Child health programmes in India.

1. CHILD HEALTH PROGRAMMES
By: Prateek Shrivastava
3rd Proff. MBBS student

2. Why do we need Child Health Programmes:
• To reduce the child mortality rate by preventing and
controlling the major causes of child illness like pneumonia
and diarrhoea etc.
• To improve growth and development of child

3. • Based on the identified causes of mortality, five major strategic
areas have been identified to improve child health outcomes

5. 1. NEWBORN HEALTH INTERVENTIONS:
• India Newborn Action Plan (INAP):
• Launched in : June 2014
• Goal: ‘’Single digit neonatal mortality rate by 2030’’
‘’Single digit stillbirth rate by 2030’’
• Features:
1. Preconception amd antenatal care
2. Care during labour and child birth
3. Immediate newborn care
4. Care of the healthy newborn
5. Care of samll and sick newborn
6. Care beyond newborn survival

6. • FACILITY BASED NEWBORN CARE (FBNC):
Level of care that is provided at the various facility levels:

7. • NEWBORN CARE CORNER ( NBCC)
• NBCC is a space within the delivery room in any health facility where
immediate care is provided to all newborns at birth.
• Mandatory for all health facilities where deliveries are conducted.
• NEWBORN STABILIZATION UNIT ( NBSU):
• A facility within or in close proximity of the maternity ward.
• Sick and low birth weight baby can be cured for during short periods.
• All FRUs/CHC need to have a NBSU with NBCC.
• Composition: 4 bedded unit + 2 beds in post natal ward for rooming in.

8. • SPECIAL NEWBORN CARE UNIT (SNCU):
• Situated in the vicinity of labour room.
• Provide special care (all care except assisted ventilation and major surgery).
• >3000 deliveries per year- should have an SNCU.
• Composition: 12 bedded unit + 4 additional beds for step down.

9. • HOME BASED NEWBORN CARE (HBNC):
• Aim: Improving newborn survival
• ASHA is the main person involved in HBNC
• Objective is to decrease neonatal mortality and morbidity
through:
1. Prevention of complications
2. Early detection and special care of preterm and low birth
weight newborn
3. Early identification of illness in newborn
4. Support the family for adoption of healthy practices

10. • Responsibilities of ASHA:
• Mobilize all pregnant mothers to ensure antenatal care.
• Undertake birth planning and birth preparedness with mother.
• Assessing if baby is at risk (preterm/LBW).
• Detect signs and symptoms of sepsis.
• ASHA visits to all newborn upto 42 days of life.
• Schedule:
• 6 visits in case of institutional delivery: Day 3, 7, 14, 21, 28, 42.
• 7 visits in case of home delivery: Day 1, 3, 7, 14, 21, 28, 42.

11. • Incentives:
• Caesarean section delivery- ₹ 250 (if she completes all 5
visits from day 7 to 42.)
• ₹50 for monthly follow up of LBW and babies discharged
from SNCU.
• Twins or triplets- The incentive amount for ASHA would
be 2 times or 3 times.
• If women delivers at her maternal house and return to her
husband’s house,
• 2 ASHA take HBNC visit
• Incentive of ₹250 devided into 2 parts ie. ₹125 to each.

12. Janani- Shishu
Suraksha
Karyakram
(JSSK)

13. Launched on: 1st June 2011
Objective: To make available better health facilities for women and
child.
Facilities provided to the pregnant women under JSSK:
1. Free and no expense delivery for all pregnant women who are
delivering in public health institutions, including C-section.
2. These includes free drugs,free diet upto 3 days during normal
delivery and upto 7 days during C- section.
3. Provide free transport from home to institutions, in case of referral
and drop back home.
4. Similar entitlements have been put for all sick newborn for
treatment till 30 days after birth.

14. • NAVJAT SHISHU SURAKSHA KARYAKRAM (NSSK):
• Aim: To train health personnel in basic newborn care and
resuscitation.
• Care provided at birth ie.
1. Prevention of hypothermia
2. Prevention of infection
3. Early initiation of breast feeding
4. Basic newborn resuscitation

17. • NUTRITIONAL REHABILITATION CENTER (NRCs):
NRCs are facility based units providing medical and nutritional care to Severe
Acute Malnutrition (SAM) childern under 5 years of age who have medical
complications.
• Services:
• 24 hrs care and monitoring of the
child
• Treatment of medical
complications
• Therapeutic feeding
• Sensory stimulation and
emotional care
• Counselling on appropriate feed,
care and hygiene
• Demonstration on the preparation
of energy dense food using lacally
available food items
• Follow up

18. • MICRONUTRIENT SUPPLEMENTATION:
• Vitamin-A:
• A large number of children suffer from sub clinical deficiency
of vitamin-A.
• Doses of vitamin A given to all under 5 children
• Doses:
1. First dose (1 lakh units) – at 9 months with measles
vaccination
2. Second dose (2 lakh units) –after 9 months
3. 2 lakh units each – at 6 months interval upto 5 years of age

19. • Vitamin-A supplementation for SAM:
• Give vitamin A in a single dose to all SAM childern unless there is
evidence that child has received vitamin A dose in last 1 month.
• Recommended oral dose of vitamin A according to child’s age:

20. • Administration:
1. Oral administration- Oil based formulation
2. IM administration- Water based formulation
In case of severe anorexia, oedematous malnutrition,
septic shock etc.

21. • Multivitamin supplements:
• Contains vitamin A, C, D, E, B12
• Folic acid:
• 5 Mg on day 1, then 1mg/day
• Elemental Zn:
• 2mg/kg/day
• Copper:
• 0.3 mg/kg/day

22. • ANAEMIA MUKT BHARAT
• Prophylactic dose and regime for IFA supplementation:
Launched in 2018

23. • NATIONAL DEWORMING DAY (NDD):
• Bi-annual mass deworming for children
in the age groups between 1-19 years.
• On 10th February and 10th August

26. Integrated Management of
Neonatal and Childhood illness
(IMNCI)

27. • IMNCI strategy is one of the main intervention under the RCH-II
/NRHM.
• Strategy is for reducing morbidity and mortality associated with
major causes of childhood illness.
• IMNCI is Indian Version of IMCI.
• Major IMNCI adaptation:
• Inclusion of early neonates of 0-7 days of age
• Incorporating national guidelines on malaria, anaemia,
vitamin-A supplements and immunization schedule
• Training of health workers

28. Target children:
• <5 years
• <2 months of age
• 2 months – 5 years of age
Objectives:
• To reduce deaths, illness and desability
• To contribute to improve growth and development

29. • The strategy includes three main components:
1. Improvement in case management skills of health staff
2. Improvement in health system required for effective
management of childhood illness
3. Improvement in family and community practices

30. • Preventive components:
• Breastfeeding
• Nutritional counseling
• Vitamin-A and iron supplementation
• Immunization
• Treatment of helminthic infestations
• Curative components:
• Integrated case management of most common childhood problems
• Diarrhoea
• ARI
• Measles
• Malaria
• Malnutrition

31. Case management process:

32. Integrated Case management process:
In OPD:
1. Check for danger signs:
• Convulsions
• Lethargy/unconsciousness
• Inability to drink/breastfeed
• Vomiting

33. 2. Assess main symptoms:
1. Fever
2.Ear problems
(otitis media)
3.Cough/difficulty
in breathing 4. Diarrhoea

34. 3. Assess nutrition and immunization status
4. Classify conditions and identify treatment action

37. • FACILITY BASED IMNCI (F-IMNCI):
Aim: To empower the health personnel with the skill to manage newborn
and childhood illness at the community level as well as the health facility.
• It’s a training program for health personnel.
• Provide appropriate in-patient management of:
Asphyxia, sepsis, LBW, pneumonia, diarrhoea, malaria,
meningitis, severe malnutrition etc.
• Trainees:
Medical officers and staff nurses at PHCs, FRUs, District
Hospitals, MCH level-I, II, III
• Trainers:
Senior paediatricians, member of dept of pediatrics and
community medicine.

38. • INTENSIFIED DIARRHOEA CONTROL FORTNIGHT (IDCF):
Aim: Zero child death due to childhood diarrhoea.
-To increase awareness about use of ORS and
Zinc in diarrhoea.
• Observed during July and August
• Low osmolarity Oral Rehydration Solution.
• Zinc: used as adjunct to ORS
• Addition of Zn would result in reduction of
number and severity of episodes and duration
of diarrhoea.

40. Rashtriya Bal
Swasthya
Karyakram
(RBSK)

41. • Launched in February 2013
• It includes provision for Child Health Screening and Early
Intervention Services through early detection and management of
4Ds:
1. Defects at birth
2. Diseases of Childhood
3. Deficiencies
4. Developmental delays and
disabilities

42. • RBSK cover 30 identified health conditions for early detection, free
treatment and management.

43. Programme Implementation
1. For newborn (age 0- 6 weeks):
• Facility based newborn screening:
• Screening of birth defects in institutional deliveries
• By ANMs/Medical officers/Gynaecologists
• Birth defects are refer to District Early Intervention Centers (DEIC) in
DH.
• Community based newborn screening:
• Done at home through ASHAs during home visits
• ASHAs mobilise mothers to attend the local Anganwadi Centers for
screening by dedicated mobile health team

44. • For children (aged 6 weeks to 6 years):
• Anganwadi center based screening by dedicated mobile
health team.
• For children (aged 6 years to 18 years):
• Government and government aided school based screening by
dedicated mobile health team
• Screening conducted at school: Once a year
• Screening conducted at anganwadi center: twice a year

47. • UNIVERSAL IMMUNIZATION PROGRAMME (UIP):
• The UIP in India is one of the largest public health programmes
in the world.
• It targets around 2.9 crore pregnant women and 2.67 crore newborn
annually.
• It is one of the most cost effective public health interventions
• Largely responsible for reduction of vaccine preventable Under-5
mortality rate.
• Launched In 1978 as an Expanded Program of Immunization.

48. • GOI is providing vaccines free of cost against 12 vaccine preventable
diseases:
1. Diphtheria
2. Pertussis,
3. Tetanus
4. Polio,
5. Measles,
6. Rubella,
7. Tuberculosis,
8. Hepatitis B
9. Meningitis & Pneumonia
10.Rota virus diarrhea,
11.Pneumococcal Pneumonia
12.Japanese Encephalitis

49. • MISSION INDRADHANUSH:
• Launched in : December 2014
• By MoHFW
• Indradhanush depicting 7 colors of rainbow for 7
prevention against 7 vaccine preventable diseases.
• Objective: To fully immunize either unvaccinated
or partially vaccinated and those who have not
been covered during Routine Immunization
sessions.
1. Diphtheria, 2. Pertusis, 3. Tetanus, 4. Polio, 5. Tubercular Meningitis,
6. Measles, 7. Hepatitis B

51. • INTENSIFIED MISSION INDRADHANUSH
• Launched in: October 2017
• The focus is an urban slum areas and districts with slowest progress and
completion of due list of beneficiaries.

52. • PULSE POLIO IMMUNIZATION
• Launched in: December 1995
• Under this program children under 5 yrs of age are
given oral polio drops during National Immunization
Days (NID) and Sub National Immunization Days
(SNID).
• Results:
• On 25th Feb 2012, India was removed from the list of
polio endemic countries.
• On 27th March 2014, India was certified as polio
free country.

53. Thank you