MATERNAL AND CHILD HEALTH

PROGRAMMES
 INTRODUCTION
• MOTHERS AND CHLIDERN NOT ONLY CONSTITUTE A LARGE
GROUP,BUT THEY ARE ALSO” VULNERABLE “ OR SPECIAL
GROUP.THEY COMPRISES 71.4 % OF POPULATION OF THE
DEVELPOING COUNTRIES,IN INDIA ,WOMEN OF CHILD
BEARING AGE (15-44 YEARS) CONSTITUTE 22.2% AND
CHLIDERN UNDER 15 YEARS OF AGE ABOUT 35.3% OF TOTAL
POPULATION, TOGTHER 57.7% OF POPULATION CONSISTS OF
MOTHERS AND CHLIDERNS.
• THE PRESENT STRATEGY IS TO PROVIDE MOTHER AND CHLID
HEALTH SERVICES AN INTEGARTED PACKAGE OF” ESSENTIAL
HEALTH CARE” ALSO KNOWN AS PRIMARY HEALTH CARE.
 MOTHER AND CHLID –ONE UNIT
1. DURING THE ANTENATAL PERIOD THE FOETUS IS
PART OF MOTHER.
2. CHLID HEALTH IS CLOSELY RELATED TO MATERNAL
HEALTH.
3. CERTAIN DISEASES AND CONDITIONS OF THE
MOTHER DURING PREGNANCY ARE LIKELY TO
HAVE EFFECT UPON THE FOETUS.
4. AFTER BIRTH THE CHILD IS DEPENDENT ON
MOTHER.
5. THE MOTHER IS ALSO THE FIRST TEACHER OF
CHLID.
DEFINITION OF MATERNAL AND CHLID
HEALTH
“ MATERNAL AND CHLID HEALTH” REFERS
TO THE PROMOTIVE,PREVENTIVE ,CURATIVE
AND REHABLITATIVE HEALTH CARE FOR
MOTHERS AND CHLIDERN ,CHILD HEALTH,
FAMILY PALNNING, SCHOOLHEALTH,
HANDICAPPED CHILDEREN ,ADLOSCENCE AND
HEALTH ASPECTS OF CHLIDERN IN SPECIAL
SETTING SUCH AS DAY CARE.
 OBJECTIVES OF MCH SERVICES
REDUCTION OF MATERNAL ,PERINATAL,
INFANT, AND CHILDHOOD MORTALITY AND
MORBIDITY
PROMOTION OF REPRODUCTIVE HEALTH
PROMOTION OF PHYSICAL AND
PSYCHOLOGICAL DEVELPOMAENT OF THE
ADLOSECENT WITHIN THE FAMILY.
 MCH SERVICES
ANTENATAL CARE:
THE CARE OF THE WOMEN DURING
PREGNANCY.
AIM
THE PRIMARY AIM OF ANTENATAL
CARE IS TO ACHIEVE AT THE END OF A
PREGNANCY A HEALTHY MOTHER AND A
HEALTHY BABY.
 OBJECTIVES OF ANTENATAL CARE
• TO PROMOTE PROTECT AND MAINTAIN THE HEALTH OF THE
MOTHER DURING PREGNANCY
• TO DETECT:” HIGH RISK” CASES AND SPECIAL ATTENTION
• TO FORESEE COMPLICATIONS AND PREVENT THEM
• TO REMOVE ANXIETY AND DREAD ASSOCIATED WITH
DELIVERY
• TO REDUCE MATERNAL AND INFANT MORTALITY AND
MORBIDITY
• TO TEACH THE MOTHER ELEMENTS OF CHILD CARE,
NUTRITION ,PERSONAL HYGIENE AND ENVIRONMENTAL
SANITATION
• TO SENSITISE THE MOTHER TO NEED FOR FAMILY PALNNING
• TO ATTEND TO THE UNDER –FIVES ACCOMPANYING THE
MOTHER
 ANTENATAL SERVICES……….
1.ANTENATAL VISITS: MOTHER SHOULD ATTEND THE ANTENATAL CLINIC ONCE
A MONTH DURING THE FIRST 7 MOTHS,TWICE A MONTH,DURING THE NEXT
MOTH AND THERE AFTER ONCE IN WEEK IF EVERYTHING IS NORMAL,
A MINIMUM OF 3 VISITS COVERING THE ENTIRE PEROID OF PREGNANCY
SHOLUD BE
1ST VISIT AT 20TH WEEKS
2ND VISIT AT 30TH WEEKS
3RD VISIT AT 36TH WEEKS
PREVENTIVE SERVICES FOR MOTHERS( BEFORE DELIVERY)
a. THE FIRST VISIT:
- HEALTH HISTORY
- PHYSICAL EXAMINATION
- LABORATORY EXAMINATION
b. ON SUBSQUENT VISITS:
-PHYSICAL EXAMINATION
- LABORATORY TESTS
CONTINUED………
c. IRON AND FOLIC ACID SUPPLEMENTATION
d. IMMUNISATION AGAINST TETANUS
e. INSTRUCTION ON NUTRITION, FAMILY PLANNING ,SELF CARE,DELIVERY
AND PARENTHOOD
f. HOME VISITING BY A FEMALE HEALTH WORKER
G. REFERRAL SERVICES
RISK APPROACH FOR HIGH RISK CASES LIKE ELDERLY PRIMI,
MALPRESENTATIONS, ANTEPARTUM HEMORRAHAGE, PRE-ECLAMPSIA,
ANAEMIA, TWINS, H\O PREVIOUS CEASAERIAN DELIVERY, AND GENERAL
DISEASES LIKE KIDNEY DISEASE, DIABETUS, TUBERCULOSIS, LIVER
DISEASES ETC…
MAINTENANCE OF RECORDS: THE ANTENATAL CARE IS PREPARED AT THE
FIRST EXAMINATION, IT INCULDE REGITRATION NUMBER, IDENTIFYING
DATA, PREVIOUS HEALTH HISTORY, AND MAIN HEALTH EVENTS.
HOME VISITS: IS BACK BONE OF MCH SERVICES. HOME VISIT BY THE HEALTH
WORKER FEMALE OR PUBLIC HEALTH NURSE.
 CONTINUED…
2.PRENTAL ADVICES:
A. DIET: LACTATION DEMAND ABOUT 550 Kcal A DAY. TOTAL WEIGHT GAIN
12KG , AT 1ST TRIMESTER 2 KG, 2ND TRIMESTER 5 KG& 3RD TRIMESTER 5KG OF
WEIGHT
B. PERSONAL HYGIENE:
 PERSONAL CLEANLINESS
 REST AND SLEEP: 8 HRS SLEEP AND 2 HRS REST
 BOWELS
 EXERCISE
 SMOKING AND ALOCOHOL SHOULD BE AVOIDED
 DENTAL CARE
 SEXUAL INTER COURSE: RESTRICTED ESPECILLY DURING LAST TRIMESTER
C. DRUGS MOST SERIOUS EFFECT ON FOETUS SHOLUD BE AVOIDED
D. WARNING SIGNS: SWELLING OF FEET, FITS, HEADCHE,BLURED VISION
BLEEDING OR DISCHARGE PER VIGNA
E. CHILD CARE SPECIAL CLASSESS MOTHER –CARFT EDUCATION CONSISTS OF
NUTRITION EDUCATION ADVICES ON HYGIENE AND CHILD REARING ETC….
CONTINUED……

3.SPECIFIC PROTECTION:
 ANAEMIA
 NUTRITIONAL DEFICIENCES
 TOXEMIAS OF PREGNANCY
 TETANUS
 SYPHILLIS
 GERMAN MEASLES
 Rh STATUS
 HIV INFECTION
4.MENTAL PREPARATION: MOTHER CRAFT CLASSES AT MCH CENTRES HELP
A GREAT DEAL IN ACHIVING THIS OBJECTIVE
5.FAMILY PLANNING
6. PAEDIATRIC COMPONENT: ALL ANTENATAL CLINICS TO PAY ATTENTION
TO THE UNDER-FIVES ACCOMPANYING THE MOTHERS
INTRANATAL CARE

CHILD BIRTH IS A NORMAL PHYSIOLOGICAL PROCESS

,BUT COMPLICATIONS MAY ARISE, SEPTICEMIA MAY ARISE
RESULT FROM UNSKILLED AND SEPTIC MANIPULATIONS,
AND TETANUS NEONATARUM FROM THE USE OF
UNSTERILED INSTRUMENTS.THE EMPHASIS ON THE
CLEANLINESS.IT ENTAILS-
- CLEAN HANDS AND FINGERNAILS
- CLAEN SURFACE FOR DELIVERY
- CLEAN CUTTING AND CARE OF CORD
 AIMS OF INTRANATAL CARE
 THOROUGH ASEPSIS
 DELIVERY WITH MINIMUM INJURY TO THE INFANT
AND MOTHER
 READINESS TO DEAL WITH COMPLICATIONS SUCH
AS PROLONGED LOBOUR, ANTEPARTUM
HAEMORRAHGE,CONVULSIONS,MALPRESENTATION
S,PROLAPSE OF CORD ETC
 CARE OF THE BABY AT DELIVERY-RESUSCITATION,
CARE OF THE CORD, CARE OF THE EYES.
 INTRANATAL CARE INCLUDES…….
1.DOMICILLARY CARE:
MOTHER WITH NORMAL OBSTETRIC
HISTORY MAY BE ADVISED TO HAVE THEIR
CONFINEMENT IN THEIR HOMES,PROVIDED
THE HOME CONDITIONS ARE SATISFACTORY.
IN SUCH CASES THE DELIVERY MAY BE
CONDUCTED BY THE” HEALTH WORKER
FEMALE OR TRAINED DAI” THIS IS KNOWN AS
“ DOMICILLARY MIDWIFERY SERVICE”.
ADVANTAGES OF DOMICILLARY SERVICE:
-MOTHER DELIVERS IN THE FAMILIAR SURROUNDINGS OF HER
HOME
-LESS CHANCE OF CROSS INFECTION
-MOTHER IS ABLE TO KEEP AN EYE UPON HER CHILDREN AND
DOMESTIC AFFAIRS.
DISADVANTAGES:
-MOTHER MAY HAVE LESS MEDICAL AND NURSING
SUPERVISION
-MATHER MAY HAVE LESS REST
-MOTHER RESUME HER DUTIES TOO SOON
-DIET MAY BE NEGLECTED
RESPONSIBILITIES OF FEMALE HEALTH WORKER
IN DOMICILLARY CARE
SHE SHOULD BE ADEQUATELY TRAINED TO
RECOGNISE THE” DANGER SIGNALS” ARE
• SLUGGISH PAINS OR RUPTURE OF MEMBRANES
• PROLAPSE OF THE CORD OR HAND
• MECONIUM STAINED LIQUOR
• EXCESSIVE SHOW OR BLEEDING DURING LABOUR
• LATE PALCENTAL SEPARATION
• POST-PARTUM HEMORRAHGE OR COLLAPSE
• INCREASED TEMPERATURE
CONTINUED………..
2.INSTITUTIONAL CARE:
AT ABOUT 1% OF DELIVERIRES TEND TO BE
ABNORMAL, REQURING THE SERVICES OF A DOCTOR
INSTITUTIONAL CARE IS RECOMMENDED FOR ALL ‘
HIGH RISK’ CASES AND WHERE HOME CONDITIONS
ARE UNSUITABLE.
3. ROOMING IN: KEEPING THE BABY ‘S CRIB THE SIDE
OF THE MOTHER ‘S BED IS CALLED “ROOMING-IN”.
IT ALSO ALLAYS THE FEAR IN THE MOTHER MIND
THAT THE BABY IS NOT MISPALCED IN THE CENTRAL
NURSERY.
3.POSTNATAL CARE
CARE OF THE MOTHER( AND THE NEW BORN )
AFTER DELIVERY IS KNOWN AS POST-PARTAL CARE.
OBJECTIVES :
• TO PREVENT COMPLICTIONS OF THE POSTPARTAL
PERIOD.
• TO PROVIDE CARE FOR THE RAPID RESTORATION OF
THE MOTHER TO OPTIUM HEALTH.
• TO CHECK ADEUQUACY OF BREAST FEEDING.
• TO PROVIDE FAMILY PLANNING SERVICES.
• TO PROVIDE BASIC HEALTH EDUCATION TO
MOTHER\FAMILY.
COMPILCATIONS OF POSTPARTUM PERIOD
• PUERPERAL SEPSIS
• THROMBO-PHELBITIS
• SECONDARY HEMORRAGE
• URINARY TRACT INFECTION AND MASTITIS
SHOULD DETECT EARLY TRAET WITH PROMPT MEASURE.
RESTORATION OF MOTHER TO OPTIMUM HEALTH:
PHYSICAL: 1. POSTANATAL EXAMINATIONS: SOON AFTER
DELIVERY ,THE HEALTH CHECK-UP MUST BE FREQUENT.i.e
TWICE A DAY DURING THE FIRST 3 DAYS AND
SUBSEQUENTLY ONCE A DAY TILL UMBILICAL CORD DROPS
OFF. FHW CHECKS VITALS, BREASTS, CHEK PROGRESS OF
NORMAL INVOULTION OF UTERUS,EXAMINES LOCHIA FOR
ANY ABNORMALITY,
CHECK URINE AND BOWELS AND ADVISES ON PERINEAL
CONTINUED…….
FURTHER VISITS SHOULD BE DONE ONCE IN 2 OR 3
MONTHS DURING FIRST 6 MONTHS, AND AFTER
ONCE IN 2 OR 3 MONTHS TILL THE END OF 1 YEAR.
2.ANAEMIA: ROUTINE Hb ESTIMATION CAN BE DONE
WHEN ANAEMIA DISCOVERED.IF ITS THERE
CONTINUE TREATMENT FOR 1 YEAR.
3.NUTRITION: THE NUTRITIONAL NEEDS OF THE
MOTHER MUST BE ADEQUATELY MET
4.POSTNATAL EXERCISES: IS TO BRING STRECHED
ABDOMINAL AND PELVIC MUSCLE BACK TO
NORMAL
CONTINUED………….
PSYCHOLOGICAL: FEAR AND INSECURITY MAY BE
ELIMINATED BY PROPER PRENATAL INSTRUCTION.
3.BREAST FEEDING
4.FAMILY PLANNING: MOTHER SHOULD ATTEND
POSTNATAL CONTACTS TO ADOPT A SUITABLE
METHOD FOR SPACING THE NEXT BIRTH.
5.BASIC HEALTH EDUCATION: HYGIENE, FEEDING FOR
MOTHER AND INFANT,PREGNANCY SPACING,
IMPORTANCE OF HEALTH CHECK-UP,BIRTH
REGISTRATION.
 NEONATAL CARE
• EARLY NEONATAL CARE:
THE FIRST WEEK OF LIFE THE MOST CRUCIAL PERIOD IN
THE OF AN INFANT.
OBJECTIVES:
1. ESTABILISH & MAINTAINANCE OF CARDIO-
RESPIRATORY FUNCTIONS
2. MAINTAINANCE OF BODY TEMPERATURE
3. AVOIDANCE OF INFECTION
4. ESTABILISH OF SATISFACTORY FEEDING REGIMEN
5. EARLY DETECTION AND TREATMENT OF CONGENITAL
AND ACQUIRED DISORDERS.
• IMMEDIATE CARE
1.CLEARING THE AIRWAY: TO HELP TO ESTABILISH BREATHING,THE AIRWAYS
SHOULD BE CLEARED MUCUS AND OTHER SECRETIONS
2.APGAR SCORE: IT IS TAKEN 1 MINUTE & AGAIN AT 5 MINUTES AFTER
BIRTH.
Sign Score 0 Score 1 Score 2
Heart Rate Absent Slow (below Over 100
100)
Respiratory Absent Slow irregular Good crying
Effort
Muscle Tone Flaccid Some flexion of Active
extremities movements
Reflex Response No response Grimace Cry

Color Blue, pale Blue, pink Completely pink

extremities blue
Total score=10 Severe Mild depression No depression
depression 0-3 4-7 7-10
 Cont………..
3.CARE OF THE CORD: THE CORD SHOULD BE CUT &
TIED WHEN IT HAS STOPPED PULSATING. CARE
MUST BE TAKEN TO PREVENT TETANUS OF
NEWBORN BY UNSTERILISED INSTRUMENTS NAD
CORD TIES
4.CARE OF THE EYES: BEFORE THE EYES ARE OPEN,
THE LID MARGINS OF THE NEWBORN SHOULD BE
CLEANED WITH STERILE WET SWABS, ONE FOR EACH
EYE FROM INNER TO OUTER SIDE.
5. CARE OF THE SKIN:THE FIRST BATH IS GIVEN WITH
SOAP AND WARM WATER TO REMOVE VERNIX,
MECHONIUM AND BLOOD CLOTS.SOME PREFER TO
APPLY WARM OIL BEFORE THE BATH.
CONT…….
6.MAINTAINANCE OF BODY TEMPERATURE:
THE NORMAL BODY TEMPERATURE OF A NEWBORN IS
BETWEEN 36.5 deg C TO 37.5 deg C IT IS IMPORTANT THAT
IMMEDIATELY AFTER BIRTH TE CHILD IS QUICKLY DRIED
WITH A CLEN CLOTH AND WRAPPED IN WARM CLOTH AND
GIVEN TO THE MOTHER FOR SKIN-TO SKIN CONTACT AND
BRESAT FEEDING.
7.BRAEST FEEDING
• NEONATAL EXAMINATIONS
• MEASURING THR BABY : Wt, Ht, HEAD CIRCUMFERENCE
• IDENTIFICATION OF “ AT RISK” INFANTS
• LATE NEONATAL CARE
REPRODUCTIVE AND CHILD HEALTH
PROGRAMME
 DEFINITION
REPRODUCTIVE AND CHILD HEALTH APPROCH
HAS DEFINED AS “PEPOLE HAVE ABILITY TO
REPRODUCE AND REGULATE THEIR FERTILITY ,
WOMEN ARE ABLE TO GO THROUGH
PREGNAANCY AND THEIR 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 FEAR OF
PREGNANCY AND OF CONTRACTING DISEASE”.
RCH PHASE 1 PROGRAMME INCORPORATED THE 4 COMPONENT

RCH PACKAGE

CHILD SURVIVAL AND

FAMILY PLANNING SAFE MOTHER HOOD
COMPONENT

CLINET APPROCH TO PREVENTION \

HEALTH CARE MANAGEMENT OF
RTI\STD AIDS
MAIN HIGHLIGHTS OF RCH PROGRAMME ARE
1. THE PROGRMME INTEGRATES ALL INTERVENTIONS
OF FERTILITY REGULATION, MATERNAL AND CHILD
HEALTH REPRODUCTIVE HEALTH FOR BOTH MEN
AND WOMEN.
2. THE SERVICES TO BE PROVIDED ARE CLIENT
ORIENTED
3. THE PROGRMME ENVISAGES UPGRADATION OF
THE LEVEL OF FACILITIES FOR PROVIDING VARIOUS
INTERVENTIONS AND QUALITY OF CARE.THE FIRST
REFERRAL UNITS BEING SET UP AT SUB-DISTRICT
LEVEL PROVIDE COMPREHENSIVE EMERGENCY
OBSTETRIC AND NEW BORN CARE.
 CONTINUED……………….
4.THE FACILITISE OF OBSTETRIC CARE, MTP AND
IUD INSERTION IN THE PHCs LEVEL ARE
IMPROVED.IUD INSERTION FACILITIES ARE
ALSO AVAILABLE AT SUB-CENTRES.
5. SPECIALIST FACILITIES FOR STD AND RTI ARE
AVALIABLE IN ALL DISTRICT HOSPITALS AND IN
A FAIR NUMBER OF SUB-DISTRICT LEVEL
HOSPITALS.
6. THE PROGRAMME AIMS AT IMPROVING THE
OUT REACH OF SERVICES PRIMARILY FOR THE
VULNERABLE POPULATION.
 RCH SERVICES AND MAJOR
INTERVENTIONS
1.ESSENTIAL OBSTETRIC CARE: IS TO PROVIDE THE
BASIC MATERNITY SERVICES TO ALL PREGNANT
WOMEN THROUGH
 EARLY REGISTRATION OF PREGNANCY ( WITHIN 12-16
WEEKS)
 PROVISION OF MINIMUM 3 ANTENATAL CHECKUPS BY
ANM
 PROVISION OF SAFE DELIVERY AT HOME OR
INSTITUTION
 PROVISION OF 3 POST NATAL CHECK UPS TO MONITOR
THE POSTNATAL RECOVERY AND TO DETECT
COMPLICATIONS.
2.EMERGENCY OBSTETRICAL CARE
IT IS VERY ESSENTIAL TO PREVENT
MATERNAL MORTALITY AND MORBIDITY
TRADITIONAL BIRTH ATTENDENCE SHOULD BE
MAINTAINED IN CONDUCTING THE
DELIVERIES.
3.24 -HOUR DELIVERY SERVICES AT PHCs\CHCs
TO PROMOTE INSTITUTIONAL DELIVERIES
,THE STAFFSHOULD BE ENCOURAGE ROUND
THE CLOCK DELIVERY FACILITIES AT HEALTH
CENTRES.
 4.MEDICAL TERMINATION OF
PREGNANCY
THROUGH THE MTP ACT 1971
• THE AIM IS TO REDUCE MATERNAL
MORBIDITY AND MORTALITY FROM UNSAFE
ABORTIONS.
• THE ASSISTANCE FROM THE CENTRAL
GOVERNMANT IS IN THE FORMS 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 AND SEXUALLY TRASNITTED
DISEASES
IT HAS BEEN IMPLEMENTED IN CLOSE
COLLABARATION WITH NATIONAL AIDS
CONTROL ORGANISATION (NACO).NACO WILL
PROVIDE ASSISTANCE FOR SETTING UP
RTI\STD CLINICS UP TO THE DISTRICT LEVEL.
o EACH DISTRICT WILL BE ASSISTED BY 2
LABORATORY TECHNICIANS ON CONTRACT
BASIS FOR TESTING BLOOD,URINE AND
RTI\STD TESTS.
6.IMMUNIZATION
THE UNIVERSAL IMMUNIZATION PROGRAMME
(UIP) BECAME PART OF CSSM PROGRAMME
IN 1992 AND RCH PROGRAMME 1997.IT WILL
CONTINUE TO PROVIDE VACCINES FOR
POLIO,TETANUS.DPT, DT, MEASLES AND
TUBERCULOSIS.
7.DRUG AND EQUIPMENT KITS
EQUIPMENT KITS SUPPLIED AT VARIOUS
LEVELS AS FOLLOWS………
 CONTINUED…..
• AT SUB-CENTRE LEVEL
DRUG KIT A
DRUG KIT B
MID- WIFERY KIT
SUB- CENTRE EQUIPMENT KIT
• AT PHC LEVEL- PHC EQUIPMENT KIT
• ATCHC\FRU LEVEL- EQUIPMENT KITS FROM
KIT E TO KIT P
8.ESSENTIAL NEWBORN CARE
THE PRIMARY GOAL IS TO REDUCE PERINATAL
AND NEAONATAL MORTALITY .THE MAIN
COMPONENT ARE..
 RESUSCITATION OF NEWBORN WITH
ASPHYXIA
 PREVENTION OF HYPOTHERMIA
 PREVENTION OF INFECTION
 EXCLUSIVE BREAST FEEDING AND REFERRAL
OF SICK NEWBORN.
9.ORAL REHYDRATION THERAPY
DIARRHOEA IS ONE OF THE LEADING CAUSE OF
CHILD MORTALITY.ORAL REHYDRATION THERAPY
PROGRAMME SRATED IN 1986-87 IS BEING
IMPLEMENTED THROUGH RCH PROGRNAMME.
 SUPPLIES OF ORS PACKETS TO THE STATES ARE
BEING ORGANISED BY CENTRAL GOVERNMENT.
 TWICE A YEAR 150 PACKETS OF ORS ARE PROVIDED
AS PART OF DRUG KIT SUPPLIED TO ALL SUB-
CENTRES IN COUNTRY.
 ADEQUATE NUTRITIONAL CARE OF THE CHILD WITH
DIARRHOEA AND PROPER ADVICE TO MOTHER ON
FEEDING ARE IMPORTANT AREA.
10.PREVENTION AND CONTROL OF VITAMIN A
DEFICIENCY IN CHILDERN
UNDER THE PROGRAMME, DOSES OF VITAMIN
A ARE GIVEN TO ALL CHILDERN UNDER 5
YEARS OF AGE.
 THE FIRST DOSE( 1 LAKH UNITS) IS GIVEN AT
NINE MONTHS OF AGE ALONG WITH MEASLES
VACCINATION
THE SECOND DOSE IS GIVEN ALONG WITH
DPT\ OPV BOOSTER DOSES
SUBSEQUENT DOSES ( 2 LAKH UNITS EACH)
SIX MONTHS INTERVALS
 11.ACUTE RESPIRATORY DISEASE CONTROL
THE STANDARD CASE MANGEMENT OF ARI AND
PREVENTION OF DEATHS DUE TO
PNEUMONIA IS NOW AN INTEGRAL PART OF
RCH PROGRAMME.
• PERIPHERAL HEALTH WORKERS ARE BEING
TRAINED TO RECOGNISE AND TREAT
PNEUMONIA .
• COTRIMOXAZOLE IS BEING SUPPLIED TO THE
HEALTH WORKER THROUGH THE CSSM DRUG
KIT
 12.PREVENTION AND CONTROL
OF ANEAMIA IN CHILDERN
IRON DEFICIENCY ANAEMIA IS WIDELY
PREVELANT IN YOUNG CHILDREN .UNDER THIS
PROGRAMME OF CONTROL AND PREVENTION
OF ANEMIA ,TABLETS CONTAINING 2mg OF
ELEMENTAL IRON AND 0.1 mg OF FOLIC ACID
ARE PROVIDED AT SUB-CENTRE LEVEL .
• THE HEALTH WORKERS TO PROVIDE 100
TABLETS TO CHILDERN CLINICALLY FOUND TO
BE ANEAMIC.
 REPRODUCTIVE AND CHILD
HEALTH PROGRAMME -PHASE II
 RCH -PHASEII
• RCH –PHASE II BEGAN FROM 1ST APRIL 2005,THE
FOCUS IS TO REDUCE MATERNAL AND CHILD
MORTALITY AND MORBIDITY WITH EMPHASIS ON
RURAL HEALTH CARE.THE MAJOR STRATEGIES ARE
 ESSENTAIL OBTETRIC CARE
a. INSTITUTIONAL DELIVERY
b. SKILLED ATTENDANCE AT DELIVERY
 EMERGENCY OBSTETRIC CARE
a. OPERATIONALING FIRST REFERRAL UNITS
b. OPERATIONALISING PHCs AND CHCs FOR ROUND CLOCK
DELIVERY SERVICES
 ESSENTIAL OBTETRIC CARE
a. INSTITUTIONAL
DELIVERY
• 24 HOURS DELIVERY
CENTRES WITH
EMERGENCY
OBSTETRIC CARE &
ESSENTIAL NEWBORN
CARE AND BASIC
RESUSCITATION
SERVICES AROUND
THE CLOCK
b.SKILLED ATTENDANCE AT DELIVERY

• WHO HAS EMPHASIED

THAT SKILLED
ATTENDANCE AT
DELIVERY IN ANY
ESSENTIAL TO REDUCE
MATERNAL MORTALITY
IN ANY COUNTRY,BY
ANM\LHVS
 EMERGENCY OSTETRIC CARE

OPERATIONALISATION
OF FRUs AND
SKILLED
ATTENDANCE AT
BIRTH ARE THE
ACTIVITIES THE
SECOND PHASE OF
RCH.
 MINIMUM SERVICES OF FULLY FUNCTIONAL
FRUs
1. 24-Delivery services including normal &
assisted deliveries.
2. Emergency obstetric care include caesarean
section
3. New born care
4. Emergency care of sick children
5. Full range of family planning services includes
laparoscopic services
6. Safe abortion services
 Continued……..
7.Treatment of STI\RTI
8.Blood storage facility
9.Essential laboratory services
10.Referral ( transport) services
There are 3 critical determinants of facility
 Availability of surgical interventions
Newborn care
Blood storage facility on a 24 hrs
 STRENGTHENING REFERRAL SYSTEM
• NEW INTIATIVES
1. TRAINING OF MBBS DOCTORS IN LIFE SAVING
ANAESTHETIC SKILLS FOR EMEGENCY OBSTETRIC CARE.
GOVT .OF INDIA IS ALSO INTRODUCING TRAINING OF MBBS
DOCTORS OF OBSTETRIC MANAGEMENT SKILLS,PREPARED
TRAINING PLAN FOR 16 WEEKS IN ALL OBSTETRIC
MANGEMENT SKILLS,INCULDING CAESERIAN SECTION
OPERATION.
2.SETTING UP OF BLOOD STORAGE CENTRES AT FRUs
ACCORDING TO GOVERNMENT OF INDIA GUIDELINES
JANANI SURAKSHA YOJANA
THE NATIONAL
METERNITY BENEFIT
SCHEME HAS BEEN
MODIFIED INTO A (JSY)
JANANI SURAKSHA
YOJANA.
IT WAS LAUNCHED ON 12TH
APRIL 2005.
SALIENT FEATURES OF JANANI SURAKSHA
YOJANA
• IT IS A 100% CENTRALLY SPONSORED
SCHEME
• UNDER NATIONAL RURAL HEALTH
MISSION ,IT INTEGRATES THE CASH
ASSISTANCE WITH INSTITUTIONAL CARE
DURING ANTENATAL, DELIVERY AND
IMMEDIATE POST-PARTUM CARE
 CONTINUED…

CATEGORY RURAL AREA URBAN AREA

MOTHER’S ASHA ‘S TOTAL MOTHER’S ASHA’S TOTAL
PACKAGE PACKAGE Rs PACKAGE PACKAGE Rs

LPS 1400 600 2000 1000 200 1200

HPS 7OO - 700 600 - 600

 VANDEMATARUM SCHEME
THIS IS A VOLUNTARY
SCHEME WHERE IN ANY
OBSTETRIC AND GYNEC
SPECILAIST ,MATERNITY
HOME,NURSING
HOME,LADY DOCTOR
MBBS DOCTOR CAN
VULNTEER THEMSELVES
FOR PROVIDING SAFE
MOTHERHOOD
SERVICES
 CONTINUED……..
• THE ENROLLED DOCTORS WILL DISPLAY
“VANDEMATARAM LOGO” AT THEIR CLINIC.
• IRON AND FOLIC ACID TABLETS,ORAL PILLS,TT
INJECTIONS ETC… WILL BE PROVIDED BY THE
RESPECTIVE DISTRICT MEDICAL OFFICERS TO THE
VANDEMATARAM DOCTORS\ CLINICS FOR FEE
DISTRIBUTION TO BENEFICIARIES.
• SAFE ABORTION SERVICES
A.MEDICAL METHOD OF ABORTION
B. MANUAL VACUUM ASPIRATION
Thank you