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INTRODUCTION

Maternal and child health care which is now also being described as
“Reproductive and Child Health” is very important component of the family
welfare programmes in India launched on October 15 1997. It is a method of
delivering health care to special groups in the population, which are
especially vulnerable to disease, disability or death.

GENERAL

At the end of the class the group will have be able to gain in depth knowledge
about the topic.

Specific Objective

After the completion of the class, the group will be able to

➢ Define MCH
➢ Enlist the objectives
➢ Know the causes of MMR
➢ Explain the MCH services
➢ Explain the RCH phase 2
➢ Enlist the health care delivery system
➢ State the NRHM
➢ Enumerate the ASHA
➢ List out key strategies
➢ Enlist the outcomes NRHM
➢ State the NGO
➢ Know the role of NGO

TERMINOLOGIES:

• Reproductive: those parts of the male and female body associated with
the production of children.
• Maternal: pertaining of the mother.
• Child: young human being.
• Health: is a state of complete physical, mental and social wellbeing and
not merely absence of disease and infirmity.
• Development: the process of growth and differentiation.
• Family welfare: well being of health in the family.
• Vulnerable: easily wounded.
• Preventive : serving to prevent
• Curative: This promotes healing by overcoming disease.
• Rehabilitative: restore to effectiveness by training.
• Paediatrics: the branch of medicine dealing with the care and
development of children and with the treatment of diseases that affects
them.
• Fertility: able to reproduce.
• Disease: unhealthy condition of the body.
• Survival: surviving to live.
• Education: development of characters
• Contraceptives: the devices used to prevent conception.
• Accreditation: to give someone official status within a organization
• Contracting: a drawing together.
• Mortality: the state of being liable to die.
• Morbidity: the state of being diseased.
• Immunization: the act of creating immunity by artificial means.
• Prophylaxis: prevention of disease.
• Voluntary: able to act of one’s own free will.
• Infrastructure: basic structural foundations.
• Resources: available.
• Deprivation: absence of parts that are needed.
• Intricately: very complicated.
• Inflicting: deal.
• Resuscitation: restoration to life of one apparently dead.
• Asphyxiated: pathological changes caused by lack of oxygen
• Pioneering: beginner of enterprise.

DEFINITION

The term “maternal and child health” refers to the promotive, preventive,
curative and rehabilitative health care for mothers and children. It
encompasses the health care aspects of obstetrics, paediatrics, family
welfare, nutrition, child development and health education.

Reproductive and child health [RCH] is defined as a state in which “people


have the ability to reproduce and regulate their fertility; women are able to
go through the pregnancy and child birth safely, the outcome of pregnancy
is successful in terms of maternal and infant survival and well-being, and
couples are able to have sexual relations free of the fear of pregnancy and
contracting disease. This means that every couple should be able to have
child when they want and that the pregnancy, the mother and the child are
safe and well, and contraceptives by choice are available to prevent
pregnancy and of contracting disease”.

Maternal and child health [MCH] refers to preventive and curative health
care activities for mothers and children.
MATERNAL AND CHILD HEALTH PROGRAMMES

Women of the reproductive age groups [15-44 years] and children [male
and female below 15 years of age] constitute almost 60% of the
population. Mothers and children are considered as a special group for
the following reasons:

➢ By virtue of their numbers, mothers and children are major consumers


of health service. They comprise of approximately two –thirds of the
population in the developing countries. In India, women in the child
bearing age [15 to less than 45 years] constitute 22.8% and children
under 15 years of age 37.1% of the total population. Thus together
they constitute nearly 60% of the total population.
➢ These groups are subjected to marked physical and physiological
stress, which if not cared for, may cause serious deviation from
normal health.
➢ They are exposed to unusual risks of widespread infection, poor
nutrition, and hazardous delivery, which may cause death or
impairment of health. The high occurrence of morbidity among
women and children is reflected in a seven village study.[Trackrov
PL, L. KapoorJ.D 1990 NIHFW]

OBJECTIVES

1. To reduce maternal, infant and childhood mortality and morbidity.


2. To promote reproductive health.
3. To promote physical and psychological development of children and
adolescent.
4. The mother and child should considered and treated as one unit for
providing health services because of the following:
• During antenatal period the foetus is part of the mother, the
period of development of the foetus is about 40 weeks.
During this period it obtains all necessary supplies to
nutrients and oxygen from the mother’s blood.
• The health of the child is intricately linked to the mother’s
health.
• Certain diseases inflicting the mother during pregnancy.
• Even after birth, the child is dependent for its feeding upon
the mother, at least in first year of life.
• During the first few years of life, the child usually
accompanies the mother during her visits to the health
facilities and there are few occasions when services to the
mothers and children are not simultaneously called for.
• The mental and social development of the child is also
dependent on the mother. The death of the mother causes a
maternal deprivation syndrome in the child.
The policy guidelines for implementation of MCH programme are:
I. Effective use should be made of existing resources and
infrastructures available in the community.
II. The services should be delivered as close to the homes of
beneficiaries as possible.
III. Services for mothers and children should be delivered, in an
integrated manner.
IV. Child survival programmes should serve as a sugar coating for
delivery of the family planning programmes which in general
are not popular.
V. Voluntary agencies working in an area should be involved in
providing MCH services.

Causes of MMR

➢ Haemorrhage
➢ Toxaemias
➢ Anaemia
➢ Obstructed labour
➢ Puerperal sepsis
➢ Unsafe abortion.

MCH SERVICES

In 1989 WHO gave for the child survival and safe motherhood [CSSM]
programme which was implemented by the Government of India and
initiated in 1992.The CSSM programme with an integrated package of
intervention for improving the health status
of women and children and reducing the material infant and child
mortality rates. The service is provided to pregnant women, infants and
children under 5 years of age. The package of services under CSSM
program includes the following:
For the mothers
➢ Immunization
➢ Prevention and treatment of anaemia.
➢ Antenatal care and early identification of maternal complication.
➢ Deliveries by trained personnel.
➢ Promotion of Institutional deliveries
➢ Management of obstetric emergencies.
➢ Birth spacing

For children

➢ Essential newborn care.


➢ Immunizations.
➢ Appropriate management of diarrhoea.
➢ Appropriate management of ARI
➢ Vitamin A prophylaxis.
➢ Treatment of anaemia.

Essential obstetric care:


It intends to provide the basic maternity services to all pregnant
women through
✔ Early registration of pregnancy[within 12-16 weeks]
✔ Antenatal check up at least 3 times.
✔ Give IFA- large tablet to all.[1 tab a day for 100 days]
✔ Treat with clinical anaemia[2 tab a day for 100 days]
✔ Deworm with mebendazole[during 2nd /3rd trimesters]
✔ Safe and clean delivery services.
✔ Prepare the women for EBF and timely weaning.
✔ Post natal care including advice and services.
• Early detection of complication:
✔ Clinical examination to detect anaemia
✔ Bleeding indicating APH or PPH.
✔ Weight gain of more than 3kg in a month.
✔ Fever 39*C and above after delivery.
✔ Prolonged labour.
Emergency obstetric care:
✔ Early identification of obstetric emergencies.
✔ Provide initial management and refer to identified referral units.
✔ Use fastest available mode of transport.
Women in the reproductive age group:
• Counselling on
✔ Optimal timing and spacing of birth.
✔ Small family norms.
✔ Use and choice of contraceptives.
• Information on availability
✔ MTP services
✔ IUD and sterilization services
Provision of clean and safe delivery practices at the
community level:
✔ Creation of awareness in the community on need for clean and safe
deliveries
✔ Deliveries by trained personnel
✔ Provision of Disposable Delivery Kits for all deliveries
✔ Promotion of institutional deliveries.
✔ Identification and referral of high-risk cases at the community level
by trained dais.
Essential newborn care:
✔ Birth weight for all new borne
✔ Resuscitation of asphyxiated babies.
✔ Care of low birth babies.
✔ Prevention of hypothermia.
✔ Exclusive breast feeding within 1 hour of delivery.
✔ Referral of newborns who show signs of illness.
✔ Advice to mother on essential newborn care, prevention of
hypothermia infections, nutrition and immunization.
Immunization:
It provides vaccines for polio, tetanus, DPT, DT measles and
tuberculosis.
✔ BCG - 1 dose at birth
✔ DPT - 3 doses beginning 6 weeks at monthly intervals.
✔ Polio – ‘0’ dose at birth for all institutional deliveries 3 doses
beginning 6 weeks at monthly interval
✔ Measles – 1 dose at completion of 9 months of age.
✔ Vitamin - First dose [100’000 IU] with measles vaccination

Children [1-3 years]


✔ DPT/OPV booster dose at 16 to 18months.
✔ Vitamin A Second dose (200,000 IU) at 16 to 18 months along
with DPT/OPV booster.
✔ 3rd dose to 5th dose (200,000 IU each) at 6 months interval.

Children (1-6 years)


✔ Prevention of anaemia.
✔ IFA-small tablets of child have clinical signs of anaemia.
✔ Stool examination for hookworm infestations ( where facilities
are available)
✔ Treatment for worm infestation with mebendazole.
Prevention of deaths due to diarrhoeal diseases:
✔ Correct management of all cases of diarrhoea
✔ Advice mothers to give increased volume of fluids.
-How to prepare ORS solution.
-Continue feeding the normal diet
-To signs when to seek help.
Prevention of deaths due to pneumonia
✔ Correct management of all cases of acute respiratory infections.
✔ Referral of children with severe pneumonia

RCH –PHASE 2

RCH approach means that every couple should be able to have


children when they want ,that the pregnancy is uneventful, that
safe delivery services are available, that at the end of pregnancy,
the mother and the child are safe and contraception by choice are
available to prevent pregnancy and contracting diseases.

➢ Essential obstetric care for all


• Register by 12-16 weeks.
• Antenatal check up at least 3 times during pregnancy.(20,32,36
weeks)
• TT immunization should be given to all pregnant women as early as
possible during pregnancy with two doses at one month interval.
• Give one tablet of IFA (large) daily for 100 days to all pregnant
women.
• Treat those with clinical signs of anaemia with two tablets of IFA.
• Deworm with mebendazole (2nd /3rd trimester) in areas where
hookworm infestation is common.
• Safe and clean delivery services.
• Prepare the women for exclusive breastfeeding and timely weaning.
• Postnatal care, including advice and for limiting and spacing birth.

➢ Early detection of complications


• Clinical examination to detect anaemia. Anaemia is not only a
major cause for mortality and morbidity but is also major
contributory factor for birth of a low birth –weight baby.
• If there is bleeding before (APH) and excessive bleeding after
delivery (PPH), referred to the nearest hospital by the quickest
mode of transport.
• Weight gain of more than 3kg in a month or systolic blood pressure
of 140mmHg more should arouse suspicion of pre-eclampsia or
eclampsia.
• Fever 39*C and above after delivery or after abortion are normally
due to infections and sometimes can be fatal.
• Prolonged or obstructed can lead to rupture of uterus.
➢ Emergency obstetric care
• Early identification.
• Provide initial management and refer to identify referral hospitals.
• Use fast available mode of transport and while transporting the
patient should lie on her left side.
➢ Women in the reproductive age group
• Counselling on:
✔ Importance of girl child.
✔ Optimal timing and spacing of birth.
✔ Small family norms.
✔ Use and choice of contraceptives.
• Prevention of RTI and STD.
• Information on availability
✔ MTP services
✔ IUD and sterilization services
• Family planning service
✔ Condom distribution
✔ Oral contraceptives dispending
✔ IUD services.
• Recognition and referral of clients with STD and RTI
➢ Provision of clean and safe delivery practices at the
community level:
✔ Creation of awareness in the community on need for clean and safe
deliveries
✔ Deliveries by trained personnel
✔ Provision of Disposable Delivery Kits for all deliveries
✔ Promotion of institutional deliveries.
✔ Identification and referral of high-risk cases at the community level
by trained dais.
➢ Essential new born care
• Take birth weight of all new borne.
• Resuscitation of asphyxiated babies.
• Prevention of hypothermia: New borne are susceptible to catch cold.
• Exclusive breastfeeding within one hour of delivery.
• Referral of newborns, who signs of illness.
• Advice the mother on essential new born care.
➢ Immunization
✔ BCG - 1 dose at birth
✔ DPT - 3 doses beginning 6 weeks at monthly intervals.
✔ Polio – ‘0’ dose at birth for all institutional deliveries 3 doses
beginning 6 weeks at monthly interval
✔ Measles – 1 dose at completion of 9 months of age.
✔ Vitamin - First dose [100’000 IU] with measles vaccination

Children [1-3 years]


✔ DPT/OPV booster dose at 16 to 18months.
✔ Vitamin A Second dose (200,000 IU) at 16 to 18 months along
with DPT/OPV booster.
✔ 3rd dose to 5th dose (200,000 IU each) at 6 months interval.

Children (1-6 years)


✔ Prevention of anaemia.
✔ IFA-small tablets of child have clinical signs of anaemia.
✔ Stool examination for hookworm infestations ( where facilities
are available)
✔ Treatment for worm infestation with mebendazole.

➢ Prevention of deaths due to diarrhoeal diseases:


✔ Correct management of all cases of diarrhoea
✔ Advice mothers to give increased volume of fluids.
-How to prepare ORS solution.
-Continue feeding the normal diet
-To signs when to seek help.
➢ Prevention of deaths due to pneumonia
✔ Correct management of all cases of acute respiratory
infections.
✔ Referral of children with severe pneumonia or very severe
illness

HEALTH CARE DELIVERY SYSTEM

A health care system is the totality of services offered by all health


discipline.

Health care delivery system exists to provide service to provide service


and resources for better health.

Changes
Health
Curative
Resources
Public Status
in
Or
Preventive
Private
Health
Health Problems
Promotive
Voluntary
Status
Indigenous
MODEL OF HEALTH CARE DELIVERY

Input Health Care Services Health Care System Output

HEALTH CARE SERVICES:

The health care service is to improve the health status of the


population. The health services of broad agreement should be

➢ Comprehensive
➢ Accessible
➢ Acceptable
➢ Provide for community participation
➢ Available at a cost the community and country can afford.

HEALTH CARE SYSTEM

The health care system is intended to deliver the health care services.
The final outcome is the changed health status or improved health status
of the country. It has five different sectors.

1. Public health sector

a) Primary health care: Keeping in view the WHO goal of “Health for
All” by 2000, the government if India evolved a National health policy
based on primary health care approach.

Village level: One of the basic tenets of primary health care is


universal coverage and equitable distribution of health resources. To
implement this policy at the village level the following scheme are as
follow,
 Village health guides: A VHG is a person with aptitude form
social service and is not a full time government functionary.
 Local dais: most deliveries in rural areas are still handled by
untrained Dai and this programme is taken to improve their
knowledge in the elementary concepts of MCH and sterilization
besides obstetric skills.
 Aganwadi worker: Agan literally means a court yard. She
undergoes training in various aspects.
 Primary health centre: It is to provide health services to the rural
population.Its function are as follows;
 Medical care.
 MCH including family planning.
 Safe water supply and basic sanitation.
 Prevention and control of locally endemic diseases.
 Collection and reporting of vital statistics.
 Education about health.
 National health programmes as relevant
 Referral services.
 Training of health guides, health workers, local dais and health
assistants.
 Basic laboratory services.


Sub centres: It is the peripheral outpost of the existing health
delivery system in rural areas.

b) Hospital/ Health centres

 Community health centres


 Rural health centres
 District hospital/health centres
 Specialist hospitals.
 Teaching hospitals

c) Health Insurance schemes

 Employees state insurance


 Central government health scheme

2. Private sector

a) Private hospitals, polyclinics, nursing homes and dispensaries

b) General practitioners and clinics

3. Indigenous systems of medicine

 Ayurveda and Siddha


 Unani and Tibbi
 Homoeopathy
 Unregistered practitioners.

4. Voluntary health agencies

5. National health programmes

NATIONAL RURAL HEALTH MISSION (NRHM)

The National Rural Health Mission (2005-2012) was launched in April


2005 by the government of India (GOI).It seeks to provide effective
health care to rural population throughout the country with special focus
on 18 states, which have weak public health indicators and /or weak
infrastructure. These states are Arunachal Pradesh, Assam, Bihar,
Chhattisgarh, Himachal Pradesh, Jharkhand, Jammu and Kashmir,
Manipur, Mizoram, Meghalaya, Madhya Pradesh, Nagaland, Orissa,
Rajasthan, Sikkim, Tripura, Uttaranchal and Uttar Pradesh.

National Rural Health Mission –The Vision

• The NRHM (2005-2012) seeks to provide effective healthcare to rural


population throughout the country with special focus on 18 states,
which have weak public health indicators and /or weak infrastructure.
• The Mission is an articulation of the commitment of the government to
raise public spending on health from 0.9% of GDP to 2-3% of GDP.
• It aims to undertake architectural correction of the health system to
enable it to effectively handle increased allocations as promised under
the National Common Minimum Programme and promote policies that
strengthen public health management and service delivery in the
country.
• It has as its key components provision of a female health activist in
each village; a village health plan prepared through a local team
headed by the health & sanitation committee of the Panchayat.
• It seeks to revitalize local health traditions and mainstream AYUSH
into the public health system
• It aims at effective integration of health concerns with determinants of
health like sanitation & hygiene, nutrition and safe drinking water.
• It seeks to improve access of rural people, especially poor women and
children, to equitable, affordable, accountable and effective primary
health care.

The goals of NRHM are as follows


 Reduction in Infant Mortality Rate and Maternal Mortality Ratio by
at least 50% from existing levels in next seven years
 Universalize access to public health services for Women’s health,
Child health, water, hygiene, sanitation and nutrition
 Prevention and control of communicable and non-communicable
diseases, including locally endemic diseases
 Access to integrated comprehensive primary healthcare
 Ensuring population stabilization, gender and demographic
balance.
 Revitalize local health traditions and mainstream AYUSH

Accredited Social Health Activists


The Government of India have launched a National Rural Health Mission to
address the health needs of rural population, especially the vulnerable
sections of the society. The sub centre is the most peripheral level of contact
with the community under the public health infrastructure. So the new band
of community based functionaries, named as Accredited Social Health Activist
(ASHA) is proposed in the NRHM who will serve the population of 1000 and
500 in hilly.
ASHA is the first port of call for any health related demands of deprived
sections of the population, especially women, children, old aged, sick and
disabled people. She is the link between the community and the health care
provider.

ASHA Sahayogini
In each Anganwadi Centre apart from Anganwadi Worker and Sahayoka one
additional worker named 'Sahyogini' is envisaged to provide door to door
information and services of Nutrition, Health, preschool education. Her role is
quite similar to the role of ASHA under NRHM. This worker is called as 'ASHA
Sahyogini', selected by the community through Gram Panchayat and
responsible to the community.

Criteria for selection


• One ASHA Sahyogini for each Anganwadi Centre.
• Woman resident of that area, Married/ Widow/ Divorcee
• Age between 21 to 45 years
• ASHA Sahyogini should have effective communication skills, leadership
qualities and be able to reach out to the community.
• ASHA Sahyogini should be literate woman with formal education up to
eighth class, in tribal and desert areas the educational qualification
may be relaxed if the 8th pass candidate is not available. This is
permitted only after the approval of State level Committee.
• Adequate representation from disadvantaged population groups
Roles and Responsibilities of ASHA Sahayogini
• Create awareness
Health, Nutrition, basic sanitation, hygienic practices, healthy living and
working conditions, information on existing health services and need for
timely utilization of health, nutrition and family welfare services.
• Counselling
Birth preparedness, importance of safe and institutional delivery, breast-
feeding, immunization, contraception, prevention of RTI/STI. Nutrition and
other health issues.
• Mobilization
Facilitate to access and avail the health services available in the public health
system at Anganwadi Centres, Sub Centre, PHC, CHC and district hospitals.
• Village health plan
Work with the village Health and sanitation Committee to develop the village
health plan
• Escorts/ Accompany
Escorts the needy patients to the institution for care and treatment. She will
accompany the woman in labour to the institution and promote institutional
delivery
• Provision of Primary Medical Health Care
Minor ailments such as fever, first aid for minor injuries, diarrhoea. A drug kit
will be provided to ASHA
• Provider for DOTS
• Depot Holder ORS, IFA, DDK, chloroquine, oral pills and condoms
• Care of new born and management of a range of common ailments
• Inform Births, deaths and unusual health problem or disease out break
• Promote Construction of household toilets

Training
Capacity building of ASHA is critical in enhancing her effectiveness. It has
been envisaged that training will help to equip her with necessary knowledge
and skills. Training of ASHA Sahyogini is a continuous process. Considering
her range of functions and task to be performed, her induction training is
planned for 23 days in 4 rounds (10+4+4+5 days). The trainings are planned
in cascade models

Janani Surakha Yojana (JSY) is a centrally sponsored scheme under NRHM


umbrella to benefit pregnant women & certified poor families.

Objective
1. To decrease maternal mortality rate & infant mortality rate.
2. To increase Institutional deliveries amongst BPL & poor families.
Beneficiary
• Women of BPL.
Key strategies
There are twelve key strategies identify for RCH II
1. Strengthening Project Management Structure at state and district levels
• Re-organizing of Medical Directorate.
• Renovation of Medical Directorate and NRHM/RCH-II cell.
• Setting up, of the PMU at state & district levels.
• Induction of newly appointed professionals done on programme
management and interventions.
• Support for communication, equipments and mobility to DPMUs.
2. Strengthening Infrastructure at various levels of health service delivery
• Upgrading of PHCs as BemOCs.
• Provision of blood storage at 26 identified CEmOCs to make them fully
functional.
• Support for equipment and labour tables at 25% PHCs.(10000.00 Rs.
Per Institution)
• Support for minor repair and renovation of public facilities at 50% PHCs.
(25000.00 Rs. Per Institution)
• Facility survey of all PHC and CHCs.
3. Human resource development and capacity building
• Development of annual training calendar.
• Strengthening of ANMTCs.
• Support medical colleges for Anaesthesia trainings.
• Library at SIHFW & Medical Directorate.
• Orientation of AYUSH Doctors on National Programmes.
4. Improving quality of care and Strengthening Referral System
• Study on referral system
• 7 days Mobility support to PHC MOs
• Installation of new telephone connection at all PHC/CHCs.
• Workshops for developing standards and protocols for quality of care.
5. Strengthening and improvement of logistics and supply systems
• Feasibility study to setting up of the drugs and logistics warehousing
has been done.
• Support for the repair of workshop for cold chain equipment has been
provided.
• Support for hiring 12 new refrigerator mechanics has been provided to
district where such positions are vacant.
6. Strengthening Health Management information system (HMIS), monitoring
and evaluation
• Integration of RCH-II/NRHM reporting format in existing HMIS software.
• Baseline and concurrent evaluation.
7. Behaviour Change Communication for increasing demand for RCH and
contraceptive services
• Intensive IEC for RCH-II and NRHM interventions.
• Provision for hiring of IEC van in all districts.
• Implementation of Integrated Media Plan.
• IEC done by printing of booklet, Banners, cards.
8. Specific Interventions
Maternal Health:
• RCH camps target:
• Dai training target:
• Night delivery facility at all PHCs and CHCs.
• Hiring of contractual staff (PHN) at CEmOCs.
• Provision of 1321 additional ANMS at 10 desert and tribal districts.
• STD/RTI drugs for PHCs.
• Jannani Suraksha Yojna
Child Health:
• Malnutrition corner at all 237 blocks.
• Purchase of ORS packets.
Adolescent Health
• AFHS training at 25% PHCs
Family Planning
• Improving quality of fix camps.
• Compensation scheme for sterilization.
• Blood donation camps.
9. Strengthening Networking and Partnership with the civil society
• Collaboration to build partnership to improve assess and quality of
health care service in services.
• Accreditation of Private nursing home for JSY.
• MNGO scheme in all districts.
• Annual consultation with stakeholders on NRHM.
• Social marketing of contraceptives and other health services.
10. Innovative schemes and pilot projects
• Pilot Project on Population stabilization initiated at Jhalawar & Tonk.
• A help line proposed at medical directorate for improving
communication between field level functionaries, districts and state
level officers.
• Campaign on Age at Marriage.
• Medical Mobile unit for all districts.
11. Improving and strengthening RCH Services in Tribal population
• Six districts, namely, Baran, Banswara, Chittorgarh Dungarpur, Sirohi
and Udaipur will be included as non-primitive tribal group districts
under the project in addition to the tribal population in the adjoining
blocks of Jhalawar and Kota district.
12. Establishing and strengthening RCH services in Urban Area
The programme will address the urban slum population in Jaipur, Jodhpur,
Kota, Bikaner, Pali, Udaipur, Ganganagar, Hanumangarh, Bhilwara and Tonk
cities.
PIP for 8 urban slums is under process.

The Mission outcomes are expected to follow a phased approach and


are at two levels:
1. National Level
• Infant Mortality Rate to be reduced to 30/1000 live births
• Maternal Mortality Ratio to be reduced to 100/100,000
• Total Fertility Rate to be brought to 2.1
• Malaria mortality reduction rate –50% upto 2010, additional 10% by
2012
• Kala Azar to be eliminated by 2010.
• Filaria/Microfilaria reduction rate: 70% by 2010, 80% by 2012 and
elimination by 2015
• Dengue mortality reduction rate: 50% by 2010 and sustaining at that
level until 2012
• Japanese Encephalitis mortality reduction rate: 50% by 2010 and
sustaining at that level until 2012
• Cataract Operation: increasing to 46 lakhs per year until 2012.
• Leprosy prevalence rate: to be brought to less than 1/10,000.
• Tuberculosis DOTS services: from the current rate of 1.8/10, 00, 85%
cure rate to be maintained through the entire Mission period.
• 2000 Community Health Centres to be upgraded to Indian Public Health
Standards
• Utilization of First Referral Units to be increased from less than 20% to
75%
• 250,000 women to be engaged in 18 states as Accredited Social Health
Activists (ASHA).
2. Community Level
• Availability of trained community level worker at village level, with a
drug kit for generic ailments
• Health Day at Anganwadi level on a fixed day/month for provision of
immunization, ante/post natal checkups and services related to mother
& child healthcare, including nutrition
• Availability of generic drugs for common ailments at Sub-centre and
hospital level
• Good hospital care through assured availability of doctors, drugs and
quality services at PHC/CHC level
• Improved access to Universal Immunization through induction of Auto
Disabled Syringes, alternate vaccine delivery and improved
mobilization services under the programme
• Improved facilities for institutional delivery through provision of
referral, transport, escort and improved hospital care subsidized under
the Janani Suraksha Yojana (JSY) for the Below Poverty Line families
• Availability of assured healthcare at reduced financial risk through
pilots of Community Health Insurance under the Mission
• Provision of household toilets
• Improved Outreach services through mobile medical unit at district-
level.

NON GOVERNMENT ORGANISATION {NGO}


“The voluntary health agency may be defined as a organisation that is
administered by a autonomous board which holds meetings, collects funds
for its support chiefly from private sources and expends money, whether with
or without paid workers, in conducting a programme directed primarily to
furthering the public health by providing health services or health education,
or by a combination of this activities “The voluntary health agencies have
been compared to “motor trucks” which can penetrate the by-ways and the
official agencies to “railway trunk lines” which must run tracks established by
law.
Functions:
a) SUPPLEMENTING THE WORK OF GOVERNMENT AGENCIES: It is
well known that government agencies cannot provide complete service
because they operate under financial and statutory restrictions. The
voluntary health agencies can help strengthen the work of government
agencies by lending personnel, or by contributing funds for special
equipment, supplies or services.
b) PIONEERING: The voluntary health agencies are in a position to
explore ways and means of doing new things. Research is one form of
pioneering. When the efforts succeed and bear fruit, the government
agencies can step in and take over the project for the benefit of the
larger numbers
c) EDUCATION: There is unlimited scope for health education in India.
The government agencies cannot cope with the problem, unless it is
supplemented by voluntary effort on the part of the people.
d) DEMONSTRATION: By putting up demonstrations and experimental
projects, the voluntary health agencies have advanced the cause of
public health. The demonstration of bore hole latrines by the
Rockefeller foundation to solve the problem of hookworm in India is a
case of point. The bore-hole latrine and its modifications have since
become an essential part of the environmental sanitation programme
in India.
e) GUARDING THE WORK OF GOVERNMENT AGENCIES: By setting a
good example the voluntary health agencies can always guide and
criticise the work of government agencies.
f) ADVANCING HEALTH LEGISLATION: The voluntary agencies can
also mobilise public opinion and advance legislation on health matters
for the benefit of the whole community.
VOLUNTARY HEALTH AGENCIES IN INDIA
1. Indian Red Cross Society: The Indian Red Cross Society was established
in 1920. It has a network of over 400 branches all over India. It has been
executing programmes for the promotion of health, prevention of disease
and mitigation of suffering among the people.
2. Hind Kusht Nivaran Sang: It was founded in 1950 with its headquarters
New Delhi.It includes rendering of financial assistance to various leprosy
homes, clinics and health education.
3. Indian council for child welfare: It was established in1952.The services
are devoted to secure for Indian’s children those “opportunities and
facilities, by law and other means” which are necessary to enable them to
develop physically, mentally, morally ,spiritually and socially in a healthy
and normal manner and in condition of freedom and dignity.
4. Tuberculosis Association of India: It was formed in 1939.It raised funds
training of doctors, health visitors, and social workers in antituberculosis
work, promotion of health education and promotion of consultations and
conferences.
5. Bharat Sevak Samaj: It is non-political and non-official organization was
formed in 1952.One of the prime objectives is to help people to achieve
health by their own actions and efforts.
6. The Kasturba Memorial fund: : Created in commemoration of Kasturba
Gandhi, after her death in 1944,the fund was raised with the main object
of improving the lot of women especially in the villages, through gram-
sevikas.The trust has nearly a crore of rupees and is actively engaged in
various welfare projects in the country.
7. Family planning association of India: It was formed in 1949 with its
headquarters in Mumbai. It has done pioneering work in propagating
family planning.
8. All India women’s conference: It is the only women’s voluntary welfare
organisation in the country. It established in 1926 and its has branches are
running M.C.H clinics medical centres and family planning clinics.

ROLE OF NGO
Improvements in equity were most pronounced for household practices
and coverage of home visits, and inequities.

To improve the equity of maternal and neonatal health programmes.

To identify and address barriers to universal coverage

To care utilization, particularly in the poorest segments of the


population.

To include equity analysis as part of a complete evaluation plan.

Included in institutional arrangement at national, state and district


levels, including standing mentoring group for ASHA

Provision of training and technical support for ASHA.

Service delivery for identified population groups on select themes

Health resource organizations

For monitoring, evaluation and social audit.

CONCLUSION:

The mother and child is belong to a special group and vulnerable to disease
in the country therefore it is very important to protect of the health of the
expectant mother and her children is of prime importance for building of a
sound and healthy nation.

JOUNRAL ABSTRACT:
The NRHM is attempting to do things differently and to make a difference. It
has to negotiate its way through historical frameworks and approaches, deal
with a variety of strong competing interests, and of course, face resistance to
change, skepticism cynicism as well as apathy.

BIBLIOGRAPHY

1. BT Basavanthappa”Text of Midwifery & Reproductive health nursing”


Chapter 1,2006 edition ,Jaypee brothers medical publishers, New Delhi
page 12-18.
2. BT Basavanthappa”Community health nursing” Chapter
11,2008edition, Jaypee brothers medical publishersNew Delhi,
page354-362.
3. Annamma Jacob “A comprehensive textbook of midwifery”
Chapter50,2005 edition
Jaypee brother’s medical publishers, New Delhi page 589-594.
4. K.Park “Preventive & social medicine” Chapter 9, 19th edition 2007 Ms
Banarsidas Bharat Jabalpur, page 442-448; 745-760.
5. K.Park “Preventive & social medicine” Chapter 8, 19th edition 2007
Ms Banarsidas Bharat Jabalpur, page364-372..
6. Nightingale nursing times, Volume 4, Issue 2 May 2008.
7. Nightingale nursing times ,Volume 4 ,Issu7 May 2008
8. Health action July 2008
9. Nightingale nursing times ,Volume 4 ,Issu2 May 2008
MASTER PLAN

TOPIC : NATIONAL HEALTH AND


FAMILY

WELFARE
PROGRAMMES RELATED TO

MATERNAL AND CHILD


HEALTH; HEALTH

CARE DELIVERY SYSTEM;


ROLE OF NGO

UNIT : 1

COURSE &YEAR : MSc NURSING 1ST YEAR

DATE & TIME : __ __ / 08 / 2OO9

NAME OF THE STUDENT : Ms DIMSEY .R .MARAK

NAME OF THE SUPERVISOR : Ms SUBHASHINI G.

SUBJECT : OBSTETRICS &


GYNAECOLOGICAL NURSING.
A SEMINAR
ON

NATIONAL HEALTH AND FAMILY


WELFARE PROGRAMMES RELATED TO
MATERNAL AND CHILD; HEALTH CARE
DELIVERY SYSTEM; NATIONAL RURAL
HEALTH MISSION; ROLE OF NGO

SUBMITTTED BY
SUBMITTED TO

MS. DIMSEY .R.MARAK MS.


SUBHASHINI.G

1ST YEAR MSC NURSING. ASS. PROFESSOR


P.I.O.N HOD OBG
NURSING

P.I.O.N

SL NO CONTENT

1 INTRODUCTION:
2 OBJECTIVES:

 GENERAL
 SPECIPIC

3 TERMINOLOGIES:

4 CONTENT:

 DEFINITION OF MCH
 MCH PROGRAMMES
 OBJECTIVES
 CAUSES MMR
 MCH SERVICES/ CSSM
 RCH 2
 DEFINITION OF HEALTH CARE DELIVERY SYSTEM
 HEALTH CARE STSTEM
 DEFINITION OF NRHM
 NRHM VISION
 NRHM GOAL
 ASHA
 ROLE AND RESPONSIBILITY FOR ASHA
 KEY STRATEGIES OF NRHM
 OUTCOMES OF NRHM
 DEFINITION OF NGO
 FUNCTION OF NGO
 VOLUNTARY HEALTH AGENCIES
 ROLE OF NGO
5 CONCLUSION

6 JOURNAL ABSTRACT