1. REPRODUCTIVE AND CHILD HEALTH PROGRAM(RCH)
Dr. KANUPRIYA CHATURVEDI

2. Dr. KANUPRIYA CHATURVEDI
Lesson Objectives
To Learn about the various components of RCH program
To know about the goals. objectives target groups, service components and RCH program
To know about the services/activities under the program
To know about the new initiatives in the program
Dr. KANUPRIYA CHATURVEDI

3. Dr. KANUPRIYA CHATURVEDI
Components
The RCH program incorporated the earlier existing programs i.e. National Family Welfare Program and Child Survival and Survival & Safe Motherhood Program ( CSSM) and added two more components one relating to sexually transmitted disease and the other relating to reproductive tract infections. The program was formally launched on 15 October 1997.
Dr. KANUPRIYA CHATURVEDI

4. Components: FAMILY PLANNING CLIENT CHILD SURVIVAL APPROACH AND SAFE
Adolescent Health Care and Family Life Education
CLIENT
APPROACH
TO HEALTH
CARE
CHILD SURVIVAL
AND SAFE
MOTHERHOOD
PREVENTION/
MANAGEMENTOF
RTI/STD/AIDS
Dr. KANUPRIYA CHATURVEDI

5. Dr. KANUPRIYA CHATURVEDI
RCH PROGRAM
Family Planning
Improved method mix
Private sector inclusion
Address quality
Collaborate with NACO in condom distribution
Maternal Health
Quality ANC
Institutional Deliveries
Skilled Birth Attendance
EmObstetric care
Home based post-partum & NBC
Quality safe abortion services
RTI/STI
Child Health)
Intensify existing services : Immunization,
NBC
Micronutrient Supply
CDD
ARI
IMNCI.
Adolescent health
Anemia
Awareness about RH issues
Dr. KANUPRIYA CHATURVEDI

6. RCH Program (cross cutting Issues)
Human
Resources
Anesthetists
Obstetricians
Lady doctors
Contractual ANMs
Staff Nurses in 24 Hrs PHCs
Counselor
IEC
Branding
Involving Professional Agencies
Media
Inter-personal Communication
Celebrity involvement
MIS
Output based Monitoring
Triangulation of Data
CES/DHS
ISC
Awareness about RH issues
Anemia
Dr. KANUPRIYA CHATURVEDI

7. Dr. KANUPRIYA CHATURVEDI
The Paradigm Shift
Dr. KANUPRIYA CHATURVEDI

8. Dr. KANUPRIYA CHATURVEDI

9. Dr. KANUPRIYA CHATURVEDI

10. Dr. KANUPRIYA CHATURVEDI
Program Objectives
Promotion of MCH to ensure safe mother hood and child survival
Reduction of maternal and child morbidity and mortality
Attainment of population stabilization
Dr. KANUPRIYA CHATURVEDI

11. Highlights of the program
Integration of all programs related fertility regulation, maternal and child health and reproductive health.
Services are client oriented, demand driven through decentralized participatory process and target free approach
Up-gradation of facilities : creation of First referral units
Provision of specialist services for STD and RTI
Provision of out reach services for vulnerable groups
Dr. KANUPRIYA CHATURVEDI

12. Dr. KANUPRIYA CHATURVEDI
Categories:
Differential approach
Based on CBR and female literacy rate,
Category A:58 districts
Category B:184 districts
Category C:265 districts
All the districts covered in a phased manner over a period of 3yrs
Dr. KANUPRIYA CHATURVEDI

13. Service Package: for mothers
Essential obstetric care
Early registration
Minimum 3 ANC
Safe delivery
3 PNC
Referral
More relevant for Assam, Bihar,Rajasthan, Orissa,UP, MP
Dr. KANUPRIYA CHATURVEDI

14. Emergency obstetric care
Strengthen FRUs
Supply of kits and skilled manpower
TBA (Traditional Birth Attendants) Dai training
NGOs involved: More local specific
24-hr Delivery services at PHCs/CHCs:
Promote institutional deliveries Additional honorariumto staff
Safe deliveries
Dr. KANUPRIYA CHATURVEDI

15. Dr. KANUPRIYA CHATURVEDI
Contd.
Deliveries by trained personnel in safe and hygienic surroundings are encouraged
Institutional deliveries are encouraged for women having complications.
In case of complication referrals are made to First Referral Units for Management of obstetric emergencies.
Three postnatal checkups are given to mothers after the delivery.
Spacing of at least three years between children are encouraged.  
Dr. KANUPRIYA CHATURVEDI

16. Dr. KANUPRIYA CHATURVEDI
For children
Essential newborn care like keeping the baby warm, checking the baby’s weight and giving the baby mother’s first milk are encouraged.
Babies that are premature or have low birth weight are provided special care.
Babies with any complications refereed to the health center.
Exclusive breast-feeding are encouraged for the first three months.
Dr. KANUPRIYA CHATURVEDI

17. Dr. KANUPRIYA CHATURVEDI
Contd.
Immunization are administered to every child meticulously to prevent death and disabilities.
Vitamin A Prophylaxis
ORT.
Acute respiratory infection in children treated by cotrimoxazole tablets.
Treatment of Anemia
Dr. KANUPRIYA CHATURVEDI

18. Dr. KANUPRIYA CHATURVEDI
For Eligible Couples
Promoting use of contraceptive methods among eligible couples is important to prevent unwanted pregnancies. Couples should be able to choose from various contraceptive methods including condoms,oral pills, IUDs,male and female sterilization
Safe services for medical termination of pregnancies should be encouraged for women desiring abortions  
Other New Services
Treatment of RTI/STI is given.
Promotion activities for adolescents health.
Dr. KANUPRIYA CHATURVEDI

19. Drug and equipment kits: Mid-wifery kit & drug kit
Kit-E – Laparotomy set
Kit-F - Mini– Laparotomy set
Kit-G – IUD insertion set
Kit-H – Vasectomy set
Kit- I – Normal delivery set
Kit- J – Vacuum extraction set
Kit- k – Embryotomy set
Kit- L – Uterine evacuation set
Kit-M – Equipment for anesthesia
Kit-N- Neonatal resuscitation set
Kit-O- Equipment and reagent for blood test
Kit-P – Donor blood transfusion set
Dr. KANUPRIYA CHATURVEDI

20. Goals set for various national /int. policies
Dr. KANUPRIYA CHATURVEDI

21. Dr. KANUPRIYA CHATURVEDI
RCH Program: Phase II
RCH Phase II began from 1 April The components being:
Essential obstetrical care
Emergency obstetrical care
Strengthening referral system Strengthening project management
Strengthening infrastructure
Capacity building
Improving referral system
Strengthening MIS
Innovative schemes
Dr. KANUPRIYA CHATURVEDI

22. Essential obstetric care
Promotion of institutional deliveries
50% of the PHCs and CHCs made operational as 24 hours delivery centers.
Skilled attendance at birth
Policy descions to permit Health workers to use drugs in emergency situations to reduce maternal mortality
Dr. KANUPRIYA CHATURVEDI

23. Emergency obstetric care
Operationalisation of FRUs to provide:
24 hours delivery services
Emergency obstetric care
New born care and emergency care of the sick child
Full range of family planning services
Safe abortion services
Treatment of RTI and STI
Blood storage facility
Essential laboratory services
Referral ( transport ) services
Dr. KANUPRIYA CHATURVEDI

24. Dr. KANUPRIYA CHATURVEDI
New initiatives
Training of PHC doctors in life saving anesthetic skills for emergency obstetric care a FRUs
Setting up of blood storage centres at FRUs
Janani suraksha yojana
Vandemataram scheme
Safe abortion services
Integrated Management of Childhood illnesses.
Dr. KANUPRIYA CHATURVEDI

25. 24 hrs. Functioning of PHCs
• It is planned to establish 2000 FRUs in phases in
RCH-II 50% PHCs and all CHCs to be
operationalised in phases
• Availability of Services such as
- 24 Hrs. Delivery services
- New Born care
- Family Planning, Counselling and services
- Availability of RTI, STI services
- Safe abortion services (MVA etc.)
Dr. KANUPRIYA CHATURVEDI

26. Training in Anaesthesia
• Training of MBBS Doctors in Life Saving Anaesthetic Skills for Emergency Obstetric Care. • 18 weeks training course • The First Training Programme Conducted at AIIMS for Chhattisgarh • Training to be conducted in phases and limited to the requirement at FRUs.
• Training guidelines giving criteria for certification,
selection of trainees & training instt./medical
college, minimum procedures etc. finalized
Dr. KANUPRIYA CHATURVEDI 26

27. Training in Obstetric Management
• Training of MBBS doctors in obstetric management and skills including C.S. in RCH-II • Training to be conducted in collaboration with FOGSI • Duration of training to be 16 weeks • Expert Group is considering other details
Dr. KANUPRIYA CHATURVEDI

28. Blood Storage Facility
Management of obstetric emergencies is sometimes not possible due to non-availability of blood.
The Drugs and Cosmetics Act was therefore
modified to facilitate establishment of blood
storage centres at FRU’s.
Dr. KANUPRIYA CHATURVEDI

29. Dr. KANUPRIYA CHATURVEDI
Janani Surkasha Yojna
To promote Institutional Deliveries
To reduce overall
Maternal Mortality Ratio
Infant Mortality Rate
A safe motherhood intervention, replacing the “NationalMaternity Benefit Scheme”, under NRHM
100 % centrally sponsored
Integrates cash assistance with delivery
& post-delivery care.
Dr. KANUPRIYA CHATURVEDI

30. Dr. KANUPRIYA CHATURVEDI
Vandematram Scheme
It is a voluntary scheme wherein any obstetric and gynaec specialist, maternity home can volunteer
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.
Dr. KANUPRIYA CHATURVEDI

31. Dr. KANUPRIYA CHATURVEDI
Referral Transport
Key issues: Roads, transportation, RCH I funds poorly Utilized, Community participation lacking Under Consideration – Place funds with AWW /ANM; [ JSY] – Develop community mechanisms – Provide out source ambulances at PHCs CHCs, and FRUs
Easy access to ambulance & assistance from AWW
Dr. KANUPRIYA CHATURVEDI 31

32. Dr. KANUPRIYA CHATURVEDI
Role of ASHA
• A village level link worker attached to
AWW/ANM
• Motivator for ANC, PNC, Institutional
Delivery, Immunization and
Family Planning Services
• Provide Escort to beneficiary for above
services.
• Adolescents Health Counsellor.
• Link between beneficiaries and ANMs.
Dr. KANUPRIYA CHATURVEDI 32

33. Dr. KANUPRIYA CHATURVEDI
Strategy for addressing Adolescent Reproductive and Sexual Health (ARSH)
A two-pronged strategy will be supported:
Incorporation of adolescent issues in all the RCH training programs and all RCH materials developed for communication and behaviour change.
Dedicated days and dedicated timings for adolescents at PHC’s.
Dr. KANUPRIYA CHATURVEDI 33

34. Infection Management and Environment Plan
IMEP which is being extended to health care facilities includes:
Treatment and disposal of biomedical wastes
Disposal of syringe waste
Provision of water sanitation and good hygiene conditions
Dr. KANUPRIYA CHATURVEDI

35. Safe Abortion Practices
MEDICAL METHOD
Termination of early pregnancy (49days) using 2 drugs
- mifeprestone followed by mesoprostol
MANUAL VACCUM ASPIRATION
Safe and simple technique for termination of pregnancy.
Can be used at PHC or comparable facility
FOGSI, WHO & state govt. are coordinating the project
Dr. KANUPRIYA CHATURVEDI

36. Some Innovative State Initiatives
Gujarat
Increase access to safe delivery services. It is in partnership with private providers (Chiranjivi Yojana)
A Dai Sangathan has been formed by 10 leading NGOs of the state to facilitate interface between the health system and the community
Punjab
Proposed to pay an incentive of Rs. 500/- to BPL SCs belonging to urban areas
Purchase and supply of nutrients like iron, calcium, D-worming tablets for pregnant mothers belonging to SC classes.
40 plus care including screening code for CaCx- in /tn
BCC including IEC, counseling, family & community participation.
Subsidized Medical Practitioner (SMP) scheme – This scheme is based on success achieved of this scheme in Pune district . Districts will identify remote and hilly areas where medical care is not available . Newly passed out Medical Graduates (Preferably Ayurvedic) will be provided with assistance in the form of honorarium, drugs etc. on a tapering basis for two years so as to settle their private practice.
Nurse Practitioners Scheme– Similar to SMP scheme districts will identify villages where nurses can practice Midwifery and other minor ailment treatment on payment basis, they will be provided with honorarium, drugs etc. on a tapering basis for two years so as to settle their private practice.
Implementation of Health Insurance scheme on pilot basis.
Dr. KANUPRIYA CHATURVEDI 36

37. Dr. KANUPRIYA CHATURVEDI
Contd….
Screening code for Ca Cervix – Tamil Nadu
Subsidized Medical Practitioner (SMP) scheme- Assam, Bihar
Nurse Practitioners Scheme
Laproscopic Training – Maharashtra
Implementation of Health Insurance scheme on pilot basis.
There is increased trained of Laproscopic Sterilization. Laproscopic Sterilization is on going activity. To train eligible candidates (Gynaecologist & General Surgeon) in Laproscopic sterilization, the following institutes are identified - 1)
Sasoon Hospital, Pune 2)
YCM Hospital, Pimpari Chinchwad 3)
Shri Sali Hospital, Manchar,Dist. Pune 4)
Women Hospital - Jalna 5)
District Hospital - Alibag 6)
Govt. Medical College,Dhule
Contribution from Private Sector is there in the form of performance as well as training to Surgeons. The training of Laproscopic Sterilization is to be imparted to team comprising of Gynaecologist / General Surgeon Private Practitioners who are eligible for training and has desired to under go training Family Planning Association of India and Sangamnerkar Dwarika
Subsidized Medical Practitioner (SMP) scheme – This scheme is based on success achieved of this scheme in Pune district . Districts will identify remote and hilly areas where medical care is not available . Newly passed out Medical Graduates (Preferably Ayurvedic) will be provided with assistance in the form of honorarium, drugs etc. on a tapering basis for two years so as to settle their private practice.
Nurse Practitioners Scheme– Similar to SMP scheme districts will identify villages where nurses can practice Midwifery and other minor ailment treatment on payment basis, they will be provided with honorarium, drugs etc. on a tapering basis for two years so as to settle their private practice.
Dr. KANUPRIYA CHATURVEDI 37

38. Monitoring : Accessibility Indicators
No. of eligible couples registered/ANM
No. of Antenatal Care sessions held as planned
% of sub Centers with no ANM
% of sub Centers with working equipment of ANC
% ANM/TBA without requisite skill
% sub centers with DDKs
% of sub centers with infant weighing machine
% subcenters with vaccine supplies
% sub centers with ORS packets
% sub centers with FP supplies
Dr. KANUPRIYA CHATURVEDI

39. Dr. KANUPRIYA CHATURVEDI
Quality Indicators
Following are the quality indicators used to monitor and evaluate RCH programme through monthly reports:
Number of antenatal cases registered
Number of pregnant women who had 3 antenatal checkups
Number of high risk pregnant women referred
Number of pregnant women who had 2 doses of TT
Number of pregnant women under prophylaxis and treatment of anaemia
Number of deliveries by trained and untrained attendants
Number of cases with complications referred to PHC/FRU
Number of newborn with birth weight recorded
SINCE IT IS A TARGET FREE APPROACH MONTHLY MONITORING IS MANDATOTRY.
Dr. KANUPRIYA CHATURVEDI 39

40. Dr. KANUPRIYA CHATURVEDI
Contd..
No. of women given 3 post natal check-ups
No. of RTI/STD cases detected, treated and referred
No. of children fully immunized
No. of adverse reactions reported after immunization
No. of cases of ARI and diarrhea under 5yrs
No. of cases motivated and followed for contraception.
Dr. KANUPRIYA CHATURVEDI

41. Dr. KANUPRIYA CHATURVEDI
Impact Indicators
% DEATHS FROM MATERNAL CAUSES
MATERNAL MORTALITY RATIO
PREVALENCE OF MATERNAL MORBIDITY
% LOW BIRTH WEIGHT
NEO-NATAL MORTALITY RATIO
PREVALENCE OF POST NATAL MATERNAL MORBIDITY
% BABY BREAST FEED WITHIN 6 HRS OF DELIVERY
COUPLE PROTECTION RATE
PREVALENCE OF TERMINAL METHOD OF STERILIZATION
PREVALENCE OF SPACING METHOD
% ABORTION RELATED MORBIDITY
PREVALENCE OF ADD
PREVALENCE OF ARI
PREVALENCE OF RTI/STDs
Dr. KANUPRIYA CHATURVEDI