National Health Intervention Programme For Mother and Child B.Pharm 8th Semester

NATIONAL HEALTH INTERVENTION PROGRAMME FOR MOTHER AND CHILD

SOCIAL AND PREVENTIVE PHARMACY B PHRMACY 4TH YEAR, 8TH SEMESTER

TOPICS: 

1. NATIONAL HEALTH INTERVENTION PROGRAMME FOR MOTHER AND CHILD
2. NATIONAL FAMILY WELFARE PROGRAMME
3. NATIONAL TOBACCO CONTROL PROGRAMME 
4. NATIONAL MALARIA PRVENTION PROGRAMME
5. NATIONAL PROGRAMME FOR THE HEALTHCARE FOR THE ELDERLY
6. SOCIAL HELATH PROGRAMME
7. ROLE OF WHO IN INDIAN NATIONAL PROGRAMME 

NATIONAL HEALTH INTERVENTION PROGRAMME FOR MOTHER AND CHILD

Reproductive, Maternal, Neonatal, Child and Adolescent health

• Janani Shishu Suraksha Karyakaram (JSSK) 
• Rashtriya Kishor Swasthya Karyakram(RKSK)
• Rashtriya Bal SwasthyaKaryakram (RBSK)
• Universal Immunisation Programme
• Mission Indradhanush / Intensified Misson Indradhanush
• Janani Suraksha Yojana (JSY)
• Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA)
• NavjaatShishu Suraksha Karyakram (NSSK) 
• National Programme for Family planning

    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.

    Based on the framework, comprehensive care is provided to women and children through five pillars or thematic areas of reproductive, maternal, neonatal, child, and adolescent health. The programmes and strategies developed by various divisions are guided by central tenets of equity, universal care, entitlement, and accountability to provide ‘continuum of care’ ensuring equal focus on various life stages.

    Ministry of Health & Family Welfare, Government of India has launched a new initiative namely- SUMAlV- Surakshit Matritva Aashwasan" with an aim to provide assured, dignified, respectful and Quality healthcare at no cost and zero tolerance for denial of services for every woman and newborn visiting the public health facility in order to end all preventable maternal and new-born deaths and morbidities and provide, a positive birthing experience. The expected outcome of this new initiative is "Zero Preventable Maternal and New-born Deaths and high quality of maternity care delivered with dignity and respect".

    Following this strategy, the Maternal Health Division strives to provide quality services to pregnant women and their new-borns through various interventions and programmes, building capacity of health personnel and routine health systems strengthening activities.

INTERVENTIONS: 

JananiSurakshaYojana (JSY): JananiSurakshaYojana (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. 

Janani Shishu Suraksha Karyakram(JSSK): Government of India has launched JananiShishuSurakshaKaryakaram (JSSK) on 1st June, 2011, which 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. 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. 

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 to ensure quality antenatal care and high risk pregnancy detection in pregnant women on 9th of every month.

LaQshya: In order to further accelerate decline in MMR in the coming years, MoFHWhas 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.

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. 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. Regular monitoring and evaluation of the services are being conducted.

Provision of RTI/STI services: Under NHM, 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.

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 counselling. 

Newer Interventions:

Midwifery: Government of India has initiated midwifery services throughout the country in 2018, with an objective 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. 

ACHIEVEMNTS:

 According to the latest figure released by Registrar General of India - Sample Registration System (RGI-SRS) Maternal Mortality Ratio (MMR) for the period 2014-16 is 130maternal deaths per 100,000 live births. With this, India has achieved the Millennium Development Goal (MDG) 5 i.e. India have achieved a reduction in MMR by three quarters between 1990 to 2015. The target was to achieve 139 maternal deaths per 100,000 live births. The table displays the trend in MMR over the years. The average decline in MMR between 2007-09 and 2011-13 had been 11.3 points per year, i.e. compound rate of annual decline was5.8% whereas average compound rate of decline is 8% between 2011-13 and 2014-16.

JANANI SHISHU SURAKSHA KARYAKARAM (JSSK)

Government of India has launched Janani Shishu Suraksha Karyakaram (JSSK) on 1st June, 2011. The scheme is estimated to benefit more than 12 million pregnant women who access Government health facilities for their delivery. Moreover it will motivate those who still choose to deliver at their homes to opt for institutional deliveries. . It is an initiative with a hope that states would come forward and ensure that benefits under JSSK would reach every needy pregnant woman coming to government institutional facility. All the States and UTs have initiated implementation of the scheme.

    The following are the Free Entitlements for pregnant women: 

• Free and cashless delivery 
• Free C-Section
• Free drugs and consumables
• Free diagnostics
• Free diet during stays in the health institutions
• Free provision of blood
• Exemption from user charges
• Free transport from home to health institutions
• Free transport between facilities in case of referral
• Free drop back from Institutions to home after 48hrs stay

The following are the Free Entitlements for Sick new-borns till 30 days after birth. This has now been expanded to cover sick infants:

• Free treatment
• Free drugs and consumables
• Free diagnostics o Free provision of blood
• Exemption from user charges
• Free Transport from Home to Health Institutions
• Free Transport between facilities in case of referral
• Free drop Back from Institutions to home

Rashtriya Bal SwasthyaKaryakram (RBSK)

Rashtriya Bal SwasthyaKaryakram (RBSK), an innovative and ambitious initiative, which envisages Child Health Screening and Early Intervention Services, a systemic approach of early identification of medical conditions and link to care, support and treatment. This programme subsumes the existing school health programme.

Objective - Early identification and early intervention for children from birth to 18 years to cover 4 ‘D’s viz. Defects at birth, Diseases in children, Deficiency conditions and Developmental delays including Disabilities.

It is important to note that the 0 - 6 years age group is specifically managed at District Early Intervention Canter (DEIC) level while for 6 -18 years age group, management of conditions is done through existing public health facilities. DEIC also acts as referral linkages for both the age groups.

Target group under Child Health Screening and Intervention Service Categories

Categories	Age Group
Babies born at public health facilities and home	Birth to 6 weeks
Preschool children in rural areas and urban slum	6weeks to 6 years
School children enrolled in class 1st and 12th in government and government aided schools	6yrs to 18 yrs

Selected Health Conditions for Child Health Screening & Early Intervention Services

Defects at Birth

1. Neural tube defect

2. Down's Syndrome

3. Cleft Lip & Palate / Cleft palate alone

4. Talipes (club foot)

5. Developmental dysplasia of the hip

6. Congenital cataract

7. Congenital deafness

8. congenital heart diseases

9. Retinopathy of Prematurity

Deficiencies

10. Anaemia especially Severe anaemia

11. Vitamin A deficiency (Bitot spot)

12. Vitamin D Deficiency, (Rickets)

13. Severe Acute Malnutrition

14. Goitre

Diseases of Childhood

15. Skin conditions (Scabies, fungal infection and Eczema)

16. Otitis Media

17. Rheumatic heart disease

18. Reactive airway disease

19.Dental conditions

20. Convulsive disorders

Developmental delays and Disabilities

21. Vision Impairment

22. Hearing Impairment

23. Neuro-motor Impairment

24. Motor delay

25. Cognitive delay

26. Language delay

27. Behaviour disorder (Autism)

28. Learning disorder

29. attention deficit hyperactivity disorder (ADHD)

30. Congenital Hypothyroidism, Sickle cell anaemia, Beta thalassemia (Optional)

Janani Suraksha Yojana (JSY)

Janani Suraksha Yojana (JSY) is a safe motherhood intervention under the National Rural Health Mission (NRHM) being implemented with the objective of reducing maternal and neo-natal mortality by promoting institutional delivery among the poor pregnant women. The Yojana, launched on 12th April 2005, by the Hon’ble Prime Minister, is being implemented in all states and UTs with special focus on low performing states. JSY is a 100 % centrally sponsored scheme and it integrates cash assistance with delivery and post-delivery care.

The Yojana has identified ASHA, the accredited social health activist as an effective link between the Government and the poor pregnant women in l0 low performing states, namely the 8 EAG states and Assam and J&K and the remaining NE States. In other eligible states and UTs, wherever, AWW ((Anganwadi workers) and TBAs or ASHA like activist has been engaged in this purpose, she can be associated with this Yojana for providing the services.

Important Features of JSY:

The scheme focuses on the poor pregnant woman with special dispensation for states having low institutional delivery rates namely the states of Uttar Pradesh, Uttaranchal, Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh, Assam, Rajasthan, Orissa and Jammu and Kashmir. While these states have been named as Low Performing States (LPS), the remaining states have been named as High performing States (HPS).

Tracking Each Pregnancy: Each beneficiary registered under this Yojana should have a JSY card along with a MCH card. ASHA/AWW/ any other identified link worker under the overall supervision of the ANM and the MO, PHC should mandatorily prepare a micro-birth plan. This will effectively help in monitoring Antenatal Check-up, and the post delivery care.

Eligibility for Cash Assistance: BPL Certification – This is required in all HPS states. However, where BPL cards have not yet been issued or have not been updated, States/UTs would formulate a simple criterion for certification of poor and needy status of the expectant mother’s family by empowering the gram pradhan or ward member.

Scale of Cash Assistance for Institutional Delivery:

Category	Rural area		Total	Urban area		Total
	Mother’s Package	Asha’s Package	Rs.	Mother’s Package	Asha’s package	Rs.
LPS	1400	600	2000	1000	200	1200
HPS	700		700	600		600

Disbursement of Cash Assistance: As the cash assistance to the mother is mainly to meet the cost of delivery, it should be disbursed effectively at the institution itself. 

For pregnant women going to a public health institution for delivery, entire cash entitlement should be disbursed to her in one go, at the health institution. Considering that some women would access accrediting private institution for antenatal care, they would require some financial support to get at least 3 ANCs including the TT injections. In such cases, at-least three-fourth (3/4) of the cash assistance under JSY should be paid to the beneficiary in one go, importantly, at the time of delivery.

Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA)

As India strives towards achieving the Sustainable Development Goals (SDGs) and looks ahead to the post-2015 era, progress in reducing maternal mortality becomes an important frontier. Every pregnancy is special and every pregnant woman must receive special care’. Any pregnant woman can develop life-threatening complications with little or no advance warning, so all pregnant women need access to quality antenatal services to detect and prevent life-threatening complications during childbirth. 

In 2007-08, India had 47% institutional deliveries (DLHS 3). However as per latest data of the Rapid Survey on Children (2013- 14), the institutional deliveries in India are 78.7%. In spite of this massive increase in the number of pregnant women coming to institutions for delivery, till date only 61.8% women receive first ANC in first trimester (RSOC) and the coverage of full ANC (provision of 100 IFA tablets, 2 tetanus toxoid injections and minimum 3 ANC visits) is as low as 19.7% (RSOC).Despite availability of treatment guidelines, mechanisms for monitoring and supportive supervision, regular As India strives towards achieving the Sustainable Development Goals (SDGs) and looks ahead to the post-2015 era, progress in reducing maternal mortality becomes an important frontier. Every pregnancy is special and every pregnant woman must receive special care’. Any pregnant woman can develop life-threatening complications with little or no advance warning, so all pregnant women need access to quality antenatal services to detect and prevent life-threatening complications during childbirth. In 2007-08, India had 47% institutional deliveries (DLHS 3). However as per latest data of the Rapid Survey on Children (2013- 14), the institutional deliveries in India are 78.7%. In spite of this massive increase in the number of pregnant women coming to institutions for delivery, till date only 61.8% women receive first ANC in first trimester (RSOC) and the coverage of full ANC (provision of 100 IFA tablets, 2 tetanus toxoid injections and minimum 3 ANC visits) is as low as 19.7% (RSOC).Despite availability of treatment guidelines, mechanisms for monitoring and supportive supervision, regular

Goal of the PMSMA

Pradhan Mantri Surakshit Matritva Abhiyan envisages to improve the quality and coverage of Antenatal Care (ANC) including diagnostics and counselling services as part of the Reproductive Maternal Neonatal Child and Adolescent Health (RMNCH+A) Strategy.

Objectives of the program:

• Ensure at least one antenatal check-up for all pregnant women in their second or third trimester by a physician/specialist
• Improve the quality of care during ante-natal visits. This includes ensuring provision of the following services:
• All applicable diagnostic services
• Screening for the applicable clinical conditions
• Appropriate management of any existing clinical condition such as Anaemia, Pregnancy induced hypertension, Gestational Diabetes etc. 
• Appropriate counselling services and proper documentation of services rendered
• Additional service opportunity to pregnant women who have missed ante-natal visits 
• Identification and line-listing of high risk pregnancies based on obstetric/ medical history and existing clinical conditions.
• Appropriate birth planning and complication readiness for each pregnant woman especially those identified with any risk factor or comorbid condition.
• Special emphasis on early diagnosis, adequate and appropriate management of women with malnutrition.
• Special focus on adolescent and early pregnancies as these pregnancies need extra and specialized care

Navjaat Shishu Suraksha Karyakram (NSSK) 

NSSK is a programme aimed to train health personnel in basic new-born care and resuscitation, has been launched to address care at birth issues i. e. Prevention of Hypothermia, Prevention of Infection, Early initiation of Breast feeding and Basic New-born Resuscitation.

New-born care and resuscitation are important starting-point for any neonatal program and is required to ensure the best possible start in life.

Objectives is to have a trained health personal in basic new-born care and resuscitation at every delivery point. The training is for 2 days and is expected to reduce neonatal mortality significantly in the country.