RMNCH+A

1. REPRODUCTIVE, MATERNAL,
NEONATAL, CHILD AND
ADOLESCENT HEALTH ( RMNCH+A)
• Presented by :-
• Chandrika-19026
• Chinmay-19027
• Dalmeet-19028
• Deepak-19029
• Deepak-19030

2. CONTENT
1. Introduction to RMNCH+A
2. Reproductive Health And Programmes
3. Maternal Health and Its Components
4. Maternal Health Programme
5. Score Card, Data and Success of RMNCH+A

3. RMNCH+A
Introduction & Overview

4. BACKGROUND
In June 2012, Government of India (GOI), Ethiopia,
USA and UNICEF convened the “Global child
survival call to action : a promise to keep.”
In Feb. 2013, GOI launched-“A strategic approach
to reproductive, maternal, newborn , child and
adolescent health(RMNCH+A).

5. RMNCH +A
• Adolescent included
• Linkage of home and community based service to facility
based care.
• Linkage of maternal and child health to
- reproductive health,
- family planning,
- adolescent health and
- prenatal diagnostic techniques.
• Ensuring linkages, referrals and counter referrals
• .

7. AIMS
• To reach the maximum number of people in the remotest
corners of the country through
- Continuum of services
- Constant innovation
- Routine monitoring of interventions

8. GOALS AND OBJECTIVES
By 2017:-
Reduction in infant mortality rate to 25 per 1000 live births
 Reduction in maternal mortality rate to 100 per 100,000
live births
Reduction in total fertility rate to 2.1

9. COVERAGE TARGETS
RMNCH+A focuses on Increase of:
• Delivery Points (@100% Institution)
• Institutional deliveries (@5.6% annually from 61%)
• Improve ANC (@6% annually from 53%)
• Improve PNC (@7.5% annually from 45%)
• Deliveries by SBAs (@2% annually from 76%)

10. COVERAGE TARGETS
RMNCH+A focuses on Increase of (2009)
• Exclusive breast feeding (@ 9.6% annually from 35%)
• 3 doses of DPT ( @ 3.5% annually from 7% )
• ORS use in Diarrhea (@7.2% annually from 43%)
• Child sex ratio (0.6% annually of base line of 91.4%)

11. COVERAGE TARGETS
RMNCH+A focuses on Decrease of:
• Underweight children prevalence (@5.5% annually from 45%)
• Unmet need for NFP methods (@8.8% annually from 21%)
• Anemia in adolescent girls & boys (@6% annually from 56%)
• Total fertility contributed by adolescents (@3.8% annually from
16%)

13. HEALTH SYSTEMS STRENGTHENING
• Cases load based deployment of HR at all levels.
• Ambulances, drugs, diagnostics, RCH commodities.
• Health education, demand promotion & behavior change
communication.
• Supportive supervision and scorecards based on HMIS.
• Public grievances redressal mechanism, client satisfaction and
patient safety through quality assurance.

14. CROSS CUTTING INTERVENTIONS
- Bring down out of pocket expenses.
- ANMs and Nurses to provide specialized and quality care to
pregnant women and children.
- Address social determinants of health through
convergence.
- Focus on un-served and undeserved villages, urban slums
and blocks.
- Introduce difficult area and performance based incentives.

15. REPRODUCTIVE HEALTH

16. Definition
A state of complete physical, mental and
social well being and not merely the absence
of disease, in all matters relating to the
reproductive system and to its functions and
processes- WHO

17. Reproductive Health
• Under 5x5 matrix
• has five interventions
1. Focus on spacing methods, particularly PPIUCD at high case
load facilities.
2. Focus on interval IUCD at all facilities including subcentres on
fixed days.
3. Home Delivery of Contraceptives (HDC) and Ensuring
Spacing at Birth (ESB) through ASHA.
4. Maintaining quality sterilization services.
5. Ensuring access to pregnancy testing kits and strengthening
comprehensive abortion care services.

18. Interventions

19. 1. Focus on spacing methods
SPACING METHOD SERVICE PROVIDER SERVICE LOCATION
IUCD 380 A
IUCD 375
Trained & certified
ANMs, LHVs, SNs and
Doctors
Sub centre & higher
levels
Injectable
contraceptive MPA
Trained ANMs, SNs
and Doctors
Sub centre & higher
levels
OCPs Trained ASHAs, ANMs,
LHVs, SNs and doctors
Village level Sub
centre & higher levels
Condoms Trained ASHAs, ANMs,
LHVs, SNs and doctors
Village level Sub
centre & higher levels

20. 2. Fixed day Interval IUCD
• At all facility on fixed days
• Including Sub centre
• Interval IUCD: Inserted in the uterus at any time of
menstrual cycle after 6 weeks of giving birth.
• Education, Motivation and counseling to adopt
appropriate Family planning methods.
• Provision of contraceptives such as condoms,
OCPs, IUCD insertions.

21. 3. Home Delivery of Contraceptives
• Improve access to contraceptives by eligible couples through
ASHA workers.
List of eligible couples and selection of contraceptive
• ASHA would charge Rs 1/- for a pack of three condoms,
Rs 1/- for a cycle of OCP
Rs 2/-for a pack of one tablet of ECP

23. 4. Comprehensive abortion care
services
• To prevent maternal death or injury
• Counselling for Post abortion contraceptive
methods.
• Clinical assessment of women with various medical
conditions.
• Providing different methods and techniques of
termination at 1st and 2nd trimester.
• Providing free pregnancy test kits to Health
workers/ASHA/USHA.

24. 5. Quality sterilization services
• Provide quality of care in sterilization at both static facilities
and camps.
• Tubectomy and Vasectomy by MBBS doctor/or a post
graduate doctor.
• Laparoscopic sterilization for females by a gynecologist
with DGO/MS qualification or by a surgeon with an MS
degree.

25. Sequence of care at different
levels of health system

26. Clinical:
Health facility level
1. Comprehensive abortion care
2. RTI/STI case management.
3. Postpartum IUCD and sterilization; interval IUCD
procedures
4. Adolescent friendly health services under RKSK Eg:
Yuva Swasthya Pramarsh Kender

27.  Outreach:
Sub-centre
1)Family planning.
2)Prevention and management of STIs.
3)Peri-conception folic acid supplementation.

29.  Family & community
1) Weekly IFA supplementation:
WIFS
• To meet the challenge of high prevalence and incidence of
anaemia and
• Tab contain Elemental Iron -100 mg and Folic Acid 500mcg
by fixed day approach
• Biannual de-worming (Albendazole 400mg) 6 months apart
(1-19)

31. 2) Information and counselling on sexual reproductive health and
family planning.
3) Community based promotion and delivery of contraceptives.
4) Menstrual hygiene: MHS (Age group covered- 10 to 19 yrs)
-Ensures adequate knowledge and information on menstrual
hygiene.
-Sanitary napkins are provided to (10-19 yrs)
girls
-Provision of incinerators in education institutes to dispose
sanitary napkins

33. MATERNAL HEALTH UNDER
RMNCH+A

34. Maternal Health
Maternal health refers to health of women during
pregnancy , childbirth and postnatal period.
About 15% pregnancies may develops complication
which mostly can be prevented.
Complication can be averted by:
 Preventive care
 Skilled care
 Early detection of risk
 Management of obstetric complications

35. NEED FOR LINKAGE: MATERNAL
HEALTH
Worldwide 810 women/ day die due to pregnancy related
complication .
94% of these deaths occur in poor and lower socio-
economic country
COMPREHENSIVE APPROCH
To tackle:
 Maternal morbidity
 Maternal mortality
"CONTINUUM OF CARE”

36. Key Intervention: Maternal Health in
RMNCH+A
1. Use MCTS to ensure early registration of pregnancy and full
ANC.
2. Detect high risk pregnancies and line list including severely
anaemic mothers and ensure proper management.
3. Equip delivery points with highly trained HR and ensure
equitable access to Emergency OC services
4. Review maternal, infant and child deaths for corrective
actions.
5. Identify villages with high numbers of home deliveries.

37. MOTHER AND CHILD TRACKING SYSTEM
(MCTS)
COMPONENTS:
Initiated by Ministry of
health and family welfare.
“Ensure timely delivery of
full spectrum of heath
services to beneficiaries”
• Pregnant women
• Children up to 5 years of
age
1. Capturing detailed
information about
beneficiaries.
2. Maternal health card
3. Mobile bases SMS
technology
4. Mother and child tracking
facilitation Centre.

38. Components of maternal
health care
ESSENTIAL
OBSTETRIC
CARE
EMERGENCY
OBSTETRIC
CARE

39. ESSENTIAL OBSTETRIC CARE
• To provide basic maternity services
• All pregnant women
•
1. Quality antenatal care
2. Essential obstetric care during delivery
3. Essential Postnatal care for mother and New born
STRATEGIES

40. 1)QUALITY ANC-
Minimum of 4 antenatal visits
ANC package
Detect of high risk pregnancies follow up and
treatment.
2)CARE DURING DELIVERIES (INTRA NATAL CARE)
Free institutional deliveries at its network of health
facility.
24 X 7 PHCs services
Safe and clean delivery.
Through FRU, Delivery units
Eessential Obstetric Care Strategies

41. POSTNATAL CARE FOR MOTHER AND NEWBORN
Diet of mother
Hygiene
Emotional support
Prevention of any disease
Breastfeeding and breast care
PNC within first 24 hours&
Subsequent visits by ASHA on 3,7 and 42 day (total of
4 visits)
Eessential Obstetric Care Strategies…..Conti…

43. EMERGENCY OBSTETRIC CARE
DELIVERY POINTS
FIRST REFERRAL
UNIT(FRUs)
MATERNAL AND CHILD
HEALTH WING

44. EMERGENCY OBSTETRICAL CARE
 INTRODUCED BY WHO, UNICEF AND UNFPA
IN1997
 To prevent morbidity and mortality.
Operational first referral units
Skilled birth attendant
Tackling obstetric emergencies

45. DELIVERY POINTS:
Designated based on provision of services for delivery care.
L1
L2
L3
CONDUCT MINIMUM 3 NORMAL
DELIVERIES /MONTH
CONDUCT MIMIMUM 10
DELIVERIES/MONTH INCLUDING
MANAGEMENT OF
COMPLICATIONS
MINIMUM 20-50
DELIVERY/MONTH INCLUDING
C- SECTION
EMERGENCY OBSTETRICAL CARE

46. DELIVERY POINTS: Purpose:
Short term goals:
Strengthening of facilities –providing comprehensive
RMNCH services.
Should be supported by referral transport system.
LONG TERM GOAL:
To establish and operationalize basic emergency
obstetric care as well as comprehensive care centres.

47. FIRST REFERRAL UNIT(FRUs)
•FRUs is an upgraded CHC
•It is the first unit going to receive the referred cases.
•3 Component: 2 Objectives
1)Availability of obstetrician
2)Availability of Anaesthetic
3)Availability of Blood bank
1. 24 X 7 functional units.
2. To promote basic
emergency obstetric
care & early neonatal
care

48. Services at FRU

49. Maternal and Child Health Wing
Dedicated MCH wing
In high load facilities
with adequate provision
of beds.
The New MCH wings
Comprehensive units
(30/50/100 bedded)
Antenatal waiting room
Labour wing ,
essential New born care
room,
SNCU ,operation
theatres,
blood banks,
Also Ensure quality postnatal care to mothers and new-borns

50. MATERNAL DEATH SURVEILLANCE RESPONSE
AIM:
 routine identification & timely notification of
maternal death.
Review of maternal death
Implementation and monitoring of steps to
prevent similar deaths in future.

51. STEPS IN
PLANNING
MDSR

52. MATERNAL DEATH REVIEW SOFTWARE
LAUNCED
QUICK
ANALYSIS
PAPER BASED
DATA
DIGITALIZED
INTEGRATION
OF SOFTWARE
WITH MCTS
THROUGH
MOTHER ID

53. MATERNAL HEALTH PROGRAMS

54. LIST OF PROGRAMMES
1) Janani Suraksha yojana
2) Safe abortion Services
3) Village health &nutrition day
4) Janani Shishu Suraksha Karyakram

55. 5) Pradhan Mantri Surakshit matritva Abhiyan
6) Surakshit Matritva Aashwasan
7) LAQSHYA Programme
8) Anaemia Mukt Bharat

56. 1)JANANI SURAKSHA YOJANA
• Initially called national maternity
Benefit scheme
• Launched on 12th April 2005
• OBJECTIVES
• Is to reduce the maternal mortality rate and
neonatal mortality rate
• By encouraging delivery at health institution
• Focusing at institutional care among the
women below poverty line

57. Features of JSY:-
• Its is 100% centrally sponsored.
• Benefit of cash assistance with institutional
care
• Benefit given to the all women of rural and
urban area
• Special focus on the 10 low performing state
like up ,MP ,Uttarakhand , Odisha , assam etc.

58. Scale of assistance from 2012-13
• Rural area Urban area
Mother ASHA Mother ASHA
package package package package
LPS 1400 600 1000 400
HPS 700 600 600 400
Eligibility:-
In LPS:- All pregnant women
In HPS:-Pregnant women of BPL and SC & ST categories.

59. 2)SAFE ABORTION SERVICE
• Main cause of maternal mortality and
morbidity
• Account for nearly 8.9% of maternal death
Facilities provided are
1)Medical method of abortion:- 1 TAB of
Mifepristone followed by 4 tablets of
misoprostol
2)Medical termination can be done up to 7
weeks.

60. 2) Manual vacuum aspiration
 Safe and simple technique to terminate early
pregnancy
 Feasible to be used in PHC or comparable
facilities

61. 3)VILLAGE HEALTH AND NUTRITION DAY
• Organised once a month
• At Anganwadi centre to provide
Antenatal/post natal care
Promote institutional delivery
Health education
Nutrition services etc.

62. 4)JANNI SHISHU SURAKHSA KARYAKRAM
• Launched by Govt of India on 1st June
2011
Initiative provide the following facilities
to pregnant women
• Absolute free and no expanse delivery including
C-section
• Free drug and consumable ,free diet up to 3 days
during normal delivery & up to 7 days for C-
section

63. • Free diagnostic and free blood transfusion facility.
• Free transport in case of referral and drop back.
• Scheme is now been extended to cover the
complication during ANC ,PNC &also sick infant
• Scheme estimate to benefit more than 12 million
pregnant women

64. 5)PRADHAN MANTRI SURAKSHT
MATRITVA ABHIYAN
[PMSMA]
Launched by the MOH&FW on June 2016
Free of cost assured and quality
antenatal care.
These service are provided on 9th of every month.
Approximately 3 crore pregnant women are
examined under PMSMA scheme

65. OBJECTIVE of scheme :-
• Ensure at least one antenatal checkup for all
pregnant women in their second or third trimester
• Improve the quality of care during ante-natal visits
• Identification and line-listing of high risk pregnancy
based on medical conditions
• Special emphasis on early diagnosis, adequate and
appropriate management of women with malnutrition

67. 6)SURAKSHIT MATRITVA AASHWASAN
[SUMAN]
• Ministry launched this initiative on 10th October
2019
AIM :-
• Assured, dignified and respectful delivery of
quality healthcare services at no cost and zero
tolerance for denial of services to any woman
and newborn visiting a public health facility .
• Expected outcome of this is ‘zero preventable
maternal and new born death and high quality
of maternal care delivery with dignity and
respect

68. 7) LAQSHAY PROGRAMME
• MOFHW launched this program to
improve quality of care in labour
room and Maternity OTs in 2017
GOAL – Reduce the preventable
maternal and new born mortality and
morbidity
IMPLIMENTED at District hospital, Sub district
hospital , high case load CHC , First Referral unit
and Medical college.

69. OBJECTIVE-
 To reduce the maternal and new born mortality due to
APH ,PPH , eclampsia preeclampsia ,obstructive
labour etc.
 To improve quality of care during the delivery and
immediate post partum care
 Stabilisation of complication and ensure timely
referrals
 To enhance satisfaction of beneficiary visiting the
health facility and provide respectful maternity care

70. 8)ANAEMIA MUKT BHARAT
PROGRAMME
• Launched by MOH&FW in 2018
• Intensified iron plus initiative
AIM :-
Strengthen the existing mechanisms and foster new
strategies for tackling anaemia
OBJECTIVE :-
To reduce prevalence of anaemia by 3%
points per year among children, adolescent &
women of reproductive age (15-49 year).

71. PROPHYLACTIC DOSE AND REGIMEN
AGE GROUP
1. Children(6-59 month age
)
2. Children(5-9 year)
3. Adolescent (10-19 year)
4. Reproductive age
women
(20 – 49 year)
5. Pregnant women
DOSE AND REGIMEN
-1ml iron and folic
acid(20mg+100mcg)
-Weekly 45mg elemental iron + 400
mcg FA
- 60 mg iron + 500 mcg folic acid
- 60 mg iron + 500 mcg folic acid
- iron and folic acid from 4th
month of pregnancy

72. DEWORMING
• Biannual dose of 400 mg albendazole
1/2 tab to children of 12 – 24 month
1 tab to children of 24-59 month
1 tab to 5-9 year age children
1 tab to adolescent 10-19 year
1 tab to women of reproductive age (20-
49year)
• For the pregnant and lactating women 1 dose of 400 mg
albendazole

73. NATIONAL AND STATE ‘SCORECARD’
• Introduced as a tool to increase transparency and track progress
against indicators related with intervention coverage.
• Refers to two distinct but related management tools:
1. HMIS based dashboard monitoring system
2. Survey based child survival score card
Latest available data from national surveys will be taken into
consideration
(SRS, Coverage Evaluation Survey, DLHS, NFHS, Census, Annual
health Survey)
• The scorecard will be updated as and when(every 1-2 years) new
survey data is available

74. HMIS-based dashboard monitoring system:
• Choice of indicators for dashboard system are based
on life cycle approach.
• All India average for each indicator will be taken as the
reference point.
• State scores will determine on the basis of national
average
• Positive score 1to 4 for those above national
average(for positive indicators)
• Negative score -1 to -4 for those national average

75. States have been classified into four categories
based on the state score (based on four quartiles)

77. Survey based score card
Latest available data from national surveys will be
taken into consideration (SRS, Coverage Evaluation
Survey, DLHS, NFHS, Census, Annual Health
Survey )
States will be colour coded based on Mortality
indicators, nutrition and fertility

80. NATIONAL MORTALITY, NUTRITION, FERTILITY
INDICATORS
Green less than 20%
Yellow 20% below and above national average
Red More than 20% of the average.
REMAINING INDICATORS
Green greater than 20%
Yellow 20% below and above national average
Red less than 20% of the average.

81. ACHIEIVEMENT UNDER MATERNAL HEALTH
• First Referral Unit: 81 FRUs are providing C section
services out of 94 FRUs
• Delivery points: state has target of 1190 delivery points of
which 550 institutions are functional.
• Janani Suraksha yojana Karyakram: free services which
include free drug, blood, diagnostics, diet and referral
services are provided to all sick newborn and infants(up to
1yr).5,06,843 pregnant women have received various JSYK
entitlements during 2020-2021.
• Skilled Attendant at Birth training was given to
paramedical and AYUSH doctors

82. • PMSMA: This programme focused on screening of
antenatal cases by doctor preferably O&G specialist at
least once during 2nd or 3rd trimester. This activity is
implemented on 9th of every month on fixed day basis.
• LaQshya: under this programme the LR & MOT( labor
room & maternity OT) are standardized for providing quality
care services.
• Initiatives for Anemia control: IFA & Calcium
Supplementation – about 7 lakhs pregnant women covered
during 2020-21.