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RCH .pptx
1.
2. DEFINITION OF REPRODUCTIVE
HEALTH
Reproductive health can be defined as:
A state in which people have the ability to
reproduce and regulate their fertility,
women are able to go through pregnancy and child
birth safely,
The outcome of pregnancy is successful in terms of
maternal and infant survival and well being, and
couples are able to have sexual relations free of
the fear of pregnancy and of contracting diseases
3. MILESTONES IN MCH CARE IN
INDIA
1880 –Establishment of training of Dais in
Amritsar.
1902 - 1st midwifery act to promote safe
delivery.
1930 - Setting up of advisory committee on
maternal mortality.
1946 - Bhore committee recommendation on
comprehensive & integrated health care.
1952 –Primary health centre net work & family
planning program.
4. MILESTONES IN MCH CARE IN
INDIA
1956 –Family planning program was adopted by govt. of India
1961- MCH centers become integral parts of
PHCs.
1971 – MTP act
1974 – Family planning services incorporated
in MCH care.
1977 – Renaming family planning to family
welfare.
1978 – Expanded program of immunization.
1985 – Universal immunization programme.
1992 – Child survival & safe motherhood programme.
5. MILESTONES IN MCH CARE IN
INDIA
1993 -National development committee report
1994 -International conference on population
development (ICPD),Cairo, Egypt.
1996 – Target free approach,
Review of safe motherhood component of
CSSM.
1997 – RCH PROGRAMME PHASE-1
2005 – RCH PROGRAMME PHASE-2
6. International conference on population
and development (ICPD)1994,Cairo.
RECOMMENDATIONS
Holistic reproductive health care should be made
available through primary health care system.
Efforts should be made by all the states to reduce infant
mortality by 50% by 2000AD
Need assessment & need fulfillment as key elements
for improving reproductive health.
7. DEFINITION OF MATERNAL
MORTALITY
Death of a woman while pregnant or
with in 42 days of termination of
pregnancy irrespective of duration &
site of pregnancy from any cause
related to or aggravated by
pregnancy or its management but
not from accidental or incidental
causes.
8. MAJOR CAUSES OF MMR
DIRECT CAUSES
HEMORRHAGE – 29.6%
PUERPERAL COMPLICATION – 16.1%
OBSTRUCTED LABOUR – 9.5%
ABORTIONS – 8.9%
TOXAEMIA OF PREGNANCY 8.3%
INDIRECT CAUSES
Anemia
Pregnancy with TB
Pregnancy with malaria
Pregnancy with viral hepatitis
9. 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
10. DISPARITY OF MATERNAL DEATH
BETWEEN DEVELOPED & DEVELOPING
COUNTRIES
Barrier to have health personnel at grass root
level
Targets/Incentives distorted the program
implementation
Top down approach which were never
appreciated by people and workers
Gaps between infrastructure and in outreach
services
The choice of contraceptives were limited.
Training and reorientation program of staff is
not uniform through-out the country
11. EMERGENCE OF RCH PROGRAM
DEPARTMENT OF
FAMILYWELFARE
(SECTORAL REVIEW)
CHANGES IN IMPLEMENTATION
OF FAMILY WELFARE PROGRAM
(SHIFT ADDRESSED TO MCH
SERVICES)
NATIONAL FAMILY
WELFARE CHANGED TO
RCH (1997)
12. PARADIGM SHIFT
Govt. of India has brought paradigm shift
in the mother and child health policy and
accepted RCH program
LIFE CYCLE APPROACH
13. DEFINITION OF PARADIGM SHIFT
It is a set of concepts ,methods, and
assumptions shared by the community of
scientists and guiding research in their
discipline.
It shifted the program to quality , client
oriented , community responsive and
towards the overall development of
women and child securing their rights.
16. VISION FOR RCH-II
To bring about outcomes as envisioned in the :-
Millennium Development Goals
The National Population Policy 2000 (NPP 2000)
Goals
The Tenth Plan Goals
The National Health Policy 2002
Vision 2020 India
17. COMPONENTS OF RCH
Bottom-up planning
Community need assessment approach
Decentralized participatory planning &
implementation
Strengthening infrastructure
Integrated training package
Improved management system
Interventions
Monitoring & evaluation
18. STRATEGIES OF RCH-II
Population stabilization:-
TFR of 2.2
Achieve universal coverage of contraceptives
Promote an expanded basket of contraceptive
choice
Focused & integrated BCC
Expanded MTP facilities
Increasing male involvement
Easy access of services
Encourage public-private partnership
Intensified monitoring
19. STRATEGIES OF RCH-II
Maternal health
Goal:- MMR<100per lakh live births and
institutional deliveries to 80% by 2010
OBJECTIVES:-
Improve access to skilled care and
emergency obstetric care
Improve coverage and quality of
antenatal care
Increasing coverage of postpartum
care.
20. STRATEGIES TO REDUCE MMR
Increasing number of facilities offering
safe delivery , emergency obstetric care
and demand for these services by two
levels of institutions :-
a) PHC & CHCs(basic emergency obstetric
care )
b) FRUs (Comprehensive emergency care)
21. STRATEGIES TO REDUCE MMR
Operationalization of all CHCs and at
least 50% of PHCs to provide 24hr
services to provide 24hr delivery & basic
emergency obstetric care by 2010.
Operationalization of comprehensive
emergency obstetric care at 2000 FRUs by
2010
Ensuring access to safe blood at all
district hospitals and FRUs.
22. STRATEGIES TO REDUCE MMR
Training of Medical officers in
Anesthesia for EmOC.
Training MBBS medical officers in
caesarean section .
Providing EmOC services to BPL
families at recognized private facilities.
23. Other recommendations to
reduce MMR:-
Transfer specialists.
Use telecommunication systems to improve
referral system
Provide incentives to doctors & staff to work
at PHCs/ CHCs/ FRUs providing 24hrs
services.
Untied funds to medical officers and ANMs.
Encourage establishment of maternity
hospitals/ nursing homes in small towns and
private sectors.
24. FRUs (Package of services)
Vacuum extractions
Administration of Anesthesia
Blood transfusion
Caesarean section
Manual removal of placenta
Suction curettage for incomplete abortion
Insert intrauterine devices
Sterilization operation e.g. Vasectomy &
Tubectomy.
25. SAFE MEDICAL TERMINATION
OF PREGNANCY
COMMUNITY LEVEL:-
Spread awareness of safe MTP and
availability of services thereof
Enhance access to confidential counseling,
by ANM, AWW, and link volunteers
Promote post-abortions care by ANM, link
volunteers and AWWs
26. SAFE MEDICAL TERMINATION OF
PREGNANCY
FACILITY LEVEL:-
Provide quality Manual Vacuum
Aspiration (MVA) facility at all CHCs and
at least 50% PHCs that are being
strengthened for 24 hr delivery services.
Provide comprehensive & high quality
MTP services at all FRUs
Encourage private sector & NGO to
establish quality MTP services.
27. BEHAVIOURAL CHANGE
COMMUNICATION(BCC)
1. Social mobilization activities against female
infanticide and feticide by preventive
counseling.
2. Formation of Block, District level committees
for saving female babies.
3. Telecasting of TV serials, Radio broadcasts, wall
paintings, hoardings and glow signs for
popularizing health and reproductive health
messages in important places.
28. JANANI SURAKSHA YOJNA
Started under NRHM On 12th April 2005
with the objectives
To reduce maternal mortality
To reduce neo-natal mortality
AIM:_
To promote institutional deliveries by
cash incentives
29. ELIGIBILITY FOR CASH
INCENTIVES
LPS:-All pregnant women delivering in
government health centers like sub-center
/PHCs/CHCs/FRUs/General wards of
district and state hospitals or accredited
private hospital
HPS:-BPL pregnant women ,aged 19 years
and above.
LPS & HPS:-All SC & ST women delivering
in a govt. health centers.
32. ANTENATAL CARE
Early registration of pregnancies (12 – 16
weeks)
Minimum 3 antenatal visits (20,32,36 weeks)
Anemia prophylaxis
Two doses of TT
Minimum investigations( Weight, B.P., Blood
group, Rh typing, Urine examination, VDRL,
HIV
33. ANTENATAL CARE
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
34. STRATEGIES OF RCH-II
RTI AND STD SERVICES
Strengthening of laboratories for prompt
diagnosis and treatment.
Preventive activities such as training
,awareness campaigns and drugs are
made available.
Syndromic approach has been adopted for
diagnosis and treatment of RTI & STIs
35. STRATEGIES OF RCH-II
NEWBORN & CHILD HEALTH
Reduce IMR to 30per 1000 live births and
neonatal mortality rate (NMR) to below 20
per 1000 live births by 2010.
IMNCI approach
Intrapartum and immediate newborn care .
Early newborn care and
Late newborn care
Early diagnosis of dehydration
Treatment with oral rehydration solution
36. STRATEGIES OF RCH-II
NEWBORN AND CHILD HEALTH
Management of acute respiratory
infections
Exclusive breast feeding for 6 months
Introduction of complementary food
Prophylactic vitamin A to prevent
blindness in children
37. STRATEGIES OF RCH-II
UNIVERSAL IMMUNISATION OF POLIO
Routine immunization
National immunization days
Surveillance of acute flaccid paralysis
Conduct extensive house to house immunization
mopping –up campaigns
38. STRATEGIES OF RCH-II
ADOLOSCENT HEALTH
Counseling services regarding:
Family planning methods
Sexual health
Nutrition
Drug addiction
39. URBAN HEALTH
To provide an integrated and sustainable
primary health care service delivery system
TRIBAL HEALTH
The tribal population in India is
socioeconomically disadvantaged so basic
health and RCH services need to be
integrated in the overall development of
tribal areas.
More emphasis is given to north-eastern
states
40. TRAINING
1. Skill up gradation training with focus on
improving/upgrading the skills of health care
providers.
2. Integrated skill training for peripheral health
functionaries such as LHVs, PHNs, medical officers
and health inspectors.
3. Improving managerial and communication skills
of health staff.
42. STRENGTHENING OF
TEACHING INSTITUTIONS
Strengthening the facilities at teaching
institutions for providing optimum obstetric,
family welfare, neonatal child health
services.
43. ESTABLISHING URBAN
HEALTH POSTS
To provide an integrated and sustainable
system for primary health care service
delivery catering to the requirements of
urban slum population and other vulnerable
groups
44. PUBLIC- PRIVATE PARTNERSHIP
NGOs , private practitioners, hospitals,
and other health institutions are
involved for providing MCH services.
e.g. VANDAE MATRAM SCHEME
45. VANDAE MATRAM SCHEME
The scheme is continuing under Public Private
Partnership with the involvement of
Federation of Obstetric and Gynecological
Society of India and Private Clinics.
Aim of the scheme :- Reduce the maternal
mortality and morbidity of the pregnant and
expectant mothers
The scheme intends to provide free antenatal
and postnatal check, counseling on nutrition,
breastfeeding, spacing of birth etc. through
public private partnership.
46. VANDAE MATRAM SCHEME
A voluntary scheme wherein any OBG specialist, maternity
home, nursing home can volunteer themselves in joining
the scheme
Any lady doctor/MBBS doctor providing safe motherhood
services can also volunteer to join this scheme. The
enrolled ‘Vandematram’ doctors will display
‘Vandematram’ logo in their clinic, Iron and Folic Acid
Tablets, oral pills, TT injections etc. will be provided by the
respective District Medical Officers to the ‘Vandematram’
doctors/clinics for free distributions to beneficiaries.
Referral services are also provided for special cases to
govt. hospital.
49. ROLE OF NURSE IN RCH SERVICES
1. Assessment of the community.
2. IEC services regarding :-
Prevention of complication and promotion of health
of mother and child.
Various services provided by the govt.
Awareness about different diseases.
3. Gathering data regarding:-
New births or conceptions in the village
Surveillance of cases of measles, diarrhea and
pneumonia ,RTI/STIs and other diseases
Cases of polio or a neonatal death
50. ROLE OF NURSE IN RCH SERVICES
ANC registration
Early registration (less than 16 weeks)
Providing complete immunization during antenatal
period
Providing IFA prophylaxis to avoid complications.
Ensuring minimum 3 antenatal visits
Conduction of ANCs clinics
Performing ANCs examinations
51. ROLE OF NURSE IN RCH SERVICES
Enforcing Institutional deliveries
Deliveries by trained person
Providing postnatal care by giving
minimum 3 visits
MTPs referral services
52. ROLE OF NURSE IN RCH SERVICES
ASSESSMENT OF INFANT /CHILD ACCORDING
TO IMNCI
Special care to birth weight below 2.5 kg
High risk newborn referred
Conduction of immunization session
Ensuring Children should be fully
immunized as per age.
53. ROLE OF NURSE IN RCH SERVICES
REFERRAL SERVICES
RTI/STD referred
Gynecological problems referred
Infertility cases referred
54. ROLE OF NURSE IN RCH SERVICES
MAINTAING OF RECORDS
Records of Vital events
- Live births
- Neonatal deaths (under 28 days)
- Infant deaths (under 1 year)
- Child (1-5) death
- Maternal deaths
- Marriage
- Marriage of girls below 18 years