Swachh Bharat

Components

RMNCAH+N


Reproductive, Maternal, Newborn, Child, Adolescent Health and Nutrition

Improving the maternal and child health and their survival are central to the achievement of national health goals under the National Health Mission (NHM). SDG Goal 3 also includes the focus on reducing maternal, newborn and child mortality. In the past years, innovative strategies evolved under the national programme to deliver evidence-based interventions to various population groups.

Following the Government of India’s “Call to Action (CAT) Summit” in February, 2013, the Ministry of Health & Family Welfare launched Reproductive, Maternal, Newborn, Child, Adolescent Health and Nutrition (RMNCAH+N) to influence the key interventions for reducing maternal and child morbidity and mortality. 

The RMNCAH+N strategy is built upon the continuum of care concept and is holistic in design, encompassing all interventions aimed at reproductive, maternal, newborn, child, adolescent health and Nutrition under a broad umbrella, and focusing on the strategic lifecycle approach.

The RMNCAH+N strategy promotes links between various interventions across thematic areas to enhance coverage throughout the lifecycle to improve child survival in India. The “plus” within the strategy focuses on:

  • Inclusion of adolescence as a distinct life stage within the overall strategy.
  • Linking maternal and child health to reproductive health and other components like family planning, adolescent health, HIV, gender, and preconception and prenatal diagnostic techniques.
  • Linking home and community-based services to facility-based services.
  • Ensuring linkages, referrals, and counter-referrals between and among various levels of health care system to create a continuous care pathway, and to bring an additive /synergistic effect in terms of overall outcomes and impact.

 

Key features of RMNCAH+N Strategy:

The RMNCAH+N strategy approaches include:

  • Health systems strengthening (HSS) focusing on infrastructure, human resources, supply chain management, and referral transport measures.
  • Prioritization of high-impact interventions for various lifecycle stages.
  • Increasing effectiveness of investments by prioritizing geographical areas based on evidence.
  • Integrated monitoring and accountability through good governance, use of available data sets, community involvement, and steps to address grievance.
  • Broad-based collaboration and partnerships with ministries, departments, development partners, civil society, and other stakeholders.

The RMNCAH+N strategy provides a strong platform for delivery of services across the entire continuum of care, ranging from community to various level of health care system.

  • RMNCAH+N

    • Health Systems Strengthening

    • Adoption of the Indian Public Health Standards: This defined not only the service package that each facility must provide, but also specified the minimum inputs required to ensure quality of care, in terms of infrastructure, equipment, skilled human resources, and supplies. It was an assurance to the states of financing the gaps between available levels of these inputs and the levels needed to achieve the IPHS norms. A substantial increase in these inputs was driven by facility surveys to identify gaps and then planning and financing to close these gaps.
    • Quality standards have been defined with respect to clinical protocols, administrative and management processes and for support services. The Operational Guidelines for Maternal and Newborn care published by the Ministry of Health and Family Welfare comprehensively defined such quality standards for RCH care.
    • Skill gaps and Standard Treatment Protocols: Skill sets and standard treatment protocols required for provide quality RCH services and training packages that would provide these skill sets were designed. These include the Skilled Birth Attendance (SBA) training package for ANMs, the Navjat Shishu Suraksha Karyakram (NSSK) and the IMNCI packages for ANMs, the Home Based Newborn Care (HBNC) for ASHAs, and the Emergency Obstetric Care (EmOC) package for doctors. These training packages also introduced the standard treatment protocols in each of these areas.
    • Hospital Management Societies (RKS) and untied funds: The mandatory creation of a hospital management society (Rogi Kalyan Samiti) and empowering this body with untied funds has allowed public participation also contributed to improved quality of care. RKS members were trained and sensitized on quality of care issues. Before the onset of NRHM, many states generated funds from user fees, however the untied grants to all public health facilities were made available under NRHM which reduced financial barriers to access of health care. This is clearly evident from the increased utilization of indoor and outdoor services at health facilities
    • Quality Improvement Programmes: NRHM also supports initiatives for building quality management systems. These range from formation of quality assurance committees which use check lists and periodic monitoring visits to assess quality gaps, to more structured quality management systems leading to a third party audit and quality certification- either using ISO 9001: 2008 or NABH. Till date, 82 facilities have been certified by ISO, nine facilities have been certified by NABH and 446 facilities are under process of certification.

    Infrastructure Maintenance

    "Infrastructure Maintenance:This component of Family Welfare Programme has been supported over several Plan periods. Support under this component is provided to states to meet salary requirement of Schemes viz. Direction & Administration (Family Welfare Bureaus at state & district level), Sub-Centres, Urban Family Welfare Centres, Urban Revamping Scheme (Health Posts), ANM/LHV Training Schools, Health & Family Welfare Training Centres, and Training of Multi-Purpose Workers (Male). This dispensation would continue. However, any new SHCs or health posts under this component would be supported only with the approval of the GOI."