National Health Intervention Program for Mother and Child

National Health Intervention Programme for Mother and Child

What is it about?

The Indian government has several programs to take care of the health of pregnant women, new mothers, and young children. These programs aim to:

• Reduce mother and child deaths
• Improve nutrition and care
• Promote safe deliveries at hospitals instead of at home

🌸 4.1.1 Pradhan Mantri Matru Vandana Yojana (PMMVY)

Timeline

• 2005: Started as Janani Suraksha Yojana
• 2014: Renamed to Indira Gandhi Matritva Sahyog Yojana
• 2017: Finally named Pradhan Mantri Matru Vandana Yojana (PMMVY)

✅ What does PMMVY do?

This scheme gives cash support to pregnant women who are having their first baby and are 19 years or older.

• It helps compensate for wage loss during pregnancy and after delivery.
• It encourages safe delivery, nutrition, and breastfeeding.
• Total benefit: ₹6,000, given in parts (installments).

🎯 Main Objectives

1. Help women get proper care during pregnancy and after childbirth.
2. Encourage good nutrition and breastfeeding practices.
3. Give cash incentives to support health and nutrition.

👩‍⚕️ Who can get it?

• Pregnant women aged 19 or more having their first child.
• Must not be getting paid maternity leave from a job.

💰 How is the money given?

₹6,000 is given in three parts, based on certain conditions:

1.     First part – ₹1,000

• Register pregnancy at Anganwadi Centre
• Attend at least one prenatal check-up
• Take Iron tablets and Tetanus injection
• Attend a health counselling session

2.     Second part – ₹2,000

• Attend one more prenatal check-up
• Take second Tetanus injection

3.     Third part – ₹2,000 (after delivery)

• Register the baby’s birth
• Give polio and BCG vaccines to baby
• Attend growth monitoring sessions
• Breastfeed exclusively for 6 months
• Attend sessions on baby feeding and nutrition

⚠️ Issues

• Many women don’t get the benefits due to strict rules or lack of awareness.

🏥 New Initiative by the Ministry of Health

The Ministry of Health introduced a plan for completely free and cashless services for:

• All pregnant women – for checkups, delivery (normal or C-section), medicines, tests, food in hospital, and transportation.
• Sick newborns (up to 30 days after birth) – free treatment and transport.

📋 Free Services Include:

For Pregnant Women	For Sick Newborns (up to 30 days)
Free delivery and C-section	Free treatment and care
Free medicines and tests	Free medicines and tests
Free hospital food	Free transport
Free blood if needed	No charges at any step
Free transport to and from hospital

⭐ Why is it important?

• Reduces money burden on poor families
• Encourages hospital deliveries
• Improves mother and child survival
• Helps over 1.2 crore (12 million) women every year

Here’s a simple explanation of the Reproductive and Child Health (RCH) Programme, including its phases and key features:

Here's a simple explanation of the Reproductive and Child Health (RCH) Programme, including its phases and key features:

🌸 4.1.2 Reproductive and Child Health (RCH) Programme

🗓️ Launched: 15th October 1997

Why? Based on recommendations from the 1994 Cairo Conference on Population and Development.

🧠 What does RCH mean?

Reproductive and Child Health is not just about the absence of disease. It means that people (especially women and children) are physically, mentally, and socially healthy in all matters related to reproduction—like pregnancy, childbirth, family planning, and sexual health.

🎯 Objectives of RCH

1. Improve the health of mothers and children
2. Reduce infant and maternal deaths (IMR & MMR)
3. Promote responsible reproductive behavior to stabilize population growth

🔧 Major Components of RCH

✅ a) Prevent and manage unwanted pregnancies

Using family planning methods and counseling.

✅ b) Safe motherhood

Proper care during pregnancy, delivery, and after birth.

✅ c) Child survival

Immunizations, nutrition, disease management, etc.

✅ d) Treatment of infections

Such as Reproductive Tract Infections (RTIs) and Sexually Transmitted Diseases (STDs)

✅ e) Prevent HIV/AIDS

💬 Other Activities

• Provide health counseling on topics like nutrition, hygiene, and safe sex
• Refer serious cases to hospitals
• Offer services for adolescents (teenagers), like education on reproductive health and nutrition

📘 RCH Phase 1 (1997)

This phase focused on building infrastructure and basic healthcare support.

🩺 Key Actions:

• Improve maternal and child care
• Supply drugs and equipment to health centers
• Hire more ANMs (nurses), staff nurses, and lab technicians
• Provide 24/7 delivery services at PHCs and CHCs
• Arrange emergency transport for pregnant women
• Promote immunization, ORS, and vitamin A
• Treat common childhood illnesses
• Conduct district-level surveys to reduce death rates
• Train MBBS doctors for emergency delivery care
• Set up blood storage units

📘 RCH Phase 2 (2005)

Launched along with the National Rural Health Mission (NRHM)

🎯 Objectives:

• Reduce deaths and sickness in:
• Mothers
• Infants
• Children under 5
• Adolescents
• Control RTIs and STIs

🌟 Key Features:

• Provide folic acid to pregnant women
• Give vitamin A to infants
• Promote early breastfeeding
• Work with Nutrition Rehabilitation Centres (NRCs) to treat malnourished children
• Focus on 1000-day window (from pregnancy to 2 years of child’s life) to prevent long-term health issues

🔁 RMNCH+A Approach (2013)

This stands for:
Reproductive, Maternal, Newborn, Child, and Adolescent Health

It integrates all health services for:

• Women before and during pregnancy
• Newborn and child care
• Adolescent health
• Family planning
• Nutrition support

🔚 Summary Table

Phase	Year	Focus Areas
RCH-1	1997	Improve infrastructure and basic maternal/child services
RCH-2	2005	Reduce death rates; provide nutritional and reproductive care
RMNCH+A	2013	Full lifecycle approach: mother, child, adolescent care

Let me know if you want a mind map, notes, or mock questions to help you revise better!

Sure! Here's a simple and clear explanation of the Mother and Child Protection Card (MCPC):

🍼 Mother and Child Protection Card (MCPC)

📅 Started in: 2010-11

📄 What is the MCPC?

The Mother and Child Protection Card is a small record-keeping and information booklet. It is given to families to:

• Track the health and nutrition of a pregnant woman and her baby (from pregnancy until the child is 3 years old).
• Identify health problems early and get treatment on time.
• Guide families on how to take care of mothers and babies.
• Encourage good practices for health, hygiene, feeding, and growth.

🎯 Why is it important?

• Helps mothers and families know what services they can use (like vaccination, check-ups, nutrition).
• Guides families to make better decisions about health and child care.
• Encourages families to follow safe and healthy habits.

👪 Who uses this card?

The card is useful for different people and groups in the village:

A. Family Members (like mother, father, in-laws, adolescent girls)

They use the card:

1. To learn about pregnancy care, danger signs, and when to go to a hospital.
2. To understand child growth, feeding, and development.
3. To use services like immunization and nutrition support.
4. To monitor the child’s height and weight.
5. To follow good care practices at home.

B. Village Groups (like Women’s Groups, VHSNC)

They use the card:

1. As a discussion tool during meetings to talk about health issues.
2. To check if health services are being delivered properly in the area.

C. Health Workers (AWW, ANM, ASHA)

They use the card:

1. To educate families about pregnancy, baby care, feeding, and hygiene.
2. To record health services (like vaccinations, visits, weight, etc.).
3. To visit homes, refer mothers and children to hospitals if needed, and follow up.
4. To help in birth preparedness and making sure care is taken before and after delivery.

D. Supervisors (ICDS and Health Supervisors)

They make sure:

1. Every family gets the card.
2. Families understand how to use the card.
3. Health services are delivered properly to mothers and children.

👩‍👧 Who is the card meant for?

• Pregnant women
• Mothers who are breastfeeding
• Families with children below 3 years
• People under government health schemes like:
• JSY (Janani Suraksha Yojana)
• JSSK (Janani Shishu Suraksha Karyakram)
• NRC (Nutritional Rehabilitation Centre)
• IGMSY (Indira Gandhi Matritva Sahyog Yojna)

👩‍⚕️ Female frontline health workers who use this card:

• Anganwadi Worker (AWW)
• Auxiliary Nurse Midwife (ANM)
• Accredited Social Health Activist (ASHA)

They play a key role in guiding families, maintaining records, and delivering health services.

 Village Health and Nutrition Day (VHND):

Village Health and Nutrition Day (VHND)

• Launched under: National Rural Health Mission (NRHM), 2005
• Guidelines issued in: 2007 by Ministry of Health and Family Welfare (MOHFW)
• Held: Once a month (preferably Wednesdays) at Anganwadi Centres (AWCs)

Purpose:

To improve access to maternal, newborn, child health and nutrition services at the village level, especially for vulnerable groups.

Key Services Provided:

• Registration and tracking of pregnant women (PW)
• Antenatal checkups, counselling
• Immunization of children (including dropouts)
• Distribution of Vitamin A, IFA tablets, OCPs, and condoms
• Weighing and growth monitoring of children
• Supplementary nutrition for underweight children
• Anti-TB drugs and family planning services
• Health education and awareness

Objectives:

• Improve access to basic health and nutrition services
• Focus on preventive care, awareness, and community involvement

Reference 

Malviya K, Sahoo S, Dasadiya D, Acharya V. Social and Preventive Pharmacy. 1st ed. Pee Vee (Regd.); 2021

Pulse Polio Immunization Programme

Poliomyelitis (Polio) is a viral infectious disease that can cause flaccid paralysis by affecting the central nervous system in about 0.5% of cases.

Etiopathogenesis of Poliovirus

1. Causative Agent:

• Poliovirus is an enterovirus belonging to the Picornaviridae family.
• There are three serotypes: PV1, PV2, and PV3 (PV1 is most commonly associated with paralysis).

2. Mode of Transmission:

• Fecal-oral route (primary)
• Oral-oral route (less common)

3. Pathogenesis:

• Entry: Virus enters through the mouth and multiplies in the oropharynx and gastrointestinal tract (lymphoid tissue like tonsils and Peyer's patches).
• Viremia: Virus enters the bloodstream and may spread to other sites.
• CNS Invasion: In <1% of cases, the virus crosses the blood-brain barrier or is transported via peripheral nerves to the central nervous system (CNS).
• Neuronal Damage: The virus targets anterior horn cells of the spinal cord, causing motor neuron destruction, leading to flaccid paralysis.
• Outcomes:
• Asymptomatic (90–95%)
• Minor illness (4–8%) – fever, sore throat
• Non-paralytic poliomyelitis (<1%) – aseptic meningitis
• Paralytic poliomyelitis (<0.5%)

Pharmacotherapy of Poliovirus

There is no specific antiviral treatment for poliovirus. Management is primarily supportive and preventive:

1. Supportive Treatment:

• Bed rest, analgesics for pain
• Physical therapy to prevent deformities and improve mobility
• Ventilatory support (iron lung or modern ventilators) in case of respiratory muscle paralysis

2. Preventive Pharmacotherapy (Vaccination):

• OPV may rarely cause vaccine-associated paralytic polio (VAPP) or circulating vaccine-derived poliovirus (cVDPV).
• IPV is introduced to mitigate VAPP and cVDPV risks.

Pulse Polio Immunization in India

• Launched in 1995 as part of the global polio eradication initiative following the 1988 World Health Assembly resolution.
• Targets children aged 0–5 years with polio drops during national and sub-national rounds.

Key Milestones

• 1995: Pulse Polio Programme launched
• 2009: India reported half of the global polio cases
• 2011: Last polio case in India
• 2012: WHO removed India from the list of endemic countries
• 2014: India declared polio-free

Aims and Objectives

• Immunize every child, especially in remote areas
• Ensure no child is missed during immunization
• Timely reporting of acute flaccid paralysis (AFP) cases and stool sample collection
• Rapid outbreak response immunization (ORI)
• Maintain strong surveillance systems

Steps to Maintain Polio-Free Status

• Annual high-quality immunization rounds
• Surveillance for any virus importation or circulation
• Environmental surveillance through sewage sampling

Polio Eradication and Preparedness Efforts in India

Rapid Response and Emergency Plans

• All States/UTs have Rapid Response Teams (RRTs) and Emergency Preparedness and Response Plans (EPRPs) to handle any polio outbreaks.

Preventing Importation

• Continuous Vaccination Teams (CVTs) deployed at international borders to vaccinate eligible children around the clock.
• As of August 31, 2015, approximately 7.8 million children vaccinated with OPV.
• Since March 2014, mandatory polio vaccination for international travelers to and from India and affected countries like Afghanistan, Nigeria, Pakistan, etc.
• A rolling stock of OPV is maintained for emergency response.

Introduction of IPV in Routine Immunization

• In line with the Polio Eradication & Endgame Strategic Plan 2013–2018, India introduced the Inactivated Poliovirus Vaccine (IPV) in 2015.
• IPV is given with the third dose of OPV at 14 weeks of age for infants.

Programme Outcomes

• Over 17.4 crore children under 5 years receive polio drops annually.
• Last polio case reported on 13 January 2011 in Howrah, West Bengal.
• WHO removed India from the list of polio-endemic countries on 24 February 2012.

Reference 

Malviya K, Sahoo S, Dasadiya D, Acharya V. Social and Preventive Pharmacy. 1st ed. Pee Vee (Regd.); 2021

NPCB 1976

Definition of Blindness:

• NPCB: Inability to count fingers from 6 meters (vision ≤ 6/60).
• WHO: Vision ≤ 3/60.

Major Causes of Blindness:

• Cataract (62%)
• Refractive Errors (20%)
• Glaucoma (6%)
• Posterior Segment Disorders (5%)
• Post Capsular Opacification, Corneal Blindness, Surgical Complications (1% each)
• Others (4%)

Types of Blindness:

• Economic: Vision ≤ 6/60.
• Social: Vision ≤ 3/60 or visual field ≤ 10°.
• Absolute: No light perception.
• Manifest: Vision 1/60 to light perception.
• Curable: Reversible with treatment (e.g., cataract).
• Preventable: Avoidable with preventive care (e.g., xerophthalmia).
• Avoidable: Includes both preventable and curable blindness.

Introduction:

• Launched in 1976 as the world's first national-level blindness control programme.
• Goal: Reduce blindness prevalence from 1.4% to 0.3%.
• Progress: Reduced to 1.1% in 2001-02 and 1.0% in 2006-07.
• Decentralized in 1994-95 with the formation of District Blindness Control Societies (DBCS).
• Aligns with Vision 2020: The Right to Sight.

Visual Acuity:

• Defined as the sharpness of vision, measured by comparing what a person can see to what a person with normal vision can see.

Objectives:

1.     Identify and treat blindness at all levels (primary to tertiary).

2.     Strengthen eye care services and deliver quality care.

3.     Upgrade Regional Institutes of Ophthalmology (RIOS).

4.     Improve infrastructure and human resources.

5.     Raise community awareness on eye health.

6.     Promote research in blindness prevention.

7.     Involve NGOs and private practitioners.

Strategies:

• Focus on free cataract surgeries through public and private sectors.
• Expand scope to include other conditions:
  Diabetic Retinopathy, Glaucoma, Corneal Blindness, Vitreo-retinal diseases, Childhood Blindness, etc.

Key Initiatives & Activities:

·        Active Screening: Focus on screening people over 50 years for cataract to reduce backlog.

·        Capacity Building: Train eye care providers and upgrade infrastructure.

·        IEC Activities: Awareness programs on eye care for the community.

·        Strengthening Institutions: Upgrade RIOS, medical colleges, and district hospitals with equipment, staff, and funds.

·        Primary Eye Care: Establish Vision Centers at PHCs and strengthen primary eye services.

·        Mobile Ophthalmic Units (MDMOU):

• Screen patients in remote areas
• Transport patients to hospitals
• Conduct on-spot refraction & provide free glasses
• Detect conditions like diabetic retinopathy & glaucoma
• Display health messages & involve local governance

·        School Eye Screening: Identify and treat refractive errors in primary and secondary school children, with focus on underserved areas.

·        Community Focus: Special emphasis on illiterate rural women, integrating with women & child development schemes.

·        Dedicated Facilities: Build Eye Wards and Eye OTs in district hospitals as needed.

·        Private Sector Involvement: Encourage participation of private practitioners and NGOs.

 Components of NPCB:

1.     Cataract surgery – Core focus of the program.

2.     Eye screening – For early detection of visual impairments.

3.     Eye donation – Promoted through Eye Donation Fortnight (Aug 25–Sep 8).

4.     Voluntary organization participation – NGOs support eye care services.

5.     Vitamin A prophylaxis – Oral syrup for all preschool children.

6.     IEC Activities – Awareness programs like World Sight Day (2nd Thursday of October).

   Integrated Initiatives:

• Free cataract surgeries, medicines, and spectacles (for postoperative care and poor students).
• Free transport for patients from remote areas.
• Coverage of all school children for screening and Vitamin A & immunization.
• Establishment of Eye Banks and one Regional Institute of Ophthalmology (RIO).
• Modern eye care services at Medical Colleges & District Hospitals (DHHs).

 Outcomes & Achievements:

• IOL (Intraocular Lens) surgeries rose from 20% (1997–98) to 95% (2013–14).
• 15.3 million cataract surgeries conducted, preventing blindness.
• 70–80% of targeted school children receive free spectacles yearly.
• Increased eye donation due to awareness campaigns.
• Free treatment provided for diabetic retinopathy, glaucoma, childhood blindness, keratoplasty, etc.

Overview

1. Definition of Blindness

• NPCB: Vision ≤ 6/60 (can’t count fingers at 6 m).
• WHO: Vision ≤ 3/60.

2. Major Causes of Blindness in India

• Cataract – 62%
• Refractive Errors – 20%
• Glaucoma – 6%
• Posterior Segment Disorders – 5%
• Others (incl. PCO, Corneal, Surgical) – 7%

3. Types of Blindness

• Economic: Vision ≤ 6/60
• Social: Vision ≤ 3/60 or field <10°
• Absolute: No light perception
• Manifest: Vision 1/60 to light perception
• Curable: Reversible (e.g., cataract)
• Preventable: Avoidable through prevention
• Avoidable: Curable + Preventable

4. Programme Overview

• Launched: 1976
• Goal: Reduce prevalence from 1.4% to 0.3%
• Vision 2020: “The Right to Sight”
• Decentralized in 1994-95 via District Blindness Control Societies (DBCS)

5. Objectives

• Identify/treat blindness at all levels
• Strengthen eye care services & RIOs
• Develop infrastructure & human resources
• Promote community awareness
• Encourage research & NGO participation

6. Key Strategies

• Free cataract surgeries, medicines, spectacles
• Mobile units (MDMOU) for screening & transport
• Vision Centers at PHCs
• Eye screening for school children
• Vitamin A supplementation for preschoolers
• IEC activities: World Sight Day (2nd Thursday of Oct)
• Focus on rural, illiterate women
• Construct Eye Wards & Eye OTs in districts

7. Programme Components

1.     Cataract Surgery

2.     Eye Screening

3.     Eye Donation (Aug 25–Sep 8)

4.     Voluntary Organizations

5.     Vitamin A Prophylaxis

6.     IEC Campaigns

8. Integrated Initiatives

• Free surgery, transport, drugs, and glasses
• Coverage of all schools and remote areas
• Establish 2 Eye Banks + 1 RIO
• Advanced care at Medical Colleges & DHHs

9. Achievements

• IOL surgeries: 20% (1997-98) to 95% (2013-14)
• 15.3 million cataract surgeries done
• 70–80% of school vision targets met yearly
• Rise in eye donation rates
• Free treatment for DR, Glaucoma, Childhood Blindness, Keratoplasty

Reference

Malviya K, Sahoo S, Dasadiya D, Acharya V. Social and Preventive Pharmacy. 1st ed. Pee Vee (Regd.); 2021.