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:
Including adolescence
Link maternal and child health- reproductive,
family planning, adolescent health
Link home based-facility based care
Linkages, referrals, counter-referrals
Background
• Aim: reach maximum people
• High priority districts: weak performance
indicators; 184 such districts
• Management tools: RMNCH+A 5X5 matrix
To implement strategies in the 5 areas
RMNCH+A 5X5 Matrix
• Reproductive health:
Spacing methods
Focus on interval IUCD
Home delivery contraceptives
Access to pregnancy kits
Quality sterlization services
RMNCH+A 5X5 Matrix
• Maternal health:
Early registration of pregnancy
Detect high risk
Trained personnel, emergency services
Review maternal, infant, child deaths-action
RMNCH+A 5X5 Matrix
• Newborn health:
Early initiation: breastfeeding
Home based newborn care: ASHA
Essential newborn, resuscitation services
Special newborn care units
RMNCH+A 5X5 Matrix
• Child health:
Complementary feeding, IFA
Diarrhoea manegement: ORS, zinc
Manage pneumonia
Full immunization coverage
Rashtriya Bal Swasthya Karakyam
RMNCH+A 5X5 Matrix
• Adolescent health:
Address teenage pregnancies, increase
contraceptive use
Community based services: peer educators
 Adolescent reproductive and sexual health
(ARSH) clinics
 Weekly Iron and Folic Acid Supplementation
(WIFS)
Promote 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
Adolescent Friendly Health Clinics: 6,302
Facility based counseling services
Outreach activities
WIFS
• Launched: meet challenge- anaemia
• Key interventions:
100 mg elemental iron, 0.5 mg folic acid
Screening
Biannual de-worming
Counseling: improve dietary intake
Menstrual Hygiene Scheme
• Aims: girls- adequate knowledge , access: high
quality sanitary napkins-safe disposal
• Key activities:
Community based education
Regular availability napkins
Distribution : napkins
Training ASHA, teachers: menstrual health
Safe disposal
Care: pregnancy, childbirth
• Nearly 15%- complications
• Deliver antenatal package
• Skilled obstetric care
• Immediate essential newborn care, resuscitation
• Emergency obstetric, newborn care
• Postpartum 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
• L1: minimum 3 normal deliveries month
• L2: minimum 10 deliveries; manage
complications
• L3: minimum 20-50 deliveries, C-section
Strengthen these systems
Strengthen transport referral system
Maternal and Child Wing
• Increase in institutional deliveries: JSY, JSSK
• MCH wings provided
 30/50/100 bedded
Antenatal waiting rooms
Labour wings
Essential Newborn care, Sick Newborn Care Unit
Operation theatre
 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 4Ds
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:
Facility based newborn screening
Community based screening: ASHAs
• Children: 6 weeks-6 months
Anganwadi Centres
• Children: 6-18 years
 Government school based screening: mobile
teams
Summary
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