INTRODUCTION :
The RCH Programme incorporated the earlier existing programme i.e. National Family Welfare Programme and child survival and safe motherhood programmes and added two more components one relating to sexually transmitted disease and the other relating to reproductive tract infections.
The programme was formally launched on 15 october 1997.
DEFINITION:
Reproductive and child health approach has been defined as "people have the ability to reproduce and regulate their fertility, women are able to go through pregnancy and child birth safety, the outcome of pregnancies is successful in terms of maternal and infant survival and well being, and couple are able to a have sexual relation, free of fear of pregnancy and of contracting disease."
APPROACHES OF RCH :
1.Improving the health status of young women and young children.
2.Universal immunization programme
3.Oral rehydration therapy
4.Child survival and safe motherhood
5.Acute respiratory infection control
RCH PHASE-I
The programme was formally launched on 15th october 1997.
The Major strategies under the first phase of RCH are:
1. Essential obstetric care
2. Emergency obstetric care
3. 24 hours delivery services at PHC and CHC
4. Terminal of pregnancy
5.Control of reproductive tract infection (RTI) and sexually transmitted disease (STD)
6.Immunization
7. Essential newborn care
8. Diarrhoeal disease control
9. Acute respiratory disease control
10. Prevention and control of vitamin A deficiency in children
11. Prevention and control of anemia in children
1.Essential obstetrics care :-
Essential obstetric care intends to provide the basic
maternity services to all pregnant women through
(1) early registration of pregnancy (within 12-16 weeks).
(2) provision of minimum three antenatal check ups by ANM or medical officer to monitor progress of the pregnancy and
to detect any risk/complication so that appropriate careincluding referral could be taken in time.
(3) provision of safe delivery at home or in an institution, and
(4) provision of three postnatal check ups to monitor the postnatal recovery and to detect complications.
2. Emergency Obstetrics Care
emergency obstetric care is an important
intervention to prevent maternal morbidity and mortality.
Under the CSSM programme 1748 Referral Units were identified and supported with equipment kit E to kit P. Under the RCH programme the FRUs were strengthened through supply of emergency obstetric kit, equipment kit and provision of skilled manpower on contract basis etc.
Traditional Birth Attendant still plays an important role during deliveries in our society.
3.24hrs delhivery services at PHC and CHC
To promote institutional deliveries, provision has been made to give additional honorarium to the staff to encourage round the clock delivery facilities at health centres.
4.Medical Termination of Pregnancy
MTP is a reproductive health measure that enables a woman to opt out of an unwanted or unintended pregnancy in certain specified circumstances without endangering her
life, through MTP Act 1971.
Aim :- To reduce maternal morbidity and mortality from unsafe abortions.
The assistance from the Central Government is in the form 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
5.Control of reproductive tract infections (RTI) and sexually transmitted diseases (STD)
Under the RCH programme, the component of RTI/STD control is linked to HIV and AIDS control.
It has been planned and implemented in close collaboration with National AIDS Control Organization (NACO).
NACO provides assistance for setting up RTI/STD clinics upto the district level.
The assistance from the Central Government is
in the form of training of the manpower and drug kits including disposable equipment.
Each district is assisted by two laboratory technicians on contract basis for testing
blood, urine and RTI/STD tests.
6.Immunization
The Universal Immunization Programme (UIP) became a part of CSSM programme in 1992, RCH programme in 1997, and currently of National Health Mission.
7.Essential newborn care
The primary goal of essential newborn care is to reduce perinatal and neonatal mortality.
The main components are:-
1.Resuscitation of newborn with asphyxia, 2.Prevention of hypothermia,
3.Prevention of infection,
4.Exclusive breast feeding and
5.Referral of sick newborn.
The strategies are :-
1.To train medical and other health personnel in essential newborn care,
2.To provide basic facilities for care of low birth
weight and sick new borns in FRU and district hospitals etc.
8.Diarrhoeal disease control
In the districts not implementing Integrated Management of Neonatal and Childhood Illness, the vertical programme for control of diarrhoeal disease will continue.
India is the first country in the world to introduce the low osmolarity Oral Rehydration Solution.
Zinc is to be used as an adjunct to ORS for the management of diarrhoea.
Addition of Zinc would result in reduction of the number and severity of episodes and the duration of diarrhoea .
De-worming guidelines have been formulated. The incidence of diarrhoea is reduced by provision of safe drinking water.
9.Acute respiratory disease control
The standard case management of ARI and prevention of deaths due to pneumonia is now an integral part of RCH programme.
Peripheral health workers are being trained to
recognize and treat pneumonia.
Cotrimoxazole is being supplied to the health workers through the drug kit.
10.Prevention and control of vitamin A
deficiency in children
It is estimated that large number of children suffer from sub-clinical deficiency of vitamin A.
Under the programme, doses of vitamin A are given to all children 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 (2 lakh units) is given after 9 months.
Subsequent doses (2 lakh units each) are given at six months intervals upto
5 years of age.
All cases of severe malnutrition to be
given one additional dose of vitamin A.
11. Prevention and control of anaemia in children
Iron deficiency anaemia is widely prevalent in young children.
To manage anaemia, the policy has been revised.
Infants from the age of 6 months onwards upto the age of 5 years are to receive iron supplements in liquid formulation in doses of 20 mg elemental iron and 100 mcg folic acid per day for 100 days in a year.
Children 6 to 10 years of age will receive iron in the dose of 30 mg elemental iron and
250 mcg folic acid for 100 days in a year.
Children above this age group would receive iron supplement in the adult dose
RCH PHASE II :
RCH phase II began from 1st april 2005.
The focus of the programme is to reduce maternal and child morbidity and mortality with emphasis on rural health care.
The Major strategies under the second phase of RCH are:
1.Essential obsteteric care
a.Institutional delievery
b. Skilled attendance at delievery
2.Emergency obstetric care
a.operational first Refferal unit .
b. PHC, and CHC for round the clock delievery services
3.Strengthening referral system
(I). ESSENTIAL OBSTETRIC CARE:
a.Institutional delivery:
To promote institutional delievery in RCH Phase II,it is envisaged that fifty percent of the PHC,and all the CHC would be made operational as 24hrs delievery centers,in a phased manner, by the year 2010.
b.Skilled attendance at delivery:
Its now recognized globally that the countries which have been successful in bringing down maternal mortality are the ones where the provision of skilled attendance at every birth and its linkage with appropriate referral services for complicated cases have been ensured.
c.The policy decision
ANM/LHV/SN have now been permitted to use drugs in specific emergency situations to reduce maternal mortality.
They have also been permitted to carry out certain emergency interventions when the life of the mother is at risk.
(II). Emergency obstetric care:
A.Operational First refferal unit (FRU)
Operational of FRU and skilled attendance at birth are the two activities which go hand in hand.
The minimum service to be provided by a fully functional FRU are:
1.24hrs delievery services care including surgical interventions like caesarean sections.
2.Emergency obstetric care including surgical interventions like caesarean sections
3.New bom care
4.Emergency care of sick children services
5.Full range of family planning services including laproscopic
6.Safe abortion services
7.Treatment of STI/RTI
8. Blood storage facility
9. Essential laboratory services
10. Referral services
(III). Strengthening referral system
New initiatives :
A. Training of MBBS doctors in life saving anaesthetic skills for emergency obstetric care provision of adequate and timely emergency obstetric care (EmOC) has been recognized as the important intervention for saving lives of pregnant women who may develop complications during pregnancy and childbirth.
B. Setting up of blood storage centres at FRU according to govt. of India guidelines.
3.Janani suraksha yojana :-
The National Maternity Benefit scheme has been modified into a new scheme called Janani Suraksha Yojana(JSY).
It was launched on 12th April, 2005.
The objectives of the scheme are -
reducing maternal mortality and neonatal mortality through encouraging delivery at health institutions, and focusing at institutional care among women in below poverty line families.
4. Vandemataram schemes
1.It is a voluntary scheme wherein any obstetric and gynaec specialist, maternity home, nursing home, MBBS DOCTORS can volunteer themselves for providing safe motherhood services.
2.Enrolled doctors will display 'vandemataram logo' at their clinics.
3.Iron and folic acid tablets, oral pills, TT injections, etc. will be provided for free distribution.
5. Safe abortion services:-
Under RCH - II the following services are provided:
A.Medical method of abortion:
Under preview of MTP act-1971: Mifepristone (RU 486) followed by Misoprostol. It is recommended upto 7 weeks (49) days) of amenorrhoea.
B.Manual vacuum aspiration:
MVA technique has been piloted in coordination with FOGSI (FEDERATION OF OBSTETRIC AND GYNECOLOGICAL SOCIETIES OF INDIA), WHO and respective state Govts.
6. Integrated management of neonatal and childhood illness.
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