Reproductive and Child

Health in India

KAUSAR BALBALE
MITISHA HIRLEKAR
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Description of RCH Project in India

 RCH is a five year project launched within the

framework of fifty year old nationwide
National Family Planning Program in India.
 It’s a new approach of managing Population
Growth by eliciting more community
participation and empowering people to take
care of their reproductive health.

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 Goal of RCH Project
in India
In a large, diverse federal set-up,
 people may acquire the ability to regulate
their fertility,
 women are able to go through pregnancy and
childbirth safely,
 the outcome of pregnancy is successful in
terms of maternal and infant survival and well
being,
 couples are able to have sexual relations free
of fear of pregnancy and of contracting
disease.

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 Objectives of RCH Project
in India
 Introduce a new system of service delivery through
decentralized planning and broadening the menu of
services delivered under the banner of Family Planning
Program in India.

 Maneuvering the health care services in a way that it may

induce a desired change in specific community health
indicators like IMR, TFR, MMR, CBR, effective CPR,
Immunization Coverage and delivery by trained hands.

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 Main Highlights of the
Programme
 Integration of fertility regulation interventions,
 maternal and child health with reproductive
health for both men and women.
 Decentralized, Target free approach, Demand
driven, High quality, and community need based.
 Set up of FRUs and up gradation of PHCs
 Facilities of Obs care, MTP and IUD insertion at
PHC.
 Specialist facilities for STD and RTI at district
hospital

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 Interventions in all
Districts
 Child survival intervention
 Safe motherhood intervention.
 Target free approach
 IEC activities
 Training
 RTI and STD clinic at district hospitals
 Safe abortion facility at PHC level
 Enhance community participation through Panchayats,
 Women’s groups and NGOs.
 Adolescent health and Reproductive hygiene

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 Relationship to other
projects
Integrated approach to the programme aimed at improving the
health status of young women and young children. This has been
going on in the country under the :
 FWP
 UIP
 ORT
 CSSM
 ARI control
 Prevention and control of Vit A deficiency in Children
 Prevention and control of Anaemia in children
 Control of RTI and STD

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 Two Phases of RCH

 Phase I- Began from Oct.1997-Components

 CSSM
 STD
 RTI
 Phase II- began from 1st April 2005-
Focused on
 Reduce child and Maternal mortality
 Emphasis on rural health care

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Components of RCH Project
in India
 Essential Obstetric Care
 Emergency Obstetric Care
 Essential New Born Care
 Medical Termination of Pregnancy
 Contraceptives Delivery
 RTI/STI Care
 Empowering Adolescents
 Strengthening Immunization

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 Project Intervention

 Based on the status of crude birth rate and

female literacy status more than 500 districts
of the country were divided in three categories.
 Weaker districts were given additional inputs
like more trained manpower at the periphery
and facilities for referral transport.

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 Logistics
 Peripheral facilities were stratified in three
categories:
 Each subcenter managed by an Auxiliary Nurse Midwife
catering to the population of 3000-5000 persons was
equipped with Kit A(prophylactics), Kit B (Essential
Drugs) and Kit C (bare minimum equipment).
 Each Primary Health Center managed by a Medical
Officer catering to a population of 25000 to 30000 persons
was equipped with Kit D with a wider set of equipment

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 Training/Manpower Development

 Awareness Generation Training

 for people’s representatives and professionals from other development
sectors.
 Integrated Skill Training
 for health professionals in the field like Auxiliary Nurse Midwives, Lady Health
Visitors, Sector Supervisors and Medical Officers working at Primary Heath
Centers.
 Specialized Skill Training
 for specialist performing contraception operations and Medical Termination of
Pregnancies and for nurses conducting IUD insertions.

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 IEC Procedures

 Extensive use of following communication

methods in persuading people to cultivate
rational reproductive health practices:
 Television-spots; films; interactive panel and live
phone-in discussions.
 Radio-talks; panel discussions and counseling
sessions.
 Field Publicity through Songs and Drama.

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 Community Need Assessment

 Health Management Information System is being

introduced where demographic and reproductive
health information of every family is updated
periodically through contact drive survey to elicit the
hidden demand for obstetric-child health services on
one hand and unmet demand for contraception on
the other. Such a procedure strengthens the
management through de-centralized planning which
in spirit fulfills the guidelines of ICPD Cairo.

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 Monitoring - Performance Indicators

 Following indicators were used to assess the

implementation progress of the RCH Project
at the central level:
 Decentralized Planning: District Action Plan on
fiscal year basis were to be prepared and
implemented by district level Managers.
 Health Facilities identified and developed as First
Referral Units for Emergency Obstetric Care.

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 Monitoring - Performance Indicators (2)

 Increase in the Percentage of children

seeking care for common disorders like
ARI and Diarrhea.
 Increase in the current contraceptive
prevalence and reduction in the unmet
demand of contraception.
 Completion of In-service
orientation/skill-impartation training.

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Evaluation - Impact Indicators

 Maternal Mortality Rate.

 Total Fertility Rate.
 Institutional Delivery.
 Reduction in the prevalence of RTI/STI.
 Infant Mortality Rate.
 Underfive Mortality Rate.
 Effective Couple Protection Rate.
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 Observations in implementing RCH
Project in India (1)
 Implementing RCH Project from April1998 to
March 2003 in a country like India has
provided following experience:
 Inadequacy of decentralization form Center to the
Districts in management of finance, procurement
and related issues.
 Weak Management capacity especially in Monitoring
and Evaluation, Budgeting, Communication and
Extension and delivery of Quality services.

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 Observations in implementing
RCH Project in India (2)
 Weakness of outreach services in holding the subjects
for completing the cycle of reproductive health care.
 Lack of one unified concept/system and one unified
nomenclature.
 Multiplicity of Funding Agencies.
 Lack of an effective referral back-up.
 RCH and AIDS being implemented in two distinct
compartments with some of the activities being
unduly duplicated.

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 Future of RCH in India
 ICPD Cairo has disseminated very strong signals throughout
the world and Government of India very enthusiastically
initiated the paradigm shift by launching a nationwide RCH
Project for five years at the turn of second millenium. It has
a huge input in the shape of soft loan from World Bank and
grants from agencies varying from UNFPA and Unicef to
SIDA and DFID.
 Implementing the project for five years, a consensus has
evolved to carry on the for yet another five years with mid-
course improvement. Thus the project implemented so far is
designated as RCH-1 and the one yet to be launched as RCH-
2.

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