HEALTH PROGRAMMES

IN
OBSTETRICS & GYNAECOLOGY
 Candidate: Dr. MAMTA
Dr. VATHSALYA

 MODERATOR: Dr. Ritu Aggarwal

 Dr. Renu Arora
 2
Why need of programmes ?
 High incidence of maternal (113) infant mortality(28.3)
 Major causes of maternal mortality
in INDIA

Other
Conditions,
33% Haemorrhage,
35%

Abortion, 8%
Sepsis, 12%
Obstructed
Labour, 6% Hypertensive
disorders, 6%

* Other Conditions includes Anemia

List of programmes :-

 1992 Child survival and Safe motherhood programme

 1997 RCH- I
 2005 RCH-II
 2005 National rural health mission
 2013 RMNCH+A Strategy
 2013 National health mission
 2014 India new born action plan(INAP)
 2015 DAKSHATA
 2016 PMSMA
 2017 PMMVY
 2017 LaQshya
 2019 SUMAN
RCH-I RCH-II
 Essential obstetrics care  Adolescent health
 Emergency obstetrics care
 Essential obstetrics care
 24hrs delivery services at PHC/CHC
 Medical termination of pregnancy  Emergency obstetric care

 Strengthening referral system

 New initiatives:

 Training of MBBS doctors

 Blood storage centres, FRU

 NRHM

Major New Initiatives

 ASHA  Home delivery of contraception by
ASHA
 JSY
 Promotion of menstrual hygiene
 JSSK
 Home based new born care
 National Ambulance services
 Rashtriya Bal Swasthya
 Web enabled mother and child karyakram(RBSK)
tracking system (link with adhar  Rashtriya Kishor Swasthya
card) karakram(RKSK)
 Mother and child health wings
 Reproductive, Maternal, Newborn, Child
and Adolescent
 National iron plus initiative (NIPI)
+Weekly Iron and Folic acid
supplementation(WIFS)
REPRODUCTIVE AND CHILD
HEALTH PROGRAMME (RCH)

RCH I: launched in 1997

RCH II: launched in 2005
 8

RCH Phase I:
LAUNCHED IN 1997
AIM:
 To bring down birth rate below 21/1000 population
 To reduce IMR below 60/1000 live birth
 To bring down MMR <400/1 lakh

Other aims : 80% institutional delivery,100% ANC care,

100% immunization
9

RCH Phase II
 LAUNCHED IN 2005
 Objective of the program-to bring about a change in
mainly three critical health indicators i.e. Reducing TFR,
IMR & MMR to realize the outcomes envisioned in the
MDG, NPP 2000, Tenth Plan Document, NHP 2002 and
Vision 2020 India.

 MDG Goals : reduce under 5 mortality rate by 2/3rd from

1990 levels, reduce MMR by 3/4th from 1990 levels
COMPONENT OF RCH-II : MOTHER AND
NEW-BORN HEALTH
ESSENTIAL OBSTETRIC CARE
Basic maternity services to all pregnant women
 Early registration of pregnancy(12-16 weeks)
 Provision of minimum 3 antenatal check-ups by ANM or MO to monitor
progress of pregnancy and to detect any risk/ complication so that appropriate
care including referral could be taken in time
 Provision of safe delivery at home or in an institution
 Provision of 3 postnatal check-ups to monitor the postnatal recovery and to
detect complications
ESSENTIAL NEW-BORN CARE
 To reduce perinatal and neonatal mortality
 Resuscitation of new born with asphyxia
 Prevention of hypothermia
 Prevention of infection
 Exclusive breast feeding
 Referral of sick new born
BASIC EMERGENCY OBSTETRICS AND NEW BORN CARE
 Availability of surgical interventions, newborn care and blood storage
facility on a 24hrs basis.

COMPREHENSIVE EMERGENCY OBSTETRIC AND NEW BORN

CARE
 Performing Caesarean sections
 Safe blood transfusion
 Provision of care to sick and low –birth weight newborns including
resuscitation
 13

COMPONENT OF RCH –II:ADOLESCENT

HEALTH

 Enroll newly married couple

 Provision of spacing methods
 HIV/AIDS/STIs preventive education
 Nutritional Counselling
 NATIONAL RURAL
HEALTH MISSION (NRHM)
 NATIONAL RURAL HEALTH MISSION

 2005, for a period of 7 years

 Extened upto 2017

 Mainly intends to improve 18 states i.e; 8 states under EAG

(Empowered action group) and 8 North-Eastern states,
Himachal Pradesh and J&K.
NRHM Depot holder for various drugs
Provider for DOTS
BODY ASHA Provision of Primary Medical Health Care

MCH clinic , immunization days, essential drugs

SUB
CENTRE
1 M.O. , AYUSH doctor
PHC 24 hr services in atleast 50% PHC
MCH /immunization clinic

24 hr referral unit
CHC/ FRU Codification of Indian public health standards
Rogi Kalyan Samiti for hospital

District health mission

District level
Mobile Medical Unit

State level State Health Mission

PUBLIC PRIVATE PARTNERSHIP MAINSTREAMING OF

AYUSH
 ASHA
Accredited Social Health Activist
 CRITERIA FOR SELECTION
 One ASHA for each Village.
• Woman resident of that area, Married/ Widow/ Divorcee
• Age- 21 to 45 yrs
 Communication skills
 Formal education – 8th class
 In tribal and desert areas the educational qualification
may be relaxed if the 8th pass candidate is not available.
 Receives a training of 23 days in 1 year.
 One ASHA for 1000 population & in hilly areas 1 ASHA for
each habitation.
 Counsel women on birth preparedness, importance of safe delivery

Ensure full package of antenatal care to pregnant women

Motivate women to take Fe , calcium & TT inj, ensure 3 ANC visits

Accompany women with high risk requiring admission to referral

WORK OF
ASHA Ensure access to institutional delivery

Provide new born care through series of home visit

Detect signs of sepsis, provide first level care and prompt referral

Recognize postpartum complications & refer

Postpartum visits(6 or 7)
BREAST FEEDING
Incentive money or Rs. 250 to ASHA on 45 th day if:
 Record of birth weight done
 BCG ,1st dose of OPV, DPT given
FAMILY PLANNING
 Registration of birth done
 NRHM : Pattern of cash assistance
(Institutional delivery)
RURAL AREA URBAN AREA

CATEGORY mother workers tota mother worke tota

l rs l Eligibility criteria ;
LOW PERFORMING  In low performing states
STATES 1400 600 200 1000 200 120
0 0
HIGH PERFORMING 700 200* 200 states- all women
STATES (Effective 900 600 800
from 1st
April 2009)

HPS(notified tribal  In high states- below BPL, and

areas)
600** age more then 19yrs,And upto 2
(1st live births
June
2010)
 NRHM: JANANI SURAKSHA YOJNA

 National maternity benefit scheme has been modified

into Janani Suraksha Yojna
 Launched on 12th April, 2005 by MOHFW
 100% centrally sponsored scheme
 Objectives:
 Reducing maternal and infant mortality through
encouraging delivery at health institution
 Focusing at institutional care among women who are
below poverty line.
 JANANI SHISHU SURAKSHA
22
KARYAKARAM

 Provide completely free and cashless services to pregnant women and

including normal deliveries and caesarean operations and sick new born( up
to 30 days after birth ).
FREE:-
 Drug
 Diagnostics
 Diet
 Transport
 Blood storage
 Delivery
 WEEKLY IRON & FOLIC ACID
SUPPLEMENTATION PROGRAMME

 Launched on 13th June 2013

 6th to 12th std. students from Govt. schools and school dropout
adolescent girls in anganwadis
 : Iron Folic Acid tab weekly
 : Albendazole (de-worming) tab twice a year.
 NUTRITION PROGRAMMES IN INDIA
25

 Special Nutrition programme

 Integrated child development services scheme (ICDS)
 Mid-day meal programme
 National iodine deficiency disorders control programme
 Vitamin A prophylaxis programme
 National nutritional anemia prophylaxis programme
 12 by 12 initiative for anemia control
 Iron folic acid supplementation programme
 Aneamia mukt bharat
 26

SPECIAL NUTRITION PROGRAMME

Launched in 1970-1971
The priority beneficiaries under the programme-
 Children 0-6 yrs with malnutrition
 Pregnant women in the last trimester
 Lactating mothers during the first four months
 Nutrition provided under the programme is required to have
 300 calories and 10 gms of proteins per day to preschool children. Severely
malnourished children are provided 600 calories and 20 gms protein.
 500 calories and 20 gms of proteins per day to expectant and nursing mother
 INTEGRATED CHILD DEVELOPMENT
SCHEME (ICDS)
27

 Launched on 19 Oct 1975

Objective:
 Improve the nutrition & health status of the children of 0-6 yrs of age.
 Improve the physical, social, psychological development of the child.
 Reduce the incidence of morbidity, mortality, malnutrition and school drop
out rate.
 Enhance the capability of the mother to look after normal health and
nutritional needs of the child through proper nutrition & health education …
 28

Beneficiaries and services

 Children less than 3 yrs- Immunisation, health checkup, referral

services

 Children 3-6yrs-All above + non formal education.

 Expectant and nursing mothers-Supplementary nutrition, health

check-up, immunisation against tetanus, nutrition and health
education.

 Women 15-44 yrs- Nutrition and health education, improve literacy

rate.
Anemia mukt bharat

 AIM; Strengthen the existing mechanism and foster newer staregies

for taking anemia
 Focusses on six target beneficiary groups ,through six interventions
and six institutional mechanisms to achieve the envisaged target
under the POSHAN Abhiyan

 The anemia mukt bharat strategy will be implement in all village,

blocks, and districts of all the states/Uts of all india through existing
delivery platform as envisaged in the National Iron Plus
Initiative(NIPI) AND Weekly Iron Folic Acid
Asupplementation(WIFS) programme
 12 BY 12 INITIATIVE FOR ANEMIA CONTROL
30

 It was launched on 23rd April 2007 in association with WHO, UNICEF, FOGSI &
Govt.of India .
 Overall goal :
 all Indian adolescents have 12g/dl hemoglobin by 2012,

 listed the main cause of anemia in india as low dietary intake ,poor availability of iron
,chorinc blood loss due to hookworm infestation, and malaria
 To decrease anemia in adolescents to ensure healthy parenthood.
 To increase awareness among adolescents regarding anemia & appropriate nutrition.
NEW INTERVENTIONS
UNDER FAMILY PLANNING
 Mission Parivar Vikas : In high TFR states
 New contraceptive choices : Injectable, centchroman, POP
 Redesigned contraceptive packaging : condom, OCPs, ECPs
 New family planning media campaign
 Enhanced compensation scheme
 New IUCD (Cu 375)
 Emphasis on postpartum family planning (PPIUCD & Minilap )
 Scheme for ensuring drop back services, appointment of dedicated RMNCH+A
counsellors, home delivery of contraceptives by ASHA
 Celebration of world population day & fortnight (July 11-July 24)

 June 27 to July 10: Dampati Sampark Pakhwada (mobilization fortnight)

 July 11 to July 24: Jansankhya Sthirtha Pakhwada (population stabilization

fortnight)
STRATEGIES ADOPTED BY
JANSANKHYA STHIRTA KOSH
PRERNA STRATEGY : girl should be married >19 years, first child after two
years of marriage.
 12000 rupees: girl, 10000 rupees: boy
 Second child after 3 years and one partner accepts permanent method within
one year

 SANTUSHTI STRATEGY :
 Wage compensation (600 for tubectomy, 1100 for vasectomy )
 NATIONAL HELPLINE: 1800116555
 THE MEDICAL TERMINATION OF PREGNANCY
AMENDMENT BILL 2017
 Introduced in Rajya Sabha on 4 August 2017.
Intends to extend the permissible period for abortion from twenty
weeks to twenty four weeks if
 doctors believe the pregnancy involves a substantial risk to the mother or the child
or
 if there are substantial fetal abnormalities.
 The Rajya Sabha passed the medical termination of pregnancy bill, 16 march 2020.
 The bill extends the limit of medical termination of pregnancy to 24 weeks with
opinion of two registered medical practitioners and also aims to ensure
confidentiality of process and respect privacy of women, the government stated.
 PPIUCD /PAIUCD INCENTIVE SCHEME

 Incentive only in induced surgical or spontaneous abortions and not medical

abortions.

 For the Post Abortion IUCD (PAIUCD) and PPIUCD, service provider and
ASHA will be provided incentive Rs. 150

 Rs. 300/- to the client to support the incidental cost and cost for two follow
up visits after the PAIUCD/PPIUCD insertion
ADVANTAGES-

 Enhancing uptake of PPIUCD and PAIUCD.

 For better willingness of the client
 Tapping the high unmet need for spacing

ROLE OF SERVICE PROVIDER-

 Ensure quality of services –infection prevention ,obtaining informed consent
 Proper counselling of client and encourage follow up

ROLE OF ASHA-
 Escort client to health facility for safe delivery/safe abortion practices.
 Counsel couple for health spacing between children.
 ONGOING INTERVENTIONS
 ‘National Family Planning Indemnity Scheme’ Clients are indemnified in the
eventualities of deaths, complications and failures following sterilization.

Sec
tio Coverage Limits
n
Death following sterilization (inclusive of death during
Rs. 2
IA process of sterilization operation) in hospital or within 7
lakh.
days from the date of discharge from the hospital.
Death following sterilization within 8 - 30 days from the Rs.
IB
date of discharge from the hospital. 50,000/-
Rs
IC Failure of Sterilization
30,000/-
Cost of treatment in hospital and upto 60 days arising Actual not
out of complication following sterilization operation exceeding
ID
(inclusive of complication during process of sterilization Rs
operation) from the date of discharge. 25,000/-
Upto Rs. 2
Indemnity per Doctor/Health Facilities but not more
II Lakh per
 EXPANSION OF BASKET OF CHOICE –

 The current basket of FP choices has been expanded to include new contraceptives
namely Injectable MPA under Antara Programme, POP and Centchroman
(Chhaya).

 NISHCHAY –
 Home based Pregnancy Test Kits (PTKs) was launched under NRHM in 2008

 ENSURING SPACING AT BIRTH (ESB):

 Rs. 500/- to ASHA for delaying first child birth by 2 years after marriage.

 Rs. 500/- to ASHA for ensuring spacing of 3 years after the birth of 1st child

 Rs. 1000/- in case the couple opts for a permanent limiting method up to 2 children
only