Reproductive and Child Health Programme (RCH):
Reproductive and child health approach has been defined as 'people having the ability to reproduce and regulate their fertility'. Women are able to go through pregnancy and child birth safely. The outcome of pregnancies is successful in terms of maternal and Infant Survival and well-being and couples are able to have sexual relations free of fear of pregnancy and of contracting diseases.
This concept is in keeping with the evolution of an integrated approach to the programmes aimed at improving the health status of young women and children, namely, National Family Welfare Programme, Universal Immunization Programme. Oral Rehydration Therapy, Child Survival and Safe, Motherhood (CSSM) Programme.
The RCH programme incorporates the components relating to CSSM and includes two addition components, one relating to sexually transmitted diseases (STD) and other relating to reproductive tract infections (RTI).
The Universal Immunization Programme (UIP) became a part of CSSM programme in 1992 and RCH programme in 1997. It will continue to provide vaccines for polio, tetanus, DPT, DT, measles and tuberculosis. The cold chain established so far will be maintained and additional items will be provided to new health facilities,
The CSSM Programme:
The CSSM Programme envisage the following maternal
At least three antenatal check-ups
Prevention and treatment of anaemia
Early identification of maternal complications
Promotion of institutional deliveries
Management of obstetric emergencies
Diagnosis and treatment of RTIs and STDs.
Essentials of newborn care :
The primary goal of essential newborn care is to reduce prenatal and neonatal mortality.
The main components of essential newborn care are
resuscitation of newborn with asphyxia
prevention of hypothermia
exclusive breast feeding and referral of sick newborn.
prevention of infection
exclusive breast-feeding and reference of the low birth weight and sick newborn.
Appropriate management of diarrhoea
Appropriate management of ART
Vitamin A prophylaxis.
The strategies are to train medical and other health personnel in essential newborn care, provide basic facilities for care of low birth weight and sick newborn in FRU and district hospitals etc.
Essential obstetric care intends to provide the basic maternity I services to all pregnant women through
early registration of pregnancy (within 12-16 weeks),
provision of minimum three antenatal check ups by ANM or medical officer to monitor progress of the pregnancy and to detect any risk/complication so that appropriate care Including referral could be taken in time,
provision of safe delivery at home or in an institution,
provision of three postnatal check ups to monitor the postnatal recovery and to detect complications.
This component of RCH programme is more relevant for Assam, Bihar, Jharkhand, Rajasthan. Orissa, Uttar Pradesh, Uttaranchal, Madhya Pradesh and Chhattisgarh as most of the deliveries in these states are conducted at home in unclean environment causing high maternal morbidity and mortality.
Emergency obstetric care:
Under the RCH programme the FRUs will be strengthened through supply of emergency obstetric kit, equipment kit and provision of skilled manpower on contract basis.
24-Hour delivery services at PHCs / CHCs:
To promote institutional deliveries, provision has been made to give additional honorarium to the staff
to encourage round the clock delivery facilities at health centres
Control of reproductive tract infection RTI)
sexually transmitted disease (STD),
Under the RCH programme, the component of RTI/STD control is linked to HIV and AIDS control. It has been planned and implemented in close collaboration with National AIDs Control Organization (NACO). NACO provides assistance for setting up RTI/STD clinics upto the district level. The assistance from the Central Government is in the form of training of the manpower and drug kits including disposable equipment. Each district will be assisted by two laboratory technicians on contract basis to test blood, urine and RTI/STD tests,
In order to make the services of specialists like gynaecologists and paediatricians available to people living in remote areas, a scheme of holding camps has been Initiated in 102 districts covering 17 states from January, 2001. Camps are being organized in Haryana, Madhya Pradesh, Rajasthan. Arunachal Pradesh, Uttar Pradesh and Meghalaya.
RCH out-reach scheme
During 2000-2001, an RCH out-reach scheme was initiated to strengthen the delivery of Immunization and other maternal and child health services In remote and comparatively weaker districts and urban slums in Uttar Pradesh, Madhya Pradesh, Rajasthan, Bihar. Assam, Orissa, Gujarat and West Bengal.
The RCH programme implementation is based on differential approach. Inputs in all districts have not been kept uniform because efficient delivery will depend on the capability of the health system in the district. Hence, basic facilities are proposed to be strengthened and streamlined in the weaker districts.
More sophisticated facilities are proposed for the relatively advanced districts. All the districts have been divided in to three categories on the basis of crude birth rate and female literacy rate. Category A having 58 districts. Category B having 184 districts and Category C having 265 districts. All the districts will be covered in a phased manner over a period of three years. The programme was formally launched on 15th October 1997.