Post Graduate student in Community Medicine(M.D) Department of Community Medicine / SRMC & RI (DU )

1. INDIA B.Sc., M.B.B.S., D.P.H., D.I.H.,PGCH&FW(NIHFW) INDIAN RAILWAY MEDICAL SERVICE Post Graduate student in Community Medicine(M.D) Department of Community Medicine / SRMC & RI (DU )

12. MAJOR CAUSES OF M.M.R • DIRECT CAUSES • HEMORRHAGE – 29.6% • PUERPERAL COMPLICATION – 16.1% • OBSTRUCTED LABOUR – 9.5% • ABORTIONS – 8.9% • TOXAEMIA OF PREGNANCY 8.3% • INDIRECT CAUSES • Anaemia • Pregnancy with TB • Pregnancy with malaria • Pregnancy with viral hepatitis

15. DISPARITY OF MATERNAL DEATH BETWEEN DEVELOPED & DEVELOPING COUNTRIES • BARRIER TO RECEIVE TIMELY & GOOD QUALITY CARE • BARRIER OF AVAILABILITY AND ACCESSIBILITY OF SERVICES • POLITICAL BARRIER • GEOGRAPHICAL BARRIER • CULTURAL BARRIER • WOMEN’S LITERACY AND WOMEN EMPOWERMENT • TIME BARRIER • ECONOMIC BARRIER • BARRIER TO HAVE HEALTH PERSONNEL AT GRASS ROOT LEVEL

17. RCH – Ι PROGRAMME 15.10. 1997

18. 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.

19. 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

24. 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

25. 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

26. 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)

27. STRATEGY • BOTTOM-UP PLANNING • COMMUNITY NEED ASSESSMENT APPROACH • DECENTRALISED PARTICIPATORY PLANNING & IMPLEMENTATION • STRENGTHENING INFRASTUCTURE • INTEGRATED TRAINING PACKAGE • IMPROVED MANAGEMENT SYSTEM • INTERVENTIONS • MONITORING & EVALUATION

28. 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

30. COMPLICATIONS DURING ANTE-NATAL, INTRA NATAL, AND POST NATAL PERIOD & WHERE TO REFER

31. 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

32. 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

33. 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)

34. 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

35. 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 STRATEGY TO TAKE CARE OF SICK NEWBORNS

39. ACHIVEMENT OF H & FW INDICATORS IN TAMILNADU( 1997-2002) • LIFE EXPECTANCY AT BIRTH – 65 • CRUDE BIRTH RATE – 19.2 • CRUDE DEATH RATE – 7.9 • NATURAL GROWTH RATE – 1.1 • INFANT MORTALITY RATE – 51 • UNDER FIVE MORTALITY RATE – 15.1( R )9.7( U ) • MATERNAL MORTALITY RATE – 1.3 • TOTAL FERTILITY RATE – 1.95 • COUPLE PROTECTION RATE – 51.6 • MEAN AGE AT MARRIAGE – 21.2 • ANTE NATAL CARE – 98.5% • POST NATAL CARE – 90% • INSTITUTIONAL DELIVERY – 87.6% • DELIVERY BY TRAINED STAFF – 98% • PNMR –43/1000 • NNMR – 38/1000 • % OF LOW BIRTH WEIGHT BABIES –17% • AVERAGE BIRTH WEIGHT OF BABIES – 2.7 KG • STILL BIRTH RATE – 11.7/1000 • IMMUNIZATION COVERAGE –100%

42. RCH - II PROGRAMME 01-04-2005

43. THE 5 YEAR PHASE OF RCH II VISIONTo 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

45. 1728 - FRU PHC-22928 SUB CENTER-38044

46. 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.

47. 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 counselling sessions for the mothers. c. Implementing integrated management of neonatal and childhood illness as a pilot initiative in selected districts in Tamil Nadu. d. Operationalising infant death/stillbirth verbal autopsy. e. Addressing the issue of female infanticide and foeticide.

48. 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.

49. 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.

50. 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