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Reproductive and Child Health Phase II (RCH-II) Dr. Rakesh Kumar PG Com. Medicine.

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Presentation on theme: "Reproductive and Child Health Phase II (RCH-II) Dr. Rakesh Kumar PG Com. Medicine."— Presentation transcript:

1 Reproductive and Child Health Phase II (RCH-II) Dr. Rakesh Kumar PG Com. Medicine

2 Situation in India High Maternal Mortality- 100,000 maternal deaths occurs annually High Child Mortality million deaths annually Unmet demand for contraception Unmet demand for contraception Increasing concern over Increasing concern over Adolescent health, Adolescent health, Urban slums Urban slums Tribal health Tribal health Rural-urban / Interstate variation Rural-urban / Interstate variation

3 Milestones in MCH care 1951 –Family Planning Programme 1951 –Family Planning Programme India first country to launch India first country to launch 1961 – Department Of Family Planning Created 1961 – Department Of Family Planning Created Universal Immunization Programme Universal Immunization Programme 1992 – Child Survival & Safe Motherhood Programme 1992 – Child Survival & Safe Motherhood Programme Integration of family planning, child survial, maternal strategies Integration of family planning, child survial, maternal strategies 1997 – RCH Programme Phase – RCH Programme Phase-1 Target free approach Target free approach Decentralised planning, Client-centred, quality-oriented, reproductive health approach Decentralised planning, Client-centred, quality-oriented, reproductive health approach

4 RCH - II Launched on 1 st April 2005 Launched on 1 st April 2005 Vision: Vision: To bring about outcomes as envisioned in the Millennium Development Goals, the National Population Policy 2000 (NPP 2000), and the National Health Policy 2002 To bring about outcomes as envisioned in the Millennium Development Goals, the National Population Policy 2000 (NPP 2000), and the National Health Policy 2002 Minimizing the regional variations in the areas of RCH Minimizing the regional variations in the areas of RCH Population stabilization through an integrated, focused, participatory programme Population stabilization through an integrated, focused, participatory programme

5 Components of RCH-II RCH-II Maternal Health Neonatal & Child Health Family Planning Adolescent Health Control of RTI & STDs

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7 Maternal Health Component 1. Essential Obstetric care 2. Emergency obstetric care 3. Safe abortion services 4. Prevention & control of RTI /STDs

8 “NISHCHAY”- Pregnancy detection kit Services for early detection of pregnancy Services for early detection of pregnancy Surveys indicate availability of pregnancy detection kits (NISHCHAY) with peripheral health functionaries Surveys indicate availability of pregnancy detection kits (NISHCHAY) with peripheral health functionaries ASHAs performed over 82 percent of tests themselves ASHAs performed over 82 percent of tests themselves

9 Skilled Birth Attendance Skilled Birth Attendant Skilled Birth Attendant Reorienting Medical Officers Reorienting Medical Officers Preservice & inservice training for SNs/LHVs/ANMs Preservice & inservice training for SNs/LHVs/ANMs Enabling Environment Enabling Environment Operationalising SCs/ PHCs/CHCs/FRUs for skilled attendance at birth.(Enabling Environment) Operationalising SCs/ PHCs/CHCs/FRUs for skilled attendance at birth.(Enabling Environment) Policy decisions- ANMs granted permission Policy decisions- ANMs granted permission to use drugs for managing PPH to use drugs for managing PPH to use drugs in emergency situations before referral to use drugs in emergency situations before referral to perform basic procedures at community level in emergency situations to perform basic procedures at community level in emergency situations

10 24×7 Hours PHCs & CHCs Aim: - To promote institutional deliveries -To provide the round the clock deliveries facility at health centres -To provide the round the clock deliveries facility at health centres 50% of PHC will be upgraded to provide essential and basic emergency obstetrics care 50% of PHC will be upgraded to provide essential and basic emergency obstetrics care All upgraded CHC to act as FRU to provide comprehensive obstetric care All upgraded CHC to act as FRU to provide comprehensive obstetric care Status – Target set for 2010 Status – Target set for % of targeted PHCs have been strengthened to provide 24-hour services 52% of targeted PHCs have been strengthened to provide 24-hour services 74% of targeted CHC’s have been operationalised as First Referral Units (FRUs) 74% of targeted CHC’s have been operationalised as First Referral Units (FRUs) Considerable variation in delivery and quality of services Considerable variation in delivery and quality of services Only 39% of FRUs and 44% of 24/7 PHCs meet all essential criteria Only 39% of FRUs and 44% of 24/7 PHCs meet all essential criteria Across states, number of c-sections per month at FRUs range from 280 to less than 4 Across states, number of c-sections per month at FRUs range from 280 to less than 4 Number of deliveries per month in 24/7 PHCs varies from 89 to 3 Number of deliveries per month in 24/7 PHCs varies from 89 to 3

11 Operationalisation of FRUs All CHCs, Sub district hospital will upgraded and operationalised as FRUs All CHCs, Sub district hospital will upgraded and operationalised as FRUs All FRUs are should provide following services: All FRUs are should provide following services: hour delivery services including normal & assisted deliveries Emergency obstetric care includes surgical intervention –Caesarian Section 3. New born care 4. Emergency care of sick children 5. Full range of family planning services –Laparoscopic 6. Safe abortion services 7. Treatment of RTI /STI 8. Blood storage facility 9. Essential laboratory services 10. Referral transport services

12 Strengthening referral System Time is an important factor for obstetric emergencies. Time is an important factor for obstetric emergencies. During RCH I – funds were given to Panchayats for providing assistance to poor people no active involvement of Panchayats. During RCH I – funds were given to Panchayats for providing assistance to poor people no active involvement of Panchayats. In RCH II : Through involvement of VHNSC In RCH II : Through involvement of VHNSC Referral transport systems, in general have been given emphasis across states; Madhya Pradesh and Gujarat has widespread availability and use of the Janani Express Yojana. Referral transport systems, in general have been given emphasis across states; Madhya Pradesh and Gujarat has widespread availability and use of the Janani Express Yojana.

13 New initiatives taken under RCH II Training of MBBS doctors in anesthetic skills for emergency obstetric care for 18 weeks Training of MBBS doctors in anesthetic skills for emergency obstetric care for 18 weeks Training of MBBS doctors in emergency obestetrics skills like caesarean section for emergency obstetric care for 16 weeks Training of MBBS doctors in emergency obestetrics skills like caesarean section for emergency obstetric care for 16 weeks Setting up a blood storage centres at FRUs according to of India guidelines. Setting up a blood storage centres at FRUs according to of India guidelines. Vandematram Scheme – a Public private partnership Vandematram Scheme – a Public private partnership

14 Janani Suraksha Yojana Modified The National Maternity Benefit scheme on 12 th April 2005 Modified The National Maternity Benefit scheme on 12 th April % centrally sponsored scheme 2. Promotes institutional delivery among poor pregnant women 3. Cash assistance with institutional care during ANC, Delivery & PNC 4. Benefit given to female age 19 & above (urban & rural), up to first 2 live births & in low performing states up to 3 live births. 5. Special dispensation for 10 states with low institutional delivery ( LPS) 6. ASHA- Link between beneficiary & govt.in LPS—other states are HPS Ac heivement: from a modest beginning of 7.39 lakh beneficiaries in , the number has risen ten-fold to lakh beneficiaries in Ac heivement: from a modest beginning of 7.39 lakh beneficiaries in , the number has risen ten-fold to lakh beneficiaries in

15 Safe Abortion Services Increasing access to safe abortion services by popularizing manual vacuum aspiration (MVA) technique at PHC level for early pregnancy Increasing access to safe abortion services by popularizing manual vacuum aspiration (MVA) technique at PHC level for early pregnancy Control of RTI /STDs Planned & implemented in close collaboration with National AIDS control Organization (NACO) Planned & implemented in close collaboration with National AIDS control Organization (NACO) NACO is supporting to set up STD clinics up to the district level NACO is supporting to set up STD clinics up to the district level Each district are assisted by two laboratory technicians on contract basis for testing blood,urine for RTI / STD test Each district are assisted by two laboratory technicians on contract basis for testing blood,urine for RTI / STD test

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17 Key Strategies Increase coverage of skilled care at birth for newborns in conjunction with maternal care - Pre-service IMNCI is underway in 62 medical colleges Increase coverage of skilled care at birth for newborns in conjunction with maternal care - Pre-service IMNCI is underway in 62 medical colleges Implement a comprehensive IMNCI approach - a newborn and child health package of preventive, promotive and curative Currently being implemented in 193 out of 612 districts Implement a comprehensive IMNCI approach - a newborn and child health package of preventive, promotive and curative Currently being implemented in 193 out of 612 districts Navjaat Shishu Suraksha Karyakram Navjaat Shishu Suraksha Karyakram Introduction of Hepatitis-B Vaccine in routine immunization Introduction of Hepatitis-B Vaccine in routine immunization Neonatal & Child Health component

18 Care at birth Facility / Home Strengthening the existing interventions BCC AND COMMUNITY MOBILIZATION Health system strengthening IMNCI RCH II: Child Health strategy ASHA/HW HBNC IPHS Standards Capacity building Improved Referral Care of New born & sick children

19 “Navjaat Shishu Suraksha Karyakram” A new programme on Basic Newborn Care and Resuscitation A new programme on Basic Newborn Care and Resuscitation High Neonatal Mortality Rate despite substantial reduction in childhood and infant mortality High Neonatal Mortality Rate despite substantial reduction in childhood and infant mortality Nearly two-thirds infant deaths each year occur within the first four weeks of life, and about two- thirds of those occur within the first week. Nearly two-thirds infant deaths each year occur within the first four weeks of life, and about two- thirds of those occur within the first week.

20 Child health cont… MoHFW has developed a comprehensive New Born and Child Health policy MoHFW has developed a comprehensive New Born and Child Health policy Village Health and Nutrition Days Organized at AWCs for service provision in the RCH-II & NRHM, and also as a platform for intersectoral convergence Organized at AWCs for service provision in the RCH-II & NRHM, and also as a platform for intersectoral convergence Over lakh VHNDs have reportedly been carried out across states in Over lakh VHNDs have reportedly been carried out across states in Nearly 70 percent of planned sessions are being held and on average there are clients per VHND Nearly 70 percent of planned sessions are being held and on average there are clients per VHND

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22 New Interventions in Family Planning (GOI) 1. Addressing the unmet need in contraception through Assured delivery of quality family planning services Assured delivery of quality family planning services Developing skilled manpower Developing skilled manpower 2. Increasing basket of choices - through 2. Increasing basket of choices - through several trials by GoI including injectables (Cyclofem and NetEn), Centchroman, and a five-year multi-load IUCD. 3. Intensive promotion of Non-Scalpel vasectomy 4. Promotion of IUDs as a short & long term spacing method 5. Promotion of Emergency Contraceptive Pills Improving awareness of FP ( e.g, FP counsellors located at Comprehensive Emergency Obstetric and New Born Care (CEmONCs) in MP and Jan Mangal couples in Rajasthan

23 Infertility management % of couples are infertile % of couples are infertile. Medical, ethical and legal issues involved. Medical, ethical and legal issues involved. Guidelines for ART (Assisted Reproductive Technology) has been prepared in Guidelines for ART (Assisted Reproductive Technology) has been prepared in Draft bill on ART is awaiting legislation. Draft bill on ART is awaiting legislation. 23

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25 Adolescent Reproductive & Sexual Health (ARSH) Strategy I. Reducing teenage pregnancies II. Meeting unmet contraceptive needs III. Reducing number of teenage maternal deaths IV. Reducing incidence of STIs and V. Reducing proportion of HIV positive in years age group Overall objective of ARSH Strategy is to contribute to the RCH II goals of reduction of IMR, MMR and TFR. Objective to be met by:

26 1. Adolescent friendly health services Detection and treatment of anemia, RTI/STDs, de-addiction psycho-somatic problems and other problems Detection and treatment of anemia, RTI/STDs, de-addiction psycho-somatic problems and other problems HIV detection and counseling HIV detection and counseling Easy and confidential access to MTP Easy and confidential access to MTP Antenatal care and advice regarding child birth Antenatal care and advice regarding child birth 2. Adolescent health counseling services To provide counseling related to Growth and development; Nutrition; Reproductive and child health; Marriage and parenthood & Life-skill education To provide counseling related to Growth and development; Nutrition; Reproductive and child health; Marriage and parenthood & Life-skill education Services provided at PHCs, CHCs, FRUs and district hospitals in the selected districts through routine OPDs and “Adolescent Health Clinics” conducted at least once every week Component of ARSH:

27 ARSH : Progress so far RCH-II ARSH Strategy approved as part of National and state RCH-II PIP Self learning module for rural youth and health care providers MOHFW RCH-II ARSH Training Sub-Group constituted & developed a training design document.

28 Achievements so far …

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30 RCH II Goal Indicators

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