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Child care

  1. Integrated Management of Neonatal and Childhood illnesses (IMNCI)
    1. IMNCI - Indian adaptation of the WHO-UNICEF generic IMCI
    2. An innovative approach to tackle early newborn and child deaths
  1. Aim
    1. To prevent and manage major illnesses in children under 5 years of age
    2. To promote healthy growth and development
  1. Strategy- Child as a whole, rather than on a single disease or condition
  1. Differences between generic IMCI and India IMNCI
  Features   Generic IMCI   India IMNCI
Coverage of 0 - 6 days (early   No   Yes
  newborn period)
  Basic health worker module
  No   Yes
  Home visit module by provider   No . Yes
  for care of newborn and young      
  Home based training
  No     Yes
  Duration of training on newborn   2 of 11 days   4 of 8 days
  / young infant
  Sequence of training   Child first then young infant   Newborn / young infant first then child
  1. IMNCI Strategy
  1. IMNCI strategy has three components:
    1. Improved case management
    2. Health systems strengthening
    3. Improved household practices
  2. India in the early stage of implementation of this strategy
  3. IMNCI developed in early 2003
  4. GoI-UNICEF initiated the programme in one district of
    1. Maharashtra                      
    2. Rajasthan                        
    3. Gujarat
    4. Tamil Nadu.                         
    5. ​Madhya Pradesh
  1. IMNCI-Plus
    1. Objectives of IMNCI plus strategy in RCH II are to:
    2. Implement, by 2010, a comprehensive newborn and child health package at the level of all SC (through ANMs) PHC (through MO, nurse and LHVs) & FRU (through MO and nurses)
    3. Implement by 2010 a comprehensive newborn and child health package at the household level in 250 districts. 
  1. Adolescent and RTI
    1. Adolescent
      1. adolescent health initiative
        1. Will be implemented only in districts where IMP <60/1000 LB
        2. Goal: To achieve optimum health and development of the adolescent segment of the population, in a phased manner
        3. Objective: To introduce a comprehensive Adolescent Health Initiative (AHI) in selected districts in collaboration with partner departments and other stakeholders.
      2. Components:
        1. Adolescent friendly clinical and contraceptive services
        2. Adolescent Health Initiative in terms of counselling
      3. Adolescent health
  1. Clinical services - Confidential MTPs, RTI/STI related treatments, nutritional advise, detection and treatment of anemia, ANC and advise regarding child birth and other health concerns
  2. Counseling- Growth and development, nutrition, reproductive and sexual health, marriage and parenthood and life skills education
  1. RTI/STI
  1. Objectives
    1. Promote recognition and referral for those with suspected RTI/STI
    2. Strengthen services for diagnosis and treatment of RTI/STI at PHCs, CHCs, FRUs and district hospitals
    3. Strengthen linkages and synergy with NACO activities
  1. Strategies
    i. Community level:
    1. ANMs to provide presumptive treatment & drugs to cases and their partners for common RTIs/STIs
    2. Train A WW s to identify/refer cases of RTI/STI
    3. Promote awareness
 ii. Facility level
  1. Operationalized services at all FRUs, all CHCs and at least 50% PHCs
  2. Revise essential drug list
  3. Post technicians, strengthen laboratories, ensure availability of supplies
  4. Provide 1st line RTI/STI drugs at remaining PHCs
  5. Train MOs and LHVs
  6. Syndrome Approach for treatment of RTIs/STIs - Government of India guidelines
  7. Symptoms
  8. Urethral Discharge & Persistent Urethral Discharge; Vaginal Discharge
  9. Genital Ulcer; Scrotal Swelling
  10. Pain Lower Abdomen
  11. Neonatal Conjunctivitis
  1. School health Service
  1. No class room should accommodate more than 40 students
  2. per capita space for students in a classroom should not be less than 10 sq ft
  3. Desks should be minus type
  4. window area should be at least 25 percent of the floor space; windows should be placed on
  5. different walls for cross ventilation
  6. ventilators should not be less than 2 % of floor area
  7. One urinal for 60 students and one latrine for 100 students
  8. School Health Committee – 1961
  9. Child labor (prohibition and regulation) act 1986- below 15 children
  10. Child Marriage restraint act, 1978
  11. Child guidance clinic- deal with all children or adolescents who for one reason or other, are no fully adjusted to their environment (juvenile delinquency)
  12. Orphanages- children who have no home or who for some reason could not be cared for by their parents are placed in orphanages           ­
  13. Foster homes- several type of facilities for rearing children other than in natural families. Child is provided with love, security, affection.
  14. Borstal homes- boys over 16 yrs who are too difficult to handle in a certified school or have misbehaved there- are sent to borstal home, sentence for 3 yrs, 6 homes in India, governed by State Inspector General of India
  15. Remand Homes- child is placed under the care of doctors, psychiatrist and other trained personnel- to improve the mental and physical well being of the child.
  1. Baby friendly hospital Initiative WHOI UNICEF- 10 steps
  1. Helping the mother initiate breast feeding within the first hour of birth in a normal delivery and 4 hours following caesarean section
  2. Encourage breast feeding on demand
  3. Allow mothers and infants to remain together for 24 hours a day except for medical reasons
  4. Give newborn infants no food or drink other than breast milk, unless medically indicated
  5. EBF to be promoted til14-6 months
  6. No advertisement, promotional material or free products for infant feeding should be allowed in the facility.
Targets of Major Policies/Projects Relevant to MCR
Indicator Tenth plan Coals (2002-2007) RCH II Goals (2005 – 2010) National population policy 2000 (by 2010) Millennium Development Goals (by 2015)
Population growth 16.2% (2001-2011) 16.2% (2001-2011) - -
Infant mortality rate - - - Reduce by 2/3rd from 1990 levels
Maternal mortality ratio 200/100,000 150/100,000 100/100,000 Reduce by 3/4th from 1990 levels
Total fertility rate 2.3 2.2 2.1 -
Couple protection rate
65% 65% Meet 100% needs -

Janani-Shishu Suraksha Karyakram (JSSK)
Government of India has launched the Janani-Shishu Suraksha Karyakram (JSSK), a new national initiative, to make available better health facitlies for women and child.
The new initiatives provide the following facilities to the pregnant women:          
  1. All pregnant women delivering at public health institutions to have absolutely free and no expense delivery, including  caesarean section.
  2. The entitlements include   i. free drugs and consumables, free diet upto 3 days during normal delivery and upto 7 days for C-section, ii.  free diagnostics, iii. free blood wherever required. iv. Free transport from home to institution, between facilities in case of a referral and drop back home.
  3. Similar entitlements have been put in place for all sick newborns accessing public health institutions for treatment till 30 days after birth.            
  4. The scheme is estimated to benefit more than 12 million pregnant women who access government health facilities for their delivery.
  5. e.it will motivate those who still choose to deliver at their homes to opt for institutional deliveries.
Facilities based newborn care
  1. As more sIck children are screened at the peripheries through IMNCI and referred to the health facilities, care of the Sick newborn and child at CHCs, FRUs, district hospitals and medical college hospitals assumes priority.
  2. Equipping the facilities to provide the requisite level of care and simultaneously enhancing the capacity of the medical officers at these facilities to handle such Cases thus becomes important.
  3. The setting up of SNCUs at district hospitals, stabilization units at CHCs and newborn care corners at all facilities offering delivery facilities, is thus a key activity.
  4. In the overall planning of facility, based care it is important to understand the level of care that is provided at the various facility levels. 
Health facility All newborns at birth Sick newborns
Primary health centre
(PHC)/Sub-centre (SC)
identified as MCH level I
Newborn -care corner in labor rooms Prompt referral
Community health centre
(CHC)/First referral unit
(FRU) identified as
MCH Level II
Newborn care corner
in labor rooms and in
operation theatre
stabilization unit
District hospital
identified as
Newborn care corner
in labor room and in
operation theatre
Special newborr
care unit

Newborn Care Corner (NBCC)
  1. NBCC is a space within the delivery room in any health facility where immediate care is provided to all newborns at birth
  2. This area is MANDATORY for all health facilities where deliveries are conducted.
Newborn Stabilization Unit (NBSU)
  1. NBSU is a facility within or in close proximity of the maternity ward where sick and low birth weight newborns can be cared for during short periods.
  2. All FRUs/CHCs need to have a neonatal stabilization unit, in addition to the newborn care corner.
  3. It requires space for 4 bedded unit and two beds in post-natal ward for rooming-in.
Special Newborn Care Unit (SNCU)
  1. SNCU is a neonatal unit in the vicinity of the labor room which is to provide special care (all care except assisted ventilation and major surgery) for sick newborns.
  2. Any facility with more than 3,000 deliveries per year should have an SNCU (most district hospitals and some sub-district hospitals would fulfil this criteria).
  3. The minimum recommended number of beds for an SNCU at a district hospital is 12,
  4. if the district hospital conducts more than 3,000 deliveries per year, 4 beds should be added for each 1,000 additional deliveries. A 12 bedded
  5. unit will require 4 additional adult beds for the step down.
Navjat Shishu Suraksha Karyakram (NSSK)
  1. NSSK is a programme aimed to train health, personnel in basic newborn care and resuscitation.
  2. It has been launched to address care at birth issue i.e. prevention of hypothermia, prevention of infection, early initiation of breast-feeding and basic newborn resuscitation.
  3. The objective of the new initiative is to have a trained health person in basic newborn
  4. care and resuscitation unit at every delivery point.
Minimum Need Programme (Fifth Five Year)
  1. Elementary Educations And Adult Education
  2. Rural Health Services
    Hilly/ Tribal                       
    Sub centre
  3. Rural Water Supply                                                        
  4. Rural Roads
  5. Rural Electrification                                                        
  6. Housing - Rural Landless Laborers
  7. Environment Improvement of Urban Slum 8. Nutrition
  8. Rural Domestic Cooking Energy                                    
  9. Public Distribution System
  10. Rural Sanitation
National Water supply and Sanitation Programme-1954
1980 - 90 => Int. Drinking Water Supply and Sanitation Decade
100% Water Supply (Safe)
Urban Sanitation - 80% Rural Sanitation - 25%
Problem Village ­(AIIMS May’08)
Water> 1.6 Km or 15 Min Walking
Ht - >100 M (Hilly Areas)
Depth ->15 M
Water with risk of cholera infection & Water containing excess Na, K & F salts.

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