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PRESENTED TO : PRESENTED BY :
MRS. SOMI BALA THOKCHOM MS. SHIVANGI
RMNCH + A
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INTRODUCTION :
Improving the maternal and child
health and their survival are central to
the achievement of national healthgoals under the National Rural Health
Mission (NRHM) as well as the
Millennium Development Goals(MDG) 4 and 5
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PURPOSES OF RMNCH+A :
!he health of an adolescent girl
impacts pregnanc" while the health of
a pregnant woman impacts the healthof the new#orn and the child
High maternal and child mortalit" in
adolescent mothers
!he ris$ of premature deliver" and
%&' dou#les
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RMNCH + A :
!wo dimensions to healthcare
()stages of the life c"cle
(*)places where the care is provided
()!hese together constitute the
+,ontinuum of ,are-
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!his ,ontinuum of ,are approach of
defining and implementing evidence.
#ased pac$ages of services for different
stages of the lifec"cle/ at various levels in
the health s"stem/ has #een adopted under
the national health programme
!his strategic approach is Reproductive/Maternal/ New#orn/ ,hild 0lus
1dolescent Health (RMN,H21)
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!he +0lus- in the strategic approach
denotes the
() Inclusion of adolescence as a
distinct +life stage- in the overall
strateg"3
(*) %in$ing of maternal and child health
to reproductive health
() %in$ing of communit" and facilit".#ased care as well as referrals #etween
various levels of health care s"stem
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!hese provide a strong platform for
deliver" of services across the entire
continuum of careIt reduces duplication of resources
and efforts in the ongoing program
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ituation of Reproductive/
Maternal and ,hild Health in India
*67/888 maternal deaths occurred in *88/
when the glo#al maternal mortalit" ratio
was *8 maternal deaths per 88/888 live#irths
India presentl" accounts for nearl" *89 of
the world-s child deathsNearl" 75 la$h of all glo#al deaths in
children occurs #efore five "ears of age
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Causes fo Ma!e"a# Dea!$s %"
I"&%aMe&%'a# :
Haemorrhage/ mainl" postpartum
(79)epsis (9)
:nsafe a#ortions (69)H"pertensive disorders (59) and
;#structed la#our (59)
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ocial Determinants
Marriage and child#irth at a ver" "oungage
%ess spacing #etween #irths
%ow literac" level among women/ in
particular those #elonging to the rural
settings
High unmet need of contraceptives due to
non.availa#ilit" of services at the
communit" outreach
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Causes Of C$%#& Dea!$s I" I"&%a :
Neonatal causes (5*9) 0neumonia (59)
Diarrhoeal disease (9)
Measles (9) Inia (89)
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(THREE DELAYS):
!he dela" in deciding to see$ care
!he dela" in reaching the appropriate
health facilit"!he dela" in receiving ?ualit" care once
inside an institution
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INDICATORS OF RMNCH+A
STRATEGY :%imited availa#ilit" of s$illed human
resources/ especiall" nurses
%ow coverage of services and of s$illed staff
posting among communities
%ow ?ualit" of training and s$ill #uilding
%ac$ of focus on improving ?ualit" ofservices
Insufficient information/ education on $e"
famil" practices
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GOALS AND TARGETS :
Reduction of Infant Mortalit" Rate
(IMR) to *5 per /888 live #irths #"
*87Reduction in Maternal Mortalit" Ratio
(MMR) to 88 per 88/888 live #irths
#" *87
Reduction in !otal @ertilit" Rate(!@R)
to * #" *87
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TARGETS :
Increase facilities e?uipped for perinatalcare
Increase proportion of all #irths in
government and accredited private
institutions
Increase proportion of pregnant women
receiving antenatal care
Increase proportion of deliveries
conducted #" s$illed #irth attendants
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Increase e>clusive #reast feeding
Reduce prevalence of under.fivechildren who are underweight
Increase ;R use in under.five children
with diarrhoeaReduce unmet need for famil" planning
methods
Reduce anaemia in adolescent girls and
#o"s
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Decrease the proportion of total
fertilit" contri#uted #" adolescents
Increase coverage of three doses of
com#ined diphtheria.tetanus.pertussis(D!0)
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RMNCH+A INTERVENTIONS :
ABORTIONCARE*STI+RTI
MANAGEMENT
POSTPARTUMIUCDAND
STERILI,ATION.
RA0R;D:,!IBA,1RA
SKILLEDOBSTETRICCARE.
IMMEDIATENE-BORNCAREAND
RESUSCITATION.
EMERGENCYOBSTETRICCARE.
PPTCTOFHIV.
0RAGN1N,C 1ND,HI%D &IR!H,1RA
ESSENTIALNE-BORNCARE.
CAREOFSICKNE-BORN.
IMMUNI,ATION.
NA'&;RN 1ND,HI%D,1RA
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AT SUBCENTRE LEVEL :
CHILD HEALTH CARE
FIRST LEVEL ASSESSMENT OFNE-BORN
MICRONUTRIENT
SUPPLEMENTATION
ANTENATALANDPOSTNATALCARE
FULL ANTENATAL CAREPACKAGE
EARLY DETECTION ANDMANAGEMENT OF ILLNESSES.
REPRODUCTIVEHEALTHCARE
FAMILY PLANNINGPREVENTION AND
MANAGEMENT OF STI
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AT COMMUNITY LEVEL :
REPRODUCTIVE
HEALTH
/0 -EEKLY IFASUPPLEMENTATION.
10INFORMATION
ON SE2UALREPRODUCTIVEHEALTH.
30 MENSTRUAL
HYGIENE.
ANTENATA
LAND
POSTNATAL
/0COUNSELLINGON NE-BOFRNCARE ANDBREASTFEEDING.
10 EDUCATE
ABOUTINSTITUTIONALDELIVERY.
30 BIRTH
PREPAREDENESS
CHILDHEALTHC
AR
E
/0 HOME BASEDNE-BORNCARE.
10 ANTIBIOTICFOR SUSPECTED
SEPSIS.
30 USE OF ORSFORDIARRHOEA
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ORDER OF LIFE STAGES FOR
INTERVENTIONS :
ADOLESCENSE
PREPREGNANCY
PREGNANCY
BIRTHNE-BORN
POSTNATALCHILDHOOD
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RMNCH + A INTERVENTIONS :
ADOLESCENCE :
A&o#es'e"! Nu!%!%o" Iron and folic acid
supplementation
Na!%o"a# Io" + I"%!%a!%4e : service pac$age
for the management of anaemia
Iron and folic acid (I@1) supplementation
Improvement in their iron status
!he iron ta#let for adolescents is coloured #lue
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-ee5#6 Io" A"& Fo#%' A'%& Su77#e8e"!a!%o"
S'$e8e :
It aims to cover adolescents enrolled in classBIEII of government/ government aided and
municipal schools as well as +out of school-
girlsupervised administration of wee$l" iron and
folic acid supplements
creening of target groups for moderate andsevere anaemia
&i.annual de.worming (1l#endaFole 488 mg)
,ounselling for improving dietar" inta$e
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A&o#es'e"! F%e" Hea#!$ Se4%'es
9A&o#es'e"! Hea#!$ C#%"%'s0 :1ccess to reproductive and se>ual
health information and services
Including access to contraceptives andsafe a#ortion services/ delivered in an
adolescent.friendl" environment
!his is important for reducingincidences of unplanned and unwanted
pregnancies
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I"fo8a!%o" A"& Cou"se##%" O" A&o#es'e"!
Se;ua# Re7o&u'!%4e Hea#!$ :
%ife $ills Aducation will #e imparted #oth through
educational institutions and in communit" settings
It generate awareness on ris$ factors
Po8o!%o" Of Me"s!ua# H6%e"e A8o" A&o#es'e"!
G%#s I" Rua# I"&%a:
High ?ualit" and safe products are made availa#le
Anvironmentall" safe disposal mechanisms are
made accessi#le
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Pe4e"!%4e $ea#!$ '$e'5u7s a"&
s'ee"%" fo &%seases* &ef%'%e"'6 a"&
&%sa
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PREGNANCY AND CHILDBIRTH :
Pe4e"!%4e use of fo#%' a'%& %" 7e%
'o"'e7!%o" 7e%o& :
0romoting use of folic acid in planned
pregnancies during the peri.conception
phase for the prevention of neural tu#e
defects and other congenital anomalies
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A"!e"a!a# Cae Pa'5ae A"& Ta'5%"
Of H%$ R%s5 Pe"a"'%es :
!o monitor the progress of foetal growth
!imel" identification of complications!o provide emergenc" o#stetric and
new#orn care
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S5%##e& o
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anani hishu ura$sha
ar"a$ram() is an initiative underthe overall um#rella of NRHM that aims
to reduce out.of.poc$et e>penses related
to maternal and new#orn care1#solutel" free and no e>pense deliver"/
including caesarean section
@ree assured transport
Inter.facilit" transfer in case of referrals
Drop #ac$
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E8ee"'6 O
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Pos!7a!u8 IUCD %"se!%o" a"&
s!e%#%>a!%o" :
!rained providers for post.partum I:,D
(00I:,D) insertion
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NE-BORN AND CHILDCARE :
Ho8e
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Fa'%#%!6
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I88u"%sa!%o" :
:niversal Immunisation 0rogrammeincludes vaccines to prevent seven
vaccine preventa#le diseases
(!u#erculosis/ 0olio/ Diphtheria/0ertussis/ !etanus/ Measles/ Hepatitis &)
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REPRODUCTIVE HEALTH :
Co88u"%!6
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Po8o!%o" of s7a'%" 8e!$o&s 9%"!e4a#
IUCD0 :
1vaila#ilit" of I:,D 68 1 and +fi>ed da"
services- at all facilities are to #e ensured
S!e%#%>a!%o" se4%'es :
,ouples who have achieved the desired famil"
siFe
,ompensation is provided for loss of wages to
the #eneficiar" and pa"ments made to the
service provider
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Co87e$e"s%4e a
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Ma"ae8e"! of STIRTI :
!Is and R!Is are associated with anum#er of adverse pregnanc" outcomes
such as
1#ortiontill#irth
0reterm deliver"
%ow #irth weight
0ostpartum sepsis
,ongenital infection
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,ontrolling !IR!I helps decrease HIB
infection rateservices are to #e provided at all ,H,s
and @R:s/ and at *4 E 7 0H,s
@or s"ndromic management ofR!Is!Is/ availa#ilit" of colour.coded
$its/ whole #lood finger pric$ testing for
HIB should #e ensured
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COMMUNITY PARTICIPATION :
Angage women s"stematicall" at the
communit" level
Angage Billage Health anitation andNutrition ,ommittees (BHN,) and
Rogi al"an amiti (R)
:tiliFe the Billage Health and NutritionDa"s (BHNDs)
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Pa'5ae Of Se4%'es I" VHND:
ImmuniFation
1ntenatal care
0ost.natal care including counselling for
contraception
@acilitating access to contraceptive services0rovision of ;R and Jinc for treatment of
childhood diarrhoea
!esting and treatment for anaemia in pregnantwomen
,ounselling on $e" practices for improved
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