reproductive and

child health
program
 Introduction
The reproductive and child health
program was formally launched by Gov. of
India on 15th Oct 1997. As per
recommendation of International
Conference on Population and development
held in Cario in 1994.
 Definition
• In ICPD at Cairo ,fathallah ,defined RCH as “A state of
complete,physical,mental, and social well-being and
merely the absence of disease or infirmity in all
matters relating to reproductive system and its
function and process.”
• “A state in which people have the ability to reproduce
and regulate their fertility are able to go through
pregnancy and child birth, the outcome of pregnancy is
successful in terms of maternal and infant survival and
well-being ,and couples are able to have sexual relation
free of the fear of pregnancy and of contracting
diseases.”
 OBJECTIVE
1. To promote the health of the mothers
and children to ensure safe motherhood
and child survival.
2. The intermediate objective is to
reduce IMR & MMR.
3. The ultimate objective is population
stabilization , through responsible
reproductive behavior.
INTERVENTION/CONCEPT OF RCH

• Prevention and management of

unwanted pregnancies
• Maternal care (safe motherhood)
• Child survival
• Prevention and management of
RTIS/STD
• Prevention of HIV/AIDS
 RCH PHASE - I
• The programme was formally launched
on 15th October 1997.
 COMPONENT OF RCH
phase I
Following services are included in the
reproductive health area as proposed by Gov.
of India.
MAIN COMPONENTS:
1. Family planning
2. Child survival and safe motherhood
program
3. Prevention /management of RTI/STD
AND AIDS
4. Client approach to health care.
 OTHER ACTIVITIES
• Providing counseling , information and
communication services on health ,
sexuality and gender difference.
• Referral services for all above
intervention.
• Growth monitoring ,nutrition
education ,reproductive health services
for adolescents etc.
 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) INSTITUTIONALDELIVERY:
• to promote institutional delivery 50% of PHC and
CHC would be made operational as 24 hours delivery
centre.
B) SKILLEDATTENDANCEAT DELIVERY:
• for MOs/ ANMs/LHVs – guidelines for conducting
normal delivery and management of obstetric
complications.
C) POLICYDECISIONS:
• 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, including 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
Z
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

CHILD HEALTH COMPONENT
• 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.
 Management of medical complication
centres
• Triage
• Assessment at admission
• Principles of hospital based management
• Micronutrient supplementation follow up of
children after discharging from NRC
 PRINCIPLES OFHOSPITAL BASED
MANAGEMENT
• STABILIZATION PHASE
• TRANSITION PHASE
• REHABILITATION PHASE
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 man
power 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
• NEWBORN CARE CORNER
• NEWBORN STABILIZATION UNIT
• SPECIAL NEWBORN CAREUNIT
• TRIAGE OF SICK NEWBORN
 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 breast-
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
 PROGRAMME IMPLEMENTATION
• FOR NEWBORN
• FOR CHILDREN 6 WEEKS TO 6 YEARS
• FOR CHILDREN 6 YEARS TO 18 YEARS
 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
• % 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
 O U
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