Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1694831816266.pdf (India)
Reproductive Maternal Newborn Child Health + Adolescent Health An Overview Vandana Gurnani JS (RCH) Ministry of Health and Family Welfare Government of India Overview Situational Analysis RMNCH+A-Introduction Reproductive Health Maternal Health Child Health and Immunization Adolescent Health and RKSK PCPNDT Recent Initiatives Challenges Polio and Maternal & Neonatal Tetanus In 2009….. Out of total polio cases across the world India accounted for over 50 percent of the polio cases India In 2014…... India certified as ‘Polio-free’ by WHO in March 2014 and has since maintained the status - A Monumental Success Maternal & Neonatal Tetanus (MNT) and Yaws– ELIMINATED !
India’s Progress on MDG 5 – Maternal Mortality Ratio India’s Progress on MDG 4 – Under 5 Mortality Rate 385 44% decline 216 556 70% decline 167 Global (MMEIG Estimates:1990-2015) India(MMEIG Estimates: 1990 & 2015) & SRS 2011-13 126 65% decline 91 53% decline 43 43 Global (IGME Estimates:1990-2015) India(IGME Estimates: 1990) & SRS 2013 MMR in India has declined much faster than the global MMR U5MR in India has declined much faster than the global U5MR Key Targets- SDG-3/ NHP 2017/ Budget  Reduction of TFR to 2.1 by 2025  Reduce MMR from current level to 100 by 2020  Reduce Under Five Mortality to 23 by 2025  Reduce Infant mortality Rate to 28 by 2019  Reduce Neo-natal mortality to 16 by 2025  Antenatal care coverage above 90% by 2025  90% full immunization by 2025 Reproductive Maternal Newborn Child Health +Adolescent Health Reproductive & Child Health Adoles Reprod -cent -uctive RMNCH+A Mater APPROACH Child nal New- born • RMNCH+A Links maternal and child survival to other components (family planning , adolescent health, gender & PC & PNDT) • Plus denotes inclusion of adolescence as a distinct ‘life stage’ in the overall strategy • Links community and facility based care as well as referrals between various levels of health care system Key Strategies – RMNCH+A Family Planning • • Expansion of the basket of FP Choices Home Delivery of Contraceptives by ASHAs, Fixed Day Static Services at all facilities Enhanced Compensation Scheme National Scheme, Emphasis on Post Partum and Post Abortion FP services Family Planning Indemnity • • • • Key Strategies – RMNCH+A Maternal Health • Early registration of pregnancy • ANC services, detection and follow-up of high risk cases using MCTS • Encouraging institutional deliveries, improving access by setting up delivery points & FRUs – Over 20000 delivery points & 2200 FRUs • Capacity Building Of HR • Maternal Death Review • Comprehensive Abortion Care • Maternal & Child Health Wings – 515 sanctioned Key Stratagies– RMNCH+A Janani Shishu Suraksha Karyakram- Free and Zero Expense delivery including C-section, free care in case of ante-natal & post-natal complications for pregnant women and infants Nearly 1.3 crore women are availing for free entitlements every year Janani Surksha Yojana-Cash assistance to eligible pregnant women who give birth in a government health facility.
In the year 2016- 17, the number of JSY beneficiaries was 1,04,59,547 Key Strategies – RMNCH+A Child Health • Essential newborn care at facility - Specialised units for stabilization and care of sick newborn babies (712 SNCUs, 2321 NBSUs & 18323 NBCCs) • Home based newborn care • Promotion of breastfeeding and timely initiation of complementary feeding • Management of cases of severe acute malnutrition at Nutrition Rehabilitation Centres (965 NRCs) • Micronutrient supplementation • Screening and management of children with 4 Ds-RBSK program.
In year 2016-17, 29.8 Crore children were screened, 1.35 Crore identified with any of the Ds and 97.6 lakhs were referred to secondary/tertiary care facilities.
Key Programmes – RMNCH+A Universal Immunization Programme • Largest immunization programme in World • 30 million pregnant women; 26 million newborns targeted annually • 9 million sessions held annually • 27,000+ cold chain points • Twelve Preventable Diseases Vaccine covered: Tuberculosis, Diphtheria, Pertussis, Tetanus, Polio, Measles, Hepatitis B, H. Influenzae B, Japanese Encephalitis Rotavirus diarrhoea, Rubella and Pneumococcal pneumonia.
• India is the largest manufacturer of vaccines with a functional National Regulatory Authority • Full Immunisation has increased from 43.5% (2005-06) to 62% (2015-16) Key Strategies– RMNCH+A Adolescent Health Rashtriya Kishor Swasthya Karyakram Being implemented to reach 253 millions adolescents (ages 10-19 years) in country in a phased manner • Adolescent Friendly Health Clinics (AFHCs) • Weekly Iron Folic Acid Supplementation (WIFS) • Menstrual Hygiene Scheme (MHS) • Peer Educator Programme Decline in Sex Ratio and PC&PNDT Act • The Pre-conception and Pre-natal Diagnostic techniques (Prohibition of Sex Selection) Act, 1994 (PC& PNDT Act) was enacted in 1996 and further amended in 2003 • Prohibits sex selection before and after conception and imposes penalty.
• Policy making bodies both at national and state levels-(Central/ State Supervisory Boards) • Implementation lies with the States though State and District Appropriate Authorities assisted by Advisory Committees • Monitoring mechanisms are in place at all levels- (Multidisciplinary National/ State/ District Inspection and Monitoring Committees)  2370 court cases have been filed, 304 Convictions have been secured and following conviction the medical licenses of 114 doctors have been suspended/ cancelled and 1416 ultrasound machines have been sealed for violations of the law.
e c n a m r o f r e P g n i t a u a v E l Web-based Mother and Child Tracking System/ MCTFC Web-based Health Management Information System for monitoring service delivery indicators Sample Registration System : Data brought out by Registrar General of India on key outcome indicators at the national & state level National Family Health Survey: All India data on key indicators through periodic surveys Coverage Evaluation Survey, Rapid Survey of Children, Common Review Missions, RMNCH+A field visits PMSMA National Deworming Day Mission Indradhanush RMNCH+A Mother’s Absolute Affection Mission Parivar Vikas Intensified Diarrhoea Control Fortnight Recent Key Initiatives to unreached Mission Indradhanush to reach out children.
6% to 7% annual expansion in the immunization coverage.

• 2.53 crore children provided vaccination • 66.16 lakh children were fully vaccinated • 68.43 lakh pregnant women also vaccinated with Tetanus Toxoid.

New Vaccines launched  Inactivated Polio Vaccine (IPV)  Adult Japanese Encephalitis (JE)  Rotavirus  Measles Rubella.
 Pneumococcal Pradhan Mantri Surakshit Matritva Abhiyaan - special ANC checkups for pregnant (PMSMA) women (in 2nd / 3rd Trimester) on 9th of every month • More than 4300 volunteers registered, • More than 12000 facilities provide PMSMA services • More than 75 lakh antenatal checkups conducted Family Planning: Three new methods introduced  Injectable Contraceptive DMPA (Antara) – a 3-monthly injection  Centchroman pill (Chhaya)– non-hormonal once a week pill  Progesterone-only pills (POP) – for lactating mothers Mission Parivar Vikas & New Family Planning Media Campaign launched - scheme for 146 High Fertility Districts Intensified Diarrhoea Control Fortnight is being observed annually during July-August, with the ultimate aim of ‘zero child deaths due to childhood diarrhoea’.
More than 14.7 crore children were reached through this campaign since 2014. is being observed National Deworming Day (NDD) annually targeting all children in the age group of 1-19 years (both school enrolled and non-enrolled).

More than 75 Crore doses of Albendazole were administered to children 1-19 years since 2014.
MAA- Mothers Absolute Affection program has been launched during World Breastfeeding week in August 2016 to promote breast feeding and improve child feeding practices, with special emphasis on early initiation of breastfeeding in health facilities 8 EAG States Contribute…  50% of India's Population  68% of Child Births  70% of Infant Deaths  72% of Under 5 Mortality  80% of Maternal Mortality  Intra – State and intra district disparities- lack of focus on HPDs  Poor tracking of high risk pregnancies  Paucity Human of Health, irrational postings Resources for Challenges  Irregular availability of essential drugs and diagnostics e.g.
availability of IFA  Weak focus on quality of care  Poor infection prevention and control practices  Lack of grievance redressal forums for JSSK/ JSY etc  Overall lack of focus on adolescent health  Lack adequate focus on of Supportive Supervision Comparative trend in DALYs among all ages Vs under 5 children in India and high income countries Contribution to DALYs among under 5 children in India-2015 Comparative pattern of DALYs in under 5 children in India Vs high income countries Maternal deaths : Causes Under 5 Deaths: Causes Source- RGI-SRS 2001-03 Medical Causes Source- WHO 2012 Others 14% Injuries 3% Measles 3% Diarrhoeal disease 12% Pneumoni a 15% Neonatal causes 53% Infections Prematurity Asphyxia 33 35 20 28 ‘3 Delays’ • Delay in decision to seek professional care • Delay in reaching the appropriate health facility • Delay in receiving care after arriving at a hospital Haemorrhage, 38%Sepsis, 11%Hypertensive disorders, 5%Obstructed Labour, 5%Abortion, 8%Other Conditions, 34%