCHA Coalition will proactively engage with the RMNCH efforts of the Global Strategy for Women and Children’s Health and the Independent Review Group India Call to Action on child survival and development Technical support at national and priority states and districts