Improving the maternal and child health and their survival are central to the achievement of national health goals under NRHM as well as the MDG 4 and 5. It is important to recognise that RMNCH cannot be addressed in isolation as these are closely linked to the health status of the population in various stages of life cycle.
A mother dies every 1o minutes in India
Prof Sir Sabaratnam Arul Kumaran
Raghunath Dhondho Karve published a marathi magazine ‘Samaj Swasthya’ starting from July 1927 until 1953
Phases of Family planning prog: 1951-56, 57-61, 62-66 61- Extension education approach
The main objective of the National Family Welfare Programme (72) was reduction in fertility rate thereby stabilising population by ensuring Reproductive health.
The first National Health Policy of 1983 was a response to the commitment to the Alma Ata Declaration to achieve “Health for All by 2000” achieve a Net Reproduction Rate of Unity (NRR-1) by the year 2000 A.D Birth Rate of 21 per thousand, death rate of 9 per thousand and natural population growth rate of 1.2% reducing infant mortality rate to below 60 per thousand live births by the turn of the century
(CSSM) Programme: integrated MCH and Immunization Programme
RCH1– Promote mch, reduce imr and mmr, population stabilization
Goals of 12th five year plan Relevant to RMNCHA
Lives Saved Tool (LiST), a computer based application was used to estimate the coverage targets for key child health interventions. The assumptions for the tool were developed based on the best available evidence and, wherever required, through expert consensus.
Coverage Evaluation Survey (CES)- by UNICEF (funding from IKEA Social Initiative.) ORG Centre for Social Research (ORG CSR) carry out the nation-wide survey
NFHS 3- 2005-06 In Haryana, conducted by Centre for Research in Rural and Industrial Development (CRRID), Chandigarh
District Level Household Survey (DLHS) 3- 2010
For instance, reproductive health—which primarily addresses family planning—was being promoted more as a population stabilization strategy and less as a strategy to improve maternal and child health outcomes.
Many steps taken are ad hoc and are not sustained in absence of a system. For example HR System: while most of the states are recruiting contractual staff in huge numbers there is no system for HR which should have included sub-systems for recruitment, selection, posting/ transfers, performance appraisal, contract renewal, career progression/ professional development, absorption in state cadre etc.
In 2010, India accounted for 19% (56,000 in numbers) of all global maternal deaths. Life time risk for india- 0.4%
About two-thirds of maternal deaths occur in just a few states – Assam, Uttar Pradesh(including Uttarakhand), Rajasthan, Madhya Pradesh (including Chhattisgarh), Bihar (including Jharkhand) and Odisha.
TFR > 3 – Bihar, U.P. (SRS 2012), TFR <2.1 – Andhra, Delhi, H.P., J & K, Karnataka, Kerala, Odisha, Maharashtra, Punjab, T.N., W.B. Currently, twenty-one states/union territories have already achieved the replacement level of fertility (i.e. 2.1) or less.
U5MR Haryana- 48, NMR haryana- 28 (SRS 2012) 43% of U5 deaths- within 7 days of birth 56% of U5 deaths- within 1 month of birth 80% of U5 deaths- within 1 year of birth
Sex ratio – 908 (India), 879 (Haryana) Child sex ratio- 912 (India), 837 (Haryana)
Still birth Rate– 5, Haryana- 9
Child Health Epidemiology Reference Group (CHERG)
In order to bring greater impact through RCH programme
Preconception and Prenatal Diagnostic Techniques
These together constitute the
Only 15% of young men and women (15–24 years) reported receiving any family life or sex education.
The adolescent period provides an opportune time for positive behaviour modification in order to mitigate emergence of risk factors that lead to non-communicable diseases.
dual challenge for the country- Under and Over nutrition
Kishori Diwas, a special health day, as part of the Rajiv Gandhi Scheme for Empowerment of Adolescent Girls (RGSEAG) – SABLA Districts covered in HRY- six districts of the state namely Ambala, Hisar, Rewari, Rohtak, Yamunanagar and Kaithal
1987-88, Nehru Yuva Kendra Sangathan (NYKS) was set up as an autonomous organization under the Government of India, Ministry of Youth Affairs and Sports
In school- (WIFS) , while ‘out of school’ adolescents will be reached through AWCs.
Union Health Minister Ghulam Nabi Azad
100mg elemental Iron and 500ug Folic Acid (IFA)
Reducing incidences of STIs, unplanned and unwanted pregnancies and unsafe abortions.
A dedicated counsellor will be available on all days at higher-level facilities (CHC onwards).
including gender-based violence, mental health, substance use, non-communicable diseases
behaviour risk modification (avoidance of junk foods with high carbohydrates, sedentary life style, tobacco and alcohol)
peer educators will be selected, trained and mentored by teachers to provide information on common health concerns in this age group
Rs 5 given to govt, Rs 1 for ASHA
Sarva Siksha Abhiyaan for classes I to VIII; Rastriya Madhyamik Shiksha Abhiyaan for classes IX to XII
entitled to free treatment through Rastriya Swasthya Bima Yojona or State Health Insurance Scheme or NRHM.
result in normal birth, it is esti mated that about 15% may develop complicati ons
Provision for testing for early pregnancy should be made accessible to all adolescent girls (unmarried and married), as it is to the women
MCTS- 16 digit unique ID code 1st 2 digits- state 2 digits- district 3 digits- block 2 digits- subcentre 1 digit- preg-1 child-2 2 digit- year code 4 digit- serial no. of client (start from 0001 from 1st april each year)
PPTCT programme: Prevention of Parent to Child transmission : single dose Nevirapine (Sd NVP) is being given as prophylaxis at the onset of labour pains or during delivery followed by Syrup Nevirapine to the baby soon after birth.
resources (infrastructure and human resources, drugs and supplies, referral transport etc.)
unreached pregnant women (nearly 7.5 million a year)
AADHAR introduced in 43 districts
BEmOC + C/S+ Blood Transfusion= CEmOC
3, 7, 14, 21, 28, 42
Sex ratio at Birth– 908 (India), 857 (Haryana) Child sex ratio- 912 (India), 837 (Haryana)
by sensitising and mobilising self-help groups and empowering women
In states that have achieved the national targets (*TN, Maharashtra, WB, Kerala, Goa) for reducing child mortality or are close to reaching this target, there will be a shift in priorities, with increasing focus on interventions that address residual causes of mortality and morbidity
A new initiative of Child Health Screening and Early Intervention Services offering comprehensive care to children (0–5; 6–9; 10–18 years) is being introduced.
component of continuum of care for newborns
newborns discharged from the Special Newborn Care Units must be followed up at home by frontline workers
Special Newborn Care Units (SNCU)- Presently SNCUs are available across half of the districts in the country
Newborn Stabilisation Unit (NBSU)
Free Emergency Referral Transport
ASHAs will be incentivised to make home visits and to provide at least one dose per week under direct observation
tracking of stocks using HMIS.
Vitamin A supplementation, children between nine months to five years
Three main components include: improvements in the case-management skills of health staff, improvements in the overall health system required for effective management of neonatal and childhood illnesses, and Improvements in family and community healthcare practices.
For Malaria- FTD (Fever treatment Depots) village wise- ASHA make slide of pts with fever and give PCM only Earlier DDC (Drug Distribution Centre)- used to give Chloroquine
the coverage of DPT first booster and the second Measles dose given at the age of 18 months is less than 50% across the country
Pentavalent- Kerala, Tamil Nadu, Goa, Gujarat, Haryana (dec 2012), Jammu and Kashmir, Karnataka and Puducherry
The ‘March of Dimes’ Report (2006) estimates that out of every 100 babies born in India annually, 6 to 7 have a birth defect.
Initially, the scheme was implemented in 233 districts across 17 states
Compensation Scheme for sterilisation acceptors- In public facility: NSV- 1100 (total -1500), Tubec- 600 (Total- 1000) (for only BPL/SC/ST in non focus states), 250 (total= 600) (for APL) Private: NSV= 1300 (total 1500) (to all) , tubec- 1350 (for all cat in high focus states and for BPL/SC/ST in others)
Family Planning Insurance Scheme- The compensation in cases of failure of sterilisation, medical complications or death resulting from sterilisation, and indemnity cover to the doctor/health facility performing sterilisation procedures is provided
8 percent of maternal deaths in India are attributed to unsafe abortions
6% of the adult population in India is infected with one or more RTIs/STIs.
conducting deliveries above a minimum benchmark (minimum three normal deliveries per month at L1; minimum ten deliveries per month, including management of complications, at L2; minimum twenty to fifty deliveries per month including C-section at L3). These are designated as ‘delivery points’.
Strengthening training institutions seven National Nodal Centres and one State Nodal Centre (in each of the ten high focus states) proposed National Nodal Centres are NRS Medical College Kolkata; St Stephen’s Delhi; Government College of Nursing, Vadodara; CMC Vellore; LHMC, Delhi; CMC, Ludhiana; Rajkumari Amrit Kaur College of Nursing, Delhi
six months skill-based internship is on the cards for ANM and GNM
Central QA team will comprise technical officers from the programme divisions of the MOHFW and counterparts working with technical support partners.
a. PHN b. Specialists (Paeds, Gynae) every quarterly c.
about their roles and responsibilities towards optimal utilisation of grants and funds in the best interest of the users planning as well as monitoring Village Health and Nutrition Days (VHNDs).
Expanded package of services in VHND: • Immunization as per schedule • Antenatal care including birth preparedness and complication readiness • Post-natal care to mothers including counselling for contraception • Facilitating access to contraceptive services • Growth monitoring • Counselling on key practices for improved newborn and child health and nutrition • Demonstration on preparing and use of ORS and Zinc, and provision of ORS and Zinc for treatment of childhood diarrhoea • Follow-up care of severely malnourished children • Testing and treatment for anaemia in pregnant women • Referral support to ASHAs, AWWs in community level care, for children with illness • Sessions and services for adolescent girls and boys
dashboard monitoring system are based on life cycle approach All India average for each indicator will be taken as the reference point • States scores will be determined on the basis of the national average
19 survey based outcome and coverage indicators related to health, nutrition and sanitation Sample Registration System, Coverage Evaluation Survey, District Level Household and Facility Survey, National Family Health Survey, Census, Annual Health Survey
International Institute for Population Sciences, Mumbai (demographic training and research centre)
RMNCH+A strategy: Reproductive, Maternal, neonatal, child and Adolescent Health
Dr. Gaurav Kamboj
“Women are not dying because
of a disease we cannot treat.
They are dying because
societies have yet to make the
decision that their lives are
President of the International Federation of
Gynecology and Obstetrics (FIGO),
XV World Congress, Copenhagen 1997
• Historical background
• Challenges of Reproductive and Child Health- II
• Situation of Reproductive, Maternal and Child Health in
• Causes for Maternal and Child Deaths in India
• Rationale of RMNCH+A strategies
• Strategic RMNCH+A Interventions across life-stages
• Health System Strengthening for RMNCH+A Services
• Monitoring, information and evaluation
Milestones of Family Welfare Programme
1951-56 National Family Planning Programme adopted by Govt. of India
1961-66 - Deptt. of Family Planning created in Ministry of Health
- Lippes loop introduced, Massive effort to promote IUCD
- Expansion of service facilities, spread of small family norm
1974-79 - Campaign for male sterilization
- Renaming ‘Family Planning’ to ‘Family Welfare’
1983 National Health Policy
1985 Universal Immunization Programme
1985-90 Inclusion of various programmes under MCH
1992-97 Child survival and Safe Motherhood Programme (CSSM)
1997-02 Reproductive and Child Health-I (CSSM + RTI/STI components)
2000 National Population Policy
2002 National Health Policy
2005 RCH II and NRHM (2005-2012)
2013-17 NRHM extended (NRHM + NUHM = NHM)
Health outcome goals established
in the 12th Five Year Plan
• Reduction of Infant Mortality Rate (IMR) to 25 per
1,000 live births and U5MR to 33 per 1000 live
births by 2017
• Reduction in Maternal Mortality Ratio (MMR) to
100 per 100,000 live births by 2017
• Reduction in Total Fertility Rate(TFR) to 2.1 by
Millennium Development Goals
Coverage targets for key RMNCH+A
interventions for 2017
• Increase facilities equipped for perinatal care
(designated as ‘delivery points’) by 100%
• Increase proportion of all births in government and
accredited private institutions at annual rate of 5.6 %
from the baseline of 61% (SRS 2010)
• Increase proportion of pregnant women receiving
antenatal care at annual rate of 6% from the baseline
of 53% (CES 2009)
Coverage targets for key RMNCH+A interventions
• Increase proportion of mothers and newborns
receiving postnatal care at annual rate of 7.5% from
the baseline of 45% (CES 2009)
• Increase proportion of deliveries conducted by SBAs
at annual rate of 2% from the baseline of 76% (CES
• Increase exclusive breast feeding rates at annual rate
of 9.6% from the baseline of 36% (CES 2009)
Coverage targets for key RMNCH+A interventions
• Reduce prevalence of under-five children who are
underweight at annual rate of 5.5% from the baseline
of 45% (NFHS 3)
• Increase coverage of three doses of DPT at annual
rate of 3.5% from the baseline of 71.5% (CES 2009)
• Increase ORS use in under-five children with
diarrhoea at annual rate of 7.2% from the baseline of
43% (CES 2009)
Coverage targets for key RMNCH+A interventions
• Reduce unmet need for family planning methods at
annual rate of 8.8% from the baseline of 21% (DLHS 3)
• Increase met need for modern family planning
methods among eligible couples at annual rate of 4.5%
from the baseline of 47% (DLHS 3)
• Reduce anaemia in adolescent girls and boys (15–19
years) at annual rate of 6% from the baseline of 56%
and 30%, respectively (NFHS 3)
Coverage targets for key RMNCH+A interventions
• Decrease the proportion of total fertility contributed
by adolescents (15–19 years) at annual rate of 3.8%
per year from the baseline of 16% (NFHS 3)
• Raise child sex ratio in the 0–6 years age group at
annual rate of 0.6% per year from the baseline of
914 (Census 2011)
Current challenges of RCH II Programme
• Three components of maternal, child
and reproductive health have actually
been vertically operated in RCH.
• ‘Adolescent health’ was the weakest
pillar of our RCH program which is
now one of the key strategies of
• Some Districts are yet to use HMIS
data to chart their progress against the target effectively.
• Timely and transparent payments for JSY are not properly
• Inadequate implementation of Strategy for fixed day static
services for family planning.
Situation of Reproductive, Maternal
and Child Health in India
• Maternal mortality ratio (MMR) declined from 254
(SRS 2005) to 178 (SRS 2013)
• MMR in Haryana – 146 (SRS 2013)
• IMR is 42 per 1,000 live births (SRS 2013)
• NMR is 29 per 1,000 live births (SRS 2012)
• U5MR is 52 per 1,000 live births (SRS 2012)
• TFR is 2.4 (SRS 2012) (TFR for Haryana- 2.3)
• JSY initiative resulted in a phenomenal increase in
the rate of institutional deliveries in India from 47%
(DLHS-3, 2007-08) to 73% (CES 2009).
1997-1998 1999-2001 2001-2003 2004-2006 2007-2009 2010-12
Causes OF Maternal Death in India
Source: Causes of maternal deaths in India, SRS 2001-03
Causes for under 5 child death in India
Source: WHO/CHERG 2010
Causes for Maternal and Child Deaths
THE THREE DELAYS
(1) The delay in deciding to seek care
(2) The delay in reaching the
appropriate health facility
(3) The delay in receiving quality care
once inside an institution
Useful to design programmes to
address these delays.
Rationale of RMNCH+A strategies
• It is important to recognize that
reproductive, maternal and child health
cannot be addressed in isolation
• To provide an understanding of
comprehensive approach to improve child
survival and safe motherhood
Why ‘Plus’ in RMNCH+A?
1. Inclusion of adolescence as a distinct ‘life stage’ in the
2. Linking of maternal and child health to reproductive
health and other components like family planning,
adolescent health, HIV, and PC&PNDT.
3. Linking of community and facility-based care as well
as referrals between various levels of health care
system to create a continuous care pathway.
Strategic RMNCH+A Interventions Across
There are two dimensions to healthcare:
(1) stages of the life cycle
(2) places where the care is provided
‘Continuum of Care’
1. Adolescent nutrition; IFA supplementation
2. Facility-based adolescent reproductive and sexual
health services (Adolescent health clinics)
3. Information and counseling on adolescent sexual
reproductive health and other health issues
4. Menstrual hygiene
5. Preventive health
• Nutrition education sessions to be held at
community level- quarterly Adolescent Health
Days (to coincide with Kishori Diwas in
• Screening for low BMI followed by counseling
at adolescent health clinics.
• National Iron + Initiative: Proposes to include
new age groups
• Adolescents, both in and out of school
• Women in reproductive age group
• Weekly iron and folic acid supplementation
scheme: It aims to cover adolescents enrolled
in class VI–XII of government, government
aided and municipal schools as well as ‘out of
school’ girls (10-19)
‘Iron ki nili goli’
Mondays will be 'Iron' days: Azad
IFA supplementation programme and
Adolescent Friendly Health Clinics
• Sub-centre level- by ANM
• PHC - Adolescent Information and Counseling Centre
will be made functional by MO and ANM on weekly
• CHC, DH/SDH and Medical College- Adolescent
Health Clinics will provide services on a daily basis by
• Appropriate referrals for HIV testing and RTI/STI
management to ICTCs
• Provision of contraceptives
Information & counseling on Health Issues
• School will serve as platform to educate and counsel
adolescents on behavior risk modification.
• Under Child Health Screening & Early Intervention
Services, screening for diabetes & other NCDs is
• Peer educators
• In order to reduce adolescent pregnancy, focused
messaging to individuals, families and communities
(including men) will be reinforced.
Life-skills-based Adolescence Education
Menstrual Hygiene Scheme
• Promotes better health and
hygiene among adolescent girls
(10-19 years) in rural areas
• Sanitary napkins are provided
under NRHM’s brand
These napkins are sold to
adolescent girls by ASHAs.
Preventive health checkups and screening
School Health Programme
• Bi-annual health screening for students (6–18 years)
enrolled in government and government-aided schools
for disease, deficiency and disability.
• Dedicated mobile health teams at block level.
2 Medical Officers (MBBS / Dental / AYUSH qualified)
2 paramedics (one ANM and any one of the following
Pharmacist/Ophthalmic Assistant/Dental assistant)
• Those need of secondary and tertiary care will be
entitled to free treatment.
Pregnancy and Childbirth
1. Delivery of ANC package &
tracking of high- risk preg.
2. Skilled obstetric care
3. Immediate essential newborn
care & resuscitation
4. Emergency obstetric and new born care
5. Postpartum care for mother and newborn
6. Postpartum IUCD and sterilization
7. Implementation of PC&PNDT Act
Preventive use of folic acid in peri-
• Enables to enter pregnancy in optimal health.
• Prevention of neural tube defects and other congenital
• Peri-conception phase ( 3 months before & 3 months
• 1 pre-pregnancy visit for couples planning pregnancy
A new scheme for delaying first birth after marriage
and ensuring spacing between first and second child
was launched in May 2012 and has provision for
incentivizing ASHAs for their efforts.
Delivery of ANC package and tracking
of High-risk Pregnancies
• Pregnancy Testing Kits ‘Nishchay’ available at all sub-
centres and through ASHAs.
• Universal access to full antenatal package both at
community outreach and facility level.
• Mother and Child Tracking system (MCTS) enables
service providers to follow up women and programme
managers to monitor service delivery
• Universal confidential HIV screening (PPTCT Program).
Skilled Obstetric care and Essential
Newborn care and Resuscitation
• Delivery points
• Prioritized for allocation of resources
• Branded and positioned as quality RMNCH+A 24 X 7 centres
• Janani Suraksha Yojana (JSY)-
• Reach the unreached pregnant women who still deliver at
• 48 hours stay at the health facility
• Postpartum family planning methods (PPIUCD) & counselling
on exclusive breast feeding
• Direct cash payments through AADHAR enabled payment
• Janani Shishu Suraksha Karyakram (JSSK)
• Reduce out-of-pocket expenses.
• Free assured transport (ambulance service)
• Newborn Care Corners
• Established at delivery points
• Providers are trained in basic newborn care and resuscitation
through Navjaat Shishu Suraksha Karyakram (NSSK).
Skilled Obstetric care and Essential
Newborn care and Resuscitation
Emergency Obstetric & Newborn Care
• MCH Wing- A comprehensive package of maternal,
newborn and reproductive (family planning) services.
Multi skilling of Doctors
• Life Saving Anaesthetic Skills (LSAS)- 8 week
training programme of MBBS doctors
• Obstetric Management Skills including
Caesarean section (CEmOC) – 16 week training
of MBBS doctors
• Basic Emergency Obstetric Care (BEmOC) - 10
days training for Medical Officers
• Skilled Birth Attendants(SBA) - 3 week
training for ANMs/Staff Nurses.
Postpartum care for mother and baby
• 48 hours of stay at health facility
for institutional delivery
• At least 3 postnatal visits to
mother and 6 postnatal visits to
newborn are to be made within
six weeks of delivery
• If Home delivery: 1st visit within
24 hours of birth
Postpartum IUCD insertion and
• Post-partum IUCD (PPIUCD)
insertion at district and sub-district
• Training of M.O.s in ‘Minilap’ for
provision of Post-Partum
Sterilisation in high case load
• RMNCH counselor will ensure healthy
timing and spacing between
pregnancies and will counsel on
breast feeding and other childcare
Implementation of PC&PNDT Act
• Improve sex ratio at birth by regulating pre-
conception and pre-natal diagnostic techniques
misused for sex selection
• Key action:
• Dedicated PC&PNDT cells at state/district level
• Strengthening of human resources &
infrastructure at all levels
• Building community opinion against sex selective
abortion and foeticide
Newborn and Child care
1. Home-based newborn care and prompt referral
2. Facility-based care of the sick newborn
3. Integrated management of common childhood illnesses
(diarrhoea, pneumonia and malaria)
4. Child nutrition & essential micronutrients supplementation
6. Early detection and management of defects at birth,
deficiencies, diseases and disability in children
Home-based newborn care and
• Home-based newborn care scheme (2011) provides
immediate postnatal care and essential newborn care
to all newborns up to the age of 42 days.
• Special care to pre terms and newborns by ASHAs.
• ASHA are also trained in identification of illnesses,
appropriate care and referral through home visits.
Facility-based care of Sick Newborns
• NBSU: 4-bedded unit providing basic level of sick
newborn care, established at CHCs/FRUs
• SNCUs at District Hospitals and tertiary care hospitals
One SNCU in
• Each district of the country, and
• Health facilities with more than
3,000 deliveries per year
Free up to
• Follow up of all LBW babies by ASHA and ANM
• National Iron + initiative
• Tracking of BMI of Adolescents at the AWC
• Deworming combined with
Vitamin A supplementation
during biannual rounds.
Nutritional Rehabilitation Centres (NRCs)
Will provide medical and nutritional care for
children with severe acute malnutrition (SAM)
Integrated management of
Common Childhood Illnesses
(pneumonia, diarrhoea and malaria)
• Availability of ORS and Zinc
ensured at all sub-centres and frontline workers
• Timely identification and prompt referral of children
with fast breathing and/or lower chest in-drawing.
• Prevention and treatment of malaria as per the
guidelines in the National Malaria Control Programme.
At community- ASHA package
First level care- IMNCI
Referral level care - F-IMNCI
• Second dose of Measles introduced
• Pentavalent vaccine, first introduced in two states
(Kerala and Tamil Nadu), is now being expanded to six
states and will eventually be scaled up to cover the
• Coverage of vaccine beyond first year of life must be
emphasised and monitored
• Investigation report of every serious AEFI case must be
submitted within 15 days of occurrence to district
To strengthen routine immunization,
newer initiatives include
Provision for AD Syringes to ensure injection safety
Support for AVD from PHC to outreach sessions
Mobilization of children to immunization session sites
MCTS for tracking service delivery by
-Generating due lists for ANMs
-SMS alerts to beneficiaries
-Maintaining records for actual services delivered.
Child Health Screening and Early
(Rashtriya Bal Swasthya Karyakram)
• Aims to reach 27 crore children annually in the age group
of 0-18 years
• Mobile health teams at block level
• Screening for 30 identified health conditions.
• Age group 0–6 years enrolled at AWC at least twice a year
• Age group 6-18 years in schools annually
• Free management of these children at District Early
Through the Reproductive Years
1. Community-based promotion and delivery of
2. Promotion of spacing methods (interval IUCD)
3. Sterilisation services (vasectomies, tubectomies)
4. Comprehensive abortion care
(includes MTP Act)
1. Prevention and management
Community based doorstep
distribution of contraceptives
• ASHA charges a nominal amount from beneficiaries
to deliver contraceptives at the doorstep, that is,
• INR 1 for a pack of 3 condoms
• INR 1 for a cycle of OCPs
• INR 2 for a pack of emergency contraceptive pills (ECP)
• Extended to all districts
in the country
Promotion of spacing methods
• Availability of IUCD CuT380 A (protection for 10 yrs)
• Incentivise ASHAs to
• Encourage the delay of the first birth in newly married couples
• Spacing of three years between the first and second childbirths.
• Ensuring IUCD services on:
• Fixed days at all sub centres and PHCs
• Regular IUCD insertion services at CHC, SDH and DH
• RMNCH counsellors at the facilities with high case load
• Promotion of NSV for increasing
• Emphasis on Minilap tubectomy.
• Accreditation of private providers & NGOs for service
• Increasing the pool of trained service providers.
• Operationalising fixed day centers for sterilization is an
essential step in this direction.
Comprehensive abortion care
• Manual Vacuum Aspiration (MVA) facilities and
medical methods of abortion in 24 X 7 PHCs
• The comprehensive MTP services at all DH & SDH
with priority given to ‘delivery points’
• Capacity building of MOs
• Medical abortion drugs are to be
included in the essential drug list:
• Mifepristone + Misoprostol for upto 7 weeks
• Ethacridine lactate for 12 to 20 weeks
Management of RTIs and STIs
• Provided at all CHC, FRU and 24 X 7 PHCs.
• Syndromic management at delivery points
• Availability of colour-coded kits
• RPR testing kits for syphilis and HIV
• Service providers should be trained in syndromic
management of STI and RTI.
• To be made available across entire reproductive age
group (including adolescents, youth and adults.)
Health Systems Strengthening
for RMNCH+A Services
a) Facility specific plans to be
prepared and implemented
as specified under IPHS
b) Assess the need for new
infrastructure, extension of
existing infrastructure on the
basis of patient load and
location of facility
c) Equip health facilities to support 48 hour stay of
mother and newborn.
d) Engage private facilities for family planning
services, management of sick newborns and
children, and pregnancy complications.
e) Strengthen referral mechanisms between facilities
at various levels and communities.
f) Provision for adequate
infrastructure for waste
• Creation of regular posts so that
contractual appointments can be
reduced and sustainable HR
structure is developed.
• Strengthening sub centres through additional human
• Accorded highest priority in this phase
• Sub centres of remote and hilly area will have 2
ANMs, 1 MPHW (M), 1 pharmacist and 1AYUSH
• Creation of a public health cadre
Policies on drugs, procurement system
and logistics management
• Availability of free generic drugs for minimizing out
of pocket expenses.
• Rational prescriptions and use of drugs.
• Timely procurement of drugs and consumables.
• Placing Essential drug lists (EDL) in the public
• Computerized drugs and logistic MIS.
• Central Procurement Agency for the efficient
purchase of quality medicines for distribution to
states and union territory governments.
• Quality assurance at all levels of service delivery
• Quality certification/ accreditation of facilities and
Certification for achievement of IPHS
Comprehensive quality assurance for both infrastructure and
First certified by District and State Quality Assurance Cells
• Central Quality Supervisory Committee
• State Quality Assurance Committees
• Quality Assurance Cell
• Full time quality assessors
• District Quality Assurance Committees
• Quality Circles at the District Hospital level.
I. Supportive supervision of health facilities
a. Engaging generalist nurse supervisors at block and
b. Preparing a clear plan of supervision
c. Engaging Medical College faculty for supportive
supervision of District Hospitals
d. Preparing integrated guidelines and checklists for
I. Supportive supervision of frontline workers
• Potential supervisors of frontline workers include
LHVs, ASHA supervisors, ICDS supervisors and
• Engage Village Health Sanitation
and Nutrition Committees and
Rogi Kalyan Samiti members
• Utilize the Village Health and Nutrition Days as a
platform for assured and predictable package of
• Social audit: Centred around activities like:
• Maternal death audits via verbal autopsies
• Utilization of health facility checklists
• Grievances redressal related to RMNCH+A
Monitoring, Information &
• Civil registration system:
Ensure 100% registration of
births and deaths.
• Web enabled Mother and Child Tracking System
• Link MCTS with AADHAR in order to track subsidies to
• Maternal Death Review (MDR):
• Facility and Community based
• Identify causes of maternal deaths and the gaps in service
delivery in order to take corrective action
• Perinatal and Child Death Review: Death reports
with cause of death for any child under five should
be shared with district health teams on a quarterly
• Health Management Information System (HMIS)
based monitoring and review: Indicator that reflect
outcomes such as Full ANC, Institutional Delivery,
Sterilization procedure, IUCD insertion, Full
Immunization, Child & Maternal Death which is
regularly monitored and interpreted.
Monitoring, Information &
• National & State ‘scorecard’:
• Introduced as a tool to increase transparency
and track progress against indicators related
with intervention coverage.
• Refers to two distinct but related
1.HMIS based dashboard monitoring system
2.Survey based child survival score card.
Monitoring, Information &
• Review missions:
• Annual Joint Review Missions by the RCH
• Common Review Missions under NRHM
• Concurrent evaluation process led by the IIPS
• Research studies and evaluations done by
international advisory panel
Monitoring, Information &
• A Strategic Approach to Reproductive, Maternal, Newborn,
Child and Adolescent Health(RMNCH+A) in India. Ministry of
Health & Family Welfare Government of India February 2013
• Revised operating manual for preparation and monitering of
RCH-II & immunization component of NRHM state programme
implementation plans (PIPs). Ministry of Health & Family
Welfare Government of India. November 2010
• Guidelines for Preparation of Annual Programme
Implementation Plan National Rural Health Mission. 2013-