Intervention programme related to maternal health care

1. National health intervention
programme for mother and
child
Presented by:-
HIMIKA RATHI

2. DEFINITION
• According to WHO, Maternal and child health services can be defined
as “promoting, preventing, therapeutic or rehabilitation facility or
care for the mother and child.”
• Thus maternal and child health service is an important and essential
service related to mother and child’s overall development.

3. NEED FOR SUCH INTERVENTIONS
• There are four main reasons why mother and child must be given top
priority in health programme
1. Mother and child below the age of 15 years make up the majority
of the population.
2. Also constitute a special risk or vulnerable group.
3. By improving the health of mother and children we can improve the
health of family and community.
4. Ensuring child survival is a future investment for the family and
community.

4. MATERNAL HEALTH PROGRAMME
• Government of India adopted the Reproductive, Maternal, New-
born, Child and Adolescent Health (RMNCH+A) framework in
2013.
• It essentially aims to address the major causes of mortality and
morbidity among women and children.
• This framework also helps to understand the delays in accessing and
utilizing health care services.

5. OBJECTIVES
• To reduce Maternal Mortality Ratio
• To increase the Early ANC registration.
• To ensure 3 or more than 3 ANCs (Antenatal care) to all the expectant
mothers and special attention to high risk pregnancies.
• To decrease the incidence and progress of anaemia in pregnant and
lactating women.

6. OBJECTIVES
• Provide adequate opportunities for safe deliveries and to increase
institutional deliveries.
• To improve the coverage of post partum care.
• To increase access to Emergency Obstetric Care for complicated
deliveries through strengthening of FRUs (First Referral Units).
• To increase access to early and safe abortion services

7. INTERVENTIONS
1. Janani Suraksha Yojana (JSY):
• Janani Suraksha Yojana (JSY), a demand promotion and conditional
cash transfer scheme was launched in April 2005 with the objective of
reducing Maternal and Infant Mortality.
• It is being implemented with the objective of reducing maternal and
neonatal mortality by promoting institutional delivery among poor
pregnant women.

8. INTERVENTIONS
2. Janani Shishu Suraksha Karyakram(JSSK):
• Government of India has launched Janani Shishu Suraksha
Karyakaram (JSSK) on 1st June, 2011.
• Entitles all pregnant women delivering in public health institutions to
absolutely free and no expense delivery including Caesarean section.
• The initiative stipulates free drugs, diagnostics, blood and diet, besides
free transport from home to institution, between facilities in case of a
referral and drop back home.

9. INTERVENTIONS
Janani Shishu Suraksha Karyakram(JSSK):
• Similar entitlements have been put in place for all sick new-born
accessing public health institutions for treatment till 30 days after
birth.
• In 2013, this has been expanded to sick infants and antenatal and
postnatal complications.

10. INTERVENTIONS
3. Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA):
• Carrying forward the vision of our Hon’ble Prime Minister, the
Pradhan Mantri Surakshit Matritva Abhiyan was launched in 2016.
• Ensures quality antenatal care and high risk pregnancy detection in
pregnant women on 9th of every month.

11. INTERVENTIONS
4. LaQshya:
• In order to further accelerate decline in MMR in the coming years,
MoFHW (Ministry of Health and Family Welfare) has recently
launched 'LaQshya - Labour room Quality improvement Initiative.
• LaQshya program is a focused and targeted approach to strengthen key
processes related to the labour rooms and maternity operation theatres
which aims at improving quality of care around birth and ensuring
Respectful Maternity Care.

12. INTERVENTIONS
5. Comprehensive Abortion Care Services:
• Comprehensive and safe abortion services are provided at public
health facilities including 24*7 PHCs/ FRUs (DHs/ SDHs /CHCs)
including the Delivery Points.
• Supply of Nischay Pregnancy detection kits to sub centres for early
detection of pregnancy is undertaken.
• Capacity Building of Medical officers is being carried out routinely in
safe MTP Techniques.

13. INTERVENTIONS
Comprehensive Abortion Care Services:
• ANMs, ASHAs and other field functionaries are trained to provide
confidential counselling for MTP and promote post-abortion care
including adoption of contraception.
• Routine orientation and training of ASHAs to equip them with skills to
create awareness on abortion issues in the community and facilitation
of women's access to services.
• District Level Committees (DLCs) have been framed and empowered
for accreditation the facilities for conducting safe abortion services
under MTP Act including approval of private and NGO sector
facilities for conducting MTPs.

14. INTERVENTIONS
6. Provision of RTI/STI services:
• Under NHM (National Health Mission) , provision of STI/RTI care
services is an important strategy to prevent HIV transmission and to
promote sexual and reproductive health services in all the FRUs,
CHCs and at 24 X 7 PHCs.

15. INTERVENTIONS
7. Village Health and Nutrition Day:
• Village Health & Nutrition Day (VHNDs) are being organized at
Anganwadi center atleast once every month.
• It is a platform to provide ante natal/ post partum care for pregnant
women, promote institutional delivery, immunization, Family
Planning & nutritional counseling.

16. NEWER INTERVENTIONS
1. Midwifery:
• Government of India has initiated midwifery services throughout the
country in 2018.
• Objective is to provide access to quality maternal and neonatal health
services, to promote natural birthing, to ensure respectful care and to
reduce over medicalization.
• The Midwifery services initiatives aim to create a cadre for Nurse
Practitioners in Midwifery who are skilled in accordance to ICM
competencies, knowledge and capable of providing compassionate
women – centric pregnancy care.

17. CHILD HEALTH PROGRAMME

18. INTRODUCTION
• The Child Health programme under the National Rural Health Mission
(NRHM) comprehensively integrates interventions that improve child
survival and addresses factors contributing to infant and under-five
mortality.
TRENDS OF CHILD HEALTH INDICATORS:
1. Infant Mortality Rate
2. Under-five Mortality Rate (U5MR)
3. Neo-natal Mortality Rate (NMR)

19. INTERVENTIONS
1. Facility Based Newborn Care (FBNC)
• Facility Based Newborn Care (FBNC) is one of the key components
under the National Rural Health Mission to improve the status of
newborn health in the country.
• A continuum of newborn care has been established with the launch of
home based and facility based newborn care components ensuring that
every newborn receives essential care right from the time of birth and
first 48 hours at the health facility and then at home during the first 42
days of life.

20. INTERVENTIONS
a) Special Newborn Care Unit (SNCUs):
• is located in close proximity to the labour room with 12 or more beds,
and has dedicated and adequately trained doctors, staff nurses and
support staff to provide 24x7 services.
• It delivers Level-II newborn care to sick and small new borns
• also training to medical officers and nurses in facility based newborn
care.

21. INTERVENTIONS
b) New born Stabilization Unit (NBSU):
• is a 4 bedded unit providing basic level of sick new born care,
established at Community Health Centres/ First Referral Units.
• Provision of new born care at these units increases the chances of
survival for babies with health conditions requiring observation and
stabilization soon after birth or in the period thereafter.

22. INTERVENTIONS
c) New Born Care Corners (NBCCs):
• Are operationalized within the labour rooms and operation theatres in
public health facilities designated as delivery points.
• These units have NSSK (Navjaat Shishu Suraksha Karyakram)
personnel who provide essential new born care and resuscitation, when
required, to all new borns delivered at these health facilities.

23. INTERVENTIONS
d) Navjaat Shishu Suraksha Karyakram (NSSK):
• training was initiated in September, 2009 with the purpose of training
all health care providers in essential newborn care and resuscitation
when required.

24. INTERVENTIONS
e) National Training Package for Facility Based Newborn Care:
• This training package has been developed with participation of
national neonatal experts, and facilitated by the National Collaborative
Centre for Facility Based Newborn Care at Kalawati Saran Children's
Hospital under the mandate of Ministry of Health & Family Welfare.
• This package will improve the cognitive knowledge and build
psychomotor skills of the medical officers and staff nurses posted in
these units to provide quality newborn care.

25. INTERVENTIONS
f) Empowering frontline health service providers:
• The ANMs are now empowered to give a prereferral dose of antenatal
corticosteroid (Injection Dexamethasone) in pregnant women going
into preterm labour.
• ANMs will also administer pre-referral dose of Injection Gentamycin
to newborns for the management of sepsis in young infants (upto 2
months of age).

26. INFANT AND YOUNG CHILD FEEDING
(IYCF)
• The importance of breastfeeding as the preventive intervention with
potentially the single largest impact on reducing child mortality has
been well recognised.
• Considering that reducing infant mortality is one of the goals of the
NRHM, promotion of Breastfeeding and optimal Infant and Young
Child Feeding practices through the public health system is another
important intervention area under child health.

27. NUTRITIONAL REHABILITATION
CENTRES (NRC)
• NRCs play a crucial role in averting deaths due to under-nutrition and
promoting physical and psychosocial growth of children with severe
under nutrition.

28. INTERVENTIONS
• Nutritional programs
• Prophylaxis against nutritional anaemia
• IFA tablets to pregnant women & young children
• Vitamin A prophylaxis program
• Single dose of 2 lakh units to preschool children

29. NEW INITIATIVES
1. Rashtriya Bal Swasthya Karyakram (RBSK)
• This is a new initiative launched in February 2013 which includes
provision for Child Health Screening and Early Intervention Services
through early detection and management of 4 Ds i.e. Defects at birth,
Diseases, Deficiencies, Development delays including disability.

30. UNIVERSAL IMMUNIZATION
PROGRAMME (UIP)
• Immunization Programme (IP) is one of the key interventions for
protection of children from life threatening conditions, which are
preventable.
• Under the Universal Immunization Programme, Government of India
is providing vaccination to prevent seven vaccine preventable diseases
i.e.: ● Diphtheria, Pertussis, Tetanus, Polio, Measles, severe form of
Childhood Tuberculosis and Hepatitis B.

31. S. No Vaccine Protection Number
of doses
Vaccination Schedule
1 BCG (Bacillus Calmette
Guerin)
Tuberculosis 1 At birth (upto 1 year if not given earlier)
2 OPV (Oral Polio Vaccine) Polio 5 Birth dose for institutional deliveries within 15 days,
Primary three doses at 6, 10 & 14 week and one
booster dose at 16-24 month of age, given orally
3 Hepatitis B Hepatitis 4 Birth dose for institutional deliveries within 24 hour,
Primary three doses at 6, 10 14 week
4 DPT (Diphtheria,
Pertussis and Tetanus
Toxoid
Diphtheria
Pertussis
Tetanus
5 Three doses at 6, 10 & 14 week and two booster
and dose at 16-24 month and 5 years of age
5 Measles Measles 2 9-12 months of age and 2nd dose at 16-24 months.
6 TT (Tetanus Toxoid) Tetanus 2
2
Children: 10 years and 16 years of age
Pregnant woman: Two doses given (one dose, if
previously vaccinated within 3 Year)

32. S. No Vaccine Protection Number
of doses
Vaccination Schedule
7 JE vaccination (in
selected 113 JE
endemic districts in
15 States)
Japanese
Encephalitis
(Brain disease)
2 1st dose at 9-12 months of age & 2nd dose 16-24
month of age in JE endemic districts after 6
months of campaign
8 Hib containing
Pentavalent vaccine
(Hib+DPT+Hep B),
Presently in eight
States (Tamil Nadu,
Kerala, Gujarat,
Haryana, Karnataka,
Goa, J & K and
Puducherry)
Diphtheria,
Pertussis, Tetanus
Hepatitis B and
Haemophilus
influenzae , type B
associated
Pneumonia
meningitis
3 6, 10 & 14 week of age

33. PULSE POLIO IMMUNIZATION (PPI)
• Pulse Polio Immunization programme was launched in India in 1995.
Children in the age group of 0-5 years administered polio drops during
National and Sub-national immunization rounds (in high risk areas)
every year.
• About 172 million children are immunized during each National
Immunization Day (NID).
• Progress:
● India has not reported any case of polio due to wild polio virus since
more than three years. The last polio case in the country was reported
from Howrah district of West Bengal with date of onset 13th January
2011.

34. PULSE POLIO IMMUNIZATION (PPI)
● WHO on 24th February 2012 removed India from the list of countries
with active endemic wild polio virus transmission.
● On 27thMarch 2014, India along with South-East Asia Region of
WHO has been certified polio free by Regional Certification
Commission for polio eradication.

35. Schemes for adolecscent girls
1. Kishori sakthi yojana (11-18year girls)
• For nutrition, self development, health status, vocational skills
2. Nutrition program for adolescent girls
• For 11-15 year girls<30kg & 15-19 year girls<35kg
• 6kg free food grain/month

36. INTERVENTIONS
• Rajiv Gandhi scheme for empowerment of adolescent girls
• SABLA : to improve nutritional & health status
• Indira Gandhi marutva sahyog yojana
• Conditional cash transfer to pregnant &lactating mothers to improve
their nutritional & health status

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