1. REPRODUCTIVE AND CHILD HEALTH PROGRAM

2. 2 Learning Objectives To learn about the evolution and various components of RCH program To know the shift in approach in Reproductive and Child Health Program from the previous approach

3. Reproductive health “Reproductive health is a state of complete physical, mental and social well being and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and to its functions and processes.” Implies that people are able to have a satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so. Implicit - right of men and women to be informed to have access to safe, effective, affordable and acceptable methods of family planning of their choice to have access to appropriate health-care services that will enable women to go safely through pregnancy and childbirth and provide couples with the best chance of having a healthy infant

4. Reproductive Morbidity and its categories Any morbidity or dysfunction of the reproductive tract, or any morbidity, which is a consequence of reproductive behavior including pregnancy, abortion, childbirth or sexual behavior and may include those of a psychological nature. Three Categories Obstetric morbidity (i.e. direct, indirect and psychological maternal morbidity and deaths due to these morbidities); Gynecological morbidity (i.e. direct, indirect and psychological morbidity of the reproductive system, including sexually transmitted diseases and deaths due to these morbidities); and Contraceptive morbidity (i.e. local and systemic morbidity caused by modern and traditional fertility regulation and deaths due to these morbidities).

5. Gynecological morbidity Gynecological morbidities include any condition, disease or dysfunction of the reproductive system which is not related to pregnancy, abortion or childbirth, but which may be related to sexual behavior. Reproductive tract infections include – 1) Non- sexually transmitted infections; & 2) Sexually transmitted infections Non-sexually transmitted infections Endogenous infections caused by organisms normally present in the vagina, e.g. bacterial vaginosis, vulvovaginal candidiasis Exogenous infections caused by unsafe obstetric and gynecological practices (traditional and modern) and poor genital hygiene. Sexually transmitted infections include chlamydia, trichomoniasis, gonorrhea, syphilis and genital warts.

6. Maternal Health Child Health Family Welfare MCH Family Planning CSSM Safe Motherhood Child Survival Adolescent Health Management of RTI/ STI Reproductive Health RCH Child Health Management of Infertility Management of Gynaec Cancers

7. 7 Components: FAMILY PLANNING CHILD SURVIVAL AND SAFE MOTHERHOOD PREVENTION/ MANAGEMENTOF RTI/STD/AIDS CLIENT APPROACH TO HEALTH CARE Adolescent Health Care and Family Life Education

8. 8 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 & Newborn Care 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

9. 9 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 ISC Awareness about RH issues Anemia MIS Output based Monitoring Triangulation of Data CES/DHS

10. Highlights of National Family Welfare Program: New Approach Target-free program Greater emphasis on Quality Decentralized participatory planning: bottom up approach State-specific intervention Increased involvement of NGOs/ Private Medical Practitioners Area specific IEC campaigns Introduction of systemic technical assessment Rapid and independent evaluation Convergence with other sectors to promote nutrition Gender sensitivity Increased male participation

11. ComponentOld ApproachNew Approach Primary GoalMeet norm of two children Help clients to meet their own family planning goals Priority Services Family Planning, especially tubectomy, immunization Full range of MCH services Performance Measures Number of casesQuality of care, client satisfaction, coverage measures Management approach Top down, target-driven approach Management approach Decentralized, driven by client needs Attitude to client Motivate, persuadeListen, assess needs, inform, advise Accountability To the authoritiesTo the client and community Changing signals

12. 12 The Paradigm Shift