Reproductive and Child Health Programme Overview

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R
EPRODUCTIVE
 
AND
 
CHILD
HEALTH
 
PROGRAMME
By
Dr. jyoti k. varthi
Dept. of Swasthavritta & Yoga
D
EFINITION
 -
People have the ability to reproduce and regulate
their fertility, women are able to go through
pregnancy and child birth safely, the outcome of
pregnancies is successful in terms of maternal
and infant survival and well being and couples
are able to have sexual relations free of fear of
pregnancy and of contacting diseases.
W
HY
 
THERE
 
IS
 
A
 
NEED
 ?
                 
Mother and children comprise
71.14 % of the population of developing countries.
57.5 % of the population in India.
Globally MMR ( Maternal mortality Ratio) averages
    16/lac.live births in developed countries
IMR and MMR are high in developing countries.
.
RCH Phase 1 
launched on 
15
th
 October, 1997
.
2001-2002 –A scheme for 
training of dais 
was initiated and
implemented in 156 districts in 18 states/Uts.
RCH Phase 2 
l
aunched
 
on 
1
st
 April 2005.
JANANI SURAKSHA YOJANA (JSY) 
launched on 
12
th
 April
2005.
1
st
 June 2011 – govt. of India launched 
Janani shishu
suraksha karyakram.( JSSK).
INTEGRATED APPROACH TO
THE PROGRAMME
Improving the health status of young women and
children
Namely-
Family welfare programme.
Universal immunization programme.
Oral rehydration therapy.
Child survival and safe motherhood.
Acute respiratory infection control.
 
7
RCH
 
PHASE
-1
The program was formally launched on 15 October 1997.
The RCH program 
 
National Family Welfare Program and 
Child Survival and & Safe Motherhood Program ( CSSM) 
S
exually transmitted disease and 
R
eproductive tract infections. 
8
 
C
OMPONENTS
 
OF
 RCH P
HASE
- 1
 
FAMILY PLANNING
CHILD SURVIVAL
AND SAFE
MOTHERHOOD
PREVENTION/
MANAGEMENTOF
RTI/STD/AIDS
CLIENT 
APPROACH
TO HEALTH 
CARE
M
AIN
 
HIGHLIGHTS
 
OF
 
RCH
 
PROGRAM
    
Family
Planning
MTP & IUD
Insertion
Private sector
inclusion
Collaborate
with NACO in
condom
distribution
Safe
Motherhood
Quality ANC
Institutional
Deliveries
Skilled Birth
Attendance
 Emergency
Obstetric care
Home based post-
partum & NBC
Quality safe
abortion services
Child
Survival
Intensify existing
services. 
Immunization,
NBC
Micronutrient
Supply
Chronic dirrohoel
diseases
ARI
   
RTI/STD
Specialist
facilities for
STD & RTI.
CLIENT
ORIENTED
Address
quality
Based on
needs of
community
M
AJOR
 
INTERVENTION
 
UNDER
 RCH 
PHASE
 
1
1.
 
Essential obstetric care
2.
 Emergency obstetric care
3.
 24 hour delivery service at PHCs / CHCs
4.
 Medical termination of pregnancy
5.
 Control of RTI & STD
6.
 Immunization
7.
 IEC Activities
8.
 Essential new born care
9.
 Diarrhoeal disease control
10.
Acute  respiratory disease control
11.
 Prevention & control of Vit A deficiency in children.
12.
 Prevention & control of anemia in children.
13.
 Introduction of Hepatitis B vaccination.
14.
 Training of Dais.
I
NTERVENTION
 
IN
 
SELECTED
 
STATES
 &
DISTRICT
Screening & treatment of RTI / STD
Emergency obstetric care
Essential obstetric care
Additional ANM at sub centers.
Improved delivery service & emergency care.
Facility of referral transport of pregnant women
 
14
RCH P
ROGRAM
: P
HASE
 II
RCH Phase II began from 
1 April 2005.
 The components being:
1.
Essential obstetric care
2.
Emergency obstetric care
3.
Strengthening referral system
15
N
EW
 
INITIATIVES
Training Of PHC Doctors  In Life Saving
Anesthetic Skills For Emergency Obstetric Care
At FRUS
Setting Up Of Blood Storage Centers At FRUS
Janani Suraksha Yojana
Vandemataram Scheme
Safe Abortion Services
Village Health And Nutrition Day
Maternal Death Review.
Pregnancy Tracking
Janani Shishu Suraksha Karyakram (JSSK)
16
A. E
SSENTIAL
 
OBSTETRIC
 
CARE
Promotion of institutional deliveries
50% of the PHCs and CHCs made operational as
    24 hours delivery centers.
Skilled attendance at birth.
Policy decisions to permit Health workers
    to use drugs in emergency situations to reduce
    maternal mortality.
B. Emergency Obstetric Care :-
         Minimum services provided by FRU are
1)
24 hour delivery services including normal and assisted
deliveries.
2)
Emergency obstetric care including surgical
interventions.
3)
New born care.
4)
Emergency care of sick children.
5)
Full range of family planning services including
laproscopic services.
6)
Safe abortion services.
7)
Treatment of STD/RTI.
8)
Blood storage facility.
9)
Essential laboratory services.
10)
Referral services.
3 Critical determinants of a facility declared as a FRU
a.
Availability of surgical interventions
b.
New born care
c.
Blood storage facility
C. Strengthening Referral system
    Indicates to involve local self help groups, NGOs
    and women groups.
19
24 
HRS
. F
UNCTIONING
 
OF
 PHC
S
It is planned to establish 2000 FRUs in phases in
  RCH-II
   
50% PHCs and all CHCs to be
  operationalised 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.)
20
T
RAINING
  
IN
 A
NAESTHESIA
• Training of MBBS Doctors in Life Saving
   Anaesthetic Skills for Emergency Obstetric
   Care.
• 16 weeks training course
• The First Training Programme
  Conducted at AIIMS  for Chhattisgarh
21
T
RAINING
  
IN
  O
BSTETRIC
 M
ANAGEMENT
 
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.
T
RAINING
 
OF
 
MIDWIVES
23
D
RUG
 
AND
 
EQUIPMENT
 
KITS
: M
ID
-
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
24
    
B
LOOD
   S
TORAGE
   F
ACILITY
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 centers at FRU’s.
25
J
ANANI
 S
URKASHA
 Y
OJNA
Launched on 12
th
 April 2005
To promote Institutional Deliveries
To reduce
Maternal Mortality Ratio
Infant Mortality Rate
A safe motherhood intervention, replacing the
    “National Maternity Benefit Scheme”, under NRHM
100 % centrally sponsored
Integrates cash assistance with delivery
   & post-delivery care.
26
V
ANDEMATRAM
 S
CHEME
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.
27
S
AFE
 A
BORTION
 P
RACTICES
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
 
Village health & nutrition day-
   Once in a month at Anganwadi centres.
Maternal death review –
   Maternal death audit both
   facility and community based.
Pregnancy tracking.
J
ANANI
 
SHISHU
 
SURAKSHA
 
KARYAKRAM
Launched on 
1
st
 June 2011.
   Provide the new facilities to the pregnant women-
Absolutely free and no expense delivery including
caesarean section.
Free medicine, diets, blood and transport.
Similar entitlements for all sick new-borns till 30
days after birth.
The scheme now extended to cover the
complications during ANC, PNC and also sick
infants.
C
HILD
 
HEALTH
 
COMPONENT
Nutritional Rehabilitation Centers (NRCs)
Integrated Management of Neonatal and Childhood
Illnesses (IMNCI).
a.
Newborn care corner (NBCC)
b.
Newborn stabilization Unit (NBSU)
c.
Special newborn care unit (SNCU)
d.
Triage of sick newborns
Navjat Shishu Suraksha Karyakram (NSSK)
Rashtriya Bal Swasthya Karyakram(RBSK)
C
LASSIFY
 
CONDITION
 & 
IDENTIFY
 
TREATMENT
ACTION
 
ACCORDING
 
TO
 
COLOUR
 
CODED
 
T
/
T
 
PINK
Urgent
referral
YELLOW
GREEN
t/t at out
patient health
facility
Home
management
N
AVJAT
 
SHISHU
 
SURAKSHA
KARYAKRAM
 (NSSK)
Aim – to train health personnel in basic newborn
care & resuscitation.
It has been launched to address care at birth issue
prevention of hypothermia
Prevention of infection
Early initiation of breast feeding
Basic newborn resuscitation.
R
ASHTRIYA
 
BAL
 
SWASTHYA
 
KARYAKRAM
Launched on 
Feb 2013
Child health screening & early intervention services
    through early detection & management of 4Ds prevalent in
    Children. (Defects at birth, Diseases in children, Deficiency
    conditions and Development delays).
Age group 0-18 yrs.
P
ROGRAMME
 
IMPLEMENTATION
1) 
For Newborn   0 To 6wks –
     a)Facility based newborn screening at public health
         facilities by existing health manpower.
     b) Community based newborn screening at home
          through ASHA
     2) 
For children 6wks to 6 years 
- At Anganwadi
         center by dedicated mobile health service.
     3) 
For children 6yrs to 18yrs 
–Govt. & Govt. aided
         school  based screening
         -  Twice a year in Anganwadi
         - Once a year  in school children
35
R
EFERRAL
 T
RANSPORT
Key issues:  Roads, transportation, RCH I funds
poorly Utilized, Community participation lacking
Under 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
36
R
OLE
   
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.
G
OALS
 
AND
 
TARGETS
   The 12
th
 five year plan
    the three goals
Reduction of infant mortality rate (IMR)
Reduction of maternal mortality ratio (MMR)
Reduction in total fertility rate (TFR)
38
H
IGHLIGHTS
 
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
39
I
NFECTION
 M
ANAGEMENT
 
AND
E
NVIRONMENT
 P
LAN
1.
Treatment and disposal of biomedical
wastes
2.
Disposal of  syringe waste
3.
Provision of water sanitation and good
hygiene conditions.
ekrk
Pre-conception care
Liquid and sweet diet in 1
st
trimister 
jljDr/kkrqo/kZd
Sweet, liquid and heavy
diet in 2
nd
 trimister
ekalesnks/kkrqo/kZd
Liquid and solid diet rich in
fats and proteins in last
trimister 
vfLFkeTtk’kqØo/kZd
Prasav Paricharya
Concept of Daee
ckyd
Exclusive breast
feeding for 6 months
Continue Breast
feeding till 2 years
Weaning diet: 6
supplementary feeds/
day (Yush, Cereals,
Rice, Legumes)
Suvarnaprashan till
16 years
A
YURVEDIC
 A
PPROACH
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Dr. Jyoti K. Varthi from the Department of Swasthavritta & Yoga highlights the importance of the Reproductive and Child Health Programme. This program aims to ensure safe reproduction, regulate fertility, support maternal and infant health, and promote healthy sexual relationships. The initiative addresses the significant population of mothers and children in developing countries, including India, where maternal and infant mortality rates remain high. Various phases of the program have been launched since 1997, focusing on training, maternal care schemes, and an integrated approach to enhancing the health status of women and children. Components include prevention and management of reproductive health issues, family planning, and child survival efforts.

  • Reproductive Health
  • Child Health
  • Maternal Care
  • Public Health
  • Family Planning

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  1. REPRODUCTIVE AND CHILD HEALTH PROGRAMME By Dr. jyoti k. varthi Dept. of Swasthavritta & Yoga

  2. DEFINITION - People have the ability to reproduce and regulate their fertility, women are able to go through pregnancy and child birth safely, the outcome of pregnancies is successful in terms of maternal and infant survival and well being and couples are able to have sexual relations free of fear of pregnancy and of contacting diseases.

  3. WHY THERE IS A NEED ? Mother and children comprise 71.14 % of the population of developing countries. 57.5 % of the population in India. Globally MMR ( Maternal mortality Ratio) averages 16/lac.live births in developed countries IMR and MMR are high in developing countries.

  4. . RCH Phase 1 launched on 15thOctober, 1997. 2001-2002 A scheme for training of dais was initiated and implemented in 156 districts in 18 states/Uts. RCH Phase 2 launched on 1stApril 2005. JANANI SURAKSHA YOJANA (JSY) launched on 12thApril 2005. 1stJune 2011 govt. of India launched Janani shishu suraksha karyakram.( JSSK).

  5. INTEGRATED APPROACH TO THE PROGRAMME Improving the health status of young women and children Namely- Family welfare programme. Universal immunization programme. Oral rehydration therapy. Child survival and safe motherhood. Acute respiratory infection control.

  6. RCHPHASE-1 The program was formally launched on 15 October 1997. The RCH program National Family Welfare Program and Child Survival and & Safe Motherhood Program ( CSSM) Sexually transmitted disease and Reproductive tract infections. 7

  7. COMPONENTSOF RCH PHASE- 1 PREVENTION/ MANAGEMENTOF RTI/STD/AIDS FAMILY PLANNING 8 CLIENT APPROACH TO HEALTH CARE CHILD SURVIVAL AND SAFE MOTHERHOOD

  8. MAINHIGHLIGHTSOFRCHPROGRAM Safe Child Survival RTI/STD Family Planning MTP & IUD Insertion Private sector inclusion Collaborate with NACO in condom distribution Motherhood Specialist facilities for STD & RTI. Quality ANC Intensify existing services. Immunization, Institutional Deliveries CLIENT ORIENTED Address quality Based on needs of community NBC Skilled Birth Attendance Micronutrient Supply Emergency Obstetric care Chronic dirrohoel diseases Home based post- partum & NBC ARI Quality safe abortion services

  9. MAJORINTERVENTIONUNDER RCH PHASE1 Essential obstetric care Emergency obstetric care 24 hour delivery service at PHCs / CHCs Medical termination of pregnancy Control of RTI & STD Immunization IEC Activities Essential new born care Diarrhoeal disease control 10. Acute respiratory disease control 11. Prevention & control of Vit A deficiency in children. 12. Prevention & control of anemia in children. 13. Introduction of Hepatitis B vaccination. 14. Training of Dais. 1. 2. 3. 4. 5. 6. 7. 8. 9.

  10. INTERVENTIONINSELECTEDSTATES & DISTRICT Screening & treatment of RTI / STD Emergency obstetric care Essential obstetric care Additional ANM at sub centers. Improved delivery service & emergency care. Facility of referral transport of pregnant women

  11. RCH PROGRAM: PHASE II RCH Phase II began from 1 April 2005. The components being: 1. Essential obstetric care 2. Emergency obstetric care 3. Strengthening referral system 14

  12. NEWINITIATIVES Training Of PHC Doctors In Life Saving Anesthetic Skills For Emergency Obstetric Care At FRUS Setting Up Of Blood Storage Centers At FRUS Janani Suraksha Yojana Vandemataram Scheme Safe Abortion Services Village Health And Nutrition Day Maternal Death Review. Pregnancy Tracking Janani Shishu Suraksha Karyakram (JSSK) 15

  13. A. ESSENTIALOBSTETRICCARE Promotion of institutional deliveries 50% of the PHCs and CHCs made operational as 24 hours delivery centers. Skilled attendance at birth. Policy decisions to permit Health workers to use drugs in emergency situations to reduce maternal mortality. 16

  14. B. Emergency Obstetric Care :- Minimum services provided by FRU are 24 hour delivery services including normal and assisted deliveries. Emergency obstetric care including surgical interventions. New born care. Emergency care of sick children. Full range of family planning services including laproscopic services. Safe abortion services. Treatment of STD/RTI. Blood storage facility. Essential laboratory services. 10) Referral services. 1) 2) 3) 4) 5) 6) 7) 8) 9)

  15. 3 Critical determinants of a facility declared as a FRU Availability of surgical interventions New born care Blood storage facility a. b. c. C. Strengthening Referral system Indicates to involve local self help groups, NGOs and women groups.

  16. 24 HRS. FUNCTIONINGOF PHCS It is planned to establish 2000 FRUs in phases in RCH-II 50% PHCs and all CHCs to be operationalised 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.) 19

  17. TRAININGIN ANAESTHESIA Training of MBBS Doctors in Life Saving Anaesthetic Skills for Emergency Obstetric Care. 16 weeks training course The First Training Programme Conducted at AIIMS for Chhattisgarh 20

  18. TRAININGIN 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. 21

  19. TRAININGOFMIDWIVES

  20. DRUGANDEQUIPMENTKITS: MID-WIFERY KIT & DRUGKIT 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 23

  21. 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 centers at FRU s. 24

  22. JANANI SURKASHA YOJNA Launched on 12th April 2005 To promote Institutional Deliveries To reduce Maternal Mortality Ratio Infant Mortality Rate A safe motherhood intervention, replacing the National Maternity Benefit Scheme , under NRHM 100 % centrally sponsored Integrates cash assistance with delivery & post-delivery care. 25

  23. 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. 26

  24. 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 27

  25. Village health & nutrition day- Once in a month at Anganwadi centres. Maternal death review Maternal death audit both facility and community based. Pregnancy tracking.

  26. JANANISHISHUSURAKSHAKARYAKRAM Launched on 1st June 2011. Provide the new facilities to the pregnant women- Absolutely free and no expense delivery including caesarean section. Free medicine, diets, blood and transport. Similar entitlements for all sick new-borns till 30 days after birth. The scheme now extended to cover the complications during ANC, PNC and also sick infants.

  27. CHILDHEALTHCOMPONENT Nutritional Rehabilitation Centers (NRCs) Integrated Management of Neonatal and Childhood Illnesses (IMNCI). Newborn care corner (NBCC) a. Newborn stabilization Unit (NBSU) b. Special newborn care unit (SNCU) c. Triage of sick newborns d. Navjat Shishu Suraksha Karyakram (NSSK) Rashtriya Bal Swasthya Karyakram(RBSK)

  28. CLASSIFYCONDITION & IDENTIFYTREATMENT ACTIONACCORDINGTOCOLOURCODEDT/T GREEN YELLOW PINK t/t at out patient health facility Urgent referral Home management

  29. NAVJATSHISHUSURAKSHA KARYAKRAM (NSSK) Aim to train health personnel in basic newborn care & resuscitation. It has been launched to address care at birth issue prevention of hypothermia Prevention of infection Early initiation of breast feeding Basic newborn resuscitation.

  30. RASHTRIYABALSWASTHYAKARYAKRAM Launched on Feb 2013 Child health screening & early intervention services through early detection & management of 4Ds prevalent in Children. (Defects at birth, Diseases in children, Deficiency conditions and Development delays). Age group 0-18 yrs.

  31. PROGRAMMEIMPLEMENTATION 1) For Newborn 0 To 6wks a)Facility based newborn screening at public health facilities by existing health manpower. b) Community based newborn screening at home through ASHA 2) For children 6wks to 6 years - At Anganwadi center by dedicated mobile health service. 3) For children 6yrs to 18yrs Govt. & Govt. aided school based screening - Twice a year in Anganwadi - Once a year in school children

  32. REFERRAL TRANSPORT Key issues: Roads, transportation, RCH I funds poorly Utilized, Community participation lacking Under Consideration Place funds with AWW /ANM; [ JSY] Develop community mechanisms Provide out source ambulances at PHCs CHCs, and FRUs 35 Easy access to ambulance & assistance from AWW

  33. ROLEOF 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. 36

  34. GOALSANDTARGETS The 12th five year plan the three goals Reduction of infant mortality rate (IMR) Reduction of maternal mortality ratio (MMR) Reduction in total fertility rate (TFR)

  35. HIGHLIGHTSOFTHEPROGRAM 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 38

  36. INFECTION MANAGEMENTAND ENVIRONMENT PLAN 1. Treatment and disposal of biomedical wastes 2. Disposal of syringe waste 3. Provision of water sanitation and good hygiene conditions. 39

  37. AYURVEDIC APPROACH ekrk ckyd Pre-conception care Liquid and sweet diet in 1st trimister jljDr/kkrqo/kZd Sweet, liquid and heavy diet in 2nd trimister ekalesnks/kkrqo/kZd Liquid and solid diet rich in fats and proteins in last trimister vfLFkeTtk kq o/kZd Prasav Paricharya Concept of Daee Exclusive breast feeding for 6 months Continue Breast feeding till 2 years Weaning diet: 6 supplementary feeds/ day (Yush, Cereals, Rice, Legumes) Suvarnaprashan till 16 years

  38. THANK YOU

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