REPRODUCTIVE AND CHILD HEALTH

PROGRAMME

SOBANA.M., M.Sc(N)

LECTURER

WHAT IS RCH APPRAOCH?

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 contracting diseases.

RCH PHASE - I

The programme was formally launched on 15th October 1997.

RCH PHASE 1 PROGRAMME INCORPORATED THE 4 COMPONENT

RCH PACKAGE

Family planning

Child survival and safe motherhood

Client approach to health care

Prevention and management of

RTI/STDs/AIDS

RCH phase – I interventions in all districts• Child survival interventions i.e immunization, vit-A, ORT and

prevention of pneumonia.

• Safe motherhood interventions e.g. antenatal check up,immunization for tetanus, safe delivery, anaemia controlprogramme.

• Implementation of target free approach

• High quality training at all levels

• IEC activities

• Specially designed RCH package for urban slums and tribalareas

• District sub-projects under local capacity enhancement

• RTI/STD clinics at district hospitals

• Facility for safe abortions at PHC by providing equipmentsand contractual doctors.

• Enhanced community participation through panchayats,women’s groups and NGOs

• Adolescent health and reproductive hygiene

RCH phase – I interventions in selected states

• Screening and treatment of RTI/STD at sub-

divisional level

• Emergency obstetric care at selected FRUs

• Essential obstetric care

• Additional ANM at sub-centres

• Improved delivery services and emergency care

by providing drug and equipments, ANM kits at

sub-centres

• Facility of referral transport for pregnant

women during emergency (through panchayats)

RCH – I services and major interventions

1.Essential obstetric care

2.Emergency obstetrical care

3.24 -hour delivery services at PHCs\CHCs

4.Medical termination of pregnancy MTP act 1971

5. Control of reproductive tract infections and sexually

transited diseases

6.Immunization

7.Drug and equipment kits : equipment kits supplied at various

levels as follows:

• At sub-centre level : United Nations Office for Project

Services

Drug kit A

Drug kit B

Mid- wifery kit

Sub- centre equipment kit

• At PHC level- PHC equipment kit

• At CHC level- equipment kits from kit E to kit P

8.Essential newborn care

9.Oral rehydration therapy

10.Prevention and control of vitamin A deficiency in children

Under the program , doses of vitamin A are given to all children under 5 years

of age.

• The first dose( 1 lakh units) is given at nine months of age along with

measles vaccination

• The second dose is given along with DPT\ OPV booster doses

• Subsequent doses ( 2 lakh units each) six months intervals

11. Acute respiratory disease control cotrimoxazole is being supplied to the

health worker through the CSSM drug kit

12. Prevention and control of anemia in children under this program of control

and prevention of anemia ,tablets containing 20 mg of elemental iron and

100 mcg for of folic acid for 5 years, 30 mg iron and 250 mcg 6-10 years

for 100 days are provided at sub-centre level .

The health workers to provide 100 tablets to children clinically found to be

anemic.

13. Training of Dais

RCH –PHASE II

RCH –PHASE II began from 1st April 2005,the focus is to reduce

maternal and child mortality and morbidity with emphasis on rural

health care. The major strategies are

1) Essential obstetric care

a. Institutional delivery

b. Skilled attendance at delivery

c. Policy decisions

2) Emergency obstetric care

a. operationalizing first referral units

b. operationalizing PHCs and CHCs for round clock delivery

services

3) Strengthening referral system

1) Essential obstetric care

• A) INSTITUTIONAL DELIVERY:

to promote institutional delivery 50% of PHC and CHC would be

made operational as 24 hours delivery centre.

• B) SKILLED ATTENDANCE AT DELIVERY:

for MOs/ ANMs/LHVs – guidelines for conducting normal

delivery and management of obstetric complications.

• C) POLICY DECISIONS:

ANMs/LHVs/SNs – Permitted to use drugs in specific emergency

situations to reduce maternal mortality.

2) Emergency obstetric care (EmOC)

• The FRUs be made operational for providing emergency obstetric care

• The minimum services provided by a fully functional FRUs

1. 24 hrs delivery services including normal and assisted deliveries

2. EmOC including surgical interventions like caesarean section.

3. New-born care

4. Emergency care of sick children.

5. Full range of family planning services including laproscopicservices.

6. Safe abortion services

7. Treatment of RTIs/STIs.

8. Blood storage facility

9. Essential lab services

10. Referral (transport ) services.

3) Strengthening referral system

• Funds were given to panchayat for providing

assistance to poor people in case of obstetric

emergencies.

• Involvement of local self-help groups, NGOs and

women groups.

NEW INTIATIVES

1. Training of MBBS doctors in life saving

anesthetic skills for emergency obstetric care.

Govt .of India is also introducing training of MBBS doctors of obstetric

management skills, prepared training plan for 16 weeks in all obstetric

management skills,inculding caesarean section operation.

2.Setting up of blood storage centres at FRUs

according to government of India guidelines

3.JANANI SURAKSHA YOJANA

• The national maternity benefit scheme has been modified

into a (JSY) JANANI SURAKSHA YOJANA.

• It was launched on 12th April 2005.

• It is a 100% centrally sponsored scheme

• Under national rural health mission ,it integrates the cash

assistance with institutional care during antenatal, delivery

and immediate post-partum care

• ASHA would work as a link worker

THE SCALE OF ASSISTANCE UNDER THE SCHEME FROM 2012-13

CATEGORY

RURAL AREA URBAN AREA

MOTHER’S PACKAGE

ASHAS’S

PACKAGE*TOTAL Rs

MOTHER’S PACKAGE

ASHAS’S PACKAGE**

TOTALRs

LPS 1400 600 2000 1000 400 1400

HPS 700 600 1300 600 400 1000

*ASHA incentives of Rs-600 in rural area: Rs-300 for ANC component and Rs-300 for

accompanying PWs for institutional delivery

** ASHA incentives of Rs-400 in urban area: Rs-200 for ANC component and Rs-200 for

accompanying PWs for institutional delivery

The eligibility of cash assistance

• In LPS:

all women including SC &ST families.

• In HPS:

BPL women and SC,ST pregnant women.

• In LPS:

all births.

• In HPS:

upto 2 live births.

The limitation of cash assistance for institutional delivery

4.VANDEMATARAM SCHEME

• It is a voluntary scheme wherein any obstetric and gynaec

specialist, maternity home, nursing home, MBBS DOCTORS

can volunteer themselves for providing safe motherhood

services.

• 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.

5.Safe abortion services

• Under RCH – II the following services are provided:

– Medical method of abortion:

• Under preview of MTP act-1971; Mifepristone (RU 486)

followed by Misoprostol. It is recommended upto 7 weeks(49

days) of amenorrhoea.

– Manual vacuum aspiration:

• MVA technique has been piloted in coordination with FOGSI

(FEDERATION OF OBSTETRIC AND GYNECOLOGICAL

SOCIETIES OF INDIA), WHO and respective state Govts.

6.Village health and nutrition day

• Once in a month at AWCs

• To provide antenatal/post-partum care to PW, promote

institutional delivery, health education, immunization, family

planning and nutrition services.

7.Maternal death review

• Both facility and community maternal death review

• To improve the quality of obstetric care and

reduce the maternal morbidity and mortality.

8.JANANI-SHISHU SURAKSHA KARYAKRAM (JSSK)

• Launched on 1st June 2011

• To make available better health facilities for women and

child.

• The facilities to pregnant women:

– all PW delivering in PH institutions to have absolutely free and no expense

including C-Section.

– The entitlements include free drugs & consumables, free diet upto 3 days

during normal delivery and upto 7 days for C-section, free diagnostics and

free blood, free transport from home to institution & between facilities an

case of referral.

– Similar entitlements for all sick newborns.

– The scheme has now been extended to cover the complications during ANC,

PNC & sick newborn.

• The strategy for child health care, aims to reduce

under-five child mortality through improved child

care practices and child nutrition.

1.Nutritional rehabilitation centres( NRCs)

• Medical and nutritional care to severe acute malnutrition

children under 5 years of age.

• The services provided:

1. 24 hrs care and monitoring of the child

2. Treatment of medical complications

3. Therapeutic feeding

4. Sensory stimulation and emotional care

5. Counselling on appropriate feed, care and hygiene

6. Demonstration and practice by doing of energy dense food

7. Social assessment of family

8. Follow-up of the children discharged from the facility.

2.IMNCI (INTEGRATED MANAGEMENT OF NEONATAL

AND CHILDHOOD ILLNESS)

• IMNCI is one of the main intervention under RCH-II.

• The objective is to implement IMNCI package at the level of

household, and through ANMs at sub-centre level; through

MOs, nurses and LHVs at PHC level.

Pre-service IMNCI

• IMNCI is being included in the curriculum of medical

colleges. This will help in providing trained IMNCI

manpower in public and private sector.

Facility based IMNCI (F-IMNCI)

• Integration of facility based care package with

IMNCI package, to empower the health personnel

with the skill to manage newborn and childhood illness

at community level as well as the health facility.

Facility based newborn care

Health facility All newborns at birth

Sick newborn

PHC/SC identified as MCH level -I

NBCC (newborn care corner) in labor

rooms

Prompt referral

CHC/FRUs identified as MCH level - II

NBCC in labor rooms and in operation

theatre

NBSU (newborn stabilization unit)

District hospitals identified as MCH

level-III

NBCC in labor rooms and in operation

theatre

SNCU (special newborn care unit)

3. HOME BASED NEWBORN CARE (HBNC)

• Aimed at improving newborn survival

• Strategy is to universal access to home based

newborn care

• The providers of service include AWWs, ANM,

ASHA and the MO.

• However ASHA is the main person involved in

home based newborn care.

4. NAVJAT SHISHU SURAKSHA KARYAKRAM (NSSK)

• Is a programme aimed to train health

personnel in basic newborn care and

resuscitation.

• Launched to address care at birth issue i.e

prevention of hypothermia, prevention of

infection, early initiation of breat-feeding

and basic newborn resuscitation.

5. RASHTRIYA BAL SWASTHYA KARYAKRAM (RBSK)

• Launched in February 2013.• Provision for child health screening and

early intervention services through early detection and management of 4 Ds prevalent in children.

• 4 Ds:1. Defects at birth2. Deficiency conditions3. Diseases in children4. Developmental delays including disabilities

Quality indicators

• % Pregnancy Registered before 12 weeks

• % ANC with 3 visits

• % ANC receiving all RCH services

• % High risk cases referred

• % High risk cases followed up

• % deliveries by ANM/TBA

• %PNC with 3 PNC visits

• % PNC receiving all counselling

Cont…

• % PNC complications referred

• % Eligible couple offered FP choices

• % women screened for RTI/STDs

• % Eligible couple counselled for prevention of RTI/STDs

• % ADD given ORS

• % ARI treated

• % children fully immunized

Reference

• Park's Textbook of Preventive and Social Medicine 24th Edition/2017.