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MATERNAL AND CHILD HEALTH PROGRAMMES

MATERNAL AND CHILD HEALTH PROGRAMMES. INTRODUCTION.

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MATERNAL AND CHILD HEALTH PROGRAMMES

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  1. MATERNAL AND CHILD HEALTH PROGRAMMES

  2. 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.

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

  4. 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.

  5. 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.

  6. 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.

  7. 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

  8. 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) • THE FIRST VISIT: - HEALTH HISTORY - PHYSICAL EXAMINATION - LABORATORY EXAMINATION b. ON SUBSQUENT VISITS: -PHYSICAL EXAMINATION - LABORATORY TESTS

  9. CONTINUED……… 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 REGISTRATION NUMBER, IDENTIFYING DATA, PREVIOUS HEALTH HISTORY, AND MAIN HEALTH EVENTS. HOMEVISITS: IS BACK BONE OF MCH SERVICES. HOME VISIT BY THE HEALTH WORKER FEMALE OR PUBLIC HEALTH NURSE.

  10. CONTINUED… 2.PRENATAL ADVICES: • 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….

  11. CONTINUED…… 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

  12. 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

  13. 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,MALPRESENTATIONS,PROLAPSE OF CORD ETC • CARE OF THE BABY AT DELIVERY-RESUSCITATION, CARE OF THE CORD, CARE OF THE EYES.

  14. 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”.

  15. 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 -MOTHER MAY HAVE LESS REST -MOTHER RESUME HER DUTIES TOO SOON -DIET MAY BE NEGLECTED

  16. 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

  17. CONTINUED……….. 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 MISPLACED IN THE CENTRAL NURSERY.

  18. 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.

  19. 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

  20. CONTINUED……. 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

  21. 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.

  22. NEONATAL CARE • EARLY NEONATAL CARE: THEFIRST WEEK OF LIFE THE MOST CRUCIAL PERIOD IN THE OF AN INFANT. OBJECTIVES: • ESTABILISH & MAINTAINANCE OF CARDIO- RESPIRATORY FUNCTIONS • MAINTAINANCE OF BODY TEMPERATURE • AVOIDANCE OF INFECTION • ESTABILISH OF SATISFACTORY FEEDING REGIMEN • EARLY DETECTION AND TREATMENT OF CONGENITAL AND ACQUIRED DISORDERS.

  23. 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.

  24. Cont……….. 3.CAREOF 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:THEFIRST BATH IS GIVEN WITH SOAP AND WARM WATER TO REMOVE VERNIX, MECHONIUM AND BLOOD CLOTS.SOME PREFER TO APPLY WARM OIL BEFORE THE BATH.

  25. 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

  26. REPRODUCTIVE AND CHILD HEALTH PROGRAMME

  27. DEFINITION REPRODUCTIVE AND CHILD HEALTH APPROCH HAS DEFINED AS“PEPOLE HAVE ABILITY TO REPRODUCE AND REGULATE THEIR FERTILITY , WOMEN ARE ABLE TO GO THROUGH PREGNANCY 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”.

  28. RCH PHASE 1 PROGRAMME INCORPORATED THE 4 COMPONENT RCH PACKAGE

  29. MAIN HIGHLIGHTS OF RCH PROGRAMME ARE • THE PROGRMME INTEGRATES ALL INTERVENTIONS OF FERTILITY REGULATION, MATERNAL AND CHILD HEALTH REPRODUCTIVE HEALTH FOR BOTH MEN AND WOMEN. • THE SERVICES TO BE PROVIDED ARE CLIENT ORIENTED • 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.

  30. 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.

  31. 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.

  32. 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 STAFF SHOULD BE ENCOURAGE ROUND THE CLOCK DELIVERY FACILITIES AT HEALTH CENTRES.

  33. 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.

  34. 5. CONTROL OF REPRODUCTIVE TRACT INFECTIONS AND SEXUALLY TRANSMITTED DISEASES IT HAS BEEN IMPLEMENTED IN CLOSE COLLABORATION WITH NATIONAL AIDS CONTROL ORGANISATION (NACO).NACO WILL PROVIDE ASSISTANCE FOR SETTING UP RTI/STD CLINICS UP TO THE DISTRICT LEVEL. • EACH DISTRICT WILL BE ASSISTED BY 2 LABORATORY TECHNICIANS ON CONTRACT BASIS FOR TESTING BLOOD,URINE AND RTI/STD TESTS.

  35. 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………

  36. CONTINUED….. • AT SUB-CENTRE LEVEL DRUG KIT A DRUG KIT B MID- WIFERY KIT SUB- CENTRE EQUIPMENT KIT • AT PHC LEVEL- PHC EQUIPMENT KIT • AT CHC/FRU LEVEL- EQUIPMENT KITS FROM KIT E TO KIT P

  37. 8.ESSENTIAL NEWBORN CARE THE PRIMARY GOAL 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.

  38. 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 SUB- CENTRES IN COUNTRY. • ADEQUATE NUTRITIONAL CARE OF THE CHILD WITH DIARRHOEA AND PROPER ADVICE TO MOTHER ON FEEDING ARE IMPORTANT AREA.

  39. 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

  40. 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

  41. 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.

  42. REPRODUCTIVE AND CHILD HEALTH PROGRAMME -PHASE II

  43. 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

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

  45. b.SKILLED ATTENDANCE AT DELIVERY • WHO HAS EMPHASISED THAT SKILLED ATTENDANCE AT DELIVERY IN ANY ESSENTIAL TO REDUCE MATERNAL MORTALITY IN ANY COUNTRY,BY ANM\LHVS

  46. EMERGENCY OSTETRIC CARE OPERATIONALISATION OF FRUs AND SKILLED ATTENDANCE AT BIRTH ARE THE ACTIVITIES THE SECOND PHASE OF RCH.

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

  48. Continued…….. 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

  49. 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

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

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