Post on 07-May-2015
Dr. Bhuwan SharmaAssistant Professor
Dept. of PSMGrant Govt. Medical College
REPRODUCTIVE AND CHILD HEALTH
PROGRAMME
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
RCH – Ι PROGRAMME
15.10. 1997
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.
• 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
Vertical Programmes Integrated Service Delivery
Camp Oriented Client Oriented
Target Oriented Goal Oriented
Quantity Oriented Quality Oriented
Camp Oriented Client Oriented
• Sterilization Camps
• IUD Camps
• Immunisation Camps
• Full Range of RCH Services
• Need Based
.
Target Oriented Goal Oriented
Performance by
Numbers
Performance by Quality
• Top Down
• Target Driven
• Bottom up• Client Need Based• Community
Participation
• To the Govt. System • To the Clients, Community
HealthyMother
& Child
Safe Motherhood Services - Essential Care for All - Early Identification of Complications - Emergency Services those who are in need
Child Survival Services
Prevention and Management of
RTI /STI
Family Welfare
- Increased access to Contraceptives
- Safe Abortion Services
Adolescent Health Care and Family Life Education
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
REPRODUCTIVE HEALTH ELEMENTS
Responsible and healthy sexual behaviourIntervention to promote safe motherhoodPrevention of unwanted pregnancyTo increase accessibility of contraceptivesSafe abortionsPregnancy and delivery servicesManagement of RTI/STDReferral facility by government/private
sector for pregnant women at riskReproductive health services for
adolescentsScreening and treatment of infertility,
cancer & other gynecological disorders
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)
STRATEGY
BOTTOM-UP PLANNINGCOMMUNITY NEED ASSESSMENT
APPROACHDECENTRALISED PARTICIPATORY
PLANNING & IMPLEMENTATIONSTRENGTHENING INFRASTUCTUREINTEGRATED TRAINING PACKAGEIMPROVED MANAGEMENT SYSTEMINTERVENTIONSMONITORING & EVALUATION
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
1. BLEEDING
2. OBSTRUTED LABOUR
1. SEPSIS
2. TOXAEMIA
3. ABORTION
1.ANAEMIA
2.FAMILY PLANNING
1.FIRST LEVEL REFERRAL CENTER
2.COMMUNITY HEALTH CENTER/DISTRIC HOSPITAL
PRIMARY HEALTH CENTER
SUB CENTER
REFERAL
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
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
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)
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
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
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 .
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 .
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.
World Health Day 2005 SloganMake 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
RCH - II PROGRAMME
01-04-2005
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
1728 - FRU
PHC-22928
SUB CENTER-38044
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.
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.
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.
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
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.
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.
4. FAMILY WELFARE
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
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
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.
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.
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
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)
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
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
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
THANK YOU