RMNCH +a

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Reproductive and Child Health program is the flagship

program of the department of family welfare, government of


India. “Make every mother and child count” reflects the need
for today. Government and international community make the
health of women and children a higher priority. The wellbeing
of societies is directly linked to health and survival of mother
and children. When mothers survive and thrive their children
survive and thrive. When both mothers and children survive
and thrive the societies in which they live prosper.

RCH I

The Reproductive and Child Health (RCH) Programme was


launched in October 1997. RCH programme is to provide
need-based, demand-driven, high-quality health and family
welfare services to mothers and children. It is one of the most
effective public health interventions, having a meaningful
impact on fertility, infant mortality and maternal mortality. It
promotes safe motherhood including emergency obstetric
care, essential new born care, reproductive services for
adolescent health and counselling.
Objectives
1. To promote the health of mothers and children
2. To reduce infant, child and maternal mortality rates
3. Population Stabilization

eproductive and child health programme, “aim is provide


need-based client centerend damand driven high quality

RCH II
RCH II is a programme of Government of India on
reproductive, child and maternal health under the National
Rural Health Mission (NRHM). RCH Program Phase II was
launched on 1st April 2005. “The main objective of the
program was to bring about a change in mainly three critical
health indicators i.e. Reducing total Fertility Rate, Infant
Mortality Rate and Maternal Mortality Rate with a view to
realizing the outcomes envisioned in the Millennium
Development Goals, the National Population Policy 2000, the
Tenth Plan Document, the National Health Policy 2002 and
Vision 2020, India”. (National Health Mission, MoHFW)

Another major objective if RCH II is “minimizing the


regional variations in the areas of RCH and population
stabilization through an integrated, focused, participatory
programme, meeting the unmet needs of the target population,
and provision of assured, equitable, responsive quality
services.” (National Health Mission, MoHFW)

Following are the salient features of RCH II:


 Adoption of a sector-wise approach,
 Building State ownership by involving States and UTs,
 Decentralization through development of District and
State level need-based plans,
 Allowing States to develop need-based work plans,
 Capacity building at the District, State and the Central
level to ensure improved program implementation,
 Performance-based funding to ensure adherence to
program objectives, and
 Convergence, both inter-sectoral as well as intra-sectoral
to optimize utilization of resources as well as infra
structural facilities.
RMNCH+A

Reproductive, Maternal, Newborn, Child and Adolescent


Health
Improving the maternal and child health and their survival are
central to the achievement of national health goals under the
National Health Mission (NHM). SDG Goal 3 also includes
the focus on reducing maternal, new born and child mortality.
In the past years, innovative strategies evolved under the
national programme to deliver evidence-based interventions to
various population groups. (Ministry of Health & Family
Welfare Government of India, 2013)

Following the Government of India’s “Call to Action


(CAT) Summit” in February, 2013, the Ministry of Health
& Family Welfare launched Reproductive, Maternal,
Newburn Child plus Adolescent Health (RMNCH+A) to
influence the key interventions for reducing maternal and
child morbidity and mortality. 

The RMNCH+A strategy is built upon the continuum of care


concept and is holistic in design, encompassing all
interventions aimed at reproductive, maternal, new born,
child, and adolescent health under a broad umbrella, and
focusing on the strategic lifecycle approach.

The RMNCH+A strategy promotes links between various


interventions across thematic areas to enhance coverage
throughout the lifecycle to improve child survival in India.
The “plus” within the strategy focuses on:
o Inclusion of adolescence as a distinct life stage within the
overall strategy.
o Linking maternal and child health to reproductive health
and other components like family planning, adolescent
health, HIV, gender, and preconception and prenatal
diagnostic techniques.
o Linking home and community-based services to facility-
based services.
o Ensuring linkages, referrals, and counter-referrals
between and among various levels of health care system
to create a continuous care pathway, and to bring an
additive /synergistic effect in terms of overall outcomes
and impact.
 

Key features of RMNCH+A Strategy


The RMNCH+A strategy approaches include:
o Health systems strengthening (HSS) focusing on
infrastructure, human resources, supply chain
management, and referral transport measures.
o Prioritization of high-impact interventions for various
lifecycle stages.
o Increasing effectiveness of investments by prioritizing
geographical areas based on evidence.
o Integrated monitoring and accountability through good
governance, use of available data sets, community
involvement, and steps to address grievance.
o Broad-based collaboration and partnerships with
ministries, departments, development partners, civil
society, and other stakeholders. (Ministry of Health &
Family Welfare Government of India, 2013)

The RMNCH+A strategy provides a strong platform for


delivery of services across the entire continuum of care,
ranging from community to various level of health care
system.

Review of RCH

“RCH-I had a number of successful and unsuccessful


outcomes, based on baseline statistics recorded in 1998-99
and compared to 2002-03. Percentage of women receiving
any ante natal care (ANC) rose by about 12 % to reach 77.2%.
However, the use of government health facilities had declined.
Use of contraceptives increased by 3.3 % to 52.0 %, while
family planning due to spacing methods rose by 3.3% to 10.7
%. Use of permanent methods had not changed. Infant
mortality came down from 71(SRS 1997) to 63 (SRS 2002)
but the aim of universal immunization was far from reach.
Cases of polio had reduced but had not met the anticipated
targets. Not enough attention was paid to awareness of
diarrhoea management and acute respiratory infections. All
this resulted in a rise in cases of diarrhoea and respiratory
infections”. (National Health Programmes for Children in
India. 2013)

In 2007 a Joint Review Mission (JRM), under the Ministry of


Health and Family Welfare, reviewed the progress of RCH-II
and found a number of key concern areas. The JRM found
that child health was being limited to immunization only and
other aspects of children’s health were being ignored. Proper
guidelines for implementation needed to be put in place for
the States. There needed to be more training programmes to
meet the need for qualified personnel. Many innovative
techniques and methods that were being implemented needed
to be evaluated before expansion took place. States like Uttar
Pradesh required giving extra emphasis on the infrastructure
and implementation of RCH and NRHM. There was a need to
increase family planning services to meet the target of on
average 2.1 children in each family/household
The Eighth Joint Review Mission (JRM-8) of Reproductive
and Child Health Programme Phase II (RCH II) primarily
assessed progress on programme management and
supervisory structures, quality, HMIS and data management
and gender and social equity. Agreements on the way forward
were reached within the core principles of RCH II that include
a strong pro-poor focus to reduce disparities in health, gender
mainstreaming, state ownership through bottom-up planning,
promoting evidence-based interventions to ensure quality of
care and strengthening results measurement.

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