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REPRODUCTIVE AND CHILD HEALTH PROGRAMME (RCH) Launched in India on 15th October 1997.

Reproductive and child health approach has been defined as ,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 well being, and couples are able to have sexual relations, free of fear of pregnancy and of contracting disease The concept is in keeping with the evolution of an integrated approach ot the programmes aimed at improving the health atatus of the young women and young children which has been going in the country namely Family welfare programme, universal immunization programme, oral rehydratin programme, CSSM,..etc.It is obliviously sensible that integrated RCH programme would help in reducing the overlapping of expenditures while implementing the programme. The RCH phase I programme incorporated the components relating to child survival and safe motherhood and included 2 additional components, one relating to STD s and other relating to reproductive tract infections.The following figure represents the various components of RCH programme;

Family Planning

CSSM components

Client approach to health care

Prevention , management of RTI / STD/AIDS

The main highlights of RCH programme are; 1. The programme integrates all interventions of fertility regulation, maternal and child health with reproductive health for both men and women.

2. The services to be provided are client oriented, demand driven, high quality and based on needs of community through decentralized participatory planning and target free approach. 3. The programme envisages upgradation of the level of the facilities for providing interventions and quality of care.The first referrel units being set up at sub district level provide comprehensive emergency obstetric and new born care.Similarly RCH facilities at PHCs are upgraded 4. Facilities of obstetric care, MTP, and IUD insertion in the PHCs level are improved.IUD insertion facilities are also available at subcentres. 5. Specialist services for STD and RTI are available in all district hospitals and in fair number of subdistrict level hospitals. The RCh programme is based on a differential approach.Inputs in all districts are not kept in uniform.Whil e the care components are same in all districts, the weaker districts get more support and more facilities.On the basis of crude birth rate and female literacy rate, all the districts are divided into 3 categories. Category A having 58 districts, Category B having 184 districts and Category C having 265 districts. This programme was formally launched on October 1997. Interventions in all districts Child survival interventions, i.e. Immunization, Vitamin A, oral rehydration therapy, and prevention of deaths due to pneumonia. Safe motherhood programme. eg. antenatal checkups, immunization for tetanus, safe delivery, anemia control programme Implementation of target free approach High quality training to all workers IEC activities Specially designed RCH package for urban slums and tribal areas RTI /STD clinics at district hospitals where not available Facility for safe abortions at PHCs by providing equipments and doctors Adolescent health and reproductive hygiene Interventions in selected States/ Districts Screening and treatment of RTI/STD at sub divisional level Emergency obstetric care at selected FRU s by providing drugs

Essential obstetric care by providing drugs and PHN/staff nurse at PHCs Additional postings of ANM staff at sub centers Improved delivery services and emergency care by providing equipments and IUD insertion at sub centers Facility of referral transport for pregnant women during emergency to the nearest referral centre through panchayat in weak districts. In 1992, CSSM came to exist with the following components; 1. Early registration of pregnancy 2. Minimum 3 antenatal check ups 3. Universal coverage of all pregnant women with TT immunization 4. Advice on food, nutrition and rest 5. Detection of high risk pregnancies and timely referral 6. Cleaned deliveries by trained personnel 7. Birth spacing 8. Promotional of institutional deliveries

Later the RCH programme Phase I integrated all these services and formed its major objectives as; 1. Essential obstetric care 2. 24 hours delivery serices through PHC/CHCs 3. Emergency obstetric care 4. MTP services 5. Prevention of Reproductive tract infections(RTIs) 6. Prevention of STDs 1.Essential Obstetric care : essential obstetric care intends to provide the basic maternity services to all Pregnant woman through Early registration of pregnancy, within 12-16 weeks Provision of minimum three antenatal checkups by ANM or medical officer to monitor progress of pregnancy and to detect risk or complications Provision of safe delivery at home or in an institution

Provision of 3 post natal checkups to monitor the post natal recovery and to detect complications

2.

Emergency Obstetric care Complications associated with pregnancy are not always predictable; hence, emergency

obstetric care is an important intervention to prevent maternal morbidity and mortality. Under the CSSM, 1748 referral units were identified and supported with equipments. But these FRUs are not fully operational because of lack of manpower and infrastructure. Under the RCH the FRUs will be strengthened through the adequate supply of manpower, emergency obstetric kit, equipments,..etc. 3. 24- Hour delivery services at PHCs/CHCs To promote institutional deliveries, provision has been made to give additional honorarium to the staff to encourage round the clock delivery facilities at the health care. 4. Medical Termination of pregnancy

MTP is a reproductive health measure that enables a women to opt of an unwanted or unintended pregnancy incertain specified circumstances with out endangering her life,

through MTPO Act 1971.The aim is to reduce maternal morbidity and mortality from unsafe abortions..The assistance from the central government is in the form of training of

manpower, supply of MTP equipment and provision for engaging doctors trained in MTP to visit PHCs on fixed dates to perform MTP. 5. Control of reproductive tract infections(RTI) and sexually transmitted diseases(STD) In close collaboration with NACO(National AIDS Control Organization), the central government in the form of training of the manpower and drug kits including disposable equipment. Each district is assisted by two laboratory technicians on contract basis for testing blood, urine and RTI/STD tests. 6. Immunization

The universal immunization programme(UIP) become a part of CSSM programme in 1992 and in RCH programme in 1997.It will continue to provide vaccines for Polio, Tetanus, DPT, DT, measles and TB.

7.

Essential newborn care

The primary goal is to reduce prenatal and neonatal mortality.the main components are resuscitation of newborn with asphyxia, prevention of hypothermia, prevention of infection, exclusive breast feeding and referrel of sick newborn.The statergies are to train medical and other health personnel in the essential newborn care, provide basic facilities for care of low birth weight and sick newborns in FRUs and district hospitals..etc 8.Diarrhoel disease control In the districts not implementing Integrated management of Neonatal and Childhood Illness, the vertical programme for control of diarrhoel disease will continue. ORS is used in the management of diarrhoel diseases. De worming guidelines have been formulated. The incidence of diarrhea is reduced by provision of safe drinking water. 9. Acute Respiratory disease control The standard case management of ARI and prevention of deaths due to pneumonia is now an integral part of RCH programme. Cotrimaxazole is being supplied to the health workers through the drug kit. 10. Prevention and control of vitamin A deficiency in children Under the programme, doses of Vitamin A are given to all children under the age of 5 years.The first dose(1 lakh units) is given at nine months of age with measles vaccination.The second dose(2 lakh units) is given after 9 months. Subsequent doses (2lakh doses each) are given at six months interval up to 5 years of age. 11. Prevention and control of anemia in children The policy envisages that , for infants from the age of 6 months onwards up to the age of 5 years are to receive iron supplements in liquid formulation in doses of 20 mg elemental iron and 100 mcg folic acid per day for 100 days in the year. Children 6 to 10 years of age will receive iron in the doses of 30 mg elemental iron and 250 mcg folic acid for 100 days in an year. Children above this age group will receive iron supplements in the adult doses.

INITIATIVESS TAKEN AFTER ADOPTION OF NATIONAL POPULATION POLICY 2000 1. RCH CAMPS: In order to make the services of specialists like gynecologists and

pediatricians available to people living in remote areas, a scheme for holding camps have been initiated in 102 districts covering 17 states from January 2001. Camps are being organized in Haryana, M.P, Rajastan, A.P, U.P, Maghalaya, Bihar, Assam, Jharkhand, Chattisgarh, Orissa, Nagaland, Uttaranchal, Mizoram, Manipur, Sikkim and Tripura. During 2001-02, 72 more districts were added to include all the states/UTs in the country. Till now, states have reported holding of 14,565 camps. 2. RCH outreach camps: During 2000-01, an RCH out-reach scheme was initiated

to strengthen the delivery of immunization and other maternal and child health services, in the remote and comparatively weaker districts and urban slums in UP, MP, Rajasthan, Bihar, Assam, Orissa, Gujarat and West Bengal. 3. Border District Cluster Strategy (BDCS): Under this initiative 49 districts

spread over 17 states have been selected for providing focused interventions for reducing infant mortality and maternal mortality rates by least 50% over the next two to three years. it is a UNICEF assisted active The activities of the project are; 4. development and training of health and nutrition teams up gradation of PHC and sub centers. Additional supply of drugs and equipments Training for medical officers Up gradation of FRUs and filling of vacant posts through contractual appointments Introduction of Hepatitis B vaccination project: Under this project hepatitis B vaccine will be administered to infants along with the primary doses of DTP vaccine. The project will be implemented in 33 districts and slums of 15 metropolitan cities. 5. Training of dais: A scheme for training of dias was initiated during 2001-02.The scheme is being implemented in 156 districts in 18 states/UTs in the country. The main aim was to train at least one dais in every village, with the objective of making safe deliveries. 1,21,017 Dais have been trained under this scheme.

RCH PHASE II
RCH II began from 1st April 2005.The focus of the programme is to reduce maternal and child morbidity and mortality with emphasis on rural health care. The major statergies under RCH II are, 1. Essential health care a. Institutional delivery b. Skilled attendance at delivery 2. Emergency Obstetric care a. Operationalizing first referral units b. Operationalizing PHCs and CHCs for round the clock delivery services. 3. Strengthening referral system

1. Essential health care


a. Institutional delivery: To promote institutional delivery in RCH II, it is envisaged that 50% of the PHC s and all CHCs should function all day means 24 hours. This centres should be responsible for providing basic obstetric care and essential new born care and basic new born resuscitation services round the clock. b. Skilled attendance at delivery: It is now recognized globally that the countries which have been successful in bringing down maternal mortality are the ones where the provision of the skilled attendance at every birth and its linkage with appropriate referral services of complicated cases.Guidelines for normal delivery and management of obstetric complications at PHC and CHC for medical officers and for ANMs have been formulated for this purpose. c. The policy decisions: ANMs/ Staff Nurses are now been permitted to use drugs while emergencies to reduce maternal mortality. They have also been permitted to carry out certain emergency interventions when life of the mother is in at danger. 2. Emergency Obstetric Care: Operationalization of FRUs and skilled attendance at birth are the two activities which go hand in hand.It has been declined that all the FRUs be made operational for providing emergency and essential care during the second phase of RCH.The minimum services to be provided by a fully functional FRUS are;

24 hour delivery services including normal and assisted deliveries Emergency obstetric care including surgical interventions like Caessarian sections New born care Emergency care of sick children Full range of family planning services including laproscopic services Safe abortion services Treatment for STDs/RTIs Blood storage facility Laboratory services Referral services

To be able to perform the full range of FRU function, a health facility should have been the following facilities; A minimum bed strength of 20-30 A fully functional operational theatre A fully functional labour room An area particularly for new born care in the labour room itself and in the ward A laboratory Blood storage facility 24 hour water supply and electricity supply Arrangements for waste disposal Ambulance facility

3. Strengthening referral system: During RCH I, funds given to panchayat for providing assistance to poor in case of obstetric emergencies. Later it has been found that funds remain in panchayat itself. In RCH -II involved local people support, NGOs, and women groups..etc. New initiatives 1. Training of MBBS doctors in live saving anesthetic skills for emergency obstetric care: Provision of adequate and timely emergency obstetric care (EmOC) has been

recognized as the most important intervention for saving lives of pregnant women who may develop complications during pregnant and childbirth. The training of MBBS doctors will be undertaken for only such numbers who are required for the functioning of FRUs and CHCs and shall be limited to the requirement of tackling emergency obstetric situations only. It is not the replacement of the specialist anesthetist. Govt. of India is also introducing training for MBBS doctors in essential obstetric management skills in collaboration with Federation of Obstetric and Gynecological society of India. 2. Setting up of Blood Bank at FRUs according to government of India guidelines. 3. Janani Suraksha Yojana : It was launched in 12 th April 2005.the objectives of the scheme are reducing maternal mortality and infant mortality through encouraging delivery at health institutions, and focusing at institutional care among women in below poverty line families. 4. Under National Rural Health Mission: Benefits of cash assistance with institutional care were given to women who were above 19 years and were under BPL, up to first two live births. For low performing states ( states having low institutional delivery rates), the benefit will be extended up to the 3rd child. The ASHA workers work as a link health worker between poor pregnant women and health institution in the low performing states. ASHA will be responsible for making availability for antenatal and post natal care for them. She should be responsible for escorting the pregnant women to the health care. The scale of assistance under the scheme from 1st april would be as follows; Rural area Catagory LPS HPS Mothers package 1400 700 ASHAs Package 600 200 Mothers package 1000 600 Urban Area ASHAs Package 200 200

Total Rs 2000 900

Total Rs 1200 800

5. Vandamataram scheme:This is a voluntary scheme , where in any obstetric and gyanac specialist, maternity home, nursing home,lady doctor/MBBS doctor can

volunteer themselves for providing safe motherhood services.The enrolled doctor would display Vandamatharam logo at their clinic. Iron and Folic acid tablets,oral pills,TT injections,..eytc will be provided by the representative District Medical officers to the vandanaatharam doctors/ clinics for free distribution to the beneficiaries.The cases

needing special care and treatment can be referred to the government hospitals, who have been adviced to take due care of the patients coming with vandamatharam cards. 6. Safe abortion services: In india, abortion is a major cause of mortality and morbidity and accounts nearly 8.9% of maternal deaths., deaths occurs because majority of them takes place outside institutions and are taken by unskilled persons. Under RCH II following facilities are provided; a. Medical method of abortion: Termination of pregnancy with two drugs- Mifepristone followed by Misoprosol is allowed and considered safe during the early stages of pregnancy, up to 7 weeks., and under supervision with proper counseling. b. Manual vaccum aspiration: The department of family welfare has introduced Manual Vaccum Aspiration(MVA) technique in the family welfare programme .It is an easy process and can be done through PHCs, thereby increasing access to safe delivery services. 7. Village Health and Nutrition Day: Organizing Village health and Nutrition day once a month at anganwadi centre to provide antenatal/post-partum care for pregnant women, promote institutional delivery, and health education..etc. 8. Maternal and death review: Maternal death review has been spelt out clearly in the RCH II. Matrenal death audit, both facility and community based, is an important strategy to improve the quality of obstetric care and reduce maternal mortality and morbidity. 9. Pregnancy Tracking: RCH II stresses the need for universal screening of pregnant women and providing essential obstetric care. Focussed antenatal care, birth

preparedness and complication readiness, skilled attendance at birth, care with in the first seven days .etc are the factors that can reduce the maternal mortality These are the various factors which come under RCH I and RCH II.

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