GUIDANCE BOOKLET

ON
MATERNAL HEALTH

COMMUNITY HEALTH OFFICERS

 CONTENTS
1. MATERNAL HEALTH SERVICES DURING PREGNANCY

INTRAPARTUM, AND POSTPARTUM PERIOD INCLUDING

PREGNANCY DETECTION -------------------------------------------------- 2

2. SERVICE PROVISION AT DIFFERENT LEVELS OF CARE -----------------3

a. FACILITY LEVEL SERVICES

b. COMMUNITY-LEVEL SERVICES

3. SUPPORTIVE SUPERVISION--------------------------------------------- 5

4. REFERRAL LINKAGES --------------------------------------------------- 6

5. MATERNAL HEALTH PROGRAMS- A BRIEF INTRODUCTION ------------7

6. ACTION POINTS AT AB-HWC --------------------------------------------9

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MATERNAL HEALTH SERVICES DURING PREGNANCY,INTRAPARTUM
AND POSTPARTUM PERIOD INCLUDING PREGNANCY DETECTION

Surakshit Matritva Aashwasan (SUMAN):

SUMAN INITIATIVE

Free Antenatal, Delivery, and Post Natal Care.

Free management of sick infants and neonates.
The assured delivery plan for the High-Risk Pregnant Women.
Ensuring quality standards at all levels of delivery points.

Service
guarantee
JSSK
JSY Health system
PMSMA strengthening Monitoring &
Laqshya Infrastructure- reporting Community
MAA LDR, OT, Call center for Awareness
SNCU care for Obstetric better grievance
Involving
sick & small HDU/ICU, NBCC, redressal and Incentives and
VHSNCs and
babies NBSU, reporting Awards
SNCU/MNCU Monthly SHGs for Awards and IEC/BCC-
Home-based
Human resource reporting better recognition to Mega IEC/BCC
care for
Drugs and HMIS analysis community performers. activities
mothers &
diagnostics. Formation of engagement. The first promote "zero
newborns
National, State responder of
(HBNC) Assured Referral Interdepartme preventable
level monitors. maternal
systems ntal maternal &
Maternal and
Creating centre of convergence death to get newborn
infant death
excellences Suman Rs 1000/- deaths"
reporting
Champions
SUMAN
volunteers
Use of Safe
motherhood
booklet and
MCP card

Each health facility is expected to notify the service guarantee package on the basis of
their current resources and service availability with measures put in place to reach
100% of the expected service standards for the level of that facility.

ABOUT THE PROGRAM

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

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Under the SUMAN initiative, all Pregnant Women & Newborns visiting public
health facilities are entitled to a set of free services. The packages under
SUMAN have been divided into Basic, BEmONC, and CEmONC for both
maternal and newborn services.

SERVICE PROVISION AT DIFFERENT LEVELS OF CARE

A community health officer is a trained health worker and is designated to be the in-
charge of the health and wellness center. Thus, service provision becomes one of the key
areas of activity. This activity will ensure that quality care is brought nearest to the
community.

Facility level services

Routine OPD: CHO should ensure that all the OPD services are
happening daily and ensure 4 ANC check-ups of all
pregnant women.
VHSND: CHO should conduct VHSND in the SHC-HWC and provide
a range of services as per VHSND guidelines.

Labour Room and Delivery:

In a place where the SHC-HWC is a delivery point, the CHO will do the normal
delivery of the pregnant woman only after getting SBA training.
All the identified high-risk pregnant women should be referred to a higher center.
CHO will ensure that the labour room is equipped as per the Maternal health
guidelines and all the logistics and drugs needed in the labour room should be present.
Partograph should be plotted and active management of
the third stage of labour should be done for all delivery
cases.
All the complications of delivery cases like PPH,
Eclampsia, etc are to be stabilized and then referred to
appropriate higher centers where the care for that health
condition is available.
Undertake breast crawl and initiate breastfeeding. Every newborn, when placed on
the mother’s abdomen, soon after birth, has the ability to find its mother’s breast on
its own and to decide when to breastfeed. This is called “Breast Crawl”, which is
helpful to the baby as well as the mother.

Benefits of Breastfeeding

To Baby :
Provide Nutrition

To Mother :
Helps in uterine contraction for faster
expulsion of the placenta
Reduces blood loss
Prevents Anemia

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Community-level services
a) Birth Preparedness:
CHO should ensure that a proper birth plan is made, and the pregnant woman is
counseled to have an institutional delivery.
The CHO should be ensuring that in case the pregnant women undergo home delivery,
then the home delivery is conducted by them.
b) Home Visits to Mother in PNC period:
CHO should ensure that postnatal home visits are undertaken and postnatal care is
given as per guidelines for all women in their postnatal period.
In this visit, the CHO should do a thorough examination of the PNC women as per
guidelines and do proper reporting in the formats.
c) Maternal Death Review:
Take part in identifying and reporting all the female deaths in the reproductive age
groups, along with reporting.

d) Village Health, Sanitation and Nutrition Days (VHSND):

VHSND plan is made to cover all pockets under the geographical area in the
jurisdiction of the health and wellness center including hilly, tribal, underserved, and
hard to reach areas.
Be the lead service provider in VHSND of hard-to-reach and underserved areas or
areas with poor ANC registration and high home deliveries.

Services provided in VHSND:

Antenatal care
All pregnant women are to be registered
Registered pregnant women to be given ANC
Dropout pregnant women eligible for ANC are to be tracked and given
services

Immunisation
All eligible children are to be given vaccines as per immunization
schedule
All dropout children who do not receive vaccines as per the scheduled
doses are to be vaccinated
Vitamin A solution is to be administered to under-five children.

Family Planning Services

All eligible couples are to be given condoms, Combined Oral
Contraceptives (COCs), Centchroman (Chhaya), Emergency
Contraceptives Pills (ECP) as per their choice and referrals made for
other contraceptive services.

Nutrition
All under-six children are to be weighed every month and their height to
be recorded every quarter, and data to be entered in CAS application
and plotted on the MCP card simultaneously by AWW.
Underweight and wasted children are to be identified and managed
appropriately. Identified SAM children with medical complications to be
referred to the NRC or health facility with paediatric care facilities.
All under-six children are to be provided supplementary nutrition.
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 HBV, Syphilis and HIV
Screening and referral, ensuring confidentiality (HIV)

SUPPORTIVE SUPERVISION:
The CHO will supervise all the work done by her team including ANM/MPW and ASHA with
regards to maternal health program.

As a Supervisor of ANM/MPW, CHO should ensure the following activities:

Early diagnosis of pregnancy using Nischay Kits.
Registration of all Pregnant women in the first trimester of pregnancy
Ensuring four antenatal care checks
Provide Iron, folic acid, and calcium tablets to all normal and anaemic (mild and
moderate ) pregnant women as per their blood hemoglobin levels
Provide TT/TD immunization to all pregnant women.
Test all pregnant women for urine albumin and sugar, haemoglobin, syphilis, HIV, and
blood grouping.
Counseling regarding care during pregnancy including information about nutritional
requirements
Identifying high-risk pregnancies and appropriate referral
Supporting birth planning.
Making PNC home visits on 0, 3, 7, 14, 21, 28 days
Maintaining the RCH register and do entries for the Anmol portal.
Ensuring bank accounts for all pregnant women for JSY and other DBT transfer.

As a Supervisor and Mentor of ASHA:

CHO may and should act as a resource person
for the training of ASHA.
Guide the ASHA in beneficiary mobilization
for VHSND.
Motivate and guide ASHA for taking pregnant
women for check-ups in PMSMA clinic and to
delivery points during labour.
Motivate and Guide ASHA for ensuring
adherence to IFA and Calcium
supplementation during pregnancy.

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 REFERRAL LINKAGES

Examples:
CHO should: A case of postpartum
Upward referral to PHC, CHC, DH/MC

hemorrhage, eclampsia,
ensure that all pregnant women in the second
retained placenta and
and third trimesters should compulsorily attend
sepsis should be referred
at least one PMSMA clinic. directly to a center with a
map the higher facilities (PHC, CHC, SDH, DH) blood transfusion facility
with respect to the type of emergency and and posting of a
gynecologist/ EmOC
establish linkages with them.
trained medical officer.
refer all the high-risk pregnant women to the
higher facility with a properly filled referral Pregnant Women with
slip, which will help in identifying the high blood pressure or
complication and the treatment given so far. GDM or Syphilis can be
referred to a PHC or a
identify women who need the services for
CHC with MBBS Medical
medical or surgical termination of pregnancy Officer or for PMSMA.
telephonically contact the higher centre and
inform them about the referral made.

Downward Referral from higher facilities to SHC-HWC

CHO should ensure that all the pregnant women who were referred to a
higher centre should be back referred and ensure treatment compliance
and follow up on the advice given by higher centre.
CHO should guide the ASHAs and MPWs regarding the follow up and
ensure treatment compliance the pregnant women.

Establish Linkages with other Line departments:

Linkages with ICDS for organizing VHSND and maternal
nutrition.
Linkages with ICTC for referral and testing and
treatment of HIV suspected cases.
Linkages with RNTCP for referral and testing and
treatment of Pregnant Women with TB

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MATERNAL HEALTH PROGRAMS

Surakshit Matritva Ashwashan (SUMAN)

Janani Suraksha Yojana (JSY)

Janani Shishu Suraksha Karyakaram (JSSK)

Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA)

Universal Screening for GDM, HIV and Syphilis

Strengthening First Referral Units (FRUs) & Delivery Points (DP)

MCH Wings and Obstetric HDUs/ICUs

LaQshya- Labor Room & Maternity OT

Capacity Building of Human Resource: Dakshata, CEmONC, LSAS, SBA etc

Midwifery Initiative

Comprehensive Abortion Care servucesb(CAC)

Maternal Death Surveillance & Response (MDSR)

1. Janani
Janani Suraksha
Suraksha Yojana
Yojana (JSY):
(JSY): To promote institutional deliveries,
incentives of Rs. 1400/cases are being given to pregnant women for
deliveries in public health facilities.

2. JSSK (Janani Shishu Suraksha Karyakaram): The entitlements include

free drugs, consumables, free diet during the stay, free diagnostics, and
free blood transfusion if required. This initiative also provides free
transport from home to institution, between facilities in case of a referral,
and drop back home. The scheme was expanded to cover complications
during ante-natal and post-natal periods and also sick infants up to 1 year
of age.

3. PMSMA
PMSMA(Pradhan
(PradhanMantri Surakshit
Mantri SurakshitMatritva
MatritvaAbhiyan):
Abhiy Under PMSMA,
all pregnant women in the country are provided fixed day, free of cost
assured, and quality Antenatal Care. As part of the campaign, a
minimum package of antenatal care services (including investigations
and drugs) is being provided to the beneficiaries on the 9th day of every
month. The Abhiyan also involves the Private sector’s health care
providers as volunteers to provide specialist care in Government
facilities.

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4. LaQshya
LaQshya (Labour
(Labour Room
Room Quality
QualityImprovement
Improvement Initiative):
Initiative): The
objective of the program is to improve the quality of care in
Labour room and Maternity operation theatres. It will ensure
that pregnant women receive respectful and the best quality of
care during delivery and immediately post-partum.

5. MCH
MCH(Maternal
(Maternal&&Child Health)
Child Wings: State of the art Maternal
Health)
and Child Health Wings (MCH wings) have been sanctioned at
District Hospitals/District Women’s Hospitals and other high
caseload facilities at the sub-district level, as integrated facilities
for providing quality obstetric and neonatal care.

6. Maternal
MaternalDeath
DeathSurveillance
Surveillanceand
andResponse
Response(MDSR):
(M The process of
MDSR including Maternal Death Reviews has been institutionalized
across the country both at facilities and in the community to identify
not just the medical causes, but also some of the socio-economic,
cultural determinants, as well as the gaps in the system, which
contribute to these deaths. This is with the objective of taking
corrective action at appropriate levels and improving the quality of
obstetric care.

7. Dakshata:
Dakshata:dThe government of India launched a national training
program named ‘Dakshata’ in 2015. It is a strategic 3-day training
capsule for building the skills of health care providers, including
doctors, staff nurses, and ANMs, for providing quality intrapartum
care and has been rolled out across States/UTs.

8. Midwifery:
Midwifery: The Government of India has taken a historic and
landmark policy decision to roll out midwifery services in the
country to improve the quality of care and ensure respectful care to
pregnant women and newborns. The ‘Midwifery Services Initiative
aims to create a cadre of Nurse Practitioners in Midwifery who are
skilled in accordance with competencies prescribed by the
International Confederation of Midwives (ICM) and are
knowledgeable and capable of providing compassionate women-
centered, reproductive, maternal, and newborn health care services.

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ACTION POINTS AT AB-HWC
Enumerate population and update registers along with RCH portal and ANMOL
tablets.
Support the organization of VHSNDs per GOI guidelines and discuss issues with the
involvement of the AAA platform.
Organize village level IEC and BCC activities like- saas-bahu sammelans, health
melas, mothers’ meet, fathers’ meet, nukkad Natak, etc for generating awareness
about health services including information on referral facilities and transport.
Ensure availability of essential commodities, drugs, registers, and other
consumables
Ensure proper maintenance of service records (including IUCD cards, IUCD
registers, MPA cards, MPA registers, eligible couple registers, commodities
registers, etc.).
Support MPWs and ANM/ASHAs in their tasks including on-the-job mentoring and
supervision and undertaking the essential functions of HWC such as inventory
management, upkeep, and maintenance of services, records, and management of
finances
Undertake supportive supervisory visits with ASHA and support her in the
preparation of village health plans
Ensure timely referral to higher facilities depending on the service need of the
patient and the capacity of the referral institute.
Capacity building and handholding of ASHA and ANM on communication skills,
counseling skills, and other need-based services
Establish referral linkages to higher centers for cases that cannot be managed at
the concerned facility.

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Namaste!

You are a valuable member of the Ayushman Bharat- Health and Wellness
Centre (ABH-HWC) team is committed to delivering quality comprehensive
primary healthcare services to the people of the country.
To reach out to community members about the services at AP-HWCs, do
connect to the following social media handles:

https://instagram.com/ayushmanhwcs

https://twitter.com/AyushmanHWCs

https://www.facebook.com/AyushmanHWCs

https://www.youtube.com/NHSRC_MoHFW

NIHFW Campus, Baba Gangnath Marg

Munirka, New Delhi -110067
E-mail:nhsrc.india@gmail.com
Website:www.nhsrcindia.org