RMNCH+A SEMINAR

7/23/2019 RMNCH+A SEMINAR

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PRESENTED TO : PRESENTED BY :

MRS. SOMI BALA THOKCHOM MS. SHIVANGI

RMNCH + A


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INTRODUCTION :

Improving the maternal and child

health and their survival are central to

the achievement of national healthgoals under the National Rural Health

Mission (NRHM) as well as the

Millennium Development Goals(MDG) 4 and 5


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PURPOSES OF RMNCH+A :

!he health of an adolescent girl

impacts pregnanc" while the health of

a pregnant woman impacts the healthof the new#orn and the child

High maternal and child mortalit" in

adolescent mothers

!he ris$ of premature deliver" and

%&' dou#les


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RMNCH + A :

!wo dimensions to healthcare

()stages of the life c"cle

(*)places where the care is provided

()!hese together constitute the

+,ontinuum of ,are-


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!his ,ontinuum of ,are approach of

defining and implementing evidence.

#ased pac$ages of services for different

stages of the lifec"cle/ at various levels in

the health s"stem/ has #een adopted under

the national health programme

!his strategic approach is Reproductive/Maternal/ New#orn/ ,hild 0lus

1dolescent Health (RMN,H21)


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!he +0lus- in the strategic approach

denotes the

() Inclusion of adolescence as a

distinct +life stage- in the overall

strateg"3

(*) %in$ing of maternal and child health

to reproductive health

() %in$ing of communit" and facilit".#ased care as well as referrals #etween

various levels of health care s"stem


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!hese provide a strong platform for

deliver" of services across the entire

continuum of careIt reduces duplication of resources

and efforts in the ongoing program


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ituation of Reproductive/

Maternal and ,hild Health in India

*67/888 maternal deaths occurred in *88/

when the glo#al maternal mortalit" ratio

was *8 maternal deaths per 88/888 live#irths

India presentl" accounts for nearl" *89 of

the world-s child deathsNearl" 75 la$h of all glo#al deaths in

children occurs #efore five "ears of age


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Causes fo Ma!e"a# Dea!$s %"

I"&%aMe&%'a# :

Haemorrhage/ mainl" postpartum

(79)epsis (9)

:nsafe a#ortions (69)H"pertensive disorders (59) and

;#structed la#our (59)


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ocial Determinants

Marriage and child#irth at a ver" "oungage

%ess spacing #etween #irths

%ow literac" level among women/ in

particular those #elonging to the rural

settings

High unmet need of contraceptives due to

non.availa#ilit" of services at the

communit" outreach


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Causes Of C$%#& Dea!$s I" I"&%a :

Neonatal causes (5*9) 0neumonia (59)

Diarrhoeal disease (9)

Measles (9) Inia (89)


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(THREE DELAYS):

!he dela" in deciding to see$ care

!he dela" in reaching the appropriate

health facilit"!he dela" in receiving ?ualit" care once

inside an institution


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INDICATORS OF RMNCH+A

STRATEGY :%imited availa#ilit" of s$illed human

resources/ especiall" nurses

%ow coverage of services and of s$illed staff

posting among communities

%ow ?ualit" of training and s$ill #uilding

%ac$ of focus on improving ?ualit" ofservices

Insufficient information/ education on $e"

famil" practices


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GOALS AND TARGETS :

Reduction of Infant Mortalit" Rate

(IMR) to *5 per /888 live #irths #"

*87Reduction in Maternal Mortalit" Ratio

(MMR) to 88 per 88/888 live #irths

#" *87

Reduction in !otal @ertilit" Rate(!@R)

to * #" *87


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TARGETS :

Increase facilities e?uipped for perinatalcare

Increase proportion of all #irths in

government and accredited private

institutions

Increase proportion of pregnant women

receiving antenatal care

Increase proportion of deliveries

conducted #" s$illed #irth attendants


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Increase e>clusive #reast feeding

Reduce prevalence of under.fivechildren who are underweight

Increase ;R use in under.five children

with diarrhoeaReduce unmet need for famil" planning

methods

Reduce anaemia in adolescent girls and

#o"s


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Decrease the proportion of total

fertilit" contri#uted #" adolescents

Increase coverage of three doses of

com#ined diphtheria.tetanus.pertussis(D!0)


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RMNCH+A INTERVENTIONS :

ABORTIONCARE*STI+RTI

MANAGEMENT

POSTPARTUMIUCDAND

STERILI,ATION.

RA0R;D:,!IBA,1RA

SKILLEDOBSTETRICCARE.

IMMEDIATENE-BORNCAREAND

RESUSCITATION.

EMERGENCYOBSTETRICCARE.

PPTCTOFHIV.

0RAGN1N,C 1ND,HI%D &IR!H,1RA

ESSENTIALNE-BORNCARE.

CAREOFSICKNE-BORN.

IMMUNI,ATION.

NA'&;RN 1ND,HI%D,1RA


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AT SUBCENTRE LEVEL :

CHILD HEALTH CARE

FIRST LEVEL ASSESSMENT OFNE-BORN

MICRONUTRIENT

SUPPLEMENTATION

ANTENATALANDPOSTNATALCARE

FULL ANTENATAL CAREPACKAGE

EARLY DETECTION ANDMANAGEMENT OF ILLNESSES.

REPRODUCTIVEHEALTHCARE

FAMILY PLANNINGPREVENTION AND

MANAGEMENT OF STI


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AT COMMUNITY LEVEL :

REPRODUCTIVE

HEALTH

/0 -EEKLY IFASUPPLEMENTATION.

10INFORMATION

ON SE2UALREPRODUCTIVEHEALTH.

30 MENSTRUAL

HYGIENE.

ANTENATA

LAND

POSTNATAL

/0COUNSELLINGON NE-BOFRNCARE ANDBREASTFEEDING.

10 EDUCATE

ABOUTINSTITUTIONALDELIVERY.

30 BIRTH

PREPAREDENESS

CHILDHEALTHC

AR

E

/0 HOME BASEDNE-BORNCARE.

10 ANTIBIOTICFOR SUSPECTED

SEPSIS.

30 USE OF ORSFORDIARRHOEA


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ORDER OF LIFE STAGES FOR

INTERVENTIONS :

ADOLESCENSE

PREPREGNANCY

PREGNANCY

BIRTHNE-BORN

POSTNATALCHILDHOOD


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RMNCH + A INTERVENTIONS :

ADOLESCENCE :

A&o#es'e"! Nu!%!%o" Iron and folic acid

supplementation

Na!%o"a# Io" + I"%!%a!%4e : service pac$age

for the management of anaemia

Iron and folic acid (I@1) supplementation

Improvement in their iron status

!he iron ta#let for adolescents is coloured #lue


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-ee5#6 Io" A"& Fo#%' A'%& Su77#e8e"!a!%o"

S'$e8e :

It aims to cover adolescents enrolled in classBIEII of government/ government aided and

municipal schools as well as +out of school-

girlsupervised administration of wee$l" iron and

folic acid supplements

creening of target groups for moderate andsevere anaemia

&i.annual de.worming (1l#endaFole 488 mg)

,ounselling for improving dietar" inta$e


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A&o#es'e"! F%e" Hea#!$ Se4%'es

9A&o#es'e"! Hea#!$ C#%"%'s0 :1ccess to reproductive and se>ual

health information and services

Including access to contraceptives andsafe a#ortion services/ delivered in an

adolescent.friendl" environment

!his is important for reducingincidences of unplanned and unwanted

pregnancies


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I"fo8a!%o" A"& Cou"se##%" O" A&o#es'e"!

Se;ua# Re7o&u'!%4e Hea#!$ :

%ife $ills Aducation will #e imparted #oth through

educational institutions and in communit" settings

It generate awareness on ris$ factors

Po8o!%o" Of Me"s!ua# H6%e"e A8o" A&o#es'e"!

G%#s I" Rua# I"&%a:

High ?ualit" and safe products are made availa#le

Anvironmentall" safe disposal mechanisms are

made accessi#le


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Pe4e"!%4e $ea#!$ '$e'5u7s a"&

s'ee"%" fo &%seases* &ef%'%e"'6 a"&

&%sa


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PREGNANCY AND CHILDBIRTH :

Pe4e"!%4e use of fo#%' a'%& %" 7e%

'o"'e7!%o" 7e%o& :

0romoting use of folic acid in planned

pregnancies during the peri.conception

phase for the prevention of neural tu#e

defects and other congenital anomalies


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A"!e"a!a# Cae Pa'5ae A"& Ta'5%"

Of H%$ R%s5 Pe"a"'%es :

!o monitor the progress of foetal growth

!imel" identification of complications!o provide emergenc" o#stetric and

new#orn care


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S5%##e& o


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anani hishu ura$sha

ar"a$ram() is an initiative underthe overall um#rella of NRHM that aims

to reduce out.of.poc$et e>penses related

to maternal and new#orn care1#solutel" free and no e>pense deliver"/

including caesarean section

@ree assured transport

Inter.facilit" transfer in case of referrals

Drop #ac$


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E8ee"'6 O


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Pos!7a!u8 IUCD %"se!%o" a"&

s!e%#%>a!%o" :

!rained providers for post.partum I:,D

(00I:,D) insertion


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NE-BORN AND CHILDCARE :

Ho8e


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Fa'%#%!6


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I88u"%sa!%o" :

:niversal Immunisation 0rogrammeincludes vaccines to prevent seven

vaccine preventa#le diseases

(!u#erculosis/ 0olio/ Diphtheria/0ertussis/ !etanus/ Measles/ Hepatitis &)


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REPRODUCTIVE HEALTH :

Co88u"%!6


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Po8o!%o" of s7a'%" 8e!$o&s 9%"!e4a#

IUCD0 :

1vaila#ilit" of I:,D 68 1 and +fi>ed da"

services- at all facilities are to #e ensured

S!e%#%>a!%o" se4%'es :

,ouples who have achieved the desired famil"

siFe

,ompensation is provided for loss of wages to

the #eneficiar" and pa"ments made to the

service provider


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Co87e$e"s%4e a


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Ma"ae8e"! of STIRTI :

!Is and R!Is are associated with anum#er of adverse pregnanc" outcomes

such as

1#ortiontill#irth

0reterm deliver"

%ow #irth weight

0ostpartum sepsis

,ongenital infection


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,ontrolling !IR!I helps decrease HIB

infection rateservices are to #e provided at all ,H,s

and @R:s/ and at *4 E 7 0H,s

@or s"ndromic management ofR!Is!Is/ availa#ilit" of colour.coded

$its/ whole #lood finger pric$ testing for

HIB should #e ensured


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COMMUNITY PARTICIPATION :

Angage women s"stematicall" at the

communit" level

Angage Billage Health anitation andNutrition ,ommittees (BHN,) and

Rogi al"an amiti (R)

:tiliFe the Billage Health and NutritionDa"s (BHNDs)


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Pa'5ae Of Se4%'es I" VHND:

ImmuniFation

1ntenatal care

0ost.natal care including counselling for

contraception

@acilitating access to contraceptive services0rovision of ;R and Jinc for treatment of

childhood diarrhoea

!esting and treatment for anaemia in pregnantwomen

,ounselling on $e" practices for improved

Documents

RMNCH+A SEMINAR