RMNCH+A just the Maternal Component

1. RMNCH+A
(MATERNAL COMPONENT)
PRESENTOR – DR. BUSHRA JABEEN
MODERATOR – DR. TEJASHWINI K
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2. CONTENTS
HISTORY
EVOLUTION
GOALS AND STRATEGIES
CURRENT SCENARIO
NEW IMPLEMENTATIONS
SUMMARY
REFERENCES
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3. HISTORY
• The ICPD – 1994 – population stabilization.
• Reproductive health programs should focus on the needs of actual and
potential clients - for limiting births, healthy sexuality and child bearing.
• India first country to launch family planning program – 1951
• Addressing reproductive, maternal and child health separately
• Different stages in the life cycle are interdependent so are the aspects of
where and how healthcare is provided
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4. EVOLUTION
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Milestones of family Welfare Programme
1950 passive, clinic-based approach
1960 Early - more proactive, extension approach
Late - "time-bound", "target oriented“ approach with a
massive effort to promote the use of IUDs and condoms
1970 "camp approach" to promote male sterilization.
Backlash
1980 emphasis on female sterilization and maternal and child
health.
1990 the ICPD, Cairo, prompted a paradigm shift.
client-centered, quality-oriented, reproductive health
approach.
2000 The National Population Policy
2013 In January - RMNCH Plus A strategy was launched.

5. AIM
To reach the maximum number of people in the remotest corners of the
country through a continuum of services, constant innovation, and routine
monitoring of interventions.
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GOALS AND STRATEGIES
 Reduction of infant mortality rate (IMR) to 25 per 1,000 live births by
2017
 Reduction in maternal mortality ratio (MMR) to 100 per 100,000 live
births by 2017
 Reduction in total fertility rate(TFR) to 2.1 by 2017

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7. COVERAGE TARGETS FOR KEY
RMNCH+A INTERVENTIONS FOR
2017
• Increase ‘delivery points’ by 100%
• Increase proportion of institutional deliveries at annual rate of 5.6 % (from 61%)
• Increase proportion of pregnant women receiving antenatal care at annual rate of
6% (from 53%)
• Increase proportion of mothers and newborns receiving postnatal care at annual
rate of 7.5% (from 45%)
• Increase proportion of deliveries conducted by skilled birth attendants at annual
rate of 2% (from 76%)
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8. CONTINUUM OF CARE
• Two dimensions to healthcare:
(1) Stages of the life cycle and
(2) Places where the care is provided.
• Evidence-based packages of services for different stages of the
lifecycle,
• At various levels in the health system
ADOLESCENCE PREGNANCY BIRTH
NEWBORN/
POSTNATAL
CHILDHOOD
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9. Continuum Of Care Across Life Cycle
And Different Levels Of Health System
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10. 10
Continuum Of Care Across Life Cycle
And Different Levels Of Health System

11. MATERNAL COMPONENT
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12. REPRODUCTIVE HEALTH
Focus on spacing methods - PPIUCD
Focus on interval IUCD at all facilities.
Home delivery of contraceptives (HDC)and ensuring spacing at birth
(ESB) through ASHAs
Ensuring access to pregnancy testing kits (PTK NIKSHAY kits) and
strengthening comprehensive abortion care services.
Maintaining quality sterilization services.
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13. Priority interventions
Community-based promotion and delivery of contraceptives
Promotion of spacing methods (interval IUCD)
Sterilisation services (vasectomies and tubectomies)
Comprehensive abortion care (includes MTP act)
Prevention and management of sexually transmitted and reproductive
infections (STI/RTI)
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14. MATERNAL HEALTH
 Use MCTS to ensure early registration of pregnancy and full ANC
 Detect high risk pregnancies and line list including severely anaemic
mothers and ensure appropriate management
 Equip delivery points with highly trained Doctor and ensure equitable
access to EMOC services through FRU, and MCH wings as per need
 Review maternal, infant and child deaths for corrective actions
 Identify villages with high numbers of home deliveries and distribute
misoprostol to selected women in 8th month of pregnancy for consumption
during 3rd stage of labour; incentivize ANMs for home deliveries.
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15. PREGNANCY AND CHILDBIRTH
Delivery of antenatal care package and tracking of high-risk pregnancies
Skilled obstetric care
Immediate essential newborn care and resuscitation
Emergency obstetric and new born care
Postpartum care for mother and newborn
Postpartum IUCD and sterilisation
Implementation of PC&PNDT act
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16. Problem Statement
In 2010, Maternal deaths 2,87,000 in the world.
• 56%- Sub-Saharan Africa
• 29%- Southern Asia
• 19%- India
Under5 mortality 76,00,000
TFR (SRS2010)- 2.5, and 21 states have achieved replacement
level
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17. CURRENT SCENARIO
99% of all maternal deaths occur in developing countries.
Maternal mortality is higher in women living in rural areas and among
poorer communities.
Young adolescents face a higher risk of complications and death as a
result of pregnancy than other women.
Skilled care before, during and after childbirth can save the lives of
women and newborn babies.
Between 2016 and 2030, as part of the sustainable development goals,
the target is to reduce the global maternal mortality
Ratio to less than 70 per 100 000 live births.
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18. Problem Statement
• As per the report of maternal mortality estimation inter-agency group,
maternal mortality has shown an annual decline of 5.7% between the
years 2005 and 2010.
• At the national level, maternal mortality ratio (MMR) declined from 254
(SRS 2005) to 212 (SRS 2007–09) – a decline of about 14 points per year
on an ‘all India’ basis.
• Currenlty MMR is 130/100000 live births as per NITI Aayog (2014-16)
(KA-108)
• Currently India’s TFR is 2.3 (SRS 2017) (KA=1.8).
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19. NFHS4-KA 2015-16
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Urban Rural Total

20. NFHS4-KA 2015-16
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Urban Rural Total

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22. CAUSES FOR MATERNAL
DEATHS IN INDIA
• The most common direct medical causes of
maternal death as per SRS (2001–03) are:
• Haemorrhage (37%),
• Sepsis during pregnancy,
• Labour and postpartum period (11%),
• Unsafe abortions (8%),
• Hypertensive disorders (5%) and
• Obstructed labour (5%).
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23. NEW IMPLEMENTATIONS
JANANI SHISHU SURAKSHA KARYAKARAM (JSSK)
On 1st June, 2011, which entitles all pregnant women delivering in public
health institutions to absolutely free and no expense delivery including
caesarean section.
MATERNAL DEATH REVIEW
The states are reporting deaths along with its analysis for causes of death.
DELIVERY POINTS (DPS)
Prioritize and direct resources in a focused manner for filling the gaps like
trained and skilled human resources, infrastructure, equipments , drugs and
supplies, referral transport.
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24. NEW IMPLEMENTATIONS
WEB ENABLED MOTHER AND CHILD TRACKING SYSTEM
Track every pregnant woman, infant & child upto 3 yrs, by name for provision of
timely ANC, institutional delivery, and PNC along-with immunization & other
related services.
A JOINT MCP CARD
Tool for documenting and monitoring services for antenatal, intranatal and
postnatal care to pregnant women, immunization and growth monitoring of
infants.
TRACKING OF SEVERE ANAEMIA DURING PREGNANCY & CHILD
BIRTH BY SCs AND PHCs:
Effective monitoring of these cases by the ANM as well as the medical officer in
charge of PHC has been started to line list these cases and provide necessary
treatment.
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25. NEW IMPLEMENTATIONS
TECHNICAL GUIDELINES & SERVICE DELIVERY POSTERS:
GOI has developed & disseminated standard technical guidelines & service delivery
posters for standardizing the quality of service delivery during ANC, INC, PNC, etc
from tertiary to primary level of institutions.
LAQSHYA
Labour room quality improvement initiative
PMSMA:
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 month.
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26. NEW IMPLEMENTATIONS
• Prasoothi Araike
• Ensure that poor pregnant women take nutritional foods
• Ensure both mother and infant survival and will bring down MMR and IMR of
Karnataka.
• MADILU KIT
• Contains 19 items useful to the newly delivered mother and her infant. Promote
institutional deliveries.
• Thayi Bhagya plus
• State government sponsored scheme.
• Rs 1000 cash incentive for delivering in Non-Thayi Bhagya accredited private nursing
home/hospital.
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28. HEALTH SYSTEMS STRENGTHENING
FOR RMNCH+A SERVICES
A) Facility specific plans.
B) New infrastructure.
C) Equip health facilities
D) Engage private facilities.
E) Strengthen referral mechanisms
F) Waste management
The key steps proposed for strengthening health
facilities for delivery of RMNCH+A interventions are as
follows:
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29. RESOURCES
• The creation of regular posts under state government
• Strengthening sub centres through additional human resources: in sub
centres of remote and hilly area, will have 2 ANMs, 1 male multipurpose
worker, 1 pharmacist and 1ayush doctor
• Capacity building of MO for reproductive, adolescent, maternal, newborn
and child health
• Training of nurses and ANM for SBA, and IUCD insertion
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30. COMMUNITY PARTICIPATION
• Engage Village Health Sanitation And Nutrition Committees
and Rogi Kalyan Samiti
• Utilize the village health and nutrition days as a platform for
assured and predictable package of outreach services
• Social audit: social audits can be centered around activities like
I) conduct of maternal death audits via verbal autopsies
Ii) utilization of health facility checklists
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31. LOGISTICS MANAGEMENT
• Availability of free generic drugs for patients
• Rational prescriptions and use of drugs;
• Timely procurement of drugs and consumables;
• Distribution of drugs to facilities from DH to sub centre; and
uninterrupted availability to patients is to be ensured.
• Placing essential drug lists in the public domain
• Computerised drugs and logistics system
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32. QUALITY ASSURANCE
• Quality assurance at
all levels of service delivery
• Quality certification/ accreditation
of facilities and services
- certification for achievement of
Indian public health standards
- certification should be on comprehensive quality assurance for both
infrastructure and service delivery
- Recommended that health facilities should be first certified by district and
state quality assurance cells
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33. MONITORING, INFORMATION &
EVALUATION SYSTEMS
1. Civil registration system
2. Web enabled mother and child tracking system
3. Maternal death review (MDR)
4. Health management information system (HMIS) based monitoring
and review
5. National & state score card
6. Review missions
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34. SCORE CARD
o Management tool for converting available HMIS information into actionable
points and assists in comparative assessment of district and block performance
o 19 survey based indicators related to health, nutrition and sanitation
o Latest data from national surveys considered
o All India average for each indicator taken as reference point
o Overall composite index to measure performance of the district.
o Updated every 1-2 years when new survey data is available.
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35. MATERNAL INDICATORS FOR
SCORE CARD
• Mortality - Maternal mortality ratio (per 100,000 live births)
• Fertility
• Total Fertility Rate
• Births to women during age 15–19 out of total births
• Couple using spacing method for more than 6 months
• Service Delivery
• Woman who received 4+ ANC
• Skilled Birth Attendance (Delivery by Doctor, ANM/Nurse/LHV)
• Mothers who received postnatal care from a doctor/nurse/LHV/ANM/other health
personnel within 2 days of delivery for their last birth (%)
• Early Initiation of Breast Feeding (<1hr)
• Exclusive Breast feeding for 6 months (among 6–9 months children)
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36. HMIS-BASED DASHBOARD MONITORING
SYSTEM:
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37. STRENGTHS
• India already has a community-based programme as well as the three-
tiered health system in place.
• Provides the programmers with direction.
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38. WEAKNESS
• Differences in life chances arise largely due to the wider determinants of
health that include the socio-economic conditions
• Individual states and districts would still need to translate the approach
proposed here to specific actions within their own context in order to
achieve state-specific targets.
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39. OPPORTUNITIES
• Strong platform for delivery of services across the entire continuum of
care, ranging from community to primary health care, as well as first
referral level care to higher referral and tertiary level of care.
• Integrated strategy can potentially promote greater efficiencies while
reducing duplication of resources and efforts in the ongoing programme.
• By defining integrated packages of services, the continuum of care
provides an effective framework for seamless delivery of services at
state and district levels
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40. THREATS
• Inadequate functioning of baby friendly hospital initiative and mother
friendly childbirth initiative.
• Monitoring is superficial and does not include Panchayat and local
bodies.
• Standards should be field tested before endorsing
• No study is documenting impact of new initiatives on MMR and IMR.
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41. SUMMARY
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42. REFERENCES :
• Park k. Text book of community medicine 23rded.Jabalpur.2015: m/s
Banarsidas Bhanot. Page: 461-67
• Kishore J .National health programmes of India. New Delhi :century
publications, 2011
• A strategic approach to RMNCH+A in India, www.Mchip.Net
• Www.Nhp.Gov.In
• Suryakantha a. H. Textbook of community medicine with recent advances. 4th
ed. The health science publisher. New Delhi. Page: 831-935
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