Reproductive Maternal Newborn Child and Adolescent Health RMNCHA

Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCH+A) Strategy, 2013. Dr. Pracheth R, MBBS, MD Assistant Professor –Community Medicine

Outline • Background • Goals and targets • Implementation of strategies • Delivery points • Maternal and Child Wing • Indian Newborn Action Plan • Rashtriya Bala Swasthya Karakyam

Background • In 2012, 80 countries: reduce child mortality • In 2013: India • Likely success: 9 lakhs ASHAs- strong delivery services • Integrated strategy: efficiency

Background • Comprehensive care; five pillars/thematic areas • Equity, universal care, accountability • Additions: üIncluding adolescence üLink maternal and child health- reproductive, family planning, adolescent health üLink home based-facility based care üLinkages, referrals, counter-referrals

Background • Aim: reach maximum people • High priority districts: weak performance indicators; 184 such districts • Management tools: RMNCH+A 5 X 5 matrix üTo implement strategies in the 5 areas

RMNCH+A 5 X 5 Matrix • Reproductive health: üSpacing methods üFocus on interval IUCD üHome delivery contraceptives üAccess to pregnancy kits üQuality sterlization services

RMNCH+A 5 X 5 Matrix • Maternal health: üEarly registration of pregnancy üDetect high risk üTrained personnel, emergency services üReview maternal, infant, child deaths-action

RMNCH+A 5 X 5 Matrix • Newborn health: üEarly initiation: breastfeeding üHome based newborn care: ASHA üEssential newborn, resuscitation services üSpecial newborn care units

RMNCH+A 5 X 5 Matrix • Child health: üComplementary feeding, IFA üDiarrhoea manegement: ORS, zinc üManage pneumonia üFull immunization coverage üRashtriya Bal Swasthya Karakyam

RMNCH+A 5 X 5 Matrix • Adolescent health: üAddress teenage pregnancies, increase contraceptive use üCommunity based services: peer educators ü Adolescent reproductive and sexual health (ARSH) clinics ü Weekly Iron and Folic Acid Supplementation (WIFS) üPromote menstrual hygiene

Goals and targets • Reduce IMR: 25/1, 000 - 2017 • Reduce MMR: 100/100, 000 live births: 2017 • Reduce TFR: 2. 1 - 2017 • National and State Scorecard: track progressindicators

Strategies- Continuum of care § Adolescence-pregnancy-birth- newborn-child • Adolescent care • Reproductive care • Pregnancy and Child birth care • Newborn and child care

Adolescent Health Programme • Nutrition, sexual and reproductive health, gender based violence, substance abuse • Develop resilience • Priority interventions

ARSH • Services delivered: fixed days: sub-centres, PHC, CHC • Promotive , preventive , curative, counseling üAdolescent Friendly Health Clinics: 6, 302 üFacility based counseling services üOutreach activities

WIFS • Launched: meet challenge- anaemia • Key interventions: Ø 100 mg elemental iron, 0. 5 mg folic acid ØScreening ØBiannual de-worming ØCounseling: improve dietary intake

Menstrual Hygiene Scheme • Aims: girls- adequate knowledge , access: high quality sanitary napkins-safe disposal • Key activities: ØCommunity based education ØRegular availability napkins ØDistribution : napkins ØTraining ASHA, teachers: menstrual health ØSafe disposal

Care: pregnancy, childbirth • Nearly 15%- complications • Deliver antenatal package • Skilled obstetric care • Immediate essential newborn care, resuscitation • Emergency obstetric, newborn care • Postpartum IUCD, sterilization • Implement PNDT act

Newborn and Child Care • Home based newborn care • Facility based care: sick newborn • Integrated Management of childhood illness (diarrhoea, pnuemonia) • Immunization • Nutritional supplementation • Rashtriya Bal Swasthya Karakyam

Care through reproductive years • Community based promotion: contraceptives • Promote spacing methods • Sterilization services • Comprehensive abortion care (MTP act) • Prevention of RTI/STI

Delivery points • To assess: functional or not • L 1: minimum 3 normal deliveries month • L 2: minimum 10 deliveries; manage complications • L 3: minimum 20 -50 deliveries, C-section ØStrengthen these systems ØStrengthen transport referral system

Maternal and Child Wing • Increase in institutional deliveries: JSY, JSSK • MCH wings provided ü 30/50/100 bedded üAntenatal waiting rooms üLabour wings üEssential Newborn care, Sick Newborn Care Unit üOperation theatre ü Blood storage units

Indian Newborn Action Plan (INAP) • Newborn health: attention • Launched : June 2014 • Strategy: reduce newborn deaths, stillbirths • Single digit by 2030 • Principles: equity, quality, integration, accountability

Six pillars • Pre-conception, antenatal care • Care during labour, childbirth • Immediate newborn care • Care of healthy newborn • Care of sick newborn • Care beyond survival

Interventions focusing on newborns • Janani Suraksha Yojna • Janani Shishu Suraksha Karyakram • Navjat Shishu Suraksha Karakyam • IMNCI • Facilty based newborn care • Home-based newborn care • Rashtriya Bal Swasthya Karakyam

Rashtriya Bal Swasthya Karakyam • Launched : 2013 • Early detection and management of 4 Ds

Defects at birth • Neural tube defects • Down’s syndrome • Cleft lip/palate • Developmental Dysplasia of Hip • Congenital cataract, heart diseases

Deficiencies • Anaemia • Vitamin A deficiency • Vitamin D deficiency • Goitre • Malnutrition

Diseases-childhood • Skin conditions • Otitis media • Dental caries • Rheumatic Heart Disease

Developmental diseases, disabilities • Vision, hearing impairment • Motor , cognitive, language delay • Behaviour disorder • Learning disorder • Attention Deficit Hyperactivity Disorder

Programme implementation • Newborn: ØFacility based newborn screening ØCommunity based screening: ASHAs • Children: 6 weeks-6 years ØAnganwadi Centres • Children: 6 -18 years Ø Government school based screening: mobile teams

Summary

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