Reproductive and Child Health Phase

II (RCH-II)Dr. Rakesh KumarPG Com. Medicine

Situation in India

High Maternal Mortality- 100,000 maternal deaths occurs annually

High Child Mortality -2.1 million deaths annually

Unmet demand for contraception

Increasing concern over Adolescent health, Urban slums Tribal health Rural-urban / Interstate variation

Milestones in MCH care

1951 –Family Planning Programme India first country to launch

1961 – Department Of Family Planning Created

1985 - Universal Immunization Programme

1992 – Child Survival & Safe Motherhood Programme Integration of family planning , child survial, maternal strategies

1997 – RCH Programme Phase-1 Target free approach Decentralised planning, Client-centred, quality-oriented,

reproductive health approach

RCH - II

Launched on 1st April 2005

Vision: To bring about outcomes as envisioned in the Millennium

Development Goals, the National Population Policy 2000 (NPP 2000), and the National Health Policy 2002

Minimizing the regional variations in the areas of RCH

Population stabilization through an integrated, focused, participatory programme

Components of RCH-IIRCH-II

Maternal

Health

Neonatal & Child Healt

h

Family

Planning

Adolescent Healt

h

Control of

RTI & STDs

Maternal Health

Maternal Health Component

1. Essential Obstetric care

2. Emergency obstetric care

3. Safe abortion services

4. Prevention & control of RTI /STDs

“NISHCHAY”- Pregnancy detection kit

Services for early detection of pregnancy Surveys indicate availability of pregnancy

detection kits (NISHCHAY) with peripheral health functionaries

ASHAs performed over 82 percent of tests themselves

Skilled Birth Attendance

Skilled Birth Attendant Reorienting Medical Officers Preservice & inservice training for SNs/LHVs/ANMs

Enabling Environment Operationalising SCs/ PHCs/CHCs/FRUs for skilled

attendance at birth.(Enabling Environment)

Policy decisions- ANMs granted permission to use drugs for managing PPH to use drugs in emergency situations before referral to perform basic procedures at community level in

emergency situations

24×7 Hours PHCs & CHCs Aim: -To promote institutional deliveries

-To provide the round the clock deliveries facility at health centres 50% of PHC will be upgraded to provide essential and basic

emergency obstetrics care All upgraded CHC to act as FRU to provide comprehensive

obstetric care Status – Target set for 2010

52% of targeted PHCs have been strengthened to provide 24-hour services

74% of targeted CHC’s have been operationalised as First Referral Units (FRUs)

Considerable variation in delivery and quality of services Only 39% of FRUs and 44% of 24/7 PHCs meet all

essential criteria Across states, number of c-sections per month at FRUs

range from 280 to less than 4 Number of deliveries per month in 24/7 PHCs varies

from 89 to 3

Operationalisation of FRUs All CHCs , Sub district hospital will upgraded and

operationalised as FRUs All FRUs are should provide following services:

1. 24 hour delivery services including normal & assisted deliveries

2. Emergency obstetric care includes surgical intervention –Caesarian Section

3. New born care 4. Emergency care of sick children5. Full range of family planning services –Laparoscopic 6. Safe abortion services7. Treatment of RTI /STI8. Blood storage facility9. Essential laboratory services10. Referral transport services

Strengthening referral System

Time is an important factor for obstetric emergencies.

During RCH I – funds were given to Panchayats for providing assistance to poor people ----- no active involvement of Panchayats.

In RCH II : Through involvement of VHNSC

Referral transport systems, in general have been given emphasis across states; Madhya Pradesh and Gujarat has widespread availability and use of the Janani Express Yojana.

New initiatives taken under RCH II

Training of MBBS doctors in anesthetic skills for emergency obstetric care for 18 weeks

Training of MBBS doctors in emergency obestetrics skills like caesarean section for emergency obstetric care for 16 weeks

Setting up a blood storage centres at FRUs according to of India guidelines.

Vandematram Scheme – a Public private partnership

Janani Suraksha Yojana

Modified The National Maternity Benefit scheme on 12th April 2005

1. 100 % centrally sponsored scheme2. Promotes institutional delivery among poor

pregnant women3. Cash assistance with institutional care during ANC, Delivery &

PNC4. Benefit given to female age 19 & above (urban & rural) , up to

first 2 live births & in low performing states up to 3 live births.5. Special dispensation for 10 states with low

institutional delivery ( LPS)6. ASHA- Link between beneficiary & govt.in LPS—

other states are HPS

Acheivement: from a modest beginning of 7.39 lakh beneficiaries in 2005-06, the number has risen ten-fold to 73.29 lakh beneficiaries in 2007-08

Safe Abortion Services

Increasing access to safe abortion services by popularizing manual vacuum aspiration (MVA) technique at PHC level for early pregnancy

Control of RTI /STDs Planned & implemented in close collaboration with National

AIDS control Organization (NACO)

NACO is supporting to set up STD clinics up to the district level

Each district are assisted by two laboratory technicians on contract basis for testing blood ,urine for RTI / STD test

Neonatal & Child Health

Key Strategies

Increase coverage of skilled care at birth for newborns in conjunction with maternal care - Pre-service IMNCI is underway in 62 medical colleges

Implement a comprehensive IMNCI approach - a newborn and child health package of preventive, promotive and curative Currently being implemented in 193 out of 612 districts

Navjaat Shishu Suraksha Karyakram

Introduction of Hepatitis-B Vaccine in routine immunization

Neonatal & Child Health component

Care

at

birt

hFa

cilit

y / H

ome

Strengthening the existing

interventions

BCC AND COMMUNITY MOBILIZATION

Health system strengthening

IMNCI

RCH II: Child Health strategy

ASHA/HWHBNC

IPHS StandardsCapacity building

Improved Referral Care of New born & sick children

“Navjaat Shishu Suraksha Karyakram”

A new programme on Basic Newborn Care and Resuscitation

High Neonatal Mortality Rate despite substantial reduction in childhood and infant mortality

Nearly two-thirds infant deaths each year occur within the first four weeks of life, and about two-thirds of those occur within the first week.

Child health cont… MoHFW has developed a

comprehensive New Born and Child Health policy

Village Health and Nutrition Days Organized at AWCs for service

provision in the RCH-II & NRHM, and also as a platform for intersectoral convergence

Over 55.29 lakh VHNDs have reportedly been carried out across states in 2008-09

Nearly 70 percent of planned sessions are being held and on average there are 30-40 clients per VHND

Family Planning

New Interventions in Family Planning (GOI)

1. Addressing the unmet need in contraception through Assured delivery of quality family planning services Developing skilled manpower

2. Increasing basket of choices - through several trials by GoI including injectables (Cyclofem and NetEn), Centchroman, and a five-year multi-load IUCD.

3. Intensive promotion of Non-Scalpel vasectomy4. Promotion of IUDs as a short & long term spacing method5. Promotion of Emergency Contraceptive Pills

6. Improving awareness of FP ( e.g, FP counsellors located at Comprehensive Emergency Obstetric and New Born Care (CEmONCs) in MP and Jan Mangal couples in Rajasthan

23

Infertility management 10- 15 % of couples are infertile.

Medical, ethical and legal issues involved.

Guidelines for ART (Assisted Reproductive Technology) has been prepared in 2005.

Draft bill on ART is awaiting legislation.

Adolescent Health

Adolescent Reproductive & Sexual Health (ARSH) Strategy

I. Reducing teenage pregnanciesII. Meeting unmet contraceptive needs III. Reducing number of teenage maternal

deaths IV. Reducing incidence of STIs and V. Reducing proportion of HIV positive in

10- 19 years age group

Overall objective of ARSH Strategy is to contribute to the RCH II goals of reduction of IMR, MMR and TFR. Objective to be

met by:

1. Adolescent friendly health services Detection and treatment of anemia, RTI/STDs , de-addiction

psycho-somatic problems and other problems HIV detection and counseling Easy and confidential access to MTP Antenatal care and advice regarding child birth

2. Adolescent health counseling services To provide counseling related to Growth and development;

Nutrition; Reproductive and child health; Marriage and parenthood & Life-skill education

Services provided at PHCs, CHCs, FRUs and district hospitals in the selected districts through routine OPDs and “Adolescent Health Clinics” conducted

at least once every week

Component of ARSH:

ARSH : Progress so far

RCH-II ARSH Strategy approved as part of National and state RCH-II PIP

Self learning module for rural youth and health care providers

MOHFW RCH-II ARSH Training Sub-Group constituted & developed a training design document.

Achievements so far …Indicator NFHS-II

(1998-99)NFHS-III (2005-06)

M.H(NFHS-III)

Percentage received atleast

3 ANC visits

44.2% 50.7% 75.3%

Institutional delivery (%)

33.6 % 40.7% 66.1%

Full Immunization Coverage (%)

42.0% 43.5% 58.8%

Children with diarrhoea

receiving ORS (%)

26.9% 26.2% 37.8%

Percent using modern

contraceptives

42.8% 48.5% 66.9%

Total unmet need

15.8 % 13.2% 9.6%

RCH II Goal IndicatorsRCH II GOAL INDICATOR

ALL STATUS(Source of data)

RCH II / NRHM

goal (2012)

Maternal Mortality Ratio (MMR)

398(SRS 1997)

301(SRS 2003)

254(SRS 2008)

<100

Infant Mortality Rate (IMR)

71 (SRS 1997)

60 (SRS 2003)

53 (SRS 2008)

<30

Total Fertility Rate (TFR)

3.3 (SRS 1997)

3.0 (SRS 2003)

2.7 (SRS 2008)

2.1

THANK YOU