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Reproductive and Child Health Programme

Reproductive and Child Health Programme. Genesis of RCH Program. Family Planning Program (1952) Family Welfare Program (1977) UIP (1985) ORT (1990) Child Survival and Safe Motherhood Program (1992) RCH Phase I (1997) NRHM (2005) - RCH Phase II RMNCH+A strategy (2013)

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Reproductive and Child Health Programme

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  1. Reproductive and Child Health Programme

  2. Genesis of RCH Program • Family Planning Program (1952) • Family Welfare Program (1977) • UIP (1985) • ORT (1990) • Child Survival and Safe Motherhood Program (1992) • RCH Phase I (1997) • NRHM (2005) - RCH Phase II • RMNCH+A strategy (2013) • National Health Mission (2013) • India Newborn Action Plan (2014)

  3. RCH Phase I • To bring down the birth rate < 21/1000 population • To reduce the infant mortality rate < 60/1000 live births • To bring down the maternal mortality rate <400/1,00,000 lakh live births • 80%% institutional delivery, 100% antenatal care and 100% immunization of children

  4. The paradigm shift • Vertical programs Integrated service • Camp oriented Client oriented • Target oriented Goal oriented • Quantity oriented Quality oriented

  5. RCH Phase II 1. Essential obstetrical care • Institutional delivery • Skilled attendance at delivery 2. Emergency obstetric care (EmOC) • Operationalising FRUs • Operationalising PHCs and CHCs round the clock 3. Strengthening referral system

  6. First Referral Unit (FRU) • 24 hours delivery services • Emergency obstetric care (Surgical interventions) • 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

  7. JananiSurakshaYojana (JSY) •  Safe motherhood intervention under NRHM • To reduce maternal and neonatal mortality by promoting institutional delivery among the poor pregnant women • 100% centrally sponsored scheme • Integrates cash assistance with delivery and post-delivery care • ASHA - effective link in 10 LPS (8 EAG states, Assam, J&K) and the remaining NE States • AWWs and TBAs/ASHA like activist - other states & UTs

  8. Tracking each pregnancy • PHC should mandatorily prepare a micro-birth plan • LPS – all births, HPS – only 2 live births

  9. JananiShishuSurakshaKaryakram (JSSK) • More than 25% women hesitate to access health facilities • Not willing to stay for 48 hours • High out of pocket expenditure (user charges, purchase from market, Caesarean section charges, diet, transport)

  10. Free Entitlements for pregnant women • Cashless delivery/C-Section • Drugs, consumables & diagnostics • Diet during stay in the health institutions • Provision of blood • Exemption from user charges • Transport from home to health institutions & drop back after 48hrs stay • Transport between facilities in case of referral

  11. Free entitlements for sick newborns/infants • Treatment • Drugs, consumables & diagnostics • Provision of blood • Exemption from user charges • Transport from home to health institutions & drop back • Transport between facilities in case of referral

  12. Vandemataram scheme • Voluntary scheme • Providing safe motherhood services • Vandemataram logo • IFA, oral pills, TT injections provided by govt. • Referral to govt. facilities for cases requiring special care and treatment

  13. PradhanMantriSurakshitMatritvaAbhiyan

  14. RMNCH+A Framework

  15. Rationale of RMNCH+A strategies • reproductive, maternal, and child health cannot be addressed in isolation • focuses on what the health delivery system can do to help achieve MCH goals • provide an understanding of comprehensive approach to improve child survival and safe motherhood

  16. Goals related to RMNCH+A approach • Reduction IMR to 25 per 1000 live births by 2017 • Reduction in MMR to 100 per 1 lakh live births by 2017 • Reduction in TFR to 2.1 by 2017

  17. Adolescent health • Adolescent nutrition; iron and folic acid supplementation • Facility-based adolescent reproductive and sexual health services (Snehaclinics) • Information and counseling on adolescent sexual reproductive health and other health issues • Menstrual hygiene • Preventive health checkups

  18. Pregnancy and childbirth • Delivery of antenatal care package and tracking of high-risk pregnancies • Skilled obstetric care • Immediate essential newborn care and resuscitation • Emergency obstetric and new born care • Postpartum care for mother and newborn • Postpartum IUCD and sterilization • Implementation of PC & PNDT act

  19. Newborn and child care • Home-based newborn care and prompt referral • Facility-based care of the sick newborn • Integrated management of common childhood illnesses (diarrhoea, pneumonia and malaria) • Child nutrition and essential micronutrients supplementation • Immunization • Early detection and management of defects at birth, deficiencies, diseases and disability in children (0–18 years) [RBSK]

  20. Through the Reproductive Years • Community-based promotion and delivery of contraceptives • Promotion of spacing methods (interval IUCD) • Sterilisationservices (vasectomies and tubectomies) • Comprehensive abortion care (includes MTP Act) • Prevention and management of sexually transmitted and reproductive infections (STI/RTI)

  21. Health system strengthening • Caseload based deployment of HR at all levels • Ambulance, drugs, diagnostics and treatment commodities • Health education, demand promotion and behaviour change communication

  22. Supportive supervision, use of data for monitoring and review including score card based on HMIS • Public grievance redressal mechanism, client satisfaction and patient safety through all round quality assurance

  23. Cross cutting interventions • Bring down out of pocket expenditure • ANMs and nurses to provide quality care • Address social determinants of health • Focus on un served and underserved areas • Include difficult areas and performance based incentives

  24. Monitoring and Evaluation • Civil registration system • Web enabled Mother and Child Tracking System (MCTS) • Maternal Death Review (MDR) • Perinatal and Child Death Review • Health Management Information System (HMIS) based monitoring and review • Review missions • National surveys

  25. Monitoring RMNCH+A using scorecard • Score card is a simple management tool for converting available HMIS information into actionable points and assists in comparative assessment of district and block performance • 16 indicators selected based on life cycle approach representing various phases

  26. Indicators that reflect key outcomes such as full antenatal care, institutional deliveries, sterilization procedures, IUCD insertion, full immunization, child deaths due to diarrhoeaand acute respiratory infections, and maternal deaths

  27. Process indicators such as postnatal home visits for mothers and newborns, newborns admitted to SNCUs, number of caesarean sections

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