MATERNAL AND CHILD HEALTH PROGRAMMES

INTRODUCTION
MOTHERS AND CHLIDERN NOT ONLY CONSTITUTE A LARGE GROUP,BUT THEY ARE ALSO VULNERABLE OR SPECIAL GROUP.THEY COMPRISES 71.4 % OF POPULATION OF THE DEVELPOING COUNTRIES,IN INDIA ,WOMEN OF CHILD BEARING AGE (15-44 YEARS) CONSTITUTE 22.2% AND CHLIDERN UNDER 15 YEARS OF AGE ABOUT 35.3% OF TOTAL POPULATION, TOGTHER 57.7% OF POPULATION CONSISTS OF MOTHERS AND CHLIDERNS. THE PRESENT STRATEGY IS TO PROVIDE MOTHER AND CHLID HEALTH SERVICES AN INTEGARTED PACKAGE OF ESSENTIAL HEALTH CARE ALSO KNOWN AS PRIMARY HEALTH CARE.

MOTHER AND CHLID ONE UNIT

1. DURING THE ANTENATAL PERIOD THE FOETUS IS PART OF MOTHER. 2. CHLID HEALTH IS CLOSELY RELATED TO MATERNAL HEALTH. 3. CERTAIN DISEASES AND CONDITIONS OF THE MOTHER DURING PREGNANCY ARE LIKELY TO HAVE EFFECT UPON THE FOETUS. 4. AFTER BIRTH THE CHILD IS DEPENDENT ON MOTHER. 5. THE MOTHER IS ALSO THE FIRST TEACHER OF CHLID.

DEFINITION OF MATERNAL AND CHLID HEALTH

MATERNAL AND CHLID HEALTH REFERS TO THE PROMOTIVE,PREVENTIVE ,CURATIVE AND REHABLITATIVE HEALTH CARE FOR MOTHERS AND CHLIDERN ,CHILD HEALTH, FAMILY PALNNING, SCHOOLHEALTH, HANDICAPPED CHILDEREN ,ADLOSCENCE AND HEALTH ASPECTS OF CHLIDERN IN SPECIAL SETTING SUCH AS DAY CARE.

OBJECTIVES OF MCH SERVICES

REDUCTION OF MATERNAL ,PERINATAL, INFANT, AND CHILDHOOD MORTALITY AND MORBIDITY PROMOTION OF REPRODUCTIVE HEALTH PROMOTION OF PHYSICAL AND PSYCHOLOGICAL DEVELPOMAENT OF THE ADLOSECENT WITHIN THE FAMILY.

MCH SERVICES
ANTENATAL CARE: THE CARE OF THE WOMEN DURING PREGNANCY. AIM THE PRIMARY AIM OF ANTENATAL CARE IS TO ACHIEVE AT THE END OF A PREGNANCY A HEALTHY MOTHER AND A HEALTHY BABY.

OBJECTIVES OF ANTENATAL CARE

TO PROMOTE PROTECT AND MAINTAIN THE HEALTH OF THE MOTHER DURING PREGNANCY TO DETECT: HIGH RISK CASES AND SPECIAL ATTENTION TO FORESEE COMPLICATIONS AND PREVENT THEM TO REMOVE ANXIETY AND DREAD ASSOCIATED WITH DELIVERY TO REDUCE MATERNAL AND INFANT MORTALITY AND MORBIDITY TO TEACH THE MOTHER ELEMENTS OF CHILD CARE, NUTRITION ,PERSONAL HYGIENE AND ENVIRONMENTAL SANITATION TO SENSITISE THE MOTHER TO NEED FOR FAMILY PALNNING TO ATTEND TO THE UNDER FIVES ACCOMPANYING THE MOTHER

ANTENATAL SERVICES.
1.ANTENATAL VISITS: MOTHER SHOULD ATTEND THE ANTENATAL CLINIC ONCE A MONTH DURING THE FIRST 7 MOTHS,TWICE A MONTH,DURING THE NEXT MOTH AND THERE AFTER ONCE IN WEEK IF EVERYTHING IS NORMAL, A MINIMUM OF 3 VISITS COVERING THE ENTIRE PEROID OF PREGNANCY SHOLUD BE 1ST VISIT AT 20TH WEEKS 2ND VISIT AT 30TH WEEKS 3RD VISIT AT 36TH WEEKS PREVENTIVE SERVICES FOR MOTHERS( BEFORE DELIVERY) a. THE FIRST VISIT: - HEALTH HISTORY - PHYSICAL EXAMINATION - LABORATORY EXAMINATION b. ON SUBSQUENT VISITS: -PHYSICAL EXAMINATION - LABORATORY TESTS

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c. IRON AND FOLIC ACID SUPPLEMENTATION d. IMMUNISATION AGAINST TETANUS e. INSTRUCTION ON NUTRITION, FAMILY PLANNING ,SELF CARE,DELIVERY AND PARENTHOOD f. HOME VISITING BY A FEMALE HEALTH WORKER G. REFERRAL SERVICES RISK APPROACH FOR HIGH RISK CASES LIKE ELDERLY PRIMI, MALPRESENTATIONS, ANTEPARTUM HEMORRAHAGE, PRE-ECLAMPSIA, ANAEMIA, TWINS, H\O PREVIOUS CEASAERIAN DELIVERY, AND GENERAL DISEASES LIKE KIDNEY DISEASE, DIABETUS, TUBERCULOSIS, LIVER DISEASES ETC MAINTENANCE OF RECORDS: THE ANTENATAL CARE IS PREPARED AT THE FIRST EXAMINATION, IT INCULDE REGITRATION NUMBER, IDENTIFYING DATA, PREVIOUS HEALTH HISTORY, AND MAIN HEALTH EVENTS. HOME VISITS: IS BACK BONE OF MCH SERVICES. HOME VISIT BY THE HEALTH WORKER FEMALE OR PUBLIC HEALTH NURSE.

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2.PRENTAL ADVICES:
A. DIET: LACTATION DEMAND ABOUT 550 Kcal A DAY. TOTAL WEIGHT GAIN 12KG , AT 1ST TRIMESTER 2 KG, 2ND TRIMESTER 5 KG& 3RD TRIMESTER 5KG OF WEIGHT PERSONAL HYGIENE: PERSONAL CLEANLINESS REST AND SLEEP: 8 HRS SLEEP AND 2 HRS REST BOWELS EXERCISE SMOKING AND ALOCOHOL SHOULD BE AVOIDED DENTAL CARE SEXUAL INTER COURSE: RESTRICTED ESPECILLY DURING LAST TRIMESTER DRUGS MOST SERIOUS EFFECT ON FOETUS SHOLUD BE AVOIDED WARNING SIGNS: SWELLING OF FEET, FITS, HEADCHE,BLURED VISION BLEEDING OR DISCHARGE PER VIGNA CHILD CARE SPECIAL CLASSESS MOTHER CARFT EDUCATION CONSISTS OF NUTRITION EDUCATION ADVICES ON HYGIENE AND CHILD REARING ETC.

B. C. D.
E.

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3.SPECIFIC PROTECTION:
ANAEMIA NUTRITIONAL DEFICIENCES TOXEMIAS OF PREGNANCY TETANUS SYPHILLIS GERMAN MEASLES Rh STATUS HIV INFECTION 4.MENTAL PREPARATION: MOTHER CRAFT CLASSES AT MCH CENTRES HELP A GREAT DEAL IN ACHIVING THIS OBJECTIVE 5.FAMILY PLANNING 6. PAEDIATRIC COMPONENT: ALL ANTENATAL CLINICS TO PAY ATTENTION TO THE UNDER-FIVES ACCOMPANYING THE MOTHERS

INTRANATAL CARE
CHILD BIRTH IS A NORMAL PHYSIOLOGICAL PROCESS ,BUT COMPLICATIONS MAY ARISE, SEPTICEMIA MAY ARISE RESULT FROM UNSKILLED AND SEPTIC MANIPULATIONS, AND TETANUS NEONATARUM FROM THE USE OF UNSTERILED INSTRUMENTS.THE EMPHASIS ON THE CLEANLINESS.IT ENTAILS- CLEAN HANDS AND FINGERNAILS - CLAEN SURFACE FOR DELIVERY - CLEAN CUTTING AND CARE OF CORD

AIMS OF INTRANATAL CARE

THOROUGH ASEPSIS DELIVERY WITH MINIMUM INJURY TO THE INFANT AND MOTHER READINESS TO DEAL WITH COMPLICATIONS SUCH AS PROLONGED LOBOUR, ANTEPARTUM HAEMORRAHGE,CONVULSIONS,MALPRESENTATION S,PROLAPSE OF CORD ETC CARE OF THE BABY AT DELIVERY-RESUSCITATION, CARE OF THE CORD, CARE OF THE EYES.

INTRANATAL CARE INCLUDES.

1.DOMICILLARY CARE: MOTHER WITH NORMAL OBSTETRIC HISTORY MAY BE ADVISED TO HAVE THEIR CONFINEMENT IN THEIR HOMES,PROVIDED THE HOME CONDITIONS ARE SATISFACTORY. IN SUCH CASES THE DELIVERY MAY BE CONDUCTED BY THE HEALTH WORKER FEMALE OR TRAINED DAI THIS IS KNOWN AS DOMICILLARY MIDWIFERY SERVICE.

ADVANTAGES OF DOMICILLARY SERVICE: -MOTHER DELIVERS IN THE FAMILIAR SURROUNDINGS OF HER

HOME -LESS CHANCE OF CROSS INFECTION -MOTHER IS ABLE TO KEEP AN EYE UPON HER CHILDREN AND DOMESTIC AFFAIRS.

DISADVANTAGES:
-MOTHER MAY HAVE LESS MEDICAL AND NURSING SUPERVISION -MATHER MAY HAVE LESS REST -MOTHER RESUME HER DUTIES TOO SOON -DIET MAY BE NEGLECTED

RESPONSIBILITIES OF FEMALE HEALTH WORKER IN DOMICILLARY CARE

SHE SHOULD BE ADEQUATELY TRAINED TO RECOGNISE THE DANGER SIGNALS ARE SLUGGISH PAINS OR RUPTURE OF MEMBRANES PROLAPSE OF THE CORD OR HAND MECONIUM STAINED LIQUOR EXCESSIVE SHOW OR BLEEDING DURING LABOUR LATE PALCENTAL SEPARATION POST-PARTUM HEMORRAHGE OR COLLAPSE INCREASED TEMPERATURE

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2.INSTITUTIONAL CARE:
AT ABOUT 1% OF DELIVERIRES TEND TO BE ABNORMAL, REQURING THE SERVICES OF A DOCTOR INSTITUTIONAL CARE IS RECOMMENDED FOR ALL HIGH RISK CASES AND WHERE HOME CONDITIONS ARE UNSUITABLE. 3. ROOMING IN: KEEPING THE BABY S CRIB THE SIDE OF THE MOTHER S BED IS CALLED ROOMING-IN. IT ALSO ALLAYS THE FEAR IN THE MOTHER MIND THAT THE BABY IS NOT MISPALCED IN THE CENTRAL NURSERY.

3.POSTNATAL CARE
CARE OF THE MOTHER( AND THE NEW BORN ) AFTER DELIVERY IS KNOWN AS POST-PARTAL CARE. OBJECTIVES : TO PREVENT COMPLICTIONS OF THE POSTPARTAL PERIOD. TO PROVIDE CARE FOR THE RAPID RESTORATION OF THE MOTHER TO OPTIUM HEALTH. TO CHECK ADEUQUACY OF BREAST FEEDING. TO PROVIDE FAMILY PLANNING SERVICES. TO PROVIDE BASIC HEALTH EDUCATION TO MOTHER\FAMILY.

COMPILCATIONS OF POSTPARTUM PERIOD

PUERPERAL SEPSIS THROMBO-PHELBITIS SECONDARY HEMORRAGE URINARY TRACT INFECTION AND MASTITIS SHOULD DETECT EARLY TRAET WITH PROMPT MEASURE. RESTORATION OF MOTHER TO OPTIMUM HEALTH: PHYSICAL: 1. POSTANATAL EXAMINATIONS: SOON AFTER DELIVERY ,THE HEALTH CHECK-UP MUST BE FREQUENT.i.e TWICE A DAY DURING THE FIRST 3 DAYS AND SUBSEQUENTLY ONCE A DAY TILL UMBILICAL CORD DROPS OFF. FHW CHECKS VITALS, BREASTS, CHEK PROGRESS OF NORMAL INVOULTION OF UTERUS,EXAMINES LOCHIA FOR ANY ABNORMALITY, CHECK URINE AND BOWELS AND ADVISES ON PERINEAL CARE

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FURTHER VISITS SHOULD BE DONE ONCE IN 2 OR 3 MONTHS DURING FIRST 6 MONTHS, AND AFTER ONCE IN 2 OR 3 MONTHS TILL THE END OF 1 YEAR. 2.ANAEMIA: ROUTINE Hb ESTIMATION CAN BE DONE WHEN ANAEMIA DISCOVERED.IF ITS THERE CONTINUE TREATMENT FOR 1 YEAR. 3.NUTRITION: THE NUTRITIONAL NEEDS OF THE MOTHER MUST BE ADEQUATELY MET 4.POSTNATAL EXERCISES: IS TO BRING STRECHED ABDOMINAL AND PELVIC MUSCLE BACK TO NORMAL

CONTINUED.
PSYCHOLOGICAL: FEAR AND INSECURITY MAY BE ELIMINATED BY PROPER PRENATAL INSTRUCTION. 3.BREAST FEEDING 4.FAMILY PLANNING: MOTHER SHOULD ATTEND POSTNATAL CONTACTS TO ADOPT A SUITABLE METHOD FOR SPACING THE NEXT BIRTH. 5.BASIC HEALTH EDUCATION: HYGIENE, FEEDING FOR MOTHER AND INFANT,PREGNANCY SPACING, IMPORTANCE OF HEALTH CHECK-UP,BIRTH REGISTRATION.

 EARLY NEONATAL CARE: THE FIRST WEEK OF LIFE THE MOST CRUCIAL PERIOD IN THE OF AN INFANT. OBJECTIVES: 1. ESTABILISH & MAINTAINANCE OF CARDIORESPIRATORY FUNCTIONS 2. MAINTAINANCE OF BODY TEMPERATURE 3. AVOIDANCE OF INFECTION 4. ESTABILISH OF SATISFACTORY FEEDING REGIMEN 5. EARLY DETECTION AND TREATMENT OF CONGENITAL AND ACQUIRED DISORDERS.

NEONATAL CARE

 IMMEDIATE CARE
1.CLEARING THE AIRWAY: TO HELP TO ESTABILISH BREATHING,THE AIRWAYS SHOULD BE CLEARED MUCUS AND OTHER SECRETIONS 2.APGAR SCORE: IT IS TAKEN 1 MINUTE & AGAIN AT 5 MINUTES AFTER BIRTH.
Sign Heart Rate Respiratory Effort Muscle Tone Reflex Response Color Total score=10 Score 0 Absent Absent Flaccid No response Blue, pale Severe depression 0-3 Score 1 Slow (below 100) Slow irregular Some flexion of extremities Grimace Blue, pink extremities blue Mild depression 4-7 Score 2 Over 100 Good crying Active movements Cry Completely pink No depression 7-10

Cont..

3.CARE OF THE CORD: THE CORD SHOULD BE CUT & TIED WHEN IT HAS STOPPED PULSATING. CARE MUST BE TAKEN TO PREVENT TETANUS OF NEWBORN BY UNSTERILISED INSTRUMENTS NAD CORD TIES 4.CARE OF THE EYES: BEFORE THE EYES ARE OPEN, THE LID MARGINS OF THE NEWBORN SHOULD BE CLEANED WITH STERILE WET SWABS, ONE FOR EACH EYE FROM INNER TO OUTER SIDE. 5. CARE OF THE SKIN:THE FIRST BATH IS GIVEN WITH SOAP AND WARM WATER TO REMOVE VERNIX, MECHONIUM AND BLOOD CLOTS.SOME PREFER TO APPLY WARM OIL BEFORE THE BATH.

CONT.
6.MAINTAINANCE OF BODY TEMPERATURE: THE NORMAL BODY TEMPERATURE OF A NEWBORN IS BETWEEN 36.5 deg C TO 37.5 deg C IT IS IMPORTANT THAT IMMEDIATELY AFTER BIRTH TE CHILD IS QUICKLY DRIED WITH A CLEN CLOTH AND WRAPPED IN WARM CLOTH AND GIVEN TO THE MOTHER FOR SKIN-TO SKIN CONTACT AND BRESAT FEEDING. 7.BRAEST FEEDING NEONATAL EXAMINATIONS MEASURING THR BABY : Wt, Ht, HEAD CIRCUMFERENCE IDENTIFICATION OF AT RISK INFANTS LATE NEONATAL CARE

REPRODUCTIVE AND CHILD HEALTH PROGRAMME

DEFINITION
REPRODUCTIVE AND CHILD HEALTH APPROCH HAS DEFINED AS PEPOLE HAVE ABILITY TO REPRODUCE AND REGULATE THEIR FERTILITY , WOMEN ARE ABLE TO GO THROUGH PREGNAANCY AND THEIR BIRTH SAFELY,THE OUTCOME OF PREGNANCY IS SUCCESSFUL IN TERMS OF MATERNAL AND INFANT SURVIVAL AND WELL BEING AND COUPLES ARE ABLE TO HAVE SEXUAL RELATIONS FREE OF FEAR OF PREGNANCY AND OF CONTRACTING DISEASE.

RCH PHASE 1 PROGRAMME INCORPORATED THE 4 COMPONENT

RCH PACKAGE
FAMILY PLANNING CHILD SURVIVAL AND SAFE MOTHER HOOD COMPONENT

CLINET APPROCH TO HEALTH CARE

PREVENTION \ MANAGEMENT OF RTI\STD AIDS

MAIN HIGHLIGHTS OF RCH PROGRAMME ARE

1. THE PROGRMME INTEGRATES ALL INTERVENTIONS OF FERTILITY REGULATION, MATERNAL AND CHILD HEALTH REPRODUCTIVE HEALTH FOR BOTH MEN AND WOMEN. 2. THE SERVICES TO BE PROVIDED ARE CLIENT ORIENTED 3. THE PROGRMME ENVISAGES UPGRADATION OF THE LEVEL OF FACILITIES FOR PROVIDING VARIOUS INTERVENTIONS AND QUALITY OF CARE.THE FIRST REFERRAL UNITS BEING SET UP AT SUB-DISTRICT LEVEL PROVIDE COMPREHENSIVE EMERGENCY OBSTETRIC AND NEW BORN CARE.

CONTINUED. 4.THE FACILITISE OF OBSTETRIC CARE, MTP AND IUD INSERTION IN THE PHCs LEVEL ARE IMPROVED.IUD INSERTION FACILITIES ARE ALSO AVAILABLE AT SUB-CENTRES. 5. SPECIALIST FACILITIES FOR STD AND RTI ARE AVALIABLE IN ALL DISTRICT HOSPITALS AND IN A FAIR NUMBER OF SUB-DISTRICT LEVEL HOSPITALS. 6. THE PROGRAMME AIMS AT IMPROVING THE OUT REACH OF SERVICES PRIMARILY FOR THE VULNERABLE POPULATION.

RCH SERVICES AND MAJOR INTERVENTIONS

1.ESSENTIAL OBSTETRIC CARE: IS TO PROVIDE THE BASIC MATERNITY SERVICES TO ALL PREGNANT WOMEN THROUGH
EARLY REGISTRATION OF PREGNANCY ( WITHIN 12-16 WEEKS)

PROVISION OF MINIMUM 3 ANTENATAL CHECKUPS BY ANM PROVISION OF SAFE DELIVERY AT HOME OR INSTITUTION PROVISION OF 3 POST NATAL CHECK UPS TO MONITOR THE POSTNATAL RECOVERY AND TO DETECT COMPLICATIONS.

2.EMERGENCY OBSTETRICAL CARE

IT IS VERY ESSENTIAL TO PREVENT MATERNAL MORTALITY AND MORBIDITY TRADITIONAL BIRTH ATTENDENCE SHOULD BE MAINTAINED IN CONDUCTING THE DELIVERIES. 3.24 -HOUR DELIVERY SERVICES AT PHCs\CHCs TO PROMOTE INSTITUTIONAL DELIVERIES ,THE STAFFSHOULD BE ENCOURAGE ROUND THE CLOCK DELIVERY FACILITIES AT HEALTH CENTRES.

4.MEDICAL TERMINATION OF PREGNANCY

THROUGH THE MTP ACT 1971 THE AIM IS TO REDUCE MATERNAL MORBIDITY AND MORTALITY FROM UNSAFE ABORTIONS. THE ASSISTANCE FROM THE CENTRAL GOVERNMANT IS IN THE FORMS 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 TRASNITTED DISEASES

IT HAS BEEN IMPLEMENTED IN CLOSE COLLABARATION WITH NATIONAL AIDS CONTROL ORGANISATION (NACO).NACO WILL PROVIDE ASSISTANCE FOR SETTING UP RTI\STD CLINICS UP TO THE DISTRICT LEVEL. o EACH DISTRICT WILL BE ASSISTED BY 2 LABORATORY TECHNICIANS ON CONTRACT BASIS FOR TESTING BLOOD,URINE AND RTI\STD TESTS.

6.IMMUNIZATION
THE UNIVERSAL IMMUNIZATION PROGRAMME (UIP) BECAME PART OF CSSM PROGRAMME IN 1992 AND RCH PROGRAMME 1997.IT WILL CONTINUE TO PROVIDE VACCINES FOR POLIO,TETANUS.DPT, DT, MEASLES AND TUBERCULOSIS. 7.DRUG AND EQUIPMENT KITS EQUIPMENT KITS SUPPLIED AT VARIOUS LEVELS AS FOLLOWS

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AT SUB-CENTRE LEVEL DRUG KIT A DRUG KIT B MID- WIFERY KIT SUB- CENTRE EQUIPMENT KIT AT PHC LEVEL- PHC EQUIPMENT KIT ATCHC\FRU LEVEL- EQUIPMENT KITS FROM KIT E TO KIT P

8.ESSENTIAL NEWBORN CARE

THE PRIMARY GOAL IS TO REDUCE PERINATAL AND NEAONATAL MORTALITY .THE MAIN COMPONENT ARE.. RESUSCITATION OF NEWBORN WITH ASPHYXIA PREVENTION OF HYPOTHERMIA PREVENTION OF INFECTION EXCLUSIVE BREAST FEEDING AND REFERRAL OF SICK NEWBORN.

9.ORAL REHYDRATION THERAPY

DIARRHOEA IS ONE OF THE LEADING CAUSE OF CHILD MORTALITY.ORAL REHYDRATION THERAPY PROGRAMME SRATED IN 1986-87 IS BEING IMPLEMENTED THROUGH RCH PROGRNAMME. SUPPLIES OF ORS PACKETS TO THE STATES ARE BEING ORGANISED BY CENTRAL GOVERNMENT. TWICE A YEAR 150 PACKETS OF ORS ARE PROVIDED AS PART OF DRUG KIT SUPPLIED TO ALL SUBCENTRES IN COUNTRY. ADEQUATE NUTRITIONAL CARE OF THE CHILD WITH DIARRHOEA AND PROPER ADVICE TO MOTHER ON FEEDING ARE IMPORTANT AREA.

10.PREVENTION AND CONTROL OF VITAMIN A DEFICIENCY IN CHILDERN UNDER THE PROGRAMME, DOSES OF VITAMIN A ARE GIVEN TO ALL CHILDERN 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

11.ACUTE RESPIRATORY DISEASE CONTROL

THE STANDARD CASE MANGEMENT OF ARI AND PREVENTION OF DEATHS DUE TO PNEUMONIA IS NOW AN INTEGRAL PART OF RCH PROGRAMME. PERIPHERAL HEALTH WORKERS ARE BEING TRAINED TO RECOGNISE AND TREAT PNEUMONIA . COTRIMOXAZOLE IS BEING SUPPLIED TO THE HEALTH WORKER THROUGH THE CSSM DRUG KIT

12.PREVENTION AND CONTROL OF ANEAMIA IN CHILDERN

IRON DEFICIENCY ANAEMIA IS WIDELY PREVELANT IN YOUNG CHILDREN .UNDER THIS PROGRAMME OF CONTROL AND PREVENTION OF ANEMIA ,TABLETS CONTAINING 2mg OF ELEMENTAL IRON AND 0.1 mg OF FOLIC ACID ARE PROVIDED AT SUB-CENTRE LEVEL . THE HEALTH WORKERS TO PROVIDE 100 TABLETS TO CHILDERN CLINICALLY FOUND TO BE ANEAMIC.

REPRODUCTIVE AND CHILD HEALTH PROGRAMME -PHASE II

RCH -PHASEII
RCH PHASE II BEGAN FROM 1ST APRIL 2005,THE FOCUS IS TO REDUCE MATERNAL AND CHILD MORTALITY AND MORBIDITY WITH EMPHASIS ON RURAL HEALTH CARE.THE MAJOR STRATEGIES ARE
ESSENTAIL OBTETRIC CARE a. INSTITUTIONAL DELIVERY b. SKILLED ATTENDANCE AT DELIVERY EMERGENCY OBSTETRIC CARE a. OPERATIONALING FIRST REFERRAL UNITS b. OPERATIONALISING PHCs AND CHCs FOR ROUND CLOCK DELIVERY SERVICES

ESSENTIAL OBTETRIC CARE

a. INSTITUTIONAL DELIVERY 24 HOURS DELIVERY CENTRES WITH EMERGENCY OBSTETRIC CARE & ESSENTIAL NEWBORN CARE AND BASIC RESUSCITATION SERVICES AROUND THE CLOCK

b.SKILLED ATTENDANCE AT DELIVERY

WHO HAS EMPHASIED THAT SKILLED ATTENDANCE AT DELIVERY IN ANY ESSENTIAL TO REDUCE MATERNAL MORTALITY IN ANY COUNTRY,BY ANM\LHVS

EMERGENCY OSTETRIC CARE

OPERATIONALISATION OF FRUs AND SKILLED ATTENDANCE AT BIRTH ARE THE ACTIVITIES THE SECOND PHASE OF RCH.

MINIMUM SERVICES OF FULLY FUNCTIONAL FRUs 1. 24-Delivery services including normal & assisted deliveries. 2. Emergency obstetric care include caesarean section 3. New born care 4. Emergency care of sick children 5. Full range of family planning services includes laparoscopic services 6. Safe abortion services

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7.Treatment of STI\RTI 8.Blood storage facility 9.Essential laboratory services 10.Referral ( transport) services There are 3 critical determinants of facility Availability of surgical interventions Newborn care Blood storage facility on a 24 hrs

STRENGTHENING REFERRAL SYSTEM

NEW INTIATIVES
1. TRAINING OF MBBS DOCTORS IN LIFE SAVING ANAESTHETIC SKILLS FOR EMEGENCY OBSTETRIC CARE. GOVT .OF INDIA IS ALSO INTRODUCING TRAINING OF MBBS DOCTORS OF OBSTETRIC MANAGEMENT SKILLS,PREPARED TRAINING PLAN FOR 16 WEEKS IN ALL OBSTETRIC MANGEMENT SKILLS,INCULDING CAESERIAN SECTION OPERATION. 2.SETTING UP OF BLOOD STORAGE CENTRES AT FRUs ACCORDING TO GOVERNMENT OF INDIA GUIDELINES

JANANI SURAKSHA YOJANA

THE NATIONAL METERNITY BENEFIT SCHEME HAS BEEN MODIFIED INTO A (JSY) JANANI SURAKSHA YOJANA. IT WAS LAUNCHED ON 12TH APRIL 2005.

SALIENT FEATURES OF JANANI SURAKSHA YOJANA

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

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CATEGORY

RURAL AREA
MOTHERS PACKAGE ASHA S TOTAL PACKAGE Rs

URBAN AREA
MOTHERS PACKAGE ASHAS PACKAGE TOTAL Rs

LPS HPS

1400

600

2000

1000

200

1200

7OO

700

600

600

VANDEMATARUM SCHEME
THIS IS A VOLUNTARY SCHEME WHERE IN ANY OBSTETRIC AND GYNEC SPECILAIST ,MATERNITY HOME,NURSING HOME,LADY DOCTOR MBBS DOCTOR CAN VULNTEER THEMSELVES FOR PROVIDING SAFE MOTHERHOOD SERVICES

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THE ENROLLED DOCTORS WILL DISPLAY
VANDEMATARAM LOGO AT THEIR CLINIC. IRON AND FOLIC ACID TABLETS,ORAL PILLS,TT INJECTIONS ETC WILL BE PROVIDED BY THE RESPECTIVE DISTRICT MEDICAL OFFICERS TO THE VANDEMATARAM DOCTORS\ CLINICS FOR FEE DISTRIBUTION TO BENEFICIARIES. SAFE ABORTION SERVICES A.MEDICAL METHOD OF ABORTION B. MANUAL VACUUM ASPIRATION

Thank you