NATIONAL FAMILY WELFARE PROGRAM

INTRODUCTION

Since India become independent, several measures have been undertaken by the national
government to improve the health of people. Prominent among these measures are
NATIONAL HEALTH PROGRAMMES. Which have been launched by the central
government for the control/eradication of communicable disease, improvement of
environment sanitation, raising the standards of nutrition, control of population and
improving rural health.

The national health programme has been implemented and modified accordingly since 1990.
Its first version, adopted by the council of ministry' committee on economy and social policy,
was based on the WHO strategy "HEALTH FOR ALL" by the year 2000.

CONCEPT OF HEALTH

"Health is a state of complete physical, mental and social well-being not merely absence of
any disease or infirmity"

Health is not a static condition. Throughout the all years of life it must be

• Protected defined as disease prevention

• Improved defined as health promotion

• Recovered defined as treatment and rehabilitation

Health care given to mother and child through these system:-

• Sub centers/ASHA/Aganwadi workers

• PHC

• CHC
 NATIONAL PROGRAMS RELATED TO MATERNAL AND CHILD HEALTH

After Independence, the Government of India took steps to strengthen maternal and child
health services as early as the first and second Five- Year Plans (1951-56 and 1956-61).
Promotion of maternal and child health has been a central objective of the Family Welfare
Programme in India. The Maternal and Child health Programme was integrated with the
Family Welfare Programme during the fourth Five-Year Plan (1969- 74), and since then, there
have been several changes and developments in the programme.

According to WHO (1976)

Maternal and child health services can be defined as promotive, preventive, rehabilitative
care to mother and child.

Maternal and child health program

Maternal and child health provides an integrated approach for covering all the basic services
for improving child care, early stimulation and learning, health and nutrition, water and
environmental sanitation aimed at the young children, expectant mother, other women and
adolescent girls in the community.

The objective of MCH are

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

• To promote reproductive health.

• To promote physical and psychological development of children and adolescent.

• Prevent communicable diseases

• Early diagnosis and treatment of health problem

• Health education and family planning services

Sub areas of MCH

• Maternal health
• Child health

• Family planning

• School health

• Handicapped children

• Care of children in special setting such as day care centre’s

Recent trends in MCH care

1. Integration of care- earlier maternal and child health services are divided into antenatal,
child care and family planning. Naturally it is helpful in increasing the capability and
effectiveness of services

2. Risk approach-this is new thought was born from lack of resources and their availability.
As per this the risk group among mother and infant identified special care is given to them.

3. Man power changes - according to new concept, maternal and child health services should
be left to traditional health workers (ANMs, health visitors) rather than specialist of field and
child volunteers and workers of NGOs.

4. Primary health care - it makes available resources for prevention, promotion and resources
for mother and child health care.

5. Reproductive and child health - as per the decision taken in world women " conferences
Beijing (1995), maternal and child health services have been included in reproductive and
child health services.

CHILD SURVIVAL AND SAFE MOTHERHOOD (1992)

Maternal health care was a part of family welfare program from its inception. Interventions
were introduced as vertical scheme, namely the national nutritional anaemia control program,
TT immunization and Dai training program etc. family planning program remained separate
intervention.

WHO in 1989 gave a call for this program. This program was initiate in 1992. The program
had following components: For safe motherhood

✓ Early registration of pregnancy

✓ To provide minimum three antenatal check up

✓ Universal coverage of all pregnant women with TT immunization

✓ Advice on food, nutrition and rest

✓ Detection of high-risk pregnancy and prompt referral

✓ Clean delivery by trained personnel

✓ Birth spacing

✓ Promotion of institutional deliveries for child survival

✓ Immunization

✓ Newborn care

✓ Management of acute diarrhoea and respiratory infection

✓ Prevention of hypothermia and infection

✓ Promotion of exclusive breast feeding

✓ Referral of sick newborns

India launched the National Family Planning Program in 1951 to reduce the birth rate at a
level consistent with the requirement of the national economy as a 100 percent centrally
sponsored program.

Evaluation of the Family Welfare Program

The approach under the program during the initial five-year plans was to reduce the birth rate
by providing contraception services especially sterilization.

The objective of the 5th plan (1974-1979) was to bring down the birth rate to 30 per 1000 by
integrating family planning services with those of Maternal and Child Health (MCH) and
Nutrition to make the program more, readily acceptable.

The program received a setback during 1977-1978 due to an element of coercion in the
implementation of the program in some areas.
As a result, government made it clear that there was no place for force or coercion or pressure
of any sort under the program and the program had to be implemented as an integral part of
Family Welfare relying solely on mass education and motivation. The name of the program
was also changed from 'Family Planning' to 'Family Welfare as per the objective.

In the 6th plan (1980-1985), certain long term demographic goals to be achieved by the year
2000 were envisaged.

1. Reduction of average family size from 4.4 in 1995 to 2.3 by 2000 AD.

2. Reduction of birth rate to 21 from the level of 33 in 1978, death rate from 14 to 9 and
infant mortality rate from 127 to below 60.

3. Increasing the couple protection level from 22% to 60 per cent.

The Family Welfare Program during the 7th five year plan (1985-1990) was continued on a
purely voluntary basis with emphasis on promoting spacing methods, securing maximum
community participation and promoting maternal and child health care with the following
initiatives:

1. It was envisaged to have one subcentre for every 5000 population (3000 population in hilly
and tribal areas). At the end of 7th plan, i.e. 1990, 1.3 lakhs subcentres were established in the
country.

2. The postpartum program was extended progressively to subdistrict level hospitals. At the
end of 7th plan, 1012 subdistrict level hospitals and 870 health posts were established in the
country.

3. The Universal Immunization Program started in 30 districts in 1985-86 was extended to

cover all the districts in the country by the end of VH plan to cover all the districts in the
country by 1990.

4. A project was taken up to improve primary health care in urban slums in the cities of
Mumbai and Chennai with assistance from World Bank.

5. Area development projects were implemented in selected districts in 15 major states with
assistance from donor agencies.

The achievements of the Family Welfare Program at the end of 7th plan were:

1. Reduction of crude birth rate from 41.7 (1951-1961) to 30.2 (1990)

2. Reduction in total fertility rate from 5.9 (1950-1961) to 3.8 (1990)

3. Reduction in infant mortality rate from 146 (1970, 1971) to 80 (1990)

4. Increase in couple protection rate from 10.4 per cent (1970-1971) to 43.3 per cent (1990)

5. Setting up of a large network of service delivery infrastructure.

6. Over 118 million births were averted by the end of March 1990.

In the 8th five-year plan (1992-1997), several new initiatives were introduced as follows:

1. World Bank assisted Area Projects which seek to upgrade infrastructure and development
of trained manpower. Indian Population Project (IPP) 8th was started aiming at improving
health and family welfare services in urban slums of Delhi, Kolkata, Hyderabad and
Bengaluru. IPP 9th will operate in the states of Rajasthan, Assam and Karnataka.

2. An USAID assisted project named "Innovation in Family Planning Services" was taken up
in Uttar Pradesh with the specific objective of reducing total fertility rate (TFR) from 5.4 to 4
and increasing couple protection rate (CPR) from 35 to 50 per cent over 10 years project
period.

3. Greater stress was laid on involvement of NGOs to supplement and complement the
Government efforts in propagating and motivating the people for adoption of small family
norm.

The Universal Immunization Program (UIP) was started in 1985 to provide universal
immunization to infants and pregnant women against vaccine preventable diseases. From the
year 1992-1993, the UIP has been strengthened and expanded into the Child Survival and
Safe Motherhood (CSSM) project. It includes sustaining the high immunization coverage
level under UIP, and augmenting activities under Oral Rehydration Therapy (ORT),
prophylaxis for control of blindness in children and control of acute respiratory infections.
Under the safe motherhood component, training of traditional birth attendants. (TBA),
provision of aseptic delivery kits and strengthening of first referral units to deal with high-
risk and obstetric emergencies have been taken up.

The targets fixed for the 8th plan of national level birth rate of 26 was achieved by all states
except the states Of Assam, Bihar, Haryana, Madhya Pradesh, Odisha, Rajasthan and Uttar
Pradesh.
In the 9th five-year plan (1997-2002), reduction in the Population growth had been
recognized as one of the priority objectives.

The objectives were:

1. To meet all the unmet needs for contraception.

2. To reduce the infant and maternal morbidity and mortality so that, there is a reduction in
the

desired level of fertility.

The strategies during the plan were:

1. Assess the needs for reproductive and child health at PHC level and undertake area-
specific micro planning.

2. To provide need-based demand-driven, high quality, integrated reproductive and child

health care.

The expected level of achievement by the terminal year of 2002 were:

1. Crude birth rate (CBR) 23/1000

2. Infant mortality rate (IMR) 50/1000

3. Total fertility rate (TFR) 2.6

4. Couple protection rate (CPR) 60 per cent

5. Neonatal mortality rate (NNMR) 35/1000

6. Maternal mortality rate (MMR) 3/1000.

Implementation of the FWP

The following were the main components of Family Welfare Program.

1. Maternal health

2. Child health

3. Population control/stabilization.

The following were the schemes and programs for implementation of national family welfare:
1. Reproductive and Child Health Program (RCH)

2. Janani Suraksha Yojana

3. Vandemataram Scheme

4. Safe Abortion Services

5. National Rural Health Mission (NRHM)

6. Integrated Child Development Services (ICDS)

REPRODUCTIVE AND CHILD HEALTH PROGRAM (RCH)

Reproductive and child health defined as

"People have the ability to reproduce and regulate their fertility, women are able to go
through pregnancy and child birth safely, the outcome of pregnancies is successful in terms of
maternal and infant survival and wellbeing, and couples are able to have sexual relation free
of fear of pregnancy and of contracting disease." The concept of an integrated approach to the
programme aimed at improving the health status of young women and young children which
has been going on namely

family welfare programme, oral rehydration therapy, child survival and safe motherhood
programme and acute respiratoty infection control etc.

The RCH phase 1 programme incorporated the components relating child survival and safe
motherhood and include two additional components, one relating to sexually transmitted
disease and other relating to reproductive tract infection (RTI)

To control population growth and taking care of health of women and children, the
government of India launched the RCH program in October 1997 with the objective of
providing quality, integrated and sustainable primary health care services to women in the
reproductive age group and children with special focus on family planning and immunization.

Essential Components of RCH Program

1. Prevention and management of unwanted pregnancy.

2. Services for mothers during pregnancy, childbirth and postpartum period

3. Child survival services for new-borns and infants

4. Management of reproductive tract infections (R11) and sexually transmitted diseases

5. Establishment of an effective referral system

6. Reproductive services for adolescent health

7. Health services including counselling on sexuality and family life.

Services included in the Program for Mother and Children

1. Essential care for all mothers and children

(a) Registration by 12th to 16th week of pregnancy

(b) At least three antenatal check-ups during pregnancy

(c) Tetanus toxoid immunization to all pregnant mothers

(d) One tablet of iron and folic acid tablet daily for 100 days (2 tablets daily for anaemic
mother)

(e) De-worming with Albendazole or Mebendazole during 2nd or 3rd trimester in areas where
hookworm infestation is common

(f) Safe and clean delivery services

(g) Preparing women for exclusive breast feeding and timely weaning

(h) Postpartum care, including contraception advice and services.

2. Early detection of complications

(a) Clinical examination to detect anaemia

(b) Referral and transportation to the nearest hospital of women with haemorrhage or
complications

(c) Referral of all women identified as having pregnancy induced hypertension ( BP > 140/90
mm Hg and weight gain> 3 > 3kg /month)

(d) Referral of all women who develop signs of infection following delivery or abortion

(e) Transfer of women in labor for more than 12 hours to the nearest hospital with facilities
for caesarean delivery.
3. Emergency care to those who need it

(a) Early identification of obstetric emergencies

(b) Initial management of emergencies and transfer to referral hospital without delay using
the fastest available mode of transport.

4. Care to women in the reproductive age group

Importance of girl child.

(b) Information on availability of: Medical termination of pregnancy(MTP)services IUCD

and sterilization services

(c) Family planning services: Condom distribution Oral contraceptive dispensing IUCD
services

(d) Recognition and referral of clients with sexually transmitted diseases and reproductive
tract infections.

5. Provision of clean and safe delivery practices at the community level

(a) Deliveries by trained personnel

(b) Provision of disposable delivery kits for deliveries

(c) Promotion of institutional deliveries

(d) Early identification and referral of high-risk cases

6. Newborn care

(a) Weighing all new-borns at birth. Normal weight 2500 to 2800 gm. Referral of new-borns
weighing < 2000 gm

(b) Resuscitation of asphyxiated new-borns using mucus sucker or breathing as required.

(c) Prevention of hypothermia

(d) Breastfeeding within one hour of birth

(e) Referral of new-borns who show signs of illness

(f) Education of mother on newborn care and feeding

7. Immunization Infants
(a) BCG one dose at birth

(b) DPT: three doses, beginning at 6th week at monthly interval

(c) Polio: First dose at birth for all institutional deliveries and 3 doses at one-month interval

(d) Measles: one dose at completion of 9 months (e) Vitamin A: First dose of 100,000 IU
along with measles vaccination.

Children 1 to 3 years

(a) DPT

(b) Oral polio vaccine booster dose at 16th to 18th month

(c) Vitamin A 2nd dose 200,000 IU at 16th to 18th month 3rd to 5th doses 200,000 IU each at
6 monthly intervals

Children 3 to 5 years

(a) Iron and folic acid (tablet) for children with signs of anaemia

(a) Counselling the women about Optimal timing and spacing of birth Small family norm Use
and choice of contraceptives Prevention of sexually transmitted diseases and reproductive
tract infections Importance of girl child.

(b) Information on availability of: Medical termination of pregnancy(MTP)services IUCD

and sterilization services

(c) Family planning services: Condom distribution Oral contraceptive dispensing IUCD
services

(d) Recognition and referral of clients with sexually transmitted diseases and reproductive
tract infections.

5. Provision of clean and safe delivery practices at the community level

(a) Deliveries by trained personnel

(b) Provision of disposable delivery kits for deliveries

(c) Promotion of institutional deliveries

(d) Early identification and referral of high-risk cases

6. Newborn care

(a) Weighing all new-borns at birth. Normal weight 2500 to 2800 gm. Referral of new-borns
weighing < 2000 gm

(b) Resuscitation of asphyxiated new-borns using mucus sucker or breathing as required.

(c) Prevention of hypothermia

(d) Breastfeeding within one hour of birth

(e) Referral of new-borns who show signs of illness

(f) Education of mother on newborn care and feeding

7. Immunization Infants

(a) BCG one dose at birth

(b) DPT: three doses, beginning at 6th week at monthly interval

(c) Polio: First dose at birth for all institutional deliveries and 3 doses at one-month interval

(d) Measles: one dose at completion of 9 months (e) Vitamin A: First dose of 100,000 IU
along with measles vaccination.

Children 1 to 3 years

(a) DPT

(b) Oral polio vaccine booster dose at 16th to 18th month

(c) Vitamin A 2nd dose 200,000 IU at 16th to 18th month 3rd to 5th doses 200,000 IU each at
6 monthly intervals

Children 3 to 5 years

(a) Iron and folic acid (tablet) for children with signs of anaemia

(b) Treatment for worm infestation with Albendazole or Mebendazole.

8. Prevention of deaths due to diarrheal diseases

(a) Correct management

(b) Teaching mothers to increase body fluid with ORS (Oral rehydration solution), and
normal feeding

9. Prevention of deaths due to pneumonia

(a) Correct management of all cases of acute respiratory infections

(b) Referral of children with severe pneumonia or severe illness

THE REPRODUCTIVE AND CHILD HEALTH PHASE-II

PROGRAMME

RCH phase II programme was started on 1 April, 2005 with an aim to reduce maternal and
child morbidity and mortality with emphasis on rural health care.

THE MAJOR STRATEGIES UNDER THE RCH PHASE II

1. Essential Obstetric Care

(i) Institutional delivery

(ii) Skilled attendance at delivery

(iii) Permitting auxiliary nurse midwives (ANMs) to use life-saving drugs and to carry out
certain emergency interventions.

2. Emergency Obstetric Care

(i) Operationalizing first referral units (FRUs) with skilled attendance at birth. The minimum
services to be provided by a fully functional FRU are:

(a) 24-hour delivery services, including normal and assisted deliveries

(b) Emergency obstetric care, including surgical interventions like caesarean sections.

(c) Newborn care

(d) Emergency care of sick children.

(e) Full range of family planning services including laparoscopic sterilization services.

(f) Safe abortion services using medical method of abortion upto 7 weeks using Mifepristone
and Misoprostol and manual vacuum aspiration for surgical abortion.
Comprehensive and safe abortion services are provided at public health facilities including 24
* 7 PHCs/ FRUs (SDHs/DHs/CHCs) including the delivery points. Supply of Nishay
pregnancy detection kits to sub centre for early detection kits to sub centre for early detection
of pregnancy is undertaken.

Nishchay-pregnancy Kit detection

To detect pregnancy at the earliest.

To save lives lost to unsafe abortion practices.

Available at the sub-centre level and with ASHA.

Capacity Building of medical officers is carried out routinely in safe MTP techniques. ANMs.
ASHAs and other field functionaries are trained to provide confidential counselling for MTP
and promote post-abortion contraception.

Routine orientation and training of ASHAs to equip them with skills to create awareness on
abortion issues in women and the community and facilitate women in accessing services is
undertaken.

(g) Treatment of sexually transmitted infections (S'T'I)/ reproductive tract infections (RTI).

(h) Blood storage facility

(i) Essential laboratory services

(j) Referral (transport) services

(ii) Operationalizing peripheral health centres (PHCs) and community health centres (CHCs)
for round-the-clock delivery services.

3. Strengthening referral system by involving local self-help groups, non-government

organizations (NGOs) and women groups.

Village Health and Nutrition Day: Organizing of village Health and nutrition Day (VHNDs)
at anganwadi centre at least once every month to provide ante natal/post-partum planning and
nutrition are the part of various services being provided during VHNDs.

Newer Interventions

Screening of gestational Diabetes mellitus, screening for hypothyroidism for high risk group
during pregnancy. De-worming during pregnancy. Medical Methods of Abortion, birth
companion during delivery, Maternal Near Miss programme and Technical and operational
guidelines for screening for Syphilis during pregnancy are newer initiatives to improve
Maternal Health services.

NEW INITIATIVES

1. Training of MBBS doctors in life-saving anaesthetic skills for emergency obstetric care.
Government of India is also introducing training of MBBS doctors in obstetric management
skills. Federation of Obstetric and Gynaecological Society of India (FOGSI) has prepared a
training plan for 16 weeks in all obstetric management skills, including caesarean section
operation.

2. Setting up of blood storage centres at FRUs according to Government of India guidelines.

3. provision of RTI/STI services under NHM (national Health Mission), provision of STI/RTI
care services is very important strategy to prevent HIV transmission a very important strategy
to prevent

HIV transmission and promote sexual and reproductive health under the National AIDS
Control

Program (NACP IV) and Reproductive and child Health (RCH II) Enhanced syndromic case

management (ESCM) with minimal laboratory tests is the cornerstone of STI/RTI

management

under NACP IV. Services are being provided to all FRUs, CHCs, and at 24 x 7 PHCs through
various kits of different colors for different STIs.

JANANI SURAKSHA YOJNA (JSY)

launched in 12 April 2005.

It was started to reduce maternal and infant mortality through encouraging delivery at health
institutions and focussing at institutional care among women in below poverty line families.

The objective of scheme are-

• Promote delivery at health institution.

• Promote institutional care among below poverty line family.

Under rural heath mission it integrate the benefit of case assistance with institutional care
during antenatal, delivery and immediate post partum

care. the benefit will be given to all women, both rural and urban, belonging to BPL and aged
19 year or above up to first 2 live birth. ASHA would work as a link between pregnant
women and public health institution. The scheme also provides performance based incentives
to women health volunteers known as ASHA (Accredited Social Health Activist) for promoting
institutional delivery among pregnant women. Under this initiative, eligible pregnant women are
entitled to get JSY benefit directly into their bank accounts.

*ASHA package of Rs. 600 in rural areas include Rs. 300 for ANC component and Rs. 300
for facilitating institutional delivery
**ASHA package of Rs. 400 in urban areas include Rs. 200 for ANC component and Rs. 200
for facilitating institutional delivery
Cash assistance for home delivery
BPL pregnant women, who prefer to deliver at home, are entitled to a cash assistance of Rs.
500 per delivery regardless of the age of pregnant women and number of children.
Features of Janani Suraksha Yojana

(i) JSY is 100% centrally sponsored scheme

(ii) Under National Rural Health Mission, it integrates the benefit of cash assistance to
mothers for institutional deliveries. The Accredited Social Health Activist (ASHA) works as a
link health worker between the women and government.

During the year 2006-2008, about 28.11 lakh pregnant women benefited from the scheme,
out of which 18.72 lakhs had institutional deliveries.

JANANI SHISHU SURAKSHYA KARYAKRAM (JSSK)

Government of India has launched Janani Shishu Suraksha Karyakaram (JSSK) on 1st June
2011, which entitles all pregnant women delivering in public health institution to absolutely
free and no expense delivery including caesarean section.

Moreover it will motivate those who still choose to deliver at their homes to opt for
institution deliveries.
Ministary of health and family welfare has taken a major initiative to evolve a consensus on
the part of all state to provide completely free and cashless services to pregnant women
including normal deliveries and carsarean operation and sick new born (up to 1 YEAR after
birth) in government institution in both rural and urban areas.

Pregnant women delivering in public health institutions to absolutely free and no expense
delivery including Caesarean section.

The initiative stipulates free drugs, diagnostics, blood and diet, besides free transport from
home to institution. between facilities in case of a referral and drop back home.

Similar entitlements have been put in place for all sick new-borns accessing public health
institutions for treatment all 30 days after birth. In 2013 this has been expanded to Sick
infants and antenatal and postnatal complications.

The following are the Free Entitlements for pregnant women:

- Free and cashless delivery

-Free caesarean section

-Free drugs and consumables

- Free diagnostics

- Free diet during stay in the health institutions

- Free provision of blood

- Exemption from user charges

- Free transport from home to health institutions

- Free transport between facilities in case of referral

- Free drop back from Institutions to home after 48 hrs stay

The following are the Free Entitlements for Sick newborns till 30 days after birth.This
has now been expanded to cover sick infants:

o Free treatment

o Free drugs and consumables

 o Free diagnostics

o Free provision of blood

o Exemption from user charges

o Free Transport from Home to Health Institutions

o Free Transport between facilities in case of referral

o Free drop Back from Institutions to home

NAVJAT SHISHU SURAKSHA KARYAKRAM(NSSK)

The Navjaat Shishu Suraksha Karyakram (NSSK), launched in the year 2009 in
September by Union Health Minister Gulam Nabi Azad, has made it possible for the
lives of several children to be saved when complications have occurred after birth,
which has been a boon to the families of these infants as well.

NSSK is a programme aimed to train health personnel in basic newborn care and
resuscitation, has been launched to address care at birth issues i.e. Prevention of
Hypothermia, Prevention of Infection, Early initiation of Breast feeding and Basic Newborn
Resuscitation. Newborn care and resuscitation is an important starting-point for any neonatal
program and is required to ensure the best possible start in life. The objective of this new
initiative is to have a trained health personal in Basic newborn care and resuscitation at every
delivery point.

PRADHAM MANTRI SURAKSHIT MATRITVA ABHIYAN (PMSMA)

Carrying forward the vision of our Hon'ble Prime Minister, the Pradhan Mantri Surakshit
Matritva Abhiyan was launched in 2016 to ensure quality antenatal care to pregnant women
in the country on the 9th of every months.

Package of services:
  Routine antenatal check-up 'Diagnostic services
 Identification and management of high risk pregnancy'
 Counselling for nutrition,
 family planning,
 birth preparedness,
 newborn and postnatal care
 'Other-communication for behavioural change health system strengthening for
providing quality services. Referral transport.

MAA (Mother's Absolute Affection)

MAA is a countrywide intensified breast-feeding promotion campaign targeting

i) All states and union territories

ii) Around 3.9 crore pregnant and lactating mothers

iii) 8.8 lakh ASHAS

iv) 1.51akhs sub-centres

v) 17,000 Birthing Facilities/Delivery Points

SAFE ABORTION SEERVICES

In India, abortion is major cause of maternal mortality and morbidity. Majority of abortion
are take place outside the authorized institution or by unauthorized person.

Under RCH phase 2 following facilities are provided-

a. Medical method of abortion - termination of early pregnancy with two drugs - mefipristone
(RU 486) followed by misoprostol. These are offered to women under the preview of MTP
Act 1971.

b. Manual vacuum aspiration (MVA) - It is safe and simple technique for termination of
pregnancy of early pregnancy, make it feasible to used in primary health centers or
comparable facilities, thereby increasing access to safe abortion services.

LAQSHYA
In order to further accelerate our decline in maternal and newborn mortality in the coming
years, Health Ministry recently launched 'LaQshya Labour room Quality Improvement
Initiative. LaQshya program is a focused and targeted approach to strengthen key processes
related to the labor rooms and maternity operation theatres Which aims at improving quality
of care around birth and Ensuring Respectful Maternity Care (RMC). Launched on
November 2017 by Ministry of Health and Family Welfare, Govt. of India.

1. To reduce maternal and newborn mortality and morbidity due to API-I (Antepartum
Hemorrhage), PPH (Postpartum Hemorrhage), Retained placenta, Preterm labor,
Preeclampsia and Eclampsia, Obstructed labor, Puerperal sepsis, Newborn asphyxia, and
Sepsis, etc.

2. The improve Quality of care

(i) During the delivery

(ii) Stabilization of complications

(iii)Enable an effective two-way follow-up system

(iv) Immediate post-partum care

(v) Ensure timely referrals

3. To enhance satisfaction of beneficiaries visiting the health facilities and provide Respectful
Maternity Care (RMC) to all pregnant women attending the public health facility

Quality Improvement (Q1) Cycles: The Fulcrum of LaQshya: The initiative prioritizes local
problem solving thereby ensuring ownership and accountability at the facility level through
formation of Quality Circles and Quality Teams at the intervention facilities. QI
methodologies (Plan-Do-Check-Act [PDCA] cycle) will be used to drive and sustain change
through 6 defined QI cycles.

1. Real-time Partograph generation, usage of safe birth and surgical safety check-list and
strengthening documentation practices for generating robust data for driving improvement

2. Presence of birth companion during delivery, Respectful Maternity Care and enhancement
of patients' satisfaction

3. Assessment, triage and timely management of complications including strengthening of

referral protocols
4. Management of Labor as per protocols including management of Third Stage of Labor
(AMTSL) and rational use of oxytocin.

5. Essential and emergency care of newborn and pre-term babies including management of
birth asphyxia, timely initiation of breast feeding as well as Kangaroo Mother Care (KMC)
for pre-term newborn.

6. Infetion Prevention including Biomedical Waste Management

The Quality Circles will work on the selected themes and improve processes using
methodologies.

Labor Room Quality Circle:

- Training

-IT (Information technology) Tools

-HR (Human resource)

- Quality Tools

VANDEMATARAM SCHEME

Vandemataram scheme is a voluntary scheme wherein the private doctors can volunteer
themselves for providing safe motherhood services. 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 District Medical Officers for free distribution to beneficiaries. The
cases needing special care and treatment can be referred to the government hospitals, who
have been advised to take due care of the patients coming with Vandemataram cards.

This is voluntary scheme where in any obstetric and gyanec specialist, maternity home,
nursing home, lady doctors/MBBS doctors can volunteer themselves for providing
motherhood services.

NATIONAL RURAL HEALTH MISSION (NRHM, 2005-12)

NRHM was started on 12 April 2005 by Government of India to deliver health services for
'underprivileged' as a strategy for 'Health For All'. The objectives are:

1. To provide integrated comprehensive primary health care services.

2. For horizontal integration of vertical national health programs.

3. To cover all the villages in 18 states through, approximately, 2.5 lakh village-based
"Accredited Social Health Activists (ASHA)".

4. NRHM has started with the activities of selection and training of ASHA.

The Goals to be Achieved by NRHM

A. At national level

1. Infant mortality rate (IMR) to be lowered to 30/ 1000 by 2012.

2. Maternal mortality rate (MMR) to be lowered to 100/100,000 live births by 2012

3. Total fertility rate (TFR) to be 2.1 by 2012

4. Sex ratio (0-6 years) to be 935 by 2012

5. Increasing utilization of FRUs-bed occupancy by referred cases from less than 20% to over
75%.

6. Reduction of mortality rates of Malaria, Filaria, Dengue, Kala-azar and Japanese

encephalitis

7. To reduce prevalence rates of leprosy and tuberculosis

8. Upgrading community health centres to Indian Public Health standards FPS"

B. At community levels

1. To avail trained community level workers at village level with a drug kit for general
ailments

2. Provision of immunization, antenatal and postnatal check-ups and services related to

maternal and child health including nutrition at anganwadi level

3. Availing of generic drugs for common ailments at sub-centres level

4. To provide good hospital care through assured availability of doctors, drugs and quality
services at PHC and CHC level

5. To provide universal immunization

6. To improve facilities for institutional deliveries

7. Improve outreach services through mobile medical units at district level

8. Provision of household toilets

Plan of Implementation of NRHM

Implementation of the NRHM program will be through ASHAs and ANMs.

Selection of ASHA

ASHA must be a resident of the village-a woman (married/widowed/divorced) preferably in

the age group of 25-45 with formal education up to eight class, having communication skills
and leadership qualities. There should be one ASHA for 1,000 population or one ASHA per
habitation in tribal, hilly and desert areas. The selected ASHAs will be trained to carry out
specific responsibilities.

Roles and Responsibilities of ASHA

The ASHA works as a health activist in the community to carry out the following
responsibilities:

1. To create awareness and provide information on health determinants like nutrition, basic
sanitation and hygiene practices, healthy living and the need for utilization of existing health
and family welfare services.

2. To counsel women on birth preparedness, safe delivery, breastfeeding, complementary

feeding, immunization, contraception and prevention of common infections like reproductive
tract infections and sexually transmitted infections.

3. To mobilize community in accessing health related services available at the anganwadi,

sub- centres and primary health centres such as immunization, antenatal check-up, postnatal
check-up, supplementary nutrition, sanitation and other services which are provided by the
government
4. To identify women in families below poverty line (BPL) as beneficiaries of the scheme
(NRHM) and assist them to obtain BPL registration

5. To ensure that the Janani Suraksha Yojana (ISY) card is filled up at least 16-20 weeks prior
to delivery.

6. To work with the village health and sanitation committee of the Gram Panchayat to
develop comprehensive village health plan.

7. To arrange escort or accompany pregnant women and children requiring treatment or

admission to the nearest pre-identified health facility (sub-centres or PHC)

8. Provide primary medical care for minor ailments such as fever, diarrhoea and first aid for
minor injuries

9. Be a provider of 'directly observed treatment short course (DOTS) under National

Tuberculosis Control Program

10. Will act as a direct depot holder for essential provisions like oral rehydration solution
(0R5), iron and folic acid tablets, chloroquine, disposable delivery kits, oral pills and
condoms and keep a medicine kit with Ayush and allopathic formulations recommended by
the technical/expert advisory group of the government

11. Ensure registration of births and deaths in her village, any unusual health problems or
disease outbreaks in the community

12. Promote construction of household toilets under total sanitation campaign.

Co-operation and Integration with ANMs

The auxiliary nurse midwife will guide ASHA in performing her functions through various
activities as:

1. To hold weekly or fortnightly meetings to discuss various activities

2. To act as resource person for training of ASHA

3. To guide ASHA regarding arrangement for outreach programs

4. To participate and guide ASHA in organizing health days in anganwadi centre.

5. To utilize ASHA to motivate pregnant women to go to the sub-centre for check-ups, take
full course of iron and folic acid tablets and tetanus toxoid injections. The ANMs inform
ASHA about date, time and place for initial and periodic training schedule and also ensure
that ASHA gets the compensation for her performance and TA/DA to attend training.

NRHM Extended (NRIW [National Rural Health Mission] +NUHM [National Urban
Health Mission] = NHM [National Health Mission) ASHA (Accredited Social Health
Activist)

ASHA One of the key components

To provide every village in the country with a trained female community health activist
(ASHA) or Accredited Social Health Activist. Selected from the village itself and accountable
to it, the ASHA will be trained to work as an interface between the community and the public
health system. Following are the key components of ASHA:

i) ASHA must primarily be a woman resident of the village married/ widowed/divorced,

preferably in the age group of 25 to 45 years.

ii) She should be a literate woman with due preference in selection to those who are qualified
upto 10 standard wherever they are interested and available in good numbers. This may be
relaxed only if no suitable person with this qualification is available.

iii) ASHA will be chosen through a rigorous process of selection involving various
community groups, self-help groups, Anganwadi Institutions, the Block Nodal officer,
District Nodal officer, the Village Health Committee and the Gram Sabha.

iv) Capacity building of ASHA is being seen as a continuous process. ASHA will have to
undergo series of training episodes to acquire the necessary knowledge, skills and confidence
for performing her spelled out roles.

v) The ASHAs will receive performance-based incentives for promoting universal

immunization,

referral and escort service for Reproductive and Child Health (RCH) and other healthcare

programmes, and construction of household toilets.

Empowered with knowledge and a drug-kit to deliver first-contact healthcare, every ASHA is
expected to be a fountain head of community participation in public health programmes in
her Village.
vi) ASHA will be the first part of call for any health related demands of deprived sections of
the population, especially women and children, who find it difficult to access health services.

vii) ASHA will be a health activist in the community who will create awareness on health and
its social determinants and mobilise the community towards local health planning and
increased utilisation and accountability of the existing health services.

viii) She would be a promoter of good health practices and will also provide a minimum
package of curative care as appropriate and feasible for that level and make timely referrals.

ix) ASHA will provide information to the community on determinants of health such as
nutrition, basic sanitation and hygienic practices, healthy living and working conditions,
information on existing health services and the need for timely utilisation of health and
family welfare services.

x) She will counsel women on birth preparedness, importance of safe delivery, breast-feeding
and complementary feeding, immunization, contraception and prevention of common
infections including Reproductive Tract Infection/Sexually Transmitted Infections
(RTIs/STDs) and care of the young child.

xi) ASHA will mobilise the community and facilitate them in accessing health and health
related services available at the Anganwadi/sub-centre/primary health centres, such as
immunisation, Ante Natal Check-up (ANC), Post Natal Check-up supplementary nutrition,
sanitation and other services being provided by the government.

xii) She will act as a depot holder for essential provisions being made available to all
habitations like Oral Rehydration Therapy (0R5), Iron Folic Acid Tablet (IPA), chloroquine,
Disposable Delivery Kits (DDK), Oral Pills and Condoms, etc.

xiii) At the village level it is recognised that ASHA cannot function without adequate
institutional support. Women's committees (like self-help groups or women's health
committees), village Health and Sanitation Committee of the Gram Panchayat, peripheral
health workers especially ANMs and Anganwadi workers and the trainers of ASHA and in-
service periodic training would be a major source of support of ASHA.
RMNCH+A (Reproductive, Maternal Newborn, Child and Adolescent Health)

The Government of India adopted the Reproductive, Maternal, New-born, Child and
Adolescent Health (RMNCH+A) framework in 2013 and it essentially looks to address the
major causes of mortality among women and children.

3 Year Action Agenda 201

Launched on August 2017 by Niti Ayog

Reprioritize goals

Healthcare system in the country must prioritize public health

Shift from being curative to preventive.

Launch in February 2013 as a heart of NHM. This is a comprehensive strategy for improving
the maternal and child health out come under NHM. It is based on the evidence that maternal
and child health can not be improved in isolation as adolescent health and family planning
have and important bearing on the outcome. This strategy in compasses various high impact
intervention across the life cycle. The strategy is based on the concepts of CONTINUUM OF
CARE there is sharper focus on adolencent health along with reproductive, maternal,
neonatal, child health.

The PLUS denotes :-

• inclusion of ADOLESCENCE as a distinct life stage

• linking of maternal and child health to reproductive health and other component like family
planning

• liking of community and facility-based care as well as referrals between various level of
health care system
NATIONAL NUTRITIONAL ANEMIA PROPHYLAXIS PROGRAMME (NNAPI)

Nutritional anaemia being a major health problem in India, especially in women and children,
the Government of India initiated the National Nutritional Anaemia Prophylaxis Program
(NNAPP) in 1970 to provide 60 mg elemental iron and 500 mg of folic acid supplements per
day to all pregnant women, lactating women, family planning acceptor women and children 1
to 11 years old.

The Ministry of Health and Family Welfare, Government of India has now recommended
intake of 100 mg of elemental iron with 500 mg of folic acid in the second half of pregnancy
for a period of at least 100 days.

TWELVE-BY-TWELVE INITIATIVE FOR ANAEMIA CONTROL

Twelve-by-twelve initiative for anaemia control was launched on 23 April 2007 in association
with World Health Organization (WHO), United Nations International Children Education
Fund (UNICEF), Federation of Obstetric and Gynaecological Societies of India (FOGSI) and
the Government of India to decrease the incidence of anaemia in adolescents in order to
ensure healthy parenthood. It aims to have Hb of 12 g/dL by age of 12 years (hence the
name).

Specific objectives

1. To determine prevalence of anemia in children between 10 and 14 years of age.

2. To provide nutritional guidelines and treatment for anemic children.

3. To vaccinate all children against tetanus and all girls against rubella.

4. To deworm all children and treat malaria, if present.

 MISSION INDRADHANUSH

- Launched by The Ministry of Health and Family Welfare (Govt. of India)

On December 25, 2014.

To strengthen and re-energize the programme and achieve full immunization coverage for all
children and pregnant women at a rapid pace, the Government of India launched "Mission
Indradhanush" in December 2014.

Goal of Mission Indradhanush:

• The ultimate goal of Mission Indradhanush is to ensure full immunization with all available
vaccines for children up to two years of age and pregnant women.

• The Government has identified 201 high focus districts across 28 states in the country that
have the highest number of partially immunized and unimmunized children.

• Earlier the increase in full immunization coverage was 1% per year which has increased to
6.7% per year through the first two phases of Mission Indradhanush.

• Four phases of Mission Indradhanush have been conducted till August 2017 and more than
2.53 crore children and 68 lakh pregnant women have been vaccinated.

The Mission Indradhanush, depicting seven colours of the rainbow, aims-to cover all those
children by 2020 who are either unvaccinated, or are partially vaccinated against seven
vaccine preventable diseases which include

Diphtheria

Whooping cough (Pertussis)

Tetanus

Polio

Tuberculosis

Measles

Hepatitis B

Intensified Mission Indradhanush (IMI)

- To reach each and every child under two years of age and all those pregnant women who
have been left uncovered under routine immunization programme.

Focus on improving immunization coverage in select districts and cities to ensure full
immunization to more than 90% by December 2018.

Menstrual hygiene scheme

(i) Pack of 6 sanitary napkins 'Freedays'

(ii) Rs 6 per pack

(iii) Available with ASHA worker

Revised Menstrual Hygiene Scheme

i) Rs 6 for a pack of six sanitary napkins by ASHA through door to door sale

ii) Out of sale proceeds, the ASHA gets an incentive amount

Rs 1 per pack free pack of sanitary napkins per month

iii) Balance fund recouped (returned) to the state health society account to be utilised for
procurement in the following year.

Dakshta

To strengthen the competency of the providers of the labor room, including medical officers,
staff nurses and ANMs (Auxiliary nurse midwife) to perform evidence based practices as per
the established labor room protocols and standards.

Clinical update cum skills standardization training: The initiative will undertake a short
customized clinical update cum skills standardization training for the providers of the labor
rooms. This will be a three-day activity which will be conducted by designated trainers at
identified training sites.
All providers of labor rooms, irrespective of their training status in the 21day in-service SBA
trainings, will be eligible for these trainings.

Weekly Iron Folic Acid Supplementation

Launched in 2013

School age children

Community based

Orientation of teachers and parents regarding health, nutrition, diet, etc.

Health card and Hb estimation of all children

Set of 8-10 slides on importance of anaemia prevention to be distributed to all schools

Organize Painting, poster competition

Incorporate a chapter on anaemia in 5th-8 h standard textbooks

Deworming, Organize iron day

Repeat Hb after 6 months Iron + Initiative

Beneficiaries receive iron and folic acid supplementation irrespective of their Iron/Hb status

Adolescent friendly health clinics

➤ PHC (primary health centre)- weekly by ANM (Auxiliary Nurse Midwife)/ MO (Medical
Officer)

➤ CHC (Community Health Centre)/DISTRICT - daily

Nutrition

➤Substance abuse

Injury, violence, non-communicable diseases

➤ Mental Health

Reproductive and Sexual health-ICTCs (integrated Counselling and testing centres)

➤ Gender sensitization
 NATIONAL STRATEGIC PLAN FOR HIV/AIDS 2017-2024

Launched on December 1, 2017

"Saving the way for an AIDS free INDIA"

PMTCT (prevention of mother to child transmission of HIV) - EPTCT (elimination of parent

to child transmission of HIV)

Targets:

Targets of 95% of pregnant women for HIV and Syphillis

Putting of 95% of estimated positive pregnant women on ART

Achieving an MTCT rate of less than 5% by 2020

Elimination strategies for HIV and Syphilis

Universal ANC Check-up

Single prick for HIV and Syphilis

Treat all who are syphilis positive

Active case detection for partners with testing and treatment for HIV and Syphilis

Available supply of commodities and drugs

Collaboration with other agencies

New detection and point of care tests

Package of services currently offered

The HIV testing and counselling (pre-test and post-test) in antenatal patients.

All HIV positive pregnant women, including those presenting in labor and breast-feeding

are to be initiated on lifelong triple ART, irrespective of CDS count and WHO clinical stage.
The recommendation duration of NVP (nevirapines) for the infants is a minimum of 6

weeks but can be extended to 12 weeks, if the duration of ART during pregnancy is <24
weeks.
 MILLENNIUM DEVELOPMENT GOALS (MDG)

In September 2000, representatives from 189 countries met in New York to adopt the United
Nations Millennium Declaration in the area of development and poverty eradication. They are
called Millennium Development Goals (MDG) and are as follows in relation to obstetrics:

1. Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate (Goal 4).

2. Reduce by three-quarters, between 1990 and 2015, the maternal mortality ratio (Goal 5).

3. Combat HIV/AIDS, malaria and other diseases

4. Skilled attendance at 90% births by 2015.

5. To reduce the infant mortality rate below 35 per 1000 live births by 2015.

6. Access to reproductive health services for all by 2015.

7. Other goals are gender quality, poverty reduction, education of girls and women.

The global strategy for Women's Children and Adolescent's Health (2016-2020) envisions a
world in which every woman, child and adolescent in every setting realizes their rights to
physical and mental health and well-being, has social and economic opportunities and is able
to participate fully in shaping prosperous and sustainable societies.

RASHHTRIYA BAL SWASTHYA KARAYAKRAM

1 years of age under its domain. It specially focuses on early detection and management of
four D's

DEFECT at birth

• DEFICIENCIES

• DISEASE in children

• DEVELOPMENTAL delay

• DISABILITIES
 INTEGRATED CHILD DEVELOPMENT SERVICES (ICDS)

ICDS scheme launched on 2nd October 1975 is one of the world's largest and unique scheme
for early childhood development. It aims to break the vicious cycle of malnutrition,
morbidity, reduced learning capacity and mortality and to provide pre-school education.

1. Objectives

(a) To improve the nutritional and health status of children in the age-group 0-6 years;

(b) To lay the foundation for proper psychological, physical and social development of the
child;

(c) To reduce the incidence of mortality, morbidity, malnutrition and school dropout;

(d) To achieve effective co-ordination of policy and implementation amongst the various
departments to promote child development

(e) To enhance the capability of the mother to look after the normal health and nutritional
needs of the child through proper nutrition and health education.

2. Services

(a) Supplementary feeding

(b) Immunization

(c) Health check-up

(d) Referral services

(e) Pre-school non-formal education for 3-6-year-old

(f) Nutrition and health education.

(g) Micronutrient supplementation

(h) Nutrition, health awareness and skills development for adolescent girls

(i) Income generation schemes for women.

Supplementary nutrition service includes growth monitoring, prophylaxis against vitamin A

deficiency and control of nutritional anaemia in children. All families in the community are
surveyed to identify children below the age of six, pregnant and nursing mothers. They are
given supplementary nutritional support for 300 days in a year. The program aims to bridge
the caloric gap between the national recommended and average intake of children and women
in low income and disadvantaged groups.

Children below the age of three are weighed once a month and children below 3 to 6 are
weighed once in 4 months. Growth rate and nutritional status are assessed and malnourished
children are given supplementary feeding and referred to medical centres.

Pregnant women are immunized against tetanus to reduce maternal and neonatal mortality.
Vaccination of infants and children for six vaccine preventable diseases poliomyelitis,
diphtheria, pertussis, tetanus, tuberculosis and measles is provided.

Health check-ups are offered to children up to 6 years, expectant and nursing mothers. The
services are provided by Anganwadi workers and primary health centre (PHC) staff and
include weight checking, immunization, management of malnutrition, treatment of diarrhoea,
de-worming and distribution of simple medicines. The education component of the ICDS
program is implemented through the 1.4 million Anganwadi centres. The early learning helps
in cumulative, life-long learning, development and aims towards universalization of primary
education. Providing children, the necessary preparation for primary schooling, nutrition and
health education are key elements of the work of Anganwadi workers. Capacity building of
women in the age group of 15 to 45 years is a long-term goal of the program.

The ICDS Team

The ICDS team comprises from below upwards the Anganwadi workers, Anganwadi helper,
supervisors, child development project officers (CDPOs) and district program officers
(DPOs). Anganwadi workers are women selected from the local communities and act as
community-based front line workers of the ICDS program. The health teams include medical
officers, auxiliary nurse midwives (ANMs) and accredited social health activists (ASHAs) as
functionaries of ICDS to provide different services.
 SAFE MOTHERHOOD INITIATIVE (SMI)

Considering the high rates of maternal deaths prevailing in developing countries of the world,
WHO launched 'Safe Motherhood Initiative' (SMI) at a conference in Nairobi (Kenya) in
1987. The global objective was aimed at reduction of maternal deaths by at least half by 2000
AD. This deadline was then extended to 2010. It was proposed to achieve this objective by
enhancing the quality and safety of the lives of girl children and women through a
combination of health and non-health strategies.

Maternal and child health promotion is one of the key commitments in the WHO constitution.

Strategies to Reduce Maternal Mortality and Achieve Safe Motherhood

1. Improve the status of women through education, health, career opportunities and
vocational training to enable them to achieve economic independence and become equal
partners in nation building.

2. Reduce high fertility through family planning.

3. Upgrade tertiary care hospitals and district hospitals to contemporary acceptable levels of
healthcare. Make transfusion services more easily accessible through networking of blood
banks.

4. Improve obstetric services by making antenatal care more easily accessible, encourage
supervised institutional deliveries or home delivery under qualified supervision for low-risk
cases. Strengthen referral systems and transport facilities to ensure timely transfer of high-
risk patients.

5. Improve standard of care for women in labor.

6. Ensure easy accessibility of medical termination of pregnancy (MTP) services.

7. Maintain appropriate training of health personnel to deal with obstetric emergencies and to
be equipped to undertake essential obstetric functions in primary healthcare centers and first
referral units (FRUs).

8. Utilize services of media (television, radio, news media) to promote women's health
awareness amongst the public. From time to time the Government of India started many
health programs to improve maternal and child health
 SUSTAINABLE DEVELOPMENT GOAL 3

By 2030

To decrease global MMR 70/100,000 live births

To decrease (neonatal mortality rate) NMR < 12/1,000 live births, under-5 mortalities <
25/1,000 live births.

Universal access to sexual and reproductive health care services + family planning,
information, education, integration of reproductive health into national strategies and
programmes.

Universal health coverage financial risk protection, access to safe, effective, quality and
affordable essential medicines and vaccines for all.

HOME BASED NEONATAL CARE

Home Based New Born Care (HBNC) is a new scheme of Ministry of Health Government of
India, launched to incentivize ASHA for providing Home Based Newborn care ASHA will
make visits to all newborns according to specified schedule up to 42 days of life. The
proposed incentive is Rs. 50 per home visit of around one hour duration. The role of ASHA
would be:

• recording of weight of the newborn in MCP card ensuring BCG, 1st dose of OPV and DPT
vaccination both the mother and the newborn are safe till 42 days of the delivery and
registration of birth has been done

INDIAN NEWBORN ACTION PLAN

India Newborn Action Plan (INAP) was launched in September 2014, for accelerating the
reduction of preventable newborn deaths and

natal Mortality Rate (NMR) by 2030' and 'Single Digit Still Birth Rate (SBR) by 2030'.
Currently, there are estimated 7.47 lakh neonatal deaths annually.

The neo-natal deaths are expected to reduce to below 2.28 lakh annually by 2030, once the
goal is achieved.The India Newborn Action Plan (INAP) is India's committed response to the
Global Every Newborn Action Plan (ENAP), launched in June 2014 at the 67th World Health
Assembly, to advance the Global Strategy for Women's and Children's Health.
 BABY FRIENDLY HOSPITAL INITIATIVE

Hospitals and maternity units set a powerful example for new mothers. The Baby-Friendly
Hospital Initiative (BFHI), launched in 1991, is an effort by UNICEF and the World Health
Organization to ensure that all maternities, whether free standing or in a hospital, become
centers of breastfeeding support A maternity facility can be designated 'baby- friendly' when
it does not accept free or low-cost breastmilk substitutes, feeding bottles or teats, and has
implemented 10 steps to support successful breastfeeding.

The process is currently controlled by national breastfeeding authorities, using Global

Criteria that can be applied to maternity care in every country. Implementation guides for the
BFHI have been developed by UNICEF and WHO.

10 STEPS OF BFHI :-

 Have a written breastfeeding policy that is routinely communicated to all health care
staff.
 Train all health care staff in skills necessary to implement this policy.
 Inform all pregnant women about the benefits and management of breastfeeding.
 Help mothers initiate breastfeeding within one half-hour of birth.
 Show mothers how to breastfeed and maintain lactation, even if they should be
separated from their infants.
 Give newborn infants no food or drink other than breastmilk, unless medically
indicated.
 Practice rooming in - that is, allow mothers and infants to remain together 24 hours a
day.
 Encourage breastfeeding on demand.
 Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding
infants.
 Foster the establishment of breastfeeding support groups and refer mothers to them on
discharge from the hospital or clinic.
SUMMARY

In my topic I discuss about

 National family welfare program

 Concept of health
 National programs related to maternal and child health
 Reproductive and child health program (RCH)
 The reproductive and child health phase-ii programme
 Janani suraksha yojna (JSY)
 Janani shishu surakshya karyakram (JSSK)
 Navjat shishu suraksha karyakram(NSSK)
 Safe abortion seervices
 Laqshya
 Vandemataram scheme
 National rural health mission (NRHM, 2005-12)
 NHM extended (NRHM [national rural health mission] +NUHM [national urban
health mission] = NHM [national health mission) ASHA (accredited social health
activist)
 RMNCH+A (reproductive, maternal newborn, child and adolescent health)
 National nutritional anaemia prophylaxis programme (NNAPP)
 Twelve-by-twelve initiative for anaemia control
 Mission Indra Dhanush
 Menstrual hygiene scheme
 Dakshta
 National strategic plan for hiv/aids 2017-2024
 Millennium development goals (MDG)
 Rashhtriya bal swasthya karayakram
 Integrated child development services (ICDS)
 Safe motherhood initiative (SMI)
 Sustainable development goal 3
 Home based neonatal care
 Indian newborn action plan
 Baby friendly hospital initiative
HEALTH CARE DELIVERY SYSTEM IN INDIA

 Selected health care definitions:

 Philosophy of health care delivery system:
 Goals/objectives of health care delivery system:
 Principles of health care delivery system:
 Functions of health care delivery system:
 Characters of health care delivery system:
 Health care delivery system in india
 Organisation and administraion of health services in india at different levels.
 Rural health care system in india
 Hospitals and health centres
 Objectives of indian public health standards (iphs) for chcs:
 Health insurance:
 National health programmes

NRHM- ROLE OF NGO

 Framework
 Principles of the revised ngo guidelines:
 Role of ngos:
 key theme areas where ngos can be effectively utilized are:
 Duration of a project assigned to an ngo:
 Monitoring, evaluation and reporting:
CONCLUSION

Safe motherhood Initiative (SMI) was started by WHO in 1987 to reduce maternal and deaths
and to promote maternal and child health. Various strategies to reduce maternal mortality and
to achieve safe motherhood are by improving the status of women in society, reducing
fertility through use of family planning and MTP services, improving referring and referral
units, easy access to obetetrics services with improved standard of care in labor. Various
intervention and programmes have meen made to prevent maternal deaths are promotion of
family welfare services, dietary supplementation and prophylaxis for anaemia, antenatal care
and hospital deliveries, improvement of health care facilities and training of healthcare
workers.
JOURNAL:-

Impact of National Health Mission of India on Infant and Maternal Mortality: A

Logical Framework Analysis

Rajesh Kumar dr.rajeshkumar@gmail.comView all authors and affiliations

Volume 23, Issue 1
https://doi.org/10.1177/0972063421994988

Abstract
Background:
Since independence, life expectancy has increased substantially in India, but the goal of
health-for-all has not been achieved yet. Hence, National Rural Health Mission was launched
in 2005, and several strategies were implemented to strengthen the health system. Impact
evaluation of the mission was done to learn lessons for future health planning.

Materials and Methods:

Logical evaluation framework was used to examine input, output and impact indicators
systematically using time series data from Health Management Information System, National
Family Health Surveys, National Sample Surveys and Sample Registration Scheme.

Findings:
After launch of the mission, fund allocation has increased nearly five times. The number of
auxiliary nurse midwives has doubled, and the number of nurses has trebled. The number of
accredited social health activists has increased to about one million. Institutional deliveries
have increased from 38.7% in 2005–2006 to 78.9% in 2015–2016. Full immunisation
coverage has increased from 43.5% to 62%. Oral rehydration solution (ORS) use in
childhood diarrhoea has increased from 26% to 51%. Infant mortality rate has declined from
58 in 2005 to 33 per 1,000 live births in 2017 and maternal mortality ratio has also registered
a decline from 254 in 2004–2006 to 122/100000 live births in 2015–2017. However, out-of-
pocket health expenditure continues to be fairly high (69.3% of the total expenditure on
health).

Conclusions:
Though National Health Mission has made a significant impact, the goal of universal care
coverage is not yet fully achieved. Hence, capacity of health system needs to be trebled by a
substantial increase in fund allocation.
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