RCH PROGRAMME

IN INDIA

Dr. Shweta Prabhakar

Dr.RML Hospital

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• Every minute in the world

• 380 women get pregnant

• Out of this 190 are unplanned

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• Every minute in the world

• 110 women experience pregnancy related

complication.
• 40 women have an unsafe abortions.
• 1 women dies from a pregnancy related
issue.

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 Historical perspective
• 1952-India was the first country in the
world to launch a National Family Planning
Programme.
• 3rd Five year plan:-clinic based approach

extension education approach

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 Contd…
• 4th Five Year plan:-NFPP was made an
integral part of MCH activities.
• Since 7th Five year plan : Focus on MCH ,
Education & birth spacing.
• 8th Five year plan:-National CSSM
launched.
• 1994- ICPD at cairo……recommended
RCH

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 M ILES STONE IN M CH CARE IN INDIA
• 1880 – ESTABLISHM EN T O F TRAINING O F D AIS IN AM RITSTAR
• 1902 - 1st M ID W IFERY ACT TO PROM O TE SAFE DELIVER Y
• 1930 - SETTING UP O F ADVISORY COM M ITTEE ON M ATER NAL
M ORTALITY .
• 1946 - BHORE COM M ITTE E R ECOM M ENDATION ON
COM PREHEN SIV E & INTEGR ATED H EALTH CA RE
• 1952 – PRIM ARY HEA LTH CEN TER N ET W ORK & FAM ILY PLANNING
PROGRAM M E
• 1956 – M CH CENTER S BECOM E INTEGRAL PA RT O F PHC S
• 1961 - DEPAR TM ENT OF FAM ILY PLANNING CR EATED
• 1971 – M TP ACT
• 1974 – FAM ILY PLANNING SERVICES INCO RPOR ATED IN M CH CARE
• 1977 – RENAM ING FAM ILY PLANNING TO FAM ILY W ELFAR E
• 1978 – EXPANDED PROGRAM M E ON IM M UNIZA TION
• 1985 – UNIVERSA L IM M UNIZA TION PROGRAM M E
• 1992 – CHILD SU RVIVA L& SAFE M OTHERHOO D PROGRAM M E
• 1996 – TARGET FREE A PPRO A CH
• 1997 – RCH PROGRAM M E PHA SE -1
• 2005 – RCH PROGRAM M E PHA SE -2

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RCH – Ι PROGRAMME

15.10. 1997

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 RCH Programme
• Based on RCH/Differential approach.
• Paradigm shift from target oriented to TFA
• This focused on beneficiaries and
responding to broader reproductive health
needs identified by the communities.

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Vertical Program m es Integrated Service Delivery

Cam p O riented Client O riented

Target O riented G oal O riented

Q uantity O riented Q uality O riented

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 The Paradigm Shift
Item Previous Approach New approach

Goal Two child norm Enable clients to meet

their goals
Approach Top down Bottom up

Service Family planning Full range of MCH

Quality Not cared High quality

Attitude to client Motivate , persuade Listen, assess need ,

inform and advice
Performance Targets Quality of care, client
Monitoring satisfaction coverage
measures
Accountability To bureaucracy To client and community

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 Safe M otherhood Services
- Essential Care for All Child Survival
- Early Identification of Com plications Services
- Em ergency S ervices those w ho are in need

Fam ily W elfare

- Increased access to H ealthy Prevention and
Contraceptives M other M anagem ent of
&
- Safe Abortion Child R TI /STI
Services

Adolescent Health Care and

Fam ily Life Education

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 RCH Package of services
For Mothers:-
• Early Registration
• ANC = or >3 visits
• Home based PNC
• MTP facilities
• Referrals to FRUs
• Institutional deliveries

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 Contd….
For New born:-
• Skilled care at birth
• IMNCI
• Immunization
Other services:-
• Family planning services
• Adolescent health
• RTIs & STIs.

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 COMPONENTS OF RCH-I
• Prevention and management of unwanted pregnancy(MTP,
IUD insertion) at sub-centre and PHC level.
• Maternal care that includes antenatal, delivery, and
postpartum services.
• FRUs are set-up to provide CEmONC.
• Child survival services for newborns and infants
• Management of RTIs and STIs at district and sub-district
level.
• Improving the Out reach of services to vulnerable group.

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 RCH-I
• Based on CBR & Female literacy Rate, all
districts are divided into:
• Category A(58)
• Category B(184)
• Category C(265)

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 RCH Package
• Comprehensive – Limited application.

• Essential – Nation wide Implementation.

(excluding gynecological problems ,
cancer screening and treatment)

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 Interventions in all districts
• Child survival interventions
• Safe motherhood interventions
• TFA
• Training
• IEC activities
• RCH package for urban slums & Tribal area
• Local Capacity Enhancement.
• Adolescent health and reproductive hygiene.
• RTI /STD clinics at DH
• Safe abortions at PHCs
• Enhanced community participation through Panchayats , women groups and
NGOs .

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 Safe Mother Hood
• Essential OC.
• Emergency OC.
• 24 hr delivery services at PHC/CHCs.
• Control of RTI and STD.
• Drugs and Equipment kits.
• Essential New Born Care.

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 Contd…
• ANC
• Intra Natal care
• Post Natal care

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 CHILD SURVIVAL ELEMENTS
• Essential New Born Care
• Prevention and management of vaccine
preventable disease
• Urban measles campaign
• Neonatal tetanus elimination
• Surveillance of vaccine preventable diseases
• Cold chain system
• Polio eradication : pulse polio programme
• ARI control programme
• Diarrhea control programme and ORS programme
• Prevention and control of Vitamin A deficiency
among children
• Baby Friendly Hospital Initiative (BFHI)

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 NEW STRATEGY

• EMPOWERED ACTION GROUP HAS BEEN CONSITUTED

on 20.03.2001
• TRAINING OF DAIS IN 156 DISTRICTS 18 STATES/UTs 2001-
2002
• RCH CAMPS & RCH OUT REACH SCHEME
• GADCHIROLI MODEL TO TAKE CARE OF HOME BASED
NEONATEL CARE IN 2002
• KANGAROO MOTHER CARE TO TAKE CARE OF LOW
BIRTH WEIGHT INFANTS
• BORDER DISTRICT CLUSTER STRATEGY – 49 DISTRICTS/17
STATES
• INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS
STRATEGY TO TAKE CARE OF SICK NEWBORNS

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RCH - II PROGRAMME

01-04-2005

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 Objectives of RCH-II
• Immediate :-
– Improve routine immunization coverage
– Reduce unmet need for contraception
• Medium :-
– To bring down TFR to replacement levels by
2010
• Long term:-
– Stable population by 2045

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 SPECIFIC OBJECTIVES
(11TH FIVE YR PLAN & NPP 2000)
Reduce
Population growth 21.34%(1991-2001) 16.2% (2001-2010)
IMR 60/1000LB (SRS 2003) <30/1000LB ( 2010)
TFR 2.7(NFHS-3) 2.1 (2010)
MMR 407 /1lac (SRS1998) <100/1lac
Improve /raise
Sex ratio 927 935 (2011-2012)
ANC coverage 44.5%(RHS-2002-2003) 89% (2010)
Institutional Deliveries 39.8% (RHS-2002-03) 80% (2010)

Immunisation coverage 48.2%(RHS-2002-2003) 100% in 2010

CPR 44.8%(RHS-2002-2003) 65% in 2010

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 THE 5 YEAR PHASE OF RCH II

VISION To bring about outcomes as

envisioned in the
1. Millennium Development Goals
2. The National Population Policy 2000
(NPP 2000)Goals
3. The Tenth Plan Goals
4. The National Health Policy 2002
5. and Vision 2020 India

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 Major strategies in RCH II
• Essential obstetric care
– Institutional delivery
– Skilled attendant at delivery
• Emergency obstetric care
– FRUs
– Round the clock delivery service at PHC &
CHCs
• Strengthening referral system

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 New Initiatives
• Training of MBBS doctors
• Setting up a blood storage system at
FRUs
• JSY.
• Vandemataram scheme.
• Safe abortion services
– Medical method of abortion.
– MVA.

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 JSY (JANANI SURAKSHA
YOJNA)
• 100% centrally sponsored scheme
• Under NRHM:-Integrates the benefits of cash Assistance
with institutional care during Antenatal , delivery and
immediate postpartum care.
• Eligibility :-
– 19yr and above, both rural &urban
– BPL household
– Upto first 2 live births
• ASHA Package is available in LPS.

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 ADOLESCENT HEALTH
• Issues :-
• Teenage pregnancy
• Anemia
• Menstrual disorders STI/RTIs
• Strategy :-
– Incorporation of AH issues in all RCH training
programme and BCC material
– Special clinics can be organised wkly/mthly at
sub-centre , PHCs/CHCs

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Infrastructure strengthening for service
delivery
a) Construction of HSC buildings where HSCs are
currently functioning in rented premises
b) Rebuilding HSCs which are unfit for occupation.
c) Taking up of repairs/renovation and provision of
water supply/electrical works to PHCs/HSCs.
d) Need-based supply of equipment/furniture to the
HSCs and PHCs as per the standard list including gas
connections.
e) Provision of Cell phones to HSCs where large
number of deliveries take place.
f) Provision of telephones to PHCs

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TRAINING
a) Skill upgradation training with focus on
improving/upgrading the skills of health care
providers.
b) Integrated skill training for peripheral health
functionaries such as VHNs, SHNs, medical officers and
health inspectors.
c) Improving managerial and communication skills of
health staff.

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HEALTH MANAGEMENT INFORMATION SYSTEMS
Introduction of IT-enabled HMIS for planning and monitoring health
services at the State/District /Block levels
STRENGTHENING OF TEACHING INSTITUTIONS
Strengthening the facilities at teaching institutions for providing
optimum obstetric, family welfare, neonatal child health services.
ESTABLISHING URBAN HEALTH POSTS
To provide an integrated and sustainable system for primary health
care service delivery catering to the requirements of urban slum
population and other vulnerable groups

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 BCC
• BCC in RCH will be Motivational than
Prescriptional.
• A combination of mass media , social
mobilization and interpersonal communication
will be used.
• Priority areas:-
– IMR
– MMR
– TFR
• Target groups in EAG states , urban slums &
N-E states.

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BEHAVIOURAL CHANGE COMMUNICATION
(BCC)
a) Social mobilisation activity against female infanticide and
foeticide by preventive counselling.
b) Formation of HSC, Block, District level committees for saving
female babies.
c) Conducting of Kalaipayanam (travelling street theatre) to
promote social mobilization and to improve health care among
the target population
d) Telecasting of TV serials, Radio broadcasts, wall paintings,
hoardings and glow signs for popularizing health and
reproductive health messages in important places.

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Progress Reporting & Monitoring
• Annual Action Plan
• Monthly Report
• Comparison of performances is done.

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 1728 - FRU

PHC-22928

SUB CENTER-
38044

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 Evaluation
• Census
• SRS
• NFHS
• DLHS
• Health facility survey
• Regional Evaluation Teams
• Population Research centres.

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 ACCESSIBILITY INDICATOR
•No. of eligible couples registered/ANM
•No. of Antenatal Care sessions held as planned
•% of sub Centers with no ANM
•% of sub Centers with working equipment of ANC
•% ANM/TBA without requisite skill
•% sub centers with DDKs
•% of sub centers with infant weighing machine
•% subcenters with vaccine supplies
•% sub centers with ORS packets
•% sub centers with FP supplies

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 QUALITY INDICATOR
•% Pregnancy Registered before 12 weeks
•% ANC with 5 visits
•% ANC receiving all RCH services
•% High risk cases referred
•% High risk cases followed up
•% deliveries by ANM/TBA
•%PNC with 3 PNC visits
•% PNC receiving all counselling
•% PNC complications referred
•% Eligible couple offered FP choices
•% women screened for RTI/STDs
•% Eligible couple counselled for prevention of RTI/STDs
•% ADD given ORS
•% ARI treated
•% children fully immunized

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 IMPACT INDICATOR
•% DEATHS FROM MATERNAL CAUSES
•MATERNAL MORTALITY RATIO
•PREVALENCE OF MATERNAL MORBIDITY
•% LOW BIRTH WEIGHT
•NEO-NATAL MORTALITY RATIO
•PREVALENCE OF POST NATAL MATERNAL MORBIDITY
•% BABY BREAST FEED WITHIN 6 HRS OF DELIVERY
•COUPLE PROTECTION RATE
•PREVALENCE OF TERMINAL METHOD OF
STERILIZATION
•PREVALENCE OF SPACING METHOD
•% ABORTION RELATED MORBIDITY
•PREVALENCE OF ADD
•PREVALENCE OF ARI
•PREVALENCE OF RTI/STDs

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HEALTH FINANCING
The health care expenditure in India
currently stands at 6.1% of GDP.
The total government expenditure on
family welfare has shown an increasing
trend from 4.9 billion in fifth plan (1974-
79) to Rs. 271.25 billion in the tenth plan
(2002-07)
Total outlay for RCH-II is
Rs.40,000crores for five yr pd(2005-
2010)

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THANK
YOU

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