RAJKUMARI AMRIT KAUR COLLEGE OF NURSING

LAJpAT NAGAR, NEw dELhI

MATERIAL
ON
RCH I AND RCH II

Submitted to: Submitted by:

Mrs. Poonam Gupta Divya
Senior Nursing Tutor M.Sc nursing (F) year
RAKCON RAKCON
 REPRODUCTIVE & CHILD HEALTH (RCH)
INTRODUCTION

The Reproductive and Child Health (RCH) Programme was launched throughout the country on
15th October, 1997. This programme aimed at achieving a status in which women will be able to
regulate their fertility, women will be able to go through their pregnancy and child birth
safely, the outcome of pregnancies will be successful and will lead to survival and well being of
the mother and the child. The couples will also be able to have their sexual relation free from fear of
pregnancy and of contracting sexually transmitted diseases. Within the overall umbrella of reducing
infant, child and maternal mortality. The second phase of RCH program i.e. RCH – II was
launched on 1st April, 2005. The main objective of the program was to bring about a change in
mainly three critical health indicators i.e. reducing total fertility rate, infant mortality rate and
maternal mortality rate with a view to realizing the outcomes envisioned in the Millennium
Development Goals.
RMCH+A approach has been launches in 2013 and it essentially looks to address the major
causes of mortality among women and children as well as the delays in accessing and utilizing
health care and services. The RMNCH+A appropriately directs the States to focus their efforts
on the most vulnerable population and disadvantaged groups in the country. It also emphasizes on
the need to reinforce efforts in those poor performing districts that have already been identified as the
high focus districts.

Miles stone In MCH Care

•1880 – Establishment of Training of Dais in Amritsar.
•1902 - 1st Midwifery Act to Promote Safe Delivery
•1930 - Setting Up of Advisory Committee on Maternal Mortality.
•1946 - Bhore Committee Recommendation on Comprehensive & Integrated Health Care
•1952 – Primary Health Center Net Work & Family Planning Programme
•1956 – MCH Centers Become Integral Part of PHCS
•1961 - Department Of Family Planning Created
•1971 – MTP Act
•1974 – Family Planning Services Incorporated In MCH Care
•1977 – Renaming Family Planning To Family Welfare
•1978 – Expanded Programme on Immunization
•1985 – Universal Immunization Programme
•1992 – Child Survival& Safe Motherhood Programme
•1997 – RCH Programme Phase 1
•2005 – RCH Programme Phase 2
•2013 - RMNCH+A

RCH APPROACH:

“People have the ability to go reproduce and regulate their fertility, women are able to go through
pregnancy and childhood safely, the outcome of pregnancies is successful in terms of maternal and
infant’s survival and well-being and couples are able to have sexual relations free of the fear of
pregnancy and of contracting disease.
COMPONENTS OF RCH-I:

 Child survival and Safe motherhood

 Fertility regulation with a focus on quality care/family planning
 Prevention and management of RTI/STI/AIDS
 Client approach to health care.
AIMS
• To meet all the felt needs for contraception.
• To bring down the birth rate below 21 per 1000 population,
• To reduce the infant mortality rate below 60 per 1000 live birth and
• To bring down the maternal mortality rate below 400/one lac live birth
80% institutional delivery, 100% antenatal care and 100% immunization of children were other
targeted aims of the RCH programme.
RCH PHASE – I INTERVENTIONS IN ALL DISTRICTS
• Child survival interventions i.e immunization, vit-A, ORT and prevention of pneumonia.
• Safe motherhood interventions e.g. antenatal check-up, immunization for tetanus, safe delivery,
anaemia control programme.
• Implementation of target free approach
• High quality training at all levels
• IEC activities
• Specially designed RCH package for urban slums and tribal areas
• District sub-projects under local capacity enhancement
• RTI/STD clinics at district hospitals
• Facility for safe abortions at PHC by providing equipment and contractual doctors.
• Enhanced community participation through panchayats, women’s groups and NGOs
• Adolescent health and reproductive hygiene

RCH PHASE – I INTERVENTIONS IN SELECTED STATES (17 STATES AND 24

DISTRICTS)
• Screening and treatment of RTI/STD at sub divisional level
• Emergency obstetric care at selected FRUs
• Essential obstetric care
• Additional ANM at sub-centres
• Improved delivery services and emergency care by providing drug and equipment’s, ANM kits at
sub-centres
• Facility of referral transport for pregnant women during emergency (through panchayats)

RCH – I SERVICES AND MAJOR INTERVENTIONS

1.Essential obstetric care: To provide the basic maternity services to all pregnant women through-
(1) early registration of pregnancy (within 12-16 weeks).
(2) provision of minimum three antenatal check ups by ANM or medical officer to monitor progress of
the pregnancy and to detect any risk/complication so that appropriate care including referral could be
taken in time.
(3) provision of safe delivery at home or in an institution, and
(4) provision of three postnatal check ups to monitor the postnatal recovery and to detect complications
2. Emergency obstetrical care: Complications associated with pregnancy are not always predictable,
hence, emergency obstetric care is an important intervention to prevent maternal morbidity and mortality.
Under the CSSM programme 1748 Referral Units were identified and supported with equipment kit E to kit
P. However, these FRUs were not fully operational because of lack of manpower and adequate
infrastructure. Under the RCH programme the FRUs were strengthened through supply of emergency
obstetric kit, equipment kit and provision of skilled manpower on contract basis etc. Traditional Birth
Attendant still plays an important role during deliveries in our society.

3. 24 -hour delivery services at PHCs\CHCs: To promote institutional deliveries, provision has been
made to give additional honorarium to the staff to encourage round the clock delivery facilities at health
centres.
4. Medical termination of pregnancy MTP act 1971: MTP is a reproductive health measure that enables a
woman to opt out of an unwanted or unintended pregnancy in certain specified circumstances without
endangering her life, through MTP Act 1971. The aim is to reduce maternal morbidity and. mortality from
unsafe abortions. The assistance from the Central Government is in the form of training of manpower,
supply of MTP equipment and provision for engaging doctors trained in MTP to visit PHCs on fixed dates to
perform MTP.

5. Control of reproductive tract infections and sexually transited diseases: Under the RCH programme,
the component of RTI/STD control is linked to HIV and AIDS control. It has been planned and
implemented in close collaboration with National AIDS Control Organization (NACO). NACO provides
assistance for setting up RTI/STD clinics up to the district level. The assistance from the Central
Government is in the form of training of the manpower and drug kits including disposable equipment. Each
district is assisted by two laboratory technicians on contract basis for testing blood, urine and RTI/STD
tests.
6. Immunization: The Universal Immunization Programme (UIP) became a part of CSSM programme in
1992 and RCH programme in 1997. It will continue to provide vaccines for polio, tetanus, DPT, DT,
measles and tuberculosis. The cold chain established so far will be maintained and additional items will be
provided to new health facilities.

7. Essential newborn care: The primary goal of essential newborn care is to reduce perinatal and neonatal
mortality. The main components are resuscitation of newborn with asphyxia, prevention of hypothermia,
prevention of infection, exclusive breast feeding and referral of sick newborn. The strategies are to train
medical and other health personnel in essential newborn care, provide basic facilities for care of low birth
weight and sick newborns in FRU and district hospitals etc.

8. Oral rehydration therapy (Diarrhoeal disease control): In the districts not implementing Integrated
Management of Neonatal and Childhood Illness, the vertical programme for control of diarrhoeal disease
will continue. India is the first country in the world to introduce the low osmolarity Oral Rehydration
Solution. Zinc is to be used as an adjunct to ORS for the management of diarrhoea. Addition of Zinc would
result in reduction of the number and severity of episodes and the duration of diarrhoea. De-worming
guidelines have been formulated. The incidence of diarrhoea is reduced by provision of safe drinking water.

9. Prevention and control of vitamin A deficiency in children: Under the program, doses of vitamin A
are given to all children under 5 years of age.
• The first dose (1 lakh units) is given at nine months of age along with measles vaccination
• The second dose is given along with DPT\ OPV booster doses
• Subsequent doses (2 lakh units each) six months intervals
• All cases of severe malnutrition to be given one additional dose of vitamin A.
10. Acute respiratory disease control : The standard case management of ARI and prevention of deaths
due to pneumonia is now an integral part of RCH programme. Peripheral health workers are being trained to
recognize and treat pneumonia. Cotrimoxazole is being supplied to the health workers through the drug kit.
is being supplied to the health worker through the CSSM drug kit

11. Prevention and control of anaemia in children : Iron deficiency anaemia is widely prevalent in young
children. To manage anaemia, the policy has been revised. Infants from the age of 6 months onwards upto
the age of 5 years are to receive iron supplements in liquid formulation in doses of 20 mg elemental iron and
100 mcg folic acid per day for 100 days in a year. Children 6 to 10 years of age will receive iron in the dose
of 30 mg elemental iron and 250 mcg folic acid for 100 days in a year. Children above this age group would
receive iron supplement in the adult dose.

12.Introduction of Hepatitis B Vaccination: Introduction of Hepatitis B in the National Immunization

Programme has been approved by the Government. Under this project hepatitis B vaccine will be
administered to infants along with the primary doses of DPT vaccine.

13. Training of Dais: A scheme for training of dais was initiated during 2001-02. The scheme is being
implemented in 156 districts in 18 states/UTs of the country. The districts have been selected on the basis
of the safe delivery rates being less than 30 per cent. The scheme was extended to all the districts of EAG
states. The aim was to train at least one Dai in every village, with the objective of making deliveries safe.

The outcomes of this stage of RCH:

 Maternal mortality rate was 450 per lac live birth,
 infant mortality rate was 55 per thousand live birth,
 birth rate was 24 per thousand population
 institutional delivery rate was only around 50 percent
 fertility rate was 2.97 per women
The outcomes of this stage of RCH were both positive and unsuccessful to some extent RCH is now at
its second stage RCH-II.

RCH PHASE II:

RCH-phase II began from 1st April, 2005. The focus of the programme is to reduce maternal and child
morbidity and mortality rate and fertility rate that are envisioned in MDGs, National Population Policy
2000, the Tenth five-year plan and National Health Policy 2002 with emphasis on rural health care.

Aims OF RCH PHASE II

• Reduction of Infant Mortality Rate (IMR) from 34 to 25 per 1,000 live births by 2017
• Reduction in Maternal Mortality Ratio (MMR) to 109 per 100,000 live births by 2017
• Reduction in Total Fertility Rate (TFR) from 2.9 to 2.5 by 2017
The major strategies under the second phase of RCH are:
• Essential obstetric care-
a. Institutional delivery
b. Skilled attendance at delivery
• Comprehensive Emergency obstetric care
a. Operationalizing First Referral Units
b. Operationalizing PHCs and CHCs for round the clock delivery services
• Strengthening referral system
Essential obstetric care
• Early registration: The first visit or registration of a pregnant woman for ANC should take place as
soon as the pregnancy is suspected.
- Early detection of pregnancy is important for the following reasons:
- It facilitates proper planning and allows for adequate care to be provided during
- Pregnancy for both the mother and the foetus.
-Record the date of the Last Menstrual Period (LMP), and calculate the Expected Date of Delivery (EDD).
- The health status of the mother can be assessed and any medical illness that she might be suffering from
can be detected and also to obtain/record baseline information (on blood pressure, weight, haemoglobin,
etc.)
- Helps in timely detection of complications at an early stage and manage them appropriately by referral
as and where required.
- This also helps in providing the woman the option of an early abortion. If so, then refer the woman at the
earliest to a 24-hour PHC or First Referral Unit (FRU) (whichever is closer) that provides safe abortion
services.
• Number and timing of visits: Ensure that every pregnant woman makes at least four visits for ANC,
including the first visit/registration. It should be emphasized that this is only a minimum requirement and
that more visits may be necessary, depending on the woman's condition and needs.
- Suggested schedule for antenatal visits:
- 1st visit: Within 12 weeks—preferably as soon as pregnancy is suspected—for registration of pregnancy
and first antenatal check-up
2nd visit: Between 14 and 26 weeks
3rd visit: Between 28 and 34 weeks
4th visit: Between 36 weeks and term
• Institutional delivery: To promote institutional delivery in RCH Phase II, it was envisaged that fifty
percent of the PHCs and all the CHCs would be made operational as 24-hour delivery centres, in a phased
manner, by the year 2010. These centres would be responsible for providing basic emergency obstetric care
and essential newborn care and basic newborn resuscitation services round the clock. The experience of
RCH phase-I indicates that giving incentive to health workers for providing round the clock services did not
function well in most of the states. On the contrary there is the experience from government of Andhra
Pradesh and Tamil Nadu, where round the clock delivery and new born care services could be ensured by
providing 3 to 4 staff nurses/ ANM at the PHCs.
• Skilled attendance at delivery - It is now recognized globally that the countries which have been
successful in bringing down maternal mortality are the ones where the provision of skilled attendance at
every birth and its linkage with appropriate referral services for complicated cases have been ensured. The
WHO has also emphasized that skilled attendance at every birth is essential to reduce the maternal
mortality in any country. Guidelines for normal delivery and management of obstetric complications at
PHC/CHC for medical officers and for ANC and skilled attendance at birth for ANM/LHVs have been
formulated and disseminated to the states.
•The policy decisions: ANMs I LHVs I SNs have now been permitted to use drugs in specific
emergency situations to reduce maternal mortality. They have also been permitted to carry out certain
emergency interventions when the life of the mother is at stake.
Comprehensive Emergency obstetric care:
To provide Comprehensive Emergency obstetric care it is essential to have fully functional FRUs having the
following facilities:
(a) A minimum bed strength of 20-30. However, in difficult areas, as the North-East states and the
underserved areas of EAG states, this could initially be relaxed to 10-12 beds
(b) A fully functional operation theatre
(c) A fully functional labour room
(d) An area earmarked and equipped for newborn care in the labour room, and in the ward
(e) A functional laboratory
(f) Blood storage facility
(g) 24 hour water supply and electricity supply
(h) Arrangements for waste disposal, and
(i) Ambulance facility.
The minimum services to be provided by a fully functional FRU are:
1. 24hour delivery services including normal and assisted deliveries;
2. Emergency obstetric care including surgical interventions like caesarean sections;
3. New-born care;
4. Emergency care of sick children;
5. Full range of family planning services including laproscopic services;
6. Safe abortion services;
7. Treatment of STl/RTI;
8. Blood storage facility;
9. Essential laboratory services; and
10. Referral (transport) services. There are three critical determinants of a facility being 'declared' as a FRU.
They are: availability of surgical interventions, new-born care and blood storage facility on a 24 hours basis.
Strengthening referral system:
During RCH phase-I, funds were given to the Panchayat for providing assistance to poor people in the case
of obstetric emergencies. Feedback from the states indicate that there was no active involvement of
Panchayats in running the scheme. Based on these experiences different states have proposed different
modes of referral linkage in RCH Phase II Some of them have indicated to involve local self-help groups,
NGOs and women groups, whereas few others have indicated to outsource it.
NEW INITIATIVES

1. Training of MBBS doctors in life saving anaesthetic skills for emergency obstetric care a FRUs
2. Setting up of blood storage centres at FRUs
3. Janani Suraksha Yojana (JSY)
4. Vande Mataram scheme
5. Safe abortion services
6. Village Health and Nutrition Day
7. Maternal death review
8. Pregnancy tracking
9. JANANl-SHISHU SURAKSHA KARYAKRAM (JSSK)
10. Child health components
11. Navjat Shishu Suraksha Karyakram (NSSK

1. Training of MBBS Doctors In Life Saving Anaesthetic Skills For Emergency Obstetric Care:
Provision of adequate and timely emergency obstetric care has been recognized as the most important
intervention for saving lives of pregnant women who may develop complications during pregnancy or
childbirth. The operationalisation of First Referral Unit at sub-district/CHC level for providing EmOC to
pregnant women is a crucial strategy of RCH-11, which needs focused attention. The training of MBBS
doctors will be undertaken for only such numbers who are required for the functioning of FRUs and CHCs,
and shall be limited to the requirement of tackling emergency obstetric situations only. It is not the
replacement of the specialist anaesthetist. Government of India is also introducing training of MBBS doctors
in obstetric management skills. Federation of Obstetrics and Gynaecology Society of India 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. JANANI SURKASHA YOJNA

The national maternity benefit scheme has been modified into a (JSY) JANANI SURAKSHA YOJANA.
• It was launched on 12th April 2005.
• It is a 100% centrally sponsored scheme
• Under national rural health mission, it integrates the cash assistance with institutional care during antenatal,
delivery and immediate post-partum care.
• ASHA would work as a link worker-
• To promote Institutional Deliveries
– To reduce overall
– Maternal Mortality Ratio
– Infant Mortality Rate
IMPORTANT FEATURES OF JSY:

• The scheme focuses on the poor pregnant woman with special dispensation for states having low
institutional delivery rates namely the states of Uttar Pradesh, Uttaranchal, Bihar, Jharkhand, Madhya
Pradesh, Chhattisgarh, Assam, Rajasthan, Orissa and Jammu and Kashmir. While these states have been
named as Low Performing States (LPS), the remaining states have been named as High performing States
(HPS).
• Tracking Each Pregnancy: Each beneficiary registered under this Yojana should have a JSY card along
with a MCH card. ASHA/AWW/ any other identified link worker under the overall supervision of the ANM
and the MO, PHC should mandatorily prepare a micro-birth plan. This will effectively help in monitoring
Antenatal Check-up, and the post delivery care.
• Eligibility for Cash Assistance: BPL Certification – This is required in all HPS states. However, where
BPL cards have not yet been issued or have not been updated, States/UTs would formulate a simple
criterion for certification of poor and needy status of the expectant mother’s family by empowering the
gram pradhan or ward member.
• Improving the state of expecting mothers – The availability of the medical facilities, in the rural areas is
not up to the mark. With the assistance of the scheme, the government will not only reduce mortality rate of
mothers but will also lower the death of the children.
• Targeting the LPS – Though the scheme has been implemented in all states and union territories, the
main target is to develop the situation of the Low Performing States such as Bihar, Odisha, Rajasthan,
Jharkhand, MP, UP, J&K, Chhattisgarh etc. The program aims at popularizing institutional deliveries in
these areas.
• Antenatal Check-up and post-delivery upkeep – All women who register under the scheme will be given
at least two Antenatal Check-ups, absolutely free of cost. Apart from this, the ASHA and Anganwadi
workers will also assist them in the post-delivery period with related services.
• Tracking the cases – With the assistance of the medical workers, the micro birth chart will be prepared.
It will contain information about the pregnant women. All registered women will be provided with a JSY
card and a MCH card.
• Primary role of ASHA and Anganwadi workers – The two main weapons that the scheme uses, are
the ASHA and the Anganwadi medical workers. These medical workers will provide the pregnant women
with the financial and the medical services.
• Forming a link between the women and the government – Unless the government is made aware of
the situation, it will not be able to make amendments. The Anganwadi and ASHA workers will work
towards bridging the gap between the two and keep the government informed about the situation of the
expecting women.
• Incentives for the medical workers – To provide encouragement to the ASHA and Anganwadi workers,
the central government has announced that these workers will be given incentives for each case they handle.

Eligibility Criteria of The Janani Suraksha Yojana

1.For BPL category – The pregnant women, residing in any urban or rural area will be allowed to enroll
under the JSY, only if they fall under the Below Poverty Line. All poor and backward women will be
targeted under the scheme.
2.Age related specification – The central government will provide the monetary assistance to the pregnant
women only if they are or above the age of 19 years. Anyone below this age mark cannot enroll.
 3.For institutional births only – All women who have enrolled under the JYS scheme will be provided
with the monetary assistance only if they deliver in government hospitals or in any private institute that
has been selected by the government.
4.Two children only – All the medical and financial facilities will be provided to the pregnant
women, for giving birth to two children only.
5.Birth of dead children – If the pregnant woman gives birth to a dead child, before or in between the
time span of giving birth to live children will be considered as valid cases. The women will be given
the money as promised under the program.

The eligibility of cash assistance

• In LPS: all women including SC &ST families.
• In HPS: BPL women and SC, ST pregnant women.
The limitation of cash assistance for institutional delivery
• In LPS: all births.
• In HPS: up to 2 live births.
4.VANDEMATRAM SCHEME
Vande Mataram Scheme is an initiative to promote Public- Private partnership. Launched on 9th February
with purpose to reduce maternal morbidity and mortality by involving vast professional resources available
in the private sector. It is a voluntary scheme for which any obstetric and gynae specialist, MBBS doctor
(male and female), nursing home, maternity home can voluntarily enrol himself/herself for providing safe
mother- hood services. They display "Vande Mataram Logo" after getting enrolled and get regular supply of
iron folic acid tablets, tetanus toxoid vials, oral pills, etc. by the District Medical officers of their areas for
free distribution to expectant, nursing and eligible mothers. The specific services rendered by Vande
Mataram Doctors/Clinics are as under:
(i) Antenatal and postnatal check up.
(ii) Distribution of iron folic acid tablets.
(iii) Giving 2 Td injections.
(iv) Counselling on nutrition, spacing of births, breast feeding, etc.
(v) Referral of cases requiring special care and treatment to Government Hospitals.

5.SAFE ABORTION SERVICES:

In India, abortion is a major cause of maternal mortality and morbidity and accounts for nearly 8.9 per cent
maternal deaths. Majority of abortions take place outside authorized health services and/or by unauthorized
and unskilled persons. Whether spontaneous or induced, abortion is a matter of concern as it may lead to
complications. Under RCH phase II following facilities are provided:
 a. Medical method of abortion: Termination of
early pregnancy with two drugs Mifepristone (RU
486) followed by Misoprostol. They are considered
safe under supervision, with appropriate counselling.
Currently its use in India is recommended upto 7
weeks (49 days) of amenorrhoea in a facility with
provision for safe abortion services and blood
transfusion. Termination of pregnancy with RU 486
and Misoprostol is offered to women under the
preview of the MTP Act, 1971.
b. Manual Vacuum Aspiration (MVA): The department of family welfare has introduced Manual
Vacuum Aspiration (MVA) technique in the family welfare programme. Manual Vacuum Aspiration is a
safe and simple technique for termination of early pregnancy, makes it feasible to be used in primary health
centres or comparable facilities, thereby increasing access to safe abortion services.
6.VILLAGE HEALTH AND NUTRITION DAY: Organizing Village Health and Nutrition Day once a
month at anganwadi centre to provide antenatal/postpartum care for pregnant women, promote
institutional delivery, health education, immunization, family planning and nutrition services etc.
7.MATERNAL DEATH REVIEW: Maternal death review as a strategy has been spelt out clearly in the
RCH-II. Maternal death audit, both facility and community based, is an important strategy to improve the
quality of obstetric care and reduce maternal mortality and morbidity. Guidelines and tools for initiating
maternal death review have been formulated.
8.PREGNANCY TRACKING: The link between pregnancy-related care and maternal mortality is well
established. RCH-11 stresses the need for universal screening of pregnant women and providing essential
and emergency obstetric care. Focused antenatal care, birth preparedness and complication readiness, skilled
attendance at birth, care within the first seven days etc. are the factors that can reduce the maternal mortality.

9. JANANI SHISHU SURAKSHA KARYAKRAM (JSSK)

Launched on 1st June 2011. In view of the difficulty being faced by the pregnant women and parents of sick
new- born along-with high expenditure on delivery and treatment of sick- new-born, Ministry of health and
Family Welfare (MoHFW) has taken a major initiative to ensure better facilities for women and child health
services. It is an initiative to provide completely free and cashless services to pregnant women including
normal deliveries and caesarean operations and sick new born (up to 30 days after birth) in Government
health institutions in both rural & urban areas.
The following are the Free Entitlements for pregnant women:
• Free and cashless delivery
• Free C-Section
• Free drugs and consumables
• Free diagnostics
• Free provision of blood
• Free diet during stay in the health institutions
• 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 48hrs stay
The following are the Free Entitlements for Sick newborns till 30 days after birth and sick infants:
• Free treatment
• Free drugs and consumables
• Free diagnostics
• 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.

10.CHILD HEALTH COMPONENTS:

The strategy for child health care, aims to reduce under five child mortality through interventions at
every level of service delivery and through improved child care practices and child nutrition.

A. Nutritional rehabilitation centres (NRCs):

Nutritional rehabilitation centres are located in health facilities, provide medical and nutritional care to
under five children with severe acute malnutrition (SAM) and have medical complications. The services
rendered by these centres are as under:
(i) Continuous care and monitoring of the child.
(ii) Treatment of complications.
(iii) Therapeutic feeding.
(iv) Counselling of parents regarding the care of the child, his/her nutrition and maintenance of hygiene and
cleanliness.
(v) Demonstration and return demonstration of child care, feeding practices and preparation of nutritions
food using locally available and affordable foodstuff.
(vi) Assessment of the family to assess contributory factors and take necessary actions.
(vii) Follow-up of discharged children.

B. Integrated Management of Neonatal and Childhood Illness (IMNCI): IMNCI strategy is one of the
main intervention under the RCH II/ NRHM. The strategy encompasses a range of interventions to prevent
and manage the commonest major childhood diseases
IMNCI management process
1. Making Assessment: It implies the checking of health and illness problems. It depends upon the health
and illness status of the child. Generally, it requires the assessment of: danger signs such as level of
consciousness, lethargy, any convulsions, difficulty in feeding, vomiting etc.; signs and symptoms of ARI,
diarrhoea, fever, ear problems etc.; nutrition and immunization status and any other problems. Assessment
is done by making
observations, asking questions, clinical physical examination of the child.
2. Identify and Classify the Conditions and Treatment Using Colour Code: It is done according to the
severity of the condition as under:
■ Urgent pre-referral treatment at the facility and referral the colour code is "red".
■ Treatment and Instructions at Health Facility the colour code is "yellow".
■ Counselling on Home Management-the colour code is "green".
3. Provide simple treatment instructions and counselling of the caretaker how to carry on treatment, how
to feed and give fluids and treat local infection and when to return immediately and do follow-up.
4. Follow-up care as required and reassess the child if necessary.
C. Facility based IMNCI (F-IMNCI) F-IMNCI is the integration of the facility based care package with
the IMNCI package, to empower the health personnel with the skill to manage new born and childhood
illness at the community level as well as the health facility. It focusses on providing appropriate inpatient
management of the major causes of neonatal and childhood mortality such as asphyxia, sepsis, low birth
weight, pneumonia, diarrhoea, malaria, meningitis and severe malnutrition in children.
D. Management of Medical Complications in a Child with Severe Acute Malnutrition (SAM)
It is vary essential to identify critically ailing children soon after they are admitted and treated immediately
to prevent mortality which usually happens within 24 hours, if delayed.
E. Newborn Care Corner (NBCC): NBCC is a space within the delivery room in any health facility where
immediate care is provided to all newborns at birth. This area is mandatory. for all health facilities where
deliveries are conducted. As of March 2014, about 13,653 NBCCs are operational in the country.
F. Facility based newborn care: As more sick children are screened at the peripheries through IMNCI and
referred to the health facilities, care of the sick newborn and child at CHCs, FRUs, district hospitals and
medical college hospitals assumes priority. Equipping the facilities to provide the requisite level of care and
simultaneously enhancing the capacity of the medical officers at these facilities to handle such cases thus
becomes important. The setting up of SNCUs at district hospitals, stabilization units at CHCs, and newborn
care corners at all facilities offering delivery facilities, is thus a key activity. In the overall planning of
facility-based care it is important to understand the level of care that is provided at the various facility levels.
G. Newborn Stabilization Unit (NBSU): NBSU is a facility within the maternity ward where sick and low
birth weight newborns can be cared for during short periods. All FRUs/CHCs need to have a neonatal
stabilization unit, in addition to the newborn care corner: It requires space· for 4 bedded unit and two beds in
post-natal ward for rooming-in. As of March 2014, 1, 737 NBSUs are functional in the country.
H. Special Newborn Care Unit (SNCU): Any facility where more than 3000 deliveries per year are
conducted, should have an SNCU in the labour room to provide special care (all care except assisted
ventilation and major surgery) for sick newborns. The minimum number of beds recommended for an
SNCU at district hospital with 3000 deliveries per year is 12. Around 507, SNCUS were functional by
March 2014 and 602 by March 2015.
I. Navjat Shishu Suraksha Karyakram (NSSK): NSSK programme has been initiated to take care of
issues and problems at the time of birth of a baby such as prevention of infection, asphyxia, hypothermia
etc.; resuscitation of newborn, observation of vitals initiation of breastfeeding, etc. The main objective of the
programme is to train health personnel in basic newborn care so as to have trained personnel in all the
delivery units.
J. Rashtriya Bal Swasthya Karyakram (RBSK)
The RBSK focuses on child health screening and early intervention services through early detection and
management of 4Ds prevalent in children. The 4Ds include: defects at birth, diseases in children,
deficiency conditions and development delays including disabilities. It is expected to cover 27 crore
children in the age-group of 0-18 years in the country in a phased manner.
K. Home Based Newborn Care (HBNC): Home based newborn care is aimed at improving newborn
survival. The care providers of service include anganwadi workers, ANM, ASHA and the medical officer.
However, ASHA is the main person involved in home based newborn care. The major objective of HBNC
is to decrease neonatal mortality and morbidity through:
1. The provision of essential newborn care to all newborns and the prevention of complications.
2. Early detection and special care of preterm and low birth weight newborns.
3. Early identification of illness in the newborn and provision of appropriate care and referral.
4. Support the family for adoption of healthy practices and build confidence and skills of the mother to
safeguard her health and that of the newborn.
RMNCH+A: (REPRODUCTIVE, MATERNAL, NEWBORN,CHILD AND
ADOLESCENT HEALTH)

In February, 2013, the Ministry of Health & Family Welfare launched Reproductive, Maternal, New-born
Child plus Adolescent Health (RMNCH+A) for improving reproductive, maternal, new-borns, child, and
adolescent health.
The RMNCH+A strategy promotes links between various interventions to enhance coverage throughout
the lifecycle to improve child survival in India. The “plus” within the strategy focuses on:
• Inclusion of adolescence as a distinct life stage within the overall strategy.
• Linking maternal and child health to reproductive health and other components like family planning,
adolescent health, HIV, gender, and preconception and prenatal diagnostic techniques.
• Linking home and community-based services to facility-based services.
• Ensuring linkages, referrals, and counter-referrals between and among various levels of health care system
to create a continuous care pathway, and to bring an additive /synergistic effect in terms of overall outcomes
and impact.

COMPONENTS OF RMNCH+A
1. Reproductive health
2. Maternal Health
3. Newborn Health
4. Child Health
5. Adolescent Health

Key features of RMNCH+A Strategy:

The RMNCH+A strategy approaches include:
• Health systems strengthening (HSS) focusing on infrastructure, human resources, supply chain
management, and referral transport measures.
• Prioritization of high-impact interventions for various lifecycle stages.
• Increasing effectiveness of investments by prioritizing geographical areas based on evidence.
• Integrated monitoring and accountability through good governance, use of available data sets, community
involvement, and steps to address grievance.
• Broad-based collaboration and partnerships with ministries, departments, development partners, civil
society, and other stakeholders.
• The RMNCH+A strategy provide a strong platform for delivery of services across the entire continuum of
care, ranging from community to various level of health care system.
ADOLESCENT HEALTH PROGRAMME:
The priority under adolescent health include nutrition, sexual and reproductive health, mental health,
addressing gender-based violence, noncommunicable diseases and substance use. The strategy proposes a
set of interventions (health promotion, prevention, diagnosis, treatment and referral) across levels of care.
These interventions and approaches operate at four major levels: individual, family, school and community
by providing a comprehensive package of services. The priority interventions are as follows :
1. Adolescent nutrition; iron and folic acid supplementation.
2. Facility-based adolescent reproductive and sexual health services (ARSH) (Adolescent health clinics).
3. Information and counselling on adolescent sexual reproductive health and other health issues.
4. Menstrual hygiene.
5. Preventive health check-ups.
1. Adolescent Nutrition and Folic Acid Supplementation:
Adequate nutrition in adolescence is important for growth and sexual maturation. It is proposed that
nutrition, education sessions be held at the community level using existing platforms like VHND, Kishori
Diwas, school setting, Anaganwadi Centres (AWC). To make deeper inroads, nutrition education is to be
included in school curriculum, establishing working linkages with ‘Sakshar Bharat’ Abhiyan..
- National Iron + Initiative:
National Iron + Initiative provides a minimum service package for the management of anaemia. This
initiative brings together existing programmes for iron and folic acid (IFA) supplementation among pregnant
and lactating women and children in the age group of 6–60 months, and proposes to include new age groups
(adolescents & women in reproductive age group). In addition, both adolescent boys and girls benefit in
multiple ways with improvement in their iron status: improved physical growth, cognitive development,
physical fitness, improved work performance and capacity, and concentration in daily tasks and school
performance. The iron and folic acid (IFA) tablet for adolescents is coloured blue (‘Iron ki nili goli’) to
distinguish it from the red IFA tablet for pregnant and lactating women.
- Weekly iron and folic acid supplementation scheme:
The Weekly Iron and Folic Acid Supplementation (WIFS) scheme is a community-based intervention that
addresses nutritional (iron deficiency) anaemia amongst adolescents (boys and girls) in both rural and urban
areas. It aims to cover adolescents enrolled in class VI–XII of government, government aided and municipal
schools as well as ‘out of school’ girls. The key features of the scheme are
(1) Supervised administration of weekly iron and folic acid supplements of 100 mg elemental iron and 500
mcg folic acid;
(2) Screening of target groups for moderate and severe anaemia and referral to an appropriate health
facility; (3) Bi-annual de-worming (Albendazole 400 mg) and
(4) Information and counselling for improving dietary intake and preventive actions for intestinal worm
infestation.
2. Adolescent Friendly Health Services (Adolescent Health Clinics):
Access to reproductive and sexual health information and services, including access to
contraceptives and safe abortion services, delivered in an adolescent-friendly environment are critical
to reducing incidences of STIs, unplanned and unwanted pregnancies and unsafe abortions.
Special focus will be given to establishing linkages with Integrated Counselling and Testing Centres
(ICTCs) and making appropriate referrals for HIV testing and RTI/STI management; providing
comprehensive abortion care; and provision of information, counselling and services for contraception to
both married and unmarried adolescents. The provision of contraceptives is to be made through this clinic,
while ensuring continuous contraceptive supplies and services. These services will be linked to a strong
community-based component for generating demand and mobilizing adolescents to the Adolescent Health
Clinics.

3. Information and counselling on adolescent sexual reproductive health and other health issues:
In order to improve knowledge, attitude and behaviours regarding sexual and reproductive health (including
gender-based violence) and other health issues (mental health, substance use, non-communicable diseases)
Life Skills Education will be imparted both through educational institutions and in community settings. To
promote healthy lifestyle (physical activity, healthy diet) and generate awareness on risk factors for NCDs
(for example, tobacco and alcohol use, junk food), school setting will serve as the platform to educate and
counsel adolescents on behaviour risk modification (avoidance of junk foods with high carbohydrates,
sedentary life style, tobacco and alcohol).
Under the Child Health Screening and Early Intervention Services, screening for diabetes and other non-
communicable diseases is proposed, following which, if required, children will be referred for treatment and
management to an appropriate health facility.

4. Scheme for promotion of menstrual hygiene among adolescent girls in rural India:
The above-mentioned scheme promotes better health and hygiene among adolescent girls (aged 10 to 19
years) in rural areas by ensuring that they have adequate knowledge and information about the use of
sanitary napkins. Through the scheme, high quality and safe products are made available to the girls and
environmentally safe disposal mechanisms are made accessible. The sanitary napkins are provided under
NRHM’s brand ‘Free days’. These napkins are being sold to adolescent girls by ASHAs.

5. Preventive health checkups and screening for diseases, deficiency and disability:
The School Health Programme addresses the need for preventive health checkups amongst school going
children and adolescents. Bi-annual health screening is undertaken for students (6–18 years age group)
enrolled in government and government-aided schools for disease, deficiency and disability, with referrals
and linkages to secondary and tertiary health facilities, as required. The components of the School Health
Programme include screening, basic health services and referral; immunization; micronutrient
supplementation (IFA, Vitamin A) and de-worming.

PREGNANCY AND CHILD BIRTH:

Priority interventions:
1. Preventive use of folic acid in peri-conception period:
Promoting use of folic acid in planned pregnancies during the peri-conception phase (three months before
and three months after conception) for the prevention of neural tube defects and other congenital anomalies
is a community-based intervention that can be undertaken by frontline workers and facility-based service
providers. As the ASHAs are now incentivised for delaying the birth of the first child and for spacing
between births, the identification of couples who will have a planned pregnancy becomes much easier. In
addition, pre-pregnancy check-ups can be offered as a component of maternity care, with one pre-pregnancy
visit for couples planning pregnancy.
2. Antenatal care package and tracking of high risk pregnancies:
Pregnancy testing to detect pregnancy at an early stage is the first step towards early registration, and timely
and quality antenatal care. Pregnancy Testing Kits are supplied under the brand name Nishchay to all the
sub centres and through ASHAs. The provision for testing for early pregnancy should be made accessible to
all adolescent girls (unmarried and married), as it is to the women, that is, across the reproductive age
group. With anaemia emerging as one of the major contributing factors for maternal deaths, line listing of
severely anaemic women, tracking pregnant women with severe anaemia for treatment and tracking these
women during pregnancy and childbirth must receive high priority.

3.Skilled obstetric care: In order to motivate women to deliver at health facilities, Janani Suraksha Yojana
(JSY) was launched as a scheme with the provision of conditional cash transfer to a pregnant woman for
institutional care during delivery and the immediate postpartum period. One of the objectives is to reach the
unreached pregnant women (nearly 7.5 million a year) who still deliver at home.
4. Essential newborn care and resuscitation: Recognizing that events at the time of birth are critical to
newborn survival, Newborn Care Corners are established at delivery points and providers are trained in
basic newborn care and resuscitation through Navjaat Shishu Suraksha Karyakram (NSSK). The saturation
of all delivery points with Skilled Birth Attendance and NSSK trained personnel and functional Newborn
Care Corners are the topmost priority under the national programme.
Linkages with sick Newborn Care Units at health facilities (FRU and District Hospital) must be in place to
refer newborns requiring special or advanced newborn care. The immediate routine newborn care,
comprising drying, warming, skin to skin contact and initiation of breast feeding within one hour of life, will
be promoted in all health facilities providing delivery care.
5. Emergency obstetric and new born care:
Sub centres and Primary Health Centres designated as delivery points, Community Health Centres (FRUs)
and District Hospitals have been made functional 24 X 7 to provide basic and comprehensive obstetric and
newborn care services. The MCH Wing, with integrated facilities for advanced obstetric and neonatal care,
will not only create scope for quality services but also ensure forty-eight hours stay for the mother and
newborn at the hospital. The postnatal period being crucial to survival of the newborn, as also the
establishment of breast feeding, contraceptive counselling and postnatal care of the mother, a comprehensive
postnatal package of maternal, newborn and reproductive (family planning) services will thus be made
possible.
6. Postpartum care for mother and baby:
To ensure postpartum care for mothers and newborns, forty-eight hours of stay at the health facility is
mandated in case of institutional delivery. The postnatal home visits are made by frontline workers
irrespective of the place of delivery. In case of home delivery, the first visit takes place within twenty-
four hours of birth. In all other cases, at least three postnatal visits to the mother and six postnatal visits
to the newborn are to be made within six weeks of delivery/birth.
7. Postpartum IUCD insertion and sterilization:
Currently the focus is on placement of trained providers for post-partum IUCD (PPIUCD) insertion at
district and sub-district hospital level only, considering the high institutional delivery load at these facilities.
A dedicated RMNCH counsellor is being placed at public sector health facilities under the NRHM. The
counsellor will provide counselling services and motivate women to adopt modern or terminal family
planning methods, wherever deemed appropriate, for ensuring healthy timing and spacing between
pregnancies.
8. Implementation of preconception and prenatal diagnostic techniques (PC&PNDT) Act:
Addressing the challenge of skewed sex ratio through stricter implementation of PC&PNDT is one key
intervention under NRHM. The mission is to improve the sex ratio at birth by regulating the pre-
conception and pre-natal diagnostic techniques misused for sex selection.
NEWBORN AND CHILD CARE:
Priority interventions:
1. Home-based newborn care and prompt referral
2. Facility-based care of the sick newborn
3.Integrated management of common childhood illnesses
4. Child nutrition and essential micronutrients supplementation
5. Immunisation
6. Child Health Screening and Early Intervention Services (RBSK)
1. Home based newborn care and prompt referral: Neonatal deaths account for 59% of under-five
mortality at the national level, most of which occurs in the first week of life. About 25% of total deaths in
the neonatal period take place in second Newborn and Childcare 25 to fourth week of life. Global evidence
shows that home visits by community health workers to provide neonatal care in settings where access to
facility-based care is limited or not available is associated with reduced neonatal mortality.
 2. Facility-based care of the sick newborns: In order to strengthen the care of sick, premature and low
birth weight newborns, Special Newborn Care Units (SNCU) have been established at District Hospitals
and tertiary care hospitals. SNCUs, with provision of advanced care for sick newborns, must serve as the
referral centre for the entire district and for their optimum utilisation this information must be available at
all peripheral health facilities. Referrals from peripheral units and admission of ‘out born’ sick newborns
to SNCUs should be monitored closely. Another smaller unit known as the Newborn Stabilisation Unit
(NBSU), which is a four-bedded unit providing basic level of sick newborn care, is being established at
Community Health Centres/First Referral Units. Provision of newborn care at these units increases the
chances of survival for babies with health conditions requiring observation and stabilisation soon after
birth or in the period thereafter.

3. Child nutrition and essential micronutrients supplementation: In order to reduce the prevalence of
anaemia among children, all children between the ages of 6 months to 5 years must receive iron and folic
acid tablets or syrup (IFA) for 100 days in a year as a preventive measure. Bi-weekly iron and folic acid
supplementation for preschool children of 6 months to 5 years as part of the National Iron + initiative.
ASHAs will be incentivised to make home visits and to provide at least one dose per week under direct
observation and educate the mothers about benefits of iron supplements and also how to administer it. In
addition, there is a provision for
(1) weekly supplementation of iron and folic acid for children from 1st to 5th grades in government and
government-aided schools and
(2) weekly supplementation for ‘out of school’ children (6–10 years) at Anganwadi Centres.
4. Integrated management of common childhood illnesses: Considering that the leading causes of
death beyond the neonatal period are diarrhoea and pneumonia, priority attention must be given to the
management of these two illnesses. Availability of ORS and Zinc should be ensured at all sub-centres and
with all frontline workers. Use of Zinc should be actively promoted along with use of ORS in the case of
diarrhoea in children. Hospital-based care and management of children with severe diarrhoea and
pneumonia is another important aspect of preventing deaths due to these two causes. This includes
training of health service providers (doctors and nurses), especially those at FRUs and District Hospitals.
5. Immunization: To strengthen routine immunization, newer initiatives include provision for Auto
Disable (AD) Syringes to ensure injection safety, support for alternate vaccine delivery from PHC to sub
centres as well as outreach sessions and mobilization of children to immunization session sites by ASHA.
The cold chain must be strengthened through improved procurement, supply and maintenance of
equipment. Also, vaccine management assessment should be conducted and corrective actions instituted.
6. Child Health Screening and Early Intervention Services (RBSK):
Under NRHM, child health screening and early interventions services will be provided by mobile health
teams at block level. These teams will include at least two doctors (MBBS /AYUSH qualified) and two
paramedics who will be adequately trained and provided necessary tools for screening. These teams will
carry out screening of all the children in the age group 0–6 years. The health screening will be conducted
to detect 4Ds: defects, deficiencies, diseases, development delays including disabilities.
THROUGH THE REPRODUCTIVE YEARS:
Priority interventions
1. Community-based promotion and delivery of contraceptives
2. Promotion of spacing methods (interval IUCD)
3. Sterilization services (vasectomies and tubectomies)
4. Comprehensive abortion care (includes MTP Act)
5. Prevention and management of sexually transmitted and reproductive infections (STI/RTI)
1. Community based doorstep distribution of contraceptives: To improve access to contraceptives by
eligible couples, the services of ASHAs are utilised to deliver contraceptives at the doorstep of
households. ASHA charges a nominal amount from beneficiaries for her effort to deliver contraceptives at
the doorstep, that is, INR 1 for a pack of 3 condoms, INR 1 for a cycle of OCPs and INR 2 for a pack of
emergency contraceptive pills (ECP).
 2. Promotion of spacing methods (interval IUCD): Introduction of a new IUCD of five years duration;
post-delivery IUCD insertion; counsellors in District Hospitals and high case load facilities and training of
health personnel in IUCD insertion at all levels of health facilities are the key measures taken for promotion
of spacing methods. Availability of IUCD 380 A (that provides protection for over 10 years) and ‘fixed day
services’ at all facilities are to be ensured.

3. Sterilization services: Important steps include promotion of non-scalpel vasectomy for increasing male
participation. Other steps include the emphasis on Minilap tubectomy services, accreditation of private
providers and NGOs for service delivery, and increasing the pool of trained service providers (Minilap,
Laparoscopic sterilization and non-scalpel vasectomy).

4. Comprehensive abortion care: The strategies for providing safe abortion services are the provision of
Manual Vacuum Aspiration (MVA) facilities and medical methods of abortion in 24 X 7 Primary Health
Centres. The comprehensive Medical Termination of Pregnancy (MTP) services are to be made available at
all District Hospitals and Sub-district level hospitals with priority given to ‘delivery points’, and also by
encouraging private and NGO sector to provide quality MTP services.

5. Management of sexually transmitted and reproductive tract infections (RTI and STI):
Controlling STI/RTI helps decrease HIV infection rates and also provides a window of opportunity for
counselling about HIV prevention and reproductive health. These services are to be provided at all CHCs and
FRUs, and at 24 X 7 PHCs. Convergence with the National AIDS Control Programme (NACP) is essential
for the provision of services for case management, laboratory services, HIV counselling services, anti-
retroviral drugs, equipment and blood safety. For syndromic management of RTIs/STIs, availability of
colour-coded kits, RPR testing kits for syphilis and also whole blood finger prick testing for HIV should be
ensured first at the delivery points and then at all levels of facilities and with service providers trained in
syndromic management of STI and RTI.

Quality Indicators of RCH program

Following are the quality indicators used to monitor and evaluate RCH programme through monthly reports:
1. Number of antenatal cases registered 2. Number of pregnant women who had antenatal checkups.
Number of high risk pregnant women referred
4. Number of pregnant women who had 2 doses of TD
5. Number of pregnant women under prophylaxis and treatment of anaemia
6. Number of deliveries by trained and untrained attendants
7. Number of cases with complications referred to PHC/FRU
8. Number of newborn with birth weight recorded.
9. No. of RTI/STD cases detected, treated and referred
10. No. of children fully immunized
11. No. of adverse reactions reported after immunization
12. No. of cases of ARI and diarrhoea under 5yrs
13. No. of cases motivated and followed for contraception.

RMNCAH+N PROGRAMME
RMNCAH+N launched in Feb 2013, major Strategic interventions under RMNCAH+N are-
1. Reproductive: Basket of choices, home delivery of contraceptives, enhanced compensation schemes,
Mission Parivar Vikas
2. Maternal: Surakshit Matritva Aashwashan (SUMAN), Janani Suraksha Yojna (JSY), Janani Shishu
Suraksha Karyakram (JSSK), LaQshya, Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA),
Midwifery, FRUs, MCH Wings etc
3 . Newborn: Facility based Newborn Care (FBNC), Home Based Newborn Care (HBNC), Home based
care of young child (HBYC), Immunization, Promotion of breast feeding etc.
4. Child: Immunization, Rashtriya Bal Swastya Karyakram (RBSK), Diarrhoea control, Social Awareness
and Action to Neutralise Pneumonia succesfully (SAANS), NDD etc
5 . Adolescent: Rastriya Kishore Swasthya Karyakram (RKSK), Adolescence Friendly Health Services
(AFHS), Mentrual Hygiene Scheme (MHS), School Health and wellness Ambassador Initiative etc
6. Nutrition: Mothers Absolute Affection (MAA) programme, Lactation management Centres (LMC),
Anemia Mukt Bharat strategy (AMB), Poshan Abhiyan, National Deworming Day (NDD), Vitamin A
supplementation, Nutrition Rehabilitation Centre (NRC), Intensified Diarrhoea Control Fortnight, Integrated
Child Development Services (ICDS) etc
1. Mothers Absolute Affection (MAA) Programme
The Mothers Absolute Affection (MAA) programme was launched to promote breastfeeding and improve
maternal and child health. Aim is to create awareness about the importance of breastfeeding, especially
exclusive breastfeeding for the first six months of a child's life. The program focuses on:
 Training healthcare providers to support mothers in breastfeeding practices.
 Involving communities to promote breastfeeding through awareness campaigns.
 Establishing lactation management centers to provide guidance and support to mothers facing
challenges with breastfeeding.
2. Lactation Management Centres (LMC)
Lactation Management Centres (LMC) are specialized facilities aimed at supporting breastfeeding mothers.
These centers provide:
 Counseling Services on breastfeeding techniques and common issues such as latching difficulties and
milk supply concerns.
 Educational sessions for mothers and families on the benefits of breastfeeding and proper techniques.
 Creating a community of breastfeeding mothers for sharing experiences and advice.
3. Anemia Mukt Bharat Strategy (AMB)
Anemia Mukt Bharat strategy is implemented to reduce anaemia among six beneficiaries age group - children
(6-59 months), children (5-9 years), adolescents (10-19 years), pregnant women, lactating women and in
women of reproductive age group (15-49 years)
Age group Dose and Regime for IFA supplementation
6 – 59 months of age - Biweekly, 1 ml IFA syrup (20 mg elemental Iron + 100 mcg of FA)
5- 10 years children Weekly, 1 IFA tablet (45 mg elemental Iron + 400 mcg FA, pink color
School going & Out of Weekly, 1 IFA tablet (60 mg elemental iron + 500 mcg FA, blue color
school adolescent girls
and boys(10-19 yr.)
Women of Weekly, 1 IFA tablet (60 mg EI+ 500 mcg FA, red color)
reproductive age
20-49 years
Pregnant women and - Daily, 1 IFA tablet (60 mg EI+ 500 mcg FA, red color) starting from the fourth
lactating mothers month of pregnancy, continued throughout pregnancy and to be continued for 180
(0-6 months child) days, post-partum
- In the pre-conception period and upto the 1st trimester 400 mcg of FA tablets,
daily
4. Poshan Abhiyan (National Nutrition Mission) aims to improve nutritional outcomes for children,
adolescents, and women. Its objectives include:
 Reducing Malnutrition by targeting stunting, undernutrition, anemia, and low birth weight.
 Involving various sectors such as health, education, and women and child development to address
malnutrition holistically.

5. National Deworming Day (NDD) aimed at reducing the prevalence of soil-transmitted helminths (STH)
among children. The program is conducted twice a year (10th Feb &10thAug) every year and focuses on:
 children aged 1 to 19 years, especially in schools and anganwadis.
 Administering deworming tablets (Albendazole) to children to eliminate intestinal worms, which can
cause malnutrition and hinder growth and development.
 Educating parents and communities about the importance of deworming and maintaining hygiene to
prevent worm infections.
6. Vitamin A Supplementation aimed at preventing vitamin A deficiency, which can lead to severe health
issues, including blindness and increased susceptibility to infections. Key aspects of the program include:
 Focused on children aged 6 months to 5 years, as well as postpartum mothers.
 Conducting awareness campaigns to educate families about the importance of vitamin A for child
health and nutrition.
 Coordinating with immunization and nutrition programs to ensure comprehensive health coverage.
7. Nutrition Rehabilitation Centre (NRC) specialized facilities to treat children suffering from severe acute
malnutrition (SAM). The objectives of NRCs include:
- Providing therapeutic feeding and medical treatment for children with SAM, including those with
complications.
- Engaging parents and caregivers in the treatment process to ensure continuity of care, education & guidance
on infant and young child feeding practices, hygiene, and nutrition to prevent future malnutrition.
- Monitoring and Follow-up

8. Intensified Diarrhoea Control Fortnight (IDCF) aimed at reducing morbidity and mortality due to
diarrheal diseases among children under five. Key components of the program include:
- Educating communities about the prevention and management of diarrheal diseases, emphasizing the
importance of hygiene, sanitation, and safe drinking water.
- Promoting the use of ORS along with encouraging breastfeeding to treat dehydration caused by diarrhea.
- vaccination against rotavirus, which is a leading cause of severe diarrhea in children.
9. Integrated Child Development Services (ICDS) aimed at improving the nutritional and health status of
children under six years and their mothers. Key features of the ICDS include Supplementary nutrition,
Immunization, Health check-up, Referral services, Nutrition & health education, Pre-school non-formal
education.

ROLE OF NURSE IN RCH PROGRAMME

1. AS SERVICE PROVIDER
a) Essential new-born & under 5 care
• Provision of ante natal care.
• Monitoring the growth of the foetus & its well being
• Supplementation of requisite vitamins & micro-nutrients.
• Provision of health aspects related to new-born
• Promotion of good delivery practices.
• Promotion of breast feeding & maternal bonding.
• Promotion of optimal new-born care including clean delivery practices, institutional delivery, provision of
warmth, care of umbilical cord, prevention of any kind of infection, periodic new-born assessment.
• Ensuring appropriate immunization services.
• Screening for mal formations, congenital anomalies & other deviations.
• Promotion of child rearing practices.
• Periodic growth, development & milestone monitoring.
• Promotion of good child rearing practices.
• Promotion of school enrollment & Anganwadi enrollment.
• Provision of de-worming services & nutritional supplementation services.
• Promoting enrollment of children in schools.
• Implement ICDS initiatives. Co-ordinate & translate the ANP.
• Co-ordinate with like,minded agencies WHO, UNICEF, translate their initiatives relevant to U5 care.
• Promote baby friendly hospital initiatives.
• Promote functioning of well baby clinic & child guidance clinic.
• Implement constitutional rights of children.
• Encourage funding agencies to provide fund for children development activities.
• Check out relevant policies for children welfare.
b) Services for mothers
The Community Health Nurse Ensure The Implementation of Initiatives Of CSSM & RCH Prog
• Promote & implement good perinatal care
• Promote institutional deliveries
• Promote delivery by trained personnel
• Provide optimal ante natal care
• Ensure clean delivery table, clean hands, clean cord, clean stump, clean scissors, & clean delivery
practices.
• Promote & maintain optimal delivery progress practices such as right identification of stage of delivery,
progress of delivery, fetal heart rate monitoring, monitoring of vital signs during delivery, episiotomy
& appropriate mode of delivery of the baby.
• Provision of immediate post natal care.
• Promote breast feeding & maternal bonding.
• Monitoring of post natal care, abnormalities of the post natal period. Examine lochia, involution pattern of
the uterus.
• Assess for feeding difficulties. Promote iron & calcium supplementation. Monitor & promote balanced
diet & good dietary habits.
• Monitor for post natal blues.
• Encourage plenty of fluids & roughage diet.
• Promote adoption of contraception & family planning practices.
• Educate the mother on the importance of child rearing & selfcare practices including diet, exercise &
sleep.
• Encourage the mother on the importance of postnatal check-ups (minimum 2 visits within 42 days of
delivery)
c) Reproductive health
• Identify demographic characteristics of the adolescents & adult population & maintain data base
• Identify target groups & advocate the pertinent family planning methods.
• Health educate sexually active population on the STD & means to prevent them
• Screen for sexually transmitted disease & take necessary action.
• Promote the concept of single partner among sexually active population.
• Promote the usage & distribution of condoms. Promote & familiarize community about contraceptive
methods
• Promote & implement the sex education in school & collegiate curriculum Implement the reproductive
health initiatives implemented by the RCH programme.

2. AS AN ADMINISTRATOR
• Evolve policy related to RCH.
• Serve as an information provider to policy makers in relation to RCH services.
• Serve as a liaison with the Govt, community & NGO in organizing & implementing RCH services.
• Develop counseling & RCH assistance network in the state
• Chalk out specific policies on maintenance & establishment of institutions catering RCH
services.
• Involve other sectors in the provision of RCH services. Develop RCH advisory committee at all
levels
• Co-ordinate the state RCH activities with the RCH activities of the nation Co-ordinate with allied systems
of medicine in the provision of RCH care.
• Translate & monitor the initiatives of CSSM & RCH programme. •
Reserve financial packages for RCH services.
• Amend policies & legislations to suit the existing RCH scenario of the nation. Create & monitor the FRU
at primary, secondary & tertiary units.
• Allocate separate budget for RCH services.
• Define job description for health manpower employed to render RCH services.
3. AS AN EDUCATIONIST
• Organize training programme for health care professionals.
• Conduct workshops & conferences relating to RCH care & sensitize the community, health care
professionals & policy makers.
• Design curriculum in medical & para medical curriculum incorporating aspects of RCH
services.
• Design health education materials & distribute.
• Develop separate channels in order to sensitize the public on RCH services.
• Practice counselling for eligible couples on the range of RCH services.
4. AS A RESEARCHER
• Identify researchable areas in RCH & conduct research.
• Pool grant in aids to support research activities in the areas of RCH services.
• Support research scholars undertaking research in the area of RCH.
• Co-ordinate & network research activities.
• Design models based on research findings.
CONCLUSION

RCH Programme is a comprehensive approach that recognises the unique health needs of women, children
and adolescents throughout their life stages. It addresses reproductive health, maternal health, newborn
health, adolescence health, nutrition, primary healthcare, equity and rights. By implementing this approach,
countries can work towards achieving better health outcomes and reducing disparities in healthcare access
and quality.
BIBLIOGRAPHY

1. Kishore’s. J, National Health Programes of India, 14th Edition, 2022.

2. Park K., Textbook of Preventive And Social Medicine 23rd Edition/2017.
3. Gulani, K.K Community Health Nursing: Practices And Principles, Kumar Publishers
4.
https://www.nhp.gov.in/reproductive-maternal-newborn-child-and-adolescent health_pg
5. https://gmch.gov.in/estudy/e%20lectures/Community%20Medicine/Reproductive%20&%20Child%20
Health.pdf