REPRODUCTIVE AND CHILD HEALTH

PROGRAMME
 WHAT IS RCH APPRAOCH?

People have the ability to reproduce and regulate their

fertility, women are able to go through pregnancy and child

birth safely, the outcome of pregnancies is successful in

terms of maternal and infant survival and well being, and

couples are able to have sexual relations, free of fear of

pregnancy and of contracting diseases.

 RCH PHASE - I
The programme was formally launched on
15th October 1997.
RCH PHASE 1 PROGRAMME INCORPORATED THE 4 COMPONENT

Family planning

Prevention and
management of
RCH Child survival and
RTI/STDs/AIDS PACKAGE safe motherhood

Client approach
to health care
 RCH phase – I interventions in all districts
• Child survival interventions i.e immunization, vit-A, ORT and
prevention of pneumonia.
• Safe motherhood interventions e.g. antenatal check up,
immunization for tetanus, safe delivery, anaemia control
programme.
• Implementation of target free approach
• High quality training at all levels
• IEC activities
• Specially designed RCH package for urban slums and tribal
areas
• District sub-projects under local capacity enhancement
• RTI/STD clinics at district hospitals
• Facility for safe abortions at PHC by providing equipments
and contractual doctors.
• Enhanced community participation through panchayats,
women’s groups and NGOs
• Adolescent health and reproductive hygiene
 RCH phase – I interventions in selected states
• Screening and treatment of RTI/STD at sub-
divisional level

• Emergency obstetric care at selected FRUs

• Essential obstetric care
• Additional ANM at sub-centres
• Improved delivery services and emergency care
by providing drug and equipments, ANM kits at
sub-centres
• Facility of referral transport for pregnant
women during emergency (through panchayats)
 RCH – I services and major interventions
1. Essential obstetric care

2. Emergency obstetrical care

3.24 -hour delivery services at PHCs\CHCs

4.Medical termination of pregnancy MTP act 1971

5. Control of reproductive tract infections and sexually

transited diseases

6.Immunization

7.Drug and equipment kits : equipment kits supplied at various

levels as follows:
• At sub-centre level : United Nations Office for Project

Services

Drug kit A

Drug kit B

Mid- wifery kit

Sub- centre equipment kit

• At PHC level- PHC equipment kit

•At CHC level- equipment kits from kit E to kit P

8.Essential newborn care

9. Oral rehydration therapy

10. Prevention and control of vitamin A deficiency in children

Under the program , doses of vitamin A are given to all children under 5 years
of age.

• The first dose( 1 lakh units) is given at nine months of age along with
measles vaccination

• The second dose is given along with DPT\ OPV booster doses

• Subsequent doses ( 2 lakh units each) six months intervals

11.Acute respiratory disease control cotrimoxazole is being supplied to the
health worker through the CSSM drug kit

12.Prevention and control of anemia in children under this program of control

and prevention of anemia ,tablets containing 20 mg of elemental iron and
100 mcg for of folic acid for 5 years, 30 mg iron and 250 mcg 6-10 years
for 100 days are provided at sub-centre level .

The health workers to provide 100 tablets to children clinically found to be

anemic.

13. Training of Dais

 RCH –PHASE II
RCH –PHASE II began from 1st April 2005,the focus is to reduce
maternal and child mortality and morbidity with emphasis on rural
health care. The major strategies are

1) Essential obstetric care

a. Institutional delivery

b. Skilled attendance at delivery

c. Policy decisions

2) Emergency obstetric care

a. operationalizing first referral units

b. operationalizing PHCs and CHCs for round clock delivery
services

3) Strengthening referral system

 1) Essential obstetric care
• A) INSTITUTIONAL DELIVERY:
to promote institutional delivery 50% of PHC and CHC would be
made operational as 24 hours delivery centre.

• B) SKILLED ATTENDANCE ATDELIVERY:

for MOs/ ANMs/LHVs – guidelines for conducting normal
delivery and management of obstetric complications.

• C) POLICY DECISIONS:
ANMs/LHVs/SNs – Permitted to use drugs in specific emergency
situations to reduce maternal mortality.
 2) Emergency obstetric care
(EmOC)
• The FRUs be made operational for providing emergency obstetric care
• The minimum services provided by a fully functional FRUs
1. 24 hrs delivery services including normal and assisted deliveries
2. EmOC including surgical interventions like caesarean section.
3. New-born care
4. Emergency care of sick children.
5. Full range of family planning services including laproscopic
services.
6. Safe abortion services
7. Treatment of RTIs/STIs.
8. Blood storage facility
9. Essential lab services
10. Referral (transport ) services.
 3) Strengthening referral system

• Funds were given to panchayat for providing

assistance to poor people in case of obstetric
emergencies.
• Involvement of local self-help groups, NGOs and
women groups.
 NEW INTIATIVES
1.Training of MBBS doctors in life saving
anesthetic skills for emergency obstetric care.
Govt .of India is also introducing training of MBBS doctors of
obstetric management skills, prepared training plan for 16
weeks in all obstetric management skills,inculding caesarean
section operation.
2.Setting up of blood storage centres at FRUs
according to government of India guidelines
 3.JANANI SURAKSHA
YOJANA
• The national maternity benefit scheme has been modified
into a (JSY) JANANI SURAKSHA YOJANA.

• It was launched on 12th April 2005.

• It is a 100% centrally sponsored scheme

• Under national rural health mission ,it integrates the cash
assistance with institutional care during antenatal, delivery
and immediate post-partum care

• ASHA would work as a link worker

 THE SCALE OF ASSISTANCE UNDER THE
SCHEME FROM 2012-13

RURAL AREA URBAN AREA

CATEGORY
MOTHER’S ASHAS’S MOTHER’S ASHAS’S TOTAL
TOTAL Rs
PACKAGE PACKAGE* PACKAGE PACKAGE** Rs

LPS 1400 600 2000 1000 400 1400

HPS 700 600 1300 600 400 1000

*ASHA incentives of Rs-600 in rural area: Rs-300 for ANC component and Rs-300 for
accompanying PWs for institutional delivery
** ASHA incentives of Rs-400 in urban area: Rs-200 for ANC component and Rs-200 for
accompanying PWs for institutional delivery
 The eligibility of cash assistance

• In LPS:
all women including SC &ST families.
• In HPS:
BPL women and SC,ST pregnant women.

The limitation of cash assistance for institutional delivery

• In LPS:
all births.
• In HPS:
upto 2 live births.
 4.VANDEMATARAM SCHEME

• It is a voluntary scheme wherein any obstetric and gynaec

specialist, maternity home, nursing home, MBBS DOCTORS

can volunteer themselves for providing safe motherhood

services.

• 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.

 5.Safe abortion services
• Under RCH – II the following services are provided:

– Medical method of abortion:

• Under preview of MTP act-1971; Mifepristone (RU 486)
followed by Misoprostol. It is recommended upto 7 weeks(49
days) of amenorrhoea.

– Manual vacuum aspiration:

• MVA technique has been piloted in coordination with FOGSI
(FEDERATION OF OBSTETRIC AND GYNECOLOGICAL
SOCIETIES OF INDIA), WHO and respective state Govts.
6.Village health and nutrition day

• Once in a month at AWCs

• To provide antenatal/post-partum care to PW, promote

institutional delivery, health education, immunization, family

planning and nutrition services.

 7.Maternal death review

• Both facility and community maternal death review

• To improve the quality of obstetric care and

reduce the maternal morbidity and mortality.

 8.JANANI-SHISHU SURAKSHA KARYAKRAM (JSSK)

• Launched on 1st June 2011

• To make available better health facilities for women and
child.
• The facilities to pregnant women:
– all PW delivering in PH institutions to have absolutely free and no expense
including C-Section.
– The entitlements include free drugs & consumables, free diet upto 3 days
during normal delivery and upto 7 days for C-section, free diagnostics and
free blood, free transport from home to institution & between facilities an
case of referral.
– Similar entitlements for all sick newborns.
– The scheme has now been extended to cover the complications during ANC,
PNC & sick newborn.
• The strategy for child health care, aims to reduce

under-five child mortality through improved child

care practices and child nutrition.

1.Nutritional rehabilitation centres( NRCs)
• Medical and nutritional care to severe acute malnutrition
children under 5 years of age.
• The services provided:
1. 24 hrs care and monitoring of the child
2. Treatment of medical complications
3. Therapeutic feeding
4. Sensory stimulation and emotional care
5. Counselling on appropriate feed, care and hygiene
6. Demonstration and practice by doing of energy dense food
7. Social assessment of family
8. Follow-up of the children discharged from the facility.
2.IMNCI (INTEGRATED MANAGEMENT OF NEONATAL
AND CHILDHOOD ILLNESS)

• IMNCI is one of the main intervention under RCH-II.

• The objective is to implement IMNCI package at the level of
household, and through ANMs at sub-centre level; through
MOs, nurses and LHVs at PHC level.
 Pre-service IMNCI
• IMNCI is being included in the curriculum of medical
colleges. This will help in providing trained IMNCI
manpower in public and private sector.
Facility based IMNCI (F-IMNCI)
• Integration of facility based care package with
IMNCI package, to empower the health personnel
with the skill to manage newborn and childhood illness
at community level as well as the health facility.
 Facility based newborn care
Health facility All newborns at Sick newborn
birth
PHC/SC identified NBCC (newborn care Prompt referral
as MCH level -I corner) in labor
rooms

CHC/FRUs identified NBCC in labor rooms NBSU (newborn

as MCH level - II and in operation stabilization unit)
theatre

District hospitals NBCC in labor rooms SNCU (special

identified as MCH and in operation newborn care unit)
level-III theatre
 3. HOME BASED NEWBORN CARE (HBNC)

• Aimed at improving newborn survival

• Strategy is to universal access to home based
newborn care
• The providers of service include AWWs, ANM,
ASHA and the MO.
• However ASHA is the main person involved in
home based newborn care.
 4. NAVJAT SHISHU SURAKSHA KARYAKRAM
(NSSK)

• Is a programme aimed to train health

personnel in basic newborn care and
resuscitation.

• Launched to address care at birth issue i.e

prevention of hypothermia, prevention of
infection, early initiation of breat-feeding
and basic newborn resuscitation.
 5. RASHTRIYA BAL SWASTHYA KARYAKRAM
(RBSK)

• Launched in February 2013.

• Provision for child health screening and
early intervention services through early
detection and management of 4 Ds
prevalent in children.
• 4 Ds:
1. Defects at birth
2. Deficiency conditions
3. Diseases in children
4. Developmental delays including disabilities
 Quality indicators
• % Pregnancy Registered before 12 weeks
• % ANC with 3 visits
• % ANC receiving all RCH services
• % High risk cases referred
• % High risk cases followed up
• % deliveries by ANM/TBA
• %PNC with 3 PNC visits
• % PNC receiving all counselling
 Cont…
• % PNC complications referred

• % Eligible couple offered FP choices

• % women screened for RTI/STDs

• % Eligible couple counselled for prevention of RTI/STDs

• % ADD given ORS

• % ARI treated

• % children fully immunized

 Reference
• Park's Textbook of Preventive and
Social Medicine 24th Edition/2017.