Submitted to : Mrs.

Jyothi Prince
Professor
Apollo College of Nursing

Subject : Obstetrical and Gynaecological Nursing

Presentation on

National Health and Family Welfare Programmes

Related to Maternal and Child Health

Submitted by : Manju Joseph

I yr M.Sc (N)
Apollo College of Nursing

Date of Submission: 12 th November 2009

 Index

Sl
Content Page no.
no.
1. Objectives 3
2. Introduction 4
3. Maternal And Child Health Programme 5
4. Child survival and safe motherhood programme 7
5. Reproductive and child health programme 9
6. Integrated Child Developmental Scheme 15
6. Health Care Delivery System 16
7. National Rural Health Mission 19
8. Role of NGO’s in the NRHM 22
9. Journal Article 24
10. Research Study 25
11. Conclusion 25
12. Bibliography 26

General Objectives :

2
 After the class students will gain knowledge about National Health and Family welfare
Programmes related to Maternal and Child Health, National Rural Health Mission and role of NGO’s.

Specific objectives :

At the end of the class students will be able to :

1. List out the different programmes coming under maternal and child health care.
2. Explain about MCH programme
3. Enumerate ICDS programme
4. Describe RCH programme
5. Elaborate the CSSM services
6. Brief out the health care delivery of Maternal and child Health Services
7. Define National Rural Health Mission and role of NGO’s

National health and family welfare programmes

Related to Maternal and child health

3
Introduction :

The protection of the health of the expected mother and her children is of prime
importance for building a sound and healthy nation. Women of the reproductive age group (15-44yrs)
and children (male and female) below 15yrs of age constitute almost 60% of the population (women in
the chills bearing age constitute 22.8% and children under 15 yrs of age 37.1%) thus together 60% of
the total population. These groups are subjected to mark physical and psychological stress which is not
cared for may cause serious deviation from normal health. They are exposed to unusual risks of wide
spread infection, poor nutrition and hazardous delivery, which may cause death or impairment of
health.

In preventive medicine, MCH is defined as field of work related to the physical,

mental and emotional health of women immediately before, during and after childbirth; and of infants
and young children. Health services begin at the time of conception. Pre-natal, intra-natal and post-
natal supervision of the mother promotes and periodically supervises her nutritional state. Avoidable
complications of pregnancy are prevented or treated. Intra-natal services provide skilled care and
attention by trained midwives during childbirth. Post-natal checks on the mother's health after
delivery, which include family planning services, make it possible for a gynaecologist to diagnose and
prevent some of the chronic and disabling conditions common in women. Child health services aim for
the prevention of acute illness and disease that will disrupt the child's early years. Child health
development programs now include the promotion of vigorous and healthy growth and development in
children.

The important maternal and child health programmes are:

1. Maternal And Child Health Programme (MCH)

2. Integrated Child Development Service Scheme (ICDS)
3. Child Survival And Safe Motherhood Programme (CSSM)
4. Reproductive And Child Health Programme (RCH)

1. Maternal and child Health Programme (MCH)

4
 Maternal and child health refers to preventive and curative health care
activities for mothers and children.

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 be considered and treated as one unit for providing health services.

Goals of MCH;

1. The main goal of the MCH services is the birth of a healthy infant into the family by every
expectant mother
2. prevention of diseases in mothers and children.
3. to provide services to promote the healthy growth and development of the child upto the age og
5 years
4. to identify health problems in mothers and children at an early stage and to initiate proper
treatment.
5. to prevent malnutrition in mothers and children
6. to promote family planning services to improve the health of the mother and children
7. to educate the mothers on improvement of their own and their children’s health.

Policy guidelines for implementing MCH programmes

1. effective use should be made of existing resources and infrastructures available in the
community.
2. the services should be delivered as close to the homes as possible.
3. services for mothers and children should be delivered in an integrated manner.
4. child survival programme should serve as a sugar coating for delivery of the family lanning
programme which is not in popular.
5. voluntary agencies working in the area should involved in providing MCH services.

The services under this programme provided to pregnant women, infants and
children under 5yrs of age include

5
 pregnant women – essential care for all

- registered by 12-16 wks antenatal check up atleast 3 times

- 2time immunization with TT
- Give folic acid to all (1 tab a day for 100 days)
- Treat those with clinical anemia (2iron tabs a day for 100 days)
- De-worm with Mebentazole (during II and III trimesters in a case where
prevalence rates of worm infestation are high)
- Care and clean delivery services.
- Prepare the women for exclusive breast feeding and timely weaning
- Postnatal care including advices and services for limiting and spacing births.

 Early detection of complications

- Clinical examination to detect anaemia

- Bleeding indicating APH and PPH
- Weight gain of more than 3 kg in a mother or systolic BP of 140 mm Hg or
more diastolic BP of 90 mmHg or more
- Fever of 39 degree C and above after delivery or after abortion
- Prolonged or obstructed labour (labour pain for more than 12hrs)

 Emergency care for those who need it

- Early identification of obstetric emergencies

- Provide initial management and refer to identify referred unit.
- Use safest available mode of transport

 Women in the reproductive age group

- Counselling on optimal timing and spacing of birth, small family norms and
use and choice of contraceptives
- Information on availability of MTP services IUD and sterilization services

6
2. Child survival and safe motherhood programme (CSSM)

MCH schemes under family planning services has been reemphasised

since1977, along with the change in the name from the family planning to family
welfare.since1992,the special programme of child survival and safe motherhood has also been in
operation. Various reasons for considering mothers and children, as the most vulnerable group of the
society as one unit for providing health services.

The concept is in keeping with the evolution of an integrated approach to the

programme aimed at improving the health status of young women and young children which has been
going on in the country namely family welfare programme is intensified improvised and specifically
précised to CSSM.

World health organisation in 1989 called for CSSM programmes which was
implemented by the government of India. The CSSM programme with an integrated package of
intervention for improving the health status of women and children and reducing the maternal and
infant and child mortality rates. The package of services CSSM programme are

 For the mothers

1. TT immunization
2. prevention and treatment of anaemia
3. antenatal care and early identification of maternal complications
4. deliveries by trained personnel
5. promotion of institutional delivery
6. management of obstetric emergencies
7. birth spacing
 For children

1. essential newborn care

2. immunization
3. appropriate management of diarrhoea (recommend ORS and home available fluids)
4. appropriate management of ARI

7
 5. Vitamin A prophylaxis
6. treatment of anaemia
7. prevention of hypothermia
8. exclusive breast feeding within 1hr of delivery
9. referral of newborns who show signs of illness
10. correct case management for acute respiratory infection

 For the Eligible couple

1. prevention of pregnancy
2. safe abortion

 RTI/STD
Prevention and treatment of reproductive tract infection and sexually transmitted disease.

In 1992 the child survival and safe motherhood programme integrated all
services for better compliance. The specific components are;

a. safe motherhood interventions

1. early registration of pregnancy

2. to provide minimum three antenatal checkups
3. universal coverage of al pregnant women with TT immunization
4. advice food, nutrition and rest
5. detection of high ris pregnancies and prompt referral
6. clean deliveries by trained personnel
7. birth spacing
8. promotion of institutional deliveries
9. essential obstetric care
10. emergency obstetric care
11. 24 hour delivery services
12. provision for legal medical termination of pregnancy
13. control of reproductive tract infections and sexually transmitted diseases

8
b. child survival interventions

1. essential newborn care

2. oral rehydration therapy
3. acute respiratory disease control
4.prevention and control of vitamin A deficiency

3. Reproductive and child health programme

The Reproductive and Child Health (RCH) Programme, which was launched on 15 October
1997, draws its mandate from the Programme of Action of the International Conference on Population
and Development 1994. Under the RCH Programme a comprehensive package of services for family
planning, maternal and child health and management of reproductive tract infections, including
sexually transmitted diseases is being implemented. Inputs are provided to improve the delivery
system of facilities provided to bridge the gap between services provided and unmet need. In addition,
the emphasis is on ensuring quality services by making available requisite logistics, in-service training
and monitoring and supervision. A differential approach has been adopted while providing inputs to
various districts to ensure that these are commensurate with the capacity of the individual
districts to utilise them effectively.

The reproductive child health can be defined as a state in which people have the
ability to reproduce and regulate their fertility, women are able to go through pregnancy and child
birth safely, the outcome of pregnancy is successful in terms of maternal and infant survival and well
being , couples are able to have sexual relations free of the fear of contracting pregnancy and
contracting diseases.

The RCH programmes incorporates the components relating CSSM and includes two additional
components, one relating to the sexually transmitted diseases, and other relating to reproductive tract
infections.

The main highlights of the RCH programme are;

9
 1. The programme integrates all the interventions of fertility regulations, maternal and child
health with reproductive health for both men and women
2. the services to be provided will be client oriented, demand driven, high quality and and based
on needs of community through decentralised participatory planning and target free approach
3. it is proposed to improve the facilities of obstetric care including MTP and IUD insertion in
the PHC and also in the subcenters.
4. specialists facilities for STD and RTI will be available in all district hspotals and in subcenters.

The basic elements of reproductive and child health programmes are :

1. Family planning
2. maternal and child health
3. safe abortion services
4. prevention and control of RTS
5. prevention and management of infertility
6. prevention and detection cum treatment of reproductive tract malignancies

The packages of services provided under the RCH programme:

RCH programme 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
the pregnancy, the mother and child are safe and contraception by choice are available to prevent
pregnancy and contracting diseases.

Child survival and safe motherhood

1.essential care for all

- registered by 12-16 wks antenatal check up at least 3 times

10
 - antenatal check ups 3 times during the pregnancy (20,32,40 wks). The purpose
of antenatal check up is to monitor the progress of pregnancy and to identify
and refer high risk cases for appropriate treatment.
- 2time immunization with TT should be given as early as possible at one
month interval. If already immunized during early pregnancy, she should
receive one dose of TT
- Give folic acid 100gm to all (1 tab a day for 100 days)
- Treat those with clinical anaemia with 2iron tabs a day for 100 days
- De-worm with Mebendazole during II and III trimesters in a case where
prevalence rates of worm infestation are high
- Care and clean delivery services.
- Prepare the women for exclusive breast feeding and timely weaning
- Postnatal care including advices and services for limiting and spacing births.

2. Early detection of complications

- Clinical examination to detect anaemia. Anaemia is not only a major cause of

maternal mortality and morbidity but also a contributory factor for birth of a
low – birth weight baby.
- Bleeding indicating APH and PPH should be referred immediately to the
nearby hospital
- Weight gain of more than 3 kg in a mother or systolic BP of 140 mm Hg or
more diastolic BP of 90 mmHg or more. Such cases may also get eclampsia.
All these cases are medical emergencies and should be referred to the nearest
hospital
- Fever of 39 degree C and above after delivery or after abortion can be fatal.
They would also require treatment at a hospital
- Prolonged or obstructed labour (labour pain for more than 12hrs) can lead to
rupture of the uterus, which requires immediate medical attention and should
be shifted immediately to the hospital

3.Emergency care for those who need it

11
 - Early identification of obstetric emergencies
- Provide initial management and refer to identified referred unit with minimal
time as delay may be fatal
- Use safest available mode of transport. The health workers must know that
hospital where such cases are been handled. The attendants should be
provided with proper guidance so that even they can shift the patient to the
hospital without lagging behind
- While transporting the patient make sure that she is lying on her left side. In
case of risks of eclampsia a rolled cloth can be placed between teeth to avoid
tongue bite

4. Women in the reproductive age group

- Counselling on importance of girl child, optimal timing and spacing of birth,

small family norms and use and choice of contraceptives, prevention of STDs
and RTIs
- Information on availability of MTP services IUD and sterilization services
- Provide family planning services like condom distribution, oral
contraceptives, IUD etc
- Recognition and referral of RTIs and STDs

5. Provision of clean and safe delivery practices

- Create awareness in the community on need for clean and safe delivery
- Deliveries by trained personnel’s
- Provision of disposable delivery kits (DDKs) to all pregnant women
- Promotion of institutional deliveries
- Identification and referral of high risk cases
6. Infants , New born care;

1. Take birth weight of the new born. Normal weight is above 2500gm. Those who are below the
level require special care. Such babies should be covered well with clothes and put close to the
mothers. They should be breast fed well and not to be handled by many people
2. While resuscitating of asphyxiated baby, the mucus should be removed gently by sucking the
mouth with the sucker and mouth to mouth respiration can be provided

12
 3. the newborn are susceptible to get cold, so thermoregulation is an essential newborn care
4. it is suggested to breast feed the baby immediately and within 1hr of the delivery. The
colostrum (the first milk) contains essential nutrients and helps developing immunity against
the infections. The infant should be breast fed for continuous 4-6 months exclusively
5. advice the mother on essential newborn care, prevention of hypothermia and infection,
nutrition, immunization etc are the essential factors needed to be taken care of while caring a
new born baby.

7. Immunization

BCG – 1 dose at birth

DPT – 3 doses beginning at 6 wks at monthly interval
Polio - doses at birth, 3 doses beginning at 6 wks at monthly interval
Measles – 1 dose at completion of 9 months of age
Vit A – first dose (10000 U) with measles vaccination
DTP/OPV booster dose – 16 - 18 months
Vit A – 2nd dose (20000 U) at 16 - 18 months
3rd to 5th dose each at 6 months interval
IFA – small tabs if child has clinical signs of anaemia. If suspected, treatment for hookworm
infestation.

8. Prevention of death due to diarrhoeal disease

 Correct the cause of diarrhoea

 Advice to mother that increasing fluid volume to child (ORS, ORT), preparing the solutions,
feeding the normal diet, recognise the complications and seeing immediate medical care
9. Reproductive tract infection and sexually transmitted infections

RTI include variety of bacterial, viral, fungal infections of the lower and upper
reproductive tract of both sexes. RTI pose a threat to women’s life and wellbeing throughout the
world. A high incidence of infertility, tubal pregnancy and poor reproductive outcome is an indirect
reflection of RTI or STD

13
prevention

1. identify the women with RTI or STD

2. refer the women to the medical center
3. identify sexual partners and ensure their treatment
4. advice correct use of condoms and other contraceptive measures
5. counsel the patient along with family members
6. the prevention includes primary (identifying the sexual partners and educating and counselling
regarding safe and hygienic sexual practices), secondary (early detection of the signs and
symptoms, counselling and advising to seek medical help) and tertiary (treatment for STDs and
RTIs) prevention.

Specific RCH interventions ;

1.child survival interventions;- immunisations, vitamin A prophylaxs, oral rehydration therapy

2.safe motherhood interventions;- antenatl checkups, immunisation for tetanus, safe delivery and
anemia control programme
3. implementation of target free approach
4.adolescent health and reproductive hygiene
5.screening and treatment of RTI and STD
6.emergency obstetric care
7.essential obstetric care
8. improved delivery services and emergency care by providing equipment kits and IUD insertion kits

4.Integrated Child development services :

The most important scheme in the field of child welfare is the ICDS sheme,
which was initiated in India in the ministry of social and womens welfare in 1975.
The ICDS seeks to lay a solid foundation for the development of the nations human recourses by
providing an integrated package of early childhood services. These consists of ;

14
 1. supplementary nutrition
2. immunisation
3. health check-ups
4. medical referral services
5. nutritional and health education for women
6. non –formal education for children upto the age of 6 years and pregnant and nursing mothers in
rural, urban and tribal areas.

ICDS scheme is designed both as preventive and developmental efforts.

The objectives of the ICDS schemes are;

1. to improve the nutritional and health status of the children in the age group 0-6 years.
2. to lay the foundations for proper psychological, physical and social development of the child.
3. to reduce the mortality and morbidity, malnutrition and school dropout.
4. to achieve an effective coordination of policy and implementation among the various
departments working for the promotion of child development.
5. to enhance the capability of the mother and nutritional needs of the child through proper
nutrition and health education.
6. to achieve the above objectives the ICDS aims as providing the following packages of services;

Beneficiary services

1. pregnant women; health check-ups

 immunisation against tetanus
 supplementary nutrition
 nutrition and health education
2. nursing mothers;
 health check-ups
 supplementary nutrition
 nutrition and health education

3. reproductive age group women; supplementary nutrition

 immunisation

15
  health check-ups
 referral services
 nonformal education

Health Care Delivery System

Delivery of health services in Andhra Pradesh is mainly governed by the National

Health Policy, which was approved by the parliament in 1983. The National Health Policy places a
major emphasis on ensuring primary health care to all by the year 2000 AD: (i) nutrition for all
segments of the population; (ii) immunization programs; (iii) maternal and child health care; (iv) the
prevention of food adulteration and maintenance of water quality, supply and sanitation; (v)
environmental protection; (vi) school health programs; (vii) occupational health services; (viii)
prevention and control of endemic diseases.
Active community participation has been considered one of the most important
supportive activities for successful implementation of health programs. After the Indian Government
committed itself to the attaining goal of 'Health for all by 2000 AD', the Government concentrated on
the largely neglected rural population. By March 1992, there were 1247 primary health centers, 10 568
sub-centers, 83 postpartum program units, and 131 urban family welfare centers in the State, providing
health and family welfare services to the population7.
In 1992, the Indian government embarked on the first of two nation-wide surveys,
the National Family Health Surveys (NFHS-I and NFHS-II) 8,9. In Andhra Pradesh, the mothers of 93%
children born in the 3 years preceding NFHS-II (1995-1998) received at least one antenatal check-up,
and the mothers of 80% of these children received at least three antenatal check-ups. For 82% of these
children, the mothers received the recommended number of tetanus toxoid vaccinations, and 81% of
mothers received iron and folic acid (IFA) supplementation. Coverage by all three interventions was
lower for women in disadvantaged socio-economic groups than for other women. Coverage was also
low for women who already had four or more children8.
In both rural and urban areas, during delivery the women had the assistance of a
doctor or ANM, rather than trained birth attendants or dais (net change of -14.6%, 3.6% and 22.2%,
respectively), indicating wide differences in the percentage of deliveries conducted by trained persons
in both urban and rural areas. More urban women were supplied with a vaccination card, but there was
no change in the low rate for rural women. Women in rural areas were less likely to have a Western-

16
trained health professional in attendance at delivery, but this availability improved over the research
period.
ROLE OF STATE GOVERNMENTS

 provides broad conceptual framework. States would project operational modalities in their
State Action Plans, to be decided in consultation with the health care delivery Steering Group.

 would prioritize funding for addressing inter-state and intradistrict disparities in terms of health
infrastructure and indicators.

 States would sign Memorandum of Understanding with Government of India, indicating their
commitment to increase contribution to Public

 Health Budget (preferably by 10% each year), increased devolution to Panchayati Raj
Institutions as per 73rd Constitution (Amendment) Act, and performance benchmarks for
release of funds.

DISTRICT HEALTH PLAN

• District Health Plan would be an amalgamation of field responses through

Village Health Plans, State and National priorities for Health, Water
Supply, Sanitation and Nutrition.

• Health Plans would form the core unit of action proposed in areas like
water supply, sanitation, hygiene and nutrition. Implementing
Departments would integrate into District Health Mission for monitoring.

• District becomes core unit of planning, budgeting and implementation.

• Centrally Sponsored Schemes could be rationalized/modified accordingly

in consultation with States.

• Concept of “funneling” funds to district for effective integration of

17
Programmes

• All vertical Health and Family Welfare Programmes at District and state
level merge into one common “District Health Mission” at the District level
and the “State Health Mission” at the state level

• Provision of Project Management Unit for all districts, through contractual

engagement of MBA, Inter Charter/Inter Cost and Data Entry Operator,
for improved programme management

ROLE OF PANCHAYATI RAJ

INSTITUTIONS

 the commitment for devolution of funds, functionaries and programmes for health, to PRIs.

 The District Health Mission to be led by the Zila Parishad. The DHM

 will control, guide and manage all public health institutions in the district, Sub-centres, PHCs
and CHCs.

 ASHAs would be selected by and be accountable to the Village Panchayat.

 The Village Health Committee of the Panchayat would prepare the Village Health Plan, and
promote intersectoral integration.

 Each sub-centre will have an Untied Fund for local action @ Rs. 10,000 per annum. This Fund
will be deposited in a joint Bank Account of the ANM & Sarpanch and operated by the ANM,
in consultation with the Village Health Committee.

 PRI involvement in Rogi Kalyan Samitis for good hospital management.

 Provision of training to members of PRIs.

18
  Making available health related databases to all stakeholders, including Panchayats at all
levels.

National rural health mission (2005- 2012)

Recognizing the importance of Health in the process of economic and social development and
improving the quality of life of our citizens, the Government of India has resolved to launch the
National Rural Health Mission to carry out necessary architectural correction in the basic health care
delivery system. The Mission adopts a synergistic approach by relating health to determinants of good
health viz. segments of nutrition, sanitation, hygiene and safe drinking water.

It also aims at mainstreaming the Indian systems of

medicine to facilitate health care. The Plan of action includes increasing public expenditure on health,
reducing regional imbalance in health infrastructure, pooling resources, integration of organizational
structures, optimization of health manpower, decentralization and district management of health
programmes, community participation and ownership of assets, induction of management and
financial personnel into district health system, and operationalizing community health centres into
functional hospitals meeting Indian Public Health Standards in each Block of the Country. The Goal of
the Mission is to improve the availability of and access to quality health care by people, especially for
those residing in rural areas, the poor, women and children.
GOALS

1. Reduction in Infant Mortality Rate (IMR) and Maternal Mortality Ratio (MMR)

2. Universal access to public health services such as Women’s health, child health, water, sanitation &
hygiene, immunization, and Nutrition.

3. Prevention and control of communicable and non-communicable diseases, including locally

endemic diseases

4. Access to integrated comprehensive primary healthcare

19
5.Population stabilization, gender and demographic balance.

6. Revitalize local health traditions and mainstream AYUSH

7.Promotion of healthy life styles

STRATEGIES

Core Strategies:

• Train and enhance capacity of Panchayati Raj Institutions (PRIs) to own, control and manage public
health services.

• Promote access to improved healthcare at household level through the female health activist
(ASHA).

• Health Plan for each village through Village Health Committee of the Panchayat.

• Strengthening sub-centre through an untied fund to enable local planning and action and more Multi
Purpose Workers (MPWs).

• Strengthening existing PHCs and CHCs, and provision of 30-50 bedded CHC per lakh population for
improved curative care to a normative standard (Indian Public Health Standards defining personnel,
equipment and management standards).

• Preparation and Implementation of an inter-sectoral District Health Plan prepared by the District
Health Mission, including drinking water, sanitation & hygiene and nutrition.

• Integrating vertical Health and Family Welfare programmes at National,

State, Block, and District levels.

• Technical Support to National, State and District Health Missions, for Public Health Management.

20
• Strengthening capacities for data collection, assessment and review for evidence based planning,
monitoring and supervision.

• Formulation of transparent policies for deployment and career development of Human Resources for
health.

• Developing capacities for preventive health care at all levels for promoting healthy life styles,
reduction in consumption of tobacco and alcohol etc.

• Promoting non-profit sector particularly in under served areas.

Supplementary Strategies:

• Regulation of Private Sector including the informal rural practitioners to ensure availability of
quality service to citizens at reasonable cost.

• Promotion of Public Private Partnerships for achieving public health goals.

• Mainstreaming AYUSH – revitalizing local health traditions.

• Reorienting medical education to support rural health issues including regulation of Medical care and
Medical Ethics.

• Effective and viable risk pooling and social health insurance to provide health security to the poor by
ensuring accessible, affordable, accountable and good quality hospital care.

STRENGTHENING PRIMARY HEALTH CENTRES

Mission aims at Strengthening PHC for quality preventive, promotive,

curative, supervisory and Outreach services, through:

• Adequate and regular supply of essential quality drugs and equipment (including Supply of Auto
Disabled Syringes for immunization) to PHCs

21
• Provision of 24 hour service in 50% PHCs by addressing shortage of doctors, especially in high
focus States, through mainstreaming AYUSH manpower.

• Observance of Standard treatment guidelines & protocols.

• In case of additional Outlays, intensification of ongoing communicable disease control programmes,

new programmes for control of noncommunicable diseases, upgradation of 100% PHCs for 24 hours
referral service, and provision of 2nd doctor at PHC level (I male, 1 female) would be undertaken on
the basis of felt need.

ROLE OF NGOs IN THE MISSION

Govt. has identified the crucial role of NGO to reach the community. At present NGOs are involved
under various programmes. As far as health department goes the role was limited to increase the
awareness in the community included in institutional arrangement at National, State and District
levels, including Standing Mentoring Group for ASHA Member of Task Groups,Provision of
Training, BCC and Technical Support for ASHAs/DHM, Health Resource Organizations,Service
delivery for identified population groups on select themes and for monitoring, evaluation and social
audit.
Involvement of NGOs is a crucial component under World Bank funded Reproductive
and Child Health Programme. Initially 4 organizations were selected as Mother NGOs in Maharashtra
State by Govt. of India viz. Sevadham Trust, Pune, SOSVA, Pune, Godavari Foundation, Jalgaon and
Pravara Medical Trust, Loni, District Ahmednagar.Funds were directly released by Govt. of India to
these 4 Mother NGOs and each FNGO used to receive about Rs. 1 to 1.5 lakhs for one year.

State representative used to participate in the meetings called by

MNGOs for approval of the projects submitted by FNGOs once in a year. State Family Welfare
Bureau organized quarterly meetings for the 4 Mother NGOs to review the progress and performance.
State Family Welfare Bureau also organize workshops for Mother NGOs and FNGOs to share their
experiences and to share the IEC material prepared by the FNGOs. In a process of decentralization,
Govt. of India issued revised guidelines for the involvement of NGOs under RCH Programme. The
overall responsibility for implementation and monitoring of the programme has been given to State
RCH Society as well as District RCH Societies. The fund flow will also be channelized accordingly.

22
Expected outcome

1. National Level:

 Infant Mortality Rate reduced to 30/1000 live births

 Maternal Mortality Ratio reduced to 100/100,000

 Total Fertility Rate reduced to 2.1

 Malaria mortality reduction rate –50% upto 2010, additional 10% by 2012

 Kala Azar mortality reduction rate: 100% by 2010 and sustaining elimination until 2012

 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: reduce from 1.8/10,000 in 2005 to less than 1/10,000 thereafter

 Tuberculosis DOTS services: Maintain 85% cure rate through entire Mission period.

 Upgrading Community Health Centers to Indian Public Health Standards

 Increase utilization of First Referral Units from less than 20% to 75%

 Engaging 250,000 female Accredited Social Health Activists (ASHAs)in 10 States.

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

23
  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 underthe 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

Journal Article:
M. Praashamma. Implimenting the RCH Programme : Challenge before nurses. The Indian
Journal of nursing and midwifery; vol.1- May 2002.
Abstract :
A professional educational programme must be socially relevant. Nursing education in India has
followed the trends and developments in health care since independence. The introduction to the
reproductive and Child Health programme is yet another development which requires dedicated
nursing personals to implement the RCH Programme. Strengthening of four types of nursing
personnel is require for successful implementation of the RCH Programme in the country.
Strengthening the midwifery services is a critical requirement for the success of the RCH
Programme.
Research study:
Dewaram Nagdeve, (2002) , Urban-rural differentials in maternal and child health in Andhra
Pradesh, India
Abstract
The unborn child is totally dependent on the mother; after birth, the child depends completely on the
immediate social environment of the family and of the mother in particular. Recently the Indian
Government changed its emphasis from family planning programs to family welfare programs. The
intention was to promote the maternal and child health (MCH) programs to improve the health of
mothers and young children. This study examined urban-rural differentials in MCH, and the factors
influencing net change in MCH input, its utilisation and its output between the Indian National Family
Health Survey (NFHS)-I and NFHS-II.
Results: The analysis revealed a positive net change in maternal and child health input, its utilisation
and its output in the years 1992-1998. Andhra Pradesh was one of the most successful Indian States in

24
providing MCH services, even though urban-rural differentials still exist. The Indian Government
must take the necessary steps to improve MCH programs, including the provision of information and
education campaigns, and sending dedicated health personnel to remote and inaccessible rural areas in
order to reduce child mortality.

Conclusion:
The programs within the National health and Family Welfare programmes Related to maternal and
Child Health Section strive to improve the health status of children and youth, women and their
families. The Section provides a focal point for influencing the efforts of a broad range of agencies
and programs committed to this goal. In addition, the Section has focused on quality assurance of
public sector health services, assurance of targeted outreach and service coordination for hard-to-reach
and high-risk populations, and community health promotion.

Bibliography :

Text books :

1. Basavanthappa B.T , Text book of Midwifery and Reproductive Health Nursing , 1st edition
(2006), Jaypee Publications, pg no – 12-20

2. Park K , preventive and Social community Medicine, 20 th Edition (2009), Jaypee Publications,
pg no – 346-52 ,379-80

3. Basavanthappa B.T, Community Health Medicine, 1st edition (2003), Jaypee Publications, pg
no -675-92

4. TNAI, Community Health Nursing Manual

5. Sridhar RB. Principles of Community Medicine.4th ed. 2007.556 AITBS Publishers. p. 556-64.

6. Shirley MH, Vivian GD, Joanna RK. Family Health Care Nursing. 3 rd ed.2007. Jaypee
Brothers Medical Publishers ; NewDelhi. p. 291-97.

7. Kasthuri SR. An Introduction to Community Health Nursing.4 th ed.2003. BI Publications

;chenni. p. 532-544

25
 8. Yash PB. A Hand Book of Preventive and Social Medicine. 16 th ed.1997. Anand publications;
Chandigarh. p. 103-107

Journal :
M. Praashamma. Implimenting the RCH Programme : Challenge before nurses. The Indian Journal of
nursing and midwifery; vol.1- May 2002.
Research study :
Nagdeve D, Bharati D.  Urban-rural differentials in maternal and child health in Andhra Pradesh,
India. Rural and Remote Health 3 (online), 2003. Available from: http://rrh.deakin.edu.au
Web Site:
http//www.healthindia.com
http//www.govtofindia.orghttp//www.ministryofhealthandfamilywelfare.org

26