REPRODUCTIVE AND CHILD HEALTH PROGRAM(RCH) Dr. KANUPRIYA CHATURVEDI.
-
Upload
bartholomew-fitzgerald -
Category
Documents
-
view
218 -
download
2
Transcript of REPRODUCTIVE AND CHILD HEALTH PROGRAM(RCH) Dr. KANUPRIYA CHATURVEDI.
Dr. KANUPRIYA CHATURVEDI 2
Lesson Objectives
To Learn about the various components of RCH program
To know about the goals. objectives target groups, service components and RCH program
To know about the services/activities under the program
To know about the new initiatives in the program
Dr. KANUPRIYA CHATURVEDI 3
Components The RCH program incorporated the
earlier existing programs i.e. National Family Welfare Program and Child Survival and Survival & Safe Motherhood Program ( CSSM) and added two more components one relating to sexually transmitted disease and the other relating to reproductive tract infections. The program was formally launched on 15 October 1997.
Dr. KANUPRIYA CHATURVEDI 4
Components:
FAMILY PLANNING
CHILD SURVIVALAND SAFE
MOTHERHOOD
PREVENTION/MANAGEMENTOF
RTI/STD/AIDS
CLIENT APPROACHTO HEALTH
CARE
Adolescent Health
Care and Family Life Education
Dr. KANUPRIYA CHATURVEDI 5
RCH PROGRAM
Family Planning
Improved method mix
Private sector inclusion
Address quality
Collaborate with NACO in condom distribution
Maternal Health
•Quality ANC
•Institutional Deliveries
•Skilled Birth Attendance
• EmObstetric care
•Home based post-partum & NBC
•Quality safe abortion services
•RTI/STI
Child Health)
•Intensify existing services : Immunization,
NBC
Micronutrient Supply
CDD
ARI
• IMNCI.
Adolescent health
•Anemia
•Awareness about RH issues
Dr. KANUPRIYA CHATURVEDI 6
RCH Program (cross cutting Issues)
HumanResources Anesthetists Obstetrician
s Lady doctors Contractual
ANMs Staff Nurses
in 24 Hrs PHCs
Counselor
IEC
•Branding
•Involving Professional Agencies
•Media
•Inter-personal Communication
•Celebrity involvement
ISC
•Awareness about RH issues
•Anemia
MIS
•Output based Monitoring
•Triangulation of Data
•CES/DHS
Dr. KANUPRIYA CHATURVEDI 7
The Paradigm Shift Vertical Programmes Integrated Service Delivery
Camp Oriented Client Oriented
Target Oriented Goal Oriented
Quantity Oriented Quality Oriented
Dr. KANUPRIYA CHATURVEDI 8
Camp Oriented Client Oriented
• Sterilization Camps
• IUD Camps
• Immunisation Camps
• Full Range of RCH Services
• Need Based
.
Dr. KANUPRIYA CHATURVEDI 9
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
Dr. KANUPRIYA CHATURVEDI 10
Program Objectives
Promotion of MCH to ensure safe mother hood and child survival
Reduction of maternal and child morbidity and mortality
Attainment of population stabilization
Dr. KANUPRIYA CHATURVEDI 11
Highlights of the program
Integration of all programs related fertility regulation, maternal and child health and reproductive health.
Services are client oriented, demand driven through decentralized participatory process and target free approach
Up-gradation of facilities : creation of First referral units
Provision of specialist services for STD and RTI Provision of out reach services for vulnerable
groups
Dr. KANUPRIYA CHATURVEDI 12
Categories:
Differential approach Based on CBR and female literacy
rate, Category A:58 districts Category B:184 districts Category C:265 districts
All the districts covered in a phased manner over a period of 3yrs
Dr. KANUPRIYA CHATURVEDI 13
Service Package: for mothers
Essential obstetric care Early registration Minimum 3 ANC Safe delivery 3 PNC Referral More relevant for Assam,
Bihar,Rajasthan, Orissa,UP, MP
Dr. KANUPRIYA CHATURVEDI 14
Emergency obstetric care Strengthen FRUs Supply of kits and skilled manpower TBA (Traditional Birth Attendants)
Dai training NGOs involved: More local specific 24-hr Delivery services at
PHCs/CHCs: Promote institutional deliveries
Additional honorariumto staff Safe deliveries
Dr. KANUPRIYA CHATURVEDI 15
Contd. Deliveries by trained personnel in safe and
hygienic surroundings are encouraged Institutional deliveries are encouraged for
women having complications. In case of complication referrals are made
to First Referral Units for Management of obstetric emergencies.
Three postnatal checkups are given to mothers after the delivery.
Spacing of at least three years between children are encouraged.
Dr. KANUPRIYA CHATURVEDI 16
For children
Essential newborn care like keeping the baby warm, checking the baby’s weight and giving the baby mother’s first milk are encouraged.
Babies that are premature or have low birth weight are provided special care.
Babies with any complications refereed to the health center.
Exclusive breast-feeding are encouraged for the first three months.
Dr. KANUPRIYA CHATURVEDI 17
Contd.
Immunization are administered to every child meticulously to prevent death and disabilities.
Vitamin A Prophylaxis ORT. Acute respiratory infection in children
treated by cotrimoxazole tablets. Treatment of Anemia
Dr. KANUPRIYA CHATURVEDI 18
For Eligible Couples Promoting use of contraceptive methods
among eligible couples is important to prevent unwanted pregnancies. Couples should be able to choose from various contraceptive methods including condoms,oral pills, IUDs,male and female sterilization
Safe services for medical termination of pregnancies should be encouraged for women desiring abortions
Other New Services Treatment of RTI/STI is given. Promotion activities for adolescents health.
Dr. KANUPRIYA CHATURVEDI 19
Drug and equipment kits: Mid-wifery kit & drug kit 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
Dr. KANUPRIYA CHATURVEDI 21
RCH Program: Phase II RCH Phase II began from 1 April 2005. The
components being: Essential obstetrical care Emergency obstetrical care Strengthening referral system
Strengthening project management Strengthening infrastructure Capacity building Improving referral system Strengthening MIS Innovative schemes
Dr. KANUPRIYA CHATURVEDI 22
Essential obstetric care
Promotion of institutional deliveries 50% of the PHCs and CHCs made
operational as 24 hours delivery centers. Skilled attendance at birth Policy descions to permit Health
workers to use drugs in emergency situations to reduce maternal mortality
Dr. KANUPRIYA CHATURVEDI 23
Emergency obstetric care
Operationalisation of FRUs to provide: 24 hours delivery services Emergency obstetric care New born care and emergency care of the
sick child Full range of family planning services Safe abortion services Treatment of RTI and STI Blood storage facility Essential laboratory services Referral ( transport ) services
Dr. KANUPRIYA CHATURVEDI 24
New initiatives
Training of PHC doctors in life saving anesthetic skills for emergency obstetric care a FRUs
Setting up of blood storage centres at FRUs Janani suraksha yojana Vandemataram scheme Safe abortion services Integrated Management of Childhood
illnesses.
Dr. KANUPRIYA CHATURVEDI 25
24 hrs. Functioning of PHCs
• It is planned to establish 2000 FRUs in phases in RCH-II 50% PHCs and all CHCs to beoperationalised in phases• Availability of Services such as - 24 Hrs. Delivery services - New Born care - Family Planning, Counselling and services - Availability of RTI, STI services - Safe abortion services (MVA etc.)
Dr. KANUPRIYA CHATURVEDI 26
Training in Anaesthesia
• Training of MBBS Doctors in Life Saving Anaesthetic Skills for Emergency Obstetric Care.• 18 weeks training course• The First Training Programme Conducted at AIIMS for Chhattisgarh• Training to be conducted in phases and limited to the requirement at FRUs.
Dr. KANUPRIYA CHATURVEDI 27
Training in Obstetric Management
• Training of MBBS doctors in obstetric management and skills including C.S. in RCH-II• Training to be conducted in collaboration with FOGSI• Duration of training to be 16 weeks• Expert Group is considering other details
Dr. KANUPRIYA CHATURVEDI 28
Blood Storage Facility
Management of obstetric emergencies is sometimes not possible due to non-availability of blood.
The Drugs and Cosmetics Act was therefore
modified to facilitate establishment of blood
storage centres at FRU’s.
Dr. KANUPRIYA CHATURVEDI 29
Janani Surkasha Yojna
To promote Institutional Deliveries To reduce overall Maternal Mortality Ratio Infant Mortality Rate
A safe motherhood intervention, replacing the “NationalMaternity Benefit Scheme”, under NRHM100 % centrally sponsoredIntegrates cash assistance with delivery& post-delivery care.
Dr. KANUPRIYA CHATURVEDI 30
Vandematram Scheme
It is a voluntary scheme wherein any obstetric and gynaec specialist, maternity home can volunteer
Enrolled doctors will display ‘vandemataram logo’
at their clinics.Iron and folic acid tablets, oral pills, TT injections, etc will be provided for free distribution.
Dr. KANUPRIYA CHATURVEDI 31
Referral Transport
Key issues: Roads, transportation, RCH I funds poorly Utilized, Community participation lackingUnder Consideration – Place funds with AWW /ANM; [ JSY] – Develop community mechanisms – Provide out source ambulances at PHCs CHCs, and FRUs
Easy access to ambulance & assistance from AWW
Dr. KANUPRIYA CHATURVEDI 32
Role of ASHA
• A village level link worker attached to
AWW/ANM• Motivator for ANC, PNC, Institutional Delivery, Immunization and Family Planning Services• Provide Escort to beneficiary for above services.• Adolescents Health Counsellor.
Dr. KANUPRIYA CHATURVEDI 33
Strategy for addressing AdolescentReproductive and Sexual Health (ARSH)A two-pronged strategy will be
supported: Incorporation of adolescent issues
in all the RCH training programs and all RCH materials developed for communication and behaviour change.
Dedicated days and dedicated timings for adolescents at PHC’s.
Dr. KANUPRIYA CHATURVEDI 34
Infection Management and Environment Plan
IMEP which is being extended to health care facilities includes:
a) Treatment and disposal of biomedical wastes
b) Disposal of syringe waste
c) Provision of water sanitation and good hygiene conditions
Dr. KANUPRIYA CHATURVEDI 35
Safe Abortion Practices
MEDICAL METHOD Termination of early pregnancy (49days) using 2
drugs
- mifeprestone followed by mesoprostol
MANUAL VACCUM ASPIRATION Safe and simple technique for termination of
pregnancy. Can be used at PHC or comparable facility FOGSI, WHO & state govt. are coordinating the
project
Dr. KANUPRIYA CHATURVEDI 36
Some Innovative State Initiatives
Gujarat Increase access to safe delivery services. It is
in partnership with private providers (Chiranjivi Yojana)
A Dai Sangathan has been formed by 10 leading NGOs of the state to facilitate interface between the health system and the community
Punjab Proposed to pay an incentive of Rs. 500/- to
BPL SCs belonging to urban areas Purchase and supply of nutrients like iron,
calcium, D-worming tablets for pregnant mothers belonging to SC classes.
Dr. KANUPRIYA CHATURVEDI 37
Contd….
Screening code for Ca Cervix – Tamil
NaduSubsidized Medical Practitioner (SMP) scheme- Assam, Bihar
Nurse Practitioners SchemeLaproscopic Training – MaharashtraImplementation of Health Insurance scheme on pilot basis.
Dr. KANUPRIYA CHATURVEDI 38
Monitoring :Accessibility Indicators 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
Dr. KANUPRIYA CHATURVEDI 39
Quality Indicators
Following are the quality indicators used to monitor and evaluate RCH programme through monthly reports:
1. Number of antenatal cases registered2. Number of pregnant women who had 3 antenatal checkups3. Number of high risk pregnant women referred4. Number of pregnant women who had 2 doses of TT5. Number of pregnant women under prophylaxis and
treatment of anaemia
6. Number of deliveries by trained and untrained attendants
7. Number of cases with complications referred to PHC/FRU
8. Number of newborn with birth weight recorded
Dr. KANUPRIYA CHATURVEDI 40
Contd..
9. No. of women given 3 post natal check-ups10. No. of RTI/STD cases detected, treated and
referred11. No. of children fully immunized 12. No. of adverse reactions reported after
immunization13. No. of cases of ARI and diarrhea under 5yrs
14. No. of cases motivated and followed for contraception.
Dr. KANUPRIYA CHATURVEDI 41
Impact Indicators % 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