Special Article

Year: 2014│Volume:2│Issue-I

RMNCH+A: A Strategic Approach to Reproductive, Maternal, Newborn, Child and Adolescent Health in India: A New Initiative in Health Care Delivery System

Dr. Kaushik Nag1 , Dr. ManasPatra2

1,2PGT(2nd year), Dept. of Community Medicine, Burdwan Medical College, Burdwan


Corresponding Author:

Dr. Kaushik Nag, 2nd year PGT (2nd year), Dept. of Community Medicine, Burdwan Medical College, Burdwan
Mobile:  829604103; email: drkaushik86@yahoo.com


Background:

Mother & child health care remained at the core of health care delivery system in India since independence. India is the first country to launch a National Family Planning Program 1952 which focused mostly on population control. After almost 25 years of operation, it was revealed that population control goals cannot be attained in isolation, without ensuring health and well-being of mothers and children. The ‘welfare’ concept was introduced in the National Family Welfare Programmelaunched in 1977.In year 1992, Child Survival and Safe Motherhood (CSSM) Programme was launched, where all MCH interventions, so long running vertically, were brought under single umbrella.Following the International Conference on Population Development (ICPD) held at Cairo in1994, Reproductive and Child Health(RCH) approach was adopted in India in 1997. RCH approach integrated all existing MCH interventions with two additional components of adolescent health and management of RTIs & STIs.1

RCH phase –II came on 1st April2005 under the umbrella of NRHM. Special focus was on up-gradation of facilities like 24 hour delivery services, First referral Unit(FRU), Sick Newborn Care, Safe Abortion Services& RTI/STI Management. Immediate objective of the program was to improve routine immunisation, reduce the unmet need for contraception & provide an integrated Service delivery for basic Reproductive & Child health Care. Medium term objective was to bring TFR to replacement level by 2010 & long term objective was population stabilization.

In the last seven years the Reproductive and Child Health Programme (RCH II) have provided the flexibility and opportunity to introduce new interventions and to pilot and scale up innovative service delivery mechanisms. Increasingly, across the globe, there is emphasis on establishing the ‘continuum of care’, which includes integrated service delivery in various life stages including the adolescence, pre-pregnancy , childbirth andpostnatal period, childhood and through reproductive age. In addition, services should be available at all levels: in homes and communities, through outpatient services and hospitals with ‘inpatient’ facilities. In order to bring greater impact through the RCH program, it is important to recognize that reproductive, maternal and child health cannot be addressed in isolation as these are closely linked to the health status of the population in various stages of life cycle. The health of an adolescent girl impacts pregnancy while the health of a pregnant woman impacts the health of the newborn and the child.

India accounted for 56000, that is 19% of 287000 mater deaths that occurred globally in 2010. Regarding under-five mortality, there were approximately 15.8 lakh under-five deaths in 2010, which is 20% of global under-five deaths and highest for any country. Thereasons for this are a large birth cohort (2.6 crore) and child population (15.8 crore in the age group0–6 years) and a relatively high child mortality rate (59 per 1,000 live births).2
Despite India being amongst the top five countries in terms of absolute numbers of maternal and child deaths, encouraging progress has been made in terms of reducing maternal and child mortality rates. In 1990, when the global under-five mortality rate was 88 per 1,000 live births, India carried a much higher burden of child mortality at 115 per 1,000 live births. In 2010, India’s child mortality rate (59 per 1,000 live births) almost equals the global average of 57. As per the report of Maternal Mortality Estimation Inter-Agency Group, maternal mortality has shown an annual decline of 5.7% between the years 2005 and 2010. At the national level, maternal mortality ratio (MMR) declined from 254 (SRS 2005) to 212 (SRS 2007–09) and to 178 (SRS 2010-12).

What is RMNCH+A strategic approach?2

  1. This is a comprehensive strategy for improving the maternal and child health outcomes , under NRHM
  2. It is based on the evidence that maternal and child health cannot be improved in isolation as adolescent health and family planning have an important bearing on the outcomes.
  3. This strategy encompasses various high impact interventions across the life cycle.
  4. The strategy is based on the concept of ‘CONTINUUM OF CARE’

What is new in RMNCH+A?

  1. Inter-linkages between different interventions at various stages of the life cycle
  2. Linking child survival to other inventions such as reproductive health, family planning, maternal health
  3. Sharper focus on adolescents
  4. Recognizing nurses as ‘pivots’ for service delivery
  5. Expanding focus on child development and quality of life
  6. Intensification of activities in High Priority Districts (HPD)

‘PLUS’denotes:

  1. Inclusion of adolescence as a distinct ‘life stage’
  2. Linking of Maternal and Child Health to Reproductive Health and other components like family planning.
  3. Linking of community and facility-based care as well as referrals between various levels of health care system.

Goals of RMNCH+A to be achieved by the end of 12th five-year plan:2