Reproductive & Child Health

Program

State Institute of Health and Family Welfare, Jaipur

SIHFW: an ISO 9001: 2008 certified Institution 1

 What is RCH….?
Reproductive & Child Health program is a model
developed through experiments in paradigm shifts,

 Clinic approach
Extension & Education
 “Cafeteria”/ “Targets”
 “Comprehensive” service delivery approach
 Primary health care (1983)
 Targeted interventions-Target couples &
EC
 TFA (1996)
 Quality services & Policy reforms
 CNAA(1997-98)
 Capacity enhancement,
SIHFW: An ISO:9001:2008 certified Institution 2
Chronological Events
Ø NFPP-1951
Ø NFWP-1977
Ø Alma Ata-1978
Ø EPI-1978
Ø NHP-1983
Ø UIP-1985 (unified approach and micro
planning)
Ø CSSM-1992 (the 1st program officially
launched by President of India)
Ø ICPD-1994

Ø RCH-I (1997, October)

Ø RCH-II (2005-06
SIHFW: An ISO:9001:2008 certified -2009-10)
Institution 3
 Why RCH………?

Program was conceived in view of the need of



Ø Unified approach
Ø Convergence for integration
Ø Performance in relation to Goals & Timeframe
Ø Shuffling priorities-Paradigm shift
Ø Fertility regulation & Replacement goals
Ø High Unmet needs
Ø High Morbidity/Mortality in women & children
•

SIHFW: An ISO:9001:2008 certified Institution 4

 Objectives of RCH
Ø Reduction in Birth Rate & Empowering women
Ø Integration of related programs for meaningful
Ø Meeting unmet needs through institutional
strengthening & Quality of Care routed by-
ØChoice of methods
ØInformation provided to clients
ØTechnical competence of providers
ØInterpersonal relationship between
Clients & service providers
ØMechanism to ensure continuity of Care
ØConstellation of service appropriate to
need of users

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 Approach
Ø Clinic approach
Ø Extension & Education
Ø “Cafeteria”/ “Targets”
Ø “Comprehensive” service delivery approach
Ø Primary health care (1983)
Ø Targeted interventions-Target couples and
Eligible couples
Ø Target free approach (1996)
Ø Quality services & Policy reforms
Ø Community Needs Assessment Approach
(1997-98)
Ø Capacity enhancement
Ø SIHFW: An ISO:9001:2008 certified Institution 6
 Approach

 Targets April 1996 Goals

 National
 State
 District
 PHC
 Sub-Center


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Phases of RCH Program

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 Components of RCH1
Ø Family Planning
Ø Child Survival & Safe Motherhood
Ø Client approach to health care
Ø Prevention/Management of RTI/STD/AIDS
Ø Adolescent Reproductive Health
Ø Modified Management Information Sub-System
Ø IEC & Counseling
Ø Community Needs Assessment Approach
(CNNA)

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Ø High Quality training at all levels
Ø District sub projects under Local Capacity
Enhancement
Ø Enhanced community participation through
Panchayats, Women groups & NGOs
Ø Implementation of Target free approach
Ø Referral System
Ø
Ø

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 Activities

Universal interventions without any



differentiation
Ø CS & SM interventions
Ø Operationalization of CNAA
Ø Institutional development
Ø Modified Management Information sub-system
Ø IEC & Counseling
Ø Urban & Tribal area RCH package
Ø District sub-projects for capacity enhancement
•
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 Differential Strategy based on




Crude Birth Rate & Female Literacy Rate
ØCategory-A (Low CBR, High Literacy)
(58)
ØCategory-B (Moderate CBR, Moderate
literacy) (184)
ØCategory-C (High CBR, Low literacy)
(265)


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Additional Activities in Selected
Districts
Ø Screening & Treatment of RTI/STI in-
Ø3 FRUs - “A” Category (FRU=First
Referral Unit)
Ø2 FRUs - “B”
Ø1 FRU of “C”
Ø Emergency Obstetric Care-
Ø2 FRUs of “B” Category
Ø3 FRUs of “C”

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Ø Essential Obstetric. Care-
ØDrugs & PHCs in “B” & “C”
category
ØContractual PHN/Staff nurse in
“C” category
Ø Additional HWF in – 30% S/C of “C” of 8
States
Ø Contractual PHNs/Staff Nurse
Ø Referral Transport facility- 25%S/C of “C”
Districts of all States
Ø
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Ø Service strengthening- inputs for-
ØMobility
ØSupervision
ØMicro-planning (50 Districts in 8
States)
Ø Dai training-142 Districts with < 30% safe
delivery
Ø RCH Camps in remote/under-utilized PHCs
Ø Border Cluster project-46 Districts in 16 States to
have addl. Inputs
Ø [Total Reported FRUs in India are 1724] 1992-97
Ø
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Child Survival Activities
ØCare of New borne
ØEye, Cord, Bath & Feed
ØSpecial care & Referral
conditions
ØImmunization
ØVitamin-A (5 dose prophylaxis)
ØDiarrhea-ORT & ARI
ØStandard case definition &
management
ØSupport Activities-
ØCold chain
ØSupplies
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Safe Motherhood Interventions
ØEssential Obstetric care-
ØEarly registration of
pregnancy (12-16 weeks)
ØANC (3 visits)
ØTT (2 or Booster)
ØIFA (100 Tab.)
ØDelivery by Trained/Skilled
Birth attendants (TBA)
observing 5C
ØReferral for emergencies-
conditions, time-frame &
place
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 ØPNC (3 visits)
ØSpacing 3 yrs
ØSTI/RTI Management
ØAdolescent Reproductive
health-
ØCounseling/IEC based on
Life cycle approach
ØEmergency Obstetric care
ØStrengthening Referrals
ØTraining of TBA/SBA

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 CNAA
[Community Need Assessment Approach]

The Committee on Population in National

Development Council (NDC) in 1993

recommended
Ø Decentralized area specific planning
based on Local Needs
Ø Creation of a District level Data base on:
ØQuality
ØCoverage
ØImpact indicators; for monitoring &
Evaluation
•
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 Purpose & Key Issues of CNAA

 Purpose

Key Issues
Ø Setting Priorities ØMicro-planning
Ø Identify Target and ØCommunity
High Risk groups involvement
Ø Estimation of Service ØClient’s perspective
needs and ØQuality of Care
matching it with
Resources
Ø Develop a realistic
action Plan


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 Process of CNAA

Focus on Participatory Planning based



on:
Ø Felt Needs
Ø Actual workload assessment
Ø Assess Capacity of Providers
Ø Involve people for better Utilization
Ø “Speak” to People”, “Get “through
Records and “Take up” surveys

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Ø Develop teams involving local people
Ø Organize meetings for decision on service
delivery
Ø Evaluate need for each Health & Family
Welfare service-Share it with people
Ø Develop an Action Plan
ØSub-Center Action plan
ØPHC Action plan
ØCHC Action plan
ØDistrict Action plan: Consolidation
ØState Action plan: Compilation
•
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Initiatives after National Population
Policy 2000
Ø RCH Camps
Ø RCH Out Reach Schemes
Ø Home based Neonatal Care
Ø Border District Cluster Strategy
Ø Hepatitis B Vaccination Project
Ø Training of Dias
Ø Empowered Action Group
Ø District Surveys
Ø

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 Lessons from RCH-I
Ø “One size fits all’ approach
Ø State/District level requirements not accounted
Ø Adequate program mgt. skills missing
Ø Planning, monitoring, budgeting and resource
allocation did not match program objectives
Ø Frequent turnover
Ø Result/outcome orientation missing
Ø Human Resource planning neglected
Ø Financial/accounting/disbursement and
utilization bottlenecks

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Ø Generic BCC
Ø Focused and thematic approach missing
Ø Low utilization of public health facilities
Ø Complaints against insensitive providers
Ø Hidden cost incurred by users
Ø Limited choices for clients
Ø No convergence between related sectors
Ø Fragmented approach
Ø Duplication
Ø Loss of opportunities to achieve effectiveness
Ø
Ø
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 RCH Phase II



Major Focus on……
Ø Reducing Maternal & Child Mortality and

Morbidity
Ø Emphasis on Rural Health Care

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 Key Issues

Ø Flexibility: States needs and capacities

Ø Strengthening management capacity
Ø Integrated Behavior Change
Communication (BCC) strategies
Ø Improved client responsiveness to
public health facilities
Ø Convergence with other critical sectors
Ø

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 Activities under RCH II
 1. Strengthening Project Management
Structure
ØRe-organizing of Medical Directorate
ØRenovation of Medical Directorate and
NRHM/RCH-II cell
ØSetting up, of the PMU at state & district
levels
ØInduction of newly appointed
professionals
ØSupport for communication, equipments
and mobility to DPMUs

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2. Strengthening Infrastructure



Ø Upgrading of PHCs as BEmOcs

Ø Provision of blood storage at 26 identified
CEmOcs
Ø Support for equipment and labor tables at 25%
PHCs (10000.00 Rs. Per Institution)
Ø Support for minor repair and renovation of public
facilities at 50% PHCs (25000.00 Rs. Per
Institution)
Ø Facility survey of all PHC and CHCs

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3. HRD and capacity building



Ø Development of annual training calendar

Ø Strengthening of ANMTCs
Ø Support medical colleges for Anesthesia
trainings
Ø Library at SIHFW & Medical Directorate
Ø Orientation of AYUSH Doctors on National
Programs
•

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 4. Improving quality of care and
 Strengthening Referral System
Ø Study on referral system by RHSDP
Ø 7 days Mobility support to PHC MOs
Ø Installation of new telephone connection at
all PHC/CHCs
Ø Work shops for developing standards and
protocols for quality of care
•

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 5. Strengthening and improvement of
logistics and supply systems


Ø Feasibility study to setting up of the drugs

and logistics warehousing
Ø Support for the repair of workshop for cold
chain equipment
Ø Support for hiring 12 new refrigerators
•

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

6. Strengthening HMIS, M&E
Ø Support for CNNA format, ECS has been
provided from state level
Ø Integration of RCH-II/NRHM reporting
format in existing HMIS software
Ø Baseline and concurrent evaluation
•

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7. BCC for increasing demand for RCH


and contraceptive services

Ø Intensive IEC for RCH-II and NRHM
interventions
Ø Provision for hiring of IEC van in all districts
Ø Implementation of Integrated Media Plan
Ø IEC for “Panchamrit program done by
printing of booklet, Banners, cards
•

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 8. Specific Interventions

Maternal Health


ØRCH camps target

ØDai training target
ØNight delivery facility at all PHCs and CHCs
ØHiring of contractual staff (PHN & LT)
ØProvision of 1321 additional ANMS at 10
desert and tribal districts
ØSTD/RTI drugs for PHCs
ØJannani Suraksha Yojna
Ø
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  Child Health  Family Planning
ØIMNCI launched ØImproving quality of fix
in 9 districts camps
ØMal nutrition ØCompensation scheme
corner at all for sterilization
237 blocks ØBlood donation camps
ØPurchase of ØNSV mega camps
ORS packets ØAFHS Training



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9. Strengthening Networking and


Partnership with the civil society

Ø Collaboration with IMA & FOGSI
Ø Accreditation of Private nursing home
for JSY
Ø MNGO scheme in all districts
Ø Annual consultation with stakeholders
on NRHM
Ø Social marketing of contraceptives and
other health services
•

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10. Innovative schemes and pilot


projects
Ø Pilot Project on Population stabilization
initiated at Jhalawar & Tonk.
Ø PARINCHE project for five districts.
Ø Help line at medical directorate for
improving communication
Ø Campaign on Age at Marriage.
Ø Medical Mobile unit for all districts.
Ø VCTC at 16 CHCs.
•
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11. Improving and strengthening RCH


Services in Tribal population

Ø Six districts, namely, Baran, Banswara,
Chittorgarh Dungarpur, Sirohi and
Udaipur
Ø Process for developing PIP for six urban

districts is under process


12. Establishing and strengthening RCH



services in Urban Area

Ø Urban slum population in Jaipur, Jodhpur,
Kota, Bikaner, Pali, Udaipur,
Ganganagar, Hanumangarh, Bhilwara
and Tonk
Ø PIP for
SIHFW:8An urban
ISO:9001:2008slums is under process. 39
certified Institution
 Goals of RCH II
Indicator X Plan Goals RCH –II NPP 2000 MDG
(2002-07) Goals(2005- (By 2010)
10)
IMR <45 <30 <30 -

U-5 MR - - - Reduce by 2/3

from 1990 levels

MMR 200 <100 <100 Reduce by ¾ by

2015

TFR 2.3 2.1 2.1 -

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 Goals for Rajasthan
Outcomes Goal of Rajasthan up to
2011-12
Infant Mortality Rate (IMR) 32

Maternal Mortality Ratio 148

(MMR)
Total Fertility Rate (TFR) 2.1

Crude Birth Rate (CBR) 21

Crude Death Rate (CDR) 7

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Performance Indicators for RCH
[Ante Natal]
Ø Number of Ante Natal cases registration
Ø Number of Pregnant women who
ØHad 3 ANCs
ØHad 2 doses of TT
Ø Were Under prophylaxis & treatment of anemia
Ø Number of high risk pregnant referred
Ø Number of deliveries by trained & Untrained
birth attendants
Ø Number of cases with complications referred to
PHC/FRU
Ø
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 Performance Indicators
[Post natal & New born]

Ø Number of New born with Birth weight recorded

Ø Number of woman given 3 post natal check
ups
Ø Number of Fully Immunized children
Ø Number of Adverse reactions reported after
Immunization
Ø Number of cases motivated & followed up for
contraception
Ø

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Institutional Deliveries (Source DLHS 2 &3)

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Number of Ante Natal Cases
Registration (Source DLHS 2 & 3)

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Number of Pregnant in Relation to
ANC (Source DLHS 2 & 3)

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Status of Full Immunization of
Children (Source DLHS 2 & 3)

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Status of Recording of Birth Weight
(Source NFHS 3)

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Status of 3 Post Natal Check Ups
(Source DLHS 3)

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 THANK YOU