Professor of Preventive and Social Medicine and

1
Reproductive and Child Health in India

• Shiv Chandra Mathur
• Professor of Preventive and Social Medicine and
• Director, State Institute of Health and Family
  Welfare, Rajasthan, Jaipur, India.

2
Description of RCH Project in India

• RCH is a five year project launched within the
  framework of fifty year old nationwide National
  Family Planning Program in India.
• Its a new approach of managing Population Growth
  by eliciting more community participation and
  empowering people to take care of their
  reproductive health.

3
Goal of RCH Project in India

• In a large, diverse federal set-up, people may
  acquire the ability to regulate their fertility,
  women are able to go through pregnancy and
  childbirth safely, the outcome of pregnancy 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 disease.

4
High-level timing goals

• Post - Alma-Ata, Government of India in its
  National Health Policy, envisaged Health for All
  by 2000. Mid-decade evaluation of NHP revealed
  the need to re-strategize to achieve certain
  reproductive health indicators. Post-ICPD
  phenomena gave a boost to this change.
• Development Program in India are being
  implemented on a five-year plan model and it was
  thought of that the goals envisaged in the new
  RCH approach may coincide with ninth five-year
  plan of the country.

5
Objectives of RCH Project in India

• Introduce a new system of service delivery
  through decentralized planning and broadening the
  menu of services delivered under the banner of
  Family Planning Program in India.
• Maneuvering the health care services in a way
  that it may induce a desired change in specific
  community health indicators like IMR, TFR, MMR,
  CBR, effective CPR, Immunization Coverage and
  delivery by trained hands.

6
Relationship to other projects

• Transition from Expanded Program of
  Immunization - Universal Immunization Program -
  Child Survival and Safe Motherhood on one hand
  and striking balance between related projects
  like Reproductive/Sexual Tract Infection
  prevention in HIV/AIDS Control Program on the
  other hand.
• Attempts to institutionalize the project based
  activities in the long term National Family
  Planning Program in India.
• Setting up a public sector - private sector
  partnership in delivery of health care services
  by eliciting NGO support.

7
Components of RCH Project in India

• Essential Obstetric Care
• Emergency Obstetric Care
• Essential New Born Care
• Medical Termination of Pregnancy
• Contraceptives Delivery
• RTI/STI Care
• Empowering Adolescents
• Strengthening Immunization

8
Project Intervention

• Based on the status of crude birth rate and
  female literacy status more than 500 districts of
  the country were divided in three categories.
• Weaker districts were given additional inputs
  like more trained manpower at the periphery and
  facilities for referral transport.

9
Logistics

• Peripheral facilities were stratified in three
  categories
• Each subcenter managed by an Auxiliary Nurse
  Midwife catering to the population of 3000-5000
  persons was equipped with Kit A(prophylactics),
  Kit B (Essential Drugs) and Kit C (bare minimum
  equipment).
• Each Primary Health Center managed by a Medical
  Officer catering to a population of 25000 to
  30000 persons was equipped with Kit D with a
  wider set of equipment

10
Training/Manpower Development

• Awareness Generation Training
• for peoples representatives and professionals
  from other development sectors.
• Integrated Skill Training
• for health professionals in the field like
  Auxiliary Nurse Midwives, Lady Health Visitors,
  Sector Supervisors and Medical Officers working
  at Primary Heath Centers.
• Specialized Skill Training
• for specialist performing contraception
  operations and Medical Termination of Pregnancies
  and for nurses conducting IUD insertions.

11
IEC Procedures

• Extensive use of following communication methods
  in persuading people to cultivate rational
  reproductive health practices
• Television-spots films interactive panel and
  live phone-in discussions.
• Radio-talks panel discussions and counseling
  sessions.
• Field Publicity through Songs and Drama.

12
Community Need Assessment

• Health Management Information System is being
  introduced where demographic and reproductive
  health information of every family is updated
  periodically through contact drive survey to
  elicit the hidden demand for obstetric-child
  health services on one hand and unmet demand for
  contraception on the other. Such a procedure
  strengthens the management through de-centralized
  planning which in spirit fulfills the guidelines
  of ICPD Cairo.

13
Monitoring - Performance Indicators

• Following indicators were used to assess the
  implementation progress of the RCH Project at the
  central level
• Decentralized Planning District Action Plan on
  fiscal year basis were to be prepared and
  implemented by district level Managers.
• Health Facilities identified and developed as
  First Referral Units for Emergency Obstetric
  Care.

14
Monitoring - Performance Indicators (2)

• Increase in the Percentage of children seeking
  care for common disorders like ARI and Diarrhea.
• Increase in the current contraceptive prevalence
  and reduction in the unmet demand of
  contraception.
• Completion of In-service orientation/skill-imparta
  tion training.

15
Evaluation - Impact Indicators

• Maternal Mortality Rate.
• Total Fertility Rate.
• Institutional Delivery.
• Reduction in the prevalence of RTI/STI.
• Infant Mortality Rate.
• Underfive Mortality Rate.
• Effective Couple Protection Rate.

16
Observations in implementing RCH Project in India
(1)

• Implementing RCH Project from April1998 to March
  2003 in a country like India has provided
  following experience
• Inadequacy of decentralization form Center to
  the Districts in management of finance,
  procurement and related issues.
• Weak Management capacity especially in Monitoring
  and Evaluation, Budgeting, Communication and
  Extension and delivery of Quality services.

17
Observations in implementing RCH Project in India
(2)

• Weakness of outreach services in holding the
  subjects for completing the cycle of reproductive
  health care.
• Lack of one unified concept/system and one
  unified nomenclature.
• Multiplicity of Funding Agencies.
• Lack of an effective referral back-up.
• RCH and AIDS being implemented in two distinct
  compartments with some of the activities being
  unduly duplicated.

18
Future of RCH in India

• ICPD Cairo has disseminated very strong signals
  throughout the world and Government of India very
  enthusiastically initiated the paradigm shift by
  launching a nationwide RCH Project for five years
  at the turn of second millenium. It has a huge
  input in the shape of soft loan from World Bank
  and grants from agencies varying from UNFPA and
  Unicef to SIDA and DFID.
• Implementing the project for five years, a
  consensus has evolved to carry on the for yet
  another five years with mid-course improvement.
  Thus the project implemented so far is designated
  as RCH-1 and the one yet to be launched as RCH-2.