REPRODUCTIVE AND CHILD HEALTH PROGRAMME Learning objectives At

REPRODUCTIVE AND CHILD HEALTH PROGRAMME

Learning objectives • At the end of the class students will be able to : understand the historical background of RCH program • Define RCH • List the aims and objectives of RCH • Explain the components of RCH • Describe the RCH phase I and II

Historical Background • 1952 - National Family Planning Programme • 1977 - National Family Welfare Programme • 1985 - Universal Immunization Programme • 1992 - Child Survival And Safe Motherhood Programme • 1997 - RCH (Phase-1) • 2005 - RCH (Phase-11)

RCH Programme- I Definition “People have the ability to reproduce and regulate their fertility, women are able to go through pregnancy and child birth safety, the outcome of pregnancies is successful in terms of maternal and infant survival and wellbeing and couples are able to have sexual relations free of fear of pregnancies and of contracting diseases”. (Fathalla, 1989)

RCH Programme- I • Immediate Objective- To promote health of mother and children. • Intermediate Objective- To reduce IMR and MMR. • Ultimate Objective- Population Stabilization

Components of RCH Phase I Family planning Child survival safe motherhood Client approach to health care Prevention/ management of RTI/AIDS 7

Service Package: for mothers • Essential obstetric care – Early registration – Minimum 3 ANC by ANM or Medical officers – Safe delivery – 3 PNC – Referral 8

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 honorarium to staff – Safe deliveries 9

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. 10

Conti. . – Three postnatal checkups are given to mothers after the delivery. – Spacing of at least three years between children are encouraged.

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. 12

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 13

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 14

Conti. . – Other New Services • Treatment of RTI/STI is given. • Promotion activities for adolescents health.

For adolescents • Menstrual hygiene • Iron and Folic acid supplementation at school • Swatch Galati

RCH Programme- I Intervention / Strategies: • Prevention $ Management of unwanted pregnancies • Maternal Care • Child Survival • Prevention $ Management of RTIs $ STIs • Prevention of HIV / AIDs

RCH Programme- I Management Strategies : • Bottom- up Planning • Decentralized Training • Management information and Evaluation System (MIES) $ • IEC and Community Participation

RCH Programme- II AIM • To reduce Infant Mortality Rate (IMR), Maternal Mortality Rate (MMR), Total Fertility Rate (TFR), To increase Couple Protection Rate (CPR), and Immunization coverage, specially in rural areas.

RCH Programme- II -Goals Goal Target Year Percentage Reduction of population growth rate 2001 - 2011 1. 62% Reduction of IMR 2007 2010 <45/1000 <30/1000 Reduction of MMR 2010 1. 5/1000 live births Reduction of TFR 2010 2. 1% Increase of CPR 2010 From 48. 2% to 100% Increase of Immunization Coverage 2010 From 44. 5% to 89%

Lacunae of RCH-I • • • Poor out reach service Inadequate financial resources Inadequate human resources MIES was lacking Effective network of FRU was lacking Poor infrastructure Quality of PHC’s $CHC’s service was poor Poor Neonatal and Adolescent health care Minimum community participation Regional variation

RCH Programme- II, Objectives • To improve the management performance • To develop human resources intensively • To expand RCH services to tribal areas also

Conti… • To improve the quality, coverage and effectiveness of the existing services and more focused on empowered action group (EAG) states • To monitor and evaluate services

Components of RCH-II • • Population Stabilization Maternal Health Newborn Care and Child Health Adolescent Health Control of RTIs / STIs Urban and Tribal Health Monitoring and Evaluation Other Priority areas

Components of RCH-II Population Stabilization- Strategies • By incorporating the newer choices of contraception methods e. g: -Centchroman • By increasing trained personals • By converging the service at grass root level • By increasing incentives

Conti… • By public private partnership • Social marketing of contraceptives to be strengthened • Involving Panchayat Raj Institutions, Urban Local Bodies $ NGO’s

Components of RCH-II Maternal Health- Strategies Essential Obstetrical Care • Three or More Checkups • Two doses of TT • IFA Tablet • Counseling Emergency Obstetrical Care • First Referral Unit

Components of RCH-II New Born Care and Child Health Effective Newborn Health Intervention • • During Antenatal Period Labor, Birth, $ the first 1 - 2 hours Early Newborn Care Late Newborn Care

Components of RCH-II New Born Care and Child Health OBJECTIVES • Skilled care at birth • Package of preventive, promotive and curative intervention • Strengthen IMNCI services

Components of RCH-II New Born Care and Child Health Strategies • IMNCI plus • Strengthening of health infrastructure and FRUs • Ensuring referral service of sick neonates and utilization of referral funds

Conti. . • Permitting ANMs to administer selected antibiotics like Gentamycin and cotrimoxazole by AWW • Availability of drugs and supplies • Good supervision and monitoring • Efficiency of the administrative/ financial system

Cont…. . • • Community based intervention Promoting breast feeding practices Vit A, Iron and Folic Acid Supplimentation Strengthening the quality of UIP

Components of RCH-II Adolescent Health Sub-centre • Enroll newly married couple • Provision of spacing methods • Routine antenatal care and institutional delivery • Referral service • HIV/ AIDS /STIs preventive education • Nutritional Counselling

Cont…. . PHC $ CHC • Contraceptive • Management of menstrual disorder • HIV/ AIDS /STIs preventive education and management • Counseling

Components of RCH-II Control of RTIs /STIs • Controlled by syndromic approach

Components of RCH-II Urban Health Centers- 1: 50, 000 Population • Medical Officer- 1 • ANMs- 3 -4 • Lab Assistant- 1 • Public Health Nurse- 1 • Clerk- 1 • Chowkidar- 1 • Peon- 1

Components of RCH-II Tribal Health • Community Level • Sub centre • PHC • Block PHC / CHC

Components of RCH-II Monitoring and Evaluation MIES • Planning • Monitoring / Information • Quality Assessment • Evaluation • Validation

Newer Schemes and Services • • • Training of MOs Training of traditional birth attendents Prasoothi araike Janani Suraksha Yojana Scheme Vandemataram Scheme n

Conti… • Safe abortion service Medical Method-Mifepristone $ Misoprostol Manual Vaccum Aspiratio

Recapitulation • Define RCH ? • Explain RC H program phase –I? • Describe RCH program phase II?

Conclusion The Reproductive and Child Health (RCH) Programme was launched in October 1997. The main aim of the programme is to reduce infant, child and maternal mortality rates.

Evaluation 1. RCH Programme was launched in the year………. . (1972, 1996, 1997, 1994) 2. In PHC, ……. . $. . . are the two drugs used for medical abortion. (Mifepristone and Misoprostone, Mifepristone and Oxytocin’ Meperidine and Misoprostone)

Cont…. 3. RCH –II was started from 1 st April………. Up to……… (2005 -2009, 2005 -2025, 2005 -2050)

Bibliography • • • 1. Park J E & K Park, Text Book of P & S. M. , M/s Banarsidasm Bhanot, Jabalpur 2. Mahajan B K and M/C. Gupta, Text Book of P & S. M. , Jaypee Publications 3. Swati Bhave , Bhave's Textbook of Adolescent Medicine Paperback – 2 4. David MN Paperny, Handbook of Adolescent Medicine and Health Promotion, FSAHM University of Hawaii, USA 5 S. Neinstein Lawrence, Adolescent Health Care, A Practical Guide Fifth Edition 6. Gulani K. K, community health nursing, principles and practices. 7. Stanhope community health nursing 1 st edition. mosby philadelhia.