National Health Mission & RMNCH+A For CHO Exams: Complete Information

National Health Mission & RMNCH+A For CHO Exams: Complete Information: Reproductive, Maternal, Newborn, Child and Adolescent Health

India has implemented various health programs aimed at improving maternal and child health.

The Reproductive and Child Health (RCH) program was launched to provide comprehensive maternal and child healthcare services. Over time, the program expanded to include a broader spectrum of healthcare services, leading to the RMNCH+A approach.

National Health Mission & RMNCH+A For CHO Exams

Evolution of RMNCH+A

A. Reproductive and Child Health (RCH) – 15 October 1997

• Launched as part of the National Health Mission (NHM).
• Aimed at reducing maternal and infant mortality rates and promoting family planning.

B. RCH Phase II (1 April 2005)

• Introduced to address gaps in RCH-I and expand healthcare services.
• Major initiatives:
  • Janani Suraksha Yojana (JSY) – Promoting institutional deliveries to reduce maternal mortality.

C. RMNCH+A (2013) – A Comprehensive Health Approach

• The Reproductive, Maternal, Newborn, Child, and Adolescent Health (RMNCH+A) strategy was launched in 2013.

Components of RMNCH+A

The program is divided into five major components:

🟠 1. Reproductive Health 🏥

🔹 Focus on Spacing and Contraceptive Services
✅ Postpartum Intrauterine Contraceptive Device (PPIUCD) to maintain birth spacing
✅ Interval IUCD services available at sub-centers on fixed dates
✅ NISCHAY Kit for early pregnancy detection
✅ Safe and Comprehensive Abortion Services
✅ Quality Sterilization Services

🔴 2. Maternal Health 🤰

🔹 Ensuring Safe Motherhood and Institutional Deliveries
✅ Early registration of pregnancy and full antenatal care.
✅ Identification of high-risk pregnancies and proper management
✅ Well-equipped delivery centers with trained healthcare staff
✅ Reducing home deliveries by promoting institutional births
✅ At least 48-hour hospital stay after delivery for monitoring
✅ Goal: Reduce Maternal Mortality Rate (MMR) to below 70 per 100,000 births by 2030

🟡 3. Newborn Health 👶

🔹 Ensuring Newborn Survival and Care
✅ Early and Exclusive Breastfeeding for the first 6 months
✅ Newborn resuscitation and intensive care for premature babies
✅ Reducing Neonatal Mortality Rate (NMR):

• Below 16 per 1,000 births by 2025
• Below 12 per 1,000 births by 2030

✅ Home-based newborn care and emergency referrals
✅ Strengthening Special Newborn Care Units (SNCUs)

🟢 4. Child Health 🧒

🔹 Addressing Childhood Morbidity and Nutrition

✅Major Interventions:

• Complementary feeding with iron and folic acid supplementation to prevent malnutrition and anemia.
• Diarrhea management at the community level using ORS (Oral Rehydration Solution) and zinc.
• Management of pneumonia to reduce child mortality.
• Full immunization coverage under Mission Indradhanush to protect children from vaccine-preventable diseases.
• Integrated Management of Childhood Illnesses (IMCI) to address multiple childhood diseases.
• Target: Reduce Infant Mortality Rate (IMR) to less than 23 per 1,000 births by 2025.

✅Iron and Folic Acid Supplementation for Children:

• 0 to 5 years: 100 days of iron and folic acid tablets/syrup administered by ASHA workers.
• 6 to 10 years: Weekly iron and folic acid supplements provided at Anganwadi Centers.

🔵 5. Adolescent Health 🏃‍♂️👩‍🎓

🔹 Promoting Healthy Adolescence

✅Key Objectives:

• Addressing teenage pregnancy and increasing contraceptive prevalence among adolescents.
• Providing iron and folic acid supplementation to combat anemia.
• Promoting menstrual hygiene through the Free Days brand sanitary napkins by ASHA workers.
• Conducting information and counseling sessions on adolescent sexual and reproductive health.
• Strengthening Adolescent Friendly Health Clinics (AFHCs) for youth-focused healthcare services.

✅Color Coding for Nutritional Supplementation:

🔴 Red Tablet – For Pregnant Women

🔵 Blue Tablet – For Adolescents (Iron ki Nili Goli)

✅ India’s goal is to achieve SDG targets for maternal and child health by 2030.

Innovations and Key Interventions in RMNCH+A

The RMNCH+A framework integrates cutting-edge innovations and community-based approaches to improve maternal, newborn, child, and adolescent health outcomes. 

1️⃣ Janani Suraksha Yojana (JSY) 🏥

Launched: 2005
Objective: Reduce maternal and neonatal mortality by promoting institutional deliveries through cash incentives.
Impact:

• Increase in institutional deliveries from 38.7% in 2005 to over 78.9% in 2021 (NFHS-5).
• More than 10 crore women benefited under JSY since its inception.

📌 Fact: JSY is targeted at low-income pregnant women and operates under the National Health Mission (NHM).

2️⃣ Janani Shishu Suraksha Karyakram (JSSK) 🚑

Launched: 2011
Objective: Ensure free and cashless maternal and neonatal healthcare services in public health facilities.
Benefits Provided:
✅ Free deliveries (including C-sections).
✅ Free transport, food, and diagnostic services for pregnant women.
✅ Free treatment for sick newborns up to 30 days after birth.

📌 Impact:

• Significant increase in institutional deliveries, contributing to a reduction in maternal mortality rate (MMR) from 167 per 100,000 live births in 2011 to 97 in 2020 (SRS data).
• Reduction in out-of-pocket expenditure for maternal healthcare.

3️⃣ Home-Based Newborn Care (HBNC) 🏡

Launched: 2011
Objective: Provide postnatal newborn care through Accredited Social Health Activists (ASHAs) at home, reducing neonatal mortality.
Key Features:

• ASHAs visit newborns within 24 hours of birth and conduct six follow-up visits in the first 42 days.
• Special care for low birth weight (LBW) babies and preterm newborns.

📌 Impact:

• Neonatal Mortality Rate (NMR) reduced from 39 per 1,000 live births in 2005 to 20 in 2020 (SRS).
• Exclusive breastfeeding rates improved to 63% (NFHS-5, 2021).

4️⃣ Rashtriya Bal Swasthya Karyakram (RBSK) 💉

Launched: 2013
Objective: Early screening and management of birth defects, diseases, deficiencies, and developmental delays among children.
Coverage:

• Children from birth to 18 years old are screened at Anganwadi centers and schools.
• Covers defects at birth (like cleft lip, congenital heart disease), deficiencies (anemia, malnutrition), and developmental delays.

📌 Impact:

• Over 27 crore children screened since 2013.
• More than 1.5 crore children are identified with health issues and linked to appropriate treatment.

5️⃣ Iron Plus Initiative 🍎

Launched: 2013
Objective: Prevent and treat anemia in adolescents, pregnant women, and children.
Key Components:

• Weekly Iron and Folic Acid Supplementation (WIFS) 💊 for school-going and out-of-school adolescents (10-19 years).
• National Deworming Day (NDD) 🌱 campaign to reduce worm infections affecting iron absorption.

📌 Impact:

• Anemia prevalence reduced from 58.6% in NFHS-4 (2015-16) to 53.2% in NFHS-5 (2021) among adolescent girls.
• More than 13 crore children and adolescents benefit from deworming programs annually.

6️⃣ Strengthening Adolescent Health Clinics (ARSH Clinics) 🏥

Launched: 2006 (under RCH II program, expanded under RMNCH+A in 2013)
Objective: Provide adolescent-friendly reproductive and sexual health services.
Services Provided:
✅ Sexual and reproductive health counseling.
✅ Menstrual hygiene awareness.
✅ Mental health support for stress and substance abuse.

📌 Impact:

• More than 7,500 ARSH clinics were established across India.
• Significant increase in contraceptive awareness among adolescents (NFHS-5, 2021).

📊 Overall Impact of RMNCH+A Strategy:

• Maternal Mortality Rate (MMR) decreased from 254 per 100,000 live births in 2004 to 97 in 2020.
• Infant Mortality Rate (IMR) reduced from 57 per 1,000 live births in 2005 to 28 in 2020.
• Neonatal Mortality Rate (NMR) declined from 39 in 2005 to 20 in 2020.
• Institutional deliveries increased from 38.7% in 2005 to 78.9% in 2021.