Post Graduate student in Community Medicine(M.D) Department of Community Medicine / SRMC & RI (DU ),INDIAN RAILWAY MEDICAL SERVICE,B.Sc., M.B.B.S., D.P.H., D.I.H.,PGCH&FW(NIHFW),INDIA,MAJOR CAUSES OF M.M.R,DIRECT CAUSES HEMORRHAGE 29.6% PUERPERAL COMPLICATION 16.1% OBSTRUCTED LABOUR 9.5% ABORTIONS 8.9% TOXAEMIA OF PREGNANCY 8.3% INDIRECT CAUSES Anaemia Pregnancy with TB Pregnancy with malaria Pregnancy with viral hepatitis,DISPARITY OF MATERNAL DEATH BETWEEN DEVELOPED & DEVELOPING COUNTRIES,BARRIER TO RECEIVE TIMELY & GOOD QUALITY CARE BARRIER OF AVAILABILITY AND ACCESSIBILITY OF SERVICES POLITICAL BARRIER GEOGRAPHICAL BARRIER CULTURAL BARRIER WOMENS LITERACY AND WOMEN EMPOWERMENT TIME BARRIER ECONOMIC BARRIER BARRIER TO HAVE HEALTH PERSONNEL AT GRASS ROOT LEVEL,RCH PROGRAMME,15.10. 1997,Objectives Reduction of Maternal Morbidity and Mortality (MMR) Reduction of Infant Morbidity and Mortality (IMR) Reduction of Under 5 Morbidity and Mortality (U5MR) Promotion of adolescent health Control of reproductive tract infections and sexually transmitted infections.,The first phase of the programme had started from 1997 To bring down the birth rate below 21 per 1000 population To reduce the infant mortality rate below 60 per 1000 life born To bring down the maternal mortality rate below 400 per one lakh. Eighty per cent institutional delivery, 100 per cent antenatal care and 100 per cent immunization of children,COMPONENTS OF RCH PROGRAMME,Prevention and management of unwanted pregnancy Maternal care that includes antenatal, delivery, and postpartum services Child survival services for newborns and infants Management of reproductive tract infections and sexually transmitted infections,REPRODUCTIVE HEALTH ELEMENTS,Responsible and healthy sexual behaviour Intervention to promote safe motherhood Prevention of unwanted pregnancy To increase accessibility of contraceptives Safe abortions Pregnancy and delivery services Management of RTI/STD Referral facility by government/private sector for pregnant women at risk Reproductive health services for adolescents Screening and treatment of infertility, cancer & other gynecological disorders,CHILD SURVIVAL ELEMENTS,Essential New Born Care Prevention and management of vaccine preventable disease Urban measles campaign Neonatal tetanus elimination Surveillance of vaccine preventable diseases Cold chain system Polio eradication : pulse polio programme ARI control programme Diarrhea control programme and ORS programme Prevention and control of Vitamin A deficiency among children Baby Friendly Hospital Initiative (BFHI),STRATEGY,BOTTOM-UP PLANNING COMMUNITY NEED ASSESSMENT APPROACH DECENTRALISED PARTICIPATORY PLANNING & IMPLEMENTATION STRENGTHENING INFRASTUCTURE INTEGRATED TRAINING PACKAGE IMPROVED MANAGEMENT SYSTEM INTERVENTIONS MONITORING & EVALUATION,ANTE NATAL CARE,Early registration of pregnancies (12 16 weeks) Minimum 3 antenatal visits (20,32,36 weeks) check-ups Anaemia prophylaxis ( Iron and Folic acid tablets) Two doses of TT Minimum investigations( Weight, B.P,Blood group, Rh typing, Urine examination,VDRL,HIV (TRIDOT TEST) Identification of high risk group, Early detection of complication of pregnancy & timely , safely referral to FRU Treatment of worm infestation with Mebendazole Health education on diet, breast feeding, care of breast, personnel hygiene during pregnancy,& family planning,COMPLICATIONS DURING ANTE-NATAL, INTRA NATAL, AND POST NATAL PERIOD & WHERE TO REFER,PACKAGES OF SERVICES AT FRU,VACCUM EXTRACTIONS ADMINISTRATION OF ANAESTHESIA BLOOD TRANSFUSION CASEAREAN SECTION MANUAL REMOVAL OF PLACENTA CARRY OUT SUCTION CURETTAGE FOR INCOMPLETE ABORTION INSERTION OF INTRAUTERINE DEVICES STERILIZATION OPERATION,TYPES OF KIT for FRU,Kit-E Laparotomy set Kit-F - Mini Laparotomy set Kit-G IUD insertion set Kit-H Vasectomy set Kit- I Normal delivery set Kit- J Vacuum extraction set Kit- k Embryotomy set Kit- L Uterine evacuation set Kit-M Equipment for anesthesia Kit-N- Neonatal resuscitation set Kit-O- Equipment and reagent for blood test Kit-P Donor blood transfusion set,INTRANATAL CARE,Delivery by trained personnel (100%) Institutional delivery (80%) Care at birth ( Five cleans: Clean Birth Canal,Clean surface for delivery,Clean Hands,Clean Cutting, & Clean Cord),POST NATAL CARE,3 post natal check-ups of mothers after delivery Breast feeding early & exclusive breast feeding Spacing minimum 3 years between two pregnancies,NEW STRATEGY,EMPOWERED ACTION GROUP HAS BEEN CONSITUTED ON 20.03.2001 TRAINING OF DAIS IN 156 DISTRICTS 18 STATES/UTs 2001-2002 RCH CAMPS & RCH OUT REACH SCHEME GADCHIROLI MODEL TO TAKE CARE OF HOME BASED NEONATEL CARE IN 2002 KANGAROO MOTHER CARE TO TAKE CARE OF LOW BIRTH WEIGHT INFANTS BORDER DISTRICT CLUSTER STRATEGY 49 DISTRICTS/17 STATES INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS STRATEGY TO TAKE CARE OF SICK NEWBORNS,ACHIVEMENT OF H & FW INDICATORS IN TAMILNADU( 1997-2002),LIFE E