Unit IV:

i) National health intervention programme for mother and child

ii) National family welfare programme
iii) National tobacco control programme
iv) National Malaria Prevention Program
v) National programme for the health care for the elderly
vi)Social health programme
vii) role of WHO in Indian national program
National health intervention programme for mother and child

DEFINITION
• According to WHO, Maternal and child health services can be defined as
“promoting, preventing, therapeutic or rehabilitation facility or care for the mother
and child.”

• Thus maternal and child health service is an important and essential service
related to mother and child’s overall development.
 Contd…
NEED FOR SUCH INTERVENTIONS
There are four main reasons why mother and child must be given top priority in
health programme …
1. Mother and child below the age of 15 years make up the majority of the
population.
2. Also constitute a special risk or vulnerable group.
3. By improving the health of mother and children we can improve the health of
family and community.
4. Ensuring child survival is a future investment for the family and community.
Development of Mother and Child Health Programme

• 1921- The health service for mothers and children started.

• 1931 – A maternal and child welfare service was founded by the Red Cross society.
• 1938- Indian Research Fund Association investigated the causes of maternal
morbidity and mortality.
• The 1946 – Bhore committee revealed that India was having the problem of high
maternal and infant mortality.
• 1954 – First five-year plan continued and the BCG vaccine is introduced by CDRI
Lucknow.
• 1960-School health committee was formed.
• 1971 – Parliament passed the Medical Termination of Pregnancy (MTP) bill, which
came into force in 1972.
• 1975-ICDS (Integrated Child Development Services) was launched.
• 1979 – On World Health Day, “A healthy child- A sure future” was the theme.
 Contd…
• 1984 – “Children’s Health – Tomorrow’s Health” -was the WHO theme.
• 1985 – Universal immunization programme was launched.
• 1987 The World Bank has initiated a global ‘healthy motherhood’ initiative. The
WHO theme was ‘Immunization-A Chance for every Child.
• 1992 – On August 20, CSSM (Child Survival and Healthy Motherhood Programme)
was released. The Infant Food Act came into effect.
• 1995 – The ICDS was renamed IMCD (Integrated Mother and Child Development
services).
• 1996- Prenatal diagnostic techniques act 1994 came into force.
 Contd…
MATERNAL HEALTH PROGRAMME
• Government of India adopted the Reproductive, Maternal, New- born, Child and
Adolescent Health (RMNCH+A) framework in 2013.

• It essentially aims to address the major causes of mortality and morbidity among
women and children.

• This framework also helps to understand the delays in accessing and utilizing
health care services.
 OBJECTIVES
• To reduce Maternal Mortality Ratio
• To increase the Early ANC registration.
• To ensure 3 or more than 3 ANCs (Antenatal care) to all the expectant mothers
and special attention to high risk pregnancies.
• To decrease the incidence and progress of anaemia in pregnant and lactating
women.
• Provide adequate opportunities for safe deliveries and to increase institutional
deliveries.
• To improve the coverage of post partum care.
• To increase access to Emergency Obstetric Care for complicated deliveries
through strengthening of FRUs (First Referral Units).
• To increase access to early and safe abortion services
 INTERVENTIONS
1. Janani Suraksha Yojana (JSY):
• Janani Suraksha Yojana (JSY), a demand promotion and conditional cash transfer
scheme was launched in April 2005 with the objective of reducing Maternal and
Infant Mortality.
• It is being implemented with the objective of reducing maternal and neonatal
mortality by promoting institutional delivery among poor pregnant women.
2. Janani Shishu Suraksha Karyakram(JSSK):
• Government of India has launched Janani Shishu Suraksha Karyakaram (JSSK) on
1st June, 2011.
• Entitles all pregnant women delivering in public health institutions to absolutely
free and no expense delivery including Caesarean section.
• The initiative stipulates free drugs, diagnostics, blood and diet, besides free
transport from home to institution, between facilities in case of a referral and drop
 Contd…
• Similar entitlements have been put in place for all sick new-born accessing
public health institutions for treatment till 30 days after birth.
• In 2013, this has been expanded to sick infants and antenatal and postnatal
complications.

3. Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA):

• Carrying forward the vision of our Hon’ble Prime Minister, the Pradhan
Mantri Surakshit Matritva Abhiyan was launched in 2016.
• Ensures quality antenatal care and high risk pregnancy detection in
pregnant women on 9th of every month.
 Contd…
4. LaQshya:
• In order to further accelerate decline in MMR in the coming years, MoHFW
(Ministry of Health and Family Welfare) has recently launched 'LaQshya - Labour
room Quality improvement Initiative.
• LaQshya program is a focused and targeted approach to strengthen key processes
related to the labour rooms and maternity operation theatres which aims at
improving quality of care around birth and ensuring Respectful Maternity Care.
5. Comprehensive Abortion Care Services:
• Comprehensive and safe abortion services are provided at public health facilities
including 24*7 PHCs/ FRUs (DHs/ SDHs /CHCs) including the Delivery Points.
• Supply of Nischay Pregnancy detection kits to sub centres for early detection of
pregnancy is undertaken.
 Contd…
• Capacity Building of Medical officers is being carried out routinely in safe
MTP Techniques.
• ANMs, ASHAs and other field functionaries are trained to provide
confidential counselling for MTP and promote post-abortion care including
adoption of contraception.
• Routine orientation and training of ASHAs to equip them with skills to
create awareness on abortion issues in the community and facilitation of
women's access to services.
• District Level Committees (DLCs) have been framed and empowered for
accreditation the facilities for conducting safe abortion services under MTP
Act including approval of private and NGO sector facilities for conducting
MTPs.
 Contd…
6. Provision of RTI/STI services:
• Under NHM (National Health Mission) , provision of STI/RTI care services is
an important strategy to prevent HIV transmission and to promote sexual and
reproductive health services in all the FRUs, CHCs and at 24 X 7 PHCs.

7. Village Health and Nutrition Day:

• Village Health & Nutrition Day (VHNDs) are being organized at Anganwadi
centre at least once every month.
• It is a platform to provide ante natal/ post partum care for pregnant
women, promote institutional delivery, immunization, Family Planning &
nutritional counseling.
 NEWER INTERVENTIONS
Midwifery:
• Government of India has initiated midwifery services throughout the
country in 2018.

• Objective is to provide access to quality maternal and neonatal health

services, to promote natural birthing, to ensure respectful care and to reduce
over medicalization.

• The Midwifery services initiatives aim to create a cadre for Nurse

Practitioners in Midwifery who are skilled in accordance to Interim Care
Model (ICM) competencies, knowledge and capable of providing
compassionate women – centric pregnancy care.
Importance of Maternal and Child Health Services

• To maintain pregnant women’s health and well-being.

• Mother and child are considered as a weaker group or special risk group of
complications community.
• To identify the risk factors that initiate during pregnancy.
• Many mother and child health issues are preventable.
• Health programmes for mothers and children include protection from
morbidity and mortality.
 Mother and Child Health Services (MCH)

1.Ante-natal care services.

2.Intra-natal care services.
3.Post-natal care services.
4.Neo-natal care services.
 Contd…
1. Ante-natal care:
• Women are provided with this service during pregnancy. Its goal is to provide a healthy
mother and a healthy baby at the end of pregnancy.
Objectives:
• Promote, safeguard and preserve women’s health during pregnancy.
• Identify incidents of high risk and give them special care.
• Identify and avoid pregnancy risks.
• Educate the mother about nutrition, clothing and personal hygiene.
Services provided:
• Prenatal advice related to diet, personal hygiene and exercise.
• Prenatal services include; physical examination, iron and folic acid supplementation,
lab investigations.
•
 Contd…
2. Intra-natal services:
• This service is provided to women during childbirth. It aims to provide good intra-
natal care so that complications can be prevented.
Objectives:
• Provide thorough asepsis.
• Prevent complications such as; haemorrhage, convulsions, etc.
• Provide care to the baby.
• Deliver the baby without injury to the baby and mother.
Services Provided:
• Domiciliary care.
• Place the mother comfortably on the bed after delivery and provide some hot drinks
(tea or coffee).
 Contd…
3. Post Natal Services:
• These services are provided to the mother after delivery. It includes the care of the
mother and the care of a newborn.
Objectives:
• Providing Family planning services.
• To check that breastfeeding is sufficient.
• Providing treatment for the mother’s rapid return to optimal health.
Services Provided:
• Postnatal examination
• Haemoglobin examination during the postnatal visit.
• Teach postnatal exercises
• Family planning services
 Contd…
4. Neo-natal care services:
• Upon the birth of a child, this service is given. For a child, early neonatal treatment in the first week of
life is most important. In the first 24 to 48 hours after birth, the risk of death is highest.
Objectives:
• Body temperature maintenance.
• Infection avoidance.
• Cardio respiratory infection management.
• Early diagnosis of congenital and acquired disorders and treatment.
• Setting up a suitable feeding schedule.
Services Provided:
• Immunization
• Breast feeding
• Growth and development
• Personal hygiene