1. Reproductive & Child Health interventions:
Status and issues at a glance….
Dr. Rakesh Kumar, Joint Secretary (RCH), Ministry of Health & Family Welfare
Government of India

2. Current Status (All India)
RCH-II GOAL INDICATORS
ALL INDIA STATUS
(Source of data)
RCH Goals (2012)
MMR
301 (SRS )
254 (SRS )
212 (SRS 07-09)
<100
IMR
60 (SRS 2003)
53 (SRS 2008)
47 (SRS 2010)
<30
TFR
3.0 (SRS 2003)
2.6 (SRS 2008)
2.5 (SRS 2010)
2.1
12 States and UTs have achieved the national target for IMR
21 States and UTs have achieved national target for TFR.
Only Kerala and Tamil Nadu have achieved all 3 RCH goals.

3. Mothers who had full antenatal check-up (%)
Maternal Health - Full Antenatal Check-up
Significant Rural –Urban Variation across 9 states; Orissa & Chhattisgarh and UP & Bihar reflect the two extremes
Mothers who had full antenatal check-up (%)
State
State value
Minimum
Maximum
Range
Assam
11.9
Dhubri (2.1)
Jorhat (18.2)
16.1
Bihar
5.9
Madhepura (2.4)
Patna (16.4)
14.0
Jharkhand
13.1
Garhwa (3.6)
Purbi Singhbhum (31.6)
28.1
Madhya Pradesh
13.3
Sheopur (1.8)
Balaghat (30.8)
28.9
Chhattisgarh
19.5
Korba (10.9)
Dhamtari (34.5)
23.6
Odisha
18.6
Jajpur (5.4)
Jagatsinghpur (36.0)
30.6
Rajasthan
8.5
Karauli (1.7)
Jaipur (19.5)
17.8
Uttar Pradesh
3.9
Balrampur (0.6)
Kanpur Nagar (14.8)
14.3
Uttarakhand
11.1
Rudra Prayag (3.7)
Dehradun (22.7)
19.0
With in a State, the maximum variability of 28.0 reported in Jharkhand. Across 284 districts, Full ANC ranges from 0.6% in Balrampur (UP) to 30.6% in Jagatsinghpur ( Odisha)- a variability of more than 28.9% points.

4. Maternal Health Issues Key actionable points
Delivery Points aim to provide comprehensive care at the 17,000 health facilities that are performing above a certain benchmark.
Issues
Irregular & Incomplete reporting on DPs
Less than 50% FRUs conducting C- section with low numbers
Only about 50% of 24X7 PHCs have a delivery load of 10 or more per month
Underutilized DPs
Key actionable points
Regular performance monitoring of DPs
Prioritization of resources including rational deployment of manpower
Regular reporting by States like Rajasthan, MP, Haryana, Orissa
Less than 40% FRUs conduct C sections in AP, Bihar, Chhattisgarh, Jharkhand, MP, Odisha, Rajasthan, Uttarakhand

5. Safe Delivery
Significant Rural –Urban Variation across 9 states; Jharkhand & Chhattisgarh and Rajasthan & MP reflect the two extremes
Safe delivery (%)
State
State value
Minimum
Maximum
Range
Assam
70.1
Karimganj, Hailakandi (34.8)
Sibsagar (88.2)
53.4
Bihar
53.5
Sheohar (30.2)
Munger (80.4)
50.2
Jharkhand
47.1
Pakaur (24.8)
Purbi Singhbhum (69.0)
44.2
Madhya Pradesh
82.2
Dindori (45.5)
Indore (96.3)
50.9
Chhattisgarh
49.5
Surguja (32.6)
Kanker (69.4)
36.8
Odisha
75.2
Nabarangpur (35.6)
Puri (92.7)
57.1
Rajasthan
76.2
Jaisalmer (48.6)
Jaipur (92.2)
43.6
Uttar Pradesh
51.3
Balrampur (22.0)
Jhansi (89.4)
67.4
Uttarakhand
56.9
Tehri Garhwal (43.1)
Nainital (79.5)
36.4
With in a State, the maximum variability of 67.0% points reported in UP. Across 284 districts, Safe Delivery ranges from 22.0% in Balrampur(UP) to 96.3% in Indore ( MP)- a variability of more than 74.3 % points.

6. Institutional Delivery (%)
Significant Inter-State variation across 9 states; Institutional Delivery: Ranges from 34.9% in Chhattisgarh to 76.1% in MP.
Institutional Delivery (%)
State
State value
Minimum
Maximum
Range
Assam
57.7
Hailakandi(28.9%)
Nalbari(77.6%)
48.7
Bihar
47.7
Sheohar(24.2%)
J Munger(75%)
50.8
Jharkhand
37.6
Dumka(19.4%)
Purbi Singhbhum(63.0%)
43.6
Madhya Pradesh
76.1
Indore(92.5%)
Dindori(44.5%)
48.0
Chhattisgarh
34.9
Bilaspur(21.9%)
Bastar(59.3%)
37.4
Odisha
71.3
Nabarangapur(31.8%)
Puri (91.6%)
59.8
Rajasthan
70.2
Barmer(34.5%)
Jaipur(90.9%)
56.4
Uttar Pradesh
45.6
Balrampur (16.8%)
Jhansi(75.2%)
58.4
Uttarakhand
50.5
Bageshwar(33.9%)
Dehradun(70.2%)
36.3
With in a State, the maximum variability of 59.8 reported in Odisha. Across 284 districts, Institutional Delivery ranges from 16.8% in Balrampur(UP) to 91.6% (Odisha)- a variability of more than 62.7% points.

7. Tracking of Severe Anemia
Maternal Health
Tracking of Severe Anemia
Issues
Poor tracking of severe anemia cases by majority of the states due to lack of orientation of frontline workers, coordinated IFA supply and Hb testing equipments
Key actionable points
Orient all frontline workers on diagnosis and line listing of pregnant women with severe anaemia.
Coordination between supply of IFA tablets, availability of trained laboratory technicians & testing equipments, referral linkages for treatment.
Odisha, J&K and M.P have started tracking and reporting on severely anemic women at Delivery Points

8. Maternal Death Review (MDR)
Maternal Health
Maternal Death Review (MDR)
Issues
Irregular and under reporting
Both FBMDR and CBMDR are in place in very few states
Poor quality review confining to medical causes rather than identifying sytemic gaps
Key actionable points
State level team to orient, train and mentor the service providers & field functionaries
Dissemination of findings of analysis of maternal deaths to all stakeholders
Prioritize constitution of FBMDR committees at DPs (FRUs and above)
No. of States reporting regularly has increased from 9 to 20 in a period of 6 months (Sept 2011 to March, 2012)
States of MP, Assam, Odisha & Punjab have taken a no. of initiatives to improve MDR process

9. Safe Abortion Services
Maternal Health
Safe Abortion Services
Issues
Poor reporting by the states, only 12 states have reported on 6 monthly formats
Status of deployment & utilisation of skills of the already trained providers is not reported
Absence or lack of functionality of District level MTP Committees
Key actionable points
Need to prioritize on expanding availability and access to quality services in public sector (particularly “Delivery Points”
Link CAC training to posting at specified “Delivery Points”.
Activate DLCs to optimally utilise and regulate private sector providers.
Strategise to disseminate visible IEC/BCC messages on safe abortion services.
MP & Maharashtra have reported more than 50% trained providers providing MTP services.

10. Maternal Health RTI/STI Services Issues Key actionable points
Lack of convergence with SACS at the state level.
Irregular availability of drugs in the field.
Poor Linkage with the adolescent friendly clinics
Testing of PW for HIV not done on regular basis
No focus on elimination of congenital syphilis
Key actionable points
Convergence with SACS
Procurement of Syndromic drug kit and RPR Testing kits.
Linkages with AFHS.
Ensuring testing of HIV in PW at delivery points.
Testing of all PW at the DPs for syphilis.

11. Janani Suraksha Yojana (JSY)
JSY PERFORMANCE:
JSY PERFORMANCE (I qtr)
All India achievement for the I qtr is 82%.
Majority of States have reported more than 70% achievement .
Low performing states are: JH & Manipur (41%), Haryana (44%), Himachal (50%)

12. Maternal Health JSY Issues Key actionable points
Poor monitoring and random verification of JSY beneficiaries
Delays in payments in most of the States (Jharkhand, Bihar, MP, UP, Manipur, Andhra Pradesh)
JSY admin expenses used for non-JSY activities (Uttarakhand, Bihar)
Less no. of mothers getting JSY benefit for home delivery (esp. Bihar, Assam, UP, Rajasthan)
Grievance redressal cells yet to be established
Delays in JSY reporting to GOI (almost all States)
Key actionable points
Monitoring and random verification of JSY beneficiaries to be initiated.
Payment of incentive before women being discharged
JSY admin expenses to be used only for JSY activities such as monitoring and IEC
Eligible BPL pregnant women need to be paid home delivery assistance
Grievance redressal cells to be established
JSY reports need to be sent timely to GOI

13. Child Health-Neonatal period
Aim is to operationalise Newborn care corner at each delivery point and make one special newborn care unit functional in each district ; Cover all newborns for first 6 weeks of life through Home Based newborn Care
Issues
Slow progress in the setting up of sick newborn care units in HFD
Paucity of trained manpower; 53% of the units have adequate MOs and 40% adequate Nurses
Equipment lying unutilized in many units especially in NBSUs
Slow pace of trainings resulting in incorrect clinical practices.
Disconnect between different level of newborn care facilities; weak linkages with the community based programme (HBNC)
Record keeping and timely reporting requires attention
Mentoring & supervision by state level institutions missing
Key actionable points
Saturation of all delivery points with Newborn Care Corners;
Facility Based Newborn Care trainings to be linked with posting to specified units
Developing at least one State level Resource Center to support trainings, observership and mentoring process
Convergence of newborn care facilities with the HBNC
Establish effective referral linkages( district specific) between newborn care facilities (NBCC, NBSU and SNCU).

14. State specific issues in Neo-natal care
States/UTs
Slow progress in establishment of SNCUs (< 50% against target)
Manipur, Tripura, Sikkim, West Bengal, Bihar, Chhattisgarh, Uttar Pradesh, J & K, Himachal Pradesh, Punjab, Haryana, Andhra Pradesh, Lakshadweep
Training of NSSK (< 75%)
All State’/UTs except Arunachal Pradesh, Goa, Madhya Pradesh, Nagaland and Odisha
Utilization of services in SNCUs (< 100 admissions/month)
D & N Haveli, Goa, Himachal Pradesh, Jharkhand, Kerala, Mizoram and Nagaland
11 States/UTs either don’t have SNCU or not reported
Out born admissions
(< 30 % )
J & K, Kerala, Uttar Pradesh, Delhi, Mizoram, Bihar, Uttarakhand, Assam, Maharashtra, Chandigarh, Karnataka, Goa
Training of ASHA in module 6 & 7 (< 50% )
Andhra Pradesh, Assam, Bihar, HP, J & K, Jharkhand, Maharashtra, Madhya Pradesh, Punjab, Rajasthan, Uttar Pradesh, West Bengal
ASHA kit (not available)
Andhra Pradesh, Assam, Bihar, J & K , Jharkhand, Maharashtra, Odisha, Punjab, Uttar Pradesh, West Bengal
HBNC roll out (Home visit started)
Chhattisgarh, Haryana, Gujarat, Karnataka, Maharashtra, Uttarakhand, Mizoram, Meghalaya, Sikkim , Tripura, Daman & Diu

15. Nutrition, ARI, Diarrhea
Community and facility based management of Diarrhoea and Pneumonia is a priority,
promote infant and young child feeding practices through the health system and home based newborn care
Issues
Low awareness among providers regarding iron supplementation guidelines resulting in very low coverage
Low use of Zinc with ORS in cases of diarrhoea
Underutilisation of Nutrition Rehabilitation centres , outcomes not monitored and national treatment protocols not being followed by many states
Limited focus on IYCF in State PIPs
Slow pace of child health trainings especially F-IMNCI
Key actionable points
Reinforce anaemia and diarrhoea management guidelines; stock management of ORS, Zinc and iron syrup/tablets
Establish State level Resource Centres to guide IYCF and Nutrition interventions
Active promotion of IYCF practices in health facilities through all MCH contacts
Review and strengthen linkages of community based program and AWC to NRCs

16. Child Nutrition, ARI and Diarrhoea
Issues
States/UTs
Vitamin A 1st Dose administration (<60%)
Nagaland, Arunachal Pradesh, Madhya Pradesh, Bihar , Manipur, Uttar Pradesh, Haryana, Tamil Nadu, Meghalaya, Jammu & Kashmir, Gujarat, Rajasthan, Chhattisgarh, Sikkim, UTs combined, Uttarakhand, Jharkhand, Orissa, Delhi
LBW babies (> 21%)
Andhra Pradesh, Chandigarh, Dadra & Nagar Haveli, UP , MP, Jharkhand, Rajasthan, Uttarakhand, Assam, Bihar, Odisha
Breastfeeding with in 1 hr
(< 40% )
Tripura , Jharkhand, Uttar Pradesh, Punjab , Bihar, Jammu & Kashmir, Uttarakhand, Andhra Pradesh, Rajasthan, Delhi , West Bengal, Madhya Pradesh, Karnataka , Himachal Pradesh, Tamil Nadu
IFA received by under 3 children (< 40%)
UP, Rajasthan, Jharkhand, Uttarakhand, Odisha, MP, Assam, Bihar, Chatisgarh
NRC establishment
(< 50%)
AP, Delhi, Rajasthan, Uttrakhand , WB
NRC Utilisation (< 50%)
UP Assam Karnataka Bihar Jharkhand Maharashtra
ORT /ORS use (< 50%)
Uttarakhand , Uttar Pradesh, Jharkhand , Bihar, Madhya Pradesh , Rajasthan , West Bengal , Punjab

17. Fully Immunized Children (AHS-2011)
Full Immunization
State
State Value
Minimum
Maximum
Uttrakhand
75.4
Haridwar (55.3%)
Pithoragarh (87.5%)
Chattisgarh
74.1
Surguja (55.5%)
Kanker ( 93.2%)
Rajasthan
70.8
Dhaulpur (37.4%)
Hanumangarh (91.4%)
Bihar
64.5
Kishanganj (26.6%)
Samastipur ( 83.9%)
Jharkhand
63.7
Giridih (28%)
Purbi Singhbhum (82.7%)
Assam 59
Dhubri (29.9%)
Dibrugarh (83.8%)
Odisha
55.0
Rayagada (11.9%)
Kendrapara (82.9%) MP
54.9
Jhabua ( 23.8%)
Indore (77.6%) UP
45.3
Etah (13.5%)
Basti (73.8%)
State of Odisha has the maximum variation among the districts min 11.9 to max and next is UP

18. Routine Immunization
Year 2012 declared as Year of Intensification of Routine Immunization
Immunization weeks being conducted across the country
Hepatitis B vaccine universalized
Issues
Missed out/hard to reach/ high risk area with low immunization coverage
Areas missed due to vacant sub-centers
Poor cold chain maintenance
Inadequately trained human resource
Low coverage of Hepatitis B, especially the birth dose
Poor demand generation and awareness activity at field level
Key actionable points
Mapping of such areas, updating microplan to incorporate them, covering these areas on highest priority
Ensuring Alternative vaccinators until vacancy filled
Ensure trained refrigerator mechanics for each district and training of all health workers
Implement Hep B-birth dose at all health institutions conducting delivery. Improve coverage of Hep B
Design BCC plan at community/district and state level

19. Routine Immunization States with Low Performance
DPT3 Coverage
(<50% coverage)
Uttar Pradesh, Assam, Puducherry, West Bengal, Karnataka, Chhattisgarh, Arunachal Pradesh, Kerala, Tamil Nadu, Sikkim, Uttarakhand
Hepatitis -B birth dose (<15% coverage)
Meghalaya, Rajasthan, Karnataka, Lakshadweep, Himachal Pradesh, Manipur, Maharashtra, Jharkhand, Chhattisgarh, Assam, Haryana, Uttar Pradesh, West Bengal, Gujarat, Arunachal Pradesh, Mizoram, Tamil Nadu, Sikkim, Uttarakhand
DPT1- DPT 3 drop out (>10% children )
Puducherry, Lakshadweep, Meghalaya, Daman & Diu, Uttarakhand
Planned sessions missed (>20%)
Meghalaya, Uttar Pradesh, Uttarakhand, Maharashtra
Measles 2nd Dose (<15% coverage Non-SIA states)
Karnataka, Andhra Pradesh, Delhi, Tamil Nadu, Uttarakhand

20. Immunization Campaigns (Polio, Measles, JE)
WHO removed India from the list of countries with active endemic wild polio virus transmission
Measles Catch-up campaign completed in 9 states vaccinating 4.8 crore children
62 new JE endemic districts identified and will be covered under campaign in phased manner.
Issues
Risk of importation of Polio virus still persists
Introduction of Measles 2nd dose under RI after 6 months of campaign pending in many districts
Phase III of Measles campaign targeting 167 districts in 5 states starting September 2012
Poor coverage of JE vaccine under RI in 113 JE endemic districts
Key actionable points
Maintain high coverage during pulse polio round
States to issue orders for incorporation of Measles 2nd dose under RI
UP, Bihar, Gujarat, MP and Rajasthan to ensure >90% coverage
Increase JE vaccination coverage under RI in endemic districts

21. Family Planning-Total Fertility Rate
Significant Rural-Urban variation across 9 large States ; Uttarakhand & Odisha and UP & Bihar reflect the two extremes.
Total Fertility Rate (TFR)
State
State value
Minimum
Maximum
Range
Assam
2.6
Kamrup (2)
Hailakandi (4.2)
2.2
Bihar
3.7
Patna (2.8)
Sheohar (4.7)
1.9
Jharkhand
3.1
Purbi Singhbhum (2.4)
Lohardagga (4)
1.6
Madhya Pradesh
Indore (2.2)
Shivpuri (4.5)
2.3
Chhattisgarh
2.9
Koriya (2.4)
Kawardha (3.7)
1.3
Odisha
Jharsuguda (2)
Boudh (3.7)
1.7
Rajasthan
3.2
Kota (2.6)
Barmer (4.7)
2.1
Uttar Pradesh
3.6
Kanpur Nagar (2.3)
Shrawasti (5.9)
Uttarakhand
Pithoragarh (1.7)
Haridwar (3.1)
1.4
Within a State, the maximum variability of 3.6 reported in Uttar Pradesh
Across 284 districts, TFR ranges from 1.7 in Pithoragarh (Uttarakhand) to 5.9 in Shrawasti (UP)- a variability of more than 4 children!

22. Family Planning Status of Key Activities
Intervention
Better performing States
Poor performing States
PPIUCD TRAINING – 6 high focus states:
Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Rajasthan and Uttar Pradesh
Bihar, Rajasthan and Jharkhand are progressing well
Madhya Pradesh, Chhattisgarh and Jharkhand
INTERVAL IUCD TRAINING in 11 states; 8 EAG states, Assam, Haryana and J&K
Assam and Haryana have started the project, Bihar, Chhattisgarh, J&K and Uttarakhand are likely to start soon
Madhya Pradesh, Uttar Pradesh, Odisha and Rajasthan
APPOINTMENT OF RMNCH COUNSELLORS – 18 states
Bihar and Madhya Pradesh
None of the other states have reported any progress.
POST PARTUM STERILISATION (PPS):
(as % of total sterilisation)
Tamil Nadu, Goa, Kerala, Andhra Pradesh, Puducherry (more than 50%)
All EAG states have less than 10% PPS

23. Family Planning
Delivery of contraceptives by ASHAs at doorstep (launched in July 2011)
ASHA are delivering contraceptives at the doorsteps in 233 districts of 17 States
231 districts have implemented except East & South Garo Hills of Meghalaya
7 of these 231 districts are yet to send utilization reports:
Bihar (Sheikhpura)
Uttar Pradesh (Lakhimpur Kheri, Bhadohi, Barabanki, Kannauj) - 4
Manipur (Ukhrul, Tamenglong),
Response from NE states (except Assam), Himachal Pradesh and Uttar Pradesh is very poor
Although Chhattisgarh and Jharkhand have reported utilisation of contraceptives, filed visits suggest that the scheme has not taken off at the field level

24. Family Planning
Ensuring spacing after marriage and between 1st and 2nd child (launched in May 2012) through incentivisation of ASHAs
Services of ASHAs for counselling newly married couples to ensure spacing of 2 years after marriage and spacing of 3 years after the birth of 1st child.
The scheme is operational in 18 states (EAG, NE and Gujarat and Haryana)
ASHA would be paid following incentives under the scheme:
Rs. 500/- to ASHA for ensuring spacing of 2 years after marriage.
Rs. 500/- to ASHA for ensuring spacing of 3 years after the birth of 1st child
Rs. 1000/- in case the couple opts for a permanent limiting method up to 2 children only

25. Adolescent Health - ARSH
Issues
Slow pace of ARSH Programme implementation in Uttar Pradesh, Bihar, Chhattisgarh and Himachal Pradesh
Irregular clinics with poor turn out
Hardly any referrals
Poor community mobilisation
Inadequate convergence with other departments
Inadequate reporting
Key actionable points
Setting up of services (clinics) for adolescents
Ensure deployment of trained staff at ARSH clinics
Training of Human Resource
Community mobilisation and out-reach services to be strengthened
Regular reporting of activities
Formulation of State specific IEC strategy for Adolescents
Best Practices:
Implementation models by States like ‘Udaan’ of Uttarakhand, ‘Maitreyi’ Clinics of Maharashtra, Sneha Clinics of West Bengal & Yuva Clinics of AP.
Peer Educator model of Assam, Haryana can be replicated.
Working on outreach strengthening and comprehensive package of services
National Strategy for Adolescent Health in India is under construction

26. School Health Programme
Issues
Biannual screening for Disease, Deficiency and Disability yet to emerge across States in the country
Dedicated school health teams not proposed by the states
Micro-planning not available
Poor mentoring, monitoring, and reporting
Poor utilization of resources approved in state
Key actionable points
Closer coordination with Department of Education.
Linkages with other NRHM – components like Adolescent Health
Pooling of resource – financial, IEC and Human, National Disease control programmes
Best Practices:
Dedicated team for screening in Maharashtra
Implementation through exclusive teams – Maharashtra, Kerala (JPHN at schools), Uttarakhand, A&N island (outsourced) and in campaign mode in Gujarat, Bihar & Himachal Pradesh, with involvement of public health infrastructure in other states, Public and PPP– Rajasthan

27. Menstrual Hygiene Scheme
Issues
Slow uptake of sanitary napkins
Incomplete re-conciliation of records across various levels
Hardly any counseling of AGs
Irregular reporting to MoHFW, especially by Chhattisgarh and Uttar Pradesh
Convergence required with Total Sanitation Campaign / for effecting disposal mechanisms
Key actionable points
Re-orientation / re-training of ASHAs regarding promotion of sanitary napkins.
Monitoring to be strengthened
Focus more on new users i.e. Girls who have not had access to any such product prior to launch of scheme.
Proper record maintenance i.e. reconciliation of delivery by HLL / receipt by State and sale of packs vis-à-vis amount of incentive paid to ASHA, as they should match
Use of incinerators and their construction through Total Sanitation Campaign / SSA funds
Status of Implementation
Total supply by HLL to States = 322 lakh packs
2nd and 3rd quarter supplies (> 600 lakhs packs) also in place
% of consumption till 31st July 2012 = 26.3 %
States performing well (good uptake) in HP, Kerala, MP, Orissa (Out of 17 implementing States through Central Supply)

28. Weekly Iron Folic Acid Supplementation (WIFS)
Issues
No plan for WIFS submitted by Chhattisgarh, Himachal Pradesh, Lakshadweep and Daman and Diu
They also did not participate in the National Level TOTs.
Difficulties in IFA procurement for NE states and UTs
State level WIFS Advisory committees yet to be activated
Key actionable points
States (UP, Chhattisgarh, Himachal Pradesh, Lakshadweep and Daman and Diu) to submit plans
Difficulties in procurement for NE states and UTs being addressed through GO on procurement of IFA and Albendazole tablets from CPSE. States need to proactively take it up
Convergence with Education and ICDS/SABLA departments
Formation of State level WIFS Advisory Committee
Trainings
Development of media plan
Regular reporting, monitoring and review of implementation
Readiness Status: PAN INDIA ROLL OUT
As per State plans, 23 states to complete procurement process by end September, , Rajasthan, Karnataka, Chandigarh, Jharkhand, Mizoram and Puducherry by October 2012.
Supply of IFA and Albendazole tablets to reach schools & Aganwadi centres by end November in 22 States / UTs except Manipur, Meghalaya, Karnataka (end December 2012) and Rajasthan (February 2013)
Training of all field functionaries to be complete by November, 2012 barring Meghalaya (in Dec 2012)

29. Reproductive age group
Adopting evidence based interventions across Lifecycle (RMNCH+A Strategy)
Promotion of IYCF practices
Routine Immunisation plus Hepatitis B, H influenza ,Pulse polio
Vitamin A & Iron Folic Acid supplementation
Use of ORS and Zinc for diarrhea
Integrated Case management of neonatal and childhood illnesses
Management of children with severe acute malnutrition
Childhood
Weekly Iron Folic Acid Supplementation, Preventive health check-ups; Screening for disease, deficiency and disability & referral
Provision of reproductive & sexual health services Promotion of menstrual hygiene
Adolescents
Family planning advice and counseling ,Provision of a range of family planning methods
Screening for STIs and its management
Access to Safe abortion & Post abortion care
Reproductive age group
Neonatal resuscitation with bag and mask
Essential new-born care at birth and up to 6 weeks
Management of sick newborns
Neonatal period
Essential care during pregnancy
Tracking of pregnant women with severe anemia and case management
Access to safe abortion and post abortion FP counseling and services
Treatment of complications of s/unsafe abortions
Management of STI/RTI
PPTCT
Pregnancy
Detection and management of postpartum sepsis & other complications in postnatal period
Home based postnatal care & support for breastfeeding
Post-partum family planning advice and provision of contraceptives
Postpartum
Care during labour and delivery (at the health facility)
Skilled birth attendance for home deliveries
Emergency Obstetric care
Birth

30. Summary of Key Actions
Imperative to closely monitor the State specific targets under RCH
Define District specific targets and review accordingly
Strengthen monitoring of key interventions at all levels (use Dashboard indicators); timely reporting (HMIS, MCTS) and feedback for midcourse correction
Special attention to High Focus Districts; 9 states should use AHS data for District specific planning
District specific strategies to be adopted to reach the ‘Unreached’ population including urban poor
Strengthen referrals and linkages between various levels of health facilities to ensure Continuum of Care
Emphasize on quality of care: national guidelines and protocols for management should be followed

31. Thank You