Download ppt - REPRODUCTIVE AND CHILD HEALTH PROGRAM(RCH) Dr. KANUPRIYA CHATURVEDI

REPRODUCTIVE AND CHILD HEALTH PROGRAM(RCH)

Dr. KANUPRIYA CHATURVEDI

Dr. KANUPRIYA CHATURVEDI 2

Lesson Objectives

To Learn about the various components of RCH program

To know about the goals. objectives target groups, service components and RCH program

To know about the services/activities under the program

To know about the new initiatives in the program


Components The RCH program incorporated the

earlier existing programs i.e. National Family Welfare Program and Child Survival and Survival & Safe Motherhood Program ( CSSM) and added two more components one relating to sexually transmitted disease and the other relating to reproductive tract infections. The program was formally launched on 15 October 1997.


Components:

FAMILY PLANNING

CHILD SURVIVALAND SAFE

MOTHERHOOD

PREVENTION/MANAGEMENTOF

RTI/STD/AIDS

CLIENT APPROACHTO HEALTH

CARE

Adolescent Health

Care and Family Life Education


RCH PROGRAM

Family Planning

Improved method mix

Private sector inclusion

Address quality

Collaborate with NACO in condom distribution

Maternal Health

•Quality ANC

•Institutional Deliveries

•Skilled Birth Attendance

• EmObstetric care

•Home based post-partum & NBC

•Quality safe abortion services

•RTI/STI

Child Health)

•Intensify existing services : Immunization,

NBC

Micronutrient Supply

CDD

ARI

• IMNCI.

Adolescent health

•Anemia

•Awareness about RH issues


RCH Program (cross cutting Issues)

HumanResources Anesthetists Obstetrician

s Lady doctors Contractual

ANMs Staff Nurses

in 24 Hrs PHCs

Counselor

IEC

•Branding

•Involving Professional Agencies

•Media

•Inter-personal Communication

•Celebrity involvement

ISC

•Awareness about RH issues

•Anemia

MIS

•Output based Monitoring

•Triangulation of Data

•CES/DHS


The Paradigm Shift Vertical Programmes Integrated Service Delivery

Camp Oriented Client Oriented

Target Oriented Goal Oriented

Quantity Oriented Quality Oriented


Camp Oriented Client Oriented

• Sterilization Camps

• IUD Camps

• Immunisation Camps

• Full Range of RCH Services

• Need Based

.


Target Oriented Goal Oriented

Performance by

Numbers

Performance by Quality

• Top Down

• Target Driven

• Bottom up• Client Need Based• Community

Participation

• To the Govt. System • To the Clients, Community


Program Objectives

Promotion of MCH to ensure safe mother hood and child survival

Reduction of maternal and child morbidity and mortality

Attainment of population stabilization


Highlights 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 Provision of out reach services for vulnerable

groups


Categories:

Differential approach Based on CBR and female literacy

rate, Category A:58 districts Category B:184 districts Category C:265 districts

All the districts covered in a phased manner over a period of 3yrs


Service Package: for mothers

Essential obstetric care Early registration Minimum 3 ANC Safe delivery 3 PNC Referral More relevant for Assam,

Bihar,Rajasthan, Orissa,UP, MP


Emergency obstetric care Strengthen FRUs Supply of kits and skilled manpower TBA (Traditional Birth Attendants)

Dai training NGOs involved: More local specific 24-hr Delivery services at

PHCs/CHCs: Promote institutional deliveries

Additional honorariumto staff Safe deliveries


Contd. Deliveries by trained personnel in safe and

hygienic surroundings are encouraged Institutional deliveries are encouraged for

women having complications. In case of complication referrals are made

to First Referral Units for Management of obstetric emergencies.

Three postnatal checkups are given to mothers after the delivery.

Spacing of at least three years between children are encouraged.


For children

Essential newborn care like keeping the baby warm, checking the baby’s weight and giving the baby mother’s first milk are encouraged.

Babies that are premature or have low birth weight are provided special care.

Babies with any complications refereed to the health center.

Exclusive breast-feeding are encouraged for the first three months.


Contd.

Immunization are administered to every child meticulously to prevent death and disabilities.

Vitamin A Prophylaxis ORT. Acute respiratory infection in children

treated by cotrimoxazole tablets. Treatment of Anemia


For Eligible Couples Promoting use of contraceptive methods

among eligible couples is important to prevent unwanted pregnancies. Couples should be able to choose from various contraceptive methods including condoms,oral pills, IUDs,male and female sterilization

Safe services for medical termination of pregnancies should be encouraged for women desiring abortions

Other New Services Treatment of RTI/STI is given. Promotion activities for adolescents health.


Drug and equipment kits: Mid-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


Goals set for various national /int. policies


RCH Program: Phase II RCH Phase II began from 1 April 2005. The

components being: Essential obstetrical care Emergency obstetrical care Strengthening referral system

Strengthening project management Strengthening infrastructure Capacity building Improving referral system Strengthening MIS Innovative schemes


Essential obstetric care

Promotion of institutional deliveries 50% of the PHCs and CHCs made

operational as 24 hours delivery centers. Skilled attendance at birth Policy descions to permit Health

workers to use drugs in emergency situations to reduce maternal mortality


Emergency obstetric care

Operationalisation of FRUs to provide: 24 hours delivery services Emergency obstetric care New born care and emergency care of the

sick child Full range of family planning services Safe abortion services Treatment of RTI and STI Blood storage facility Essential laboratory services Referral ( transport ) services


New initiatives

Training of PHC doctors in life saving anesthetic skills for emergency obstetric care a FRUs

Setting up of blood storage centres at FRUs Janani suraksha yojana Vandemataram scheme Safe abortion services Integrated Management of Childhood

illnesses.


24 hrs. Functioning of PHCs

• It is planned to establish 2000 FRUs in phases in RCH-II 50% PHCs and all CHCs to beoperationalised 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.)


Training in Anaesthesia

• Training of MBBS Doctors in Life Saving Anaesthetic Skills for Emergency Obstetric Care.• 18 weeks training course• The First Training Programme Conducted at AIIMS for Chhattisgarh• Training to be conducted in phases and limited to the requirement at FRUs.


Training in 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


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 centres at FRU’s.


Janani Surkasha Yojna

To promote Institutional Deliveries To reduce overall Maternal Mortality Ratio Infant Mortality Rate

A safe motherhood intervention, replacing the “NationalMaternity Benefit Scheme”, under NRHM100 % centrally sponsoredIntegrates cash assistance with delivery& post-delivery care.


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.


Referral Transport

Key issues: Roads, transportation, RCH I funds poorly Utilized, Community participation lackingUnder 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


Role 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.


Strategy for addressing AdolescentReproductive and Sexual Health (ARSH)A two-pronged strategy will be

supported: Incorporation of adolescent issues

in all the RCH training programs and all RCH materials developed for communication and behaviour change.

Dedicated days and dedicated timings for adolescents at PHC’s.


Infection Management and Environment Plan

IMEP which is being extended to health care facilities includes:

a) Treatment and disposal of biomedical wastes

b) Disposal of syringe waste

c) Provision of water sanitation and good hygiene conditions


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 FOGSI, WHO & state govt. are coordinating the

project


Some Innovative State Initiatives

Gujarat Increase access to safe delivery services. It is

in partnership with private providers (Chiranjivi Yojana)

A Dai Sangathan has been formed by 10 leading NGOs of the state to facilitate interface between the health system and the community

Punjab Proposed to pay an incentive of Rs. 500/- to

BPL SCs belonging to urban areas Purchase and supply of nutrients like iron,

calcium, D-worming tablets for pregnant mothers belonging to SC classes.


Contd….

Screening code for Ca Cervix – Tamil

NaduSubsidized Medical Practitioner (SMP) scheme- Assam, Bihar

Nurse Practitioners SchemeLaproscopic Training – MaharashtraImplementation of Health Insurance scheme on pilot basis.


Monitoring :Accessibility Indicators No. of eligible couples registered/ANM No. of Antenatal Care sessions held as planned % of sub Centers with no ANM % of sub Centers with working equipment of

ANC % ANM/TBA without requisite skill % sub centers with DDKs % of sub centers with infant weighing machine % subcenters with vaccine supplies % sub centers with ORS packets % sub centers with FP supplies


Quality Indicators

Following are the quality indicators used to monitor and evaluate RCH programme through monthly reports:

1. Number of antenatal cases registered2. Number of pregnant women who had 3 antenatal checkups3. Number of high risk pregnant women referred4. Number of pregnant women who had 2 doses of TT5. Number of pregnant women under prophylaxis and

treatment of anaemia

6. Number of deliveries by trained and untrained attendants

7. Number of cases with complications referred to PHC/FRU

8. Number of newborn with birth weight recorded


Contd..

9. No. of women given 3 post natal check-ups10. No. of RTI/STD cases detected, treated and

referred11. No. of children fully immunized 12. No. of adverse reactions reported after

immunization13. No. of cases of ARI and diarrhea under 5yrs

14. No. of cases motivated and followed for contraception.


Impact Indicators % DEATHS FROM MATERNAL CAUSES MATERNAL MORTALITY RATIO PREVALENCE OF MATERNAL MORBIDITY % LOW BIRTH WEIGHT NEO-NATAL MORTALITY RATIO PREVALENCE OF POST NATAL MATERNAL

MORBIDITY % BABY BREAST FEED WITHIN 6 HRS OF

DELIVERY COUPLE PROTECTION RATE PREVALENCE OF TERMINAL METHOD OF

STERILIZATION PREVALENCE OF SPACING METHOD % ABORTION RELATED MORBIDITY PREVALENCE OF ADD PREVALENCE OF ARI PREVALENCE OF RTI/STDs