28.3.2 REPRODUCTIVE, MATERNAL, NEWBORN, CHILD AND ADOLESCENT HEALTH (RMNCH+A) APPROACH

TABLE 28.7: Important components of RMNCH+A strategy

In February 2013, Government of India launched a strategic approach to Reproductive, Maternal, Newborn Child and Adolescent Heath (RMNCH+A), which has become the heart of the India's flagship public health program, the National health mission (NHM).

RNMCH+A is a paradigm shift from previous RCH programs, recognizing the need to include adolescents as a distinct life-stage in the holistic approach.

Objectives: RMNCH+A strategy aims to achieve various NHM goals revised time to time, also specified in national health policy 2017 (Table 28.2). It also aims to focus on reducing maternal, newborn and child mortality as per SDG Goal 3 for 2030, i.e. reduction in: (a) MMR lt;70/1000 and (c) NMR lt;12/1000 live births and U5MR lt;25/1000 live births.

Components: RMNCH+A strategy rests on the provision of comprehensive care in five pillars of MCH services, i.e. Reproductive, Maternal, Neonatal, Child and Adolescent health, with plus (+) sign representing: (a) addition of adolescent health, (b) linkage of MCH services with reproductive health, (c) linkage of community-based services to facility-based care, and (d) linkage between various levels of health facilities from primary health centres to tertiary hospitals.

Interventions: Table 28.7 summarizes important inter­ventions under RMNCH+A, often termed as 5 ? 5 matrix (Five high impact interventions in Five components), along with other measures, e.g. strengthening of health system and monitoring, prioritization of high-impact interventions in different life-cycle stages and inter­sectoral coordination.

These interventions, also termed as continuum of care, cover Five phases of life-cycle, i.e. adolescence, pregnancy, birth, newborn and childhood, and different levels of health care. Strategy also involves Five inter­sectoral interventions-Water, Sanitation, Nutrition, Education and Empowerment.

Implementation: RMNCH+A is not a health program per se but a guiding strategy to cover different aspects of care under different programs, e.g. JSSK, RBSK, NSSK, UIP, etc. discussed later.

RCH portal is designed for early identification and tracking of the individual beneficiary throughout the reproductive lifecycle of women and promote, monitor and support the reproductive, maternal, new-born and child health (RMNCH) schemes/programme delivery and reporting.

This portal helps health workers to (a) monitoring implementation of health schemes, (b) plan for service delivery and identification of beneficiary for antenatal

A. Reproductive health

1. Birth-spacing: Postpartum and interval IUCDs

2. Reproductive traction infection case-management

3. Home delivery of contraceptives

4. Comprehensive abortion care and pregnancy-testing kit

5. Quality sterilization services

B. Maternal health

1. Pregnancy registration and quality antenatal care

2. High-risk screening of pregnant mothers

3. Skilled obstetric care at all delivery points

4. Review of maternal/infant deaths for corrective actions

5. Post-partum sterilization

C. Newborn health

1. Early and exclusive breastfeeding

2. Home-based newborn care

3. Essential newborn care and resuscitation

4. Care of sick newborn: SNCU, NBSU, etc.

5. Community-level use of gentamycin

D. Child health

1. Nutrition care: IYCF with micronutrient supplementation

2. Facility- based IMNCI: sp for diarrhea and pneumonia

3. Care of severe acute malnutrition (NRCs)

4. Universal immunization

5. Screening for 4 D's (RBSK)

E. Adolescent health

1. Address teenage pregnancy and contraceptive use

2. Community-based information and counseling services

3. Facility-based service: ARSH clinics

4. National iron-plus initiative

5. Promote menstrual hygiene

IUCD: Intrauterine Contraceptive Devices; IYCF: Infant and Young Child Feeding; IMNCI: Integrated Management of Neonatal and Childhood Illnesses; NRC: Nutritional Rehabilitation Centres; RBSK: Rashtriya Bal Suraksha Karyakram; ARSH: Adolescent Reproductive and Sexual Health Clinics.

Check-up, postnatal Check-up and Immunization Services, (c) Identification of high-risk pregnant women and tracking their health conditions and assistance during the delivery, (d) generate the work plan for delivery of immunization services to children.

28.3.3