(RMNCH+A MCH PART)

1. HIGH IMPACT INTERVENTIONS IN RMNCH+A

2. High Impact Interventions
INPUT…… PROCESS … OUTPUT…..OUTCOME …..IMPACT

3. WHO Fact sheet
Global India
3,60,000 births/day
15000 births/hour
250 births/min
4 births/sec
49,481 births/day
2062 births/hour
34 births/min
1 birth/2 sec

4. 5 “W”
 Every day, approximately 830 women die from
preventable causes related to pregnancy and
childbirth.(when)
 99% of all maternal deaths occur in developing
countries.(where)
 Maternal mortality is higher in women living in rural areas
and among poorer communities.(Where)
 Young adolescents face a higher risk of complications and
death as a result of pregnancy than other women.(who)
 Main Causes of maternal mortality –
Hgh,infection,obstruction,HTN (What)
 3 Delays(why)

5. Causes of Maternal & Under 5 Mortality in India

6. 3 Delays
The 3 Delays Model(why)

7. RMNCH+A High Impact Interventions
The approach
 RMNCHA+A is a comprehensive strategy for improving the maternal
and child health outcomes under NRHM
 It is based on the evidence that maternal and child health can not be
improved in isolation as adolescent health and family planning have
an important bearing on the outcomes.
 This strategy encompasses various high impact interventions across
the life cycle
 This strategy is based on the concept of ‘CONTINUUM OF CARE’

8. Plus +Denotes
 Inclusion of adolescents as a distinct life stage
 Linking of Maternal Child Health to Reproductive
Health and other components like Family planning
 Linking of community and facility based care as
well as referrals between various levels of health
care system

9. GOALS
 Health outcome goals established in the
12th Five Year Plan.
 Reduction of Infant Mortality Rate (IMR)
to 25 Per 1,000 live births by 2017
 Reduction in Maternal Mortality Ratio
(MMR) to 100 per 100,000 live births by
2017
 Reduction in Total Fertility Rate(TFR) to
2.1 by 2017

10. Strategic RMNCH+A Interventions Across
Life Stages
 There are two dimensions to health
care
1)Stages of the life cycle
2)Places where the care is provided
These two together constitute the
‘Continuum of Care’
Adolescents
&Prepregnancies
Pregnancy Birth Postnatal Childhood
community
facility
Referral

11. Why high impact
 implementation of the RMNCH+A strategy across the continuum of
care,
 • Five high-impact interventions across each of the five thematic
areas.
 • Five cross-cutting and health systems strengthening interventions.
 • The matrix focus on 25 actions for desired outcomes. When
implemented with high coverage and high quality, these
interventions are expected to have a great impact on reducing
maternal and child mortality and morbidity.

12. 5*5 Matrix of High impact interventions

13. Maternal Health
1.Name-based tracking
of pregnant women and
children with intention
to track every pregnant
woman, infant and
child up to the age of
three years
2.Universal access to
ull antenatal package
3.Tracking and
monitoring of severely
Anaemic women ,low
birth weight babies
and sick neonates
4.A more recent
nitiative is to link
MCTS with AADHAR in
order to track the
1.line listing of
severely anaemic
women
2.Timely and
appropriate
management of
severely anaemic
women.
3.In malaria endemic
areas, provision of
insecticidal bed nets
and timely check up of
anaemia is required.
1.Sub centres and Primary
Health Centres designated
as delivery points
2. Community Health
Centres (FRUs) and
District Hospitals made
functional 24 X 7 to
provide basic and
comprehensive obstetric
and new born care
services.
3.Multi skilling of doctors
in the public health
system
• Maternal Death
Review (MDR) To
identify causes of
maternal deaths
and the gaps in
service delivery
• The Perinatal and
Child Death
Review is an
important strategy
to
•
Identify villages with
high numbers of home
deliveries and
distribute Misoprostol
to selected women in
8th month of
pregnancy for
consumption during
third stage of labour
Incentivize ANMs for
Home deliveries

14. NEW BORN CARE
1.Early Initiation of Breast
Feeding (<1hr)
2.Exclusive Breast feeding
for 6 months (among 6–9
months children)
1.The home-based
Newborn care scheme,
launched in 2011, for
immediate postnatal care
(especially in the cases of
home delivery)
2Essential Newborn care
to all Newborn up to the
age of 42 days.
3.Frontline workers
(ASHAs) trained and
incentivised to provide
special care to Preterm
and Newborns;
4.Identification of
illnesses, appropriate
care and referral through
home visits.
1.Newborn Care Corners
at delivery points
2.Trained providers for
basic new-born care and
resuscitation through
Navjaat Shishu Suraksha
Karyakram (NSSK).
3.The saturation of all
delivery points with
Skilled Birth Attendance
and NSSK trained
personnel
4..Linkages with sick
Newborn Care Units at
health facilities
5.The immediate routine
newborn care, comprising
drying, warming, skin to
skin contact and initiation
of breast feeding within
To strengthen the care of
sick, premature and low
birth weight New-borns,
Special New-born Care
Units (SNCU) at District
Hospitals and tertiary
care hospitals.
Under IMNCI, use of
recommended antibiotics
based on national
guidelines) in children
aged 2 months to 5 years
with non-severe
pneumonia must be
ensured through frontline
workers (ASHA, ANM)
and at all levels of health
facilities.

15. CHILD HEALTH
1.Promotion of ‘infant
and young child
feeding practices’
.
2. Line listing of
babies born with low
birth weight
3.follow up to ensure
optimum feeding and
child care practices
4. Iron and folic acid
tablets or syrup for
100 days in a year
5.Bi-weekly iron and
folic acid
supplementation for
preschool
children of 6 months
to 5 years as part of
the National Iron +
initiative.
1. Availability of ORS and
Zinc
2.Use of Zinc should be
actively promoted along
with use of ORS
1..Use of recommended
antibiotics (based on
national guidelines) in
children aged 2 months
to 5 years with non-
severe pneumonia
through frontline
workers (ASHA, ANM) and
at all levels of health
facilities
2.Emergency
management of children
with pneumonia included
in the facility-based
IMNCI trainings .
1.largest immunisation
programmes in the world
2.The second dose of
measles has been
introduced
3.Hepatitis B made
available in whole
country
4.Incorporation of
Pentavalent vaccine, a
combination vaccine
(DPT + Hep-B + Hib)
,
5.Provision for Auto
Disable (AD) Syringes to
ensure injection safety,
6.The cold chain must be
further strengthened
7.The district AEFI
Committees must be in
place
1.A new initiative “Child
Screening and Early
Intervention Services”
2.screening to detect
medical conditions at an
early stage, thus
enabling early
intervention and
management, ultimately
leading to reduction in
mortality, morbidity and
lifelong disability

16. Pregnancy and Child birth(Priority
Interventions)
1. Preventive use of folic acid in Periconception period
2. Delivery of antenatal care package and tracking of High Risk
Pregnancies
3. Skilled Obstetric care
4. Immediate essential newborn care and resuscitation
5. Emergency Obstetric and new born care
6. Postpartum care for mother and newborn
7. Postpartum IUCD and sterilization

17. New born care and Child Care(Priority Interventions)
 Home Based newborn care and prompt referral
 Facility Based care of the sick newborn
 Integrated management of common childhood
illnesses( Diarrhoea, pneumonia and malaria)
 Child nutrition and essential micronutrient
supplementation
 Immunization
 Early detection and management of Defects at
Birth, Deficiencies, Diseases and Disability in
children(0-18yrs)

18. Health System Strengthening for RMNCH+A Services
Case load based deployment of HR at all levels
•Ambulances, drugs, diagnostics, reproductive
health commodities
•Health Education, Demand Promotion & Behaviour
change communication
•Supportive supervision and use of data for
monitoring and review, including scorecards based
on HMIS
•Public grievances redressal mechanism; client
satisfaction and patient safety through all round
quality assurance
System
strengthening

19. Cross cutting Interventions
 Bring down out of pocket expenses by ensuring JSSK, and
other free entitlements
 ANMs & Nurses to provide specialized and quality care to
pregnant women and children
 Address social determinants of health through
convergence
 Focus on un-served and underserved villages, urban slums
and blocks
 Introduce difficult area and performance based incentives

20. Resources
 The creation of regular posts under state
governments so that contractual appointments can
be slowly reduced and sustainable HR Structure is
developed
 Strengthening subcentres through additional human
resources: In subcentres of remote and hilly areas
there will be two ANMs,1 multipurpose worker ,1
pharmacist and 1 AYUSH doctor
 Capacity building of MO for reproductive,
adolescent, maternal ,newborn and child health.
 Training of nurses and ANM for SBA,IMNCI,NSSK and
IUCD insertion
Resources

21. Drugs and logistics
Drugs and logistics
 Availability of free generic drugs for out/in patients in
public health facilities is to be made by states for
minimizing out of pocket expenses
 Rational prescriptions and use of drugs
 Timely procurement of drugs and consumables
 Distribution of drugs to facilities from DH to subcentres;
and uninterrupted availability to patients is to be ensured
 Placing essential drug lists(EDL) in the public domain
 Computerized drugs and logistics MIS system

22. SWOT ANALYSIS
STRENGTHS WEAKNESSES OPPORTUNITIES THREATS
1.Very strong &high
commitment by GOI
1.Implementation
challenges specially in
northern states
1.Private sector
involvement in providing
services
1.Timelines for reaching the
goals may get extended as per
previous experience
2.Strategy based on
previous experiences
and gains achieved so
far
2.HMIS data though used for
scoring still has gaps of
recording the data from
private sector
2.Development partners
have a role to play in all
thematic areas
2.New diseases as
epidemiological transition
3.Strengthening of
health care delivery
infrastructure in a
holistic manner
3.High expectations with
limited resources may hamper
the progress
4.Life cycle approach
with each stage given
equal importance
5.Capacity building
,M&E given high
importance
6.All initiatives as

23. Thank You
Meetings
Microplanning
Mobilization
Monitoring