“Maternal and Child Health Programs in India: A Comprehensive Journey from 1951 to RCH Phase-II”

“Discover the evolution of maternal and child health programs in India from 1951 to RCH Phase-II, and explore the vital roles played by community health nurses in enhancing rural healthcare.”

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Maternal and Child Health Related Programs:

“The journey of maternal and child health programs in India began in 1951 with the Family Planning Program. Over the decades, these initiatives have evolved significantly, culminating in the Reproductive and Child Health (RCH) Program Phase-II, launched in 2005 to further reduce maternal and child mortality and improve healthcare in rural areas.”

1. 1951: Family Planning Program Initiated

• India started its first family planning program to reduce birth rates and control population growth.

2. 1966: Family Planning Department

• A separate department was created to focus on family planning efforts.

3. 1974-79: Integrating Family Planning with Maternal and Child Health

• During the 5th Five-Year Plan, efforts were made to reduce the birth rate by integrating family planning with maternal and child health services.
• The program faced setbacks due to rigid enforcement of laws during 1977-78.

4. 1977-78: Transition to Family Welfare Program

• After learning from past experiences, the program was renamed the “Family Welfare Program,” emphasizing voluntary participation and health education.

5. 1992: Child Survival and Safe Motherhood (CSSM) Program

• This program included various initiatives such as:
  • Universal Immunization Program (UIP)
  • Oral Rehydration Therapy (ORT)
  • Prophylaxis programs for anemia and vitamin A deficiency
  • Introduction of Acute Respiratory Infection (ARI) control, First Referral Units (FRUs), and disposable delivery kits.

Reproductive and Child Health (RCH) Programs

Definition

• Reproductive and Child Health (RCH): Ensures the ability to reproduce safely, manage fertility, and have a healthy pregnancy and childbirth, leading to maternal and infant survival and well-being.

Historical Development

• India introduced several programs under the RCH approach to improve maternal and child health:

Major Milestones:

• 1992: CSSM Program
• 1997: RCH Phase-I
• 2005: National Rural Health Mission (NRHM)
• 2013: RMNCH+A Strategy (Reproductive, Maternal, Newborn, Child, and Adolescent Health)
• 2014: India Newborn Action Plan

RCH Phase-I (1997)

• Integrated family planning, CSSM, prevention, and management of reproductive tract infections (RTIs), sexually transmitted diseases (STDs), and AIDS.
• Key Interventions:
• Client-oriented services for men and women.
• Upgraded health facilities to provide quality care.
• Establishment of First Referral Units (FRUs) for emergency obstetric and newborn care.

Essential Services:

• Obstetric Care: Early antenatal registration, safe delivery options, postnatal visits.
• Emergency Obstetric Care: Critical to reducing maternal and neonatal mortality.
• 24-hour Delivery Services: At Primary Health Centers (PHCs) and Community Health Centers (CHCs).
• Medical Termination of Pregnancy (MTP) Act: Reduced deaths from unsafe abortions.

Immunization & Newborn Care:

• Universal Immunization Program (UIP): Part of RCH, covering vaccines like polio, tetanus, and measles.
• Essential Newborn Care: Focus on preventing hypothermia, infections, and promoting exclusive breastfeeding.

Diarrheal Disease Control:

• Use of low osmolarity Oral Rehydration Solution (ORS) and zinc to reduce severity.

Prevention of Vitamin A Deficiency:

• Vitamin A Supplementation: Administered to children at specific intervals to prevent deficiency.

Anemia Prevention in Children:

• Iron and folic acid supplementation for children from 6 months to 10 years and beyond.

Reproductive and Child Health Program – Phase II

Overview

• Launched: April 1, 2005
• Objective: To reduce maternal and child mortality and morbidity, focusing on rural healthcare.

Major Strategies

1. Essential Obstetric Care

• Institutional Delivery: Promoting deliveries in medical institutions.
• Skilled Attendance: Ensuring skilled personnel conduct deliveries.
• Emergency Obstetric Care: Providing urgent care during childbirth.
• Operationalizing FRUs: Establishing First Referral Units for emergency care.
• 24/7 Delivery Services: Round-the-clock delivery services at PHCs and CHCs.
• Strengthening Referral Systems: Improving the process of referring patients to higher care facilities.

Critical Determinants for FRUs

• Surgical Interventions: Available 24/7.
• Newborn Care: Continuous care for newborns.
• Blood Storage Facility: Must be operational at all times.

Essential Obstetric Care

• Institutional Delivery Promotion:
• 50% of PHCs and all CHCs to become 24-hour delivery centers by 2010.
• Staffed with 3-4 nurses/ANMs for continuous services.
• Skilled Attendance:
• Training and guidelines for safe delivery and management of complications.
• ANMs and LHVs trained to handle emergencies.
• Emergency Obstetric Care:
• FRUs provide services like cesarean sections, newborn care, and safe abortions.
• Facilities must include a functioning operation theater, labor room, and newborn care area.

Strengthening Referral System

• Funding for Panchayats: Initially provided funds for obstetrical emergencies, but alternative support like self-help groups and NGOs is being considered.
• Recent Initiatives:
• Training of MBBS Doctors: Specialized training in obstetric emergencies and cesarean sections.
• Blood Storage Centers: Established in FRUs following government guidelines.

New Initiatives under RCH Phase-II

• Rashtriya Bal Swasthya Karyakram (RBSK): Health program for children.
• Rashtriya Kishore Swasthya Karyakram (RKSK): Adolescent health program.
• Weekly Iron Folic Acid Supplementation (WIFS): Program to prevent anemia in adolescents.

Role of Community Health Nurse in RCH Program

Antenatal Care

• Early Registration: Ensures antenatal mothers are identified and registered early.
• Supervision: Oversees regular checkups, nutrition, weight gain, and screening for high-risk pregnancies.
• Tetanus Toxoid & Supplementation: Ensures administration of tetanus injections and iron/folic acid supplements.
• Preparation for Delivery: Guides mothers for safe home or institutional delivery.

Postnatal Care

• Visits and Assessments: Monitors mother and baby post-delivery for any complications, breastfeeding, and nutrition.
• Contraceptive Advice: Provides temporary and permanent family planning advice.

Child Care

• Newborn Care: Monitors health, including management of diarrhea and respiratory infections.
• Immunization: Ensures children receive all vaccines under the universal immunization program.
• Growth and Nutrition: Assesses and monitors the growth and nutritional status of the child.

These initiatives and the roles of community health nurses are critical to improving maternal and child health outcomes in India, particularly in rural areas.

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