obg sem by padmashree institute of nursing

INTRODUCTION

Maternal and child child health care which is now also being described as “Reproductive and Child Health” is very important component of the family welfare programmes in India launched on October 15 1997. It is a method of delivering health care to special groups in the population, which are especially vulnerable to disease, disability or death. GENERAL At the end of the class the group will have be able to gain in depth knowledge about the topic. Specific Objective After the completion of the class, the group will be able to ➢ ➢ ➢

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Define MCH Enlist the objectives Know the causes of MMR Explain the MCH services Explain the RCH phase 2 Enlist the health care delivery system State the NRHM Enumerate the ASHA List out key strategies Enlist the outcomes NRHM State the NGO Know the role of NGO

TERMINOLOGIES: •

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Reproductive: those parts of the male and female body associated with the production of children. Maternal: pertaining of the mother. Child: young human being. Health: is a state of complete physical, mental and social wellbeing and not merely absence of disease and infirmity. Development: the process of growth and differentiation. Family welfare: well being of health in the family. Vulnerable: easily wounded. Preventive : serving to prevent Curative: This promotes promotes healing by overcoming disease. Rehabilitative: restore to effectiveness by training.

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Paediatrics: the branch of medicine dealing with the the care and development of children and with the treatment of diseases that affects them. Fertility: able to reproduce. Disease: unhealthy condition of of the body. Survival: surviving to live. Education: development of characters Contraceptives: the devices used used to prevent prevent conception. conception. Accreditation: to give someone someone official status status within a organization Contracting: a drawing together. Mortality: the state of being liable to die. Morbidity: the state state of being diseased. diseased. Immunization: the act of of creating immunity immunity by artificial means. Prophylaxis: prevention of disease. Voluntary: able to act of one’s own free will. Infrastructure: basic structural foundations. Resources: available. Deprivation: absence of of parts that are are needed. Intricately: very complicated. Inflicting: deal. Resuscitation: restoration to to life of one apparently apparently dead. Asphyxiated: pathological changes caused by lack of oxygen Pioneering: beginner of enterprise.

DEFINITION

The term “maternal and child health” refers to the promotive, preventive, curative and rehabilitative health care for mothers and children. It encompasses the health care aspects of obstetrics, paediatrics, family welfare, nutrition, child development and health education. Reproductive and child health [RCH] is defined as a state in which “people have the ability to reproduce and regulate their fertility; women are able to go through the pregnancy and child birth safely, the outcome of pregnancy is successful in terms of maternal and infant survival and well-being, and couples are able to have sexual relations free of the fear of pregnancy and contracting disease. This means that every couple should be able to have child when they want and that the pregnancy, the mother and the child are safe and well, and contraceptives by choice are available to prevent pregnancy and of contracting disease”.











MATERNAL AND CHILD HEALTH PROGRAMMES

Women of the reproductive age groups [15-44 years] and children [male and female below 15 years of age] constitute almost 60% of the population. Mothers and children are considered as a special group for the following reasons: ➢

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By virtue of their numbers, mothers and children are major consumers of health service. They comprise of approximately two –thirds of the population in the developing countries. In India, women in the child bearing age [15 to less than 45 years] constitute 22.8% and children under 15 years of age 37.1% of the total population. Thus together they constitute nearly 60% of the total population. These groups are subjected to marked physical and physiological stress, which if not cared for, may cause serious deviation from normal health. They are exposed to unusual risks of widespread infection, poor nutrition, and hazardous delivery, which may cause death or impairment of health. The high occurrence of morbidity among women and children is reflected in a seven village study.[Trackrov PL, L. KapoorJ.D 1990 NIHFW]

OBJECTIVES

1. To reduce reduce maternal, maternal, infant and and childhood childhood mortality mortality and morbidit morbidity. y. 2. To promote reproductive health. 3. To promote promote physical physical and psycholo psychological gical developme development nt of children children and adolescent. 4. The mother and child should considered and treated as one unit for providing health services because of the following: During antenatal period the foetus is part of the mother, the period of development of the foetus is about 40 weeks. During this period it obtains all necessary supplies to nutrients and oxygen from the mother’s blood. •











Even after birth, the child is dependent for its feeding upon the mother, at least in first year of life. During the first few years of life, the child usually accompanies the mother during her visits to the health facilities and there are few occasions when services to the mothers and children are not simultaneously called for. The mental and social development of the child is also dependent on the mother. The death of the mother causes a maternal deprivation syndrome in the child. The policy guidelines for implementation of MCH programme are: I. Effective use should be made of existing resources and infrastructures available in the community. II. The services should be delivered as close to the homes of beneficiaries as possible. III. Services for mothers and children should be delivered, in an integrated manner. IV. Child survival programmes programmes should serve as a sugar sugar coating for delivery of the family planning programmes which in general are not popular. V. Voluntary agencies working in an area should be involved in providing MCH services. •

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Causes of MMR ➢ ➢ ➢ ➢

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Haemorrhage Toxaemias Anaemia Obstructed labour Puerperal sepsis Unsafe abortion.

MCH SERVICES

In 1989 WHO gave for the child survival and safe motherhood [CSSM] programme which was implemented by the Government of India and initiated in 1992.The CSSM programme with an integrated package of intervention for improving the health status of women and children and reducing the material infant and child mortality rates. The service is provided to pregnant women, infants and children under 5 years of age. The package of services under CSSM program includes the following:











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Antenatal care and early identification of maternal complication. Deliveries by trained personnel. Promotion of Institutional deliveries Management of obstetric emergencies. Birth spacing

For children ➢ ➢ ➢ ➢ ➢

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Essential obstetric care: It intends to provide the basic maternity services to all pregnant women through registration of pregnancy[within pregnancy[within 12-16 weeks] ✔ Early registration ✔ Antenatal check up at least 3 times. ✔ Give IFA- large tablet to all.[1 tab a day for 100 days] ✔ Treat with clinical anaemia[2 tab a day for 100 days] nd ✔ Deworm with mebendazole[during 2 /3rd trimesters] ✔ Safe and clean delivery services. ✔ Prepare the women for EBF and timely weaning. ✔ Post natal care including advice and services. Early detection of complication: ✔ Clinical examination to detect anaemia ✔ Bleeding indicating APH or PPH. ✔ Weight gain of more than 3kg in a month. ✔ Fever 39*C and above after delivery. ✔ Prolonged labour. Emergency obstetric care: ✔ Early identification of obstetric emergencies. ✔ Provide initial management and refer to identified referral units. ✔ Use fastest available mode of transport. Women in the reproductive age group : Counselling on Optimal timing and spacing of birth. •

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Essential newborn care. Immunizations. Appropriate management of diarrhoea. Appropriate management of ARI Vitamin A prophylaxis. Treatment of anaemia.











MTP services ✔ IUD and sterilization services Provision of clean and safe delivery practices at the community level: ✔ Creation of awareness in the community on need for clean and safe deliveries ✔ Deliveries by trained personnel ✔ Provision of Disposable Delivery Kits for all deliveries ✔ Promotion of institutional deliveries. ✔ Identification and referral of high-risk cases at the community level by trained dais. Essential newborn care: ✔ Birth weight for all new borne ✔ Resuscitation of asphyxiated babies. ✔ Care of low birth babies. ✔ Prevention of hypothermia. ✔ Exclusive breast feeding within 1 hour of delivery. ✔ Referral of newborns who show signs of illness. ✔ Advice to mother on essential newborn care, prevention of hypothermia infections, nutrition and immunization. Immunization: It provides vaccines for polio, tetanus, DPT, DT measles and tuberculosis. ✔ BCG - 1 dose at birth ✔ DPT - 3 doses beginning 6 weeks at monthly intervals. ✔ Polio – ‘0’ dose at birth for all institutional deliveries 3 doses beginning 6 weeks at monthly interval ✔ Measles – 1 dose at completion of 9 months of age. ✔ Vitamin - First dose [100’000 IU] with measles vaccination ✔

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Children [1-3 years] DPT/OPV booster dose at 16 to 18months. Vitamin A Second dose (200,000 IU) at 16 to 18 months along with DPT/OPV booster. 3rd dose to 5th dose (200,000 IU each) at 6 months interval. Children (1-6 years) Prevention of anaemia. IFA-small tablets of child have clinical signs of anaemia.













Prevention of deaths due to diarrhoeal diseases: ✔ Correct management of all cases of diarrhoea ✔ Advice mothers to give increased volume of fluids. -How to prepare ORS solution. -Continue feeding the normal diet -To signs when to seek help. Prevention of deaths due to pneumonia ✔ Correct management of all cases of acute respiratory infections. ✔ Referral of children with severe pneumonia

RCH –PHASE 2

RCH approach means that every couple should be able to have children when they want ,that the pregnancy is uneventful, that safe delivery services are available, that at the end of pregnancy, the mother and the child are safe and contraception by choice are available to prevent pregnancy and contracting diseases.

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Essential obstetric care for all Register by 12-16 weeks. Antenatal check up at least 3 times during pregnancy.(20,32,36 weeks) TT immunization should be given to all pregnant women as early as possible during pregnancy with two doses at one month interval. Give one tablet of IFA (large) daily for 100 days to all pregnant women. Treat those with clinical signs of anaemia with two tablets of IFA. Deworm with mebendazole (2nd /3rd trimester) in areas where hookworm infestation is common. Safe and clean delivery services. Prepare the women for exclusive breastfeeding and timely weaning. Postnatal care, including advice and for limiting and spacing birth.











Fever 39*C and above after delivery or after abortion are normally due to infections and sometimes can be fatal. Prolonged or obstructed can lead to rupture of uterus. Emergency obstetric care Early identification. Provide initial management and refer to identify referral hospitals. Use fast available mode of transport and while transporting the patient should lie on her left side. Women in the reproductive age group Counselling on: ✔ Importance of girl child. ✔ Optimal timing and spacing of birth. ✔ Small family norms. ✔ Use and choice of contraceptives. Prevention of RTI and STD. Information on availability ✔ MTP services ✔ IUD and sterilization services Family planning service ✔ Condom distribution ✔ Oral contraceptives dispending ✔ IUD services. Recognition and referral of clients with STD and RTI Provision of clean and safe delivery practices at the community level: ✔ Creation of awareness in the community on need for clean and safe deliveries ✔ Deliveries by trained personnel ✔ Provision of Disposable Delivery Kits for all deliveries ✔ Promotion of institutional deliveries. ✔ Identification and referral of high-risk cases at the community level •

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Polio – ‘0’ dose at birth for all institutional deliveries 3 doses beginning 6 weeks at monthly interval Measles – 1 dose at completion of 9 months of age. Vitamin - First dose [100’000 IU] with measles vaccination

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Children [1-3 years] DPT/OPV booster dose at 16 to 18months. Vitamin A Second dose (200,000 IU) at 16 to 18 months along with DPT/OPV booster. 3rd dose to 5th dose (200,000 IU each) at 6 months interval. Children (1-6 years) Prevention of anaemia. IFA-small tablets of child have clinical signs of anaemia. Stool examination for hookworm infestations ( where facilities are available) Treatment for worm infestation with mebendazole.

Prevention of deaths due to diarrhoeal diseases: ✔ Correct management of all cases of diarrhoea ✔ Advice mothers to give increased volume of fluids. -How to prepare ORS solution. -Continue feeding the normal diet -To signs when to seek help. Prevention of deaths due to pneumonia ✔ Correct management of all cases of acute respiratory infections. ✔ Referral of children with severe pneumonia or very severe illness HEALTH CARE DELIVERY SYSTEM











MODEL OF HEALTH CARE DELIVERY

Input

Health Care Services

Health Care System

Output

HEALTH CARE SERVICES:

The health care service is to improve the health status of the population. The health services of broad agreement should be ➢

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Comprehensive Accessible Acceptable Provide for community participation Available at a cost the community and country can afford.

HEALTH CARE SYSTEM

The health care system is intended to deliver the health care services. The final outcome is the changed health status or improved health status of the country. It has five different sectors. 1. Public health sector











knowledge in the elementary concepts of MCH and sterilization besides obstetric skills.  Aganwadi worker : Agan literally means a court yard. She undergoes training in various aspects. Primary health centre : It is to provide health services to the rural population.Its function are as follows;  Medical care.  MCH including family planning.  Safe water supply and basic sanitation.  Prevention and control of locally endemic diseases.  Collection and reporting of vital statistics.  Education about health.  National health programmes as relevant  Referral services.  Training of health guides, health workers, local dais and health assistants.  Basic laboratory services.

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Sub centres: It is the peripheral outpost of the existing health delivery system in rural areas.

b) Hospital/ Health centres     

Community health centres Rural health centres District hospital/health centres Specialist hospitals. Teaching hospitals

c) Health Insurance schemes 

Employees state insurance













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Unregistered practitioners.

4. Voluntary health agencies 5. National

health programmes

NATIONAL RURAL HEALTH MISSION (NRHM)

The National Rural Health Mission (2005-2012) was launched in April 2005 by the government of India (GOI).It seeks to provide effective health care to rural population throughout the country with special focus on 18 states, which have weak public health indicators and /or weak infrastructure. These states are Arunachal Pradesh, Assam, Bihar, Chhattisgarh, Himachal Pradesh, Jharkhand, Jammu and Kashmir, Manipur, Mizoram, Meghalaya, Madhya Pradesh, Nagaland, Orissa, Rajasthan, Sikkim, Tripura, Uttaranchal and Uttar Pradesh. National Rural Health Mission –The Vision •

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The NRHM (2005-2012) seeks to provide effective healthcare to rural population throughout the country with special focus on 18 states, which have weak public health indicators and /or weak infrastructure. The Mission is an articulation of the commitment of the government to raise public spending on health from 0.9% of GDP to 2-3% of GDP.











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Universalize access to public health services for Women’s W omen’s health, Child health, water, hygiene, sanitation and nutrition Prevention and control of communicable and non-communicable diseases, including locally endemic diseases Access to integrated comprehensive primary healthcare Ensuring population stabilization, gender and demographic balance. Revitalize local health traditions and mainstream AYUSH

Accredited Social Health Activists

The Government of India have launched a National Rural Health Mission to address the health needs of rural population, especially the vulnerable sections of the society. The sub centre is the most peripheral level of contact with the community under the public health infrastructure. So the new band of community based functionaries, named as Accredited Social Health Activist (ASHA) is proposed in the NRHM who will serve the population of 1000 and 500 in hilly. ASHA is the first port of call for any health related demands of deprived sections of the population, especially women, children, old aged, sick and disabled people. She is the link between the community and the health care provider. ASHA Sahayogini











Roles and Responsibilities of ASHA Sahayogini •

Create awareness

Health, Nutrition, basic sanitation, hygienic practices, healthy living and working conditions, information on existing health services and need for timely utilization of health, nutrition and family welfare services. •

Counselling

Birth preparedness, importance of safe and institutional delivery, breastfeeding, immunization, contraception, prevention of RTI/STI. Nutrition and other health issues. •

Mobilization

Facilitate to access and avail the health services available in the public health system at Anganwadi Centres, Sub Centre, PHC, CHC and district hospitals. •

Village health plan

Work with the village Health and sanitation Committee to develop the village health plan •

Escorts/ Accompany

Escorts the needy patients to the institution for care and treatment. She will accompany the woman in labour to the institution and promote institutional delivery •

Provision of Primary Medical Health Care

Minor ailments such as fever, first aid for minor injuries, diarrhoea. A drug kit will be provided to ASHA











2. To increase increase Instituti Institutional onal deliveries deliveries amongst amongst BPL BPL & poor families. families. Beneficiary •

Women of BPL.

Key strategies

There are twelve key strategies identify for RCH II 1. Strengthening Project Management Structure at state and district levels •

Re-organizing of Medical Directorate.

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Renovation of Medical Directorate and NRHM/RCH-II cell.

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Setting up, of the PMU at state & district levels.

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Induction of newly appointed professionals done on programme management and interventions. Support for communication, equipments and mobility to DPMUs.

2. Strengthening Infrastructure at various levels of health service delivery •

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Upgrading of PHCs as BemOCs. Provision of blood storage at 26 identified CEmOCs to make them fully functional. Support for equipment and labour tables at 25% PHCs.(10000.00 Rs. Per Institution) Support for minor repair and renovation of public facilities at 50% PHCs. (25000.00 Rs. Per Institution) Facility survey of all PHC and CHCs.











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Support for hiring 12 new refrigerator mechanics has been provided to district where such positions are vacant.

6. Strengthening Health Management information system (HMIS), monitoring and evaluation •

Integration of RCH-II/NRHM reporting format in existing HMIS software.

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Baseline and concurrent evaluation.

7. Behaviour Change Communication for increasing demand for RCH and contraceptive services •

Intensive IEC for RCH-II and NRHM interventions.

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Provision for hiring of IEC van in all districts.

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Implementation of Integrated Media Plan.

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IEC done by printing of booklet, Banners, cards.

8. Specific Interventions Maternal Health: •

RCH camps target:

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Dai training target:

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Night delivery facility at all PHCs and CHCs.

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Hiring of contractual staff (PHN) at CEmOCs.

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Provision of 1321 additional ANMS at 10 desert and tribal districts.

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STD/RTI drugs for PHCs.

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Jannani Suraksha Yojna













10. Innovative schemes and pilot projects •

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Pilot Project on Population stabilization initiated at Jhalawar & Tonk. A help line proposed at medical directorate for improving communication between field level functionaries, districts and state level officers.

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Campaign on Age at Marriage.

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Medical Mobile unit for all districts.

11. Improving and strengthening RCH Services in Tribal population •

Six districts, namely, Baran, Banswara, Chittorgarh Dungarpur, Sirohi and Udaipur will be included as non-primitive tribal group districts under the project in addition to the tribal population in the adjoining blocks of Jhalawar and Kota district.

12. Establishing and strengthening RCH services in Urban Area The programme will address the urban slum population in Jaipur, Jodhpur, Kota, Bikaner, Pali, Udaipur, Ganganagar, Hanumangarh, Bhilwara and Tonk











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Utilization of First Referral Units to be increased from less than 20% to 75% 250,000 women to be engaged in 18 states as Accredited Social Health Activists (ASHA).

2. Community Level •

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Availability of trained community level worker at village level, with a drug kit for generic ailments Health Day at Anganwadi level on a fixed day/month for provision of immunization, ante/post natal checkups and services related to mother & child healthcare, including nutrition Availability of generic drugs for common ailments at Sub-centre and hospital level Good hospital care through assured availability of doctors, drugs and quality services at PHC/CHC level Improved access to Universal Immunization through induction of Auto Disabled Syringes, alternate vaccine delivery and improved











b) PIONEERING: The voluntary health agencies are in a position to

explore ways and means of doing new things. Research is one form of pioneering. When the efforts succeed and bear fruit, the government agencies can step in and take over the project for the benefit of the larger numbers c) EDUCATION: There is unlimited scope for health education in India. The government agencies cannot cope with the problem, unless it is supplemented by voluntary effort on the part of the people. d) DEMONSTRATION: By putting up demonstrations and experimental projects, the voluntary health agencies have advanced the cause ca use of public health. The demonstration of bore hole latrines by the Rockefeller foundation to solve the problem of hookworm in India is a case of point. The bore-hole latrine and its modifications have since become an essential part of the environmental sanitation programme in India. e) GUARDING THE WORK OF GOVERNMENT AGENCIES: By setting a good example the voluntary health agencies can always guide and criticise the work of government agencies.











7. Family planning association of India : It was formed in 1949 with its

headquarters in Mumbai. It has done pioneering work in propagating family planning. 8. All India women’s conference : It is the only women’s voluntary welfare organisation in the country. It established in 1926 and its has branches are running M.C.H clinics medical centres and family planning clinics. ROLE OF NGO

Improvements in equity were most pronounced for household practices and coverage of home visits, and inequities. To improve the equity of maternal and neonatal health programmes. To identify and address barriers to universal coverage To care utilization, particularly in the poorest segments of the population.











The NRHM is attempting to do things differently and to make a difference. It has to negotiate its way through historical frameworks and approaches, deal with a variety of strong competing interests, and of course, face resistance to change, skepticism cynicism as well as apathy.













BT Basavanthappa”Community health nursing” Chapter 11,2008edition, Jaypee brothers medical publishersNew Delhi, page354-362. 3. Annamma Jacob “A comprehensive textbook of midwifery” Chapter50,2005 edition Jaypee brother’s medical publishers, New Delhi page 589-594. 4. K.Park “Preventive & social medicine” Chapter 9, 19th edition 2007 Ms Banarsidas Bharat Jabalpur, page 442-448; 745-760. 2.











MASTER

TOPIC FAMILY

PLAN

: NATIONAL HEALTH AND











A SEMINAR











P.I.O.N NURSING

HOD OBG P.I.O.N











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CONCLUSION JOURNAL ABSTRACT

obg sem by padmashree institute of nursing

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